Jonathan Reisman: The Human Body – From Sex & Sperm to Hands & Heart

Lex Fridman (01:18.280)

are most parts of the human body a feature or a bug?

Jonathan Reisman (01:21.900)

Is it like the optimal solution

Lex Fridman (01:24.220)

or just a duct tape solution?

Jonathan Reisman (01:26.280)

Great question.

Lex Fridman (01:27.160)

I think that most of the time,

Jonathan Reisman (01:29.460)

the way the body works is the best solution.

Lex Fridman (01:32.420)

I haven't seen many alternatives, so it's hard to compare.

Lex Fridman (01:35.660)

But I think, you know, there's some parts of the body

Lex Fridman (01:38.240)

that make more sense than others.

Jonathan Reisman (01:40.160)

You know, the way our hands work, for instance.

Lex Fridman (01:43.560)

You know, the muscles are up in the forearm

Lex Fridman (01:45.320)

and then the tendons kind of come down

Lex Fridman (01:47.060)

like strings on a puppet.

Lex Fridman (01:48.900)

And just the dexterity it gives our hands

Lex Fridman (01:50.740)

is just really amazing.

Lex Fridman (01:52.640)

And it's hard to imagine a better tool

Lex Fridman (01:55.340)

than the human hand to do everything from, you know,

Jonathan Reisman (01:57.380)

hold things to play piano

Lex Fridman (01:59.780)

and do a million other daily activities that we do.

Jonathan Reisman (02:03.960)

One thing I talk about in the book,

Lex Fridman (02:05.100)

there's some other body parts that seem to be lacking

Jonathan Reisman (02:07.820)

that kind of brilliant design, such as the throat,

Lex Fridman (02:11.540)

you know, where the food, drink are swallowed

Lex Fridman (02:15.260)

and air is inhaled, and they kind of,

Lex Fridman (02:17.000)

those two paths come within millimeters of each other.

Lex Fridman (02:19.860)

And you slip up once, you laugh while eating,

Lex Fridman (02:22.580)

or you speak while trying to swallow and you die

Jonathan Reisman (02:25.540)

from choking.

Lex Fridman (02:26.380)

So it seems less than optimal,

Jonathan Reisman (02:28.300)

though I'm not sure it could be better

Lex Fridman (02:30.060)

from the way we're kind of formed in the womb

Jonathan Reisman (02:33.020)

as a beginning as this tiny little tube.

Lex Fridman (02:35.860)

I don't think it could have been done any better

Jonathan Reisman (02:37.700)

or there's any other way to do it,

Lex Fridman (02:39.100)

but it is an unfortunate thing that, you know,

Jonathan Reisman (02:41.500)

does lead to some problems.

Lex Fridman (02:42.980)

So the hand, if I could just link on that for a second,

Jonathan Reisman (02:46.420)

you talk about the wisdom of a design in the book.

Lex Fridman (02:50.420)

What are the important things about the hand?

Jonathan Reisman (02:52.340)

It seems like very useful for many things

Lex Fridman (02:55.220)

and it seems to be quite effective.

Jonathan Reisman (02:57.420)

A lot of people think the thumb is foundational

Lex Fridman (03:01.060)

to the human civilization.

Lex Fridman (03:05.580)

Is there any truth to that?

Lex Fridman (03:07.220)

I think that is true.

Jonathan Reisman (03:08.060)

Actually, one of the ways in which the importance

Lex Fridman (03:10.260)

of individual fingers comes to attention

Jonathan Reisman (03:13.300)

is when people have severe injuries to their fingers.

Lex Fridman (03:15.780)

For instance, I have a story in the book

Jonathan Reisman (03:18.420)

about a guy whose thumb is nearly ripped off

Lex Fridman (03:21.220)

by his dog's leash.

Jonathan Reisman (03:23.100)

And, you know, when plastic surgeons

Lex Fridman (03:26.180)

who are often the ones to repair that,

Jonathan Reisman (03:27.740)

sometimes it's orthopedic surgeons,

Lex Fridman (03:29.660)

they will debate, you know,

Lex Fridman (03:31.340)

how important is it to save this finger

Lex Fridman (03:33.900)

or how important is it to save, you know,

Jonathan Reisman (03:36.020)

let's say the kind of tip,

Lex Fridman (03:38.700)

the one third, the tip one third of one of your fingers.

Jonathan Reisman (03:41.340)

You know, it depends on the length that you'll lose.

Lex Fridman (03:43.140)

It depends on which finger.

Lex Fridman (03:44.740)

And so the thumb really is the most crucial,

Lex Fridman (03:47.980)

just, you know, for your occupation in most cases

Jonathan Reisman (03:50.620)

to just daily life and your ability to get around

Lex Fridman (03:54.060)

and take care of yourself and others.

Jonathan Reisman (03:55.220)

So, you know, there'll be more,

Lex Fridman (03:57.540)

they're willing to go further, do more surgeries,

Jonathan Reisman (03:59.980)

more aggressive therapy to save a thumb, let's say,

Lex Fridman (04:03.340)

than, you know, the tip of your pinky finger.

Lex Fridman (04:05.420)

So in that way, I do think the thumb, you know,

Lex Fridman (04:07.620)

does seem like the most important in many ways.

Jonathan Reisman (04:09.820)

It's nice that there's backups.

Lex Fridman (04:11.300)

I wonder if that's part of the future

Lex Fridman (04:13.100)

or is it just the symmetry that nature produces?

Lex Fridman (04:15.940)

You think the two hands is like,

Lex Fridman (04:18.740)

is it about the symmetry or is it about backup?

Lex Fridman (04:21.460)

We'd be much less formidable hunters, gatherers,

Jonathan Reisman (04:25.620)

survivors in any way if we only had one hand.

Lex Fridman (04:29.340)

So I think that is important to have two

Lex Fridman (04:32.220)

so we can, you know, even everything from kind of

Lex Fridman (04:34.820)

spearing an animal to firing a bow and arrow

Jonathan Reisman (04:36.940)

to butchering an animal.

Lex Fridman (04:37.820)

You really need two hands to do it very effectively.

Lex Fridman (04:40.340)

But can you do a better job with three?

Lex Fridman (04:43.140)

Great question.

Lex Fridman (04:44.780)

And we'll never know, perhaps.

Lex Fridman (04:48.700)

You tweeted, now I'm gonna analyze your tweets

Jonathan Reisman (04:51.500)

like it's Shakespeare sometimes.

Lex Fridman (04:54.140)

You tweeted that, quote, millions of years

Jonathan Reisman (04:56.180)

of sex and death design the human body.

Lex Fridman (05:00.140)

It's like poetry.

Jonathan Reisman (05:01.620)

Are those two basic activities basically summarize

Lex Fridman (05:05.860)

everything that resulted in humans on Earth?

Lex Fridman (05:09.100)

So like, is that a good summary of the evolutionary process

Lex Fridman (05:13.820)

that led to this conscious intelligent being,

Lex Fridman (05:16.500)

is death and sex?

Lex Fridman (05:19.220)

In a way, yeah.

Lex Fridman (05:20.300)

So sex is how more of us get made, obviously.

Lex Fridman (05:23.500)

And death is how we get weeded out

Jonathan Reisman (05:25.700)

or the gene pool gets weeded out

Lex Fridman (05:27.940)

and certain genes survive and others don't.

Jonathan Reisman (05:30.140)

And, you know, the age at which we die,

Lex Fridman (05:33.500)

whether it's before we've, you know,

Jonathan Reisman (05:35.620)

had sex and reproduced ourselves is a big factor

Lex Fridman (05:38.620)

and who survives, who doesn't, who passes on their genes

Lex Fridman (05:41.180)

and what the future of the body looks like.

Lex Fridman (05:43.900)

You know, who lived and who died

Jonathan Reisman (05:46.340)

before they were able to be at reproductive age

Lex Fridman (05:48.980)

a million years ago was pretty important

Jonathan Reisman (05:50.860)

in what we look like now.

Lex Fridman (05:52.660)

And perhaps how we have sex and die now

Jonathan Reisman (05:55.820)

will determine what we're shaped like

Lex Fridman (05:58.180)

unless technology has an even bigger role in that,

Jonathan Reisman (06:00.300)

you know, a million years from now.

Lex Fridman (06:01.580)

So you think that's fundamental

Jonathan Reisman (06:02.860)

to like if there's alien civilizations out there

Lex Fridman (06:05.260)

that have the same order of magnitude

Jonathan Reisman (06:07.740)

of intelligence or greater,

Lex Fridman (06:09.460)

do you think that we will see something like sex

Lex Fridman (06:12.020)

and something like death?

Lex Fridman (06:13.820)

So the reproducing and this selection process

Jonathan Reisman (06:18.740)

plus the weeding out of the old to make room for the new,

Lex Fridman (06:23.260)

is that kind of foundational to life?

Jonathan Reisman (06:25.540)

I would think so.

Lex Fridman (06:26.380)

I mean, it sure seems to be on earth,

Jonathan Reisman (06:27.900)

you know, perhaps in some distant future

Lex Fridman (06:29.860)

when medicine is nearing, you know, perfection

Lex Fridman (06:33.300)

and people can live a really long time.

Lex Fridman (06:35.520)

Maybe we won't even need to reproduce as much

Jonathan Reisman (06:39.060)

or something like that, you know,

Lex Fridman (06:41.060)

it's hard to even know what life will be like

Jonathan Reisman (06:43.780)

in the distant future.

Lex Fridman (06:44.620)

But I would guess that any alien civilization

Jonathan Reisman (06:46.900)

will have the same dependence on who has sex and who dies.

Lex Fridman (06:50.100)

Well, that's the problem with immortality.

Lex Fridman (06:51.820)

How are we going to clear out the old

Lex Fridman (06:55.980)

to make room for the new, which is kind of a,

Jonathan Reisman (07:00.400)

it's like a framework of adaptability

Lex Fridman (07:03.420)

to changing environments.

Lex Fridman (07:04.560)

So as long as the environment is changing,

Lex Fridman (07:06.620)

and it seems to always be,

Jonathan Reisman (07:09.140)

because the entirety of the earth system

Lex Fridman (07:11.340)

is a complex system, it seems like you have to adapt.

Lex Fridman (07:14.140)

And to adapt, you have to kill off the stubborn old ideas.

Lex Fridman (07:19.500)

And unless there's a way to like not become stubborn and old,

Lex Fridman (07:23.940)

but it feels like the nature of wisdom is stubborn and old.

Lex Fridman (07:30.180)

Like that's what wisdom is.

Jonathan Reisman (07:32.160)

It's like the lessons of life,

Lex Fridman (07:34.520)

the lessons of experience solidified.

Lex Fridman (07:37.300)

And the solidification is the thing

Lex Fridman (07:39.420)

that actually prevents you from reinventing yourself

Jonathan Reisman (07:43.380)

to adapt to the new changing conditions.

Lex Fridman (07:47.320)

But then again, why not have that both of those modes?

