Transcript: Dr. Sanjay Gupta on The Checkup with Doctor Mike Podcast

Mostly because most folks who went into medical media were selling snake oil, were making miracle promises, were not truly discussing evidence based medicine. At least if you look at the long run of their careers, perhaps they’ve started correctly and then moved on.

So I’ve always looked at your career and been so impressed that you’ve managed to stay true to evidence based medicine. And how did you find yourself speaking to millions of people and always staying true to the integrity of healthcare?

Staying True to Evidence-Based Medicine

DR. SANJAY GUPTA: Yeah. First of all, can I just say thank you for having me. I’m a big fan of yours. These are weird times.

DOCTOR MIKE: Oh, yeah.

DR. SANJAY GUPTA: And I just think no one should be sitting this out. No one should be sitting on the sideline. And not just medical communicators. I mean, everybody. It’s a big time for us. And you do just such a great job of addressing things head on. You’re clear, you’re authoritative. I think people need more of that.

I think sometimes for me to be just candid is that my mind, the way that it works is I dig deeply into things and spend a lot of time in the gray and in the nuance. And sometimes it can be tough to transition that to really effective, clear messaging for the masses. I mean, I’m working at it, you know, 20, 25 years now. But you’re—I just want to say that you’re really good, really, really good at that. It’s kind of like watching an athlete who’s just got a naturally good arm or whatever. That’s you.

DOCTOR MIKE: Okay. I appreciate that. But I will say it’s not natural.

DR. SANJAY GUPTA: Well, I mean, you know, that’s—you’re sitting here with no notes. I’m sure you did a lot of prep, but you’re not needing to. I mean, it’s here. And so I know that it’s hard work. So you make it seem very flawless and easy.

DOCTOR MIKE: I remember the first time Dan here, we started the YouTube channel together. He put the camera on me in 2017 and he said, “Just say your name and what you do for a living.” 45 minutes later, I don’t think we got anything out of it. And all I needed to say is that I’m a family medicine doctor. I see patients of all ages. That’s it. So this was a journey. And I think doing it as many times as we’ve done it, obviously reps, reps, reps helps a lot.

DR. SANJAY GUPTA: Yeah, and I think you’ve always had a voice, but I think you find your voice very clearly. And it’s great. So I just, I was, when I heard I could be on your podcast, I was thrilled.

DOCTOR MIKE: Well, thank you.

DR. SANJAY GUPTA: Honored. Yeah. You know, as far as my career, you know, it’s interesting. Mike. Can I call you Mike by the way?

DOCTOR MIKE: Please. Yeah, you got to call me Dr. Gupta.

DR. SANJAY GUPTA: That’s a must.

DOCTOR MIKE: I’m 20 years older than you.

DR. SANJAY GUPTA: Not Dr. Gupta. Dr. Sanjay Gupta, sir.

DOCTOR MIKE: Yes. No, call me Sanjay.

The Journey into Medical Media

DR. SANJAY GUPTA: But I got into this in part for some of the same things that we’re talking about. I did not want to be on the sidelines as I saw significant things happening in health care. This is in the mid late 90s. For a period of time I worked at the White House. I was writing speeches primarily about health care, but doing domestic policy. There was a lot happening in health care at that time. So that got me very interested.

I started doing more and more writing and eventually took a job at Emory in Atlanta. And folks at CNN had seen my work at the White House and asked if I would come on to talk about health policy on television. So sort of doing, you know, Sunday morning talk shows, talking about that. And Mike, that was August of 2001.

DOCTOR MIKE: Wow.

DR. SANJAY GUPTA: And three and a half weeks later, 9/11 happens. And they basically say, “Hey, look, we’re probably not going to be talking about health policy for a while, but now you’re a doctor working in an international news network in the midst of what is unfolding in the world.” And so they asked if I’d want to cover those stories, and I did. And that’s sort of what launched me.

But I think as far as maintaining the evidence based sort of reporting, I continue to practice medicine and I sort of bifurcate my life half and half. And I think there’s something, as you well know, about being in the hospital, about constantly getting those reps there. How do we evaluate studies, what do they translate to tangibly for people? How are other doctors talking about it, you know, and all that. And I think I’m constantly bringing that to my reporting.

Balancing Surgery and Communication

DOCTOR MIKE: But it’s unique because you’re a neurosurgeon. Most surgeons are not taking the time out to do a lot of education with patients. And I don’t want to say that about everyone, but just as a general sort of stereotype, surgeons operate, they don’t do a lot of education. They have staff for that, which actually kind of makes sense given the fact that they’re busy in the operating theater. So why did you have this notion to want to talk about health policy in these topics?

DR. SANJAY GUPTA: Well, initially I think it was because I saw that there were massive changes happening to our healthcare system. And when I read the papers and figured out who was talking about it, there were a lot of people, but very few, if any, were clinicians. And the idea that people who were actually practicing medicine—and yeah, I mean, it could have been me as a neurosurgeon. There were others who were doing it, Atul Gawande, others who were getting out there and starting to really dig into this. It just was of high interest to me.

So that part really had nothing to do with my neurosurgical career. In fact, I’ll tell you, when I started med school, I thought I wanted to be a pediatrician.

DOCTOR MIKE: Interesting.

DR. SANJAY GUPTA: In fact, that’s what I wanted to be. There’s nobody in my family who’s a doctor. The doctor that I knew was my pediatrician growing up. I loved that guy. And when I did my—even when I did my rotation as a medical student, I kind of realized that pediatricians were sort of the best doctors in the hospital because kids galvanize people. No one wanted to check out if there was a sick kid coming in. I’m not suggesting other doctors do that, but pediatricians.

But then I did a neuro rotation and fell in love with neurosurgery. But that was really separate from my interest in health policy and then subsequently journalism.

Neurosurgical Practice and Specialization

DOCTOR MIKE: And I know there’s multiple directions you can go down to practice neurosurgery. Some people focus on the brain, some focus on spinal surgery. What was your or what is your current sort of practice?

DR. SANJAY GUPTA: I am very fortunate to be able to have a practice where I basically do half and half now, which is unusual. I did a fellowship after my residency in image navigation. So basically taking these cameras, putting them in the operating room, and then impregnating everything, all your instruments and everything with these LED sort of sensors.

I don’t know how familiar you are with this, but basically when a patient’s there on the table before we make an incision or do anything, I can just hold my instrument above the head. Haven’t done anything. And now I’m seeing on the MRI, which is right there in 3D. Where am I with this tumor? Oh, it’s right there. And I can make a small incision, do a cookie cutter sort of opening in the bone.

That was a sort of fellowship training that I got. But it’s really relevant to both brain and spine. So I do a lot of that. I do a lot of trauma. You know, I get to do kind of just a little bit of everything. I love the upper cervical spine. To the extent that we have to have our favorite part of the body. That skull base, C1, C2 area, I find to be just beautiful part of the body.

DOCTOR MIKE: Is that because the vagus nerve hangs out in the vagus?

DR. SANJAY GUPTA: Yeah, it’s a lot of really valuable real estate there. And the spinal anatomy is so cool. You’re looking at the base of the brain stem, spinal cord. It’s awesome when you get in there and you’re actually—I’ve been doing this for so long now, but still, anytime I get to see that, get the sort of sense of awe, it’s like looking at a beautiful clear sky.

DOCTOR MIKE: It’s probably how an obstetrician feels when they deliver the baby. I think so each time they still are excited about it.

DR. SANJAY GUPTA: Yeah, I get to do this. And this guy trusted me to do this.

Teaching and Mentoring

DOCTOR MIKE: Right. That’s a big part of it. Do you take on residents and students follow along. What’s that like for you?

DR. SANJAY GUPTA: You know, I think it’s one of the best parts of the job. You know, I’m in my mid-50s now. I think being able to hang out with—I have a chief resident’s always sort of with me. A mid level resident, intern and med students. And it keeps you young, which is a lot of—I have a lot of fun with them.

When you’re doing long cases, you know, you’re across the table from somebody for a long time and, you know, especially once you’ve gotten a good cadence and you kind of know what each other is doing, you’re allowed to have conversations about other things in life.

DOCTOR MIKE: Yeah, sure. What’s the go to?

DR. SANJAY GUPTA: Music evaporating. Oh, well, that’s a big topic.

DOCTOR MIKE: Yeah.

DR. SANJAY GUPTA: And the funny thing is, like, you allow—it’s almost like a thing where you allow the resident to start choosing music when you feel like they have deserved it, but they don’t deserve it. You’re like, they know what kind of case it’s going to be if I pick the music as I walk in.

I still have four playlists, some of which go back to residency. Yeah, I have a—so I have my cranial playlist, two of them, which is an opening cranial playlist, a closing. Then I have an opening spine playlist and a closing.

DOCTOR MIKE: You have like a true symphony.

DR. SANJAY GUPTA: I do. And it’s kind of fun, you know, and it’s different. Sometimes we’ll keep music going during the operation and stuff, but a lot of times during the actual operation, we’ll either tone it down or turn off the music altogether. But yeah, music’s a big part of it.

Impact of the Pandemic on Medical Education

DOCTOR MIKE: That’s so interesting. This is perhaps a controversial question. Do you feel that the pandemic has impacted the quality of education for this current generation of residents and trainees?

DR. SANJAY GUPTA: When you said it was a provocative question, I thought you were going to ask me how much sleep I got last night.

DOCTOR MIKE: No, I saved that for head to state only.

The Impact on Medical Training

DR. SANJAY GUPTA: Somebody needs to look this up if they’re just watching this. I think it did. I think there was a negative impact. Just, you know, for surgeons, the volume of cases went down for a while. Grady hospitals are a big trauma hospital and a significant amount of training happens there. I was still going in every week throughout the pandemic.

There were two things. One is that I think because there were just fewer people out and about, cars and just humans, that there was less trauma. And that was a lot of what gets taken care of at Grady. So the volume went down for that reason.

And then there were weeks, Mike. I don’t know what it was like at your hospital, but there were weeks when it essentially was just entirely a COVID hospital. The only patients they were taking in were patients who had COVID. So obviously, from a neurosurgery standpoint, we had our residents sometimes rotating, doing ICU rotations, taking care of patients who had nothing to do with neurosurgery just because it was all hands on deck. So they got a different kind of training during that. But the hardcore surgical training, I think probably did take a bit of a hit during that time.

Balancing Medicine and Communication

DOCTOR MIKE: Was it harder for you being a doctor during the pandemic COVID era or a public communicator as a doctor during the COVID era?

DR. SANJAY GUPTA: It was, I think, from a time standpoint, the communication part of it was taking more of the time at that point. And it was interesting because two things sort of happened simultaneously. In a way, the hospital got less busy because elective cases got moved. All that sort of selective cases got rescheduled. And there wasn’t as much emergent cases because people were mostly home.

And at the same time that was happening, there was no break. Right? Because for a while there, I mean, it was 18 hours a day. And I was waking up very early in the morning because I was talking to people on the other side of the globe every morning to see what was happening in China and Taiwan. Primarily people that I had close relationships with and we would talk and I needed to catch them before they would go to bed and then do television first thing in the morning. Yeah, do television. And when you work for a 24 hour news network, it can be just sort of constant.

So news gathering throughout the day. But it was obviously terrible, but in a way fascinating as well. Seeing an entirely new disease emerge, seeing a novel virus. People use the word novel coronavirus a lot, and they know coronavirus, but the idea of the novelty of something, I think sometimes is lost on people. We really hadn’t seen anything like that. Certainly not in my lifetime. I know, not in your lifetime.

And so to just sort of see what the response is like, how different countries respond. So it was a lot of work, but I was fully in. I was fully, as my wife would tell you, I was dreaming about it. You know, I mean, wake up in the middle of the night thinking, ah, here’s something. That lady in France, how did all of her family members get sick? Because she was never sick herself when she actually interacted with them. Just like whatever it might be. So that was a particularly busy time.

The Danger of Asymptomatic Spread

DOCTOR MIKE: Yeah, that insidious nature that you mentioned of spreading it, spreading the virus asymptomatically to me, was the most problematic of this virus. And initially, I don’t feel like the public understood that they wrote off the virus because people were asymptomatic at times. Where to me, that’s what made it so dangerous that we didn’t know in who exactly with 100% certainty that would get really sick.

And it’s easy to feel fine and be walking around as a vector getting everyone else sick. So it spread like absolute wildfire. And that was the scariest part of it, because it wasn’t as lethal as, you know, the initial SARS virus.

DR. SANJAY GUPTA: Yeah, I totally agree. And, you know, you see somebody who’s sneezing, coughing, you stay away from them, and hopefully that person knows to stay home. The Typhoid Mary sort of part of this. And I know you’ve interviewed a lot of infectious disease doctors, but people who spend entire careers working on these types of viruses, I think were also really thrown by that.

And it was interesting, Mike, because I think obviously you want experts who are focused on this, researching it, communicating it. But I think one of the challenges for a lot of people was they immediately put this virus into the flu box. You know, virus, you know, spreading respiratory sounds like flu, or they put it in the SARS box. Right. Coronavirus from China. This is going to behave like SARS1.

And at some point, it became sort of obvious that it wasn’t behaving like either one of those. But then it becomes a question of what is the evidence threshold? I need to be able to say, hey, this is different. This is novel. Like, how much evidence do I need to be convinced of that? And the truth is, that’s different for different people.

