ZDoggMD - Dogg Days of Summer

Speaker 0 00:00:08 Welcome. I'm Dr. Robert Groves, your host for the groves connection podcast, the groves connection brings you intimate conversations with pundits providers, patients, leaders, and late people all to help us understand a contradiction. How can our healthcare systems be both magnificent and yet so deeply flawed. We're going inside healthcare to talk candidly with those who know what they have to say, may delight, surprise frustrate, or at times even anger. But I invite you to get curious and listen to the truth about healthcare and those who want to fix it. Maybe the answers have been there all along. We just need to make the connection. Speaker 2 00:01:17 Welcome to the connectors. And by that, I mean, those listeners who actively follow this show and believe in the power of human connection to transform our relationships and to facilitate honest and open dialogue, all leading to a more meaningful change in healthcare. In this episode, I sit down with Dr. Zubin Demaya, AKA Z Dogg MD. Dr. Demani is a special guest indeed. He's what I call the king of the internet. Healthcare, bad boy, Cognis, Senti, but don't be fooled by the Seadog dog MD persona that he often adopts to parody the flaws in our system. He is one of the smartest docs I know, and he has a remarkable grasp of a broad range of healthcare topics on his Z dog MD show. He routinely hosts the best and brightest in the field, and because he is supported solely by his audience, you can depend on Zubin to call it as he sees it. Speaker 2 00:02:14 He is a supporter of the alter medal, a term he uses to describe those who acquire reliable information and then use logic to question every belief, including perhaps especially their own, the Huffington post calls him one of the most talented and innovative forces in healthcare. Wikipedia has called his numerous videos and parodies entertainment that just might save your life. And so he is an enigma of sorts. He is both a top notch, often irreverent, entertainer and musician, but also a Stanford trained board certified physician and assistant professor with a razor sharp mind. I feel very fortunate to have him on the show. And I now invite you to connect with Dr. Zubin <inaudible> are you ready? Speaker 2 00:03:26 Everybody. We have an incredibly special episode today because we have none other than, uh, the king of bad boy online medical cognizanti Z dog MD himself is here with us today and Zubin you and I go back a couple of years now. Speaker 3 00:03:45 Yeah, we sure do. That's a great intro, man. I'm going to have to steal that for when, you know, speaking engagements or like, what's your preferred intro? I like the bad boy cognizanti of the internet. Uh, I'm not sure what it means, but it sounds provocative. We, we met back at an event back in Arizona, I believe. Yeah. Yeah. It was. Speaker 2 00:04:03 I was trying to remember if it was 2017 or early 18 when, when we first met at, uh, an event that we were doing together, but it's, it's been a couple of years anyway. Speaker 3 00:04:14 Yeah, it was BC before COVID so we, we have no idea. I mean, all of that time, just smears into a continuum in the end. Uh, yeah, I mean, I remember we, we were at a talk and you were speaking before me and I saw you speak and I was just like, dude, this guy is woke in a good way. Like really understands that healthcare is about a narrative and storytelling and human relationships and the system should support those kinds of things. And I think we kind of became a fast buddies after that. And you were on my show, I think at one point in Las Vegas, Speaker 2 00:04:43 The curious case, I think you called it the curious Speaker 3 00:04:46 Case of Robert groves that's right. And it grows curiouser and curiouser. Yeah, Speaker 2 00:04:52 It does. It does, even to me, um, w what I want to find out, and, and, and I've been dying to ask so many questions, uh, but what I'm going to find out is, is how was Z dog MD created? And I want to start back to, uh, where'd you grow up? Where'd you go to school? What was that like? W what is it like to be Zubin to Manya growing up wherever you grew up? Tell us a little bit about that story. Speaker 3 00:05:18 Yeah. It's interesting. You know, when you're young, you are just this open consciousness, you know, you're just experiencing things without all the conceptual overlay. And it's only in adulthood that, uh, you know, there was this beautiful quote that said something like, uh, adults are the corpses of children. Yeah. And, uh, yeah, it's it's, and I think it's true that they're resentful of it because when they look, they see kids, they resent them because they see what they've lost. And so when you ask like, oh, what was growing up? Like, I can only sort of answer that through a filter of conceptual overlay and revisionist history and all of that. I still have this vague sense, instinctual sense of childhood as being this, you know, crazy anxious. Now you'd call it OCD kind of weird person that I was growing up in New Jersey and two immigrant parents from India. Speaker 3 00:06:07 And, you know, living in little apartments in New Jersey as they did their second residencies that were required of, you know, FMDs foreign medical grads. Yeah. So a lot of like, kind of this sense of instability and, you know, the immigrant experience of any minute you could be out on the street and a very stressed parents. And so that was New Jersey until I was eight. And it was always one of those things where I, I had this, I had the sense that I was weirdly odd. Like there, I didn't quite fit in to anything. First of all, being, being immigrant, you're all, you're naturally other, although in New Jersey, that didn't matter. Cause everybody was other in New Jersey. But the sense that, oh, you know, I I'm, I'm just constantly curious about how things work and what's going on in the world and with experience and nature and digging up every rock and taking apart every toy and looking at the innards and trying to figure out how it ticked. Speaker 3 00:06:58 And I mean, it would drive my parents crazy. They would buy me something, you know, they'd save all their money and buy me something nice. And a day later it was totally dismantled with no hope of getting it back together. That's the thing, you know, you reach a event horizon beyond which you, your mechanical knowledge as a five-year-old doesn't translate into being able to put it back together. I remember private school in New Jersey where that was kind of thing was encouraged. And then, um, my dad up and decided as a primary care doc, he actually trained like you, he trained in pulmonary, but ended up just not taking the boards and said, you know, I kind of like primary care. I'm gonna take this thing in Clovis, California, which is wow. Interesting. Yeah. This little rural town in Clovis. And he bought, he bought a practice that someone was retiring and it came with a house in the country and yeah, it was like, you buy my practice, but you also have to buy my house kind of thing. I Speaker 2 00:07:49 Think those days are gone now. So did you always want to be a doc? Is that something that you aspire to be because of your dad and you know, how did you get on the path? No, Speaker 3 00:07:58 Because, you know, I would look at my parents and be like, that looks unhappy. Like that look that looks miserable. You know, everything about it looks bad except they would still be so passionate about doing this thing that was clearly affecting family life and a clearly stressing them out and clearly, you know, putting them on edge. And yet if you ask them what else they could do, they'd say nothing. This is what I was meant to do. And so there's something about that. That was definitely a draw, but I thought, you know, oh, you know, I'm going to be an entomologist. I like bugs, or I'm going to be an astronomer. I love, you know, space or I'm going to be, then it translated into I'm going to become a pop star because I love being the center of attention and the clown and the performer. And so it was anything but Madison actually in those days, Speaker 2 00:08:42 Zubin, I have to stop you there for just a second, because I think you have become all of those in one way or another. Speaker 3 00:08:50 I, I didn't quite fully occur to me, but I guess you're a you're right in the end. Uh, except for bug guy, although I still am fascinated with insects, but yeah. They're mostly hospital administrators. I remember referring to, I'm kidding. I'm joking. I'm joking. I had to make a stupid joke. Uh, yeah, I think in a way I have integrated a lot of those sort of urges there really were just kind of urges. Like what's your offense. Yeah. Very Speaker 2 00:09:13 Cool. And so, so take us through, um, I don't know, high school college, uh, and that decision to go to medical school, how you made that, where you went yeah. Speaker 3 00:09:24 You know, high school, I was always trying to find out what's my identity. So, you know, was I a skater kid? I was never a sports guy. Never did team sports, never did team anything, to be honest, it wasn't really in my DNA. I was always just a little bit off. And so, uh, picked up guitar was really into that thought. I'd become a musician professionally realized I didn't have enough talent or drive to do that. And, um, kind of drifted to UC Berkeley for my undergraduate and talk about every single liberal value you can find, like in terms of personality traits, like openness to experience like all this. And yet the biggest, the biggest organization student organization on campus was a young Republicans. Uh, so it was a really fascinating place where you could hold paradox and, uh, really explore what it was you wanted to do. Speaker 3 00:10:07 And, and that's when it became clear to me that I did a music minor in molecular biology. I loved, I loved the science of it. I loved music, but I knew I wasn't going to make a living doing it. And so I was practically minded thinking, okay, saw what my dad did in his clinic kind of fell in love with that and said, okay, I'll let me give medical school a shot and see kind of what happens. And that's kind of how, how it went. And, you know, college was one of those things you're experimenting with psychedelics and your, your mind is changing and evolving. And you're, you're having these experiences where you, you are convinced that there's something more to life than just going through the motions. You know, like you're here for some reason that's beyond your articulation or understanding, but you'll know it when you find it, it's