--- title: Health Panelists Talk Vaccines, Weight Loss, and the Importance of Respectful Discussion description: Dr. Raj Panjabi, Jillian Michaels, and Dr. Nir Barzilai engaged in a spirited and wide-ranging discussion at a TIME100 Talks event. canonical: https://time.com/7332162/time100-talks-panel-raj-panjabi-jillian-michaels-nir-barzilai/ author: Chantelle Lee article:opinion: false article:content_tier: free article:published_time: 2025-11-13T04:50:48.000Z article:modified_time: 2026-10-19T08:12:55.958Z article:section: Health og:title: Health Panelists Talk Vaccines, Weight Loss, and the Importance of Respectful Discussion og:description: Dr. Raj Panjabi, Jillian Michaels, and Dr. Nir Barzilai engaged in a spirited and wide-ranging discussion at a TIME100 Talks event. og:url: https://time.com/7332162/time100-talks-panel-raj-panjabi-jillian-michaels-nir-barzilai/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltc96f7637dc246c89/6998cb947323af9a962bd082/time-100-talk-nov-12.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 2400 og:image:height: 1350 og:image:alt: time-100-talk-nov-12 og:type: article twitter:card: summary_large_image twitter:title: Health Panelists Talk Vaccines, Weight Loss, and the Importance of Respectful Discussion twitter:description: Dr. Raj Panjabi, Jillian Michaels, and Dr. Nir Barzilai engaged in a spirited and wide-ranging discussion at a TIME100 Talks event. twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/bltc96f7637dc246c89/6998cb947323af9a962bd082/time-100-talk-nov-12.jpg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # Health Panelists Talk Vaccines, Weight Loss, and the Importance of Respectful Discussion > Sponsored content. 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Terms and conditions apply. * Savings buckets are a feature of Ally Bank's Savings Account. * No ATM fees from Ally Bank at Allpoint and Moneypass ATMs plus we reimburse for fees charged by other ATM owners nationwide up to $10 per statement cycle. * Early direct deposit offers eligible direct deposits up to two days sooner. * Spending buckets are a feature of Ally Bank's Spending Account. ## Video: Health Panelists Talk Vaccines, Weight Loss, And The Importance Of Respectful Discussion [Watch (HLS stream): Health Panelists Talk Vaccines, Weight Loss, And The Importance Of Respectful Discussion](https://cdn.jwplayer.com/manifests/Q7mHCFoU.m3u8) (45:07)  _Published 2025-11-13. Dr. Raj Panjabi, Jillian Michaels, and Dr. Nir Barzilai engaged in a spirited and wide-ranging discussion at a TIME100 Talks event._ by [Chantelle Lee](https://time.com/author/chantelle-lee/) ## Chantelle Lee Reporter Nov 13, 2025 4:50 AM UTC by [Chantelle Lee](https://time.com/author/chantelle-lee/) ## Chantelle Lee Reporter Nov 13, 2025 4:50 AM UTC Three panelists engaged in a spirited discussion about longevity and disease prevention at a TIME100 Talks event moderated by TIME senior health correspondent Alice Park in New York City on Wednesday. Dr. Raj Panjabi, senior partner of the bioplatform innovation company Flagship Pioneering, leading its Preemptive Health and Medicine Initiative; Jillian Michaels, creator of The Fitness App and host of the podcast _Keeping It Real: Conversations with Jillian Michaels_; and Dr. Nir Barzilai, director of the Institute for Aging Research at the Albert Einstein College of Medicine and president of the Academy for Health and Lifespan Research, joined Park on stage to discuss topics ranging from vaccines to weight-loss drugs. During the conversation, Park asked Panjabi, who previously served as White House Senior Director for global health security and biodefense during the Joe Biden Administration, about growing mistrust in vaccines in the U.S. Panjabi emphasized that it’s important to approach any claim made about vaccines “with curiosity” and “help folks understand the science.” He said, for instance, that scientists learned that the COVID vaccine was [more effective at preventing hospitalizations](https://www.nytimes.com/live/2021/10/04/world/covid-delta-variant-vaccine) than it was at preventing infection. In the first two years after the COVID vaccine was distributed in the U.S., more than 18 million hospitalizations and more than 3 million deaths were prevented, according to a 2022 [report](https://www.commonwealthfund.org/blog/2022/two-years-covid-vaccines-prevented-millions-deaths-hospitalizations) from The Commonwealth Fund. “The takeaway that I have, from the work of vaccinations, is that it is still a proven, effective intervention. It’s worth studying them, continuing to study them, but then it’s worth actually looking at the data,” Panjabi said. Park went on to ask Michaels what questions she has about the safety of vaccines, in light of a [post](https://x.com/JillianMichaels/status/1963068263618814372) on X in September in which she said, “If we can recognize the undeniable success of vaccines historically, why is it treated as dangerous or taboo to raise legitimate questions about how we use them today?” Michaels has sparked controversy in the past for expressing support for the Make America Healthy Again (MAHA) movement, led by [prominent vaccine skeptic](https://time.com/7294477/former-cdc-rfk-wrong-vaccines/) and Health and Human Services Secretary Robert F. Kennedy Jr. A [New York _Times_ story](https://www.nytimes.com/2025/08/25/well/jillian-michaels-profile.html) published over the summer described Michaels as “concerned vaccines haven’t been studied vigorously enough (though she does not consider herself broadly anti-vax).” Michaels replied that her questions weren’t necessarily about safety but about some aspects of the vaccine schedule. She criticized the fact that the Centers for Disease Control and Prevention (CDC) [recommends](https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-notes.html) that the first dose of the hepatitis B vaccine, which protects against a highly infectious disease that can damage the liver, is given at birth. Critics, like Michaels, have questioned why a newborn should be vaccinated against a virus that can be transmitted through unprotected sex or shared needles. “Parents want to know these things,” she said. (Public health experts have [emphasized](https://time.com/7319049/vaccine-children-news-cdc-covid-mmrv/) that the sooner the vaccine is administered, the greater the chances of preventing early childhood exposures, including mother-to-child transmission of hepatitis B.) Panjabi said that a key part of recommending any medical intervention—whether that be vaccines or drugs—is whether the benefits outweigh the risks. He urged people to have respect for one another when engaging in those discussions. Park turned the conversation to [GLP-1 weight-loss drugs](https://time.com/7278429/weight-loss-obesity-pill-eli-lilly/), asking Barzilai if they are a good thing, to which he replied “definitely yes.” He said that “obesity accelerates aging,” so treating that can address that issue. And he cited new research that suggests that GLP-1 weight-loss drugs [may have other positive health