For some people, they see the first hint of something different here and they say, all right, wipe the board clean. Let’s just throw up all the evidence as it’s coming in new, and we’ll take it as it comes, and we won’t assume anything. And other people will say, hey, maybe this French woman or the German guy over there. Maybe these were one offs. You know, we don’t have to pay as much attention to that. This is still going to behave like SARS1 or it’s going to behave like flu.

And I found that interesting. That was a real time conversation that was happening among researchers in China, folks at the CDC, at NIH everywhere. And I’d have these conversations every day. And they’re like, oh, no, no, no, no. Smart people, experts, of course. Yeah. And this isn’t to malign them, but this is to say that when you’re dealing with something novel, it’s mass confusion, at least initially.

Public Exposure to Medical Uncertainty

DOCTOR MIKE: I think what shocked people the most is they got a front row seat, which they never had had before in watching the arguments that usually unfolded at our yearly respective specialty conferences. That happens all the time. At what level should we transfuse? 6, 7, 8? No, depending on this page. That happens all the time. But they never saw it.

And now all of a sudden, they’re seeing it happen in front of them and impacting them directly. So it became a virus that was equally medical, societal, cultural, and where I feel like we perhaps didn’t handle it well from a communication standpoint of how we talked about this level of uncertainty.

And everyone had a different approach. Dr. Fauci felt it was better to be certain, even when we didn’t have perfect certainty, better to recommend the booster for absolutely everyone so we don’t send a garbled message. And that backfired a bit. But it’s easy to say that now, Monday morning quarterback and say, oh, we should have done this. Is there anything you look back on that you say, oh, me personally, I would have done differently had I known?

Lessons Learned and Natural Immunity

DR. SANJAY GUPTA: Well, first of all, I was convinced that those are really hard jobs.

DOCTOR MIKE: Oh, yeah.

DR. SANJAY GUPTA: I mean, you know, the thing about it is, Mike, I mean, every patient visit that I have always ends with some version of the same question, which is, what would you do? What would you do if it were your mom or your daughter or whoever it might be? So I’ve presented all the data on something and now they want to know what do I do with that information?

And, you know, I think it usually matches exactly what I’ve just told them. But I think when you’re suddenly confronted with this idea that you need to make decisions or recommendations, at least on behalf of a society, not just an individual, I think it automatically forces you to mitigate risk. You have to now think about the situation where someone is particularly vulnerable and you have to consider them as part of the overall recommendation.

I think that was the real challenge, the trade off between sort of trying to stratify people based on risk versus making more blanket recommendations. I think it’s going to be one of the great lessons here. I think the one area, if I had to pick one thing for me, specifically where I think we started to dig in but could have dug in more, was really understanding the value of natural immunity.

I think you and I both, when we go to medical school, we know that once you get sick, you are going to be immune for a while, different for different viruses. But that does provide really robust immunity. It’s activating your antibodies, activating your T cells. All these things get activated with an illness. No question that it’d be better to avoid that illness in the first place goes without saying.

But I think at the point where it was clear that so many people had been infected and we saw these waves in South Africa, for example, and you knew, wow, that burned through the entire population. It seemed like almost. Because it all of a sudden came way down. It’s like, oh, that’s the natural immunity because they hadn’t been vaccinated yet, then pop up again with the new variant.

That should have been a signal that, hey, we need to be well aware that natural immunity is strong. It works. And I think some of the Israeli data, so I asked about that a few times in terms of how that would change recommendations based on vaccines and other things. Never really got a clear answer on that. And I think the message seemed to be just get vaccinated.

Which was obviously a problem because not everyone was getting vaccinated, people were losing their jobs, all this sort of stuff. So I think the natural immunity part of it still to this day is a bit of a question mark as to why that wasn’t acknowledged more.

Patient Communication Strategies

DOCTOR MIKE: Yeah, that’s a really good point. You know, in thinking about that final question that you often get asked by patients of what would you do in scenarios like that? My official training from school days was never give that recommendation because you’re not supposed to. It’s their decision, not yours.

What I like to do is give sort of the answer that I think works best for them and then at the same time present the devil’s advocate case at the same time. So in your case, I would recommend surgery because physical therapy has failed, conservative management has failed, et cetera, et cetera. And I think you would be a great candidate in recovery as long as you do the physical therapy at the same time.

I wouldn’t consider surgery for X, Y and Z. And you see which one feels better to them. Because a lot of times when we present data and facts, it’s hard to understand it because it wasn’t presented in a storied narrative. But when you make it as if you’re debating with yourself, they say, oh, well, I’m obviously on this team, and it makes it an easier comparison there.

DR. SANJAY GUPTA: That’s a good point.

The Risk of Losing Public Trust

DOCTOR MIKE: And in the same time, when you mention how there’s risk involved in making a decision, you try to mitigate that risk of the general population as opposed to the individual. I also think about the risk that exists in presenting information and how you could risk losing trust. And I don’t think that was ever considered. It was, we have to make a decision now and we have to say something. And the risk that was considered was the medical risk, but not so much the trust risk. So I…

DR. SANJAY GUPTA: Or the overall impact on society.

DOCTOR MIKE: Exactly.

DR. SANJAY GUPTA: Yeah. Children’s school. Yeah, all that sort of stuff. You know, it is a really challenging balance, there’s no question about it. I think that when I was covering H1N1 and even Ebola, so H1N1 was 2009, Ebola, 2014, you had Richard Besser and you had Tom Frieden, who were the CDC directors at that time.

And I remember reflecting on this during COVID they would get up in front of the CDC. First of all, just from an optic standpoint, these weren’t press briefings that were happening at the White House. I think the press briefings at the White House, intentionally or not, really, really entangled the science and the politics. It just became more of a political sort of thing because all those briefings were happening at the White House.

Frieden and Besser would get up in front of the CDC and basically say something like, hey, so, you know, 4,000 of some of the smartest, hardest working scientists in the world are working behind me as of today. Here’s what we know and here is…

DOCTOR MIKE: What we don’t know.

The Value of Uncertainty in Medicine

DR. SANJAY GUPTA: And it was always sort of paired that way. It was always some phrasing that was similar to that. And I think I remember being struck by the idea that as physicians saying, you don’t know, a lot of people see that as a sign of weakness or maybe incompetence even.

And yet I think it really did engender a lot of trust. It said, hey, I’m putting my cards on the table. I’m giving it to you straight. There are things we still don’t know. Here’s what we know, here’s what we don’t know, but here’s what we think is the best thing to do because we’ve got to make some recommendations still.

We can’t just stay flat. You can’t just let the patient languish. In this case, the patient being the country. And so I think that would have been helpful, maybe not to be so didactic about things, but to constantly say what we don’t know.

DOCTOR MIKE: Do you think the fact that the media landscape has changed, leaning more towards social media, podcasting away from the typical 60 minute sit down interview, it’s allowed those who are ultra confident, even when they’re wrong, to be able to be the more effective communicators?

DR. SANJAY GUPTA: Yes, absolutely. I mean, that’s the thing. You and I will sit down, have a two hour long conversation and get into some of the nuance, lean into that somewhat. I think that there, and again, something you do very well is you do give clear messages that are concise for social media and for more digestible sort of content. But I think you do it in a very fair way.

I think there’s a real risk for a lot of people to be forced into really consolidating being overly certain, confident about something that requires more nuance. You’ve talked about this. It’s easy to just sort of be very confident. And I do find, I mean no disrespect to some of these folks out there, but frankly, the more confident I hear someone, the more confident I am, they probably really don’t know what they’re talking about.

DOCTOR MIKE: Well, what is the common line where the more someone is educated towards the PhD level, the more they just realize how much they don’t know as opposed to what they know.

DR. SANJAY GUPTA: Mike, I’m 55. I probably spend more time now reflecting on what I don’t know. I mean, coming out of residency, right, trained in neurosurgery, top of my game. And I was the guy that you’d say something, “Hank, what about this?” I’d be like “100%.” 100%, yeah.

Now it kind of makes me cringe when I hear 100%, nothing’s 100% sure. But now at 55, I wouldn’t say that I’ve lost confidence. I’m not emasculated in this way, but I reflect a lot more. I have a lot more reflection than ambition in my life right now. And I think that reflection allows me, if I’m given the time, like you’ve generously given the time to talk about something, I think you can lean into uncertainty and lean into nuance.

DOCTOR MIKE: Is that you creating a new love for the art that is of health care?

Finding Depth in Medical Communication

DR. SANJAY GUPTA: I think so. In some ways, I think it’s allowing me to do what I’ve always wanted to do. It’s kind of like I say to our medical students, you’re not going to medical school to be a medical student. You hope to move on to something.

I think even when I started doing early reporting and doing more day of air reporting, in some ways it felt like a necessary thing to do as a journalist in order to do what I really wanted to do, which is to dive into deep topics, do documentaries or cover huge stories around the world, like going into Iraq or going into Afghanistan or something. You’re fully immersed. Right. You haven’t think about anything else.

DOCTOR MIKE: Right.

DR. SANJAY GUPTA: That is it. If you didn’t want to talk to me about that topic, I probably didn’t have much to say at that point. Even during COVID, I mean, I was probably not a lot of fun to be around socially because it was just so much on my mind.

So this is, it is a love. I think it’s always been there. And now I think after nearly 25 years, I’m allowed to pursue more of the things that I love. Not just content wise, but depth wise.

DOCTOR MIKE: Right. Do you like, how has been your journey in adapting to the new media landscape of doing podcasts? I mean, you famously did the Joe Rogan interview through the middle of the pandemic. How did you find that?

DR. SANJAY GUPTA: I like podcasts. That was a long podcast. Three hours long.

DOCTOR MIKE: It was an experience.

DR. SANJAY GUPTA: It’s the Joe Rogan experience. Yeah, I like Joe. Joe and I had been in touch for a while before that, and we’re still in touch. He’s in Austin. I have a daughter in Austin.

I think that I like doing podcasts. I think that there’s sometimes a little bit of a danger in terms of how the podcasts are subsequently cut up and put out there. I mean, if you go into, it’s like writing an entire book and then having someone take a paragraph out and say, “Well, this is what the book is about.” If that was what the book was about, I would have just written that one paragraph. Right. I’ve spent three years writing this book, so I think that’s a little bit of the danger in terms of co-mingling different media sources.

DOCTOR MIKE: So, like the clipping of the podcast.

DR. SANJAY GUPTA: The clipping. And this wasn’t, by the way, Joe or his team, but it’s just people will take certain clips out of context and then use it for their own purposes. And, did I say that? Yeah, absolutely, I said that. But you cut out the five minutes before and the five minutes after the whole thing to really frame that discussion.

And I think, and I know why it happens. It gets clicks and generates revenue, and I get all that. And maybe that’s just the world that we’re in now. And sometimes I don’t want to spend a lot of time in my life banging my head against the wall. So maybe that’s just the world that we’re in right now.

But aside from that, I think podcasts are great. I’m not as facile with things like social media. I think it’s kind of like going back to my medical world. There’s certain things that residents are now doing in the OR using certain technologies that they grew up with, essentially they’ve been doing since they were interns. And I’ve learned now as a full attending, so it’s still like, “Hey, is this really going to work? Let’s just do it the way that I do it normally” type thing.

So I grapple with that a bit, Mike. But overall, I think a lot of the content that’s getting out there I think is actually pretty good and pretty helpful for people.

Navigating Controversial Conversations

DOCTOR MIKE: Yeah, a lot of medical organizations, scientists, have been quite critical of Joe Rogan and perhaps information that he’s put forward during the pandemic. Now, I had Dr. Peter Hotez on the podcast, and he had a big spout with Joe. So I’m curious, how do you manage that from your hat that you wear as a medical communicator and at the same time being friends with Joe?

DR. SANJAY GUPTA: One thing, I’ll give you this quote that I think I’ve sort of lived my life by in some ways. And the quote is, “It’s hard to hate close up.” It’s hard to hate close up. I think a lot of people develop very strong feelings about people that they’ve never met.

And I would say that about Joe as well. I think there’s a lot of people who love him, obviously a lot of people who hate him. I spend time with him whenever he’s talked about me, whenever he’s put out things on social about this. He says, “We’re friends, we have great conversations.” I feel the same way.

I think it’s okay and maybe even necessary to, even if you don’t agree on things, not to hate each other and not to be so vitriolic about things. Look, I’m not naive. I don’t think, Mike, maybe somewhat naive, my wife would say, but I think that most people are not bad people. There are some bad people out there, sure.

DOCTOR MIKE: And it’s not about throwing a label on someone.

DR. SANJAY GUPTA: Not throwing a label. I mean, I think there are some truly malignant people that I just would not trust. I think that they are not, they’re not in good faith, terribly intentioned people. I don’t think that he’s that.

I think that he hears from a lot of people, some of whom I also hear from, who are very confident, again, going back to this confidence thing, very confident in their point of view. And they probe uncertainty for their own benefit. But it can be presented in a very seductive way. And I think that he, I mean, he talks to me, he talks to Peter Hotez, he does talk to other folks, but I think there’s a lot of other people in his ear as well.

DOCTOR MIKE: Yeah, because we take segments that are done by CNN and they get X number of views and you’re trying to put out evidence based, accurate information on the platform. And then on the Joe Rogan experience, he’ll host someone that is saying something completely inaccurate, a lot of conspiracy theory baked into it and it gets 100x the views. Does that destroy the work that’s been done by your network and the information you’ve presented? How do you fight back against that?