almost like you have to open a portal to what is authentically you. And I knew that in college, but I was like, yeah, it'll, it'll, it'll happen. And then you go down the path and then you find out exactly how long it takes before it happens if ever. And, uh, yeah, I Speaker 2 00:11:01 Think the F ever is important. Cause I think for most people that that's a dream that never really comes to fruition. And I wanted to point out that one of the things that I have admired about you is the courage that it took to step out of, you know, the tried and true. Your parents are proud. I'm a doctor. You know, this is what I do. We're getting ahead of ourselves a little bit. But I just wanted to point that out that in order to actually realize those things, you have to be willing to take what would be considered. At least societaly a pretty big risk. Do you agree with that? You have Speaker 3 00:11:38 To open yourself and trust that what you're doing that feels authentic is the right thing to do. And that is the scariest plunge that you can take. You know, like this, the spiritual gurus will say, you know, you step up to the kind of abyss of emptiness that is consciousness, your ego rebels. It just says, no, this is like akin to dying. But you take that step, that people who go through it take the step and they wake up, they undergo enlightenment, whatever you want to call it. E it's it's, there's a smaller step you take when doing a co like a career shift like that, or trying to find your authentic self is saying, okay. Yeah. Okay. This is really scary. I could end up broke. I couldn't, I'm definitely going to piss my parents off. I'm definitely gonna not look so good in society's eyes, but this is who I am. I have to do it. And if I don't try to do it, then why am I even alive? What's the point of all this it's feels empty as it is. So why are, why am I continuing to fill emptiness with more emptiness? Right? So let, let, let me at least try to be me. And that is scary. It's very scary. And the truth is, you know, you can pretend to be all brave and all that, but it's not, you're, you're full of fear. The question is, do you do it anyways? Speaker 2 00:12:47 Yeah, I've heard, uh, uh, gosh, I can't remember who the quote came from, but that's the definition of courage is not the absence of fear it's doing what you must in spite of the fear. Speaker 3 00:12:57 Yeah. You push through anyway. Yeah. And in fact, I mean, you can't, you cannot have bravery without fear because what are you being brave about? If you're not scared, you're working so hard. Speaker 2 00:13:08 You have been so busy lately because I remember, uh, gosh, uh, BC before COVID let me take a step back first. Let's go back to medical school. You did something that I thought was fabulous, entertaining, and also kind of brave. You, you did a presentation before your entire medical school class. Tell us about that and the results of that and, and what it did for you or how it shaped you. Speaker 3 00:13:32 That was one of those deals where, you know, I, I kinda co-produced our second year of class play, which is kind of like a comedy series of comedy skits. And so people knew I was this kind of like attention seeking class clown type and not, not very, not a very rigorous thinker per se. I think it was more like, okay, to care the least about medicine, but can complain the loudest. And at the time I think that seemed to be me, even though, you know, again, I did reasonably well in medical school and got what I wanted, but it was one of those things where I, there was a subtle part of me that was just like, is this me? Am I being me here? This feels like I'm being someone else. But how do you articulate that in your early twenties? You don't. So at this point, my class kindly gave me the opportunity to actually be me in the face of all this. Speaker 3 00:14:15 They said, okay, we're going to, we get to class speakers. We're going to elect Zubin is one of them because he's just going to go crazy and it's going to be a total shit show and it's going to be wonderful. And then we'll have Amy do the other one, who is this very hyper-conscious wonderful speaker articulate about social issues. Perfect UCF. It's like crazy and social justice. I was like the perfect for me. And so, you know, that's when I started to really panic because I had never done anything like that. You know, it's our graduation. There's like an imagined, oh my God, it was a couple thousand people in the Masonic in San Francisco, this big venue. And I had written this whole thing out and I leaned on my friends a lot. My med school buddies like helped me write this, come on, let's come up with some comedy and stuff. Speaker 3 00:15:00 And I had this whole star wars theme for the first version of my speech, which was, you know, it was just like the Phantom menace had just come out this new star wars, first new star wars in a decade or whatever, and oh, what a big deal it was. And thank God I didn't do that cause it wouldn't age well. And second of all, it just was, it was, I was clearly trying to hide from whatever truth I was trying to tell. So I tore it up like two days before the talk and started writing a new one in a pant dude. It sucks so much. I I've never been that scared. I even now like I'm holding myself in a fetal position just thinking about it. And at that point I was like, well, I'm just gonna do me then, which is bad jokes. And really complaining in a very pointed way about what I found was the funny, yet horrifying aspects of medical school. And I did that. And, uh, it was funny, like people really loved it. And then there were a few faculty that were like, this guy shouldn't be allowed to graduate after doing that. Like this Speaker 2 00:15:54 Is, you know, I find that so hard to believe that there was that much of a backlash, but I probably shouldn't, by the way, this is on YouTube still and you can go look at it yourself. And it just is one of my favorite YouTube videos. And, and I've, I've seen it a couple of times now and I'm I'm, I can't wait for the third. It's an amazing performance. And, and you get the sense that while you're doing this, there is so much adrenaline flowing through you. Uh, that it really, uh, you know, it, it brings the energy up. And in my mind, I'm thinking about times that I've spoken in, in large crowds like that when I was younger and it's, it's fear, you know, that kind of keeps it going. Speaker 3 00:16:33 Yeah. Yeah. I mean, you nailed it. I mean, I'm back there right now in my mind on that podium. And as you walk up, you know, first of all, you're graduating, right? Robert. So it's like, you're already in this weird semi real state. I just finished four years of the most difficult experience of my life medical school. And here I am, and my family's here, all my colleagues and I mean, future colleagues and med students and mentors are there. It's a very emotionally charged thing. And then you step up there and I said, I made a comment in the video that people didn't pick up what exactly I was saying, like I was holding my fake speech. Cause that was part of the gag is like, this was my first speech. And it was basically wear shoe covers, which was a, like a video going around at that time. Speaker 3 00:17:12 One of the early viral little things. And I, and my hand was shaking so much that I thought everyone could see. So I said, oh, I should have taken the beta blocker. And I threw it away. People didn't pick up that I was dead serious. Like I was shaking. Like I couldn't, I couldn't function. And it's a fight or flight, you know, it's like, we're evolved to persuade other people in our tribe. That we're correct. And when you're on the spotlight, that it is literally a life or death situation, as far as our evolutionary heritage goes, cause that's when, oh, am I going to lose hunting privileges? Am I gonna lose breeding privileges? Like what's going to happen. If I make a fool of myself here, say the wrong thing, the tribe X communicates, Speaker 2 00:17:49 Have I ruined my career. Right, Speaker 3 00:17:51 Right, right. Right. And even going more primal than that, you know, am I going to survive? This could be the end of me and my genetic lineage. And you're not thinking that, but that's how important it is. Evolutionarily. That's how that fear of public speaking, I think starts from a pure ontological position. It's like that this is where it starts, you know, we're afraid of dying. Yeah. That's Speaker 2 00:18:11 The instinctual translation, if you will, of that fear into actual survival. And, and when you start getting that, then it starts to make sense that a lot of people, their number one fear is speaking in public. It's because you're so vulnerable and exposed and your body, uh, you know, the, the evolutionary line interprets that. Exactly. You got it exactly right. As I may not survive this. Yes. You are such Speaker 3 00:18:35 An amazing public speaker. Like I, when I watched you the first time I remember just going, oh, this guy has it. You know, like the talent agents are like, oh, he's got it. Say this, guy's got it. The minute I saw Robert Grove speaking, I was like, oh, he's got it. Like, this is not even a, not even a question like you're natural, you're unguarded, you're vulnerable. You're telling stories. Your body language says you're open. Like all these other things. Now you never think about these things consciously, but they happen naturally. And I had to actually evolve that over time, over the 10,000 hours of doing speaking, you know, teaching M cat for two hours at a time. I remember in medical school, that was my 10,000 hours actually that led me to be able to even do the speech because, you know, I had to deal with these fricking Berkeley pre-meds and teach them general chemistry. And, you know, they were assholes, you know, they, they were know-it-alls and there, I was just barely one year, one year ahead of them. So in order to do that, I had to adopt a lot of comedy and a lot of being vulnerable there, like being like, Hey, I don't know everything, but I can help you pass this test. And we'll have fun getting Speaker 2 00:19:35 To whatever point I happened to be at now. Uh, didn't happen overnight. And, and, you know, there's a misinterpretation by many that when they see somebody that's really good at public speaking or entertaining or, you know, music or whatever it is that all of a sudden they burst on the scene with all this talent. But I want to go back to how the positive response to that speech impacted you and how you then got to the point where you started to do some really