Jonathan Reisman (07:49.980)

Like have two minds and one person,

Lex Fridman (07:51.620)

one immortal person that like in the morning,

Jonathan Reisman (07:55.080)

they act like a teenager,

Lex Fridman (07:56.580)

in the evening they act like a old wise man.

Jonathan Reisman (07:59.960)

That's possible.

Lex Fridman (08:00.900)

So you see, you can imagine within one mind both modes,

Lex Fridman (08:07.200)

but those are required.

Lex Fridman (08:08.380)

You have to have the ability

Jonathan Reisman (08:11.740)

to completely reinvent yourself,

Lex Fridman (08:13.800)

which is what death does in an ugly way,

Jonathan Reisman (08:18.600)

or a beautiful way, depending on your perspective,

Lex Fridman (08:20.740)

depending whether you take the human perspective

Jonathan Reisman (08:22.500)

or the human, the nature's perspective.

Lex Fridman (08:25.020)

And then you have to have the selection.

Lex Fridman (08:27.060)

So competition, so sexual selection.

Lex Fridman (08:30.500)

It's an interesting, interesting little planet we got.

Jonathan Reisman (08:33.380)

What's the weirdest part, function, concept, idea

Lex Fridman (08:37.020)

about the human body to you?

Jonathan Reisman (08:38.540)

We'll talk about fascinating details,

Lex Fridman (08:40.640)

but I should say for people that should read your book,

Jonathan Reisman (08:46.620)

they will come face to face with the fact

Lex Fridman (08:48.940)

that you do not shy away from the weird

Lex Fridman (08:51.380)

and the wonderful of the human body.

Lex Fridman (08:53.460)

It's like, it's fun, but it's honest.

Lex Fridman (08:57.540)

So given that, sorry to make you pick one of your children,

Lex Fridman (09:03.220)

but what's the weirdest one, would you say?

Jonathan Reisman (09:06.580)

The weirdest body part.

Lex Fridman (09:09.080)

Or concept or function.

Lex Fridman (09:12.460)

So the chapters, you divide it up kind of into parts,

Lex Fridman (09:16.380)

but there could be a thread that connects all of them,

Jonathan Reisman (09:19.460)

the weirdness, maybe, or maybe the texture of the substance.

Lex Fridman (09:23.980)

It could be the liquids, the solids, I don't know.

Jonathan Reisman (09:26.980)

Definitely every body part and bodily fluid

Lex Fridman (09:29.220)

has their own kind of both gross and fascinating aspects.

Jonathan Reisman (09:33.000)

That's probably why I'm a generalist as a doctor

Lex Fridman (09:36.060)

and couldn't just, as you said, pick one of my children,

Jonathan Reisman (09:38.700)

become a specialist, because I like them all.

Lex Fridman (09:42.560)

I feel like one of the strangest concepts

Jonathan Reisman (09:44.980)

about the human body is that kind of the aspects of it

Lex Fridman (09:49.100)

that are the most universal, that we all do,

Jonathan Reisman (09:51.620)

are the most taboo socially.

Lex Fridman (09:54.400)

I wouldn't have expected that if I had, you know,

Jonathan Reisman (09:56.560)

just looked from the outside, like what we do

Lex Fridman (09:58.700)

in the bathroom, what we do in the bedroom,

Lex Fridman (10:00.940)

what we do to our own genitals, what we do to our,

Lex Fridman (10:04.940)

you know, quote unquote, private parts, they're private,

Jonathan Reisman (10:07.540)

even though it's sort of the thing that we all have

Lex Fridman (10:10.340)

in common is the most we try to hide from other people

Lex Fridman (10:13.500)

and don't talk about in polite company.

Lex Fridman (10:15.500)

I mean, it makes sense as a human living in this society,

Lex Fridman (10:17.820)

but from the outside, it sort of might be surprising.

Lex Fridman (10:20.140)

How do you make sense of that if you put on

Lex Fridman (10:21.740)

your Sigmund Freud hat?

Lex Fridman (10:23.900)

The thing we all do, why do we make that a taboo thing?

Lex Fridman (10:28.900)

Is it because we like taboos?

Lex Fridman (10:30.860)

Maybe we get off, or maybe our kinks as humans

Jonathan Reisman (10:35.720)

is to have taboos, and it's kind of efficient

Lex Fridman (10:38.940)

to have taboos about the things that everybody does.

Jonathan Reisman (10:41.920)

Like, you can make walking taboo or something, I don't know.

Lex Fridman (10:45.660)

But just, maybe that's what we love,

Jonathan Reisman (10:48.300)

that's what's exciting to us, is the forbidden.

Lex Fridman (10:52.220)

I think, yes, society loves rules, for sure.

Jonathan Reisman (10:54.780)

They love, some societies more than others.

Lex Fridman (10:57.820)

You know, they love controlling how you think

Lex Fridman (11:00.260)

and what you do in public versus in private.

Lex Fridman (11:02.700)

You know, there's a lot of societies where, for instance,

Jonathan Reisman (11:05.180)

parents have sex in front of children.

Lex Fridman (11:08.180)

Not, you know, for instance, like in traditional

Jonathan Reisman (11:10.900)

Inupiat Eskimo societies, that was sort of normal.

Lex Fridman (11:14.680)

I mean, but what are you gonna do,

Jonathan Reisman (11:15.580)

go outside in the middle of the winter in the Arctic

Lex Fridman (11:17.840)

and do it out there?

Jonathan Reisman (11:18.760)

Of course not.

Lex Fridman (11:19.600)

So, you know, there's different taboos

Jonathan Reisman (11:22.580)

in different societies.

Lex Fridman (11:23.780)

Some taboos make perfect sense.

Jonathan Reisman (11:25.260)

Some taboos are even public health measures,

Lex Fridman (11:28.580)

you know, like, as I talk in the book about in India,

Jonathan Reisman (11:32.060)

where they, you know, the hands are symmetric, as you said,

Lex Fridman (11:35.700)

but in Indian culture, and the left hand is taboo,

Lex Fridman (11:38.500)

and the right hand is what you use for shaking hands,

Lex Fridman (11:41.780)

for eating, for other things, and the left hand

Jonathan Reisman (11:44.100)

is the dirty hand that you use for wiping your own bottom.

Lex Fridman (11:47.560)

You know, that's the toilet paper is your left hand.

Jonathan Reisman (11:49.420)

So, while the body is anatomically symmetric,

Lex Fridman (11:52.780)

the taboo creates this pretty intense asymmetry.

Lex Fridman (11:56.460)

But for a good reason, you know,

Lex Fridman (11:57.540)

yet you probably shouldn't be shaking hands

Jonathan Reisman (11:58.940)

with other people with the same hand that you use

Lex Fridman (12:01.220)

to kind of clean your bottom.

Lex Fridman (12:02.240)

So in that sense, it makes sense.

Lex Fridman (12:05.500)

Yeah, maybe the roots of it makes sense,

Lex Fridman (12:07.380)

but the way it propagates, especially as the times change,

Lex Fridman (12:10.700)

might not, because you can wash your hands.

Lex Fridman (12:14.380)

But the taboo remains.

Lex Fridman (12:16.200)

Right, society is very slow to change.

Lex Fridman (12:19.160)

What is the most fascinating part, function,

Lex Fridman (12:21.660)

or concept in the human body?

Jonathan Reisman (12:23.860)

So, you know, something that fills you with awe.

Lex Fridman (12:30.420)

I guess the most obvious one is the brain,

Jonathan Reisman (12:32.540)

partly because it's so, you know, sort of poorly understood,

Lex Fridman (12:36.660)

though we understand more than we ever have in the past.

Jonathan Reisman (12:39.740)

There's still so much that we don't understand

Lex Fridman (12:41.580)

about how the lump of matter in our skulls

Jonathan Reisman (12:44.580)

kind of creates this subjective experience

Lex Fridman (12:46.620)

that we all kind of understand quite viscerally.

Jonathan Reisman (12:50.700)

That's an easy one.

Lex Fridman (12:51.580)

I would say the kidneys are an underappreciated organ.

Jonathan Reisman (12:55.620)

The way they tinker with the bloodstream,

Lex Fridman (12:58.580)

raise levels of this, lower levels of that,

Jonathan Reisman (13:01.060)

kind of our entire lives from inside the womb until we die

Lex Fridman (13:05.620)

is just really incredible.

Lex Fridman (13:07.500)

And when you look at how much energy

Lex Fridman (13:09.180)

different organs consume,

Jonathan Reisman (13:10.540)

the brain and the kidneys are two of the biggest ones,

Lex Fridman (13:13.440)

because the brain obviously in us is always active,

Lex Fridman (13:16.600)

and controlling parts of the body,

Lex Fridman (13:17.980)

but the kidneys are just consuming a ton of energy

Jonathan Reisman (13:21.040)

to do what they do.

Lex Fridman (13:21.880)

They're kind of the unsung hero of the body,

Jonathan Reisman (13:24.220)

relegated to the back of the abdomen,

Lex Fridman (13:26.060)

like some forgotten organ, but they are great.

Jonathan Reisman (13:28.400)

I did consider being a nephrologist,

Lex Fridman (13:29.980)

which is a kidney specialist,

Jonathan Reisman (13:31.120)

because I was so taken with the kidneys,

Lex Fridman (13:33.140)

but decided I like all the organs,

Lex Fridman (13:35.240)

so couldn't pick just one.

Lex Fridman (13:37.580)

So your book is ordered in a particular way.

Jonathan Reisman (13:40.540)

It's throat, heart, feces, genitals, liver, pineal gland,

Lex Fridman (13:47.180)

brain, skin, urine, fat, lungs, eyes, mucus,

Jonathan Reisman (13:54.180)

fingers and toes, and blood.

Lex Fridman (13:57.260)

All right.

Jonathan Reisman (13:59.060)

First of all, great chapter titles.

Lex Fridman (14:03.120)

Is there a reason for this ordering, or is it all madness?

Jonathan Reisman (14:06.500)

There's a few different reasons that went into it.

Lex Fridman (14:09.120)

I did wanna start with the throat for the reason

Jonathan Reisman (14:13.740)

that it kind of presents the topic of death,

Lex Fridman (14:18.100)

which is sort of obviously very important

Jonathan Reisman (14:20.600)

in the training of a physician, in the career of physician.

Lex Fridman (14:23.120)

It's a big part of what I deal with.

Jonathan Reisman (14:25.580)

On the first day of medical school,

Lex Fridman (14:27.900)

we started the dissection of a cadaver

Jonathan Reisman (14:30.220)

in the class called anatomy lab.

Lex Fridman (14:32.040)

And so in a way, we were kind of thrown right in there

Jonathan Reisman (14:34.940)

in the beginning, like this is the end of the human story.

Lex Fridman (14:38.780)

Understand this, and then we sort of backed up

Jonathan Reisman (14:40.700)

to the beginning with embryology and reproduction and stuff.

