Eric Topol: The Keys to Healthy Aging

Harlan Krumholz: Welcome to Health & Veritas. I’m Harlan Krumholz.‌

Howard Forman: And I’m Howie Forman. We’re physicians and professors at Yale University. We’re trying to get closer to the truth about health and healthcare. We have a very special episode to start off our fifth season, and I really can’t imagine anyone better—‌

Harlan Krumholz: Our fifth season? Our fifth season.‌

Howard Forman: Fifth season. I know, it’s hard to believe.‌

Harlan Krumholz: Oh my God, Howie.‌

Howard Forman: And I can’t imagine anyone better to be on the pod with—‌

Harlan Krumholz: No one better.‌

Howard Forman: ... all the news swirling about right now than Eric Topol who we had back on the pod—‌

Harlan Krumholz: How did we snag Eric Topol? That is extraordinary.‌

Howard Forman: Well, we luckily had him on December 1st, 2022, in the middle of probably a different COVID wave on episode 58 of the podcast, and now we’re able to get him back because he just published his newest book.‌

Harlan Krumholz: Let’s sell some of these books, because it’s a terrific book. It’s a really terrific book.‌

Howard Forman: It is a fantastic book, Super Agers: An Evidence-Based Approach to Longevity. And before he was on the podcast last time, he had launched Ground Truths, which is an amazing newsletter Substack, and he’s been doing his own podcasts and videos as well. So, we’re going to try to touch on those topics. I do want to start off with the book, and point out to our listeners, first of all, that you do a deep dive on an array of topics that are far afield from your specialty of cardiology and really look at the evidence from all angles. And I wanted to ask you: what are the biggest surprises that you think that a reader or our listeners might learn from this book that may not be apparent if you’re reading the popular press every day?‌

Eric Topol: Yeah, I think the biggest thing was that everyone considers their genetics as their risk for getting a particular disease, age-related disease, and it turns out that’s just a minor component. And as we’ve learned in recent years, it’s really the immune system, how well that hangs on as we get older. With respect to protection or getting dysregulated, the immune system is key. And if I go back, I’d probably become an immunologist and a computer scientist rather than a cardiologist, because that’s the center of all this right now, age-related diseases. If you get your immune system just right, I think that’s the ticket for most people.‌

Howard Forman: It really is remarkable. You think about the number of people who can have a relatively healthy young-middle part of their lives, and then the immune system dysregulates later in life, and you have all sorts of things. We always think about things like arthritis or hepatitis, things like that, or liver dysfunction, but there’s just so many things, including neurologic implications of that over time. And we’re learning more every day. And you go into that in practically every chapter, but you have a specific chapter on the immune system in the book.‌

Eric Topol: Yeah, the fact that we’re getting to control it now, like a rheostat. The more we get at that point, where we get really good control, and being able to measure it. As both you and Harlan know, one of the biggest deficits we have in clinical medicines, we don’t have a way to measure the immune system, and we desperately need that because that’s really the key.‌

Howard Forman: So, for our listeners, first of all, part of the book, you talk about the fact that your parents died at relatively young ages, and thankfully you are now—explicit in the book, I think you’re 71 years old right now—and you even give data that has been acquired about you and how it informs you. What advice would you give our listeners? What are the best pieces of advice you can give our listeners? And as a second part to that, do you find it hard to follow your own best advice? Because I do. I eat some ultra-processed foods that I cannot stop. I do exercise every day. There are some good things I do. There are some things I don’t do well. What do you do, and what do you think are the things that people could reliably change about their behaviors to live longer and live healthier?‌

