194. Why the Food Pyramid Flipped, How to Exercise for Longevity, & Will AI Replace Doctors?

Welcome to Medicine Redefined. I'm Dr. Altamasharaja, and I'm Dr. Darsh Show. Let's put the help back in the healthcare. If you're a high performer who wants a clear plan for longevity, performance, and staying active with fewer setbacks, I'm now seeing patients through my telemedicine practice refining health and performance. I'm opening a limited number of founding member spots at refininghealthrx.com. All right, let's jump in. Dr. Darsh, welcome back. What's up, man? What is up? Same old. Going back to work. It was in a little leave as, I don't know actually, I don't know if I told anybody that, but yeah, recent surgery. Going back to work full time next week, so that'll be a little bit of a wonder if I'm going to be rusty. We'll find out. Was it a nice break at least? Like good recovery? Yeah, I mean, I got a lot done in other realms in terms of reading and exploring. Talk a little bit more about LLM's and artificial intelligence. I feel like every podcast could be about that, right? Just because the rate of development. But it was fun. It was fun. So we'll excited to get back to some patient care. Although I did see some patients inpatient this past weekend. So I guess technically I've already went back. What about you? Same old man. Same old. Building out the practice. Community medicine. It's just one year in here and still grow and still going. So it's been fun. Yeah, that picture you posted on social media. It looked exactly like you. Yeah, so yeah, apparently the problem was that put a character of yourself with everything you know about me for my work that everyone's doing. Oh, but then you thought below the picture. So now it's gone so good where if you upload the picture, it'll make it just like you. Yeah, I want to do that. Except it's got to be better. I don't want it to make it just like me. It's no good. So where should we start? I feel like we're late to the game with this one. I know we had talked about. I think there was like a period of maybe a week where every single person on my social media feed on LinkedIn. I spend more time on LinkedIn now was talking about the dietary guidelines. And so I think maybe let's just go and crawl out chronological order and start there. What do you think? No, let's do it, man. This is why social media is hilarious to me. Oh, yeah. Well, many reasons. So for those listening who are not aware, although I imagine everybody already knows that, right? So January 7th of 2026, a new guide to guidelines, they're updated every five years. So this one is from 2025 to 2030, at least by Secretary Kennedy and Secretary Rollins. The tagline, eat real food. I love it. I love it. So it's end is the return of the food pyramid, right? But here's the cat. It's upside down. It's inverted pyramid. So I listened to, here's what's funny about it. I was cracking up because I listened to EC St. Kowski talk a little bit about this on her show, where some people weren't even aware of the food pyramid has been out of like for 20 years. I don't know, 15 years or 20 years because they do. Yeah. No, maybe 2010 or something like that. Oh, shit. Or maybe a little bit before because we've ever. It just shows that people are not paying attention and it's been the my plate. So either way, just to give a brief primer about an inverted pyramid, they're emphasizing, emphasizing protein, dairy, healthy fats are at the top, along with vegetables on the top right. And then you have whole grains oil gets narrower as you go down. And the whole grains are there at the bottom. And so a couple of key changes, I think worth noting here. First explicit call to avoid ultra processed foods. So big fan of that. They took a hard line stance on added sugars. No amount recommended zero zero for kids under four. And they also included non-neutral sweeteners in there. So we could talk about that. They really emphasize the importance of getting your protein from full fat dairy over low fat stuff and protein elevation across all meals. So, and we've given protein this love. I think a lot of people have given proteins love. And the other interesting thing was they really just removed the limits of alcohol, although they did say that you should consume moderately or try to limit overall intake. But I think previously the two a day limit like that, that was completely removed. And so that was interesting. When I started reading a little bit about it, I came to learn that the process was a little unusual. So for those who don't know, typically there is an independent dietary guideline advisory committee, right? Who spends years reviewing the evidence of what's happened in the prior five years. And they give a documentation like this long document. So they developed that over the last two years, gave a 421 page scientific report to the administration. The administration looked at it and said, nah, we don't want this. They completely rejected that report. And they commissioned a separate expedited review committee through contracted panels whose membership isn't fully disclosed, although a word is that a lot of them have affiliations with big dairy and big meat. So I want to put that out there. But that was a departure from how every prior edition was done. So that was funny since 1980, since the start of this. And so that should I think be worth or noted as we talk about this. So anything, any questions there, just as I said the stage for people. No, I think that's perfect. I didn't realize that. I never really looked into how it came to be. I just kind of looked at social media like he said for that week long where everyone jumped on the content and wagon. Yeah, nobody cares about it. Yeah. So what do you have you looked at it since the actual guidelines or thoughts on to it? So yeah. So what I was interested in is it came out