Lex Fridman (14:43.780)

So it's kind of like we got, and I got thrown into that

Jonathan Reisman (14:47.060)

right away, right in the beginning,

Lex Fridman (14:48.820)

kind of like here's a dead body.

Jonathan Reisman (14:50.260)

Now start cutting it apart and learn the name

Lex Fridman (14:52.460)

and function of absolutely every bit of flesh.

Lex Fridman (14:54.940)

How did that change you, that first experience

Lex Fridman (14:58.480)

with the cold honesty of human biology?

Jonathan Reisman (15:01.740)

Right, that's exactly what it was,

Lex Fridman (15:02.940)

is cold honesty about kind of the story

Jonathan Reisman (15:05.220)

of each individual human body.

Lex Fridman (15:06.740)

It has an end, and that's it.

Jonathan Reisman (15:09.300)

I think that, well, actually before the end

Lex Fridman (15:12.140)

of that first day, so what we did on that first day

Jonathan Reisman (15:14.360)

was study the superficial muscles of the back,

Lex Fridman (15:16.480)

like the lats or latissimus dorsi and some other muscles.

Jonathan Reisman (15:19.420)

We cut through the skin of the back.

Lex Fridman (15:21.420)

My cadaver was laying face down on this metal gurney.

Jonathan Reisman (15:24.040)

We pulled back the kind of plastic sheets

Lex Fridman (15:25.920)

that would keep him moist for the next four months

Jonathan Reisman (15:28.340)

as we dissected him, cut through the skin on his back,

Lex Fridman (15:31.140)

and then started dissecting through the superficial muscles

Jonathan Reisman (15:33.400)

of the back.

Lex Fridman (15:34.240)

And that was really all we saw that first day.

Jonathan Reisman (15:36.540)

We didn't get any deeper, didn't enter the abdominal

Lex Fridman (15:38.700)

or chest cavity to see internal organs,

Lex Fridman (15:41.460)

but I was so fascinated with this sort of

Lex Fridman (15:44.580)

behind the scenes look at how things work in the body,

Lex Fridman (15:48.060)

how you move your arms, how you arch your back.

Lex Fridman (15:50.420)

You know, these are the muscles that do it

Jonathan Reisman (15:52.540)

that I decided I wanted to donate my own body

Lex Fridman (15:54.780)

for the same purpose.

Lex Fridman (15:56.300)

So I made that decision literally

Lex Fridman (15:57.980)

before the end of that first day of class,

Lex Fridman (16:00.180)

and I'm still sticking to it.

Lex Fridman (16:02.980)

So someday there'll be a medical student

Jonathan Reisman (16:05.440)

that can watch and listen to this podcast

Lex Fridman (16:09.340)

while dissecting your body.

Jonathan Reisman (16:11.480)

It could happen.

Lex Fridman (16:12.320)

They might not know that that person

Jonathan Reisman (16:13.980)

they're listening to on the podcast

Lex Fridman (16:15.220)

will be the carcass in front of them,

Lex Fridman (16:17.140)

but we never learned anything.

Lex Fridman (16:18.980)

The universe will know.

Jonathan Reisman (16:20.160)

The universe will know.

Lex Fridman (16:21.000)

And they will acknowledge the irony or the humor,

Jonathan Reisman (16:24.780)

the absurdity of that.

Lex Fridman (16:26.500)

The universe will chuckle,

Lex Fridman (16:27.780)

but the medical student won't know

Lex Fridman (16:29.900)

because they never, as I did not,

Jonathan Reisman (16:31.920)

learn any personal information about the person,

Lex Fridman (16:35.740)

only what I could glean from looking inside them,

Jonathan Reisman (16:37.780)

which actually tells you quite a bit.

Lex Fridman (16:39.020)

I knew he was a smoker.

Jonathan Reisman (16:40.180)

I knew he had coronary artery disease.

Lex Fridman (16:41.900)

You know, you get a window into,

Jonathan Reisman (16:44.020)

I knew he was overweight.

Lex Fridman (16:45.020)

You get a window into people's lives

Jonathan Reisman (16:46.680)

just by looking in their bodies after death.

Lex Fridman (16:49.620)

Other cadavers in the lab, not my own,

Jonathan Reisman (16:53.900)

or I shared one with three other students,

Lex Fridman (16:55.880)

but other cadavers, some had metal joints,

Jonathan Reisman (16:58.980)

like a knee replacement.

Lex Fridman (17:00.100)

Some had a kidney missing.

Lex Fridman (17:01.480)

So they probably,

Lex Fridman (17:02.900)

and we could tell it was surgically removed,

Jonathan Reisman (17:04.480)

not that he was born with one.

Lex Fridman (17:07.020)

And we could tell that he probably had a kidney tumor

Jonathan Reisman (17:08.980)

or cancer that was removed.

Lex Fridman (17:10.100)

So you do get an insight into people's lives

Jonathan Reisman (17:12.580)

from picking them apart after they're dead,

Lex Fridman (17:16.060)

but you don't know their name

Jonathan Reisman (17:17.260)

or what podcast they've been on.

Lex Fridman (17:19.580)

So as the book title says, Unseen Body,

Lex Fridman (17:23.780)

so it tells some kind of story of your life.

Lex Fridman (17:27.860)

So it does capture the decisions you've made in your life,

Jonathan Reisman (17:30.900)

the things you've done,

Lex Fridman (17:32.460)

that might be kind of secret to that person

Lex Fridman (17:37.500)

and maybe to a few others that knew him or her well.

Lex Fridman (17:41.700)

It's so fascinating.

Lex Fridman (17:42.860)

So what kind of things can it reveal?

Lex Fridman (17:46.020)

Like what kind of choices in terms of the injuries,

Jonathan Reisman (17:49.860)

the catastrophic events,

Lex Fridman (17:53.420)

the lifestyle choices of smoking and diet

Lex Fridman (17:56.900)

and all those kinds of things?

Lex Fridman (17:57.900)

What can you see?

Lex Fridman (17:59.820)

What kind of history can you see about the human before you?

Lex Fridman (18:03.460)

So all those things you mentioned are things you can see.

Lex Fridman (18:06.580)

Take the skin, for example, right?

Lex Fridman (18:08.220)

Most things that happen to us leave a mark,

Jonathan Reisman (18:11.900)

as I say, kind of a story written in the language of scar

Lex Fridman (18:15.360)

where it tells you injuries you've had.

Lex Fridman (18:16.980)

And same thing with animals.

Lex Fridman (18:19.060)

I've seen deer hides that have marks

Jonathan Reisman (18:21.320)

that look like they're made by maybe a barbed wire fence,

Lex Fridman (18:23.740)

something like that.

Jonathan Reisman (18:24.580)

You can tell, sometimes it's conjecture,

Lex Fridman (18:27.900)

but you can sort of imagine what might've happened

Jonathan Reisman (18:30.060)

to cause that.

Lex Fridman (18:30.900)

Perhaps two bucks were fighting

Lex Fridman (18:32.640)

and one got injured with an antler.

Lex Fridman (18:34.780)

And the same with humans.

Jonathan Reisman (18:36.460)

I have scars on my body,

Lex Fridman (18:37.660)

and when I notice them, I remember what happened.

Jonathan Reisman (18:40.960)

I got a big cut on my hand when I was 13,

Lex Fridman (18:44.180)

and it's still there,

Lex Fridman (18:45.100)

and I remember what happened every time I look at it.

Lex Fridman (18:48.940)

And so in that way, only I might know that story,

Lex Fridman (18:52.860)

but other people, when they dissect me

Lex Fridman (18:54.820)

and notice the same scars,

Jonathan Reisman (18:56.060)

they can kind of, it can fire their imagination

Lex Fridman (18:58.100)

as my cadaver, you know, did for me.

Jonathan Reisman (19:00.140)

They know that there is a story there.

Lex Fridman (19:02.780)

That's such an interesting way

Jonathan Reisman (19:03.980)

that the skin does tell a story,

Lex Fridman (19:07.020)

both tattoos and scars.

Jonathan Reisman (19:09.740)

Right.

Lex Fridman (19:10.580)

Some of the fun you've had

Lex Fridman (19:12.100)

and some of the damage you've done.

Lex Fridman (19:14.140)

Right.

Lex Fridman (19:14.980)

And even when I evaluate a patient,

Lex Fridman (19:16.940)

I can use scars to help me make medical decisions.

Lex Fridman (19:20.540)

So for instance, someone that comes in with abdominal pain

Lex Fridman (19:22.820)

into the emergency room,

Jonathan Reisman (19:24.280)

you can see scars on their abdomen

Lex Fridman (19:26.060)

that tell you about, you know,

Jonathan Reisman (19:27.420)

the past kind of activities of a surgeon, perhaps.

Lex Fridman (19:30.620)

I know, I recognize the scars that are left

Jonathan Reisman (19:33.420)

when someone has their gallbladder removed,

Lex Fridman (19:35.220)

the scars when someone has their appendix removed,

Jonathan Reisman (19:37.460)

maybe when someone's had a hysterectomy,

Lex Fridman (19:38.940)

and that can tell you what it might be or what it isn't.

Jonathan Reisman (19:42.380)

You know, if someone doesn't have an appendix,

Lex Fridman (19:43.980)

their abdominal pain's not appendicitis, end of story.

Lex Fridman (19:46.640)

So in that way, I'm sort of looking at these,

Lex Fridman (19:49.740)

the tracks or the footprints of past surgeries

Jonathan Reisman (19:52.740)

to tell me what might and might not be the cause

Lex Fridman (19:55.300)

of this patient's abdominal pain,

Jonathan Reisman (19:56.480)

which is kind of my main job in the ER

Lex Fridman (19:58.220)

is figuring out what's causing it and to help them.

Lex Fridman (1:00:01.180)

All right, what about the neighbors, poop, feces?

Lex Fridman (1:00:07.540)

There seems to be a lot of interesting stories

Jonathan Reisman (1:00:11.660)

in that particular output as well.

Lex Fridman (1:00:16.700)

What to you is fascinating?

Lex Fridman (1:00:20.260)

What to you maybe is misunderstood

Lex Fridman (1:00:26.860)

or little known about poop?

Jonathan Reisman (1:00:30.580)

Well, it's hilarious, for one thing, that we do it.

Lex Fridman (1:00:35.140)

The word is great as well.

Jonathan Reisman (1:00:36.660)

There's so many different words.

Lex Fridman (1:00:38.060)

I do, when I'm talking to the parents

Jonathan Reisman (1:00:40.600)

of pediatric patients, I use the word poop.

Lex Fridman (1:00:42.740)

I don't often, when I'm talking to adult patients,

Jonathan Reisman (1:00:44.620)

try to choose a more mature word.

Lex Fridman (1:00:47.140)

But poop is amazing.

Jonathan Reisman (1:00:49.920)

I mean, I guess it's sort of the dirtiest, the most vile,

Lex Fridman (1:00:55.220)

the most hated aspect of our bodies.