Eric Topol: Yeah. Well, the problem with the generalized recommendations like an anti-inflammatory diet, avoiding ultra-processed foods as best you can, but as you point out, Howie, it’s hard to just completely get off of them. Attention to not just aerobic but resistance and balance training exercise and trying to do that as much as you can. I try to do that an hour a day with some combination of that. And most days I do that. And then sleep. That was a big thing for me, which was tracking it because I knew I didn’t sleep enough or well, and then tracking it and working on that deep sleep component where the lymphatics of the brain do the washout of all your waste products, which otherwise will inflame your brain. So, I got much better at that. I’m still working. The problem with the general recommendations, as you know, is that most people don’t do them.‌

And that’s why I think the book is trying to set up a whole different mode, which is we have to partition people’s risk, and we have to... since it takes 20 years for the major age-related diseases, cardiovascular cancers, neurodegenerates, 20 years or more for them to take hold in our body, we got to get ahead of that, and we can do that now. We could never do that before. Once we establish a person’s at high risk for one of these diseases, then we have all these ways, using lifestyle factors, which are not just these three, there’s a long list, to help them, but of course, we’re going to use more than just lifestyle factors in the future. So, the point being is we can’t just put out general recommendations because they’re largely ignored, but we can work with each person through multimodal AI of all their layers of data. So, for me, a big thing recently, I’m an APOE4 carrier, and 25% of us are. I don’t know if either of you have gotten your—‌

Howard Forman: I have not been tested for it, but just to remind our listeners, that puts you at risk for Alzheimer, right?‌

Eric Topol: Yeah. And I don’t have a family history of Alzheimer’s, because as you pointed out, Howie, my parents, my family members, they all died in their 60s or younger. So, I’m thinking, well, when you forget stuff, a name or something, “Oh man, that must be my amyloid and tau in my brain, whatever.” So, this breakthrough, the biggest breakthrough in neuroscience in decades, is this p-tau217. It anticipates whether you’re going to have Alzheimer’s 10, 15, 20 years in advance. So, I just recently got my p-tau217, and it was almost zero. And you know how liberating that is? Oh, my gosh. So, the point is that I wouldn’t be the one to fixate on the risk factors and prevention of Alzheimer’s. I’d be much more... because my polygenic risk score for heart disease is really high, which people don’t get and they should be getting. And also there’s a polygenic risk score for each of the common cancers and for Alzheimer’s. And there’s these markers like p-tau217.‌

There’s organ clocks, a brain clock, an immune system clock, a heart clock, an artery clock, liver clock. We’re not using any of these incredibly important tools to predict the risk, to guide a person about their lifestyle, their prevention plan. That’s what we’re going to do in the future. Someday prevention, real prevention... Not this give somebody a pneumovax, check their lipid panel, no, real prevention will someday be the norm. And we could do this now, but nobody’s doing it.‌

Howard Forman: So, how do you move toward that? Go ahead, Harlan.‌

Harlan Krumholz: Well, I was just going to say that on the lifestyle side, though, there’s a lot of overlap in terms of what represents healthy intervention. So I do wonder whether or not it’s enough to give people, “Oh, you’re off the hook for Alzheimer’s,” as opposed to saying, “There are actually behaviors and approaches like good sleep, like exercise, like avoiding ultra-processed foods and diet,” which we actually have less evidence for than some of the other things, but still seem like the right thing to do based on what we know. That crossover that probably helps reduce your risk of cancer, heart disease, and neurodegenerative disease all together. And so there does seem to me to be some pluripotent preventive strategies, ones that actually cross all those boundaries. And then there are some things you can do specifically for each of the individuals, but... right?‌

Eric Topol: I’m with you, totally. The lifestyle factors, they extend to a lot of other things, air pollution—‌

Harlan Krumholz: Alcohol, for example.‌

Eric Topol: ... plastics and alcohol.‌

Harlan Krumholz: Plastics, alcohol.‌

Eric Topol: Forever chemicals, social engagement. There’s a long list of... that’s why I call it “Lifestyle Plus.” You’re absolutely right. They cut across all three. The point is, though, we’re not doing well. Right now 75% of Americans don’t even meet the minimal standards for physical activity. All right, so what I’m saying is if you can tell a person, “This is the disease you’re going to get in 16 years, you’ll start having symptoms,” because we can even give time now, not “yes or no,” we can give temporal link, then the chance of them doing these things might be increased. For example, in Finland they did a polygenic risk score for heart disease, a prospective study. What they found, when people were given their polygenic risk score was very high for heart disease, those people made radical changes in their lifestyle. They stopped smoking, they lost weight, they had physical activity.‌