interesting stuff in Cognito at first, hence the, the Z dog MD tag hat. Tell us how that evolved. How did you get to that place where you were going to be Z dog MD and was that before or after the healthcare 3.0, as you call it, I'll have you explain to us what that is. So I'm a little confused on that timeframe. And what happened to you during that timeframe? Can you walk us through that? Yeah. Speaker 3 00:20:31 So, you know, the speech was interesting because when I really think about it, that that was the, that was the proof of concept that I might be able to do something that I love. That is hard. That's a challenge for me that also incorporates everything that I've been through in terms of medicine and health. And that helps people like people go, oh, that's my pain too. Like, oh yeah, I see that. And it's something that recently I've termed communalism of pain. I think I stole it from someone. I don't remember who, that's the other thing, Robert, you just, you gotta steal stuff and just own it. And then when someone comes at you and is like, I invented that, I'm like, okay, you invented that great. It's yours. I'll give you credit. But until then just own it. Who cares? You know, ask for permission later, that's something I've learned. Speaker 3 00:21:12 It's like all creative activity is building on the work of others. It's wonderful when you can acknowledge others, but when you can't like you don't remember, or it doesn't matter just own it, do it. And they'll come out of the woodwork and you can thank them and hold them up. But until then just create the art you want to create or the statement you want to create. And don't worry about all that people, a lot of doctors and stuff coming to me. How do you do these parodies without worrying about copyright? I'm like I trust in the universe that if I make a good parody, the person who I'm parodying, they're going to look at it and go, oh, that doesn't suck. Just let it be. And that's what's happening. And in fact, many of the, many of the people that we've parodied have actually tweeted our parodies and said, this is the best Berti art stuff we've ever seen, which is like the hugest compliment. Speaker 3 00:21:55 I just, I get, so, so back to this, the speech, the speech then led me to say, oh, this may be a thing. I ended up going through all of residency at Stanford, internal medicine. And about six years of my hospitalist career at Stanford, before I created a YouTube account in 2010 and a Twitter account and created this alter ego. And it was because I had posted the graduation speech on YouTube. And it got like immediately like 30,000 views, which back then to me was like, are you kidding me? This is crazy famous. Yeah. And, um, and I said, oh, maybe this is a thing. If I do it consciously, like, cause I love this stuff. Like maybe that's the thing. Cause YouTube, it never existed. Like you had no platform to distribute this kind of thing, short of word of mouth and put a VHS tape in a brown paper bag and mail it to someone. Speaker 3 00:22:43 Now it was like, oh, this could actually happen. And so it was around 2010 that I was like, oh, you know, I'm kind of a little miserable here. And I was like, this isn't me anymore. Like, well, what can I do that's me. I like to make these stupid videos. And it would help keep patients out of the hospital maybe and help other healthcare practitioners be less miserable. And because they see, oh, we're all in this together. And that was before any health 3.0 ideology came up, but that was later. And so it was more just this urge to like, ah, I gotta be me in some way. And that's this kind of thing. Speaker 2 00:23:14 So did you, uh, did you come out of the closet and marry the two identities before healthcare? 3.0, did Zubin Demaya and, and Z dog MD meet publicly before 3.0 it was Speaker 3 00:23:31 Clear that it was me. Cause it's kinda my face. Right. Stanford never figured that part. Yeah. But Steve at Stanford never figured it out. Hey, there's my face that I know that guy. Um, but I never said, oh, I'm pneumonia, et cetera. Although occasionally would slip out. So there was a separation and mainly it was because I was worried about my career and I didn't want to put my name in, into a Google mix where a patient Googling me would then see this guy doing, who's dressed up as this like fake rapper doing these, you know, dumb wraps. And, and so I was a little concerned about it back then because also the character that I created was more of a character. It was an aspect of me, but it wasn't me, you know, the early Z dog, especially it was not me at all. Speaker 3 00:24:12 It was this kind of silly cartoon that I created looking back at it, you can psychoanalyze it and go, oh, it was a way of putting some distance between the real me and what the world sees. It's a way of being less vulnerable. Right. And for sure that was the case. And it only evolved slowly that the two characters faced each other and said, oh, we're the same thing. So let's stop trying to be one or the other. And now I'm just me. So, you know, yeah. I'm stuck with the name Z dog MD because it was kind of a thing that unfortunately stuck. And so now it's a brand and I actually tried to change it on the Facebook to just doctor Zubin, to Manya and Facebook wouldn't let me change it. They said, no, sorry, your brand is identified with this. And I was like, how dare you? Okay. Goodness, I am the brand. Uh, but yeah, yeah, exactly. But they were right. They were probably right. Yeah. Speaker 2 00:25:01 They were, I, I, I liked the, uh, I liked the, you mentioned earlier that, uh, the ability to hold paradoxes, uh, at Stanford. And I think that that is an incredibly useful, I don't know if it's a skill or a mindset or a philosophy, but to be able to hold paradox and, and the two are paradoxical in many ways. I mean the, the Z dog, uh, persona is the bad boy. And yet you also are a brilliant logical thinker. Uh, you know, I presume that you were an excellent physician. Uh, so both of those characters live within that head and, and that's pretty cool. And being able to hold that I think is, is something that we don't think about enough and we don't acknowledge enough that we have to be able to, to live with those kinds of paradoxes in, in the people we love in ourselves, et cetera. Speaker 3 00:25:59 That's, uh, it's, it's almost one of the key Metta beliefs that we should have because, you know, belief is such an interesting thing. Like as many people believe that in order to have integrity in order to trust someone, they have to be one identity. One thing, very, very, very harmonious, like no internal identities that that's separate from that and consistent and so on, but no humanist like that. We're all these complex mind systems of different characters and are, you know, entering consciousness through these ideas and belief in images and thoughts and from a thought identification standpoint. In other words, if you think, if you think thinking is all there is like, I'm a thought, I'm a thought, I'm a thought paradox is painful because from the standpoint of you can't unravel it, the mind can't unravel paradox. That's hence it's a paradox. But from the standpoint of just awareness, like being aware, there's no paradox. Paradox is a construction of language in the mind. So holding paradox in my mind is being able to see multiple truths, even if they contradict each other at the same time as being true, but partial as part of a larger whole and holding that and then acting in the world out of that understanding, I, you know, I use the term recently all to middle, which has kind of a tongue Speaker 2 00:27:14 In cheek. I love that term. Yeah. Yeah. You know, Speaker 3 00:27:16 It's a kind of a tongue in cheek way of saying there's, let's not hold on to any of our beliefs too dearly because when a belief doesn't serve us, when it's shown to be incompatible with what's going on in the world this second, we should be able to evaluate it, examine it and release it. And if that's our fundamental belief that all beliefs should be examined, that's a good belief to have an operating from that operating system puts you in the middle. It doesn't mean it's a, it's not a political statement. It's not saying, oh, I'm a centrist or I'm a whatever libertarian it. It means I look at that world from that standpoint, which means I'm going to love you if you're liberal, if you're conservative, you're libertarian because you're expressing something that's true, but partial, and I'm gonna assume reasonably good intent on your part that you're not trying to be evil. Most people. Yeah. One of the, Speaker 2 00:28:02 Uh, the tenants, I think that I believe to be true is if I have any belief and I can't think of any fact or any issue or any way that that belief can be changed, then it is motivated reasoning. It's not logical reasoning or logical. Maybe isn't the right word because we don't always use logic when we arrive at conclusions. But, uh, what I'm saying is if I hold onto something so tightly that there is nothing that could possibly change my mind, then I've got a problem and we all do this, right. It's confirmation bias. We tend to look at those things that validate what we already believe and ignore those things that don't validate what we believe. It's kind of like the whole, uh, rider, uh, and elephant thing that the writer spends most of its time justifying what the elephant did it. Can you explain that rider? Elephant thing? I like the way you do it. Can you explain it for everybody? Yeah, Speaker 3 00:29:01 Sure. Because I think it's central to this like, like intimate, it's central to this idea of belief as a personal identity, that then if it's attack, you're attacking me and holding onto that belief, not examining it, not being aware of it. You're just going to, like you said, engage in cherry picking data to support your belief, confirmation bias and instinctual knee-jerk reaction. So the elephant in the writer is John Jonathan Heights. Um, he's a social psychologist, his construction of how the human mind generally works. And it's backed up by Daniel Kahneman. Who's, uh, a Nobel prize winning psychologist talks about system one and system two, these two aspects of our brain. So elephant or system one, I believe is this ancient primordial part of our brain that is largely unconscious. That is emotion driven. It's like our limbic system. It's a little higher than the reptilian reptilian brain. Speaker 3 00:29:53 I wouldn't call it that, but it is very conditioned by our genetics. It's conditioned by our experience. And it's unconscious. So