Jonathan Reisman (1:00:57.900)

It's the grossest, we don't want to think about it,

Lex Fridman (1:01:00.580)

talk about it, have it anywhere near our food

Jonathan Reisman (1:01:04.460)

or in social interactions with good reason.

Lex Fridman (1:01:08.580)

I mentioned gastrointestinal infections

Jonathan Reisman (1:01:10.180)

are one of the most common infections

Lex Fridman (1:01:11.700)

the human body suffers from.

Lex Fridman (1:01:13.220)

And the way they spread from person to person,

Lex Fridman (1:01:17.520)

grossly enough, is referred to as the fecal oral route,

Jonathan Reisman (1:01:20.660)

which means a bit of someone's stool

Lex Fridman (1:01:22.840)

is getting into your, you're swallowing it,

Jonathan Reisman (1:01:25.920)

through water supply.

Lex Fridman (1:01:27.900)

For instance, diarrhea is actually quite

Lex Fridman (1:01:29.940)

a brilliant mechanism of these microbes, right?

Lex Fridman (1:01:32.820)

If you, let's say you're in the intestine of one person,

Jonathan Reisman (1:01:35.720)

your goal is to get into the intestines of another person.

Lex Fridman (1:01:38.900)

Brilliant to just trick their intestines

Jonathan Reisman (1:01:41.620)

into secreting all this fluid into the intestines

Lex Fridman (1:01:45.020)

to increase the volume of stool and its runniness

Lex Fridman (1:01:47.780)

so that when they do poop, it gets into the water supply

Lex Fridman (1:01:50.100)

and then everyone else kind of ends up

Jonathan Reisman (1:01:51.380)

getting infected as well.

Lex Fridman (1:01:52.780)

Wow, that's brilliant.

Jonathan Reisman (1:01:54.380)

Just the same way like tuberculosis or coronavirus

Lex Fridman (1:01:57.920)

kind of infects your lungs and makes you cough

Lex Fridman (1:02:00.140)

and you send it out into the air

Lex Fridman (1:02:01.380)

and it ends up in other people's lungs.

Lex Fridman (1:02:02.740)

And that's all evolution.

Lex Fridman (1:02:04.580)

Yeah, it's brilliant.

Lex Fridman (1:02:06.000)

So diarrhea is intelligent, is a big takeaway lesson.

Lex Fridman (1:02:11.020)

It's one of the most intelligent things we can do

Jonathan Reisman (1:02:14.020)

as an entirety of an organism,

Lex Fridman (1:02:15.980)

not just the particular cognitive organism,

Lex Fridman (1:02:17.900)

but there's, we're made up of bacteria and viruses

Lex Fridman (1:02:22.280)

and there's a lot of visitors and so on.

Jonathan Reisman (1:02:24.320)

As the entirety of the system,

Lex Fridman (1:02:25.760)

diarrhea is one of our better accomplishments.

Jonathan Reisman (1:02:28.360)

It's fascinating.

Lex Fridman (1:02:30.880)

Well, I wonder, why is poop funny?

Jonathan Reisman (1:02:34.520)

I think a lot of that is socially constructed,

Lex Fridman (1:02:37.020)

just how it's sort of supposed to be hidden away

Jonathan Reisman (1:02:39.420)

yet something we always do,

Lex Fridman (1:02:41.140)

something we chuckle about as children.

Lex Fridman (1:02:43.380)

But even in healthcare,

Lex Fridman (1:02:45.020)

it becomes this big topic of conversation

Jonathan Reisman (1:02:48.100)

because you end up talking about it constantly.

Lex Fridman (1:02:50.340)

Like in the ER, people come in,

Jonathan Reisman (1:02:53.560)

they're complete strangers.

Lex Fridman (1:02:55.100)

Sometimes like a nice old lady who resembles my grandmother

Lex Fridman (1:02:58.700)

and all of a sudden I have to ask her all about

Lex Fridman (1:03:00.600)

what's happening in the bathroom.

Lex Fridman (1:03:01.980)

Like, is she straining?

Lex Fridman (1:03:03.300)

What color is it?

Lex Fridman (1:03:04.480)

What's the consistency?

Lex Fridman (1:03:07.840)

Does it float on top of the water more than it should?

Lex Fridman (1:03:10.300)

Is it hard to flush?

Lex Fridman (1:03:11.200)

I mean, there's a million different questions you learn

Jonathan Reisman (1:03:13.340)

as a medical student and you're like this poop detective

Lex Fridman (1:03:17.420)

when people come in with issues.

Lex Fridman (1:03:19.380)

And so it's funny, I guess,

Lex Fridman (1:03:22.300)

in the exam room with the doctor patient relationship,

Jonathan Reisman (1:03:25.060)

there's sort of no barriers.

Lex Fridman (1:03:26.620)

You talk about everything

Lex Fridman (1:03:27.700)

and you're talking about the most intimate details

Lex Fridman (1:03:29.900)

of a person's life,

Jonathan Reisman (1:03:31.380)

even though you just met them a second ago.

Lex Fridman (1:03:33.260)

It's so different than normal social interactions.

Jonathan Reisman (1:03:36.820)

Yet there is this social aspect.

Lex Fridman (1:03:38.940)

A lot of what I do is social.

Jonathan Reisman (1:03:40.740)

It seems like doctors, what they do is mostly scientific,

Lex Fridman (1:03:43.900)

but actually it's just relating to another person

Lex Fridman (1:03:46.540)

and you have to maintain your professional demeanor

Lex Fridman (1:03:49.860)

and this normal human level interaction,

Jonathan Reisman (1:03:51.860)

even though you're talking about poop.

Lex Fridman (1:03:54.820)

And that's a skill, that's an art and a science.

Jonathan Reisman (1:03:57.460)

Well, okay, actually I wanna linger on that

Lex Fridman (1:03:59.620)

because I'm a fan of just diving into conversations

Jonathan Reisman (1:04:03.260)

right away with strangers, just getting no small talk.

Lex Fridman (1:04:08.260)

And this is the ultimate, I don't know if it's the ultimate,

Lex Fridman (1:04:12.500)

but it's one version of no small talk.

Lex Fridman (1:04:14.460)

You get right to the point.

Jonathan Reisman (1:04:18.100)

That's really powerful from a psychology perspective.

Lex Fridman (1:04:21.260)

You're a kind of therapist

Jonathan Reisman (1:04:22.460)

or you have the power to be a therapist.

Lex Fridman (1:04:26.260)

I don't mean just about the medical condition of the body,

Lex Fridman (1:04:28.700)

but the psychological.

Lex Fridman (1:04:30.460)

There's so much fear connected to this concern.

Jonathan Reisman (1:04:35.460)

Also, self doubt, insecurities,

Lex Fridman (1:04:42.820)

even sort of existential thoughts about your mortality,

Jonathan Reisman (1:04:46.300)

all of those things are right there in the room.

Lex Fridman (1:04:50.020)

So I think one way doctors deal with that

Jonathan Reisman (1:04:52.500)

is they kind of have this cold way about them.

Lex Fridman (1:04:54.940)

They almost have like dual mode.

Jonathan Reisman (1:04:56.740)

One is like, I'm going to be friendly on the surface

Lex Fridman (1:05:00.900)

and cold about the brutal honesty of the biology.

Lex Fridman (1:05:05.980)

But I wonder if there's like a skillful middle ground,

Lex Fridman (1:05:11.900)

this dangerous place where you can help people

Jonathan Reisman (1:05:15.580)

deal with their psychological insecurities,

Lex Fridman (1:05:18.460)

concerns, fears, all those kinds of things.

Lex Fridman (1:05:21.020)

Is that just really tough to do?

Lex Fridman (1:05:23.140)

Yeah, it's a huge part of being a doctor

Jonathan Reisman (1:05:25.860)

is dealing with the psychological aspects

Lex Fridman (1:05:28.300)

of whatever's going on with the patient's body.

Jonathan Reisman (1:05:30.300)

I mean, in the ER, you deal with psychiatric emergencies

Lex Fridman (1:05:32.980)

kind of left and right more than ever these days.

Lex Fridman (1:05:35.540)

And that's a huge issue,

Lex Fridman (1:05:37.420)

not to mention sort of drug use, alcohol related stuff,

Jonathan Reisman (1:05:41.540)

that gets into sort of psychology

Lex Fridman (1:05:43.140)

and the human love of intoxicants

Lex Fridman (1:05:45.340)

and changing the brain's chemistry and habit, of course,

Lex Fridman (1:05:49.740)

we're creatures of habit and that plays in as well.

Jonathan Reisman (1:05:51.940)

I mean, a big part of, for instance, pediatrics

Lex Fridman (1:05:54.060)

is reassuring parents and kind of convincing them,

Jonathan Reisman (1:05:59.060)

giving them the confidence that what's going on

Lex Fridman (1:06:01.060)

with their child is not serious, will go away on its own,

Jonathan Reisman (1:06:03.740)

does not need any particular intervention.

Lex Fridman (1:06:06.300)

And, but adults too, reassurance is a huge part of the game.

Jonathan Reisman (1:06:12.980)

Yeah, in the ER, you see humanity at its most raw.

Lex Fridman (1:06:17.420)

I feel like you get this tremendous insight into people,

Lex Fridman (1:06:20.780)

how they live, what they worry about,

Lex Fridman (1:06:22.260)

what they think about, how their body works

Lex Fridman (1:06:24.060)

and also how their mind works

Lex Fridman (1:06:25.300)

that you almost don't see anywhere else.

Jonathan Reisman (1:06:28.140)

It's a really interesting place to work.

Lex Fridman (1:06:30.940)

And also the way our society is shaped,

Jonathan Reisman (1:06:32.980)

the ER is where people go for almost everything.

Lex Fridman (1:06:35.500)

When they're suicidal, they come to the ER.

Jonathan Reisman (1:06:37.780)

When they're too high on drugs to walk, they come to the ER.

Lex Fridman (1:06:40.660)

Children who have been abused, sexually abused,

Jonathan Reisman (1:06:42.780)

physically abused, come to the ER for us to investigate.

Lex Fridman (1:06:45.900)

It's sort of like the all purpose waste bin

Jonathan Reisman (1:06:48.380)

for the dregs of society, what people do to themselves

Lex Fridman (1:06:51.260)

and what they do to other people.

Jonathan Reisman (1:06:53.300)

You mentioned you're interested in the darkness of humanity

Lex Fridman (1:06:55.420)

and made me think of the ER where you really see

Lex Fridman (1:06:58.900)

what human life is like in the ER.

Lex Fridman (1:07:02.020)

Okay, you tweet about, you write about,

Jonathan Reisman (1:07:04.420)

you think about the emergency room ER.

Lex Fridman (1:07:07.660)

That's really fascinating.

Jonathan Reisman (1:07:10.100)

Just the little window you give to that world

Lex Fridman (1:07:13.100)

is fascinating.