effects](https://time.com/7207986/health-risks-benefits-weight-loss-drugs-ozempic-wegovy/), such as reducing the risk of Alzheimer’s disease. The topic sparked a question from an audience member. Andrea Deierlein, director of Public Health Nutrition and associate professor at the New York University School of Global Public Health, expressed concerns that the drugs could be used to replace other aspects of a healthy lifestyle. Barzilai replied that exercise, diet, sleep, and social connectivity are “good for everyone,” but as people age, it becomes harder to “optimize” those aspects of a healthy lifestyle. “What we determined is that there are drugs that could, when you’re old, change the rate of your aging,” Barzilai said. But, he said, in a conclusion that spoke to the state of play across the topic: “How we’re going to do it and to whom is still a discussion.” _TIME100 Talks: Living Better, Longer—Reimagining Healthcare from Sickcare to Wellcare was presented by Shaklee._ ## Transcript [00:00] It is really my pleasure to be here [00:01] moderating this conversation with this amazing panel. [00:04] So I'd like to start by asking each of you to just very [00:06] briefly introduce yourselves so [00:08] we can get right into the discussion. [00:10] And we'll start with you. Sure. [00:12] By the way, maybe they can hear me, [00:13] but I cannot see them. [00:15] Kind of look youngish, [00:16] but so I'm Nir Barzilai, [00:19] I'm a professor of medicine and genetics and the head [00:22] of the Institute for Aging Research at Einstein. [00:24] But today I'm here more as the president [00:27] of the Academy of Health and Lifespan Research. [00:30] Those are the professors and leaders who are [00:34] actually leading this revolution [00:36] that we're talking about, [00:38] of, of targeting our health rather [00:39] than waiting for a disease. [00:41] So nice being here. Thank you. [00:44] Yes. [00:45] My name is Jillian Michaels. [00:46] I'm really here tonight to listen to these two guys. [00:48] Uh, I do lunges for a living occasionally, [00:51] have a stick of broccoli for [00:52] my overall health and wellness. [00:54] Uh, and hopefully I can [00:55] just give you some common sense information, [00:57] because there is no way I'm going to tell you how [00:59] to edit the genome and things like that. [01:01] So I'm very, very excited [01:02] to listen to these two guys talk. [01:04] You look a little old for a 20 year old. [01:06] I have to tell you. You know what? That's why I'm here. [01:09] I what am I? [01:10] I'm living age free. That's what I was. [01:12] Hoping to figure out tonight, actually. [01:14] Well, Raj Punjabi here. [01:16] I'm a physician and entrepreneur. [01:19] I am senior partner at Flagship Pioneering, [01:22] which is a biotech venture creation company. [01:26] It's created over 100 scientific ventures [01:28] over the last 25 years. [01:30] And I lead an initiative called [01:32] the Preemptive Health and Medicine Initiative. [01:35] And the focus of that is to [01:36] extend healthy lifespan for everyone. [01:39] And I think we can't forget to [01:42] mention that one of those companies is Moderna, [01:44] which I think a lot of people are probably [01:46] familiar with from the Covid pandemic. [01:48] So, um, in medicine, [01:50] there has long been a push and pull between trying to [01:53] prevent disease and finding [01:56] new options for treating it right. [01:58] It's an important balance. [02:00] Very important balance. [02:01] Um, and it's even more critical, [02:05] I think, as we develop better ways, [02:08] as Nair was saying, [02:10] to extend not just lifespan, [02:12] but health span, which is the new buzzword. [02:15] So I'd like to start with you. [02:18] This year, we've seen the release [02:20] of the Make America Healthy Again report, [02:23] which focuses a lot on prevention [02:25] and on addressing chronic diseases, [02:29] which really account for [02:30] the bulk of our health care costs now. [02:32] Um, can you, can you, [02:34] in looking at that report, [02:36] can you talk a little bit [02:37] about does it help us from a policy perspective, [02:41] really start moving the needle [02:43] toward prioritizing prevention? [02:44] We've got a health care system that probably [02:46] doesn't do that enough at this point. [02:48] So so the answer is yes. [02:51] Okay. But I'll give I'll give [02:53] examples and I'll really focus on aging now. [02:57] So there is a biology of aging. [02:59] You know, who's old and who's young, right? [03:01] You know more than that. [03:02] You know that people age at different rates. [03:05] Maybe in your age you don't quite see it. [03:07] But in your parents age, you know, [03:09] some are young and some are old for their age. [03:11] So that people know what people don't realize that [03:15] it's this biology is what drives diseases. [03:18] It's not that you get disease and you get old, [03:21] you get old, and it drives diseases. [03:23] So you can be born with genes for Alzheimer ApoE4. [03:27] If you heard it, you can have two copies of ApoE4. [03:30] So you're likely to be demented at 60 or 70 dead at 80. [03:34] But you're not born demented and you're not demented when [03:37] you're one year or 20 years or 40 years. [03:40] It takes the aging to bring this disease out. [03:43] And I can go over every organ. [03:45] And the point of that is we want to [03:47] intervene in the process of aging before you got disease. [03:52] Now, why do we think that we are right. [03:56] And why did we actually [03:58] convince politicians to follow us? [04:01] I have a I have a cohort of scenarios. [04:04] I have 850 centenarians and we discovered lots of things. [04:09] But for this discussion, we. [04:12] We wondered, do they get sick when everybody [04:14] gets sick at 60 and now they're sick longer? [04:16] No. There are 30 years a [04:20] healthier than than people who live at the same time. [04:24] But this is not really the interesting thing. [04:26] They have what we call a contraction of morbidity. [04:29] They die. They are sick for a few weeks. [04:32] 30% of them don't take drug and [04:34] are just not waking up in the morning one day. [04:37] So. So they live, live, live and die. [04:40] The CDC made rest in peace. [04:43] The CDC have have [04:45] shown that the medical cost in the last two years [04:48] of somebody who dies at [04:49] 100 is third of those who dies at 70. [04:53] And. okay, but this is the medical cause. [04:56] People are telling us economic economies [04:59] have figured it out. [05:01] Okay, so they're not in the hospital. [05:02] But if they're not in the hospital, what are they doing? [05:06] They're traveling, they're shopping, [05:07] they have a lot of money. [05:09] They're building houses for their kids. [05:11] So there's an economic value of being healthy, [05:14] healthy, healthy and die. [05:15] And since we know [05:17] the biology and we know the intervention, [05:19] since we know that it will save [05:20] the economy and not ruin the economy, [05:22] I think