hope, fear, love discussed threat detection, certain deep core beliefs that we've made unconscious operate from our elephant. And they happen instantly. The elephant is there to keep us safe. It's designed as a evolutionary adaptation to protect us. So we learn these heuristics. We make them unconscious. They live in the elephant because the elephant never forgets. And we operate from that. Whether we know it or not, because it's very fast and very low energy to do that. And it's generally right, because millions of years of evolution can't be wrong, right. Except when they are in the last million years or so, we evolved, you know, neocortex in humans and, um, neocortex is, is more our writer, the little character that rides on top of the elephant. Speaker 3 00:30:45 And that is that's meant to symbolize thinking and planning and strategizing and math and verbal persuasion and conscious thought. So this high energy process, that's slower. It's more deliberate. It's there in awareness. So we're aware we're doing it. It takes a lot of ATP. Um, and so it's, it's very expensive, sort of from an energetic standpoint and, and a metabolic standpoint. So you use it very carefully. Now this idea, then that the writer sits on top of the elephant and it designed, it's designed to control our emotions and control these unconscious processes. Hight and others have argued. It's actually, that's not true. The writer did not evolve to create logic for logic sake and to seek truth. The writer evolved as the press secretary for the, for the elephant. Speaker 3 00:31:37 He evolved to be able to convince others in the tribe, using logic and argument and, and some strategy that our elephant is right. And he's not aware he's doing this. He thinks he's in charge. Um, but, but he's not. And study after study shows. That's true. And it's everything you said, show somebody something that counters their belief and they will use their writer to go on the internet and find things to either shoot down that study, find holes in it, or find studies to counter it that already back what they believe, never once do they stop, open their mind and go, oh, what's my fundamental belief. That's feeling attacked here. That's in the elephant. Oh, that belief is that vaccines are always good. And anyone who's against vaccines is a bad person. So maybe that's your unconscious belief. Let's just take a Provax stance for example. Speaker 3 00:32:26 So then study comes out that says Johnson and Johnson rarely, rarely, rarely, rarely causes these unusual blood clots. Kevin is fetus, uh, sinus thrombosis in certain women. Okay. Your first instinct. And I saw it happen all over Twitter. If you're like a Provax believer is to deny that the data is associated with the vaccine, then you're going to deny that it's important at all. Then you're going to make all kinds of comparisons to, oh, well this is like being struck by lightning or whatever. So that's how you're going to defend your core belief. That vaccines are good. Now I happen to actually agree with that core belief, but what that's going to do to people who are already vaccine hesitant, whose core belief is pharma can do no good government and corporations should not be involved in my body. Mandated vaccines are a violation of the sanctity of my body. Speaker 3 00:33:11 And you don't get to do that. So different elephant. They're going to find all kinds of data that they can use to support the idea that the vaccines are not safe. And that data may not be reliable. It doesn't matter. They'll find it and they'll believe it. And the two will never persuade each other because they don't understand each other's elephants. They only will use their rider to spend data at each other to throw more science and evidence. And here we go, here I am. Oh, well, I found this well, I had an anecdote of this, okay. But that's not going to change the fact that you haven't addressed the core belief. And this is the thing, Robert, the reason I tell I'm passionate about this as this has been the centerpiece of my later platform, especially during COVID, you can go out there and mask, shame people and anti-vaccine people, and all it will do is cause them to entrench at the same time you need exactly. Speaker 3 00:33:56 Right. And at the same time, you need to look at your own belief structure and go, am I wrong? Like, what is the data on outdoor masking? It's crap. It's garbage. There's no good data on outdoor masking. So maybe we should tell the public look if you're crowded outdoors, maybe so evaluating that in a fluid way means then people on all spectrum of belief will trust what you're saying. And based on the emails that I get that's what's happened. A lot of people have changed their stance on vaccines. And a lot of people message me and say, Hey, I'm really on the fence about this vaccine. And here's why, and I'll say, you know what? You're not wrong to question the way you're questioning, honestly, for you, you're younger. You don't have to get vaccinated. Here's why I would get vaccinated if I were you, but obviously it's your choice and you're not wrong to question any of this. And I like your skeptical attitude and they then make a decision. But that, that, that involves respecting their belief and not directly attacking it because that's just going to backfire. They're just going to entrench. Yeah. Yeah. Speaker 2 00:34:52 I, I think, uh, all of us want to be seen as human beings first and belief systems are overlays on that and those are malleable and they can change and, and, and respecting the humanness of anyone, whatever their beliefs may be is, is a first step towards really getting to understanding. And, you know, w w w we could talk all day about, uh, the, the impact of social media, uh, fake news, uh, the polarization of our political process, but it all comes back to that. And, and to some extent that rider elephant, uh, issue is what's being exploited by sensationalism, right? That's, that's what gets our, it either triggers our fear, our anger, and that feels good. There's a whole lot of energy in that. And as print James said, the, the writer spends most of its time justifying what the elephant just did, just like a press secretary, uh, and, and understanding that having some insight into that, I think allows us to be first of all, more forgiving of others when they take stances that seem to us to be irrational. And second of all, more knowledgeable about ourselves. When we take a strong, hard position, this is the only way it can be to, to think, wait a minute, there's a lot of energy and anger in this. I feel defensive. What's going on here? What is it that, you know, I feel attacked by and being able to do that is the first step towards a dialogue and finding the middle ground, which is where the answer usually is. It's not usually at the extreme thinking on, on one side or the other. Speaker 3 00:36:34 I think he put it really perfectly. I mean, that's really what it is. And, and, and the truth is, yeah, social media is weaponizes the elephants, um, tendencies, you know, you, you immediately hear something, see something there and you go, oh, I'm angry and you hit the dislike and then you share it. And then your writer spins a reason of this. Guy's a total clown. Can you believe what they're doing here to immigrants or whatever, and that's what it is. And so by having the mindfulness, even understanding the elephant rider situation, you can look in your own mind and go, oh, look what I'm doing. That's interesting. And then you look at someone else and go, oh, look what they're doing. That's interesting. And the true that you said, something people want to be seen for what is actually going on. So if they have this belief and you are actually a witness of it, and you reflect it back to them in some way, also your core belief is this, about this. Speaker 3 00:37:22 Let's talk about that. Just that understanding goes a long way, because now they they're like, okay, at least he understands what I'm saying. Like he understands where I'm coming from. And you could actually, even if you want to get metaphysical, you can go one step further and go every experience, emotion, fear, feeling thought in your own mind, that arises really as a kind of an energy pattern that just wants to be experienced. That's why I thought tries to get your attention. That's what I mean, I don't mean to personify thought. That's why it's a thoughts. Goal is really only two things to get your attention and to direct it to the next thought. And so it just wa you know, it just wants to be your wants to be you, you know, and when you can step off that train and go, oh, I see you thought, I see you shame, you know, like this feeling of like vulnerability. Speaker 3 00:38:09 I don't want to feel ashamed of being who I am and you'll hold their shame again. It's trying to keep me safe. I see you immediately, it releases maybe not immediately, but you feel it, it passes through your physiology. And, and then you're okay. And, and I think it's same with inner subjective interactions with other humans. When you see them, when you feel them, when you're there with them, even if they they're fundamentally opposed, suddenly an understanding can happen. And intersubjective understanding that then allows, you know, truth. Like you said, a lot of it's in the middle. Yeah. Speaker 2 00:38:39 You know, Zyban, you and I are, are, are basing a lot of these extrapolations on, uh, the notion that there is such a thing, metaphorically speaking as an elephant and a rider for those of you who doubt that I encourage you to look at the studies that have been done on split brain patients and very, very quickly, uh, you will find that it is, uh, it is a, a very different world than what you imagine it to be. When you think of yourself as one integrated whole brain, that's not the way it works. And, uh, this stuff might make more sense. And you might be more open to, uh, to swallowing it. If you look at some of those studies and understand that, you know, in, in folks that had bad seizures at, at one point in time, uh, the medical, uh, intervention was a surgery that separated the right side of our brain from the left side. Speaker 2 00:39:34 And to briefly describe it, what you find is that there are two different personalities occupying those different halves. One of them has the advantage of language, but you can communicate with the other side via visual stimuli, et cetera. And, and the upshot is that we are not an integrated whole brain, as we seem to feel in everyday life. That there's a lot more going on behind the scenes that we don't understand. And you begin to understand how the mind works. And if there's one thing that in this lifetime, I would like to get as much information as I can about it is how my mind works. And, and we'll get to this in a minute, zoom, because I know you love talking about it, that's consciousness, but before we go there, I want to talk a little bit about some of the, uh, uh, the work that you did in three point. Oh, and I want you to describe that because, you know, we're talking about a lot of stuff that seems extraneous now. I don't think it is because I think it applies directly to a lot of the work that you've done on healthcare. 