The Battle Against Misinformation

DR. SANJAY GUPTA: Well, we find guys like Dr. Mike. We’re true. Dr. Mike. Look, I think it’s hard. If you say super provocative things that are not founded in evidence and fit a narrative that a lot of people want to hear, you’re going to get a lot of views.

I’m a guy, I’m an optimist. I think the truth does prevail. Ultimately, I worry about how much damage will be done before that truth prevails. I mean, I also think, so let’s say there’s a lot of bad information or misinformation, even disinformation. I think there’s all these different strategies.

You counter a lot of that in what you do and it’s hard. And I think sometimes it feels like you’re playing whack a mole because as soon as you say something over here, then it’s this or it’s this. I think you ask yourself, even if it’s much lower levels of viewing, is it good to just make sure that good information is out there? I don’t want there to be a vacuum of that.

And so people get really curious about something. Should I vaccinate my kids? Should I take Tylenol during pregnancy? At least there’s good information for people to find. Present it in a way that’s not so sterile like you might get from a government agency. Sure. Because that’s problematic.

I think, a little bit of a side issue. But going back to the early part of your career and you said people are looking at you side eyed, as you might imagine, 25 years ago when I started this, it was probably even more so.

DOCTOR MIKE: Oh, really?

DR. SANJAY GUPTA: Yeah. I mean, what were you hearing those days? Well, I think that this idea of doctors being communicators in any way other than the journals, in any way other than the organized meetings, it’s like, “What are you doing? Why would you write articles for Time magazine? Or why would you do television appearances?”

And not only do I think there was sort of a question mark around it to some extent, there may have been some disdain, not towards me, but I’m saying this idea that doctors would, to the industry. Yeah. That they would spend time doing that sort of thing, “Hey, go take care of patients.”

DOCTOR MIKE: Right.

DR. SANJAY GUPTA: Why are you sitting there with a mic in front of your face?

DOCTOR MIKE: Right.

DR. SANJAY GUPTA: That kind of stuff. And I do think that that’s changed, but I think that there is still a sense of that. Like I heard you talking about the quality of production that might come out of AMA or something like that. It’s not like they can’t do it, but there is this idea like, “Hey, we’re not fancy pants over here, we’re doctors, we’re serious. This doesn’t need to look like some fancy movie set.”

So there’s this sort of, not, I think, and I disagree with that as a person who’s done this for 25 years, I think you have to persist material in a really accessible, engaging to some extent, if it’s appropriate, entertaining way while obviously being highly informed.

DOCTOR MIKE: Yeah, I don’t think it’s even about having incredibly high production value. It’s just about the effort of would you go to a job interview or a date with food all over your suit jacket or no suit jacket? Because it’s important. You’re trying to provide the best version of yourself.

You might be an amazing partner. You might be an amazing physician interviewing physician, the job. But if you don’t look presentable, there’s just something off from the human trust factor of it all that I feel like we’re totally leaving behind as a medical industry.

The Cultural Perception of Medical Communication

DR. SANJAY GUPTA: It’s surprising to me a little bit and just sort of, again, this idea that there’s a cultural sort of, we think of sports reporting and entertainment reporting, and it’s usually very, it’s great. It’s well written, it’s well produced, well presented. Medical, there’s still this idea that, hey, we’re the buttoned up sort of, as I say this as I’m wearing a tie, by the way, on your podcast. Should I take the tie off?

DOCTOR MIKE: I mean, yeah, if you want to get off the, right. Yeah.

DR. SANJAY GUPTA: Okay. I did this for you. I said, Dr. Mike, I respect him so much.

DOCTOR MIKE: Oh, no, I hope you don’t think I—

DR. SANJAY GUPTA: Where’s your tie, Mike? Not at all. Not at all. But I think that there is still this sort of, if not disdain, maybe that’s a strong word, then this sort of skepticism.

DOCTOR MIKE: Cynicism. Yes.

DR. SANJAY GUPTA: I think it’s not necessary. The words are what counts. It doesn’t have to be a certain presentation. And I think that the medical establishment needs to be better about that.

Trust and the Current Administration

DOCTOR MIKE: Yeah, we’ve definitely lost trust, and we talked about that during the pandemic. But now we’re facing an administration that, as you just mentioned, that perhaps a government will discuss with you a medical topic with a lot of sterility. That’s not happening now. It’s quite the opposite. And the pendulum has shifted. What’s your take on our current administration as it exists scientifically, health wise?

DR. SANJAY GUPTA: Look, I think there’s a lot of parts of it that are worrisome at the granular level, but also I think at a broader level as well. At a broader level, I think the United States has always been sort of this leader in health and health sciences, really, since the end of World War II. And I think we’ve taken great pride in that. And it hasn’t just been a source of pride. It’s been a huge, huge producer of jobs and people staking their entire careers, people coming from other countries to the United States.

DOCTOR MIKE: That’s why I’m here.

DR. SANJAY GUPTA: That’s why you’re here. I mean, you saw what was happening in the United States and you said, well, that would be a great place to practice medicine, to do what I want to do. My parents, same sort of thing. I think we’re at risk of losing some of that. And I’m speaking haltingly because I don’t want to overstate that, but that’s like, do we value that? Do we value sort of holding up health and health sciences as something that we can pretty confidently say we’re the best in the world at this? I think we run the risk of losing some of that.

I already see scientists who I’ve known for a long time leaving the United States. One of our scientists, actually brain tumor science, went to South Korea, another one went to Israel. So that worries me at a more granular level.

I think that the irony of it is that under the guise of let’s create more transparency and create more trust, I think there’s less trust than ever, and there’s mass confusion on things. And you and I can have conversations about Tylenol and autism and vaccines, but I live in the South. There are a lot of people who come up to me who, they’re not watching either of us, not even you. And you got a lot of viewers, but they’re not. That’s not how they’re consuming content.

All they hear is that I took Tylenol last, last trimester, is my kid going to have autism? So it’s kind of heartbreaking to have these people think that they may have contributed to their child’s autism. So it’s worrisome.

The Tylenol and Autism Controversy

I think, overall, I will say one thing, and maybe you’ve got sense of this as well. If you look at the Tylenol autism thing and you heard this super weird press conference, we had the President of the United States, we got Gaza happening, we got Ukraine happening, we got government shutdown moving all these things. And he’s up there saying, don’t take Tylenol. Tough it out. He did say a couple times, talk to your doctor, or if it’s a bad fever. But clearly the weight of the evidence, as they say, was on don’t take Tylenol.

But the FDA comes out with a letter shortly thereafter, which is measured and says basically the same thing that obstetricians have been saying for a decade. So there’s this sense that there’s these huge fireworks that go off. We’re going to get rid of vaccines. We’re going to do all this sort of stuff. And you do have the health leaders of the country all sort of part of that, but it’s almost like they come in behind and sort of play a little cleanup on terms of what to do responsibly for the country. Hopefully that continues. We’ll see.

DOCTOR MIKE: Yeah, I saw that letter and it actually left me more perplexed because it didn’t really match the tone of the press conference. But then the commissioner of the FDA will go on Fox News evening show, a very opinion focused show, say things like, there is a definitive causal link. And then in the same letter that he’s publishing the following day, say that there is no causal link. So if we’re trying to create transparency and honesty, how do we do that when we’re talking out of both sides, depending on which audience we’re speaking to?

DR. SANJAY GUPTA: I totally hear you. I know exactly what you’re talking about. Here’s what he would say. Marty Macri, who’s been a guest on the podcast, he’s been a guest. Good guy, surgical oncologist, by the way. He calls me Dr. Gupta, too. I’m also older than him. I’m kidding.

DOCTOR MIKE: Well, he did the Choosing Wisely campaign, which was a big part of my education and family medicine, about over ordering tests. So he’s been in my education curriculum from when I started.

DR. SANJAY GUPTA: Yeah. And I read his book Blind Spots and thought it was quite good. There was a, so there, so this gentleman, Andreas Baccarelli, who was the dean of the public health school at Harvard, I think at the time this was written, or maybe he was at Yale and then moved to Harvard. I can’t remember. He testified in a lawsuit, and within that testimony, the judge summarized his comments. Maybe you know all this. But the way the judge summarized it was to say that there was a causal association between Tylenol and autism. That was the judge’s words.

And I saw this. And I think that’s what Dr. Macri, Marty is referring to when he says, he said it. He said there’s a causal thing between Tylenol and autism. He’s not wrong. Because I think that that was what the judge sort of summarized Dr. Baccarelli’s comments to be. But I think at the same time, he knows that maybe the judge misinterpreted what he said or if he said it, he misspoke at the time. The truth is that there is no causal link between Tylenol and autism. You can look at the studies yourself. Anybody can look at these studies and find that.

DOCTOR MIKE: And I don’t know if I’m mistaken, but I believe the physician who was part of that trial actually sent briefing notes before this Tylenol autism press conference specifying that there is no causal link.

DR. SANJAY GUPTA: He did. You’re right. So it’s weird. But if you’re trying to, again, find that sort of kernel of truth to support your point of view and someone says, where are you getting this causal thing from? Well, let me show you. It’s right here.

DOCTOR MIKE: But isn’t that antithetical to science?

DR. SANJAY GUPTA: Totally.

DOCTOR MIKE: Because you’re supposed to disprove. It’s the null hypothesis of always what you believe, not trying to find evidence to support yourself.

DR. SANJAY GUPTA: Yeah. To bolster your claim. This is where it gets, I think, particularly confusing because I think, and I’ve interviewed Marty as well, and I think that, first of all, they work for the health Secretary, they work for the president. So they’re never going to say, I disagree with them. So that’s never going to be part of what comes out of their mouth when talking about this. And they will look for opportunities to sort of support what their principals are saying as well.

But I do think for the health of the country overall, the idea that what actually transpired from that FDA letter, admittedly it was confusing, but what it still said was the recommendation was still the same recommendation that obstetricians have been giving for a long time. So hopefully, at least people aren’t harmed. Maybe there still will be some.

DOCTOR MIKE: It just, if we’re being realists, percentages or numbers of people reading the letter versus hearing the press conference.

DR. SANJAY GUPTA: I hope that at least if the system works at all appropriately, people, as they’re always advocated to do, will talk to their doctors. And the doctors hopefully have seen the letter, because doctors, I’m sure, will be more likely to seek out, what was that all about? Let me get the summary on this from the FDA, the people who are regulating this. So—

DOCTOR MIKE: And I don’t think anything novel was presented in the sense of my practice. We’ve always cautioned against unnecessary use of any medication over the counter. Otherwise.

DR. SANJAY GUPTA: That’s the thing. And the flip side is that, and this is where everything gets so political, you probably saw on social, women who were pregnant popping Tylenol indiscriminately.

DOCTOR MIKE: Yes, ridiculous. Yeah.

DR. SANJAY GUPTA: But this is where we’ve arrived, where on one, there’s no middle ground here. I am, too, to spite the president or the health Secretary. I’m going to pop Tylenol. As a pregnant woman, these are weird times. Yeah.

Being Political vs. Partisan in Public Health

DOCTOR MIKE: I said something in a, I don’t remember if it was a speech, but I said that I try not to be political and be more clinical, but I actually don’t think that’s accurate because in order to advocate for public health, you have to be political. There’s no way around that. But you could be nonpartisan.

DR. SANJAY GUPTA: Yeah. So I—

DOCTOR MIKE: My information’s not partisan. I’m giving you the information, whether you’re on the team left or team right. It’s still going to be the truth. And I would hope to see our government move in that direction, at least from the public health space. I’m not venturing into finances and all these things. As a podcast host, I’m trying to stick to health. And I feel like, again, whether you’re a Republican or you’re a Democrat, you’d want to know the truth, right, to make the best decision about your health.

DR. SANJAY GUPTA: I think so. And it’s bizarre to me how entangled some of these things become with politics. Again, I don’t think I’m naive to this, but the first few times I saw this, it was a little bit bewildering. Why do you believe this so strongly? Where is that coming from?

And to even put more of a punctuation mark on it, we did this documentary, sort of 2017, 2018 timeframe about vaccines. This is well before, obviously the pandemic. And the anti vax or vax resistance sort of movement at that point was primarily fueled by young liberal women.

DOCTOR MIKE: West Coast.

The Shifting Demographics of Vaccine Resistance

DR. SANJAY GUPTA: Yeah, west coast. And here in New York and Brooklyn and other places. And you got the corresponding predictable outbreaks, young liberal women. And now if you were to look at the person most resistant, reluctant or anti, even to vaccines, it’s older conservative men.

So here’s a weird sort of thing where you realize in some ways a very important health issue is being co-opted for political reasons. How could it transition so fast, within a decade, within a few years, even from almost opposite demographic, both in terms of age and political persuasion, to a different thing, that quickly. And I think it’s, people should just pay attention to that because it means you’re probably being co-opted, you are part of the movement without even necessarily recognizing you are.

DOCTOR MIKE: A bit of a direct question. Do you believe Secretary Kennedy is anti vaccine? I think he is.

DR. SANJAY GUPTA: He has said there’s no such thing as a safe and effective vaccine. Again, if you talk to Marty and other people, he will say, well, he just recommended the measles vaccine in the middle of this West Texas outbreak. And I said, yeah, but I feel like he was sort of forced into that. I don’t think that he, I don’t think he thinks vaccines are safe and effective. He has said that, what that ultimately leads to. And by the way, I think he really believes that because I think, you’ve probably run into people who are saying things they may not necessarily believe what they are even saying.

DOCTOR MIKE: Why do you think so?

