Episode 17: Can you insure yourself against a bad outcome from cancer?

This is Dr. Charles Malcolm here with Inside the Cure with Dr. Warren Ringgold. Did I pronounce that right? Ringgold. Yes, Ringgold.

Yeah, you sure did.

And we're talking about full body mri, an imaging study to detect things such as hidden cancers and pick things up in advance. In our prior podcast, I talked about looking for the big three, which would be cardiovascular disease, cancer, and neurocognitive decline, which are the most common things that are going to take you out before you expected it. And the ideal situation, you know it well before it happens, you can take action. So give me a little bit about your story. You told me that you had gone through some issues yourself, that you started thinking about changing the way we approach cancer.

Yeah. Dr. Mok, about five years ago, unbeknownst to anything, on a Sunday, I had driven home from Chicago with my wife. We had gone to visit our daughter. I was symptomless. I had no night fevers, chills, rash, appetite loss, weight loss, nothing. I became acutely short of breath. The following day, I went to the hospital and I had stage four non Hodgkin's lymphoma, and it had spread into my abdomen, my liver, multiple lymph nodes. I never had a symptom. When I went for treatment, I was told by the oncology people, this is typical when you have a symptom and it's cancerous, you're at stage three or stage four almost invariably. So I decided I have a beautiful MRI facility in Southfield, Michigan. I decided to join the hunt. It's being done throughout the United States, California, Minneapolis, Tucson, Palm Springs. People using total MRI from the head through the genitals, looking for cancers at an early stage, 9 millimeters to 10 millimeters, when they can simply be excised and no further treatment. Sometimes we all know people who have had a tumor removed, and they say they don't have to have radiation or chemotherapy. But in the case of people who have symptoms, which is 71% of people who have symptoms first, they're usually stage three or stage four. Said, yeah.

So going back just briefly, your story, wanted to divulge too much, but you had an advanced stage cancer. Is this gone now?

Yes, I was treated at the University of Michigan in 19 or 2018 for about six months, and I was in remission. It was difficult treatment, but I was in remission. Nine months later, it came back in my brain, which is very, very rare. It's a very rare tumor. It's called secondary central nervous system lymphoma. Lethal if you look it up. It's two months life expectancy without treatment. I called the National Institute of Health in Maryland and. And they said we're looking for patient number one in a new study. We've abandoned the current treatment 18 months ago because it didn't provide any useful longevity. So I became patient number one in a federal phase one study, and I'm now 39 months in remission.

That's great.

Yeah. So I'm excited.

And you're one of the lucky ones.

Very, very lucky.

Yeah. So going back to your discussions, stages of cancers 1 through 4 and 1 is basically what you want to get. Precancerous. And then there's stage one, two, three, and four and four is one where it is spread, and it's usually too late. When you said about one, you said about nine millimeters or centimeters.

Nine to ten millimeters, Dr. Moka. A centimeter. About the size of a pencil eraser.

Roughly. And if you had a cancer like that, say, in your liver, what stage is it going to be?

It's going to be stage one, almost. Almost always with simple excision. Well, not simple excision. If it's in your liver, it's an open excision, but there's not going to be lymph nodes. Typically I have seen since we started doing it. Once I had a patient who had a 9 millimeter malignancy with a 4 centimeter metastatic lesion in the lumbar spine. So some of these small tumors can throw off metastatic lesions early, but in general, they have to be around for a while and go through a lot of doubling. We talk about doubling time. Doubling time of various tumors can be anywhere from three weeks to six months.

Yeah. Yeah. A fast one would be the pancreas. And that's a scary one.

Yes.

And slow ones might be. What would be an example of a slow. Like prostate.

Prostate would be very slow. That would be a great example.