we have an ear in this administration. [05:25] Okay. We're going to come back to that. [05:28] Julian, I want to ask you about earlier this year, [05:31] you went viral for your speech. Yeah. [05:36] One for Covid. [05:38] For for your speech, [05:40] calling out a time article that [05:43] looked at processed foods and questioned whether, [05:47] you know, they were [05:48] such a bad thing, you know, uniformly. [05:51] So you're here. We're here. [05:54] Tell us what is set up. [05:56] No, it's not a job opportunity. [05:59] It's an opportunity for you to say, um. [06:01] What? You know, how can we how can we look [06:04] at the behemoth of processed foods? [06:07] And what was your issue with the article and [06:10] the dietitian who tried to make [06:12] the argument that they're not all created equal? [06:15] Ultra processed foods are ultra processed foods. [06:19] So of course, freezing of food [06:21] is a form of processing food. [06:23] But ultra processed food means [06:26] that it's actually not food at all. [06:29] And the reality is there are so many different chemicals. [06:34] For example, you take a piece of bread from subway, [06:38] and there's a chemical in that bread [06:40] that also exists in your yoga mat. [06:42] Why? So that it's squishy. [06:44] That's not food. There is no. [06:46] Room. [06:47] For these kinds of chemicals in our food. [06:50] And you're wondering why You're seeing what? [06:53] What is the inquiry? I can't remember the rate right now. [06:55] It's like an increase of 79%. [06:58] Diagnoses increase in people 18 to 49. [07:02] Getting cancer over the last 20 years. [07:04] I think infertility is going up 1% a year. [07:07] Like we could sit here and talk about the insane cascade, [07:10] the explosion of diseases. [07:14] Something's wrong. [07:15] And absolutely no question [07:18] this explosion coincides with [07:20] the rise of ultra processed foods. [07:23] All right, show of hands here. [07:25] To your point of [07:27] ultra processed foods versus processed foods, right? [07:30] Because they're. [07:31] Absolutely different. Right? Okay. Show of hands here. [07:34] Who here thinks that flavored yogurts are [07:37] not processed? Oh, okay. [07:42] We've got a pretty educated audience here. [07:44] I think a lot of people [07:45] in the public would probably think, [07:47] oh, that's a quote unquote good food, right? [07:49] That's not a flavored yogurt. [07:50] Yogurt, right? Of course. [07:51] And people think like, oh, [07:53] yogurt, dairy fermented probiotics. [07:55] But when you read the ingredients [07:57] and I'm sure you guys have all heard this, [07:58] so much of this is common sense. [08:00] And you can't pronounce over half of what's on there. [08:02] It's because it's not food. [08:04] It's just it's, it's very simple. [08:06] They complicated on purpose. [08:09] And the reality is that this narrative of like, [08:12] no, this stuff's not so bad. [08:13] This is a big food psyop. We know it. [08:16] The Washington Post did a whole piece on it. [08:19] You have registered dietitians that are being [08:21] paid off to tell you this. [08:23] And again, it's not coming from me. [08:25] This is coming from The Washington Post. [08:27] You guys know that food dyes [08:31] that come from petroleum, that's not food. [08:35] Okay. And we're starting to see [08:37] some movement on that from the administration, [08:40] particularly on synthetic food dyes. Right. [08:43] I mean, there's 10,000 [08:45] things that make it through the grass rule, [08:47] which is the generally recognized as safe rule. [08:50] Um, and this is a loophole for the with the FDA, [08:53] so that big food can [08:54] vouch for roughly 10,000 chemicals like no, [08:57] no, no, it's safe and all [08:59] is generally recognized as safe. [09:01] Uh, but in other parts of the developed world, [09:04] many of those 10,000 things are banned. [09:08] So, you know, hopefully I'm there's hope. [09:11] Maybe Kennedy wants to [09:13] revisit and reevaluate the grass rule. [09:15] I don't know if that will get done, [09:17] but if it does get done, [09:18] that would be a good thing. [09:20] Okay. Um, I want to move on to [09:23] another hot topic lately, which is vaccines. [09:27] And Raj, you began your career really in [09:31] with founding Last Mile health in [09:34] helping to ensure access to vaccines, [09:36] distributing them to areas where, [09:40] you know, people really weren't [09:41] able to access healthcare. [09:43] Um, you then played a role in the administration, [09:47] the Biden administration during the Covid pandemic and [09:50] in overseeing access and distribution as well. [09:54] And now at flagship, [09:56] you're involved in looking at [09:57] some of the next generation and [09:59] innovations in where vaccine technology can go. [10:02] Um, it vaccines have become such a divisive health tool. [10:08] Um, you know, there was for, for decades, [10:11] it was assumed that they were called the, [10:13] you know, miracle of modern medicine. [10:15] Right? And they've really helped to [10:16] control a lot of infectious diseases. [10:19] When you look at where we are now with both policies [10:23] and the public opinion on [10:26] vaccines and increasing mistrust and skepticism. [10:29] What do you make of that? [10:31] Well, I think there are a couple of claims that are [10:35] made about vaccines that are worth evaluating. [10:38] One is that the vaccine may be more [10:41] harmful than the pathogen [10:43] it's meant to prevent you from getting. [10:46] There's there's data to show that a lot of data to [10:51] show that we have ingredients in [10:53] vaccines that have been removed from vaccines. [10:56] And yet people the incidence rate, [11:00] say in the case of measles vaccines, [11:02] there is a claim that [11:05] measles vaccines had thimerosal in it, [11:08] that thimerosal was an ingredient that may [11:10] have been contributing to the rise of autism, [11:12] that was removed from [11:14] the from the from the manufacturing of that vaccines. [11:18] MMR vaccines. Many years ago, [11:20] autism rates still went up. [11:22] So what I take from that is not to say one side is right, [11:26] the other side is wrong, [11:28] but rather for us to approach [11:31] any claim that's made with curiosity. [11:34] Help folks understand the science that's critical. [11:38] The other claim that is made or claims to Covid vaccines, [11:43] for instance, is that [11:44] the Covid vaccines don't don't work. [11:47] What we found initially, [11:49] and the claim that was made was [11:51] that and this was before I joined the, [11:54] the, the Covid team and the National Security Council is, [11:58] is that, you know, [11:59] we think the vaccine might actually prevent infections. [12:02] What we found actually is it [12:04] was not as great at doing that. [12:06] The science evolved and it [12:09] was still great at preventing hospitalizations. [12:11] How do we know that? [12:13] We know that because third parties [12:15] like the Commonwealth