The Peter Attia Drive

Latest Episodes:

#71 - Katherine Eban: Widespread fraud in the generic drug industry Sep 16, 2019

Show notes

In this episode, Katherine Eban, investigative journalist and author of Bottle of Lies, illuminates the prevalence of fraud in generic drug manufacturing which brings into question the idea that generics are identical to brand-name drug as we are lead to believe. Katherine walks us through how this widespread corruption came to be, including the shocking story of one particularly egregious (and unfortunately not uncommon) example of an Indian drug company, Ranbaxy, whose business model was completely dependent on falsifying data in their drug applications to the FDA. We then discuss the subsequent investigation into Indian and Chinese drug manufacturing plants which revealed that nearly 80% of them are tainted with fraud. We conclude this discussion on a positive note with i) how individuals can investigate their own drugs to protect themselves ii) an innovative pharmacy attempting to disrupt the market and iii) some ideas on how to reform to the regulations around generic drugs, the FDA, and more.

We discuss:

How Peter found Katherine's book, and what convinced her to investigate the generic drug industry [5:45];
Branded vs. generic drugs: Why they aren't the same thing [11:15];
The Food and Drug Administration: Why it was originally created and what it does today [20:45];
How the generic drug industry really got its start in the U.S., and the flaw of the Hatch-Waxman Act [28:20];
PEPFAR: How a well-intentioned plan to help Africa with the AIDS epidemic laid the groundwork for corruption [36:30];
The story of Ranbaxy: An Indian drug company whose business model was fraud and deceit [40:45];
How the FDA approves drugs, the impact of "first to file", and Peter's tangent on moral corruption [47:30];
A booming generic drug market and the FDA struggling to keep up [57:15];
Dinesh's internal investigation finds widespread fraud and falsified data inside Ranbaxy [1:00:15];
Presenting the famous SAR document to Ranbaxy's board of directors which spells out the company-wide fraud [1:09:15];
Dinesh blows the whistle on Ranbaxy which leads to a raid on their US plant [1:19:45];
Formal investigation of Ranbaxy is launched, but the FDA keeps approving Ranbaxy drug applications [1:33:30];
What role does the culture in India play in the high prevalence of fraud in the drug industry? [1:41:00];
The extreme prevalence of data fraud/manipulation in foreign generic drug factories [1:52:30];
Concluding the Ranbaxy story [2:06:15];
How concerned should you be when buying a generic drug from your local pharmacy? [2:11:15];
How to investigate your own drugs for quality to ensure you are getting what you need [2:18:30];
An innovative pharmacy that tests all its drugs for quality [2:24:45];
Reforming the FDA and generic drug industry: Why we need reform and ideas on how to do it [2:27:45];
The importance of taking individual ownership and not waiting for Congress to bail us out [2:34:00];
Closing thoughts from Katherine [2:36:50]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:

https://peterattiamd.com/katherineeban/

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Qualy #24 - What are the "ABCs" of Alzheimer's prevention? Sep 13, 2019

Show notes

Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer's prevention.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

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#70 - David Sinclair, Ph.D.: How cellular reprogramming could slow our aging clock (and the latest research on NAD) Sep 09, 2019

Show notes

In this episode, David Sinclair, Ph.D., a Professor in the Department of Genetics at Harvard Medical School and co-Director of the Paul F. Glenn Center for the Biological Mechanisms of Aging, returns to the podcast to discuss the content of his new book, Lifespan: Why We Age - and Why We Don't Have To. This conversation focuses on the biological mechanisms involved in what David terms the Information Theory of Aging which provides insights into the "clock" that determines our aging and to what degree it can be manipulated. Our discussion on aging of course leads us into interconnected topics of epigenetics, sirtuins, cellular senescence, as well as what compounds David is personally taking for his own longevity. Additionally, we discuss the most up to date information related to NAD and longevity by looking at the potential benefits (if any) of supplemental agents (NAD precursors, NR, NMR, etc.) that pose a promise of increasing NAD.