So let's kind of go back to how we screen for cancer. Now, a lot of people don't know this, but prior to what's called the Affordable Health Care act, or we know affectionately as Obamacare, insurance companies were not required to pay for routine screening. In fact, routine screening was considered not medically necessary. And the insurance company could decide, or the employer could decide if they're going to pay for it or not. And in 2011, when they did the Obamacare Affordable Health Care act, they required insurance companies, including the government, to pay for certain screenings, such as mammograms and pap smears and cat Scans for people who are smokers and colonoscopies. But keep it in mind, prior to 2011, insurance company thought this wasn't even medically necessary. They want you to wait until you get sick and then they'll pay for. And that brings us back to, I think a fundamental of this series is that your health insurance is definitely not health insurance. You got disease insurance, just like your car insurance takes your car to accident but doesn't fill your tires or check your fluids. And your house insurance doesn't pay for. Your carbon monoxide detector pays for when the house burns down. Generally, health insurance is disease insurance. And an anomaly is that they are required to pay for screening tests which they never had been required to before. And if you do all the necessary screening tests on a general population, we will only pick up about one fourth of cancers before they're symptomatic. 1/4. So 75% of cancers are still missed with routine screening. That's how far we have to go. We look at colonoscopies starting at age 50. A lot of people don't do those. But even doing the colonoscopy, the mammogram, the Pap smear, the different studies looking for cancer and pre cancer, we pick up about one out of four cancers before they're symptomatic. There's something called liquid biopsy. I'm not going to go into a length here. I'll talk about it later on. This has got approved in the United States last year to do a blood test where you screen for genetic fragments of tumors. That doubles the effectiveness about 50%. We can find about 50% of cancer if we use a liquid biopsy, which is not covered by insurance just yet, and regular screening, 50%. And then now we're talking about a full body MRI. If you can just kind of explain to the audience, just briefly, what, how would you describe an mri?

An MRI is of course, it's a closed circular unit. We have a large bore mri. We don't have what's called an open mri, which is open on the sides. We have a large bore though. And after doing this for a year, we haven't had any patients who are unable to do it due to claustrophobia. I have had some patients that had to wear a mask. The MRI is done of your brain, your vascular system in the brain, looking for aneurysms. We do the MRI of the neck and soft tissues and lymph nodes and thyroid, and we move right down the body. We get access to your shoulders, your cervical spine, your thoracic spine, the lumbar spine. We do the chest, looking for aneurysms or cardiac enlargement. And when we move to the abdomen, that's where the meat of this is. The abdomen looks at the liver, the spleen, the stomach, the gallbladder, the pancreas, both kidneys, the ureters, the bladder, and the female and male genitalia. We do not do the legs. The legs add an extra 40 minutes of scanning. And in fact, when people have trouble with bony tumors, they present with pain. And the X rays of proper treatment, a proper evaluation. I mean, you are absolutely right when you talk about your percentages. 71 to 75% of cancers we cannot screen for. So colonoscopy, like you said, mammography, prostate examination, chest X rays, blood tests, those kinds of things covered. But more than 70%. Many figures say 71. Up to 75% of cancers occur outside the area that we routinely screen. No insurance is paid for it. So over the years, as a doctor, family doctor, and you would know, well, Dr. Mok, I've had many patients say to me, I want my whole body scanned. I would say, I would love to be able to order that for you, and I will. If you want to pay $45,000. If you look on a website of a local hospital, every area for an MRI costs $3,800.

We're talking about when it's not covered, which it would not be for screening.

Would not be. If it's screening, each area is 3,800. We do about 10 areas typically. So it would be 3,800 times 10, plus the radiologist reading fee, which is about 15 to 20%, say another 500 times 10. You're talking 45,000, $43,000 to be screened.

Like this in about probably eight hours.

Yeah. A long time in the machine.

Yeah. So I've talked to different radiology groups because I think you're the only one in Michigan doing this. I had my nuts into Health Nucleus in California, and there's a different protocol. So when we're looking at an mri, say of the pancreas, for example, they use a different protocol than a screening mri. So it takes a long, long time to scan the entire body with conventional methods. But in your case, is it a software from the manufacturer that gives you more time, efficient mri?