Lex Fridman (1:07:16.380)

What lessons about humanity do you draw

Lex Fridman (1:07:20.540)

from this place where you're so near to death?

Jonathan Reisman (1:07:24.380)

There's so much chaos.

Lex Fridman (1:07:26.860)

There's so much variety of what's wrong.

Lex Fridman (1:07:29.180)

So little information or the urgent nature

Lex Fridman (1:07:34.740)

of the information inflows such that you can't really reason

Jonathan Reisman (1:07:39.380)

sort of thoroughly and deeply and collect all the data,

Lex Fridman (1:07:41.900)

all those kinds of things.

Jonathan Reisman (1:07:42.900)

You have to act fast and then everybody's freaking out.

Lex Fridman (1:07:45.900)

Can you just speak to the human condition

Lex Fridman (1:07:48.020)

that you get a glimpse at through the ER experience?

Lex Fridman (1:07:55.020)

Yeah, I think you do see all those things.

Jonathan Reisman (1:07:57.420)

I think on one end of the spectrum,

Lex Fridman (1:08:00.340)

it is this very unique place

Jonathan Reisman (1:08:02.100)

where you get all these unique insights.

Lex Fridman (1:08:03.820)

On the other end, it can become a ho hum workplace

Jonathan Reisman (1:08:07.220)

just like any other, which is sort of surprising.

Lex Fridman (1:08:09.660)

As I mentioned before, humans seem to be able to get used

Jonathan Reisman (1:08:11.900)

to almost anything and doctors can get ho hum used to,

Lex Fridman (1:08:15.540)

oh, dying of a heart attack, oh, actively in labor

Lex Fridman (1:08:18.220)

and the baby's half out.

Lex Fridman (1:08:19.380)

Oh, just ho hum, I know what to do, going about my job

Lex Fridman (1:08:23.620)

and go home and have dinner with my family

Lex Fridman (1:08:26.020)

and not think too much about it.

Jonathan Reisman (1:08:27.300)

That's amazing.

Lex Fridman (1:08:28.580)

I do try to maintain both my fascination.

Jonathan Reisman (1:08:33.220)

I think writers in general tend to think more

Lex Fridman (1:08:35.820)

about what they see, write more about what they see,

Jonathan Reisman (1:08:37.620)

maybe draw connections with what they see to other things.

Lex Fridman (1:08:40.620)

So I do think that writer's perspective

Jonathan Reisman (1:08:42.380)

does help me kind of maintain my fascination

Lex Fridman (1:08:45.940)

and my kind of more of an insightful perspective

Jonathan Reisman (1:08:48.780)

than just a ho hum, water cooler conversation.

Lex Fridman (1:08:53.180)

But you do see a lot.

Jonathan Reisman (1:08:55.940)

In a way, medical problems are sort of

Lex Fridman (1:08:58.020)

the great equalizer, right?

Jonathan Reisman (1:09:00.180)

Class, race, culture, background,

Lex Fridman (1:09:03.180)

the failings of the human body, the way it fails

Lex Fridman (1:09:05.940)

and what we can do to help in those situations

Lex Fridman (1:09:08.500)

is almost universal.

Jonathan Reisman (1:09:10.340)

I always like this quote from, Chekhov was a doctor

Lex Fridman (1:09:13.140)

and a writer and he treated a lot of peasants

Jonathan Reisman (1:09:18.260)

very low class and also treated a lot of aristocrats.

Lex Fridman (1:09:20.860)

And he wrote that they all have the same ugly bodies

Jonathan Reisman (1:09:24.260)

basically, which I think is really right on.

Lex Fridman (1:09:27.380)

And it's sort of, you can see people

Jonathan Reisman (1:09:29.940)

underneath a superficial layer of clothing,

Lex Fridman (1:09:32.340)

maybe it's the most expensive clothing

Jonathan Reisman (1:09:34.100)

bought from the fanciest places,

Lex Fridman (1:09:35.700)

but underneath their body is still failing in the same way

Lex Fridman (1:09:38.460)

and they still have the same anxieties, the same worry

Lex Fridman (1:09:40.660)

about mortality, the same concerns about why their poop

Jonathan Reisman (1:09:43.460)

turned green today, all these things

Lex Fridman (1:09:46.260)

that they bring to the table.

Lex Fridman (1:09:47.380)

So in a way, it is this great equalizer

Lex Fridman (1:09:49.980)

where people are kind of all the same in some ways.

Jonathan Reisman (1:09:53.580)

Yeah, I feel like people sometimes, class, money,

Lex Fridman (1:09:58.660)

fame, power, makes you for a time forget

Jonathan Reisman (1:10:02.900)

that you're just a meat vehicle.

Lex Fridman (1:10:06.300)

And just as good and just as bad

Jonathan Reisman (1:10:09.780)

as the other meat vehicles all around you.

Lex Fridman (1:10:14.100)

In that sense, there's this question sometimes raised,

Lex Fridman (1:10:18.180)

are some people better than others?

Lex Fridman (1:10:20.300)

And I usually answer no to that question because of that.

Jonathan Reisman (1:10:24.740)

Yeah, some people might be better at math,

Lex Fridman (1:10:26.620)

some people might be better at music.

Lex Fridman (1:10:29.540)

But in the end, we're just meat bags.

Lex Fridman (1:10:33.300)

Beautiful as we are.

Jonathan Reisman (1:10:35.020)

There's a poem that just, a small tangent I want to take,

Lex Fridman (1:10:39.820)

I just saw it, Just Acting, that you have written.

Lex Fridman (1:10:47.140)

I have to, would you classify it as a poem?

Lex Fridman (1:10:49.980)

Yeah.

Jonathan Reisman (1:10:50.940)

At first, if I may read it, at first you enter the clinic,

Lex Fridman (1:10:54.740)

shoulders weighed down by white coat pockets,

Jonathan Reisman (1:10:57.500)

book stuffed, timid, you act out a role,

Lex Fridman (1:11:01.780)

your white coat, a costume, your questions, a script,

Jonathan Reisman (1:11:05.660)

your demeanor, a rehearsed act.

Lex Fridman (1:11:08.380)

No one is going to buy this.

Lex Fridman (1:11:10.540)

But then, as you play the role again and again,

Lex Fridman (1:11:13.860)

repeating the lines and the motions,

Jonathan Reisman (1:11:16.300)

the script slowly dissolves

Lex Fridman (1:11:17.980)

and the interaction becomes thoughtless.

Lex Fridman (1:11:20.900)

And the rehearsed act slowly fades into a profession.

Lex Fridman (1:11:24.300)

You suddenly find yourself unable to tell

Jonathan Reisman (1:11:26.980)

if you're still acting or if you're doing it for real.

Lex Fridman (1:11:31.140)

And now you're a doctor.

Jonathan Reisman (1:11:33.620)

Jonathan Reisman, MD, Harvard,

Lex Fridman (1:11:36.260)

Massachusetts General Hospital of Medicine

Lex Fridman (1:11:38.060)

and Pediatrics Department.

Lex Fridman (1:11:39.980)

Beautiful, so that is what it is to be a doctor.

Jonathan Reisman (1:11:44.140)

You're just acting.

Lex Fridman (1:11:45.420)

Fake it till you make it.

Jonathan Reisman (1:11:46.460)

Exactly, fake it till you make it.

Lex Fridman (1:11:48.140)

And I think, I imagine every medical student

Jonathan Reisman (1:11:50.420)

has this feeling when they first go into a room.

Lex Fridman (1:11:53.020)

Like I talked about asking this nice old lady

Jonathan Reisman (1:11:56.100)

about the color of her poop for the first time

Lex Fridman (1:11:58.420)

and you're just like, what am I doing here?

Lex Fridman (1:12:00.300)

Like, does she believe I'm a doctor?

Lex Fridman (1:12:02.660)

You know, this just feels absurd.

Lex Fridman (1:12:04.580)

But then it's, again, ho hum, becomes normal.

Lex Fridman (1:12:09.140)

Now there's not a sperm chapter in your book.

Jonathan Reisman (1:12:14.580)

You mentioned offline that this is a second and a third book

Lex Fridman (1:12:17.940)

that you're working on all about sperm.

Jonathan Reisman (1:12:19.660)

No, I'm just kidding.

Lex Fridman (1:12:21.320)

But, or maybe I'm not.

Jonathan Reisman (1:12:24.020)

Humor tends to make way for reality.

Lex Fridman (1:12:26.940)

So the tweet was that a human, an average human male

Jonathan Reisman (1:12:32.600)

produces 500 billion sperm, I believe,

Lex Fridman (1:12:36.120)

which is about four to five times more

Jonathan Reisman (1:12:39.340)

than the number of people who have ever lived.

Lex Fridman (1:12:42.840)

And each of those sperm is genetically unique

Lex Fridman (1:12:45.740)

so you can think of them, you can kind of imagine

Lex Fridman (1:12:48.680)

the possible humans they could have created.

Lex Fridman (1:12:51.040)

And they're all different.

Lex Fridman (1:12:53.140)

They have similarities, of course,

Lex Fridman (1:12:54.600)

but they have peculiarities that make them different.

Lex Fridman (1:12:57.720)

And you can think of all the different trajectories,

Jonathan Reisman (1:12:59.500)

all the Einsteins, the Feynmans, the Hitlers,

Lex Fridman (1:13:03.720)

and all the people who would have died during childbirth,

Jonathan Reisman (1:13:08.200)

would have died early in their years

Lex Fridman (1:13:09.960)

given the different diseases.

Jonathan Reisman (1:13:11.320)

It's fascinating to think about.

Lex Fridman (1:13:13.280)

An average human, yeah, we're all winners

Jonathan Reisman (1:13:17.080)

of a very competitive race.

Lex Fridman (1:13:19.080)

So the people who make it, we're winners, hashtag winning.

Jonathan Reisman (1:13:23.880)

Is there something that you find fascinating,

Lex Fridman (1:13:30.600)

interesting, beautiful, ugly, surprising about sperm?

Jonathan Reisman (1:13:38.560)

I think sperm is, yes, it is a very interesting bodily fluid.

Lex Fridman (1:13:43.240)

Maybe I'll write about it in a second or third book,

Jonathan Reisman (1:13:45.400)

we'll see, but I guess sperm is interesting

Lex Fridman (1:13:49.000)

because it's kind of the only projectile bodily fluid

Jonathan Reisman (1:13:53.440)

from the body.

Lex Fridman (1:13:56.160)

Vomit can be projectile.

Jonathan Reisman (1:13:57.600)

Usually that's a diseased state.

Lex Fridman (1:13:59.000)

That's not the expected kind of normal healthy state.

Lex Fridman (1:14:01.400)

Oh, sneezing, would you classify that or no?

Lex Fridman (1:14:03.840)

True, I guess it's, yeah, there's some particles in the air.

Jonathan Reisman (1:14:06.920)

I guess it's not a fluid, I mean, not a liquid, but true.