But who gets a polygenic risk score today about anything? And so I’m just trying to suggest that we will do better when we give people specific individualized or personalized recommendations because we’re not doing too well with these generalized things, which I couldn’t agree with you more. These are things, by the way, in the book I review. If you do all these things that you and Howie were reviewing, you get seven to 10 years of healthy-aging-added years if you start at age 50. If you start at age 50. If you start younger, you get even more. So, if you start older, you’ll still get something. So yeah, they would help everybody, but everybody’s not doing these things.‌

Howard Forman: How does one get access to a polygenic risk score in today’s day and age in society? Is it something accessible to the average person?‌

Eric Topol: Well, there’s 10 companies at least that are offering them. I mentioned many of them in the book in that section. We’re working with one of those called Haplotype to get them cheap because some of these are like $200. This is the cheapest thing to do. We could do it, but not at scale. At Scripps Research, we were doing it. Now, for $20 it’s a cost for us to do it. It’s a SNP-ChIP. 1,000,000 SNPs, a variant. So, it’s very easy. The work here has been done over 15 years to define what are the letters, steps that are associated with the polygenic risk for each of these common diseases. So, we’re working with Haplotype because the guy that did all these for 23andMe, he branched off or left 23andMe and their turbulence and set up this company. And we’re trying to get that hopefully in the months ahead, so it’ll be like $25 for everyone.‌

Anyway, at Mass General Brigham, they launched, all clinicians can get polygenic risk scores. Pradeep Natarajan put out a post now. I don’t know how much it costs, but they can do it. Add it to the companies. So, academic labs know how to keep the variants updated because for heart disease, there’s hundreds of variants that are used to give the most accurate ancestry-specific, ethnic-specific risk score. Because in the beginning of all this, we didn’t have these millions and millions of people of diverse backgrounds with this kind of data, but we do now for all these polygenic risk scores. And I can’t believe... Here it is, 2025, this data has been available for almost 10 years. It keeps getting better every month, and no one’s using it. It’s just amazing. As a cardiologist, every patient I see, I ask them...‌

Now, it used to be easy when they could get their 23andMe data before the company imploded, I would sit in the clinic with them and say, “Just upload it. Go to MyGeneRank,” our app that we made for free, “and get us your polygenic risk score.” And they would do it in two minutes for free once they had 23andMe, but now they can’t do that, unfortunately.‌

Harlan Krumholz: Well, Eric, do you want to... I believe that everybody will have this sometime in the future, I don’t know when, but do you want to explain to people listening, because not everyone’s going to know the concept behind the polygenic risk, so I might as well let... You’re a master teacher, so instead of me saying that, why don’t you go ahead and explain.‌

Eric Topol: Well, to simplify, you’re going to find out risks that you didn’t think were in your family or you knew weren’t in your family. And the reason for that is polygenic, these common diseases, there are hundreds of gene variants that contribute to their risk, and you’re going to get something from your mother’s side of the genome and your father’s side of it. And that mixture comes up with unpredictable things. You don’t just get a pure paternal or pure maternal inheritance. Okay? We get a recombination. So, the point about the polygenic risk score is for each of these conditions, could be colon cancer, could be atrial fibrillation, validated to the health, there’s hundreds of variants that are linked to that condition. Now, the only problem is they don’t tell you when. So, let’s say you have a high-risk polygenic risk score for Alzheimer’s. It’s yes/no. So, it only would tell maybe you could be age 99 for Alzheimer’s or it could be 69 or at 59, so now we have much more than that.‌