Fund, uh, [12:17] put out a report that said in the first two years [12:20] of the US campaign for vaccinations, [12:23] which which put hundreds of millions of shots into arms [12:26] across the country in just the first two years, [12:29] we found that 18 million hospitalizations were [12:32] prevented because people got less severely sick. [12:35] 3 million lives were saved. [12:37] And by the way, we it resulted in $1 trillion [12:42] of cost being saved to society because [12:44] people didn't have to stay in the hospital. [12:47] And hospitalizations, [12:48] especially unnecessary hospitalizations, [12:50] as we know from chronic disease care, [12:53] whether it's preventing diabetes or [12:55] heart disease or cancers or dementias. [12:58] Hospitalizations cost all of [13:00] us in our premium in our deductibles. [13:04] If you're an employer, your costs [13:05] go up because hospitalizations, [13:07] especially when they're unnecessary, [13:09] lead to catastrophic impact on health care. [13:13] So the takeaway that I have is that from from the work [13:17] on vaccinations is that it is still [13:19] a proven effective intervention. [13:22] It's worth studying them, [13:24] continue to study them, [13:25] but then it's worth actually looking at the data. [13:27] What's critical about vaccinations that's relevant to [13:30] chronic diseases and extending [13:32] the ability to live long better, [13:34] is that vaccines teach us that you cannot cut [13:39] costs and cut care without Getting ahead. [13:45] You can't cut costs without cutting [13:47] care unless you get ahead of disease. [13:49] That's what vaccines teach us, [13:50] and I think we could apply that [13:52] to other chronic diseases. [13:54] But I think one of the. [13:56] Downfalls of vaccines in a way, [13:59] is that they have been so effective. [14:01] Right. And I talked to a lot of [14:03] health experts who say that, [14:05] you know, before these recent outbreaks of measles, [14:07] for example, we hadn't seen [14:09] really serious cases of [14:12] measles in this country in decades. [14:15] So, um, in in some ways, [14:17] vaccines were a victim of their own success. [14:20] And this idea of [14:21] prevention and avoiding disease really was hard for, [14:26] I think a lot in the public to take right or to [14:29] understand because we just [14:30] simply didn't see those diseases. [14:33] I think seeing is believing and, [14:35] and that adage turns out to be true in this case. [14:38] What's ironic is that in the parts of the world, [14:41] like I grew up in, in Liberia, in West Africa. [14:44] Uh, low income countries, [14:46] middle income countries around the world. [14:49] Uh, there's still many people who don't have [14:50] access to basic vaccines like measles. [14:53] You still see measles outbreaks. [14:55] You see children die from measles in those settings. [14:58] You see people voluntarily take vaccines, uh, [15:02] regardless of what the policy is on mandates, [15:04] because they see the consequences of not having that. [15:08] I hope that's not where we have to get to here [15:10] before we continue to embrace this technology. [15:14] Again, I think it's important not to be to [15:17] not demonize one side or the other on this side. [15:20] I don't think we get to that embracing of [15:24] vaccinations [15:26] without actually humanizing people and understanding. [15:29] If they're afraid of taking a vaccine, [15:31] you actually have to spend some time [15:33] listening and empathizing with them. [15:34] That's what I did as a doctor. [15:36] And you may not persuade everybody to take it. [15:38] They may choose not to take it, [15:40] but it's important not to put them in [15:43] a category that then makes them, [15:46] it almost sounds like they're in a different tribe, [15:48] and you can't speak to them ever again. [15:50] I think that's wrong. [15:51] Okay. [15:52] Can I, can I just comment [15:55] because I have the same problems with medication in [15:59] the sense that what what I'm saying is that [16:03] every FDA approved drug and [16:04] vaccine saves 100 and kills three. [16:08] I just invented those numbers. [16:10] Okay. It's always been the truth. [16:13] And we just have to get better of choosing the [16:17] right 100 and avoiding the other three. [16:20] And we're coming close to that by lots of methods. [16:23] And probably AI will do the rest of it. [16:25] But you still rather save 100, okay. [16:30] And kill three rather than not [16:31] do rather than get the 103 died. [16:36] Okay. And it is a very nuanced point. [16:39] And Jillian, you recently posted on [16:41] this question as as Raja Near are [16:44] saying that there we [16:46] shouldn't be looking at the vaccine [16:48] question as black and white, [16:49] which is increasingly where we're [16:51] going in this country, it seems. [16:53] And I just want to quote what you wrote, [16:55] which is if we can recognize [16:57] the undeniable success of vaccines historically, [17:00] why is it treated as dangerous or taboo to raise [17:03] legitimate questions about how we use them today? [17:06] In your view, where are the areas that, [17:10] you know, there are still questions about [17:12] safety and that we still need more data? [17:14] It's not necessarily safety. [17:16] It's the fact that after [17:18] the drug companies were given blanket immunity in 1986, [17:22] the amount of shots a kid got went from like [17:25] 15 when I was a kid to 72 or something. [17:28] Shots by the time they're 18. [17:29] And people wonder, like, [17:30] why did the schedule get so aggressive? [17:33] And one that I think is obvious, [17:35] right, is something like hepatitis B. [17:37] So this is a disease that you get from having risky, [17:41] unprotected sex or using needles. [17:43] Newborns are not doing either of those two things right. [17:47] And so why do we give it to the baby? [17:49] Well, because mom could have it. [17:51] But then a million doctors will say, [17:54] well, we can test mom. [17:55] So then it's like, well, again, [17:57] why are you giving a child [17:59] within 24 hours of being on the planet, [18:02] a hepatitis B vaccine? [18:04] Like, is it something we should discuss? [18:06] Maybe pushing out a bit longer? [18:08] Like parents want to know [18:10] these things because it doesn't really make sense. [18:12] And then last but not least, [18:14] I if you can show me [18:17] a longitudinal safety study [18:19] with an inert placebo for hepatitis B, [18:22] I've yet to see one. [18:24] And it isn't for a lack of looking. [18:25] I know the studies that doctors reference, [18:28] and they don't actually look at hep B. [18:29] And last but not least, [18:31] I had a gentleman who's a pediatrician, has his M.S. [18:33] in epidemiology and wrote a book [18:35] called I think Worth a Shot is the name of his book? [18:39] And this is a guy that did [18:40] exceptional amount of research on this. [18:42] And he's like, we just don't know enough. [18:45] And I was like, is there [18:46] a longitudinal