January. Everybody was hyping on it, talking about it. I think most people are fans of it because of the talk about protein and the removal of ultra processed foods. Yeah. Back by mine, I'm like, who does this like even matter for? Right? And nobody cares. Like nobody's talking about it anymore. Right? So like, where does this policy even matter? Yeah. That's not me interested. So look at that. LGBT. And what's interesting is that it's not for people like you and me, right? Like we're still going to eat what we eat. Adults are going to go and, well, let me look at the guidelines and see what I should eat today. But from a federal policy standpoint, when it comes to kids and the food assistance programs, that's where SNAP, WIC, women and children. Those programs now have to follow those guidelines, especially schools. So the people who benefit are actually our children. Those go into school. In order for schools to still receive federal funding, they have to now follow these guidelines. So that's where the benefit is. Military as well. But again, I don't know too much of the weeds. I think David Wiss would be, you know, a perfect person to kind of talk to about that when it comes to food politics. And are these schools actually still abiding by these guidelines or whatnot? Yeah. Yeah. I think that's ultimately where it's somewhat upsetting. And so I actually read what I liked it. Like they made it a succinct 10-page document, which will link in the show notes for people to read. So it's a nice PDF. And I'll just read a little bit from the beginning to you because this is a message from both of the secretaries, right? They talk about how United States is amid a health emergency. 90% of health care spending goes to people who have chronic diseases. I think we've talked about this. We know this. Many of the illnesses are not genetic destiny. They're predictable, blah, blah, blah. They're the result of standard American diet. That's highly processed foods and coupled with sedentary lifestyle. All great stuff, right? More than 70% of Americans are already like all these things that we know talking about how kids, you adolescents have prediabetes and all these scary stats. And then they talk about for decades, federal incentives have promoted low quality highly processed foods and pharmaceutical intervention instead of prevention. And the crisis is poor policy choices. It had a good nutrition research and a lack of coordination across federal state. And so they highlight the problem exactly what you're talking about. Yeah. Now, here's, there are a couple of interesting things about it when you actually look at it and then there's some contradictions in there too, right? So let's just start off the positive. So you talked about, again, every single person that I know who's even interested in looking at this, it likes the fact that it's whole real foods, minimize ultra processed foods. And we know that they're problematic. First time ever protein call out, I think that the fact that they are emphasizing the importance of more protein, I think that's good for a variety of reasons. What's not so good is like the people who are looking up, if you want this to be actionable, 1.2 to 1.6 gram per kilogram, I'm guilty of saying that myself, but I'm speaking to the scientific people of scientific minded, I guess, or from a scientific lens. And that makes sense to me, I know what that equates, but most people aren't going to do that, especially the American population. That's a little bit of a disconnect. I mean, most people aren't even finding their weight in kilograms. So to come back to you see, that's why she goes like 0.7, right? I think even you and I, when we had talked about the last progress note, we had done 0.7 to 0.9 for that reason. So that's another thing. I think, again, sugar, like all that stuff is good. What the figure does a bad job communicating is, you know, you have dietary meats and dairy and all that stuff. And they're really emphasizing that. But when you read the text still says, hey, you should cap your saturated fat, which is what it said before, which again is important. But the problem is they also talk about, hey, don't be scared of using essential fatty acids, which they call olive oil, which is like, that's not an essential fatty acid. So who, what are we doing here? And then they talk about using butter and beef talent. So if you are going to be cooking with butter, beef talent, you're going to exceed that 10% pretty quickly. And so the visual is not congruent with the text actually communicates. And guess what, man, in 2026, as we're just talking about nano banana and all these things, everybody wants just a visual to communicate that less is more attention spans. And there's one thing you've got to get right. It's the actual visual. So, I don't know, not the best for a public service announcement perspective. Right. Right. No, I totally agree. Yeah. How much else to say that? The cost axis problem, I think, is important. Right. So the other thing, aside from a policy perspective, I'll also say this. Well, actually, this does fall into policy. Right. So the pyramid puts protein and dairy front and center. But we also know those along with produce, these are among the most expensive food categories when you are the grocery store. And the populations most directly affected by these guidelines, like you highlighted not just schools, hospitals, but also people on snap, wake these food stamps, like all these low incentive programs that the people who utilize them tend to be lower income communities. And so telling somebody who's on food stamps, your prioritize steak and full fat dairy without addressing these affordability, the crisis that we have really and offering accessible alternatives, like beans, lentils, eggs, canned fish, like that's a little bit of a disconnect. And if anything, it's