The Base Rate Fallacy and Vaccine Statistics

DR. SANJAY GUPTA: Why do I think he believes it? It’s a good question. I think you hear a lot of stories, sometimes you talk to a lot of families and you start to conflate anecdotes with real statistics. I think he sometimes will hear data in a way that is persuasive to him not recognizing that there’s more to that story.

I’ll give you an example. I remember him saying once that you were more likely to die of COVID if you were vaccinated versus being unvaccinated. “I got a study. I point to a study,” right? And so I pulled the study. Maybe you did the same thing. And basically, I think it was September of 2023 maybe. And there was about 12,000 people who died that month of COVID of which I think 8,000 were vaccinated and 4,000 were not vaccinated. People are more likely to die, right? That’s the answer.

And yet anybody who’s taken basic statistics will know of something known as base rate fallacy. So those 8,000 people who died, the denominator is 200 million, whereas the 4,000 people who died, the denominator was 10 million. So you are far, far, far exponentially less likely to die if you were vaccinated, if you account for the denominator as well.

So if you just present the 8,000, 4,000, and that’s the message you want to get across, you can convince a lot of people that vaccines are deadly. But if you’re trying to be honest about it and fully transparent and lean into this nuance, which I don’t even think is nuance, it’s just a more complete story of statistics, then you would realize that it’s far different, 50-fold or so more likely to die if you’re unvaccinated versus vaccinated. So I think sometimes he either gets presented incomplete stories or he just chooses to focus on that part of the story.

DOCTOR MIKE: Yeah, it’s like a good metaphor for the general public. I don’t know if you watch murder mysteries on Netflix. Do you ever? Yeah. This is what we find fun these days.

DR. SANJAY GUPTA: As a society.

DOCTOR MIKE: Do you have a favorite one? No, no, there’s a million of them. There’s so many. But what they cover, a true story of something that happened. Most recently, I watched one of a woman who went missing that was on a cruise ship, and it was three or four episodes.

What Secretary Kennedy often does is like watching one episode of that murder mystery where the producers and editors do such a good job making you feel like you know what the story is about to be. And at the end of episode one, they actually go, “Here’s a new piece of information that’s going to make you watch episode two because it’s actually a completely different narrative.”

DR. SANJAY GUPTA: Right, right.

DOCTOR MIKE: And then you go, “Oh, I’m watching episode two now because everything I thought I had this figured out was done.” But Secretary Kennedy never watches episode two. He’s done on episode one. And obviously we’re laughing about this.

Understanding Kennedy’s Motivations

DR. SANJAY GUPTA: I do think that, I mean, look, going back to the “it’s hard to hate close up,” I’ve talked to him before. I’m not sure if we’ve ever actually met in person. We’ve had phone conversations. You know, this gets back to what you believe versus what you say.

I think he was really touched by some of the stories of kids who had developed autism and persuaded by the stories that they happened in conjunction with vaccines and all that. And I think he’s done some of the hard work as well, but just not totally complete, like this base rate fallacy sort of thing.

I think what he tried to do with Riverkeepers or what he has done with Riverkeepers and things like that, I mean, there were huge. I worked for the Turner family. They were huge fans of his work for what he did for the environment. So there’s all these sort of things that are happening at the same time. So I think for some people who noted his work as an environmentalist, this is a bit confusing in a way.

DOCTOR MIKE: And also, speaking to left or right, he was running for president as a Democrat.

DR. SANJAY GUPTA: That’s right.

DOCTOR MIKE: To start.

DR. SANJAY GUPTA: That’s right.

The Evolution of Kennedy’s Vaccine Stance

DOCTOR MIKE: Compounding the picture even more. What perplexes me about his stances and why I perhaps can see your side of why he probably believes everything he’s saying, because he’s been so moved by these anecdotes and hasn’t had the complete picture of the scientific evidence. But if I look at the trajectory of how he got to where he is today with vaccines, this all started in the mid-2000s, like 2007 or so, when the Rolling Stone’s article.

Well, even before that, he came on to join the World Mercury Project. And then when mercury essentially became less of an issue because most of the childhood vaccines removed mercury, except the thimerosal, except from the multi-dose flu vials, he renamed the organization to be Children’s Health Defense Fund. Right? So it’s like always pivoting to see whatever is in the media.

It’s like, well, you were very passionate about mercury. And in fact, some of his first interviews, he was saying, “I’m not interested in attacking vaccines. I’m talking about mercury exposure. I think vaccines are amazing. They’ve saved millions of lives.” And then comparing that to the interviews he’s giving these days, it’s like, well, what happened? What do you truly believe? Because recently he did a podcast where he said, “Doctors are just interested in keeping patients sick.” And that’s defaming all of us.

DR. SANJAY GUPTA: That’s crazy. I heard that. And you know, that breaks your heart. You know, I mean, you think, yeah, it’s been decades of my life.

DOCTOR MIKE: Yeah.

DR. SANJAY GUPTA: By the way, you know, neurosurgery training, I gave up an entire decade. I’m not complaining, but like, you’re being a realist. And then you’re 100 hours a week, you have no friends, they have no social life. Getting paid $28,000 a year, barely pay my rent. And then to come out of that and have the health secretary for the country say, “You’re all a bunch of hucksters, you know, just trying to profit off the system.” I tell you, it’s really weird.

It’s an interesting point about these pivots that you’re sort of alluding to here with the Children’s Health Defense Fund. I think what is interesting now is that when he comes out and talks about Tylenol and autism and we all say, “Okay, hey, let us clarify this as medical communicators,” what he’s also hearing from folks at Children’s Health Defense Fund, an organization that he helped found, is, “Hey, man, you’re not going far enough. What is this Tylenol nonsense? You said you were going to get rid of vaccines, so where is that? That was the September announcement, right? That was what we were supposed to hear.”

So in a way, he’s sort of getting outflanked, you know, by both people who are trying to clear up the things he does say and other people who are saying, “You’re not going far enough.”

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Trump’s Influence on Vaccine Policy

DOCTOR MIKE: All right, let’s get back to the interview. I remember I forgot who it was, but they said that when they called him to tell him that he was going to be picked by Donald Trump to be his Health and Human Services Secretary, he needed to make the promise that he’s not anti-vaccine to President Trump.

DR. SANJAY GUPTA: Is that right?

DOCTOR MIKE: Yeah. And I believe it was Vance who said that at a podcast.

DR. SANJAY GUPTA: Am I correct on that?

DOCTOR MIKE: Yeah.

DR. SANJAY GUPTA: Interesting.

DOCTOR MIKE: I’m not 100% sure that it was Vance, but this was definitely said. I watched the interview and it’s interesting because it then speaks to why it’s not a full push to get rid of vaccines. Because it seems like President Trump mitigated some of that by saying that at the outset.

DR. SANJAY GUPTA: That’s really interesting. You know, I do wonder though, you know, so just to keep that going. So President Trump is doing this Tylenol autism thing. And as you heard, as part of that, he also talks about the idea of creating monovalent vaccines, so MMR, separating them into three different vaccines.

And it was weird because it had nothing to do with Tylenol and autism. And I think it didn’t get a lot of attention because so much of the attention was on Tylenol. But all of a sudden he threw that in there and like having worked at the White House, I sort of have some sense of how these things go, which is it was a walk from the Oval Office to that room, which is two and a half, three minutes or whatever amount of time. And basically just hearing the briefing at this point.

And by the way, “Mr. President, you know, we’re concerned about vaccines,” you know, and so he gets up there and freelances splitting them up. So if people are constantly in your ear, sort of, you know, trashing the efficacy of vaccines, laying some uncertainty into how safe they are, I think it starts to affect how you’re talking about it.

So we’ll see. But I think President Trump is actually going back to Operation Warp Speed. Even in a way, he’s mostly said the right thing about vaccines. He talked about the need for a childhood vaccine schedule for a while. He talked about the need for COVID vaccines until obviously his base wasn’t too happy about that.

DOCTOR MIKE: Although he did bring in some hepatitis B misinformation. I know it seems out of nowhere to bring that in.

DR. SANJAY GUPTA: These aren’t like some long briefing, I tell you. I guarantee it was like a few minutes on the way to the briefing from the Oval Office. So it’s like these nuggets that are coming to him that he then has to, then he pontificates, I think.

Calls for Resignation

DOCTOR MIKE: Yeah, that makes sense. We, I believe it was pretty early on in this administration, called for Secretary Kennedy to be removed or to step down. I think as recent as this week, six previous surgeon generals came together in the Washington Post and called for him to resign as well. Your thoughts?

DR. SANJAY GUPTA: I think one thing that I’ve learned over the years is that you have to ask the next question as well, which is, okay, if he’s gone, then who? Okay. And I think, you know, like, even with the CDC director, we saw CDC director leaving, and now someone else is coming in who immediately is pretty robust in terms of their comments about vaccines. So what he’s doing is concerning. It’s worrisome, all the things that I said earlier.

DOCTOR MIKE: The CDC director left because RFK?

DR. SANJAY GUPTA: I know this is, God, it’s very hard to keep it all straight.

DOCTOR MIKE: Yeah, that’s what I was…

DR. SANJAY GUPTA: Do we have a surgeon general, by the way?

DOCTOR MIKE: No.

DR. SANJAY GUPTA: I mean, here we are.

DOCTOR MIKE: Yeah, we do not have a surgeon general. It says vacant on the website.

DR. SANJAY GUPTA: It says vacant on the website. And I don’t even know what’s happening. I mean, I know that Callie means Casey, but one of them is going to probably testify at some point. But regardless, I think you have to ask what is it going to be replaced by, I think.

Marty and Jay and Oz, I do think that they are people who, whatever you may say about them politically, have been doing sort of behind the scenes, like with this Tylenol autism thing, the right thing in terms of making sure at least the FDA notice that went out was responsible.

So I would hate to see a huge sort of complete dust up where even some of the gatekeepers of this were also gone. Because if he leaves, they may all leave as well. And who are they replaced with? You know, so I think you just, you’ve got to think it completely through, I think.

DOCTOR MIKE: So if you had your way, how would you play it?

I would find an HHS secretary who is very committed to preserving the integrity of the medical establishment in the United States and following evidence-based science and putting that person in the job. They don’t have to be a doctor. There have been plenty of HHS secretaries who are not doctors, but somebody who really, when they were testifying before these Senate committees, really made it clear that that was their priority. That’s what I. You’d have to have that person ready in place, ready to go.

DOCTOR MIKE: Yeah.

DR. SANJAY GUPTA: Just leaving the whole organization totally rudderless is not good either.

DOCTOR MIKE: Well, I don’t think they were calling on everyone to resign.

DR. SANJAY GUPTA: No. But I think that people will go. You know, what happens a lot of times is if you were appointed and asked by a certain person, then if they’re no longer in the job, maybe you’re asked to stay on, but these appointees, maybe they’re not.

DOCTOR MIKE: You mentioned Dr. Oz. You and him were on air at the same time, at least during my education. What’s your relationship like with him these days?

DR. SANJAY GUPTA: You know? Good. And I don’t want to overuse this quote, although I think I will. It’s hard to hate close up.

DOCTOR MIKE: I like Dr. Oz. I believe firmly that you don’t have to hate anyone. This is not—oh, no, okay.

DR. SANJAY GUPTA: I didn’t say that. Okay. I don’t think I’m going to name them.

DOCTOR MIKE: Okay. Can you name them? And we bleep it.

DR. SANJAY GUPTA: These aren’t people you would know. These are former bosses. These aren’t like—

DOCTOR MIKE: I thought you were going to say someone that bullied you.

DR. SANJAY GUPTA: Oh, that happened too.

DOCTOR MIKE: Okay.

DR. SANJAY GUPTA: I mean, being a little Indian kid in rural Michigan, you know, Sanjay Gupta. English was not the first language till I turned six, you know, so showing up my first day with Indian accent, the head wobble. Sanjay Gupta is a name. Brylcreem in the hair. Yeah. You got some bullying tears.

DOCTOR MIKE: Yeah. It’s ironically the same exact story for me. I came when I was six, not knowing English. Same bullying. Really? Same story? Yeah, exactly.

DR. SANJAY GUPTA: Did you fight back?

DOCTOR MIKE: No tears. Tears? Yeah, exactly. Came home and cried to my parents who said, solve it on your own.

DR. SANJAY GUPTA: Good advice from your parents.

DOCTOR MIKE: Good advice, acutely. Had it gone on chronically and it was debilitating, I hope they would have stepped in.

Balancing Parental Intervention

DR. SANJAY GUPTA: Yeah, it’s a tough balance, you know, now, as a dad myself, of three teenagers knowing when to step in. You know, is this a life lesson or is this something I need to get involved with? You know, it’s hard to know sometimes.

But, no, I like Oz. I do. I think he, like you, is very good at what he did in terms of medical communication. I think that realizing that clinicians, people who practice medicine, should be part of the conversation in terms of informing people about medical issues. I mean, he was early on in recognizing that. So he’s got a big job, you know, at CMS. I do.

DOCTOR MIKE: Do you like him for that position?

DR. SANJAY GUPTA: That’s a good question. And if I say no, it shouldn’t be interpreted as maligning him. You know, I was asked to be the Surgeon General, and I remember thinking when I was asked to do that, that it’s very flattering, but at the same time, I’m not sure I love this country. I’m not sure I’m the right person for this.

DOCTOR MIKE: Interesting that you say that.

DR. SANJAY GUPTA: Why?

DOCTOR MIKE: Well, you know, I think, fantastic communicator, decades of experience.