Yes, we have a software that aids us in doing more rapid evaluation of each area as such. It's a screening MRI. About 14 to 18% of people have some actionable problem. May it be malignant, may it Be vascular. May it be something that needs biopsy? We've had several that need thyroid biopsy. They shows a fairly large thyroid nodule. I just did a doctor this week who has a 2 centimeter lesion of a lymph node in his neck on the left side. We know, you and I know Dr. Mok that a 2 and a half centimeter lymph node is extraordinarily unusual and that could easily be a lymphoma. So hopefully Hodgkin's if it is a lymphoma. But we are able to move right down through the body in an orderly fashion. We generate a hologram of the whole body in the end so people can see it. And we print that out for them on their, on their finding. And we do that for a price of $2,799. Very affordable. Haven't had anybody complain about the price. People are happy with our facility, happy with our people and happy with the job that we do. And nothing brings me greater satisfaction than to tell somebody you're normal, it's all normal. We see nothing.

Are there times where you do the mri, the screening MRI and you see something that is just not sure. You just say we're just going to do a more conventional MRI to be more specific. Or is it. Yes.

Then it's typically covered by insurance. In other words, if you come in and I say look, you've got this little nodule in your spleen. We think that it requires some follow up CAT scan, mri, whatever. I have to send them back to their doctor to order it. I can't order MRIs at my own facility. Patients however can have an MRI of their whole body without a prescription.

Going back to this function findings, you know, we're talking about cancer and there's other abnormalities such as I assume AVMs of the brain. What are the kind of things would you might expect that's been found in the literature in your clinics and experience?

The, the big one would be aneurysms or vascular malformations. Av arterial venous fistulas, that type of thing that can create sudden devastating problems in people in their 30s or 40s. We see.

Let's just kind of. I'm just gonna make this more for lay people. John Ritter, A lot of us know who are in our 50s or 60s from Trees Co. Diabetoracic dissecting aneurysm. Would that have been picked up?

Yes.

And he. The thing is it wasn't around then. Now they had full body CT scans back then. I did one myself. Back in 04. But I think this is what we gotta look at is that, you know, you take John Ritter died, I think 55 or 57. Thoracic aneurysm. Today we could pick that up for less than $3,000.

That's correct.

Brain aneurysm. There was a famous billionaire, I can't think of his name, that died of a brain aneurysm in the last five years that could have been picked up. So it's not just cancer, it's also aneurysms that could. An aneurysm is just basically a dilation of a vessel that can kill you. The classic one is abdominal aortic aneurysm, which is in your stomach and there's one in your chest and there's ones in your brain. And those are the most common aneurysm. We see that they actually are fatal if they're not picked up.

Absolutely. And we can pick up aneurysms in all three areas. We can pick up vascular abnormalities in the carotid arteries when we do the neck. All of those things are easily discernible with mri.

And you could probably pick up cardiac dilation, but not cardiac disease, correct?

That's correct. So cardiac disease requires CT evaluation or ultrasound. Or ultrasound. Yeah. Something. The particular drawbacks with MRI that I don't want people to have unusual expectations. We do not evaluate female breasts. It does not replace mammography. It cannot adequately evaluate the colon completely, so it doesn't replace colonoscopy. Those two things still need to be done. And if a person's a smoker, I recommend them having a ct. Yeah.

And now they covered.

Because MRI takes so much longer than CT scan to move through the lung that there's movement artifact every time they take a breath. If there's a small 1cm nodule, it's going up and down. It can look like a 3 or 4 centimeter item. So it's not perfect for the lung, it's not perfect for the colon, and it certainly doesn't replace mammography.

And my understanding too is the prostate maybe requires like a 3D MRI. It's maybe not adequate enough for picking up prostate cancer.

You know, I just had yesterday, I just did a fellow and his prostate has a right sided nodule. It certainly picks up differences in appearance from side to side and it will certainly size the prostate. I don't think you're wrong about the 3D MRI, but we have been able to make comments to people. In fact, I have a gentleman that I did on Thursday. Yesterday he went to his urologist because I told him he had a right sided nodule. So it does pick things up in terms of size and discrepancy from left to right.