going to create a undo amounts of stress and probably even make it much more difficult for it to be actionable and helpful. Right. That's something really important word. The other thing actually I wanted to get your take on this is because again, all the carnivore people everybody put in this upfront. You're a vegetarian. So when I read the document, they actually gave a good shout out towards the very very end. They're talking about people who are vegetarians and vegans. Here's what they should do. And this is how you should consume. But the again, the image doesn't do a great job. So I'm actually curious like if you have a stance from that perspective. And as you were hearing this on social media and the echo chambers and people were just promoting, yeah, this is why you should be eating steak all day every day. If you had any thoughts there. I feel we don't, you know, I mean, it's tough because the vegan vegetarian community is like, they're the only one that would understand that it's still possible to hit one point. Like if I really want to hit 200 grams of protein day, I could, you know, and I recommend people fall like me, my Delgado, for example, like he is so good at showing his meal prep and how he hits 150 plus. I don't know if they needed to show it on the visual itself, you know, or highlighted. I actually didn't read the whole document. So I'm surprised they actually even gave a shout out to be vegetarians at the end. But I think the way I look at it too. And again, it's how are people going to be healthier? And if that means they have to eat meat for that, you know, that's their choice of dietary preference. Then so be it, right? Or if people want to be vegetarian vegan, which again, doesn't necessarily mean it's healthy. You can be a vegan vegetarian, just eat pure carbs and not do well, right? I mean, look at a lot of the South Asian population in our chronic disease, right? Like those that are vegetarian, especially the Indian population is strictly carbs. And that's why they're not healthy. So yeah, be vegan vegetarian. Sure. If you're doing it right way, it could definitely be beneficial. The other thing that really pisses me off out of it does for you is when people say it's not expensive to eat healthy. Like sure, there is a way to make it happen. But when you talk about from like an affordability standpoint, I 100% think it is way harder to eat healthier in a specific budget. If you had unlimited funds and you're able to kind of not worry, then sure, you can shop the outside of a grocery store and not have to worry about what's in your wallet. But if you don't have that privilege, then yeah, of course you're going to be looking, you know, with a cognitive load too, at what's at the center and those processed foods and those types of things. So yeah, I do think the visual then needs to be a little bit more refined. Do you know how expensive berries are, man? Dude, eight bucks are a freaking carton. Yeah, strawberries, blueberries, it's insanity, how expensive they are and they've already gotten worse and worse. So yeah, it is absolutely crazy. I mean, yeah, there's some work rounds and a lot of people talk about you getting frozen vegetables. And yeah, interestingly, you know, a little side take here, people will talk about the importance of vegetables. But fresh vegetables actually don't tend to be as nutritious as frozen vegetables because they are flash frozen to a point where they can get the maximum highest nutrient portfolio. I think we've talked about this with other people. I hope you're listening. It could be only as fresh vegetables that I'm like that nutrients. But I gotta say though, I don't find them to be as easy and then my especially would like frozen fruit frozen vegetables. I think, but that could just be a byproduct of my pal, it's been conditioned over years and years to eat that other way. Nevertheless, very expensive. Yeah, and the same thing coming back to me, right? And the only I think maybe affordable meats are going to be your deli meats. But then we have other issues with that, right? That's not going to talk about not processed foods. What are we talking here? Yeah. So I think generally a lot of great things to come out of from this. I'm going to I'm going to plug that podcast for me because I think she shared some similar frustrations is like this is not helpful for the people that it's supposed to be for. It's not helpful. I think that ultimately it gets really hard when you are fighting an environment that's impossible. And so I think that if we actually are serious about implementing this stuff, then starting with the environment is going to be the most important thing. I think the action will take away is, let's just forget the politics. I think that's probably the reason it was shared over and over and over again. I don't remember in 2020, 2020 people being as excited about the guidelines. Maybe it's because of COVID. Maybe we're more excited about that at that time. Yeah. But I also don't remember in 2015 people being as excited about this. But I think the right. Yeah, every five years. So the principal eat real food messages correct, regardless of who wrote it, I think simplifying the protein. So forget the one point things. I think if you go anywhere from 20 to 25 to 35 grams, depending on what your targets are, like that's actually pretty good. There is a baseline of what you should try to hit for protein. I think that muscle protein synthesis, like depending on who you talk to. Like there's a floor that you're going to try to hit that. It could be as little as 10. But you know, if you try to hit the 2025, you'll be OK. But I think most importantly, you got to focus on the environment. And so if you don't have control over at the hospital of the school, all that kind of stuff, you do have control of what you're doing with your kitchen and your home. So