DR. SANJAY GUPTA: I think, you know, so much of that job is public health, you know, and spending time in that world of public health. I think the communications part is important, and being a clinician is important, but public health is a thing unto itself. And I think there is a difference in terms of how you think about individualism versus collectivism. You know, you’re just programmed that way as a public health person.

So I’m not saying I was certain that it was not the right job, but it did cross my mind. CMS, as doctors, we’re not really necessarily trained in all the accounting of these gigantic federal entitlement programs.

DOCTOR MIKE: And I think cardiothoracic surgeons are probably least equipped.

DR. SANJAY GUPTA: Yeah, I mean, look, they know how to bill for cabbages and stuff like that. He’s a smart guy. He’s a quick study. I’m sure he’s learning that. I’m sure he’s got a great staff. I’m sure he’s providing direction in terms of where he thinks we should be spending money in this country. They are, you know, I mean, they are making some interesting decisions on how to spend money with regard to things like AI and healthcare and things like that. So, you know, sort of keep tabs on that.

DOCTOR MIKE: Wait, so going back, do you think it’s a good fit?

The Right Person for the Job

DR. SANJAY GUPTA: I think that there’s probably people who are just really immersed in healthcare policy and understanding both the history and the trajectory of where we’re going as a country that may be better for a job like that. Love you, Dr. Oz. You know, I do love him, but I think that maybe if he were sitting here, he’d even say that. It’s hard to say no to the president if they ask you to do a job. So I get that pressure, but at the same time, you know, like I did to say, hey, look, flattered, but maybe I’m not the perfect person for this. Maybe Surgeon General would have been better for Dr. Oz because of the communications background.

DOCTOR MIKE: Interesting. Does it worry you, he recently came out and said, if we lower or raise the retirement age and we get people to work a little bit longer, we can save trillions of dollars. Does that mindset worry you on the public health scheme of things?

DR. SANJAY GUPTA: I think that a lot of the way, yeah. I mean, it does worry me. But I think what is happening there is basically, these are sort of trial balloons that are sort of put out there. And it’s just knowing him, I’ve known him for a long time. I think it’s a little bit of how he operates. How about this? What about this? And just throw it out there. And then someone may say, hey, look, that’s the stupidest idea that we’ve ever heard. It can’t work. And here are all the reasons why. And I think he would sort of recognize that.

We talked a lot about that during the pandemic. He was oftentimes putting, asserting things about whatever it might be, schools, et cetera. Schools, and even some of these therapeutics and things like that. And I think part of him was sort of saying, let’s just throw this out there, see what people are actually how they respond to it. And any of it sticks.

DOCTOR MIKE: Yeah, it’s scary because I used to, as a young doctor, just say to my patients, well, look at what the CDC or FDA or HHS is saying. What’s the advice to give to young doctors now when it comes to our federal agencies?

Navigating Federal Health Guidance

DR. SANJAY GUPTA: You know, I still think that a lot of the information coming out of there is good information. I think you have to—I keep using the Tylenol autism example because it just happened. But, you know, I think what ultimately gets presented after all the sort of fanfare and fireworks around some of these things is reasonable so far.

I think we’ll see with regard to ACIP in particular on immunization practices, what happens with the potential splitting of the MMR vaccine. By the way, people are really going to want their kids to get poked three times now instead of one time. I mean, isn’t this like, I can’t believe they get a hundred million shots. You know, that was always the sort of thing. And now they realize they’re advocating for basically giving even more shots. Yeah, I mean, started off this podcast by saying, Mike, things are weird. I keep getting reminded.

DOCTOR MIKE: Well, even again. But listening to President Trump talk about the amount of liquid injected into a baby, I don’t even understand what is being said from a medical perspective.

DR. SANJAY GUPTA: You know, when the bleach thing happened during COVID, going back to unpacking the behind-the-scenes scenario, I ended up having a conversation with Dr. Birx about this, who had been in the Oval Office.

DOCTOR MIKE: I remember her standing by his side.

DR. SANJAY GUPTA: She was standing there, but she was also—there was somebody else who had been in the Oval Office with them. Somebody who talked about the use of bleach for pathogens.

DOCTOR MIKE: Disinfecting. Disinfecting constantly touched spaces or something.

DR. SANJAY GUPTA: Yeah, I mean, something that made total sense. Inanimate spaces, not the human body. But I think for President Trump, he sort of internalized that in a very quick sort of thing and said, well, did that on the countertop. Why can’t we just do that inside the lungs? And I think it’s the same sort of thing here with these slight bits of information that are wildly over-interpreted, I think, by people.

The Problem with Partisan Outrage

DOCTOR MIKE: I also think to really flip this onto the other side of the equation, the way that partisan media on the left reacted to the bleach statement was a wild overreaction. It’s almost like reaching for the top tier of outrage when something that should have been, oh, that’s not an accurate statement. It was probably charitable thinking. Exactly what you said. Something that was mentioned. And then he extrapolated.

But people weaponized it for partisan politics. So much so that it leaves us without an ability to fact check now, because it’s like, oh, they’re always offended, even when he made this one-off statement. But now when we really need to stand up for vaccines, for the discussion of Tylenol autism links, we feel like we don’t have much to say because we’ve already said it then.

DR. SANJAY GUPTA: I think that’s a very fair point. I mean, I think—I don’t know how I would contextualize the level of outrage around the bleach thing, for example. You’re right. There was a fair—it got a lot of attention for a while. And I remember we interviewed Stephen Hahn that evening, who was the FDA commissioner, and he made some comment like, look, a lot of patients are asking their physicians about this. And I said to him, I said, they weren’t before you guys brought this up. I don’t think people are saying, hey, what if I drink a little bleach? You know, so.

But I like it. The bleach thing, maybe. Maybe there was an overreaction to it. But at the same time, it’s worrisome to sort of think that people who are just tuning into this issue a little bit from the side, they’re not really plugged into this issue, and they hear, wait a second. So bleach could potentially help get rid of the coronavirus. I could do a little bit of that. You think that sounds preposterous, right? You’re dealing with 350 million people. Anything is possible when you’re starting to talk about that scale.

So how outrageous do you have to be to make it very clear that there’s no way or how that that should be done? It’s a tough balance. And at the same time, you cannot disentangle anything from politics.

DOCTOR MIKE: Nothing.

DR. SANJAY GUPTA: I can’t think of a single issue that can be disentangled from politics. I hosted Jeopardy for a couple of weeks during the pandemic, and I remember even then, some of the questions that were—I was—I give the answers. They have to ask the question. Some of the answers that I had, people are like, oh, they only gave those answers to Sanjay Gupta because, you know, he worked for CNN and is a leftist sort of thing. Yeah, this is Jeopardy, for crying out loud.

So you cannot disentangle anything from politics. So everything ends up being a big sort of bludgeoning tool. And health, I think, somewhat surprisingly, compared to other issues, has become one of the biggest bludgeoning tools of all. People are really using it to pound the other side. And I think a lot of it is to no avail. It’s not helping the American people.

Coverage Choices and RFK Jr.

DOCTOR MIKE: In November 2024, when President Trump either was elected or was in the final stages of the election, was pointing out that he might have Secretary Kennedy as head of HHS at that time. Just RFK Jr. Right. You were putting out a lot of information with CNN, how dangerous that would be. You were voicing your concern. I remember in April, May, summer of this year, looking up your name and RFK Junior into Google News search to see how you guys have been covering it. There was not a single piece of coverage. Why that choice?

The Challenge of Covering Health Misinformation

DR. SANJAY GUPTA: I mean, we’ve definitely covered him since then, so I’m not sure why that wouldn’t pop up. I mean, he’s generated a lot of news over the last several months. So, no, I think that we’ve still been covering every one of these hearings and certainly during his hearings. But then, I mean, I know during his hearings he got a lot of coverage at that point, I think around the ACIP meeting.

I do think there needs to be a conscious choice, though. Sometimes when you’re covering something, are you just elevating something that is likely to not be a thing? Kind of like the bleach thing. Again, should we have given that as much attention as we did? I think there are times when he says something and we know that there’s no way that that’s going to be of significance. It’s not going to amount to anything.

But I know that we covered certainly during West Texas, certainly during Wisconsin and the lead crisis. We talked about him a fair amount. We talked about the cuts that were happening at the CDC, obviously, the stance on vaccines and measles specifically.

DOCTOR MIKE: Well, just firing the whole ACIP panel was just ridiculous.

DR. SANJAY GUPTA: So, yeah, maybe we need to talk to our search engine optimization, perhaps. No, but I think, I think, I don’t know that I used the word aggressively covered, but I think we’ve robustly and I think fairly covered what has been happening within the Health Department, including Secretary Kennedy.

DOCTOR MIKE: Yeah. The reason I was even searching this was not to question you, because I’m a fan of your work, is because I was feeling, as a content creator myself and in charge of our production schedule, feeling like, oh, man, there are so many other passion projects I would rather cover on this channel. But I feel like I’m having to cover so much of the misinformation coming out from Secretary Kennedy or the office. And I wondered how you were handling it. That’s why I searched it. So how do you decide when to cover, when to not cover? Or is this a production thing that is decided by someone else?

Editorial Decisions and Combating Misinformation

DR. SANJAY GUPTA: No. Well, I would say it’s a collaborative. It’s not just me deciding. I think we have editorial meetings and within Health, but also within the company as a whole to try and make those determinations. And, you know, and again, we’re a 24 hour news network, so typically we cover things, if not on television, then digitally, online. And these are newsworthy, you know, these are newsworthy events.

I mean, I think there’s sometimes been this inclination to say just ignore it and not cover it. And I think that’s the wrong approach. I think you have to cover it. I will say again, you do such a great job combating the misinformation, but it is exhausting. Sure, it’s exhausting. And there is a sense sometimes that it’s just playing whack a mole like I do.

I remember you doing a, I saw a session with you when you were talking to a bunch of people and you asked the woman a question like, is there anything I could say to convince you? And she basically said, no, there’s nothing. She’d like to hear your point of view, but she wasn’t going to be convinced. And I feel like she was representative of a lot of people.

So, you know, I don’t like to bang my head against the wall. I’m very aware of time passing and how I want to spend my time. So if I don’t think it’s going to be of value to people, then I may not spend as much time on it. I also do like to work on other projects like this. Like, I’m not trying to transition to the pain, but I do like to work on big, big ideas like pain, Alzheimer’s, you know, things like that, and really dive deep into that.

When I start to write a book or work on a documentary, I’m pretty head down for a few weeks, certainly for the documentary, a few years for the book. So, you know, some of the other stuff. And we have an entire team of health reporters who continue to cover all the stuff. So it’s not just me, but I think it’s important to cover. We will continue covering it. We’ll do it robustly, aggressively if need be, and always honestly and transparently.

Understanding Pain: A Personal and Professional Focus

DOCTOR MIKE: Got it. Well, tell me about the book then. Because that’s a world I have to function in quite often for a couple of reasons. One, I’m a family medicine physician. I’m an osteopathic physician. I have a musculoskeletal focus in that I’m a professional athlete myself. And I was initially going to do a sports medicine fellowship until social media got in the way.

So I was already doing a lot of research in that space, going to the annual meetings, and therefore, whenever anyone in my practice or in the nearby practice has a patient with some sort of musculoskeletal condition, it ends up being referred over to me.

DR. SANJAY GUPTA: Got it.

DOCTOR MIKE: That’s number one. And then number two, because I’m fortunate enough to be able to dictate to some level of how much time I spend with a patient, because I work as a volunteer, I’m able to say, I need 30 minutes with this patient who has elbow pain, because I feel like it has a psychological cause just as much as a physical cause. And that’s interesting because that’s a big part of your book.

The Mind-Body Connection in Pain

DR. SANJAY GUPTA: That is a big part of the book. And I think maybe in some ways the most provocative part of the book. You’re too young to know who John Sarno is.

DOCTOR MIKE: I know exactly who John Sarno was. You’re too young for that. I’ve read multiple books. The divided mind is the common bibliotherapy that I recommend to patients.

DR. SANJAY GUPTA: Okay, so you, so you know, in some ways, we…

DOCTOR MIKE: Have a YouTube video on John Sarno’s.

DR. SANJAY GUPTA: Do you. Okay, I’m going to find this. You know, we all stand on the shoulders of other people. Right? And essentially, I don’t know if you ever read John’s, his obituary in the New York Times, but I’m not going to get it exactly right. But basically the gist of it was that half the country thought he was a prophet and half the country thought he was a pariah.

And this idea of introducing the concept of psychosomatic and the idea that that pain is generated in the brain and it’s in your head was something that a lot of people found minimizing and stigmatizing, even when it came to pain. And yet, you know, I think he was right in the sense that if your brain doesn’t decide you have pain, then you don’t have pain.

And when it gets to be chronic pain, it always comes with baggage attached, like I think you’re referring to with that patient with elbow pain. Always. And sometimes it’s depression and anxiety. 40 to 50% of people who have chronic pain have depression and anxiety. It’s bi-directional. Sometimes they already had the depression and anxiety. It exacerbated their chronic pain. Sometimes it goes the other way. Sometimes it’s a combination of both.

But I think the thing that Sarno was advocating, as well as people like Bessel van der Kolk, who wrote the Body Keeps a Score, is that you have to treat both. It’s not saying don’t treat the pain. It’s saying that if you don’t treat the baggage, you’re not effectively or completely treating the chronic pain. And I think that was a message that I really wanted to get across.