We discuss:

SIR genes and cellular identity [8:45];
Sirtuins regulate gene expression [14:30];
DNA is methylated at the deepest layer of the epigenome [17:45];
Methylation pattern and determining cellular age [20:15];
Cellular reprogramming [33:45];
Yamanaka factors to push cells "back in time" [41:00];
Human cellular reprogramming viability [57:00];
Measuring the rate of aging [1:02:45];
Cellular reprogramming for longevity [1:14:45];
Compounds David takes for his own longevity [1:29:15]
NAD precursors (NR, NMN) and pterostilbene [1:40:00];
The current field of sirtuin activators [2:03:15];
David's artistic work [2:05:15] and;
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/davidsinclair2/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #19 - A unifying theory of aging Sep 05, 2019

Show notes

Today's episode of The Qualys is from podcast #27 – David Sinclair, Ph.D.: Slowing aging – sirtuins, NAD, and the epigenetics of aging.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#69 - Ronesh Sinha, M.D.: Insights into the manifestation of metabolic disease in a patient population predisposed to metabolic syndrome, and what it teaches us more broadly Sep 02, 2019

Show notes

In this episode, Dr. Ronesh Sinha, a physician, author, and educator based in Silicon Valley, shares his many insights into metabolic illness that he has gleaned from his South Asian patient population. In this conversation we focus on hyperinsulinemia, insulin resistance, metabolic dysregulation, inflammation, blood pressure, obesity, etc. and ways to address them with nutrition, sleep, exercise, stress management, and more. We also take a deep dive into insulin resistant phenotypes, evolutionary theory and geographic determinants of insulin resistance which provides insight into the genetic architecture and pathophysiology of metabolic syndrome. Additionally, we discuss the surprisingly interrelated topic of stress, and how we might be inadvertently passing this on to our children, leading to mental and physical sickness down the road.

We discuss:

How a stubborn case of insulin resistance connected Peter with Ronesh [7:15];
Ronesh's clinical treatment focus of metabolic illnesses in South and East Asian patient populations [8:45];
The distinction between visceral fat and subcutaneous fat stores [15:00];
Shortcomings of a body mass index (BMI) calculator for evaluating metabolic disease risk [17:15];
Cortisol and blood glucose variability [28:30];
Insulin's role in elevated blood glucose: A symptom of metabolic syndrome [33:25];
Mechanistic explanations of insulin resistance (there may be more than one) [35:15];
Theories on origins and evolutionary reasons for insulin resistance [40:00];
The inverse relationship between the amount of brown adipose tissue and rates of insulin resistance, and the role of climate in patterns and prevalence of insulin resistance [49:50];
Vitamin D levels, hyperinsulinemia, and other effects [53:45];
The evolutionary benefit of being able to turn fructose into fat (and the price we are now paying for it) [58:00];
The VO2 max relationship to insulin resistance and familial metabolic health [59:30];
Using zone 2 fitness test to evaluate mitochondrial performance [1:01:15];
Exercise for long-term functional health [1:06:00];
Lifestyle changes to improve insulin resistance and other metabolic phenotypes [1:14:00];
Is PCOS a manifestation of insulin resistance? [1:21:00];
The impact of stress on adiposity, and Peter's treatment regimen for overweight females resistant to typical nutritional approaches [1:23:45];
How a culture of achievement and expectations can lead to undue stress, unhappiness, and health problems in our children (a Silicon Valley case study) [1:35:00];
The negative impact of devices and social media on children [1:48:45];
How you can help yourself, your family, and your community without being an MD or PhD [1:55:00]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/roneshsinha/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #16 - How much does cognitive activity ward off cognitive decline? Aug 30, 2019

Show notes

Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer's prevention.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#68 - Marty Makary, M.D.: The US healthcare system—why it's broken, steps to fix it, and how to protect yourself Aug 26, 2019

Show notes

In this episode, Marty Makary, Johns Hopkins surgeon and NYT bestselling author, discusses his ambitious attempt to fix the broken U.S. healthcare system through educating the public, changing the lexicon, encouraging radical transparency in pricing, and more. We go in detail into the main drivers of inflated health care costs, the money games being played making it hard to understand, and the unfortunate system structure that has resulted in one in five Americans finding themselves in medical debt collections which can ruin the lives of people and families seeking basic medical care. Marty also shares some very practical advice and tips if you find yourself a victim of predatory pricing and stuck with an outrageous medical bill. In the end, despite the current state of the system, Marty discusses the many exciting trends gaining traction in healthcare and why he is very optimistic and hopeful about the future.