Okay, so. And then we have. I want to talk briefly about pancreatic cancer. That's always a scary one. They grow very fast. The is there is, I know that there's certain genetic testing you can do to see if you have the gene that gives you pancreatic cancer. In fact, there's a test called Myrisk by Myriad Labs, my Riad Labs. And it's kind of an interesting one. It's covered by insurance if you have certain risk factors. So there's a 10 page document. Your doctor can go through and click off the boxes and then select certain tests of the 40 or so on the Myriad panel. Or you can write a check for $250 and pay out of pocket and see if you have any of these 40 genes, which seems to me absurd that somebody would not do that test. You only do it once in your lifetime. Right. So save up and do it. But if somebody has a pancreatic risk factor, they are going to do MRI the pancreas. But how sensitive do you think a screening study is for pancreatic cancer?

We feel very comfortable that it's very sensitive. We're going to see a lesion. Let's say there's a lesion in the mid portion of the pancreas that's 1cm that can probably be cut out without taking the whole pancreas out and rendering the person diabetic. Once we've taken the whole pancreas out. As you well know, Dr. Mok, typically cancer of the pancreas presents as sudden onset of jaundice and discomfort. Stage 4. Stage 4, 18 to 21 month life expectancy. Although with some of the newer directed medications, people have lived longer. I just had a friend who recently passed away. He lived almost four years with stage four pancreatic cancer. So we're very, very excited to be able to find a lesion that's small before it gets to the end of the pancreas, the end towards the liver. That's when trouble begins. And it blocks the outflow of bile from the liver.

So I want to swing back to a point you made earlier. It's really important audience knows this. This is not designed to replace routine screening. That's solid. There's certain parts of routine screening that are under substantial questions, such as a PSA blood test. The US Task Force on Preventable Disease has recommended against doing PSAs routinely, but they've advised that doctors should discuss with their patients the relative weakness to the test overall. So it's something that's not automatically recommended because it's just not that good. Now just to give it in a nutshell, the PSA test. The studies have shown that if you studied 1000 men for 10 years, 1000 men for 10 years with PSA screening, you would save one life of prostate cancer and you would kill one person. About bad outcomes from going after a disease that doesn't exist, biopsies and complications. So it's not that good. So really we want to get a better test for screening for prosthetics. There's no screening for pancreatic cancer other than mri. There's no screening for ovarian cancer other than MRI or perhaps ultrasound. Brain cancer, Nothing. Liver cancer. To my knowledge, nothing. But we have chest X rays or CAT scans. Moreover, for smokers, for lung cancer, we have Pap smears. For cervical cancer, we have skin exams for skin cancer. Interesting. The same U.S. task Force Preventative disease is recommended against routine screening for skin cancer. It seems absurd, but their rationale is that patients kind of discovered them on their own. But numerous studies show that patients aren't that good at picking up cancers on their skin, which I think we'd all agree with. And sometimes the U.S. preventative Task Force is more about rationing health care costs on a epidemiologic standpoint versus the individual. So I would, you know, have your skin screened and it's not covered by insurance, but your dermatologist would be happy to look at your skin and so your family doctor. We have colonoscopy for colon cancer. I'm probably missing some other ones, but there's some standard screenings we should consider. We should consider doing the myriad blood test to see if you have genetic risk for cancer. Only about 11 cancers are strongly tied to genes, or, I'm sorry, 11 to cancer. 11% of cancer are strongly tied to your genes. And you can do the genetic test again for about 250 bucks. It's hard to get your insurance cover for it if you don't have a genetic tendency, but you can just do it. Liquid biopsy, which I'm not going to talk about now. That's another way to increase your sensitivity. And then full body mri. Now, two things I want to talk about is how often should somebody do it. The other thing is that we have something we call incidental omas. So incidental and OMA is like tumors. So there's things that you see. And when I had my mri, they saw a couple cysts on my liver. And if a regular radiologist reads this, they're gonna say, well, there's cysts on the liver. Further investigation warranted? Well, it's not really warranted. Maybe I do a scan again in a couple years. So how do you handle these things that we might see? Cause this is actually the biggest controversy over doing whole body MRIs, CAT scans. You'll see nodules or something that maybe have no clinical significance.