To say all pain is in the brain is not to say it’s all in your head. Those are two different things. But I think this idea that we can start to have this deeper conversation about what exactly is driving chronic pain, which affects 50 million people in the United States, fastest growing chronic condition in the country, to be able to have that honest conversation was really important.

The Journey to Writing About Pain

I started off thinking about this, Mike, when I was in the operating room one day and we were doing an ACDF, an anterior cervical discectomy and fusion. So neck operation to do a fusion. Had my microscope, had all my elegant instruments. We were using navigation for something. And I was looking through the chart and the patient had put in their chart a pain score. And it was literally drawing, circling one of the frowny faces on a thing which we’ve all seen.

And it was very discordant to me. There was this cognitive dissonance where I thought, look at all this amazing stuff we have in this OR. And what landed him here is still this incredibly archaic thing of how they’re trying to measure pain. And I think that’s what sort of launched me into really looking at pain.

Where were we with the Holy Grail, which is measuring pain? Is it even something that can be measured or should it just remain mysterious? Your pain is always going to be different than my pain. Where are we with treating pain? What were the repercussions of the opioid epidemic other than the things that we’ve heard about for so long? Deaths, addictions and all the other things? What was the suppression of other research?

Why haven’t we had a new pain medication in a quarter century? I mean, we as a country will approve 40 to 50 new medications a year. And yet for the fastest growing chronic condition in America, there was not a new medication approved for a quarter century, 27 years, actually. Why? I just found myself asking these questions and then, you know, as journalists, we have the benefit of being able to call whoever we want, start having the long conversations, trying to determine if there’s a book there, going back and reading Sarno’s books, even all that stuff, and decided that I wanted to write about it.

The Gap in Pain Medication Development

DOCTOR MIKE: What is the answer to that question? Why didn’t we have, because there’s now currently a few new medications.

DR. SANJAY GUPTA: There’s one, yeah, there’s Suzetragine.

DOCTOR MIKE: And also we have those combinations where they have something with an anti-constipation medication attached to them.

DR. SANJAY GUPTA: So like a combo pill, they’re the combo pills. A lot of these were existing pills that were reformulated in a way, but there was only one new medication in 27 years. The most honest answer as to why that happened, I don’t know is the most honest answer.

I will say that I think the opioid story sucked up a lot of oxygen in the room. And I think that when that happens, it just became so much easier to say, hey, we’ll just give opiates. Why do we need to be pursuing other things here? To be fair, pain is complicated. So it’s not like developing these new medications is easy. But still, 27 years, 40 to 50 other new medications a year, including really sophisticated immunotherapies and things like that. Tough drugs to develop. Nothing new for pain.

So I think there’s a lot of different reasons, but I think there’s these ripple effects when we hear about things like the opioid epidemic or other problems in society. If you take the second beat and ask, what’s the rest of the story? What didn’t we learn because of opioids? I think that’s one of them, by the way, the suzetragine story. Are you familiar with this?

DOCTOR MIKE: No.

The Fascinating Story of Suzetragine

DR. SANJAY GUPTA: Let me just tell you real quick because I think you’ll find this fascinating. These researchers essentially found, these were told of this circus performer in Karachi, Pakistan. Wow, 14 year old kid. And he could do these crazy things like put sharp things through his appendages and walk on hot coals and all this sort of stuff.

And there was two fascinating things about him beyond the obvious. One is that when he walked on hot coals, he felt that they were coals and he felt that they were hot. He just didn’t feel pain, which was very different than other hot coal walkers who were just essentially insensate or numb to it. They didn’t feel anything. First fascinating thing, the second fascinating thing was other members of his family also had the same thing.

DOCTOR MIKE: Were you like a spinothalamic tract? What’s happening here?

DR. SANJAY GUPTA: This is really interesting. So this is a, they found a gene and the gene actually codes for a specific sodium channel blocker, SCN9. Double check me on that. I think it’s SCN9. Basically, as you know, sodium channels are what allows communication to happen from any part of the body to another part of the body. That’s how signals are transmitted.

People, and there’s tons of them, people have been trying to find sodium channel blockers that are really highly specific for pain. Well, they basically found sort of retro-engineered what this gene was doing. Specific sodium channel blocker. And they created a medication that essentially did what that does, block that sodium channel blocker for a period of time.

So it was just a fascinating sort of, you know, streets of Karachi to the lab, to a medicine that people can now use. But, you know, it took 25 years to do that. You know, again, aside from Celebrex, which was approved in 1998, they’d been working on this sort of medication for about a quarter century.

The Opioid Era in Medical Practice

DOCTOR MIKE: I was not practicing as a physician in the era where opioids were booming. By the time I went into practice, even as a resident, we already had judicial use recommended strategies in place from a pain contract. You know, these mitigation strategies. Because we realized we overdid it. Was there a time during your practice where you experienced drug reps coming to you and saying, saying, not addictive, totally good. Treat pain like it’s the fifth vital sign. Overdo it, because that’s kind of what’s out in the ether. But I’m curious if it ever hit home for you.

The Role of Pain Clinics and Alternative Treatments

DR. SANJAY GUPTA: Me, personally, I did not experience it, although I knew it was happening, and I read a lot about it at the time. I happened to be trained by a guy, Julian Hoff, who was really resistant to letting drug reps come into the clinic or instrument reps coming to the operating room. He just was really, and I think in some ways, he was ahead of his time in this regard.

I ended up writing articles about this guy because I was always curious, like, how he thought about things, you know, why he was concerned about that at the time that he was, which was the mid to late 90s. But we knew it was happening.

We also, I was trained at the University of Michigan. We had a pain clinic, which was a luxury. A lot of big institutions did not have a separate pain clinic. So with somebody who came to us for a neurosurgical evaluation, but was found to not have an operative problem, we did have a place to have those patients follow up with their care, as opposed to just saying, you know what? I can’t just send the guy home. He’s in pain. Let me give opioids.

DOCTOR MIKE: Right.

DR. SANJAY GUPTA: We had people who were very judicious about this, and they were using things like nerve blocks and other sorts of things to try and combat pain beyond the obvious. But look, Mike, there’s no question that the narrative that you described was happening in many places around the country.

DOCTOR MIKE: Yeah, it’s quite scary. And interestingly, how it shifted back then, perhaps there was overuse of opioids now, maybe less now, but especially during my training, there was an over prescription of surgeries, especially spinal surgeries, with not great evidence behind them.

Now I’m seeing pain clinics, interventional pain clinics, pop up on every corner where the way that they describe it, because I have some friends that work in this industry as they’re printing money because so many patients are being referred to them for primary care physicians being afraid of prescribing opioids because of state monitoring programs, et cetera, that they’re just getting so much influx of people who are in pain.

They can do procedures all day long, nerve blocks and things, nerve blocks, epidurals, et cetera. And they can just procedure all day long. And I see it being overdone. And that’s why I’m excited about your book, because you’re giving people an alternative that so many people don’t trust yet.

Meditation and Measurable Brain Changes

DR. SANJAY GUPTA: Yeah, well, thank you for saying that. I think I really did want to get that across also with the recognition that there are modalities which, you know, even things like ketamine, even things like virtual reality where, you know, if you’ve grown up in a world where opioids were the thing, anything less than that seems like, hey, man, you’re not giving me what I really need.

DOCTOR MIKE: Why are you judging me? I think it’s in my head, that.

DR. SANJAY GUPTA: Whole thing, virtual reality, really, like, what’s that going to do for me? Nerve block. Just give me the pill. I think some of what I talk about are not new modalities. They’re existing modalities that are sort of getting a resurgence because of all this. But people want the data, and there is now good data behind many of these things, even things like meditation.

I mean, I’m a neurosurgeon. That’s how I was trained. The idea of meditation, I don’t know if I’d use the word antithetical, but certainly if I brought that up in clinic, it was laughed at. People would be like, come on.

DOCTOR MIKE: But even, I’m sure in academic institutions 30 years ago, if you were to say, hey, meditation could be valuable, they’d say, oh, absolutely.

DR. SANJAY GUPTA: And I think there’s some places where that’s still the case, although it’s changing. But I think part of why that’s changing is that there were these incredible functional scans, studies where actually looked at the changes in brain that happened to people who regularly meditated, and you saw an objective, measurable change in an area known as the posterior cingulate cortex.

Just behind the anterior cingulate cortex, which a lot of people believe is a great sort of modulator of pain. So the idea that you could change parts of your brain, I mean, it’s really interesting. Like I can measure changes in my brain. I thought this was just something that I was doing to relax myself. And yeah, you’re doing that, but you’re also measurably changing your brain.

And those areas may make you more resilient to pain. And then they put that to the test by training thousands of practitioners who go out and use these, what are called MORE protocols, meditation oriented recovery enhancement protocols. And they get these incredible results and then they’re asked, hey, contextualize, what does it mean? Incredible, like, how good is this?

Well, a single meditation session under MORE protocol is equivalent to 5 milligrams of hydrocodone. Since you want it spelled out as clearly as that. We’ve taken a decade to basically get you that answer. It works and here’s how well it works.

So people understandably want that sort of data and yet for all sorts of reasons, they hadn’t heard that and it wasn’t presented that way. So I really wanted to make sure I got things like that across.

Understanding Inflammation and Pain

In your world of sports medicine, to really look at inflammation, to really dive into what has become a four letter word where people say, I don’t want inflammation, inflammation bad, get rid of inflammation. And there was a study that came out a few years ago, I guess two years ago, that said those people who had the lowest levels of inflammation at the time of injury were the most likely to have chronic pain.

Lowest levels of inflammation, most likely have chronic pain. Everyone thought, I think it was the opposite. If you were really inflamed, oh, this is going to hurt for a long time. And in fact what we do, and maybe you’ve done, I’ve certainly done, is to recommend to people to decrease the inflammation, take anti-inflammatories, rest it, ice it, compress it, elevate it, all things to lower inflammation, which may help in the acute setting, but as we now know, may increase the likelihood of them developing chronic pain.

I don’t think that was widely known. So, you know, those are really specific things I think people can incorporate into their own lives, which I wanted to make sure to get across in the book and then to get at the wonderful sort of big questions about pain. Can it be measured, can it be interrupted? The cultural differences.

You’re too young to have had a colonoscopy so far, right? If you get one, you will, one day you’ll likely get propofol. In Japan, they don’t use propofol. In Finland, only 6% of the population uses propofol.

DOCTOR MIKE: What do they get?

DR. SANJAY GUPTA: They get nothing. Pain is cultural as well. Pain is defined by our expectations. How we expect to have pain very much informs how we experience pain. So if you don’t expect it, as they don’t in other places, then you don’t need these other medications.

I had a colonoscopy. I got propofol. Just being totally, totally candid, transparent. But, you know, so pain is really complicated in that way. So, you know, it was just, it was an opportunity to do a deep dive into all that.

DOCTOR MIKE: Yeah. I’m curious how much of all of this is the placebo effect in the sense of this very specific protocol for meditation improved pain as much as the opioids did. I’ve seen research where they tested acetaminophen or ibuprofen.

DR. SANJAY GUPTA: How’d you say that word?

DOCTOR MIKE: Acetaminophen? Just in case President Trump does it again. Where their pain improved to the same level as the randomized group that received opioids. So is it just about getting something?

The Placebo Effect and Endogenous Opioids

DR. SANJAY GUPTA: It might be. I think the placebo effect with regard to pain, we can more completely define as, you know, we have an endogenous opioid system. We make opioids and we can make them really, really fast.

DOCTOR MIKE: And for people just, he means internally.

DR. SANJAY GUPTA: Internally. Sorry, sorry.

DOCTOR MIKE: No, because it could come off as we make, this isn’t a Breaking Bad.

DR. SANJAY GUPTA: You wonder what happens in the back room over here. No, no, you, we all make opioids and we do this in response to certain things, one of them being pain. So, for example, every time that I’ve had a pain episode, I know that my body reacts robustly to pain by making a lot of opioids, because I go through a period of time where it’s like, ah, that really hurt.

And then all of a sudden, I almost have this euphoric feeling for a couple of minutes or, you know, longer after that as my opioids sort of rush in. You can create opioids in response to the expectation that something’s going to work. So the placebo effect, I think, takes on a little bit more a deeper meaning when it comes to pain.

You can start to imagine the mechanisms here. It’s not just I’m willing myself to not feel pain. Opioid production actually goes up. And again, these are really good opioids, meaning that they turn on and off really fast, unlike a pill, if you take it, that’s going to stick around for a long time.

The opioids that you take, they can actually, they can increase your memory of an event, so they actually can cause you to sort of replay that memory loop over and over again of your traumatic injury. Whereas your endogenous opioids sort of suppress memory. So they’re great at pain, they’re great at suppressing memory, and they can turn on and off. They’re far better opioids than the opioids you take.

I think that’s a suppressing memory thing that I find so interesting. I made a comment in the book that were it not for the endogenous opioid system, no woman would ever have a baby more than once. But it’s amazing. You talk to people and they’re like, yeah, I mean, that was painful, but I don’t really remember. The endogenous opioids purposely suppress memory, which, it’s fascinating. The human body and brain is so fascinating.

DOCTOR MIKE: Well, it’s similar to how during surgery, we give medications that not only sedate patients, but also create amnesia.

DR. SANJAY GUPTA: Yeah, no, it’s so interesting. I’m going to give you pain medications, but I also want you to not remember this. And I’m going to give you what’s called an antegrade amnestic. You know, if you hit your head, people say, I got retrograde amnesia. I can’t remember the past. I’m going to make you forget everything that’s about to happen to you, which is wild, you know. So in addition to the pain medications.