curating your own kitchen environment is. That's up to you, right? The government guidelines are not going to fix. Like that, that's in your control. So yeah, I think those are like the big takeaways. Hopefully people have that from that. Yep. Any last word on that for real switch topics about this other paper that I was quite excited about. This was much more fun to read. What's your source of antioxidants? Now that berries are so expensive. For me, it's like a cup of coffee now. It's that is literally. I still buy them. I mean, after weekend shifts to buy them. I'm buying them. Yeah. Well, the other thing is. I don't know. I still, I don't know if you follow this thing the whole dirty doesn't thing. For strawberries, I try to follow that. Yeah. And of course the organic strawberries are a little bit more. I am shifting more to try to eat more seasonal fruits. So the winter time as cold as it was. I'm just not big on the citrusy fruits as much. Pairs are really big. I don't like pairs. Yeah. Dude, you got it. You got it from the Florida, man. It's just it's such a different game down here. Everything you got at all. It's dude, but it's just the fruit is so much sweeter. It's just so much better down here because it's not traveling. You know that far. Yeah. It's just like imported from you. It's from Mexico or from Florida. No, but that's what that's what's happening with you guys and it's just taking a long time. So it's like losing whatever it is. Yeah, this is different. What is cool about it though is like when you do get that really good batch, you're like, oh, man, this is amazing. So there's that. All right. So let's shift gears. Let's talk about the more exciting things. So this paper that I read about this was far more exciting when people see it share down on social media. And I read this a couple of weeks ago because I was excited. And the reason I wanted to talk about it is because a recent conversation that I had with a friend where we were just talking about curating his exercise regimen and how we can maximize and extract value on his day to day. And we ultimately asked me, hey, what about zone two? Like for interesting longevity zone two has got to be in there. We got to talk about zone two and zone two. We've talked about it. Of course, it is important and previously known as low intensity study state cardio, whatever you want to call it zone two is having its moment. And I think much like anything else is a little pendulum that's swung a little too far where people think that is the most important thing when we're talking about healthy aging. And so I think this study tries to address that. So this is a paper published January 20 in the British Medical Journal, right? So the BMJ medicine on set out. So basically what they did was they sent epidemiological study. So I'll point that out, but it's actually good quality data, right? So it's a core data. They had the two groups that have been studied over decades. So it's the nurses health study, which has 70,000 women from 1986 to 2018. And then you have the health professionals follow, which has 40,000 plus men. And so combined, that's over 11,000 people followed for 34 years, right? And what they were really trying to answer is the question is, does it matter what kind of exercise you do or is it just really more exercises better, right? Volume we know is good intensity is good, but it's a variety or the type of exercise also matters. So that's a question they were trying to answer. And the answer is yes, variety is the spice of life. And in this case, I'll tell you specifically why it matters. So you know, most activities, right, they're going to reduce the all cause mortality. So they presented the data with hazard ratios. I'll keep it in percentage because hazard ratio basically think of it as like a discount or so one is baseline. And if you had a hazard ratio of 0.85, that's a 15% discount on your mortality. If you had to think about that way. So so I'll go activity by activity. So walking had a 17% lower risk on all cause mortality, rolling calisthenics, 14% lower risk, running 13% lower risk, weight training, resistance training, 13% lower risk, jogging 11% stair climbing, about 10% cycling, about 4% swimming. Interestingly, no significant association. And then walking and racket sports came out on top. Oh, I didn't meant to racket sports. Yeah, racket sports was about 15% lower and that's your thing right now, right? And so so walking and racket sports actually came out on top. And then weight training was a maybe a close third and then jogging and running. Now this is when they equated it to met hours. So Metz or like metabolic equivalence is what we'll call it. That's how you baseline measure energy. One is think about just as you're existing, you're idle. And then as you increase intensity, you're going to increase Metz or higher energy expenditure. So you can think about walking at a normal pace walk. You're going to have very low Metz. And then there's a curve that, you know, we'll link the paper. But you can see the curve that at about 20 Metz hours, you have that slope increasing like it's going down first. And then it flattens out. So by 20 hours or so, you're going to get some really good effect. Then you have a point of diminishing return. So you still get more effect at 25 30 hours. If you're doing a lot of exercise, but it's not going to be as robust. So that I thought was really cool. Now here's what the best part was, right? So if you did only one activity, you had substantial benefit. And that was good, right? So the activity is I mentioned those were when you were only doing that activity. But what they found was is when the people who did a variety of activities, they had a compounding effect, right? So people like the highest variety versus the lowest variety, there was a 19% difference in all-cause mortality. And