Lex Fridman (1:14:11.760)

I mean, cough, in addition to sneeze, right?

Jonathan Reisman (1:14:13.840)

Sneeze is how our nose gets rid of something

Lex Fridman (1:14:16.200)

that shouldn't be there.

Jonathan Reisman (1:14:17.040)

Cough is how our lungs get rid of something

Lex Fridman (1:14:18.480)

that shouldn't be there.

Jonathan Reisman (1:14:19.400)

Vomiting is sometimes how our stomachs

Lex Fridman (1:14:20.880)

get rid of something that shouldn't be there.

Jonathan Reisman (1:14:22.900)

All projectiles sometimes in their own way.

Lex Fridman (1:14:25.440)

Sperm is sort of interesting.

Jonathan Reisman (1:14:26.680)

It's created with the food for its journey.

Lex Fridman (1:14:28.920)

Sperm mostly feed off of fructose, a kind of sugar,

Jonathan Reisman (1:14:32.680)

for the few days that they live inside

Lex Fridman (1:14:34.120)

the female genital tract.

Lex Fridman (1:14:35.840)

But it's sort of, I like comparing our genitals

Lex Fridman (1:14:38.160)

to the genitals of the plant world, which is flowers,

Lex Fridman (1:14:40.520)

and in the same way that a touch me not, for instance,

Lex Fridman (1:14:44.600)

the kind of flower where when you brush up against it,

Jonathan Reisman (1:14:46.720)

it sort of launches seeds into the distance

Lex Fridman (1:14:48.940)

to try to survive in a way kind of the sperm

Jonathan Reisman (1:14:53.640)

is doing something similar,

Lex Fridman (1:14:54.740)

launched into the female genital tract,

Lex Fridman (1:14:56.680)

and then all trying to find this,

Lex Fridman (1:14:58.980)

competing against each other to find this egg.

Jonathan Reisman (1:15:01.600)

It's really amazing.

Lex Fridman (1:15:02.440)

And when you learn about it from the biological perspective,

Jonathan Reisman (1:15:05.160)

the most amazing thing is how many things can go wrong,

Lex Fridman (1:15:09.440)

just in the sperm not surviving long enough

Jonathan Reisman (1:15:11.880)

for it making it to the egg,

Lex Fridman (1:15:13.600)

and then some genetic abnormality causing a miscarriage.

Jonathan Reisman (1:15:17.720)

It's sort of astounding that it works as often as it does,

Lex Fridman (1:15:21.280)

and I think the lesson there is just that

Jonathan Reisman (1:15:23.360)

people have a lot of sex, and so statistics just favor

Lex Fridman (1:15:26.520)

it's gonna work out a good number of times.

Jonathan Reisman (1:15:29.280)

Yeah, and there might be intelligence in the design

Lex Fridman (1:15:31.720)

of just the sheer number of sperm.

Jonathan Reisman (1:15:33.940)

Maybe that's yet another way

Lex Fridman (1:15:35.480)

to inject variety into the system.

Lex Fridman (1:15:38.640)

And redundancy, I guess.

Lex Fridman (1:15:40.320)

We have two kidneys, we have two hands.

Jonathan Reisman (1:15:42.680)

If we lose one, we can still go on.

Lex Fridman (1:15:44.560)

We have however many millions of sperm

Jonathan Reisman (1:15:47.880)

get sort of launched in every ejaculation

Lex Fridman (1:15:50.160)

is if a bunch fail or don't make it inside.

Jonathan Reisman (1:15:54.360)

There's papers on this, by the way,

Lex Fridman (1:15:56.200)

that I read for some reason.

Jonathan Reisman (1:15:57.780)

Not read, but skimmed for some reason,

Lex Fridman (1:16:00.300)

which is talking about which sperm usually wins.

Jonathan Reisman (1:16:04.400)

Like what are the characteristics of sperms

Lex Fridman (1:16:06.160)

that are winning, and it's not the fastest.

Lex Fridman (1:16:09.280)

So apparently there's some kind of slaughter

Lex Fridman (1:16:13.400)

that happens early on, people will correct me,

Lex Fridman (1:16:15.340)

but it's not the fastest.

Lex Fridman (1:16:17.260)

There is an aspect of it's the luckiest.

Jonathan Reisman (1:16:19.360)

It really is, like the body tries

Lex Fridman (1:16:21.360)

to make it a random selection.

Jonathan Reisman (1:16:23.400)

It tries to make it fair in making it as random as possible.

Lex Fridman (1:16:27.920)

Interesting, and also interesting

Jonathan Reisman (1:16:29.520)

that they're fueled by fructose.

Lex Fridman (1:16:30.760)

I didn't really think about that.

Lex Fridman (1:16:32.320)

So they're a carb loaded athlete.

Lex Fridman (1:16:37.280)

Right, with food for the journey.

Jonathan Reisman (1:16:38.860)

Food for the journey, because I'm somebody

Lex Fridman (1:16:40.520)

that actually does a lot of running on,

Jonathan Reisman (1:16:43.640)

I guess you would call me a fat adapted athlete.

Lex Fridman (1:16:46.400)

So I do sort of meat heavy diet.

Lex Fridman (1:16:51.200)

And so you could do a lot of endurance kind of stuff

Lex Fridman (1:16:53.860)

when you don't need any carbs, any glucose,

Jonathan Reisman (1:16:56.500)

any of that kind of stuff.

Lex Fridman (1:16:58.000)

And you're very low.

Jonathan Reisman (1:16:59.960)

It's interesting to think that sperm are like,

Lex Fridman (1:17:01.900)

nope, they're total bros.

Jonathan Reisman (1:17:04.120)

Let's go to the gym, sprint, performance,

Lex Fridman (1:17:08.480)

short term performance is everything.

Jonathan Reisman (1:17:11.360)

All right, well, that sperm, returning to the liver,

Lex Fridman (1:17:16.400)

the place that deals with all our poor decisions.

Jonathan Reisman (1:17:20.440)

No.

Lex Fridman (1:17:21.840)

Many of them.

Jonathan Reisman (1:17:22.680)

Many of our poor decisions.

Lex Fridman (1:17:24.060)

Is there, you said that the liver does quite a few things.

Lex Fridman (1:17:30.380)

What to you is fascinating, beautiful about the liver?

Lex Fridman (1:17:33.000)

I'd say it's primary function seems to be

Jonathan Reisman (1:17:35.880)

as the sort of gatekeeper for what we eat and absorb.

Lex Fridman (1:17:40.240)

You know, the entire gastrointestinal tract

Jonathan Reisman (1:17:42.920)

from the esophagus to the rectum,

Lex Fridman (1:17:45.840)

the blood flows from it, not back to the heart,

Lex Fridman (1:17:48.720)

but to the liver where it's first examined,

Lex Fridman (1:17:51.920)

kind of things are evaluated, packaged,

Jonathan Reisman (1:17:55.680)

you know, processed, detoxified, perhaps.

Lex Fridman (1:17:59.480)

It's kind of this great overseer

Jonathan Reisman (1:18:01.180)

of what we digest and absorb.

Lex Fridman (1:18:03.880)

And so it kind of keeps track of what's coming in,

Jonathan Reisman (1:18:07.680)

you know, the outside world that comes in

Lex Fridman (1:18:09.640)

and will become part of us.

Jonathan Reisman (1:18:11.860)

You know, that's why partly the liver suffers

Lex Fridman (1:18:14.600)

sometimes the injury from certain toxins like alcohol.

Lex Fridman (1:18:19.240)

But beyond that, the liver is also the place,

Lex Fridman (1:18:21.720)

as I said, it metabolizes things too.

Lex Fridman (1:18:23.760)

So it metabolizes alcohol

Lex Fridman (1:18:25.680)

and why it can be injured by alcohol.

Jonathan Reisman (1:18:27.360)

It metabolizes drugs like Tylenol,

Lex Fridman (1:18:29.320)

which is why Tylenol can be very toxic to the liver

Jonathan Reisman (1:18:33.640)

when taken as an overdose.

Lex Fridman (1:18:36.480)

So the liver, you know, even beyond that,

Jonathan Reisman (1:18:38.520)

the liver produces a lot of different, you know,

Lex Fridman (1:18:42.080)

things that float in the bloodstream.

Jonathan Reisman (1:18:43.540)

It packages cholesterol and fats

Lex Fridman (1:18:46.240)

and sends them to where they're needed.

Jonathan Reisman (1:18:48.080)

It deals with protein in the blood.

Lex Fridman (1:18:50.080)

It deals with clotting factors in the blood,

Jonathan Reisman (1:18:51.880)

helping the blood clot, you know,

Lex Fridman (1:18:54.960)

processes things like bilirubin and other things

Jonathan Reisman (1:18:57.360)

that really, as I mentioned,

Lex Fridman (1:18:58.440)

is like 15 organs wrapped into one.

Jonathan Reisman (1:19:00.440)

Maybe that's why it's sort of the biggest internal organ.

Lex Fridman (1:19:02.840)

The skin's bigger, but it's not an internal organ.

Jonathan Reisman (1:19:06.280)

Right, the biggest organ in the human body is the skin.

Lex Fridman (1:19:10.320)

Right, but the liver's the biggest internal organ

Lex Fridman (1:19:13.060)

and it really is a powerhouse and does a lot,

Lex Fridman (1:19:15.960)

which is why when people suffer from liver failure,

Jonathan Reisman (1:19:18.600)

kind of everything goes wrong in a way.

Lex Fridman (1:19:21.440)

And in terms of replacing organs,

Lex Fridman (1:19:24.020)

what are organs that are easily replaceable,

Lex Fridman (1:19:28.320)

which are not?

Jonathan Reisman (1:19:29.840)

Like on the list of things that are hard to replace

Lex Fridman (1:19:31.800)

and not, what would you put in number one?

Lex Fridman (1:19:34.800)

What would you put like at the bottom?

Lex Fridman (1:19:37.200)

Well, I'd say the kidneys are, you know, nothing's easy,

Lex Fridman (1:19:39.600)

but kidneys are easiest in a way.

Lex Fridman (1:19:41.840)

Partly, I mean, maybe a big factor there

Jonathan Reisman (1:19:44.040)

is that other people have two of them

Lex Fridman (1:19:45.520)

and can give one to you.

Lex Fridman (1:19:46.480)

So you don't have to wait for people to die,

Lex Fridman (1:19:47.980)

which is the case with hearts and livers.

Jonathan Reisman (1:19:50.000)

Sometimes you can take a part of a liver

Lex Fridman (1:19:52.000)

from someone who's alive

Lex Fridman (1:19:53.400)

and the liver does have this kind of mythological ability

Lex Fridman (1:19:57.100)

to regenerate itself.

Jonathan Reisman (1:19:59.240)

In the myth of Prometheus, he's chained to a rock

Lex Fridman (1:20:03.080)

and the bird eats his liver every day

Lex Fridman (1:20:04.880)

and it grows back every day.