Harlan Krumholz: Or never. It’s just about risk.‌

Eric Topol: Yeah. It gives you a gradient of risk. And so if you’re in the 90th percentile, 95th percentile, you know that’s probably something you want to be preventing, but you don’t know when. Now we can take that much further.‌

Harlan Krumholz: But just to follow up on that, you’re also the guy who did the Wellerby study and said, “Part of what this taught me was that genes aren’t as important as everything else I can do.” So, how do you reconcile this idea that I can get an assay of my genes? And the way I explain it to people is it’s a super duper family history. This has taken all of the stuff that’s happened with all your ancestors, how you’ve inherited that, and telling you based on a whole bunch of different genes what your risk is. And so it’s kind of a super duper family history rather than us just asking.‌

Eric Topol: It’s additive and independent of the clinical family history, yes.‌

Harlan Krumholz: Of what people will report. But how do you reconcile? Because you also are the guy who’s saying, “Hey, double down—.” Let me put it like this. I think you’re saying, which I think... and I definitely agree with you, if this is what you’re saying, you can control your destiny to a large extent.‌

Eric Topol: Yes, absolutely.‌

Harlan Krumholz: So, you’re not trapped in what you’ve inherited because you have a lot of latitude to modify that risk, whatever it is, wherever it starts.‌

Eric Topol: Yeah, so let me get to this, because the Wellderly were the 1,400 people that we did whole genome sequences. They were over age 85, ranged up to 102, and we didn’t find any real differences in their polygenic risk.‌

Harlan Krumholz: Oh, Wellderly.‌

Eric Topol: Wellderly. That’s okay.‌

Harlan Krumholz: I mispronounced it. Sorry about that.‌

Eric Topol: Yeah, the Wellderly, it took seven years to find these people. They now are no medicines, never had a disease, cognitively intact. And I present my lady patient Mrs. Rosol, the first thing in the book, 98. I mean, she’s incredible, right? And I’ve even had her at grand rounds here to present her because she’s just like, wow. And she’d never stood up before anybody in her life and here she is... She’s joking with the crowd, they’re all laughing their heads off because she’s so amazing. Oil painter, a jigsaw puzzle, thousands of pieces. So, these people, their polygenic risk scores are essentially similar to the elderly. The elderly are Americans over age 60 who have at least one chronic disease, typically two or more. So, we say, “Wait a minute, how did these Wellderly get to age 90 or 89, and they have the same polygenic risk score?” Well, you look at their lifestyle, and as you say, Harlan, it’s not deterministic.‌

These people were relatively thin. They were very physically active, they’re socially engaged. They have a sunny disposition, all sorts of... They have hobbies. And these people are different the way they have approached life and taken care of themselves. It was very rare we would find somebody in the Wellderly who was obese or smoked still, very rare. Most of them really took good care of themselves, and they have a lot to show for it.‌

Harlan Krumholz: I was just going to weigh in and just say, Eric, look, this book, there’s so many wackadoodles out there who want to ride a wave and depart from conventional science in their recommendations to people. The one thing about you that people should know is, in addition to everything else, being an extraordinary thinker, a great communicator, so creative, is you’re an outstanding scientist. Your roots are in science and you’re evidence-based. You can evaluate studies. And people should know if they go to this book, unlike many other books, it’s replete with references, it analyzes the science in ways that are accessible to the lay public, but are also rigorous. And that’s what’s really distinctive about it. I wanted to ask you, sometimes by going off on these tangents and suggesting sort of wild things to people, it’s easier to get attention. Did you think as you did this book, “Gosh, it’s like I don’t know if I can get people excited about real evidence”? How did you approach it like that when you thought about this book?‌