safety study on hepatitis B? [18:49] Yes or no with inert placebo? No. [18:53] Yeah. I think one of the through lines between the point [18:57] we're talking about Covid or [18:59] measles and autism, or in this case, [19:01] that's is that our communication in general has failed, [19:05] especially with the public, [19:08] especially in the area of because [19:13] especially because we tend to tell and not teach there. [19:19] I think your question about [19:21] why people should lean into it, [19:24] but in a way that you're able to help people over [19:27] time build their instincts, [19:31] their understanding of, of how vaccines work. [19:35] I think that's the, [19:36] we're in a moment of tension. [19:38] That tension could become destructive. [19:40] It could lead to more outbreaks, [19:42] or it could be a moment of tension that is creative, [19:45] that could actually be constructive. [19:46] And I think one way to make it constructive is in [19:48] the way other countries have done it over time, [19:51] which is to actually engage community leaders, [19:55] church leaders, podcasters, uh, [19:57] others that are in, [19:58] in the community itself to be [20:01] part of the team that helps ask the question why? [20:05] And help understand it, whether it's for vaccines or it's [20:08] for diabetes or it's heart disease or it's cancer. [20:11] I think there is a way to build an approach. [20:14] People with respect acknowledge their lived expertise, [20:18] their lived experience as expertise itself. [20:20] That's important as medical expertise. [20:22] It is telling, controlling, [20:25] telling on its own doesn't [20:27] help without that kind of engagement. [20:29] I think to your point, you know, [20:31] I had as a medicine writer, [20:33] I had the privilege of listening in [20:35] on pretty much every single conversation [20:38] that the expert committees that were [20:40] convened by the FDA on the Covid vaccines had. [20:44] And it was interesting to hear [20:45] their discussions about everything [20:47] from the science understanding, you know, what it does, [20:52] what the vaccines did for antibody responses, [20:54] as well as public health perspectives, [20:57] which I think is important here because, [20:59] Jillian, to your point, [21:00] the hepatitis B vaccine for newborns, [21:03] I think part of the equation [21:05] is if newborns aren't vaccinated with that, [21:09] then would we get them later in life? [21:14] And it's a public health [21:16] population level question, right? [21:18] And it's a question of if we lose them, [21:21] then we lose the ability to protect them. [21:24] Um, and it's a, it's a balance, [21:27] of course, of looking at, [21:29] you know, getting people, [21:31] the most people at the right time [21:33] versus the safety of [21:35] the vaccine and the effectiveness of the vaccine. [21:38] We don't even give a HPV vaccine [21:40] until they're like 15 years old. [21:42] So it's simply and I'll be honest, [21:46] if we're going to put on our tinfoil hats [21:47] here for just a moment, okay. [21:50] They created this drug for sex workers and drug addicts, [21:53] the hepatitis B vaccine. [21:55] This is not a population [21:57] that's overwhelmingly concerned about their well-being. [21:59] So they didn't get the shot. [22:01] And it was like, gosh, gosh, [22:03] we lost lots and lots and lots of money. [22:06] What are we going to do? [22:07] Oh, I know we'll lobby to get it on the schedule. [22:10] Oh, I know we'll lobby [22:11] the World Health Organization and we'll start [22:13] a campaign with Carter's wife and every child. [22:15] And the thing is, when you know [22:17] how much money is associated with this vaccine, [22:20] it's a lot of money. And you hear that? [22:24] And no one can give you a good reason for why [22:26] a newborn gets a shot. [22:30] And are there adjuvants in this like aluminum. [22:34] And this is not a conversation about like, hey, [22:36] listen, you know, we eat so much aluminum. [22:39] Like I've sat with different doctors who [22:40] say there's a big difference between being [22:42] a developed adult and [22:43] ingesting certain amounts of aluminum, [22:46] then injecting aluminum into a child that's 24 hours old. [22:53] And I'm not an anti-vaxxer. [22:55] This is not a hill I want to die on, [22:57] but I'm simply explaining to you [22:58] because I'm exposed to it [22:59] all the time what the concerns are for parents. [23:04] Uh, my, my view on, [23:07] on a number of these issues. [23:08] And I'm not commenting [23:10] specifically on hepatitis B vaccine, [23:12] not because I don't want to, [23:13] I just think there's a there's [23:14] a deeper fundamental issue here, which is there's no. [23:17] Answer on hepatitis. No one can tell me the answer to. [23:21] There is no longitudinal safety study, [23:24] and there is no fricking reason [23:26] to give it to a newborn, a vaccine. [23:28] What's really critical is to weigh [23:30] benefits on one side and risks on the other. [23:33] So when you're vaccinated, [23:34] it's just the way I explain it to my own family. [23:37] I explain it to my patients. [23:39] Over the years, I've seen [23:40] community health workers, which are people, [23:42] you know, who are from the community, [23:44] who get educated. Explain it. [23:46] One of the most important parts [23:47] of this debate that isn't coming [23:49] through is how much do they do? No, no. [23:52] And I just want you to understand [23:54] that's why I'm that's why I'm actually, [23:56] um, building on your point, [23:58] which is benefits when they outweigh risks, [24:03] that is the, that is usually the, [24:07] a key part of recommending any medical intervention, [24:10] be it a vaccine or chemotherapy for a patient with [24:13] cancer or a drug for diabetes. [24:16] That concept is something people have. [24:20] Let's respect people like they they can understand [24:24] that concept that is [24:27] getting lost in this entire conversation. [24:30] Not here, I mean, but just in general, [24:32] to your point, and I [24:33] hope we could get to a place where, again, [24:36] we're able to teach and learn [24:38] how a concept like that [24:40] weighs into decision making about medicine. [24:43] Instead, what happens is you [24:45] get one group that's sort of framed as anti-vax, [24:47] another group that's phase is pro-vax, [24:49] and people stop listening to each other. [24:51] Exactly. And that is that is that lack of [24:53] finding common ground hurts all of us because in the end, [24:56] the folks who you hope [24:58] to let me say another point here, just to. [25:00] It is also possible. [25:02] I've seen this in my entire medical career. [25:04] It's possible to help. [25:06] People can change their behavior without [25:09] being forced to change their beliefs [25:10] about something, right? [25:12] And you can't get there unless you have [25:14] a non-judgmental conversation that's front and center. [25:18] So I think the that is my view on what's missing