that's what was really cool, right? And so a 19% difference in all-cause mortality, 17% for cardiovascular. And 41% lower respiratory disease mortality over time. And so that's probably when you're combining like a bunch of exercise including running a jogging and things that require more aerobic efficiency and cardiovascular fitness. It's you can imagine downstream as you age, pneumonia, things of that nature are really getting you. And when you have a more robust cardiovascular respiratory system, it's going to be really good. So this I thought was really awesome because it really highlighted the importance of a combination of high volume but also high variety is a sweet spot, right? So we've known for a long time that training, putting yourself in multiple domains, trains different parts of your body, right? So if you're doing zone two stuff, if you're training your aerobic engine, you're playing tennis and squash those with the racquet supports, you're doing a hand-eye coordination and you're training your nervous system a little bit differently, weight training, you're loading your bones, right? So you're doing that, you're having a resistance and anabolic response. And so you're getting different benefits from different things. And it really emphasizes the importance of diversifying your movement portfolio. And I think it's actually really important there. That's awesome. That's what I love sports, right? Because practice and actual gameplay give you those two different heart rate zones too, right? If I'm just hitting tennis balls from the ball machine, I'm going to be at a zone two maybe, right? I might exert myself a little bit from running, but then actual gameplay, yeah, you're going to be using those reflex, triggering the nervous system, ballying, hand-eye coordination, all those different things. And then you mix in the training for tennis, which is a lot of stability, balance, weightlifting as well, explosion, plyometrics. You're definitely getting all of it. So yeah, I definitely like that. When you're using with that ball machine, is it automatically turning right or left or is it only in one spot? You can choose. There's different settings for it. So span, the spread of it. So you can make it run if you want, man. Yeah, I got excited to have this heel this so I can get back into start low. Maybe start a little pick a ball, go into paddle, we'll pick up the tennis and kind of work our way out. They're all different. I'll tell you that. They're all very different. And then I'll work my way down and play you, eat some fruit, come right back up. Exactly. We'll make it, we'll make it a day. I guess I should highlight there are a couple of limitations of worth noting, right? So I did say that this is observational data, not randomized, but you know, a really big sample size self-reported physical activity. They had questionnaires about every two years or so people were looking at that. The swimming finding was interesting, probably a measurement artifact. I think that some of the authors they had described is okay, intensity, mismatch, where sometimes people are just floating in pools and they're saying they're swimming and they're not really actually getting exercise, right? Or like doing the type of swimming that I'm doing with my daughter who's swimming, but I'm really walking in the pool. Yeah. So that might not capture some intensity. Well, the population was predominantly white health professionals. So generalizability to other populations, sociognomy studies, like those things could be overlooked, healthy user biases and other big thing. And people who do a variety of exercises such as yourself, like you're also cognizant of your sleep, you're probably eating better. And so that's always the thing. Nevertheless, I think that it is something that is really cool just by, I mean, it's the first time we've had something like this that I'm familiar with. And so I think it's really powerful and important just because it's longitudinal data that I think is worth noting for it. So case in point for people, variety, right is really good. And you just got to take a look at what you're doing. And so this is actually important for me too, because like right now my number one thing, and some limitations I'm recovering tissue healing, whatnot. But if you are only doing jogging or zone two or running, then maybe it's time to add a different type of class. Maybe throw a little resistant training in there. Maybe a rec sport, maybe golf, maybe anything. Just do a little 80, 20, you know, and just look at your how many hours or how many days a week are you training? And can you just diversify your portfolio? I mean, look at it as investing. I mean, you're not going to just have bonds in there. You're not going to have just stocks. So I guess maybe some people might. But I think a diversified portfolio is going to be better long term. Yeah. This is why I'm really fascinated by who, and just like waiting to see what kind of data and research they come out with, right? Because I mean, a lot of obviously people who use who are already going to be high performers. I think that's the clientele they look at. But the ability to then choose what activity you're doing and all the different metrics that they have, right, with the HRB and biological age and whatever else. Rest probably rate, heart rate, whatever else they're looking at. I think their data team is pretty profound where they are looking at trying to sort through it and come up with studies just like this. So that'll be pretty interesting to see too. You know what I noticed this morning on my eight-sleeve stuff and I turned it off? It actually gives you something called the performance zone or a focus zone. Do you have your own message? Yeah, I get it. I wonder how they get that. I don't know. And it's always in the morning. Is yours always in the morning? Like