Eric Topol: Well, thanks so much for your comments, Harlan. It means a lot to me. This is a really tough mission because we have books out there like Peter Attia’s Outlive, and Casey Means’ Good Energy, and both those books have some good parts to them, but they also have a lot of things that are completely off the rails. And they are extremely popular, having sold over two million, one million copies, respectively, and still going strong. So, the problem is they tell things to people that they want to hear, like “There’s these secrets and that the medical establishment has got it all wrong, but we know.” Take rapamycin or get a total body MRI or take these peptides and on and on and on. And so I don’t know... over time when you try to tell stuff that is representing the medical establishment with evidence, I don’t know if it will compare with giving the messages that people want to hear, which is basically from people who are challenging the medical establishment, which as you know is kind of the rage right now.‌

Harlan Krumholz: Just want to follow up one thing, Howie, because we’re so excited to talk to you, we’re colliding. That’s why it’s like... I wanted people to know who are listening, because they may have heard about Super Agers, but you’ve really created a body of work that actually I see coming together. There was starting with The Creative Destruction of Medicine, with a big idea about digitization of everything would fundamentally disrupt medicine. Of course, you were right about that, and then The Patient Will See You Now is such an important book. Of course, as you know, I resonate a lot with the idea of: how do you empower patients, how do you put them in this position? And your idea there about smartphones and digital tools, putting patients really in the middle, and I just love that flip: “The Patient Will See You Now.” It’s a fantastic title. You go into Deep Medicine, where you start talking about the promise of AI, and then you get into the longevity stuff and wellness with Super Agers.‌

I really see this as a connected group. And if people haven’t had a chance to dig into these, even though some of these are a little bit older now and the world’s changed, you actually did them in a way that I think they have enduring wisdom associated with them, that you’re providing insights that are still relevant. Even if people go back to these, they’ll see lessons that we’re still applying even as the sciences move forward. Did you ever conceptualize these together, or did these just come out one by one as you did it? How did you approach the idea of books? Because earlier in your career you weren’t writing books like this.‌

Eric Topol: No, no. I actually... I got started much later than I probably should have because I didn’t ever think I would write a book for the public rather than just these medical textbooks and stuff.‌

Harlan Krumholz: And of course, you wrote the major interventional cardiology…edited the major interventional cardiology textbook for many years. I think through four editions it was—‌

Eric Topol: Oh, now it’s soon going to be at the ninth edition—‌

Harlan Krumholz: The ninth, so yeah.‌

Eric Topol: We haven’t given up on it. It’s kind of amazing. But I think what I’ve learned is our audience has to be the public because we live in this microcosm, whether it’s radiology or cardiology, whatever specialty, even internal medicine, it’s just not the right audience. It’s fine to talk to your colleagues and peers, but it’s much bigger than that, so I finally learned later. Now, every book, including Super Agers, I try to forecast the future, and I’ve always been wrong, not by what was going to happen, but when, because it takes much longer for medicine to reset and change. And here, the thing that I tried to put forth in Super Agers was, we have an opportunity to prevent the big three age-related diseases like never before. That’s really the big idea here, but are we going to do it? Are all the gutting of our medical research support, the resources going to prevent it or suppress it or slow it down?‌

But that’s what’s, to me, so exciting. So, each of these is kind of an optimistic forecast, which has been off—by years! The first one in Creative Destruction, I kept talking, the chapter on telemedicine. It took a pandemic, so that we would have telemedicine! But fortunately, I think so far AI, as you mentioned, Harlan, as deep medicine, we’re starting finally to get into the AI, use of AI. And the generative AI wasn’t even known then, but we knew it was coming. And I had spoken to the leaders in the field, and we knew that this whole ability to read text and images, and everything was going to change. And it did, and now we’re in a new era, but it’s the very early era of medicine. And as you know, both of you know so well, there’s lots of fear, lots of reluctance, and some of that’s justified, of course. So it’ll take time, but we will get into AI being incorporated into daily medicine eventually.‌