Lex Fridman (1:20:06.880)

And that's actually biologically accurate.

Jonathan Reisman (1:20:10.160)

Not that you can completely get rid of it

Lex Fridman (1:20:11.760)

and it'll appear again,

Lex Fridman (1:20:12.640)

but when pieces of it are removed or injured,

Lex Fridman (1:20:15.100)

it does regenerate itself pretty amazingly.

Lex Fridman (1:20:19.240)

So I'd say the kidneys,

Lex Fridman (1:20:20.160)

the fact that there are more around,

Jonathan Reisman (1:20:21.960)

also it's, you know, the kidney is a smaller organ.

Lex Fridman (1:20:24.200)

It's often just, you don't have to put a transplanted kidney

Jonathan Reisman (1:20:27.320)

where the kidney should be in the back of the abdomen.

Lex Fridman (1:20:29.360)

You can just kind of stuff it into the pelvis there

Jonathan Reisman (1:20:31.680)

because it's a smaller organ.

Lex Fridman (1:20:32.760)

The liver would be hard because it's huge.

Lex Fridman (1:20:36.200)

And I guess we just have the most experience

Lex Fridman (1:20:38.120)

with kidney transplants because they are the most common.

Lex Fridman (1:20:41.920)

And the heart and the brain are probably quite difficult.

Lex Fridman (1:20:46.440)

Brain, as far as I know, hasn't been successfully done.

Jonathan Reisman (1:20:49.500)

The heart is done.

Lex Fridman (1:20:52.120)

And definitely I've evaluated a lot of patients

Jonathan Reisman (1:20:55.360)

with a heart transplant.

Lex Fridman (1:20:56.920)

It does work pretty well.

Jonathan Reisman (1:20:58.200)

The mechanical heart substitutes

Lex Fridman (1:21:00.520)

are also advancing quite rapidly these days.

Jonathan Reisman (1:21:03.660)

For a failing heart,

Lex Fridman (1:21:04.720)

there are certain kinds of devices

Jonathan Reisman (1:21:06.240)

they can surgically implant.

Lex Fridman (1:21:08.320)

Like when a failing heart isn't able to push hard enough,

Jonathan Reisman (1:21:10.960)

you know, that's the heart's job is pushing blood

Lex Fridman (1:21:13.120)

with sufficient pressure to create blood pressure.

Jonathan Reisman (1:21:15.600)

When it fails, there are actually these devices

Lex Fridman (1:21:17.820)

you can strap onto the heart to help it pump harder.

Jonathan Reisman (1:21:21.500)

Those are rapidly advancing.

Lex Fridman (1:21:23.180)

Many of those were not available even 10 years ago

Jonathan Reisman (1:21:25.320)

when I got out of med school and now they're commonly used.

Lex Fridman (1:21:29.280)

So maybe heart transplant won't be as necessary

Jonathan Reisman (1:21:31.200)

in the future if those mechanical things do advance.

Lex Fridman (1:21:34.480)

And as I said, the heart is basically a mechanical pump.

Lex Fridman (1:21:37.160)

So perhaps it would be the easiest organ

Lex Fridman (1:21:39.200)

to replace with some mechanical device.

Jonathan Reisman (1:21:41.880)

Now for something completely different,

Lex Fridman (1:21:43.600)

returning to testicles for a time.

Jonathan Reisman (1:21:45.040)

You posted a Instagram post of testicles as food.

Lex Fridman (1:21:51.520)

Perhaps eating them doesn't help libido

Jonathan Reisman (1:21:54.260)

because ingested testosterone is totally metabolized

Lex Fridman (1:21:58.200)

in the liver, returning to our liver,

Jonathan Reisman (1:22:01.160)

leaving none to reach the bloodstream.

Lex Fridman (1:22:03.440)

That is why testosterone only comes as injection

Jonathan Reisman (1:22:06.440)

or topical foam, not as pills.

Lex Fridman (1:22:10.360)

On the other hand, estrogen and progesterone

Jonathan Reisman (1:22:14.180)

can be absorbed orally, hence the pill.

Lex Fridman (1:22:17.360)

But testosterone is mostly responsible

Jonathan Reisman (1:22:19.760)

for libido in women too.

Lex Fridman (1:22:21.420)

I was not expecting for this biology lesson

Jonathan Reisman (1:22:23.640)

when I was looking at an Instagram picture of,

Lex Fridman (1:22:28.440)

are we looking at testicles?

Jonathan Reisman (1:22:30.000)

Yeah.

Lex Fridman (1:22:30.840)

Are these like, which species?

Jonathan Reisman (1:22:34.160)

I believe all those are from cows.

Lex Fridman (1:22:36.360)

From cows, cow testicles.

Jonathan Reisman (1:22:37.560)

Cows are technically female, so bulls.

Lex Fridman (1:22:39.880)

Yeah, well, speaking of which, just we'll jump around a bit,

Lex Fridman (1:22:43.760)

but you've also traveled the world quite a bit.

Lex Fridman (1:22:47.720)

What is the craziest food you've eaten across the world?

Lex Fridman (1:22:56.280)

What have you learned about the extremes

Lex Fridman (1:22:58.800)

of the culinary arts by traveling the world?

Jonathan Reisman (1:23:03.720)

I would say, I guess I've always been extra fascinated

Lex Fridman (1:23:07.720)

with the diets of natives of the far north.

Jonathan Reisman (1:23:11.600)

I spent some time there in Russia and in Alaska

Lex Fridman (1:23:15.300)

and always loved their diet.

Lex Fridman (1:23:18.440)

So when I worked in Alaska in emergency room

Lex Fridman (1:23:21.520)

and did some other travels in Arctic Alaska,

Lex Fridman (1:23:24.040)

and they eat a lot of fat.

Lex Fridman (1:23:27.760)

Traditionally before contact,

Jonathan Reisman (1:23:29.940)

more than half of all calories in the Inupiat Eskimo diet

Lex Fridman (1:23:33.000)

came from blubber, marine mammal fat,

Jonathan Reisman (1:23:36.120)

or also fat from fish, fat from ducks

Lex Fridman (1:23:38.600)

and other birds that go up there to mate in the summer.

Lex Fridman (1:23:41.640)

So things like raw whale blubber

Lex Fridman (1:23:43.440)

was especially interesting for me and very exciting.

Jonathan Reisman (1:23:48.120)

You know, I had some beluga whale chowder, things like that.

Lex Fridman (1:23:52.240)

There's just all these very unusual dishes.

Jonathan Reisman (1:23:55.900)

You know, there's a dish called Mikiyak,

Lex Fridman (1:23:58.720)

which is whale meat fermented in whale blood,

Jonathan Reisman (1:24:03.340)

which is quite delicious actually.

Lex Fridman (1:24:05.000)

So is it cooked, is it eaten raw?

Lex Fridman (1:24:08.320)

How do they like their fat?

Lex Fridman (1:24:09.520)

Like in the same way up north in Russia, as you mentioned.

Lex Fridman (1:24:14.760)

So they often eat it raw.

Lex Fridman (1:24:16.760)

So the raw whale blubber is called Muktuk

Lex Fridman (1:24:20.140)

and it's often just sliced thin

Lex Fridman (1:24:22.040)

and it's sort of cold, but not frozen often when they eat it

Lex Fridman (1:24:25.560)

and they slice it thin.

Lex Fridman (1:24:26.820)

And a lot of people assume it would be very chewy,

Lex Fridman (1:24:30.100)

but it's not that chewy.

Lex Fridman (1:24:31.360)

It's quite pleasant actually

Lex Fridman (1:24:32.480)

and has this kind of sea smell to it as you're eating it.

Lex Fridman (1:24:36.280)

I quite like it.

Lex Fridman (1:24:37.180)

And what's the culinary culture like?

Lex Fridman (1:24:41.480)

Meaning, is it just source of energy or is it art?

Jonathan Reisman (1:24:45.680)

Well, there's, you know, traditionally,

Lex Fridman (1:24:47.520)

there's not a lot of cooking in the Arctic.

Jonathan Reisman (1:24:51.600)

A lot of things are eaten raw,

Lex Fridman (1:24:53.160)

partly because there's not a lot of fuel for making fires.

Lex Fridman (1:24:56.720)

So they will, you know,

Lex Fridman (1:24:58.160)

some of the big rivers in Russia, for instance,

Jonathan Reisman (1:25:01.240)

that flow north, they will bring trees,

Lex Fridman (1:25:03.700)

you know, dead trees and logs up to the north

Lex Fridman (1:25:05.800)

and they can get some wood that way.

Lex Fridman (1:25:07.680)

And same thing in some of the rivers

Jonathan Reisman (1:25:09.580)

kind of flowing northward from the Brooks Range of Alaska.

Lex Fridman (1:25:12.860)

You do get some trees,

Lex Fridman (1:25:14.020)

but just not enough to really produce a culinary art

Lex Fridman (1:25:18.200)

that requires cooking with heat.

Jonathan Reisman (1:25:20.740)

You know, they do have traditionally blubber lamps

Lex Fridman (1:25:24.000)

where the blubbers of seals and whales are used

Jonathan Reisman (1:25:26.320)

to create a little flame.

Lex Fridman (1:25:28.280)

Often that's for light and for a little bit of heat

Lex Fridman (1:25:32.280)

and less for cooking.

Lex Fridman (1:25:34.580)

But eating things raw is definitely a huge part

Jonathan Reisman (1:25:37.200)

of the culture there.

Lex Fridman (1:25:38.040)

And while I was, I went on a whale hunting trip

Jonathan Reisman (1:25:40.220)

out on the spring ice in the Arctic Ocean by Barrow, Alaska.

Lex Fridman (1:25:44.720)

And two of the guys, the Inupiat guys who had invited me

Jonathan Reisman (1:25:48.840)

were kind of talking about how eating things raw

Lex Fridman (1:25:51.480)

is sort of the most essential characteristic

Jonathan Reisman (1:25:53.480)

of Inupiat culture.

Lex Fridman (1:25:54.880)

And the one guy who's half white, half Inupiat,

Jonathan Reisman (1:25:56.920)

said people often doubt his ethnicity

Lex Fridman (1:25:59.160)

because he looks like a white guy.

Lex Fridman (1:26:00.680)

So he'll, you know, bite the head off of a raw bird

Lex Fridman (1:26:04.360)

to show them that he is truly Inupiat, is what he said.

Jonathan Reisman (1:26:07.320)

That's how you prove you're legit.

Lex Fridman (1:26:09.080)

We're looking at an Instagram pic.

Jonathan Reisman (1:26:11.080)

As a doctor, I was used to knowing fat

Lex Fridman (1:26:14.060)

as the most maligned of all body parts

Lex Fridman (1:26:17.120)

and the culprit in an obesity epidemic.

Lex Fridman (1:26:19.520)

But in Arctic Alaska, fat has always meant

Jonathan Reisman (1:26:23.000)

health and survival.