Absolutely correct. A lot of it's age related to Dr. Moak, we know that cancers begin in the 20s or 30s, and there's a slow uptick each decade. As we get older, 60, 70, that uptick becomes fairly dramatic. So in younger people, I've had someone as young as 29 have it done. I tell them, look, you can wait three years if you want to have it done regularly. If a person's 65 when they start, I say, this is something you might want to do annually. It's $27.99 for your, for your evaluation. Let's say I do someone who's 65 and they've got disc disease in their neck, disc disease in their lower back. Nothing that shows true narrowing of the spinal cord or real bad pressure on the spinal cord. I tell them over the phone, I go over it with each patient on the phone. I say, you got some neck trouble, you got some back trouble, unless it's hurting you too badly. No further evaluation. You got a little bit of fat in your liver. We know that. A little bit of fat in the liver, fatty liver, not supposed to be there, but surprisingly is very, very common. People are supposed to stop drinking, they're supposed to stop taking, lose lose weight. There's a lot of things recommended. In my history of seeing people with fatty liver. I've never had anybody develop cancer, which they talk about. I've never had that happen. So there are many things that we have found that I am able to settle with the patient and get them to agree this can be checked again in a year. But you don't have to do anything right now. So that, I hope, answers your question. The older a patient is, the more easily I can say we don't need to do anything. If a person's 30 and I see something in their liver, that would be more unusual, maybe a hemangioma, which is a blood vessel tumor, as you know, that might require a follow up in.

About a year or so.

Yeah.

So just kind of circling back To, I don't want to say circling back. That's like a, that's like a teens, you know, 2018 tournament. We don't say that here at Allure. So I'm gonna go back to you know, the big three. So there's things that we look at what you die of and you know, there's a lot of talk about anti aging and extending life. Extending, extending healthspan. I'm definitely all into that. I'm doing some active interventions to extend my life. I've reversed my cardiac age, my brain age, I'm reversing my genetic age. And we might look at things like we call gero inhibitors, senolytic drugs, ways to reverse your epigenetic age. But the first thing is not to die of something stupid, which would be maybe a car accident, drunk driving, you got Uber, which would be having killing yourself. We've got social connections, we have psychiatrists, we have help. When we cut those things even like influenza, there's the influenza vaccine and the Pneumovax. When we cut those out, we're left with number one, cardiovascular disease, which is heart attacks and strokes. Number two and three would be cancer and neurocognitive decline. And they're actually age wise. So we look at heart disease, cardiovascular disease, strokes tend to be a little older but cardiovascular disease, everybody knows somebody had died young, young of a heart attack. I have men my age that have died of heart attacks, my friends or had heart attacks and nearly died. And we could detect that early by doing what's called a calcium score of the heart which really isn't good over about 40, but that's good for screening for young people and what's called a CIMT cry Dymphyma media thickness test, which is very highly sensitive picking up cardiac disease about a decade in advance. We talked briefly about clarity, which is a type of angiogram of the heart. That's CAT scan angiogram, that's, that's a little more expensive and maybe people don't want to go that far. I've done them both myself. But that's, that's the first thing is if you have high cholesterol, you have no idea if you're have a heart attack or not. And if you have normal cholesterol, you have no idea. This is almost a useless test. It's helpful when you have disease to monitor but not predicting disease. So we should absolutely do screening and I think CIMT carotid intermediate thickness test, which is an ultrasound of the arteries that right when they exit your Heart. That's the most sensitive and cost effective and accurate and something we can track. That's something we do here at allure. It costs $300. So that's the one. The next thing is cancer screening, which you, if you want to not die of something unexpected, you would do your routine screening. You know, it's colonoscopy at age 50. There's certain criteria if you have risk factors, mammograms at a certain age. So go through that and check for cancers. Then we should think about screening you genetically to see if you have a genetic risk for cancer, as well as doing a liquid biopsy as a consideration, as well as doing a full body MRI every one to three years, depending on your age. And the last thing, neurocognitive decline. And I'm not quite there yet. We're not there in Michigan yet. But looking at the volumetric age of the brain. So the best way to predict who, who's going to have Alzheimer's and when is by weighing or measuring the size of the hippocampus and the amount of dead space or what we call ventricles around it. And we can pick up neurocognitive decline years in advance, maybe even more than a decade in advance, by just volumetric measurements of the brain. And then if you have an issue where you're below the 50 percentile for your age, then you might want to take intervention. There is specific intervention that can reverse cardiovascular age and brain age. And we talked about also with cancers, removing cancers at the earliest stage and then maybe modifying your lifestyle so you have less risk. I mean, a classic one would be stop smoking in the case of colon cancer, maybe less meat, more roughage. And there's a lot of things we can do to reduce our risks. So this is kind of where we're going, is that before we start talking about how to extend life, how do we remove diseases from taking us out unexpectedly? We look at our aging population, and once it gets over 90, they have a high, high incidence, developing neurocognitive incline or Alzheimer's. We want to keep that brain healthy, getting there. And science is going to put us in a situation where we are living longer. So we want to have as many parts as possible. We go into the grave and want to age with as few heart attacks and strokes as we can, and we want to have as few cancers that are scaring us that we're going to be taken out in the future. And I think that's step one of anti aging is screening for diseases that are treatable or preventable. So any final thoughts?