3.0, can you take us through that analogy and describe what you mean by 1.0 2.0 and 3.0, yeah, Speaker 3 00:40:45 Absolutely. And, you know, I think you bring a point here. Nothing is extraneous. Like everything we've said leads to this leads to this idea of 3.0, because the concept of health 3.0 is something that we kind of emerged while we were building our clinic, uh, turntable health in Las Vegas. And again, it was in conjunction with other people like the Nigela Polly who coined the term medicine 3.0, and has written about it. So the idea is that it's each sort of phase of our evolution is a kind of emergent that builds on the previous phases and is a little more true and still partial. And so it's still a stepping stone to the next. So health 1.0 was kind of our 20th century. And for a long time, actually our cottage industry, if you know, Dr. Patient's sacred relationship, not a lot, we did, it was a lot more about this kind of paternalistic energy where, you know, patients just got a lot out of having someone tell them, Hey, this is okay. Speaker 3 00:41:40 Or this is not okay. Or take this. And it was very relationship driven. There wasn't a ton of science, but the physician had a lot of autonomy. And so from that standpoint, there was a lot of beauty there and a lot of good, but then a lot of downside. So that in any emergent sort of paradigm, there's a, a good side and a kind of a shadow. So the shadow for health, 1.0 was fee for service medicine means we get paid to do things to people, not necessarily for them because of the paternalism. This is not a partnership with our patients. This is, Hey, I know what's best for you. That's not the highest game we can play. Patients didn't have an internet. So they, all the information was on the doctor side. And it wasn't very team-based. So it was very hierarchical, a dominator hierarchy. Speaker 3 00:42:22 So meaning the doctor just basically abused anybody else in could abuse anybody else in the, in the system that was quote unquote beneath them. It wasn't that everybody was kind of practicing at the top of their game. It was like, no, the doctor was the undisputed boss of everything. And it was usually a man. So yeah, 1.0, had its shadow. Um, yeah. And that shadow always leads to a tension. And this is true in societies too. You know, when you have this sort of, you know, mythic magic phase of development, when everybody believes in a mythic magic God, and it's very hierarchical and so on, and then emerges a sort of a more, Hey, no, it's about a meritocracy in science and then emerge as a whole. No, Hey, no. It's about diversity and multiculturalism and oh, Hey, no, there's something even beyond that called integral thinking in order for the next emergent to happen, the shadow of the current has to get pretty strong and we start to feel the tension. Speaker 3 00:43:08 And in one point, oh, that started in the seventies and eighties when people are like, this is getting too expensive. And so 2.0 was the next emergent. And 2.0 said, Hey, you know, we kind of have solved some of these problems in business. We have lean and Toyota assembly line processes, and we have quality management and ways that we can kind of fix medical errors. That was clear in the thing. It was at 1980 report, uh, to err is human. I think it was 1980. So we're just, you know, we're killing patients with errors. There's so much care variation. Um, we're going bankrupt. Like, okay, well, let's start thinking about managed care and an electronic health record and technology to kind of support the way it supports, how it supports in, in business and so on. And so, so that actually was very good intention and actually, you know, NC QA and these quality programs and so on very good intentions and actually some good data that, Hey, some of the stuff is very important, right. Speaker 3 00:44:00 You know, wrong side surgeries, you could stop with a timeout, you know, things like that. So a lot of beauty then there's the shadow, right? And I think we all know the shadow of 2.0, it's commodification electronic health record. That's not designed about patient care. It's designed as a billing platform, the flattening of the doctor, patient relationship to one of where here have some data you decide, go on the internet and Google. No good. You know, uh, so the human element we talked about earlier, member, nothing is extraneous. The intersubjective being with patients when they're vulnerable and having them be felt, having them feel, felt and understood that, that, that goes away in 2.0, because you're staring at a screen because you have too many responsibilities. And then the moral injury for the doctors is, oh, I got to do all this paperwork and pleased the bean counters, but I, I'm not here for my patient anymore, but that's what I'm here for. Speaker 3 00:44:50 That's why I did this. So the inauthenticity of that moment, tears people apart. So now you have, you know, 60% of docs that won't recommend the career and all the usual suspects of burnout and everything. And so that's the shadow of 2.0, to simplify the question I had when we were trying to build our clinic was, well, what does, what's 3.0, look like, like, how do we make this better? And the truth is all middle health, 3.0, Ken Wilber's integral philosophy, mindfulness, the elephant and the writer, all of that goes into what health 3.0 is. It's a new emergent that says, okay. Yes. And to the best parts of the previous iterations. And it's the first emergent that actually does that. Because 1.0 said, Hey, 2.0, has a bunch of robots, 2.0, says a one point. I was a bunch of Cowboys. None of that 3.0, says kids, kids, kids calm down. Speaker 3 00:45:42 You're both partially. Right. You know? Yes. 1.0, physician leadership, physician autonomy and authenticity is important. Yes. The human relationship is important, but no, it's not paternalistic. It's collaborative. Okay. That's different. 2.0, you're right. We need to measure stuff that matters. And we need to have guidelines that people can then violate. If the unique patient at hand says that it needs to be violated and we need to, yes, we need teams, but we also need autonomy within the teams because we're all a whole in ourselves and also part of a whole, so let's honor both those elements, that tension between communion and autonomy. And so what 3.0 does then, is it says, okay, let's emerge something new. That's bigger than the sum of its parts. Kind of like a human cell. You can take the golgi apparatus and the mitochondria and all that, but you don't add them combinatorially and create a cell. Speaker 3 00:46:31 There's something wonderful. That happens. That emerges, that creates this resilient kind of antifragile thing. That's what 3.0 is it says, oh, but now, so we have good technology that enables a human relationship. We have a team-based care. We measure what's important, but really just pay people to do the right things for patients. They change the payment model and watch what happens. Rehumanized re personalized medicine. That's technology enabled, but it's not technology enslaved like 2.0 where unexplained care variation is to be avoided. But care variation is to be celebrated because every patient is unique. So it's kind of like a unique self medicine that is powered by the algorithms of 2.0, but knows when to transcend and release them. And that requires a new way of thinking. It requires an alt middle mindset where you question the core beliefs at every time. Like that's, that's your core belief is question everything. Speaker 3 00:47:25 So it, it, it evolves. And an emerge is almost like an organism. It's a much more evolutionary or organismal kind of scenario. Then the mechanistic construct of 2.0 or the paternalistic construct of, or dominator hierarchy concept of 1.0, which means that 3.0, you can have a nurse practitioner and a PA and a doctor working on a team, all practicing at the top of their game. There isn't this constant tension between, oh well or the nurse practitioner be independent. And should the doctor be the boss, is that that's not how it works. It's a whole archi, not a hierarchy. Meaning everybody is a whole and a part of a bigger whole, including the doctor. So the doctor knows a lot more about these things. Okay. That's where they Excel. The nurse practitioner is good at spending time with whatever it is great. That's where they Excel. And as part of a team, they emerge something bigger than the sum of the parts. So that's the vision Speaker 2 00:48:13 Of, and that's a beautiful, uh, description and a coherent description of one, two and three, and also a nice unpacking. Uh, that's very palatable of a concept of whole ons and, uh, the concept of how we as organisms evolve over time, we as societies evolve over time and we as industries evolve over time, I think that we've gotten to the point in this country where everyone believes that we have to change something that things need to shift it. It's expensive. It's unreliable the services poor. Now, you know, I'm not completely down on, on us health care. We do an amazing job of rescue medicine. We really do. If you're a hit by a truck, there's probably no place you'd rather be than in the good old USA, because we will pick you up. We'll get you into the emergency room, uh, Pronto, and we'll do all the things that are needed to optimize the chances of saving your life. Speaker 2 00:49:13 Where we don't do a good job is in the day to day management of health. And, and I think it's fair to say at this point that all of this, that we spend $3.6 trillion on only accounts for maybe 15, 20% of the kinds of outcomes that most of us I think care most about. Well, I shouldn't say care most cause if I'm hit by a truck, I care a lot about what happens to save me, but what we think about in terms of quality of life and longevity. So there's a whole other category of issues that, that need to be addressed. And we've tended to focus