Howard Forman: I wanted to briefly just touch on something, your second to most recent Substack was on protein, and that is one of the biggest fads right now. Everybody’s trying to figure out how they can get all their calories in protein. And I fall prey to this all the time. I have protein bars in the office, but my protein bars are almost passé right now compared to the new super protein bars that everybody has. I’m curious, though, another topic in Super Agers is about this issue about rapamycin and its interaction with immunology. And on your most recent one on the protein, you talk about leucine and how so many of these sort of health-oriented individuals are taking leucine and they’re also taking rapamycin. Can you just talk about what the evidence is about this and why it’s so crazy?‌

Eric Topol: This is incredible to me. I was on this topic, but then when The Daily, New York Times podcast, last week had one on David bars and Peter Attia and Andrew Huberman being the number one and two influencers pushing the protein one gram per pound, which obviously is a lot of protein to ingest every day. And of course they’re selling these bars that have the most protein ever with the lowest calorie in bars, and they’ve sold so much that they can’t even make them fast enough. Hundreds of millions of dollars. Anyway, I started getting into this because in the book I even mentioned about how all the work from Washington University St. Louis, which hasn’t gotten enough regard, shows that high protein intake, and this is shown both in mice and in people, will add to inflammation of the body, and at least in the mice models, promote atherosclerosis.‌

And in fact, the leucine, as you mentioned, Howie, that’s the essential amino acid. We can’t get... the body can’t make it, but we get it through eating food or bars. Most of it comes from animal sources. Well, it turns out leucine is the culprit. That’s the big thing. And this is a real problem because these people that advocate taking rapamycin with no data to know that your immune system is not knocked out because we can’t measure it, that inactivates mTOR, the molecular targeted rapamycin. And the leucine activates it. So, what they’re doing is they’re getting the yin and yang opposing effects. They’re knocking out whatever the rapamycin was supposed to do with the leucine. It’s just crazy. And there’s no data. There’s no data. And I just reviewed every meta analysis, every paper out there, every randomized trial, there’s hundreds of them, that support this one gram per pound—‌

Howard Forman: It’s insane.‌

Eric Topol: ... which is 2.2. And people are on it. All these TikTok videos, and take 200 grams of protein a day. This is a sick—with no basis. It’s kind of reckless. And some people, especially if they take this big protein intake through animal sources, they’re going to get a lot of leucine. And if they had a risk for heart disease, it’s not going to make it any better.‌

Howard Forman: Not to mention that these David bars and most of these high-protein products are ultra-processed foods—‌

Eric Topol: Yeah, that’s right.‌

Howard Forman: ... on top of that.‌

Eric Topol: They’re all ultra-processed, but especially these David bars with the EPG. This stuff is just... You could never make this up. It’s just amazing. And of course, the peptides, as another Ground Truth I wrote a couple of weeks before that, that’s the same story. You got RFK Jr. advocating everyone should take BPC-157 peptide. And people are taking stacks of peptides, each a few hundred dollars or more every month, and they’re self-injecting themselves with these peptides. It’s the same issue. There’s no data for any of this stuff.‌

Harlan Krumholz: We can’t get people to control their blood pressure, but there’s all these people following all this other stuff.‌

Eric Topol: But try to dissuade from the influencers who have massive following. And they are “trying to tell you the secrets that the medical establishment won’t tell you that”... this is what we’re up against. It’s a real challenge right now. You saw it, even the hearing with RFK Jr.‌

Harlan Krumholz: Crazy.‌

Eric Topol: They got truth and evidence versus stuff that’s made up, and you can’t tell the difference out there.‌

Howard Forman: I’d be remiss to not reflect on the fact that the moment that we’re in right now, we had the RFK hearing, and you did a podcast with Dr. Mike Osterholm which I thought was great, where you talked about the challenges that we’re in in the public health space right now. Do you want to just say a couple of words? You are incredibly careful about not going out too far with running around with your head cut off. You do judge bad behaviors out there, but it’s not like this is the thing you do. You don’t sit there and say, “Look how crazy everybody is.” Tell us how you feel about the current moment though, because it does make a lot of us feel like it’s crazy.‌