I never get an afternoon. And it's always the same time. Like they're like, do your work or do your workouts? Three hour window. Which is really annoying. I don't know how to do my work. Yeah. And I also have work. I can't work in two hours. But I am curious. I don't know how they how they came up with that. Yeah. I got to look into that a little bit more. That was interesting. It does. At least it's the first time I noticed it. So I got to pay attention to it a little bit more. All right. Cool. So hopefully that's actionable for people. And yes, simple message. So we'll put all that in the show notes. So let's talk about AI. What's new there? Dude, we got to come back to it. I don't know. So I watched this documentary called The Thinking Game. I don't know if you heard of it. But it's on Amazon Prime. And they follow the origins of this guy named. Is that a unique name? Demis DEMIS. I asked him to look it up here. Possibus. Right. And he's the CEO of DeepMind. So a lot of people have heard of DeepMind. Okay. So it's basically the advent of AGI. Not AI. Right. Well, this guy basically played chess when he was younger. And King was just real quick. Or artificial general intelligence. Right. So this is the concept of when AI can actually just do the tasks that humans aren't doing. So it's more advanced than where we are right now, which actually could be Claude, Gemini, et cetera. This guy. So he grew up playing chess. And then he was like pretty much all his way to be a grandmaster. And he realized, what are we all doing wasting our time playing chess for six hours if I could just take the minds of all these people in this tournament? Think about what we could achieve. And he's always been interested in the brain neuroscience. I think he was at Oxford or MIT. I think he was at Oxford. And then he creates DeepMind. But dude, I didn't realize like where we are with freaking AI. So there's actually that they, if you, if only the episode to the podcast for my first million, because they do a good job of kind of just explaining the entire documentary. But we're at, so protein folding, right? So this is a concept where if we can understand protein structures and the receptors and how proteins fold, we can then do drug discovery. We can create new drugs. We can quote unquote cure cancer. And all these different things is kind of what the idea is. They entered, so there's competitions for protein folding across the world. So different teams come together and they have to create models to see if they can accomplish protein folding at a certain accuracy. DeepMind already did it like last year. And it's a holy crap. We are further than people expect with AI. And I think the latest sentiment right now with AI is, oh, it's hitting a bubble like these chatbots are slowly improving. But I don't think people realize that there's a whole other world out there that people are focused on when it comes to pharmaceuticals and health and science and real world, more real world application than just talking to chatbots and it's getting very close and a little scary. So even with work, you're an encompass, right? To have you use the AI when you, yeah, they're there. They're there. So they just, so Oracle is responsible for serners, AI and compass. And so there I was trying to probably compete with Epic and all those things. I'm assuming you've done Epic's AI. Yeah. Yeah, I've used that once. So serner just did it. And I was always so resistant because I was like, I have what I first saw and got the demo. I was like, okay, I think it's going to make 20 mistakes. I'm going to loosen it. I might as well do it from a liability standpoint. Well, I tried it like last week. And it's my new go to for H and P's, like it's saving me at least 40 minutes a day, just on two, three H and P's where it will take the first 24 hours of any uploaded documents and scan through it, write your history, family history, social history, family history, everything. But the plan, I'll have most of the co-morbids in there as well. You can create the plan if you want. But it's getting to a point now where I'm like, damn, okay, this is great for me. And then by the end of this year, they're going to do discharge summaries and progress notes as well with AI. So the question becomes, what's the utility of doctors? Or the AI is going to get better, which yes, I think. But I think now it's, I think jobs are still secure, right? From a doctor standpoint, right now in the next five years, the question is volume. There's already a physician shortage. So everyone's saying, okay, well, now instead of seeing 30 patients, you can go see 60. Especially as AI just does all day, subscribe, we'll input everything you have in there. But it's coming at us so rapidly. And I don't think there's enough Gen Z trainees, residents, medical students looking at this and learning it and trying to keep up. So that they can differentiate themselves when they get to our position. That's my running. No, I love it. It's funny that you mentioned that. I'm glad you told me about it. I got to look into it more because. Yeah, I'll send you a video overflow. I upgraded my whisper flow stuff. I love it. By the way, whisper flow. But you can't do whisper flow though, right? I can't. That's the issue. Different. Yeah, it's a different. I wish I could just use whisper flow in there, but I can't. You use dragon, right? I do use dragon. Yeah. But you know, it's not as good because you got a whole list. It's not whisper flow. It's better. I'm not because I'm dragging you out of. Yeah, I used to text and all that. Well, but you also have to tell periods and commas and stuff. And so I actually train myself because I used to dictate on my phone and I had to give the punctuation. But whisper flow. You don't give the punctuation because if you try to, it messes it up. So now learn how not to do it. So no, I can't