narrowly on this one. And that, that brings me to something else I wanted to talk to you about. We're going to have to have many of these sessions because there is so much to cover. And I really appreciate talking to somebody who has the same sort of perceptions that I do. Speaker 2 00:50:05 Of course, we all love to be around people who believe what we believe. So I don't want to take that too far, but I want to talk a little bit about some of the positions that you have held with regards to the pandemic and how you think about that. Because you've been out there saying some things that could be considered controversial things like, you know, what the heck is wrong with you? Why are you wearing masks outside? And so I want you to start maybe giving us a little insight into how this pandemic landed on you, how you arrived at the perceptions that you have of what's appropriate. And what's not. And save a little bit of time because I want to talk about how we fix this healthcare system. That should probably take what five minutes we'll have that done, Speaker 3 00:50:46 But that's a rounding error, but first Speaker 2 00:50:50 Talk to us about the pandemic and the experience that you had being a public figure. You've got quite a following now and the Z-Pak as they're called, you know, but you're out there, you're vulnerable. You're, you're putting your ideas out there and they are subject to some backlash and also a lot of approval I might add. But, but talk to us about that whole process. What Speaker 3 00:51:12 You're yeah. You know, 2020 is interesting because I got to meet some really, really smart people who think very clearly and rationally and in a very alt middle way. And what I found was that early on, I mean, instantly this whole pandemic was politicized around belief. Okay. If I'm in tribe, then I put a mask on. If I'm in tri B, I refuse to put a mask on. If I am in <inaudible> I want to get vaccinated. If I'm in B, I don't want to get vaccinated. If I'm in tribe, I'm telling everyone to stay home. If I'm in Tribby, I'm telling businesses to open because staying home is going to hurt, hurt the economy in individuals livelihoods. And you could see that early on that this was polarized on belief. And so the first thing you gotta do is check what's what's my belief, like what's my elephant say about this. Speaker 3 00:51:53 Oh, okay. Then let me see if I can disprove that. And then let me talk to some different people and let me get them on the show. And so, as it started to evolve, I realized, wow, a lot of people are watching the show because I'm telling them exactly inauthentically. What I think, based on everything that I've seen, putting my biases out there and saying it when I, I got it wrong. First of all, I was convinced that, um, the CDC was competent and that American public health apparatus would be competent. And, and so I was saying, you know, people were freaking out about COVID and I was like, stop freaking out about COVID. This is, uh, this is going to be fine. We managed it during SARS. We have the best public health apparatus, and CDC will be able to deal with this. We put course we'll be able, it didn't even occur to me that we wouldn't be able to test and contact, trace and do all that. Speaker 3 00:52:37 It just didn't even occur to me. So I said, you know, guys, stop wearing masks, stop freaking out. This is going to be fine. Well, of course it wasn't. And so a lot of the assumptions that I had my belief based on were shown to be wrong. So at that point, I said, Hey, sorry, I got this very wrong. I assumed these things, those assumptions were wrong. So what's next. Okay. Now we're in lockdown. Lockdown feels right, right now. Okay. Now it doesn't feel right, because we're really harming our poorest people. This is an equity issue. Now, you know, we're, we're, it's easy for rich people to say, stay home. And then the poor people go either and get COVID cause they still are essential workers or they no longer have a livelihood. So these kinds of issues around justice and you know, Dr. Monica Gandhi has been my show talking about this. Speaker 3 00:53:17 She's a little left. I've had others on the show that are more right-leaning and they all will say, if we really follow the science saying we're hurting poor people preferentially. So let's talk about that. Yeah. So just putting it out there and what I found is I grew an audience by over a million, some odd people during COVID added to our audience, because they would say, it sounds like you're just speaking common sense. And you admit when you're wrong and you're not afraid to say something because you don't get funding from the government and you know, who's paying you. I'm like you are, you know, we have subscribers that pay five bucks a month to hang out with me on live shows that are just for subscribers. They fund the show. So I can say whatever I want. Do I lose sleep at night? If I get something wrong? Speaker 3 00:53:58 Totally. So then I do another show and I go, Hey, you know, I got this wrong. Like, let's talk about this. And masking was an interesting one because early on I said, cloth mask just sounds stupid. People are going to get it wrong. They're going to touch their face. At that time, we were still really concerned about the fomite theory that this wasn't so much airborne. And it was more, you know, foaming surfaces. I said, this is gonna, this is gonna backfire. And you know, it's giving people a false sense of confidence. They're not distancing and so on. And then I, and then I changed when I met Monica and she said, no, well, here's the viral inoculum theory of masks. So mass indoors are a great idea. She was never a big fan of mass outdoors. And then just looking at the data and going, okay, so what's the data says, you know, yeah. Speaker 3 00:54:36 You know, especially about outdoor masking. Now I've been quite firm. Like I think we ought to be ripping our masks off outdoors when we can't distance. So if we're not in a big crowd or big rally, why are we wearing a mask? And the reason it matters Robert is that it discourages people. Honestly, I think from going outside and we're starting to stigmatize humans as being dangerous, like you see someone walking on the street, you give them a wide berth. It's like, when did we become like that for a disease, with, you know, an infection fatality rate that's 0.3, that can kill a lot of people at an infection fatality rate of 0.3, do we ruin our humanity for something that's scientifically not going to help you putting a mask on and keeping 10 feet of distance between you and a stranger on the street? Speaker 3 00:55:16 You know, that I think having those conversations is important and you can easily, and this is something I think that's important too. The blow back you get is because there are two schools of thought. And actually Jay Bhattacharya came on my show and talked about this. The first school of thought is the public health school, which is you present a unified message because you're trying to influence the public. And if you deviate from that message in any way you are causing harm, those are the people that blow back against me. Then there's the other side, which is science in science. You're constantly challenging and debating and showing evidence and having civil debate. And that's a totally different ethos than the public health ethos. Because in the science you ask you question everything you always in mass vaccination, a good idea. Okay. Maybe it is. But you question, you can even make that question in public health. You cannot because it's antithetical to the outcome you want. So I think that's part of the tension too, is that it's public health versus sort of science mind. Um, they're not fully aligned all the time. Did the, do you Speaker 2 00:56:11 Think that the public health approach is sort of anachronistic? I mean, it sounds like 1950s or something when, when that was an accepted approach to, and, uh, you know, people do want the truth now and, and, and, and what it really does when you, when you, uh, you know, hold the party line, no matter what is it makes it harder to tell what's fake news. And what's not. I mean, if, if the issue is we don't have enough PPE for our docs and our nurses, then we should say that and say, you know, do whatever you can make shift, but we've got to protect our healthcare workers, tell the truth. People are capable of understanding the truth. And this is what really irritates me about a lot of the information that has come out. It's not the truth. Now I will push back on you a little bit in that the masking and social distancing. Speaker 2 00:57:05 I, the position that I hold is that yes, we should have shut down when it was early. We didn't really know what the mortality rate was. We didn't know what it was going to be. All we know at that point is that we have lost the opportunity to intervene early because it's widespread now. And so, you know, let's lock it down for a little while, figure out what the heck is going on. That's okay. I think the mistake that we make and we make it in medicine a lot is we treat the disease no matter what. Well, it's not, no matter what, there, there are too many other nuances and consequences, you know, treating somebody who has no chance of survival to the bitter end. You know, there's a corollary for me there. And in my position is that I do believe that masks and social distancing add something, you know, do we have a lot of data to back that up? Speaker 2 00:57:58 No, but, uh, using them wisely so that we can completely open up the economy also makes a lot of sense to me, the rules can't be so restrictive that it is hurting people and killing people. Literally people die because of economic shutdowns and they died in a variety of ways, but we have to balance that against the, uh, the risk of disease transmission. And that's what we fail to do, whom we're always polarized either. It's shut yourself in your house. Don't go outside, no traveling, no seeing friends and it's even continued to afterward vaccinated. And I think that's wrong. I agree with you there. However, I do believe that there is some utility in masking, in certain environments and in social distancing, it's extrapolating from common sense. If somebody sneezes in my face, I'm a lot more likely to get infected than if they sneeze into their handkerchief. And essentially what most people are wearing is a handkerchief around their face. I wouldn't go so far as to say that it doesn't work. I agree with you that we don't have good data and that the data is mixed, but most of the