Eric Topol: Yeah, you could go crazy by doing that, so I try to stay sane. And obviously we’re in a dark time. We have all this dis- and misinformation and made-up stuff and politicization of everything. The way I keep my sanity is I get my head into other topics. I don’t fixate on it, knowing that someday this will get righted. It may be too long from now and it may take too much to get back on our footing, but this can’t go on forever, how bad it is. So, I try to just stay optimistic. I know it’s bad, but I’m on Bluesky and Bluesky, you know, if you want to get anyone to pay attention to your posts, it’s got to be something about how crazy everything is and how the world is ending. And I just post stuff about some interesting science stuff to try to titrate that because the science isn’t going to go away.‌

And as much as the funding might get cut, people who do good science, they’re just going to keep on going. And eventually, great discoveries will be made, maybe not at the same velocity. So, I have always been optimistic, and I’m not losing it. I refuse to have a derangement syndrome. I can’t handle it. I’d rather try to find whatever positives out there that are fascinating discoveries that tell us that the world is not going to... that the sky isn’t falling. It kind of is falling, but you know what I mean. Yeah.‌

Howard Forman: One last thing. This comes from Tobias, our research assistant in undergrad at Yale. He raises a point that a number of years ago you thought Level 5 autonomy was not achievable with AI, and more recently you seem to indicate that you think it is. Do you want to just say a quick word on... I know you say you get the timing wrong, and I agree, you get the timing wrong a little bit—‌

Eric Topol: Oh, a lot. Yeah.‌

Howard Forman: ... on the AI dissemination, but I’d love to hear you say what you think is going to happen in the future with healthcare, medicine, and AI.‌

Eric Topol: Yeah, so I was borrowing from the car, auto industry, and Level 5 autonomous driving means that under any condition, fog, ice, that the AI can navigate. And I’m just trying to say in medicine, we will never get there. There will always be conditions that the AI... You have a new cancer diagnosis, do you want the AI to tell you that, and what treatments? No. No. So, we are not going to ever get to Level 5. We may not even get really to Level 4. So, it’s just about how deep, how far, the breadth that AI can take us. I do think the biggest thing of AI in the future is going to be this remarkably precise and accurate forecasting of conditions, long before they ever start to show up. People haven’t centered on that, but that, to me, is the big thing that we haven’t yet even started talking about. But we’re not going to get to Level 5. I maintain that. And if I ever intimated that, I would retract it or say it isn’t true.‌

Harlan Krumholz: Well, I’ll just say you might... How about this? You might get to Level 5 for selective things. What about—‌

Eric Topol: Oh, yeah, yeah.‌

Harlan Krumholz: ... people have a rash, they take their phone, they take a picture of it, it tells them what it is, and for 80% of them, they’re telling them, “Put a little steroid cream on it. Take care of it.” I don’t know. I’m just joking.‌

Eric Topol: Yeah, but that’s Level 3. Level 3 is under specific conditions—‌

Harlan Krumholz: Oh, I see. I see.‌

Eric Topol: ... where the roads are clear and the maps are good. So yeah, specific things that doesn’t get you out to the 5. Total autonomy, I don’t think —‌

Harlan Krumholz: Total autonomy. I got it.‌

Eric Topol: I don’t think medicine can ever go there. I hope it doesn’t go there because the human touch and knowing that the doctor has your back, if there isn’t anything more essential in medical practice—‌

Harlan Krumholz: What about on the Mars trip? They have to bring a hologram that—‌

Eric Topol: This is ridiculous. No human being is fit to go to Mars. You can’t even live up in the International Space Station for a while. I just got to know the twins, and the one that stayed up there and the one that was up there and the one that got grounded. We’re talking about real suffering of the brain and everything. People aren’t going to Mars here. Maybe they could find a gene that’s Mars-selective that could get you there, six months trip. This is ridiculous stuff.‌