in, [25:23] in, in, in the discourse about vaccinations. [25:26] And I'm afraid we'll see as [25:28] more medical innovations come [25:29] forward that are less understood, [25:31] that we are going to face [25:34] similar challenges if we if we don't, [25:36] you know, address this one. [25:37] Well, as we saw with the mRNA Covid vaccines. [25:41] And I want to jump in here. [25:42] I know we don't have a whole lot of time, [25:44] but I near I wanted to ask you another one of [25:47] these innovations recently are [25:49] the GLP one drugs for weight loss. [25:52] Um, are they a good thing? [25:55] You know, it took me time to answer you. [26:00] Definitely. Yes. Definitely yes. [26:03] Let me explain. [26:05] And I'm talking about aging now. [26:06] Okay. Let me explain. [26:08] When I started my studies in biology of aging, [26:12] there were a few of us only. [26:14] And we all did kind of the same experiment. [26:16] We took animals, mice, rats, [26:18] spiders, and we turned them into two groups. [26:23] One group, eight were all brothers. [26:26] Okay. One group, half of them ate [26:28] whatever they could, whatever they wanted. [26:30] And the others was caloric, restricted. [26:32] They got in the case of rats and mice. [26:35] 40% of the calories that their brothers got. [26:38] This simple experiment in [26:40] all animals resulted in a markedly extension of lifespan. [26:46] Lifespan was increased by 40%. [26:48] The mice lived three years rather [26:49] than two years, pretty much. [26:51] And we spend a lot of [26:53] time since then trying to understand [26:56] because we cannot tell humans [26:57] okay to caloric restriction. [27:00] It wasn't going to work. [27:01] So we were looking for what we called caloric mimetic, [27:04] something that will mimic the caloric restriction. [27:08] And we did lots of interesting studies. [27:10] We learned a lot of biology, [27:11] and then all of a sudden come GLP one. [27:15] And what GLP one [27:17] is doing is pretty [27:19] much what caloric restriction is doing. [27:21] But not only it's only a third of what it's doing. [27:24] Okay. So, um, What? [27:27] What? So first of all, [27:29] the part of obesity is I'll take the example of Covid. [27:33] If you were over the age of 180/80, [27:36] your chances of dying from Covid was [27:38] 180 times more than if you were 20. [27:41] Okay. That was the aging part. [27:43] If you were obese at any age, [27:45] you had eight times more chances of dying from Covid. [27:48] Okay. So BCT accelerates aging. [27:52] Okay. So this is good to do, [27:54] but GLP one has also [27:56] effects that are independent of that. [27:59] They are touching all the hallmarks of [28:01] aging or most of the hallmarks of aging. [28:03] And that's that's why they're effective for Alzheimer. [28:06] Parkinson. I mean we'll see. [28:08] It's initial studies and many, [28:10] many other diseases that were not [28:12] totally related to the obesity itself. [28:15] So I think those are [28:16] very important drug that showed not only [28:18] that they prevent variety of age related diseases, [28:22] but also prevented by 45% overall mortality, [28:26] not disease specific mortality, [28:28] not from diabetes or obesity, but overall mortality. [28:32] So in our book, [28:33] that's what we call a zero therapeutics. [28:36] Okay. So they're going to I think we're going to [28:38] see a lot of studies, as you noted, [28:40] in areas that perhaps aren't as obvious now, [28:43] like Alzheimer's substance abuse, right. [28:45] Where, where we might see benefits of these drugs. [28:49] The Incretin class, as they're known to extend life [28:53] and potentially address some of [28:55] those chronic diseases of aging, right? [28:58] The hallmarks of aging that are responsible [29:00] for death at older ages, really? [29:05] And I've talked to some scientists who are really [29:09] excited about potentially the idea [29:11] theoretical still at the at this point, [29:13] but the idea that we could be addressing [29:17] aging diseases and really [29:18] pushing that life extension, right? [29:21] Healthy life extension to [29:23] years that we can't even imagine right now. [29:26] Right? And by the way, [29:27] there are three other drugs [29:29] that are just as good as GLP one. [29:31] One is metformin. [29:33] One is a class that's called [29:34] sglt two inhibitors and one [29:37] is bisphosphonates, the Anti-osteoporosis class. [29:40] All of them have a remarkable effect [29:42] on many parts of aging. [29:45] Okay. [29:46] If I could jump in on this point, Alice, [29:48] the your point about age related diseases. [29:52] They are driving. [29:54] Whether it's dementia, heart disease, diabetes, [29:58] cancers drive a tremendous amount [30:01] of preventable suffering in this country. [30:03] They drive a tremendous amount of [30:05] preventable hospitalizations [30:06] in this country, and therefore, [30:07] they drive a large proportion [30:10] of preventable costs in this country. [30:12] And no matter where you are on the ideological spectrum, [30:15] you can see it now in what's happening in Washington. [30:18] You agreed that the cost of [30:19] care needs to be more affordable. [30:22] We have not what we [30:23] have failed to do it until this moment, [30:26] is to leverage the unprecedented advances [30:30] in AI and machine learning in biotechnology, [30:34] and our advances in understanding cell biology [30:36] to predict our risk of these diseases, [30:39] to detect the precursors of those diseases, [30:43] and then to preempt meaning to [30:46] actually not just take medicines if they're useful. [30:49] But someone like me who's a [30:51] pre-diabetic is on a continuous glucose monitor, [30:54] and I'm able to actually follow some of [30:56] Jillian's advice on processed foods, [30:59] not because the CGM, [31:01] the continuous glucose monitor, [31:02] which is this thing that monitors your sugar [31:05] and your blood and gives data on an app. [31:07] It's not that it's magical. [31:09] It's because I trust [31:11] the fact that this is data coming from my body. [31:14] And as someone who is an Indian kid [31:16] and loved rice and rotis at every meal, [31:18] um, I never would have relinquished that. [31:22] But now that I have prediabetes [31:24] and a onesie that's creeping up, [31:25] and I saw in that monitor that my glucose [31:28] spiked as high as it did when I had a scoop of ice cream. [31:31] I've been able to get rid of that. [31:33] And that, to me, is [31:34] the potential future where human beings are thought of [31:39] as humans and not even as patients can [31:41] take care and be proactive about their health, [31:44] not simply waiting for [31:46] disease to happen and then treating it. [31:48] That's how we pioneer a future of, of, [31:51] of health care that's both able [31:53] to cut costs without cutting care. [31:55] And that's empowering, I think [31:57] individuals to really take [31:59] their health into their own hands. [32:00] Okay, we could keep going and I would love