DOCTOR MIKE: And other drugs, how does this message of it’s not made up, but it’s in your brain land for your patients.

Explaining Pain to Patients

DR. SANJAY GUPTA: You know, I think if you can explain this to people and have a little bit of time to explain it and not have it be presented in a way that’s dismissive of their pain or minimizing of their pain. I think it lands well. I’ve had a lot of patients ask me about the book. I’ve had a lot of other people just, you know, flying around. People stop you on planes and talk about the book.

And it’s a common problem. So if you don’t have it yourself, you know somebody who does, and you know, this idea that the brain is the ultimate arbiter of pain, and to be able to sit down and explain that, like, look, it did something to your body, and those pain signals are going to your brain.

Your brain is looking at those pain signals, but they’re also looking at, have you done this before, is there bleeding associated with this? What’s the weather like outside? Are you in a good mood? Do you have depression? Do you have anxiety? It’s taking all of these different things and basically trying to make sense of it and seeing how it should respond. You know, how much pain you’ll actually have from that. It’s a complicated scenario.

And the brain can even make pain. People have phantom limb pain, right? It’s wild to me. The limb doesn’t even exist.

DOCTOR MIKE: Pain medications can cause pain and pain.

DR. SANJAY GUPTA: Medications can cause pain because they suppress your body’s own opioid system. So all of a sudden you don’t have your nice reserve of opioids to rush to the rescue when you have a pain episode because those outside opioids have suppressed. Your body says, hey, I don’t need to make opioids anymore. I’m getting it happily from these pills.

So then all of a sudden you may start to have more pain. And if you stop the opioids, that pain may be exacerbated even more, which leads to the addiction.

Acupuncture and Alternative Treatments

DOCTOR MIKE: Yeah, it’s very interesting. Within your book you talk about work that is in the alternative space. People oftentimes in evidence based world, look down upon things like acupuncture, for example. And I find acupuncture so interesting for a few reasons.

One, I see why they say that because the evidence hasn’t been fantastic. But at the same time, as someone who got acupuncture, I tore my not rotator cuff. This was for my labrum. I got acupuncture performed at the recommendation of my father, who is also a primary care physician and having the issue for three, four years of sometimes just locking terrible pain, recurrent, over and over. Can’t solve it. PT failed all of this stuff. One session with an acupuncturist solved it for like a decade.

DR. SANJAY GUPTA: Wow, good for you.

The Acupuncture Experience

DOCTOR MIKE: And I said, how? I’m a disbeliever in this thing. And yet it worked. And then interestingly enough, when I was preparing for my Showtime pay-per-view boxing match, funny thing to say, as a—

DR. SANJAY GUPTA: Your friendly neighborhood neurosurgeon did not—

DOCTOR MIKE: Think that was a good idea. If only we’d met, that I was experiencing some medial epicondylitis and I went to an acupuncturist and I said, oh, this could be a good opportunity because it wasn’t getting improved with anything else. And off one session it improved 80% where I said, this is amazing. Let me go for the second session and just knock it out.

Of course, second session hits a nerve and I had the worst neuropathy shooting into my head for months on end. So it’s interesting to see how perhaps it was good that happened because to me, it says something. If there are side effects, because some people say there’s no side effects. If there are side effects, that must mean there are effects, because anything that has no side effects probably has no effect anyway.

What people often say about supplements and oh, just take this, there’s nothing that can go wrong. But then if nothing can go wrong, that means it’s not doing—it’s an inert substance, it’s the active ingredient. So I’m curious where you land with all that you said with acupuncture.

The Challenge of Evidence-Based Medicine

DR. SANJAY GUPTA: So if I can just widen the aperture for a second, because I think this is a really interesting point you’re making about acupuncture, but also the point you make about supplements. There’s not good data. And what I would say on top of that is there may never be good data. We may be waiting for data that may never come because there’s no need for it.

Number one, in terms of a regulatory standpoint, people are performing procedures, people are taking supplements. There’s no need for phase 3 clinical trial sort of level data to be presented in order to do that. So people aren’t going to do it if it’s not required, number one.

Number two, those are really hard studies to do. If you have a single molecule drug or even a simple drug that’s more than a couple molecules, that’s easier to sort of test and to control against things. When you were getting your acupuncture, my guess is you probably had tried other things. Maybe it wasn’t your first thing, and maybe after the acupuncture you tried other things as well.

It may have been hard to know exactly how much of your benefit, at least initially, was from the acupuncture. But in no way does that take away your experience where you say it was 80% beneficial. So I think that’s just something to keep in mind. And I struggle with this because we do a lot of reporting on supplements and you can always say, hey, look, there’s not great data behind this.

DOCTOR MIKE: Fair.

DR. SANJAY GUPTA: But there may never be great data behind this. So what is your obligation then as a physician, if a patient asks you about this? I think the obligation is twofold. One is you’ve got to make sure they’re not doing anything dumb in terms of harming themselves. And I think you and I talked about this the last time we spoke. That safety part of it has to—that is an obligation in terms of recommending good sources for the supplements.

But I think the second thing is that who am I as a physician to say that didn’t help you? You say it helped me. Well, no, it didn’t. There’s no data to suggest that it would have helped. You can’t say that. The patient is the North Star when it comes to this stuff.

Traditional Medicine and Modern Evidence

So when it comes to things like acupuncture, I do place some credence, and some would say maybe I place more credence than it deserves on the fact that some of these modalities have withstood the test of time, more than a thousand years of people doing these types of things. You do think that just from an evolutionary behavioral standpoint that if something truly was not working at some point, it would just sort of fade away over time.

And yet, in fact, you’re starting to see some data, first of all, around acupuncture. People are trying to do these studies, as hard as they may be. And you’re seeing it appear in places around the world where you really hadn’t seen it before. It was primarily in China, primarily part of traditional Chinese medicine. And now you tried it here in the States, presumably. And I know a lot of other of my patients who’ve tried it as well. My wife does acupuncture.

DOCTOR MIKE: Right.

DR. SANJAY GUPTA: My father does acupuncture. So I think you have to weigh all that together. That person sadly hit your ulnar nerve. Sounds like that’s terrible. That shouldn’t happen. And you do need to go to—and it’s the same sort of thing with supplements. You want safe supplements, you want well-trained practitioners should not be hitting an ulnar nerve. You can feel the ulnar groove, and you should feel that. And you know exactly what that ulnar nerve is. And if you’re not sure, I can tap here. My pinky fingers smell, right?

DOCTOR MIKE: There’s pink.

DR. SANJAY GUPTA: I can feel it. That’s where it is. They shouldn’t hit your ulnar nerve is my point. So you want to make sure these things are done safely.

The Business of Supplements

DOCTOR MIKE: Yeah. The line that I always think about with supplements is, look, if it’s working for my patient, they’re happy with it, and I see no negative outcome. Again, who am I or who are we to say that it’s wrong? It’s when it starts creeping into the business model of health care and people make that their calling or they make that the predominance of their business. Where, oh, doctors are hiding supplements from you. The medical system is hurting you.

And I actually, I know it feels like we’re name dropping and you’re probably going to say the same line that it’s hard to hate from up close, but there’s a prominent name, Dr. Mark Hyman, that comes up quite often in this space, especially in the functional medicine space. I know you’ve blurbed his book in 2018.

DR. SANJAY GUPTA: You’ve done your homework. How do you—you don’t have any notes. How do you remember all this? Medical school? Can you tell me what other books I have learned?

DOCTOR MIKE: It’s a topic I’m very passionate about because I always—the curiosity of why I started the channel was always to get at the truth and it never was because I favored one side over the other. I wanted to know the truth so I could best help people. And if someone has something that is valuable and can help people, I don’t care if it’s a supplement. I don’t care if it’s at my expense. I want to help people.

And I oftentimes see people who go into this space, perhaps with good intentions, and then it turns into a business and it starts losing the sense of actually helping people.

DR. SANJAY GUPTA: Yeah.

DOCTOR MIKE: And you start seeing Mark Hyman introducing Secretary Kennedy on his podcast as someone who’s not anti-vaccine, as introducing concepts like detox your body or leaky gut syndrome, which we know not to be a true medical diagnosis. It further makes the practice of medicine difficult because it leads patients down a path which is not very scientific and it further creates a disconnect between us. So I’m curious where all of that lands for you.

The Money Question

DR. SANJAY GUPTA: It’s complicated, Mike. I think first of all, as a top line, I don’t necessarily begrudge people for making money.

DOCTOR MIKE: Sure, on its own it doesn’t mean anything. This YouTube channel is a for-profit YouTube channel.

DR. SANJAY GUPTA: But there’s people who immediately assume that if someone’s making money on something, they’re too inherently conflicted to be able to present things. And people may say that you’re not doing that, but people may say that about you. Hey, he’s going to try and get the clicks. So he’s going to try and say things that are going to get more clicks and make more money. That’s what they say. Mark, again, I don’t know if you’ve heard me say this yet, but it’s hard to hate close up.

DOCTOR MIKE: I haven’t heard that in at least half an hour.

DR. SANJAY GUPTA: I mean, I’ve known Mark for a long time. I think the book that I blurbed, I think you were talking about one of his diet books. He’s written a few. And I do think that there’s this notion that as much as we think people know how to eat well, they don’t always. And being able to present that information to them, I think is important.

We don’t talk a lot about nutrition. So the fact that he was doing that and he was doing that at Cleveland Clinic and setting up that clinic there I thought was good because Cleveland Clinic is this place that you think of as a tertiary care center. So to have a super primary care sort of functional health component I thought was very interesting.

If someone is saying these supplements are going to help you, and at the same time we keep in mind that there’s not good data around that, and there may never be good data around that, what are we to do with that? And I’m sort of just riffing with you because I don’t know the answer to this. I thought about this a lot. If you’re an experienced doctor for something that you’ve done and you think it can really help people, again, making sure it doesn’t harm them and doesn’t fleece them, which is harm as well.

Informed Consent and Transparency

DOCTOR MIKE: What do you do with that? To me, it ends up like every other recommendation I give to my patient. It has to be done with full informed consent.

DR. SANJAY GUPTA: Yes.

DOCTOR MIKE: And in order to be honest about the informed consent, as you just were in discussing this, if you’re Mark Hyman and you’re recommending supplements, you have to honestly say that there’s no data to support it or no quality data. And that’s not being said.

DR. SANJAY GUPTA: I think you’re right about that. I think the claims are exaggerated, for sure, and that’s problematic. I agree with you on that. That’s a good point. I think sometimes that just becomes the inertia of something. Or we’ve had patients who’ve had a complete turnaround in their XYZ problem. However it might be presented, it’s definitely presented in a way to be highly persuasive. And I think that’s where it veers into being potentially problematic.

But there are people out there who are clearly selling bad things out there. Not only do they not have good data behind it, they could harm you. They could actually cause you to get sick. And I think for me, still, that is, if there’s such a thing as a red line in medicine, that’s where I draw that red line where you’re harming people, you’re just fleecing them their money and you know it’s problematic for them, but you’re doing it just to make money.

DOCTOR MIKE: Yeah. There’s obviously a spectrum here. I’m not saying that those are equivalent by any means. At the same time, as one of my friends says, we can walk and chew gum at the same time and call out those for the truth. In the same way that I’ve recommended acupuncture for patients.

DR. SANJAY GUPTA: Yes.

DOCTOR MIKE: Even though I know that there’s a paucity of evidence. But when I present it, I explain that there’s a paucity of evidence and we don’t yet know how this truly works in the human body, of giving you a complete mechanism of action. But it’s worked for me. And I know you’ve run out of options and you’re looking to try something. Perhaps we could find you someone who’s legitimate to do it.

I think that’s a fair way to do it. And some people would still argue that I’m wrong and that I shouldn’t recommend anything unless it has a Grade A Cochrane level of evidence behind it. And that’s where it becomes tricky. And everyone has their own line.

The Spinal Surgery Comparison

DR. SANJAY GUPTA: I mean, just not to interrupt you, but we as a country in 2023 did 1.2 million spinal operations. You alluded to this earlier to give context. In the UK, they did about 50,000. Now they’re a quarter of our population. But even after you account for population size differences, we still do six times as much as a country like an area like the UK.

Point being that there’s probably not great data on the necessity for all those spinal operations. Patients come in terrible pain, they have a spinal problem. Are we sure that fixing that spinal problem is going to actually help their pain? No, but we tell the patient, look, we’re not certain it’s going to help, but they’re at their wit’s end, they want to have something done. I think you sort of see that same thing permeating in the supplements.

DOCTOR MIKE: So you’re seeing the consumerization part of it.

DR. SANJAY GUPTA: Yeah, I think so. I think when it comes to supplements overall, I mean, it’s a huge industry and people are making a ton of money on this, make no mistake.

DOCTOR MIKE: I mean, some people say that it’s more in terms of, if you put everything into the wellness industry, it’s bigger than the pharmaceutical industry that people oftentimes badmouth for being financially invested.

The Supplement Industry Debate

DR. SANJAY GUPTA: Yeah, that is an irony that I think you and I have both probably just witnessed up close, which is the same people who are berating the pharma industry and saying, well, those guys are all conflicted and they’re making tons of money selling their supplements now. As you say, you can walk and chew gum at the same time. Both things could be true.