We discuss:

The science of delivering healthcare, how we need to do better as a system, and why no single person or entity fully to blame [10:15];
The stories that prompted Marty to write his first book (Unaccountable) [19:15];
The Surgery Checklist [26:15];
The problem is with the system (not any one person or entity) and the misaligned interests of all the parties involved [28:15];
Patients crave honesty and transparency, and the story of Peter's back surgery gone wrong [33:00];
Today's med students and young doctors have less tolerance for predatory pricing and healthcare industry BS [44:30];
Funny stories about John Cameron (legendary surgeon at Johns Hopkins) [48:00];
How doctors are trained to internalize traumatic experiences which can result in a misunderstood form of "burnout" [57:40];
The beat down of med students with traditional medical education and some exciting innovations to medical education [1:07:00];
Exciting trends in healthcare and an optimistic view of the future [1:11:30];
The Price We Pay (Marty's new book), an attempt to illuminate the blackbox that is the US healthcare system [1:21:00];
Why it's not always in the best interest of the insurance company to negotiate the best price [1:28:30];
Who is actually paying for medical costs, and Marty's frustration with the healthcare lexicon [1:32:00];
Pros and cons of a single payer system [1:37:00];
How to fight outrageous medical bills and predatory pricing (and make a dent in the wasteful healthcare spending for the country) [1:49:30];
Disrupting the healthcare industry with private healthcare facilities with market demanded transparency [2:05:45];
The people hurt the worst by the current US healthcare system, the sad breast cancer statistic, and the importance of knowing that medical bills are negotiable [2:09:30];
The healthcare industry bubble [2:14:00];
Increased costs from unnecessary tests and procedures [2:16:30];
Malpractice concerns due to the litigious culture in America: What influence does it have on unnecessary testing, healthcare costs, and overall quality of treatment [2:22:00];
Drug pricing, price gouging, middle-men money games, kickbacks, and other drivers of healthcare costs [2:27:45];
How can we possibly fix the healthcare system? [2:34:30];
Helpful resources [2:46:15]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/martymakary/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Qualy #9 - The importance of exercise for brain health Aug 20, 2019

Show notes

Today's episode of The Qualys is from podcast #02 – Rhonda Patrick, Ph.D.: the performance and longevity paradox of IGF-1, ketogenic diets and genetics, the health benefits of sauna, NAD+, and more.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

#67 - AMA #8: DNA tests, longevity genes, metformin, fasting markers, salt, inflammation, and more Aug 19, 2019

Show notes

In this "Ask Me Anything" (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter's head of research, asks the questions. If you're not a subscriber and listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #8 show notes page. Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs. We discuss:

Do DNA kits provide actionable info for cancer, CVD, diabetes, Alzheimer's, nutrition, or exercise? [1:45];
What genes increase longevity? And do those genes show up on genetic tests like 23andMe? [12:00];
Who are some people that Peter would like to have as guests on The Drive? [15:00];
Inflammation: Is CRP a useful marker? What can one do to reduce it? And what other inflammatory markers can I look at to gauge health? [18:30];
What lipid test does Peter now use on his patients? What are the three best cardiovascular laboratories? [28:00];
Metformin for longevity: What considerations should one think about before doing taking metformin for longevity purposes? [32:30];
What is Peter's take on salt and its role in things like high blood pressure and stomach cancer? [40:00];
What markers does Peter find most interesting (and surprising) during his quarterly fasts? [47:30]; and
More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:http://peterattiamd.com/ama08 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.