to, [32:03] but I know that there are questions from the audience, [32:06] so I want to open it up. [32:07] I do believe there is someone who has [32:11] a question and the microphone is coming around. [32:16] It's hard to see here, son. [32:18] I'm over here. Over here. [32:21] I don't You probably can't see. [32:23] Should I stand up? Okay. Hi, my name is Andrea. [32:26] I'm a professor at NYU in Public Health nutrition. [32:30] Um, so I can't say I [32:33] wanted to ask about the GLP ones [32:34] in all honesty and trying to understand, [32:36] because it seemed to me like you were sort of suggesting [32:38] GLP ones for the broad population instead of, [32:43] you know, as a treatment for obesity. [32:46] Is that true or no? [32:48] Because I think my other problem with [32:50] the GLP ones that I'm seeing or, [32:52] and we know it's a new field, [32:54] is just this idea of maybe people [32:57] not then appreciating dietary intakes, [32:59] the physical activity, [33:00] the other lifestyle behaviors [33:03] that you've been talking about [33:04] that I think are so important. [33:06] If we just rely then on a, [33:08] you know, one aspect of this drug. [33:10] Well, they are prescribed with [33:12] diet and physical activity. [33:15] Whether or not, you know, [33:16] they are a question. [33:17] And first of all, let let me confirm that [33:20] if you go to a longevity doctor or a longevity clinic, [33:24] and what your doctor should tell you that you should [33:26] optimize your exercise, your diet, [33:29] your sleep, and your social connectivity, [33:31] because all of them are [33:33] have an underlying biology of aging. [33:35] Okay. And I didn't mean to ignore it. [33:38] And that's good. And this is good for every age. [33:41] The point is that you age and at a certain time, [33:46] you cannot optimize it anymore. [33:48] You certainly cannot maximize it [33:49] anymore or you run into trouble. [33:51] And when is when is the point? [33:55] We haven't really determined that. [33:57] What we determined is that, listen, [34:00] there are four drugs that could, [34:03] when you're old, could change the rate of your aging. [34:07] And we're trying to tell you which drug is [34:10] available for whatever you need. And you're right. [34:14] If there was a 65 year old guy [34:17] who would come to a clinic and he's obese. [34:20] He would probably get glp1 to lose weight and maybe then [34:23] metformin to to treat the aging. [34:27] I mean, how we're going to do it and [34:29] to whom is still a discussion. [34:32] My point is those drugs have [34:33] strong anti-aging effect in clinical studies. [34:37] Okay. I don't know that [34:39] that means that everybody should take them, [34:41] but everybody should know that there [34:44] there's help that can be realized right now. [34:47] Okay. By the way, doctors, [34:49] it's legal to to [34:52] repurpose any FDA approved drug [34:55] because there is a safety already. [34:56] So it's legal to do that. [34:58] You don't really supposed to get [35:00] into trouble if you do that. [35:02] Metformin was repurposed for obesity, for PCOS, [35:05] for macular degeneration for [35:07] prediabetes, and now for Covid. [35:09] It's the the first drug that you get if you have [35:11] Covid now in New England journal study. [35:14] So so things can be repurposed. [35:17] And I didn't call for the public to get on GLP one. [35:22] Jillian, I want to see if you have anything to [35:26] say on the question of drugs versus. [35:28] Oh dear. [35:29] Fitness and nutrition, which you spent your career. [35:31] Let's look at this. And doc, I appreciate [35:33] your perspective and the mechanisms you seem [35:35] to be citing for the vast majority of [35:37] the health benefits are calorie reduction. [35:39] But technically, I mean, [35:41] you could reduce your calories without the drug. [35:44] And if people can't, [35:46] I think one of the top reasons for that would be [35:49] circling back to ultra processed foods, [35:52] which literally are designed [35:55] to make you not eat just one. [35:57] And in fact, when you think about [35:59] what kind of foods make the body [36:01] release GLP one naturally fat, protein, fiber. [36:05] Well, there's none of that stuff in a soda. [36:07] So just saying, when you're eating ultra processed foods, [36:11] it creates the opposite of satiety. [36:15] Now, having said that. [36:16] Right. Okay. Obesity. Also, losing [36:20] weight has a general halo effect on every biomarker. [36:23] When we're talking about I have [36:25] heard the neuroprotective piece, [36:26] and I'm actually curious myself [36:29] with regard to what is the mechanism there. [36:31] I've heard that Alzheimer's [36:32] is called type three diabetes. [36:34] I'm wondering if it has to do with the fact that [36:36] this drug was used for patients that were diabetic, [36:39] which would bring me back to is [36:41] there a diet that's higher in fiber, [36:44] higher in protein, helps you manage your blood sugar. [36:46] Utilize a glucose monitor. [36:49] Um, could you not get [36:51] similar benefits in potentially preventing Alzheimer's? [36:55] But again, I don't know the mechanism. [36:57] It hasn't been explained to me, [36:58] but I have heard that it is neuroprotective. [37:00] Having said that, on GLP ones, [37:03] you would bring me to two places [37:05] at this point in my career. [37:06] If you have somebody who is morbidly obese and [37:10] is already experiencing a host of co-morbidities, [37:14] and in the cost benefit analysis that both literally. [37:17] I mean, this these two brilliant [37:18] men have spoken to you about, [37:20] which is very real. [37:21] Medications have side effects, right? [37:23] You weigh out these cost benefit analyses [37:25] with your doctor. [37:26] So in looking at this, [37:28] if a person is £500, [37:30] £400, £100 overweight, has type two diabetes, [37:33] all of these different health issues. [37:35] And we've tried everything and it's not working. [37:38] And that's a last resort. [37:40] I get it 100%. [37:42] Another possibility, and I would [37:44] love to hear what you guys think about this. [37:46] I've seen people utilize these medications in [37:51] a much lower dose when [37:53] compounding pharmacies were legally allowed to make them, [37:56] which they're not right now. [37:58] Doctors were able to personalize [38:02] your care and titrate your dose up or down. [38:05] And I've seen people get [38:07] incredible results and have minimal side effects. [38:12] And when they're not on this massive dose, [38:15] they are actually able to [38:17] eat and they are actually able to work out [38:19] because on these insane dose or [38:22] the insane amount of medication in that little pen, [38:26] you could sit down with a steak. [38:28] It's recommended. You can't eat it, [38:30] you can't, you cannot eat it. [38:31] And not only that, if we're talking about longevity, [38:34] we're also not looking at sarcopenia. [38:37] And these drugs are associated [38:38] with significant muscle