studies have been, uh, does it protect the, uh, the wearer rather than does it protect those around the wearer? Uh, so I'm, I'm open to your pushback on that. Uh, it, uh, Speaker 3 00:59:19 I'm not sure that we disagree at all then, because I think indoors masking, I'm a firm believer because it reduces viral inoculum, both for the wearer and for the, uh, potential, uh, recipient of virus. We're the only place where I'm quite firm in my, uh, understanding of the data is outdoor masking where you're not in a crowd for a long period of time. So in other words, yeah, so I think we agree a hundred percent because I agree it's a mix of mitigation with mass, and that's why it's funny. One of our biggest videos was here's what masks really do. And it was with Monica Gandhi and it was saying, Hey, you guys think master just to protect other people. Here's why it may protect you. Here's why we should do it. So exactly what you said, Robert, we can open the economy so that we can open up the retail and stuff, just throw a mask on. And generally in the absence of very contagious variant, uh, variants, that works pretty well. And then once you throw vaccines, and then I think, you know, the nail in the coffin for outdoor masking, in my opinion, indoor masking, I think you still have to do it because how do you know who's vaccinated and who isn't, um, until we get a decent, um, critical mass of vaccination, which I think is going to hopefully happen soon. Speaker 2 01:00:26 Yeah, yeah, no. Okay. And this is a perfect example of what you described as the middle, right? It's not the one-sided argument that everybody should be wearing their social distancing and don't open up anything, uh, versus nobody needs to wear a mask act like it's not happening. Neither of those is, you know, it's a false dichotomy that we've been offered and, and the answer is in the middle on balancing those two risks. Speaker 3 01:00:51 Yep, exactly. Uh, and in fact, uh, yeah, in fact, you know, it's funny, that's a theme of many of the videos I've done. It's trying to find the balance. Like let's bring this back to balance. Something's out of balance. Let's bring it back to balance. And even when I do a ranty video where I take one side very strongly in a way, what I'm trying to do is pull people back to the middle and go, you know, look here, here's the good side of this, but this is crazy. Like people wearing gloves to the supermarket is insane because the gloves are just going to touch everything. They're going to end up touching your keys. It makes no sense. And what it does is it creates this contamination mindset that I think is harmful to human flourishing. So there's a balance there at the same time, not wearing a mask in a supermarket is kind of a Dick move and it's not good for you. Speaker 3 01:01:32 It's not good for people around you. Um, I get it that you're a Liberty versus oppression, kind of an elephant. I get that. But you know, it's not very freeing if you put someone on a ventilator and, and, and what you said about us torturing old people to death, um, when, when it's not helping that that was something that we talked about early on too. It's like, no, no, no, it's not. Okay. You know, again, this, this was especially early on a predominantly a disease of elder vulnerable people, nursing home patients, 40 odd percent of fatalities, you know, we could have targeted that better. And then we should have made decisions, you know, really have those conversations about code status and end of life that were so uncomfortable having. Yeah. Well, Speaker 2 01:02:13 Let me ask you if you've got a few more minutes here, there are so many things I want to talk to you, but let me ask you at least where do you think we are today in terms of the pandemic? What should we be doing in this country? Should we be helping with the rest of the world that will serve as a reservoir for this? If you know, uh, how do you think about next steps in terms of, uh, individuals and, and, uh, public health? Yeah, Speaker 3 01:02:43 So I think one thing we can say clearly in the United States is the doom profits on Twitter of public health. That we're saying that, you know, we're going to get a fourth or fifth surge, and it's going to crush us that that's just not true everywhere, where vaccines are happening. Um, cases are declining dramatically. And, uh, you know, in the UK, it's like a 96% decline in cases in Israel where we have 60 odd percent of the population vaccinated, it's a 99% decline in cases it's ridiculously effective these vaccines. So the United States have seen the same thing. Our cases continue to decline. There will be hotspots. And, uh, you will see people who are vaccinated, still getting infected because the vaccines are not perfect. Nothing is overall, we're trending in such a wonderful direction that if we just keep on a general pace, I think we're going to do just fine. We're going to be able to open up. We're going to be able to tear off our mass outside first and then eventually inside. And we're going to get back to some semblance of normal, which means we ought to be concurrently helping places like India, which Biden just announced. This just came out while we were talking that they're considering waiving patents on vaccines for, uh, situations like that. Yeah. Which is a huge deal. Um, they're gonna Speaker 2 01:03:50 Back, that would be so helpful. So Speaker 3 01:03:52 Helpful. I mean, it's just, you know, how much money did pharmaceutical companies make during this, like Pfizer made something like 40 odd billion. Like, there's nothing wrong with making a profit by doing good. You should do well financially by doing good in the world. So continue to go good and relax the patent during the crisis. Um, because what happens in India is going to be what happens around the rest of the world. If you end up using it as a breeding ground for more infectious variants and so on. And I would argue Speaker 2 01:04:17 Part of doing good is knowing when you have enough and you can share with some of your fellow beings. Yeah. Speaker 3 01:04:24 I mean, we're all conscious entities. And, and on top of that, you know, people are in our vaccination rates in the us are starting to decline because we're reaching, you know, we've got the low hanging fruit of people that are willing. Now we're going to get people who are not so willing in which case it may not be that we need them. It may be that herd immunity is a little bit of an illusion. It may be that we get to a steady state endemic. COVID where people who choose not to be vaccinated may get sick man up in the hospital may be fine. They may be fine, but it's not going to break our healthcare system. And people can use individual choice and accountability given the data that's on hand. And then we don't have to be shaming people and pressuring people and mandating it and so on. Um, that's my take. Um, the Speaker 2 01:05:03 Other thing that I wanted to ask you is, and by the way, I, if you haven't listened and you've had both of these guys on your show, but there's a great podcast. It's out with Peter <inaudible> and Paul, Offit talking about what to, in terms of vaccines, uh, will we need a booster? How often will we need one and the uniqueness of this virus and that it's, in-between in its incubation period, you know, between those that we can wipe out because they have a long enough incubation period that the T-cells have chance to be activated and kill the virus before it in facts. And those that have a very short incubation period, like influenza that we never complete. And part of influenza is that it mutates so rapidly, but that we never get complete control of it. And this virus is somewhere in between. So we honestly don't know often it's a prediction by the way, is that we might need a booster shot somewhere between two to 10 years. Speaker 2 01:05:59 Uh, it's not going to be a yearly thing. Now that's only a prediction, but Paul off, it's a smart guy. He's a virologist, uh, and, and developed the vaccine for, uh, oh gosh, uh, rotavirus ethic or co-developed the vaccine for rotavirus. So a smart dude. Uh, so I do listen to him and that's just a fascinating podcast, but what I want to ask you, it goes back to healthcare 3.0, and I know I'm jumping around a little bit here, but what is it that is keeping us from getting over the hump from getting to a system that functions like that? I don't think anybody would argue with a system as you described it. All of us want that what's holding us back Speaker 3 01:06:41 More bright spots to emerge that we can point to and say, okay, this is a thing. Look, it was working here, you know, I, or a health, um, do the kind of, uh, they were, uh, partners that turntable health that's one example, different, um, collaborations between even insurance companies and clinical groups. There's lots of ways that you can express 3.0, there's no one size fits all. Healthcare is kind of local, but ultimately it's going to require some reform at the government level in terms of how we're paid. So when, when, when they set, yeah. When they set payment changes like Medicare advantage is an interesting model, right? Fee for service. Medicare is not so interesting a model because it just means actually it's more of the same. That's why it frustrates me. When people talk about Medicare for all, or our current system as the dichotomy, that's not the dichotomy. That's very, non-audit middle thinking. And all middle says, no, is there a, is there, are there 20 other ways that we could skin this? Do we use a German model that pays insurance companies? You know, not-for-profit insurance companies compete to administer healthcare dollars and therefore 3.0 minded clinical entities can integrate and try to compete to provide the best care at the lowest cost, with the best outcomes. And the most convenience Speaker 2 01:07:48 Are on the same page. There. I absolutely believe that there are bad guys in healthcare. There's no doubt about that, but no more. And perhaps less than there are in lots of other industries. What we've got is a very bad system because incentives do work. That's why they're called incentives. And right now incentives that we have with fee for service, even bundled payments, encourage volume at the margin, the decision is always going to be towards volume. Uh, and that's what has to change in that because the government now accounts for more than 50% of healthcare spending in this country, that's what needs to change. And I agree with you. If we went to Medicare for all, we would lock in and incredibly expensive and floods. Speaker 3 01:08:34 I couldn't agree more and there's nothing wrong with universal coverage. There's no, in fact, we need it. We, there should never be a medically related bankruptcy in this country. Are you kidding me? We have so much money. We crap it away in healthcare. Like so much of it is wasted. 