Well, you mentioned liquid biopsy. I just want to point out that Henry Ford began offering a gallery, G A L L E R I testing, for $670. It's not covered by insurance, but it does check you for the DNA parts of 50 different cancers. And if you get a positive gallery test, the chances are 1 in 200 that it's a false positive. So it's a very good test, Very exciting. They did not invent the test. They simply are the first in the area to utilize it. They're drawing it both downtown and at the West Bloomfield office right now. The West Bloomfield, Henry?

Yeah, we haven't. We have them here, too. And I think they're getting a better price than we are. We don't charge for. We send it through galleries. The list price is, I think, 950 or so. So I might direct my patients to get a Henry Ford because it's something that, you know, again, it's not great. It picks up certain cancers better than others. It doesn't pick up any thyroid cancers, for the most part, like yours can. But the gallery testing is good to start, considering. I think what's really exciting is that there's better liquid biopsies that are better than Galleri that are not available in the United States yet that probably will be. There's some in other countries. One called Zar Labs, Tzar Labs in India. And unless they're falsifying their data, it's a total different game we'll be playing because they're almost 100%, and it's probably 10 years from being here in the United States. They've got FDA approval in India, and they're trying to get their costs down, but they're using a whole different technology, looking at cancer signatures and something called B cells, which are very small embryonic stem cells that float around in our body. So that's pretty exciting. But it's not here yet. I'm working with some people to see if we can send blood over to India to get tested. That's not here yet. But Galleri, like you talked about, that's the only one that's FDA approved for screening for cancer. And I know Dr. Khan, a friend of mine, he offers that we offer it here. Henry Ford offers it a little cheaper. That's good. Full body screening is now. Full body screening in Michigan is more expensive than other states, potentially, because we have a unique situation where the state of Michigan, the government, decided to give radiology groups a monopoly on advanced imaging Studies and you're not going to see the cost get much below that right now unless the law changes allow doctors buy MRIs. But right now the MRIs are deliberately kept in a shortage to protect the monopolies that hospitals and large radiology groups have over other clinical physicians. So if you want to Wonder why it's 2900, not 1500 is your government, you can thank them or leave the state and get it done. There might be other states you can get it done cheaper, but for the most part that's a really good price for this technology. When I did mine back in 2018, it was 25,000, but I had other stuff done as well as that Health Nucleus and they were kind of looking, finding low hanging fruit, which is the people that were gonna do testing no matter what the cost was. And it was a few other things, wasn't worth 25,000, but now that same health nucleus down around 5,000 and they do full body MRI in addition to a few other things. That's really a good value.

So, Dr. Mok, you're absolutely right about the monopoly. Hospitals and a group of powerful radiologists got the laws in Michigan written as such that it's very difficult to acquire an mri. And when you do, you have to have what's called a mobile mri. You have to lease it from one of these powerful groups. And it's very expensive. We had a mobile MRI. Until you do a certain number of MRIs, then you're entitled to get a fixed MRI. To the best of my knowledge, A, I'm the only facility in Michigan that's doing total body MRIs and B, I'm assuredly the only family doctor in Michigan who has an mri. And they're difficult to acquire and they need a lot of cooperation.

Yeah, you have a unique situation. You have a radiology radiologist reading them.