wasting. [38:41] When we look at people who are on these drugs, [38:42] I've heard Doctor Robert Lustig [38:44] suggest that he's seen patients in [38:46] his clinic who lose [38:47] a significant a significant amount of weight, [38:49] up to 60 to 65% of it is muscle. [38:52] Doctor Attia said the same exact thing. [38:55] And when you're taking [38:57] weight off of somebody in a healthy way, [38:58] they're exercising, they're eating less. [39:00] You shouldn't really see more than 25% [39:03] lean body mass lost. [39:05] So I'm simply saying, [39:07] I think this is a sledgehammer and it should be used [39:10] judiciously for very specific individuals, you know. [39:16] That's my that's my take on it. [39:18] Guys. When you're obese, [39:22] when you have £50 more on you, [39:24] you're going to increase your muscle mass. [39:27] And when you're decreasing £50, [39:29] you're just are going to decrease the muscle mass. [39:32] Some people get into trouble with it. [39:35] I had a 75 year old woman, by the way. [39:37] I'm treating diabetes for all my career. [39:40] Okay? I'm actually actively treating diabetes. [39:43] GLP one have been using for ten years. [39:45] Okay. I know everything that needs to do. [39:47] Before it came public, [39:49] I had a woman who was 75 year old, [39:52] obese and diabetic, and I gave her [39:55] ozempic and she lost her obesity in diabetic £50. [39:59] She couldn't get up off the chair. [40:01] Okay. She had. [40:03] So what I'm saying. [40:05] Yes, this is not good for everyone. [40:07] She's the only one in my clinic [40:09] that couldn't get out of chair. [40:11] Okay, I told I told you about saved 100 and kill three. [40:16] Yes. And in fact, [40:18] I'm very busy in consulting to [40:20] several companies that are developing the drug. [40:23] The combination of drugs that will stop [40:26] the muscle from decreasing, [40:30] preserve the muscle, just get fat. [40:33] IGF, LR three, I've seen that combination. [40:36] Three. There are actually several efforts. [40:39] Nobody's a winner now, [40:41] but I think that's what that's what will happen. [40:43] I will also tell you that in my diabetes clinic, [40:46] when every time all diabetic are obese, [40:49] whenever we say your diabetes is terrible, [40:51] it's a ticking clock. [40:52] You'll lose your eyesight and, [40:54] and, and legs and, and kidneys. [40:57] Okay, so you should diet. [40:59] It's less than 3%. [41:01] That would actually lose weight. [41:03] Okay, so it's true that we wish we would do that. [41:07] And it's true that maybe other things [41:08] have contributed to the obesity. [41:10] I'm not I'm not talking about it, but. [41:13] But they're not going to lose enough weight to, [41:15] to, to stop this ticking time clock. [41:18] So so I think that's really the clinical reality. [41:23] And I think we're only at [41:24] and unfortunately, we're running out of time. [41:26] So I think we're only at the beginning. [41:27] You know, Gillian, to your point [41:29] of understanding how these drugs are going [41:31] to be used and to your question of how they will [41:33] be used in the clinic. [41:36] You know, over time, [41:37] when we see the oral versions come out in the pill form, [41:40] I think that will also [41:42] help for doctors and patients to have [41:44] a better conversation about so-called maintenance doses, [41:48] um, and helping people to get to a point. [41:50] Perhaps you start with injections and lose enough weight. [41:53] I've also heard patients talk about, you know, [41:56] once they've understood what it means to lose weight, [41:59] change some of their markers, you know, [42:01] heart disease and diabetes markers, it motivates them. [42:05] And so that might be [42:06] the catalyst they need for some people. [42:08] It's different for everyone, of course. [42:10] So I think we're just at the beginning [42:12] of understanding where these drugs may go [42:14] and how they can combine with [42:15] lifestyle behaviors like change. [42:17] I think that's the point is that whether [42:20] you're on a GLP one or not on a GLP one, [42:23] it's got to be a both an approach. [42:25] What I'm afraid of as a physician is that [42:27] we wait for people to now get obese or, [42:31] and then we act and we [42:36] give up on the lifestyle nutrition [42:38] that should complement the medications. [42:41] I'm sure in your clinic you do all of the above. [42:43] I think the, the messaging [42:46] has to go with it because I think there's a risk [42:48] and there's a lot of history [42:49] that we sort of fetishize the [42:51] biomedical and don't understand [42:54] disease and illness as it is for all of us. [42:56] It's biological, it's psychological, it's social. [43:00] And it has a lot to do with biology, [43:02] behavior and the environment and the best programs, [43:05] the ones that have the biggest returns on investment, [43:08] the lowest cost are actually using value based care or [43:11] virtual coaching models to to both [43:14] help those prevent them from ever needing a drug. [43:18] But if they're on a drug, [43:19] to be able to help them also potentially reverse [43:22] the disease and complement the medicine they're taking. [43:24] I think that both and approach is critical. [43:26] Can I just say one thing? [43:28] In the 1970s, only 5% [43:31] of American adults were obese or overweight. [43:34] So what happened? [43:35] It wasn't that they were lacking GLP one. [43:39] What happened? Ask yourself that. [43:41] We didn't have a quantum leap in genetics. [43:44] What happened from 1970 to now? [43:49] Could it be the revolution of ultra processed foods? [43:55] Certainly a part of it. Yes, certainly [43:57] a part of it. Certainly a part of it. [43:59] And of course, for the chronic disease epidemic, [44:01] the excess in salt when salt is cut out, [44:04] that makes a huge difference [44:06] in high sugar foods When that's cut out, [44:08] that makes a big difference. [44:10] We just can't forget that it's got to be [44:12] a much more comprehensive approach [44:15] if we're going to succeed. [44:17] And again, there's there's a number [44:19] of things policymakers can do. [44:21] Providers can do patients and their families can do. [44:25] And that is going to be critical, [44:27] I think, if we're going to get our arms around, again, [44:30] the preventable suffering in [44:31] this country and the preventable [44:33] costs that that are [44:35] escalating in affordability crisis, right? [44:38] And it's the ultra processed foods as well [44:40] as our now physical activity habits, right? [44:43] Which we're not moving. [44:44] We're absolutely not moving at all. [44:45] Kids are not outside. [44:47] They're playing Fortnite. Yeah, absolutely. [44:49] Exactly. All right. Well, we could keep [44:51] going all night and probably even to tomorrow, [44:53] but near Gillian and Raj, [44:56] thank you very much for your time [44:57] for these interesting points. [44:59] Thank you so much. 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