30% of what we do probably or more is just is garbage and it's harmful and it's wasteful and where the physician culture needs to change. I did an interview with Robbie Pearl. He used to run Kaiser. And, uh, we talked for about an hour about how the medical culture is part of the problem. You can blame the system and all of that's true, but you also have to look at a culture that values this sort of cowboy attitude, independence, not working in teams. You know, these kind of very 1.0 kind of mindset. And in a way, you know, you said something interesting. Speaker 3 01:09:17 You, you may or may not resonate with, but I definitely understood this and was simultaneously disturbed. And also like, yeah, you know, he's probably right. At some point, what physicians have to do is, and is look at the system and go, you know what, it's time to go through our Kubler-Ross stages of grieving. You know what we thought we were signing up for it. You know, it starts with denial actually. Now way. These is never going to happen. That we were already past denial, anger. Can't believe these administrators are telling us what to do. This is garbage. I'm a doctor. I'm the boss then bargaining. Well, I'll tell you what, I'll tell you what, just let let's form an ACO, just pay us this way. And we'll Italy. Maybe everything will be okay. And then, and then it goes to, you know, depression and the depression is where we're seeing the burnout and the misery. Speaker 3 01:09:57 And I'm, I'm unhappy, but you know, if we can survive depression and it is potentially fatal because people die. If we can survive depression and get to acceptance, you know, as Robbie said in his book, it's not about surrender. It's not saying I give up. It's saying, okay, the world is different. There's actually something that might be better, but it's going to allow, it's going to mean that I have to accept the grief of the loss of what I thought I was doing, which sometimes means I'm no longer going to be a generalist. That's able to do everything because I can't do it. Well, I have to specialize in some aspect of it and a seed, some authority to a guideline that's better than me. And then spend more time with my patient, you know? And once we get through that grieving process, then we can start to build something better. Yeah. Speaker 2 01:10:39 I think he would agree with me that the potential to transform the system and redirect those, you know, 30% of what's going to be $4 trillion. You know, there are so many ways that we could use that money to narrow the gap between the haves and the have nots. And I'm not talking about necessarily social programs. I'm talking about, for example, onshoring we learned that in the pandemic, we have a critical problem with supply chain. If we depend on foreign nations with whom we have fragile, although beneficial, if we rely on that and it's a national security problem. And so onshoring those manufacturing jobs for PPE or ventilators or, you know, drugs that are critical to, uh, the operation of a hospital or a clinic, those jobs go directly to those folks who have been left behind by globalization. So there are things that we can do that are so important if we stop wasting that money and the potential to improve our healthcare system and get to a 3.0 is just astonishing. And, and we can't lose sight of that because that's, that's the dream that we're all reaching Speaker 3 01:11:50 For. I mean, that's a beautiful summary of the whole thing. That's a macro look at this that we ought to be redirecting our resources to where they're actually useful and away from waste. And I like that onshoring idea because it solves a lot of problems. Like you said, including people who've lost jobs to globalization, Speaker 2 01:12:04 Do some interesting stuff on your show. You've had Donald Hoffman on, for example, and you recently had, oh gosh, I can't believe I'm blocking on it. Speaker 3 01:12:14 Uh, Federico Fijin or Bernardo Castro. Yes, yes, Speaker 2 01:12:17 Yes. Machine. And that is so outside of the typical healthcare podcast, but I think it is highly relevant. Talk to me a little bit about why you're doing that, what the reception has been from the pack and how you think about that going forward. So, Speaker 3 01:12:36 You know, since I've been young, I've always been interested in like, what, what is the nature of reality? Like what, w what is this like, just looking around, what is, this is this stuff, is, are these atoms, what are the atoms made of? Are they strings? Are they quarks? What is this? And the older I get and the more I experienced and the more I learn and the more smart people I talked to, the more I'm convinced that we have it all backwards, that our enlightenment ideals of materialism, that the world is made of stuff that emerges consciousness and awareness, uh, in some magical way. Cause we can't understand it. We can't explain it. There's no science, that's even close to explaining how Addams generate the taste of chocolate, the experience of the taste of chocolate. I I'm convinced. We just have it backwards. Like no, everything starts with consciousness and you spin up reality from that. Speaker 3 01:13:21 Atoms are what consciousness looks like to itself in a certain form. You know, we're living in a vast social network of awareness and we see it through an interface that species specific and that's Donald Hoffman's work. And Bernardo Castro takes that and basically says, instead of everything being stuffed, everything is fundamentally made of mental stuff, consciousness, and you can explain the world much more. Parsimoniously much more simply that way and still have science as a method. In fact, science is supercharged because you say, okay, we're not operating from a fundamental delusion that a stuff somehow generates mind. It doesn't mind generate stuff. So now we can still have science that works logically based on the principles of how this mind operates. So much of what we do in medicine and Robert, you know, this as an amazing clinician is about the intangible interaction of two conscious agents with each other, you know, the doctor and nurse and the patient and the, you know what I mean? Speaker 3 01:14:13 And the healing happens in a way that often we don't even understand the placebo effect. We don't understand the placebo. There's people doing research on it, trying to reduce it to serotonin and COMT and all of that Harvard guy doing that in the end. I think it's because we are made of mind and our body is, is what mine looks like from the outside, from an outside perspective of mine. And another part of mine and Bernardo actually says, we're all just alters, like alter egos of the one mind. And so it's like, it's like God had, uh, had a, uh, multiple personality disorder. And the way he says it is, you know, anything that metabolizes is basically an alter ego of the one mind. And it looks like there's a boundary because just like when we dream, we create an altar and there are alters in the dream. Speaker 3 01:14:59 It really fascinating stuff. Like we do this every day when we dream, why wouldn't it be true of the universe at large? So just fascinating stuff. Now, how has the Z-Pak respond to it? The majority of them are perplexed and then about, let's say 20% of them maybe less are. So they, I get so many messages, please talk more about this. I've wondered all my life. And they'll quote Morpheus from the matrix at me. And they'll say, you know, it's like, you don't know what's wrong with the world, but it's like a splinter in your mind slowly driving. You mad that, that we think the world is this way when it may not be, Speaker 2 01:15:35 You know, and I, and I break this, I break this down to what it's all about is relationships, right? It's connecting with each other. It's seeing each other, it's feeling heard. Uh, that's what drives healing in the physician patient relationship. That's why it's so important. And that's, what's missing in two point, oh, I'm going to end it there. Uh, not because, uh, uh, we can't have discussions about this for another three hours, but because you've already been so generous with your time and I appreciate it. The last thing I want to say is I get so excited. I subscribe to Seadog MD's podcast and I get so excited when there's a new one, because I know it's going to be fun. I know I'm going to learn something. And I know I'm going to hear from some really smart people. So tell us, uh, briefly, uh, how to find you. So Speaker 3 01:16:31 Thank you, Robert, by the way, for letting me on the show, this is a real joy, and it's great to talk to you. The, um, the easiest way is just go to Z dog md.com and all our links to YouTube. Twitter. Facebook is our biggest platform, Instagram, LinkedIn, they're all there. And, uh, you can find ways to join our supporter tribe. You can find ways to subscribe, um, for free and for, um, pay and the paid subscribers get like nightly live conversations with me, where we talk about consciousness and reality and the latest news and just what's for dinner. So if you're into that kind of thing, uh, hit me up. Absolutely. Speaker 2 01:17:06 And by the way, I'm a paid subscriber. So nice. Thank you Zubin for coming on the show. It has been an absolute joy to have you here. I hope you'll come back cause we have so much more to talk Speaker 4 01:17:18 About a hundred percent. I'm really looking forward to it, man. All right, take care. Take care. Speaker 0 01:17:29 You've been listening to the groves connection, your connection to the inside story on healthcare. Featuring in-depth interviews with those who know you can find us on apple podcast, Spotify, and anywhere else, you get your podcasts. If you like what you hear, give us a five star review to keep the connection going and hit the subscribe button to be sure you never miss a beat. The Grove's connection is produced by Dr. Robert groves, original music editing and creative direction provided by Alden groves, production, support, content guidance, courtesy of Janae sharp and Elizabeth Barrett. Thank you for listening. Speaker 2 01:18:15 The professional ideas and opinions expressed in this podcast are mined and do not reflect those of any current or past employers. Thank you so much for listening and we hope you'll join us next time on the groves connection.