go back. I can't go back. Anyways, it's actually begs the question is you were at the mercy of the technology, aren't you? The technology training us. It's kind of what's happening. I do your point about students. And I think about this a lot because we do have people who talk to us all the time about medical students. People interested in going to medical school. And I just, I wonder, I have some pause about where the state of medicine and physician is going to be a decade from now. I don't know if you've got a chance to play with Claude Opus 4.6. Just got it just released last week. And it's amazing. I mean, every level, every three months, every two months, when the new level, new thing comes. I remember reaching out to him like, hey, my Gemini Pro 3 is as good. And now it's okay. When they came out with 5.2 would beat that and Opus 4.6. It keeps getting better and better. Even Proplexity has a model council now where you have to get it where you can run it across all these things. And it just, it comes back to us. Yeah, our knowledge bank that we needed to have, that's certainly not necessary. I do think there is something interesting about the experience and then actual day-to-day interaction. Because I think a lot of people will say that artificial, these LM's, they're not actually coming up with new thoughts. They're just taking all the thoughts out there. They're summarizing it and they're giving it back to you. For novel things, I'm not sure, like, for instance, if you have a case of N of 1 in front of you and you are trying to iterate on experimentation with this person, like at that point right now, it's not there. Like you have to feed the right prompts. Like I do this, right? I spar with it as a coach all the time back and forth. What's fascinating to me is some things that are so basic that I learned, like a strength and conditioning principle, I might have learned in 2010 is something that it won't get right. It's like, what are we talking about here? So that, and that makes me feel a little bit better. Interestingly, I saw this thing, somebody had posted a study where they looked at lawyers. I think it was maybe an eight-month running case study. I'll try to find it and see if we can link it. They looked at the works that lawyers do under day-to-day and not these benchmark tests that they have out there for these tests. And actually, MFM, they talked about this, right? Like, within internally the only system, they have their own benchmark of they take the LLM, they're like, okay, do these eight things or these ten things that actually matter to me for my business? Not the humanities last exam and this exam and that exam is how they measure it. These are things that matter to me is which one is the best. And so they did it that way in actual workflow. Geminiets Flash 2.5 was better than all the other models, like the more advanced models, including Pro. So, again, it doesn't always make sense. I think that's another thing, like with OpenAI, a lot of people love ChatGPT 40 and Sam almost pushing 5.2, 5.2 for even got rid of the legacy models and people were coming back. So are we taking a step forward or are we taking a step backwards? So that's not very clear. There's, of course, a pushback a lot from people regarding it being a robot. I think with the aging population, certainly the patients that you and I take care of on the inpatient setting, like they are not going to be comfortable with some form of artificial intelligence and technology interfering with their care, right? In fact. Correct. I've got something. Well, the last thing I'll say is I've even had patients and I know my colleagues, like the recording with, you know, you have DAX. They say, no, I don't want anything recording because I don't interested in that kind of stuff. So I don't know. I still think we got a couple of years there. Yeah. I was going to say, so a lot of, you're right. I think a lot of my patients are 80 plus. They don't understand AI. They're not going to use AI. I've done some paranoid patients. Like you said about everything you guys do is data. It's in the computers. But they're kids. They're adult kids who are 40 years old, 50 years old. Instead of Google, they're using ChatGPT a lot of the times to figure out what's wrong with their parents. And what's interesting is. How there's a game when it comes to rehab, like length of stay and all these things and how you can appeal the discharge process. And so patients can stay longer and families can stay longer. Everyone knows the game now because of AI. You just input, how do I stay longer? How do I do this with insurance? How do I do that? And so it's like a cat and mouse game, right? Where houses, leadership, and things have to figure out. Okay, insurance is telling us this thing. We're handcuffed. Then these patients know how to navigate through that to get extended stay. So it becomes a little bit of a mess. But it's interesting to see how that whole thing is going to result if it will at all. Yeah, it's definitely interesting. I do think that the point that you made earlier about just increasing the volume of work, I see that happening. I think there are already some early case reports of people commenting that is that with AI, we're not working less. We're like, oh, it's actually taking stuff off of. We're just like, oh, but now because we can be more efficient, let's just be busier and do more. Right? Everybody's really addicted to being productive. Productivity is really sexy and it's an addiction. Right? Right. It gives massive amounts of dopamine. It's like more. You feel good because you're checking off boxes. And so that's probably what it's doing. And then there's a term for this. And I actually thought about shutting this off today because I was listening to this podcast about. AI and education and the future of education, like how it's making