Howard Forman: I’m willing to send Elon Musk to Mars if that’s what it takes.‌

Eric Topol: I’m with you. I’m with you. I think he should go and start the interplanetary colonization.‌

Howard Forman: Exactly. Yes.‌

Eric Topol: Yeah, I think it’d be good. I think it’d be really good.‌

Howard Forman: I am so grateful that you joined us today.‌

Harlan Krumholz: We’re so happy to have had you on. It’s so great to see you here.‌

Howard Forman: And hopefully we’ll get you back again. And, again, the book is Super Agers: An Evidence-Based Approach to Longevity.‌

Harlan Krumholz: Buy it, it’s worth it.‌

Howard Forman: And the Substack is Ground Truths, which is so fantastic. It is free. You can subscribe for additional content, but it is free and it is fantastic. And it comes out—‌

Harlan Krumholz: The podcast, Substack, fantastic. I’ll tell you, it’s so easy to get behind this book because it really looks at the science. It’s something people can rely on. And for that, we thank you, Eric, for all you do. And it’s really great to see you.‌

Eric Topol: Oh, thanks to both of you. This was so much fun. I really, really enjoyed—‌

Harlan Krumholz: Thanks, Eric.‌

Eric Topol: ... and really appreciate all your feedback. And keep up your great work because—‌

Harlan Krumholz: Thank you.‌

Eric Topol: ... it’s changing the medical world for sure. Yeah.‌

Howard Forman: Not like you, but we’re going to keep watching you.‌

Eric Topol: We’re trying. We’re trying. We’re trying.‌

Howard Forman: We’re going to keep following you. And let us know if we can do anything. And if you ever are willing to come out to Yale and do a series of events like we did with Mandy [Cohen], I am all in.‌

Eric Topol: No, I would love to do that.‌

Howard Forman: Thank you.‌

Harlan Krumholz: We’ll even try to sell some books if you do.‌

Eric Topol: All right. You guys take care. Thank you.‌

Howard Forman: Take care.‌

Harlan Krumholz: Bye-bye.‌

Howard Forman: All right, bye.‌

Harlan Krumholz: What a way to kick off Season Five, baby.‌

Howard Forman: Absolutely. I’m so grateful for him. He is such a good guy. He’s such a nice man.‌

Harlan Krumholz: Yeah. And kudos to Tobias for putting together great notes for us to—‌

Howard Forman: Absolutely.‌

Harlan Krumholz: ... enable us to do a good interview. Anyway, everyone, you’ve been listening to Health & Veritas with Harlan Krumholz and Howie Forman. We’re back for Season Five.‌

Howard Forman: Back, baby, back. How did we do? To give us your feedback or to keep the conversation going, email us at health.veritas@yale.edu or follow us on LinkedIn, Threads, or Twitter, or whatever social media you want to try.‌

Harlan Krumholz: Yeah. I’ll plus one on that. We always enjoy hearing from you. Rate us. It helps people find us. And we’re off to the races this season.‌

Howard Forman: Absolutely. And if you have questions about the MBA for Executives program at the Yale School of Management, reach out via email for more information or check out our website at som.yale.edu/emba.‌

Harlan Krumholz: Health & Veritas is sponsored by the Yale School of Management and the Yale School of Public Health. We are fortunate to have superstar students that Howie’s recruited from his class, Tobias Liu and Gloria Beck. We have a remarkable producer who somehow makes us sound okay every week, Miranda Shafer. And I’ve got the best cohost in the world, Howie Forman.‌

Howard Forman: I am so grateful for all of you. And we just are excited for the new season, and happy to have started with Eric Topol. So—‌

Harlan Krumholz: Talk to you soon, Howie.‌

Howard Forman: Thanks very much, Harlan. Talk to you soon.‌