Sure I do, yes.

So the radiologist reading them. But as a family doctor, you can use your expertise and your background to consult patient. I think is really important because if your family doctor is not really doing these, they're not really sure what to do with these incidental findings. And, and if you have an expert that can say, you know, based on experience and research, what's the next step or where you might refer the patient to get intervention if they're, if they're kind of lost.

Absolutely. Yeah. We urge people at the time of coming in to have a family doctor. I can't be their family doctor afterwards that it just doesn't work. I'm too busy.

You're the Screening guy.

I'm the screening guy. Exactly. And if there's a finding that's actionable, like I said 14 to 18%, they have to have a physician I send the items to and request the proper follow up. And if that person is not inclined to do it. I'm sure there are some people who do not believe in doing total body MRIs. I've had doctors react to me and say, well if you look hard enough, you're going to find something. I say, isn't that the point? I think that's the point.

Well, to me, because you make that point and I talk about living longer. My number is 153. That's how long I want to live to. And then I had to reverse engineer how I'm going to get there. And then people say, well why'd you want to live that long? It's like, okay, let's say you were 100 and you were healthy and you were fit and you had family and you were rich and you were surrounded by people you know, and your life was good. Are you ready to die? The answer is no. And there's that mindset that if we live longer, we lay in a nursing home longer. That doesn't really happen. If you look at the people that are centrogenarians, live past 100 years old, 120 years old. 122 is the oldest living human recorded. Is they live healthy, healthy, healthy, and then they fall off a cliff versus dying in your 70s. More likely you had a period of prolonged illness.

Absolutely.

Yeah. So living longer typically leads longer health span. And we look at drugs that have extended the lives of mammals and are now being tested in humans. They actually go a longer period of time before they get sick.

Sick.

So disease is sickness, is aging. And I think that's one issue. What's interesting is that the FDA does not recognize aging as a disease. So much so that if there's a drug that reverses aging, it could not be FDA approved because the FDA has acknowledged that aging is not a disease. Therefore a drug cannot be made to reverse aging. So there's a large trial called the TAME trial. TAME, it's a 50 million dollar trial. And they're using a drug called metformin, which does seem to extend age. But the whole purpose of the trial is not to see if metformin makes people live longer. You know, it probably does, but to prove to the FDA that aging first off exists, which to their knowledge it does not. And also prove to them that it can be modified and if it can be modified, therefore it becomes a disease. And therefore all these anti aging therapies that seem to work could theoretically be FDA approved. Right now they can't. So if I have a drug that can extend your health span and make you live longer, and I do studies showing it's safe and effective, but all it does is make you live longer and healthier. Healthier. They have to say, well, we will not approve it because we don't recognize aging. They just don't see it. And they're a bureaucracy, so they can't use common sense. They use their advisors talking about aging, really, we're supposed to get old and die. And that's the mindset. So that is coming. So there's studies coming that reverse aging. There's one on rapamycin. I can't think of the name of that trial. There's a tame trial. There was the study done in 2019 where they had a group of about 50 men that were in their 50s and they gave them three drug cocktail and they reversed their age, their epigenetic age, by about two years. So I mean, we've already seen this stuff happening. Myself and a lot of other doctors in this space are doing it themselves. I'm seeing effects, I'm getting younger. And we'll be offering to our patients at some time. But right now, the first thing is not to die of something that you don't need to die from or not to get sick from something you don't need to get sick from. So keep all your parts, don't have a heart attack, stroke, don't get cancer or get cancer. If you do get cancer, pick it up at the earliest stage possible where it can be gone and coming soon. We'll figure out how to measure the brains. Right now you do have to travel to measure your brain age. And there's some intervention you could do to reverse the brain age. A friend of mine, Dr. Hassey, in the Maxwell Clinic in Tennessee, his whole clinic works on just brain age. And they have an mri, they do volumetric measuring. So I'm going to visit him. And I haven't measured my brain age in two years, but I have reversed my brain age substantially. So this is all exciting. I appreciate you coming out this morning and spending your Saturday morning with me.

Thank you, Dr. Mo. I appreciate you having me on.