college students. Just say, hey, I don't even have to think anymore, right? And so the author was making the argument that, hey, the writing process. And actually, you'll probably agree with this is the writing process is so much more than just putting a five paragraph essay out there. So construction thought and it's about communicating that and being very clear and refining it over and over and not putting work out there until you have something that you can. Again, communicate very clearly. But people like all, I don't need to do this because you actually, if you can just tell me. And so we have to ask the question, what's the purpose of education? But to come back to this, what they were looking at is people are just doing more stuff. And they're going to continue doing more stuff. And they're going to do more stuff that's also even maybe not as productive, not actually enhancing their skills. And so I've got to look this up. Do you know what it is? When you ask it to do something, you give it a command, it'll go through it and answer your question. And then it'll ask you a follow up and a prompt you to ask further questions and engage with it further. There's a term for that. And I can't think of it. I got to look this up iteration or anything, right? Yeah. No. Let's look this up. First thing, Amanda, is back to your point of technology dictates what we do in the workforce, right? So you get the industrial revolution. Everyone has learned machines. It's not like you learn new jobs. They learn machines, which then created a job. The internet came out. You learn the internet. And then you get e-commerce and everything else after it. Yeah. Same thing here. You're going to have to learn AI. And then you're going to learn how AI is used. I wonder though, like community per academic medicine, right? Because at 10.99, I eat what I kill. But a reimbursement is going to go down now. Even though my job clinical gets easier by seeing the number of patients. So I don't know, man. This is all like interesting, interesting stuff from a health care perspective. Because they're going to be like, well, your doctor, you can't make X-Watt, you know, this much. This is how what the normal salary has been. So I don't know. So sorry to come back to so interactive prompting or guided conversational loop. But it's almost like a dopamine thing. It keeps you locked in, right? So you're not going. And I think I might have heard Brunei Brown talk about this. Or African who was one of those people who were a little bit more informed. But it keeps you locked in. It's like, hey, would you like me to do this for you? Would you like me to look it into it this way? You realize that. Wow. Yeah. And you're like, yes. Oh, yes, servant. You are so good to me. Right. And it keeps you going and getting engaged, engaged. Which brings me to a, did you by any chance look at those super bowl ads by Claude? Oh, anthropic towards. Well, I told Claude about the ads coming in. Yeah. That's a great one. Yeah. Yeah. Sam Allman made a long post on Twitter. I think about addressing it too. Okay. He said it was like it was like it was really cheap or whatnot. But it was funny. I mean, he's out there. Claude's not wrong, though. Right? Like it is weird. No, they're weird. If you're on chat with T and the ad pops up and like a discount code's there. And you're like, wait. Yeah. Well, he's like, he says it's not going to be like that at all. But he was complaining. For them to put it on during Super Bowl Sunday is pretty low. And it's not. I mean, why not? It's. It's. Yeah. Yeah. Yeah. Yeah. Well, I think Elon's back to Elon. We always got to bring Elon up. Dude, Tesla. Like now with building the robots. Optimus, Optimus robots. That's easy. He's all in on it. It's going to be pretty. If you talk to him, there's really no reason to go to medical school. Did you see that? Yeah. Three years. Surgeons are going to be obsolete essentially. Yeah, absolutely. He's the word he used. He said there will be better robot surgeons than all surgeons. Yeah. Yeah. Yeah. I don't know. How good are the car's self-driving feature? Amazing. FSD is incredible. Incredible. The data actually came out. Yeah. Way thing for the humans, dude, it's. FSD is. It's incredible. And the iterations of it too, like over the last six months, it's all I use. Like, it has saved me from accidents. With you running your life or not hands on it whatsoever. But you can't be on your phone, right? You like, yeah, you can't, but you can like have your phone near the screen and kind of like look at it and get away with it a little bit. But it'll like remind you if it's either sensors everywhere. But I think he's trying to get to the point where there doesn't have to be any sensors and you can just do whatever like his robot taxis. But yeah, it is absolutely incredible. Yeah, FSD. Yeah. Yeah. But he got rid of the model X and S production because he's just focused to make the optimist is that what I think it's called. I think it's called optimist. It's like dancing. Optimist crime. Let's see. Test. Robots. Yeah, optimist. Yeah. Yeah. And I mean, people think this is what Tesla is going to be known for. Not even their carps. It's going to be known for their robots. Yeah. Well, I'm looking forward to it. I have three years. We'll see. Apparently he's always early. So let's just say six, seven. It's going up an asymptote. It's compounding. Yeah. So. Okay. Well, I'm not sure if that's a positive note or negative note that we're leaving on, but we're going to leave it there. So it's all about how you choose to use it. There you go. Yeah. All right. Until next time. All right. Sounds good. Thanks for listening to the other episode of Medicine Redefined. If you enjoyed this episode, please be sure to check out some of the additional resources in the show notes. 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