There were times when we prescribed way too many pharmaceuticals. We still do. But I’m not sure filling the vacuum with supplements that don’t have great evidence is the right answer. And yet I find it a little bit hard to, if people are doing it in the best interest, making sure things are safe for them. Like someone who’s working out a lot and they want to start taking creatine, for example. I get asked this all the time.

DOCTOR MIKE: You probably do as well, especially right now. It’s Hot Topic.

DR. SANJAY GUPTA: Hot Topic. So I’m curious, how do you answer that question?

Creatine and Supplements for Athletes

DOCTOR MIKE: Obviously patient dependent, depending on age demographic, all that, but my general sense is unless you’re a professional athlete, you don’t need it. You just don’t need it. Simply because whatever advantage is going to give you is going to be so minimal in comparison to whether or not you actually stick with this program or continue working out.

So to me, professional athlete, I use loosely because I have some of my weekend warriors that I consider professional athletes. So you have to prove that you’re going to be working out religiously for years on end before you need the last 5% coming from a supplement.

DR. SANJAY GUPTA: So you could tell from my physique that I work out continuously. Absolutely.

DOCTOR MIKE: So for you crazy 55 year old.

DR. SANJAY GUPTA: No brainer. I work out every day. I try and do something every day, swim, bike, run or do some sort of resistance training every day. I mean, I’m seriously asking this because, you know, you and I again have looked at the same data and also what I would say about my diet, which I think is germane to this conversation, is that it’s a pretty good diet, but I probably don’t get as much protein as I should. If you listen to guys like Peter Attia and stuff like that, they’re saying, I think it’s a gram per kilogram or something.

DOCTOR MIKE: Well, he goes a little bit extreme and Eric Topol here has criticized him in the opposite direction.

DR. SANJAY GUPTA: I know. And there’s been others who say, you know, they come to the United States.

DOCTOR MIKE: But I think a gram per kilogram is reasonable. Gram per kilogram is reasonable.

DR. SANJAY GUPTA: But, you know, based on diet and all that, I sort of came to the conclusion that those precursor amino acids, for me, would be a good thing. I’m worried about the BCAs. And also the creatines, you know, the things that are harder for me to get in my own diet.

DOCTOR MIKE: Got it.

DR. SANJAY GUPTA: Muscle mass is harder for me to put on. As I’ve gotten older, I was always sort of more muscular, and I’ve noticed myself sort of having to work harder to maintain that muscle. So that’s sort of where I arrived at it. I think there are some of these companies, again, which I’ve dug into in terms of the safety, again, really making sure that they’re not selling some sort of product that could be harmful to people. And, you know, I guess we’re saying sort of the same thing, but I think there can be a role, for sure.

DOCTOR MIKE: I mean, I prefaced it by saying it depends on the individual. For someone who is losing muscle mass and wants to maintain it and is actively working out, it makes sense. And then there are patients who are just curious and want to do it casually and are asking, safety profile.

DR. SANJAY GUPTA: Right.

DOCTOR MIKE: And I’m like, look, you’re healthy. There’s no reason why this is. I’m not going to discourage you.

The Politicization of Health Topics

DR. SANJAY GUPTA: Yeah, I totally agree with you. I think it’s funny, though, this hearkens back to what you said earlier. For some reason, even something like creatine ends up getting politicized.

DOCTOR MIKE: Yeah, for sure.

DR. SANJAY GUPTA: Don’t you think? I mean, if you say, who are the most likely people to take creatine in the country? Why should a Republican be more likely to take creatine than a Democrat? Makes no sense.

DOCTOR MIKE: Well, because they’re consuming the media that is most frequently talking about it.

DR. SANJAY GUPTA: And so as a result, let’s say something was truly beneficial. Would people purposely opt out of it just so as not to align themselves with the political party?

DOCTOR MIKE: That’s the fear I have.

DR. SANJAY GUPTA: It’s crazy. Yeah, it’s weird.

DOCTOR MIKE: Which is why I’m encouraging everyone in the political sphere, whatever party you’re a part of, to come into this world. And we kind of saw that play out on the presidential election, based on just the number of podcasts done by each party, to see the impact that that’s had.

DR. SANJAY GUPTA: Yeah. And the idea. I never, again, after almost 25 years of doing this, I never imagined that these types of topics would end up being such a political sort of bludgeoning tool. It’s strange.

FDA Regulation and Research Funding

DOCTOR MIKE: It’s very strange. And I’m curious ultimately how it will play out. Will the FDA ever have a role in regulating supplements? And I see why you say that. From a regulatory standpoint, it’s really expensive to do randomized controlled trials. What company’s going to do that for something that’s generic and they’re not going to make any money on.

To me, that’s where the government funding comes in. You’re supposed to be funding the research that is not profitable. I had the pleasure of interviewing Dr. Fajgenbaum, who you also had on your program.

DR. SANJAY GUPTA: Wonderful, wonderful guy.

DOCTOR MIKE: And he’s doing work that is financially not very valuable, but from a systemic healthcare standpoint and practical standpoint, incredibly valuable.

DR. SANJAY GUPTA: Yes.

DOCTOR MIKE: And he’s doing it through a nonprofit lens. But why isn’t the NIH doing that?

DR. SANJAY GUPTA: That’s a great question. Yeah. And you know, it takes whatever a billion dollars in 10 years to bring a new drug to market. So if you could repurpose an existing drug, save a lot of money for society. The NIH, I think, does have a division that studies repurposed drugs.

DOCTOR MIKE: They do, they do. And they have a complementary medication division as well.

DR. SANJAY GUPTA: I’m not sure how active it is.

Global Health and International Cooperation

DOCTOR MIKE: But we see the funding cuts that we’ve experienced thus far, obviously zooming out and even going further, watching us pull out of GAVI and WHO and USAID. I’m currently the UNICEF ambassador for USA.

DR. SANJAY GUPTA: Congratulations. My wife’s on the board of UNICEF in the Southeast and she flagged it for Ms. Dr. Mike.

DOCTOR MIKE: But it’s terrible because our nation is not really a part of it anymore. We had UNGA here, 80th anniversary. I’m speaking, and I’m frankly embarrassed that I’m part of a country that’s not supporting this movement.

And what’s interesting is I’m not trying to pull on heartstrings to get people involved in the UN and WHO. Be selfish and invest in WHO. It’s in your own self interest to know what tuberculosis is going on in small parts of the world and in small pockets where it still exists.

DR. SANJAY GUPTA: Yeah.

DOCTOR MIKE: So I don’t understand. It’s in self interest to help others and you’re discontinuing the funding for it.

DR. SANJAY GUPTA: And you could even make the case that it’s financially responsible to do this in terms of preventing potential problems. You know, I mean, I’m worried about highly pathogenic avian influenza. I don’t, you know, we were talking about it a lot a year ago and all of a sudden all the information about what is happening with that sort of dries up.

You know, states may report it, but we don’t have sort of a federal repository of that information anymore. Yeah, it’s almost like turning a, literally turning a blind eye to some of these problems. And then I think, you know, I’m worried that we’re going to get caught flat footed.

I do think the point that you’re making about the United States role overall in this is really important. When this brain tumor researcher left and went to South Korea, I remember having this conversation with somebody. I was sort of lamenting the fact that we were trying to build this brain tumor consortium in the southeast and you know, we’re losing people.

And he said this thing to me that I won’t forget. He said, if that person goes to Seoul and develops a new therapeutic for brain tumors, would citizens of the United States have access to it? And to be fair, I thought, well, yeah, I don’t think they’re going to just hold it themselves and be so proprietary about it, not to allow it to help other people.

And then it became a question of should we be the ones that are investing in that then, or should we let some of this stuff happen elsewhere and then be brought to the United States? And I think this is one of the big cultural inflection points with regard to the country as a whole. Who do we want to be 10 years from now?

You know, we don’t manufacture the way that we used to. You know, my parents are both automotive engineers. How we think about manufacturing is different now than when they were working. Will medicine be thought of the same way? Like we used to attract everyone and now we’re allowing some of that to happen elsewhere because we’re so focused on, you name it, quantum mechanics, AI and going to Mars.

I don’t know, whatever those things may be, that may be where we’re headed. I don’t like it, obviously as a physician, but I think there are some big decisions being made about the very direction of the country.

The Brain Drain and Economic Impact

DOCTOR MIKE: Yeah, it’s quite literally, especially in this scenario, a brain dump.

DR. SANJAY GUPTA: It’s tough to manage, it’s tough to keep on top of all of it.

DOCTOR MIKE: And I think about this hypothetical that you’re presenting and I’m wondering if they do develop a drug there and it’s good, what happens here in the U.S.? Well, to me what plays out is they sell it here because they still want to make money.

DR. SANJAY GUPTA: Sure.

DOCTOR MIKE: And they know we’re a wealthy market.

DR. SANJAY GUPTA: Yes.

DOCTOR MIKE: So they’ll charge us heavily for it. And one might say, well, it’s the same. We’re paying a lot now, and we’ll be paying a lot then, but we didn’t have to do that research. Well, to me, at least, we’re paying it into our own pockets versus now you’re paying it into another country’s pockets.

DR. SANJAY GUPTA: There you go. I mean, however you want to dissect this issue, medically, morally, financially, it does make sense to do the things the way that we’ve done, the way that they evolved into the system that existed for a long time. Seventy years since World War II, at least, we would be not only paying our own selves, but also recruiting those scientists to be here and recognizing that knowledge in and of itself is a currency.

It’s a valuable currency, one that we should be investing in. You don’t have kids. I have three kids, and I often get asked the question, would you encourage them to go into medicine? I’m curious, and I always do. Really?

DOCTOR MIKE: Okay.

The Future of Medicine as a Profession

DR. SANJAY GUPTA: Yeah. I think medicine is still the queen of all professions. It’s just, I mean, you and I get to bifurcate our lives. And I don’t know about you, Mike, but I imagine on the days you’re waking up and you’re going to see patients, your purpose that day is pretty clear, for sure.

And you take it for granted. Maybe, but that’s not something a lot of people get to experience. You come to your media world and it’s probably more convoluted, you know, taking care of patients one on one. I think it’s very, there’s few things that are as gratifying as that, so I agree.

But, you know, kind of like you’re saying, I want to present the whole picture. There’s a lot of changes happening in healthcare. They need to know that AI is probably going to take some of those jobs. So certain jobs I’d probably gravitate away from, others that I’d lean into, but I still think it’s a wonderful profession, for sure.

DOCTOR MIKE: So hopefully we’re around in 10 years. Hopefully our nation’s still around in 10 years. We’re having our conversation. V2, perhaps we’ll talk before then. But where do you think we are in 10 years?

DR. SANJAY GUPTA: I think the truth prevails. Ultimately, I think that these are tough times. I mean, here’s what I would say. And I mean, this is sort of a gloom and doom question. So, and I’m an optimistic guy, but I think either truth prevails or everything is lost. So I don’t think there’s a lot of, how’s that? How’s that?

DOCTOR MIKE: I love it. Yeah.

The Future of Truth and Healthcare

DOCTOR MIKE: That’s how we’re ending it. Just either implosion or succession.

DR. SANJAY GUPTA: Yeah, I mean, kind of like. And I heavily tilt the odds in favor of the truth will prevail and we’ll be okay. And we’ll look at this chapter as one that was strange, destructive to a huge extent. But sometimes things get broken in order to be fixed. You know, I mean, things can simmer along semi bad for a long time and no one actually does anything about it.

But I think there’s some things right now that are being broken that hopefully will be rebuilt in a way that will be maybe even better. And I think the truth will prevail. I think that people will learn a lot more about how to embrace uncertainty, to lean into the nuance of things again, which you do so well. I’m not just saying that because you’re here, but you do.

I think we’ll, in that way we may become a more informed society. I am bullish on AI. Like any new technology, I think that there’s concerns about it, but I think it’s here. I think it’s going to actually fundamentally make our healthcare system stronger. Ultimately, I’m glad CMS is putting money into this.

So, you know, I’m optimistic and I’m not going to sit on the sidelines just praying that it happens. I got kids, you know, I care about this country. I care about our collective well-being a great deal. So with you, me and lots of others, I hope things turn out well and I’m pretty optimistic that they will. Same.

DOCTOR MIKE: I’d like to believe I’m an optimist as well. So I share your notion in this regard. And I think I was speaking to Senator Chuck Schumer the other day and he said something like “good always wins. It just depends on the timeline.” And I think that applies here. So I hope to be as optimistic in 10 years as we are today.

DR. SANJAY GUPTA: The Martin Luther King quote about the arc of, and in that case, he’s talking about justice. Maybe a slow bend, maybe a deep bend, but it always bends. And I think that’s the case here as well.

DOCTOR MIKE: For sure.

Closing Remarks

DR. SANJAY GUPTA: Well, Dr. Gupta, sir, call me Sanjay, please, after this. You called me Sanjay.

DOCTOR MIKE: No, no, I took the tie off. I have to.

DR. SANJAY GUPTA: To keep it.

DOCTOR MIKE: Okay. Fair. Sanjay, thank you for your integrity leading the way for inspiring me to continue doing this work. And hopefully the channel and our team continue to make you proud.

DR. SANJAY GUPTA: I have no doubt you will. And like I said, it’s an honor for me to be here with you. I feel like I’m getting a little glimpse into the future. You’re going to outlast all of us. And so I really appreciate you doing the work that you do.

DOCTOR MIKE: Thank you. Speaking of CNN and the news, I reacted to medical emergencies that were caught live on television. Click here to check that out. And as always, stay happy and healthy.

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