Lex Fridman (1:26:24.720)

In fact, the entire story of life in the Arctic,

Jonathan Reisman (1:26:27.280)

especially human life, is basically a tale of fat.

Lex Fridman (1:26:30.720)

And in Barrow, what's A.K.?

Jonathan Reisman (1:26:33.560)

Alaska.

Lex Fridman (1:26:34.400)

Alaska, okay.

Jonathan Reisman (1:26:36.320)

A lawn covered with a whale blubber

Lex Fridman (1:26:39.160)

is still equivalent of a plush green lawn

Jonathan Reisman (1:26:42.440)

in temperature suburbia, swelling in its owner with pride.

Lex Fridman (1:26:46.980)

And that's what we're looking at,

Jonathan Reisman (1:26:48.120)

is a lawn full of whale blubber.

Lex Fridman (1:26:53.520)

A beautiful, and this, so this is,

Jonathan Reisman (1:26:55.000)

I mean, there's a lot of calories there.

Lex Fridman (1:26:56.800)

Oh, yeah.

Lex Fridman (1:26:57.640)

And this can feed a lot of people.

Lex Fridman (1:26:58.880)

A lot of energy, a lot of warmth.

Jonathan Reisman (1:27:01.220)

Absolutely, and it's delicious.

Lex Fridman (1:27:03.280)

This was like, I was a kid in a candy store, basically.

Jonathan Reisman (1:27:06.960)

I rounded a corner in Barrow.

Lex Fridman (1:27:08.480)

So when people do get a whale

Jonathan Reisman (1:27:10.120)

during the spring whaling season,

Lex Fridman (1:27:12.120)

they raise a flag or the whaling captain

Jonathan Reisman (1:27:14.020)

raises a flag over his house

Lex Fridman (1:27:15.520)

and everyone in town is welcome to come try some.

Lex Fridman (1:27:18.680)

And so before I went inside to try some,

Lex Fridman (1:27:21.600)

I was kinda playing around with blubber

Lex Fridman (1:27:23.960)

and I saw the, this is a bowhead whale.

Lex Fridman (1:27:26.320)

I saw its heart, which was huge,

Jonathan Reisman (1:27:29.260)

like the size of a yoga ball.

Lex Fridman (1:27:31.560)

And that was, for me, just like amazing.

Jonathan Reisman (1:27:33.800)

I spent probably the next 45 minutes

Lex Fridman (1:27:35.560)

just looking at all aspects of it.

Lex Fridman (1:27:37.080)

And the stump of aorta that was attached to it

Lex Fridman (1:27:39.640)

was the size of my thigh.

Jonathan Reisman (1:27:41.880)

That was really fascinating.

Lex Fridman (1:27:43.660)

It's similar Alaska and Northern Russia,

Jonathan Reisman (1:27:46.080)

like Siberia and out there.

Lex Fridman (1:27:48.160)

So where were you?

Jonathan Reisman (1:27:50.560)

I think you have some pics from that time.

Lex Fridman (1:27:53.960)

Where were you in Russia?

Lex Fridman (1:27:55.540)

So I spent a lot of time in kind of Western Russia as well,

Lex Fridman (1:27:58.480)

but I did take two trips to Kamchatka,

Jonathan Reisman (1:28:02.160)

including Northern Kamchatka.

Lex Fridman (1:28:04.380)

I didn't go far enough,

Jonathan Reisman (1:28:06.640)

I didn't go to Chukotka, for instance,

Lex Fridman (1:28:08.280)

until more recently when I was a ship doctor

Jonathan Reisman (1:28:11.160)

on a wildlife cruise that sailed from Anadyr, Russia,

Lex Fridman (1:28:15.640)

up to, through the Bering Strait into Wrangell Island.

Lex Fridman (1:28:19.400)

And we stopped in some villages in Chukotka

Lex Fridman (1:28:21.440)

and I got a chance to try some whale and stuff like that.

Jonathan Reisman (1:28:25.220)

Northern Kamchatka, where it's more the Koryak

Lex Fridman (1:28:27.740)

are the indigenous people.

Jonathan Reisman (1:28:29.240)

They do a lot of seal hunting,

Lex Fridman (1:28:30.480)

so I had a lot of seal blubber,

Lex Fridman (1:28:31.640)

but I don't believe they do any whale hunting quite there.

Lex Fridman (1:28:35.540)

But the Chukchi in a way are sort of, you know,

Jonathan Reisman (1:28:38.020)

similar to the Inupiat in their diet and their life ways.

Lex Fridman (1:28:42.320)

Of course, everyone's diet, all these people's diet

Jonathan Reisman (1:28:44.460)

has changed dramatically in the last 100 years,

Lex Fridman (1:28:47.040)

as it has for actually everyone

Jonathan Reisman (1:28:48.440)

living in kind of modern societies.

Lex Fridman (1:28:50.760)

But for them, perhaps more than anyone else

Jonathan Reisman (1:28:52.600)

since their diet was the most extreme,

Lex Fridman (1:28:54.680)

I think of any human culture on earth.

Jonathan Reisman (1:28:57.520)

Just to stay on the wild travel you did,

Lex Fridman (1:29:01.080)

and I should say, I'm using the word travel,

Lex Fridman (1:29:03.440)

but it really, you were a doctor there.

Lex Fridman (1:29:10.640)

Well, first of all, can you just comment on the decision

Jonathan Reisman (1:29:13.080)

to go to such places and to help people,

Lex Fridman (1:29:17.200)

to be a doctor there?

Lex Fridman (1:29:18.280)

What was the motivation?

Lex Fridman (1:29:19.480)

What was the thinking behind it?

Jonathan Reisman (1:29:20.980)

Well, I think I got the travel bug

Lex Fridman (1:29:22.660)

before I ever went to medical school

Lex Fridman (1:29:25.120)

and even wanted to be a doctor.

Lex Fridman (1:29:26.780)

So right after college, I kind of wasn't very into college,

Jonathan Reisman (1:29:31.280)

didn't enjoy things, kind of wanted to get out there

Lex Fridman (1:29:33.960)

and see the world, get out of New York City

Jonathan Reisman (1:29:36.560)

where I was a student at NYU.

Lex Fridman (1:29:39.780)

The first thing I did after finishing college

Jonathan Reisman (1:29:42.160)

was I was invited to be an intern at a research center

Lex Fridman (1:29:45.560)

in St. Petersburg, Russia.

Jonathan Reisman (1:29:47.300)

I spent six months there on my first trip

Lex Fridman (1:29:49.180)

and went back four more times to Russia,

Jonathan Reisman (1:29:52.560)

traveled all over, including to Kamchatka twice

Lex Fridman (1:29:55.840)

and other parts of the country.

Jonathan Reisman (1:29:57.680)

I'd never heard of cities like Petrozavodsk

Lex Fridman (1:30:00.680)

and Syktyvkar and Pskov.

Jonathan Reisman (1:30:02.680)

I didn't even know a word could start with P, S, K,

Lex Fridman (1:30:05.720)

like the city of Pskov, but it can.

Lex Fridman (1:30:08.860)

And I was sort of fascinated.

Lex Fridman (1:30:10.920)

I was actually studying

Jonathan Reisman (1:30:12.880)

the international environmental movement

Lex Fridman (1:30:14.960)

and how it came to Russia

Jonathan Reisman (1:30:16.560)

after the fall of the Soviet Union

Lex Fridman (1:30:18.520)

and how organizations like Greenpeace

Lex Fridman (1:30:20.280)

and World Wildlife Fund and the World Bank

Lex Fridman (1:30:23.200)

are trying to kind of push the timber industry,

Jonathan Reisman (1:30:27.140)

which is huge in Russia, toward a more sustainable path.

Lex Fridman (1:30:29.920)

And so I was sort of evaluating how is it working?

Lex Fridman (1:30:32.860)

If not, why not?

Lex Fridman (1:30:34.280)

And that seems like such a little niche,

Jonathan Reisman (1:30:36.320)

such a small detail about Russian society,

Lex Fridman (1:30:38.880)

but in a way, researching that in depth

Jonathan Reisman (1:30:41.600)

was almost this window into the entire country

Lex Fridman (1:30:44.680)

and the history in a place I knew nothing about.

Lex Fridman (1:30:46.920)

And I learned the language, traveled all over the country,

Lex Fridman (1:30:50.760)

got to know the food, the history, the literature.

Jonathan Reisman (1:30:53.040)

It was just an immersive and amazing

Lex Fridman (1:30:55.320)

and life changing experience

Jonathan Reisman (1:30:56.640)

that made me want to see every spot on the globe, basically,

Lex Fridman (1:31:01.080)

and learn about every culture.

Lex Fridman (1:31:03.080)

So I took that desire with me to medical school.

Lex Fridman (1:31:06.240)

I decided I would go to medical school.

Lex Fridman (1:31:08.400)

And from the very beginning,

Lex Fridman (1:31:10.120)

I was intent on traveling around the world.

Lex Fridman (1:31:13.320)

So a lot of my career has been fashioned

Lex Fridman (1:31:16.200)

so that I'm practicing medicine in a place

Jonathan Reisman (1:31:18.360)

with an interesting geographic context,

Lex Fridman (1:31:20.520)

an interesting place with an interesting cultural context.

Lex Fridman (1:31:24.400)

And that just makes it more interesting, I find.

Lex Fridman (1:31:27.520)

Not only are medical services often more needed

Jonathan Reisman (1:31:29.960)

in these remote and rural parts of the country and world,

Lex Fridman (1:31:32.800)

so I feel like I'm taking my knowledge

Lex Fridman (1:31:35.560)

and education experience to places where it's needed,

Lex Fridman (1:31:38.580)

but also for me,

Jonathan Reisman (1:31:39.420)

it's just such an enlightening experience,

Lex Fridman (1:31:41.920)

the way culture, history, geography, climate

Jonathan Reisman (1:31:44.940)

affects medical disease,

Lex Fridman (1:31:46.600)

but just getting to know the people,

Jonathan Reisman (1:31:47.880)

getting to know their culture,

Lex Fridman (1:31:49.700)

being a very useful traveler

Jonathan Reisman (1:31:51.480)

by providing medical services in that place.

Lex Fridman (1:31:54.760)

And that's taken me to Arctic Alaska,

Jonathan Reisman (1:31:57.360)

to Pine Ridge Reservation, South Dakota.

Lex Fridman (1:31:59.440)

I currently work in a few different parts

Jonathan Reisman (1:32:01.400)

of Pennsylvania, Appalachia,

Lex Fridman (1:32:02.960)

which for me is a unique geography and culture

Jonathan Reisman (1:32:06.860)

that I didn't grow up with, wasn't familiar with.

Lex Fridman (1:32:08.920)

So in some ways, it's exotic for me as well.

Jonathan Reisman (1:32:12.480)

I worked in other places too, like Kolkata, India, Nepal.

Lex Fridman (1:32:16.680)

Just I think my love of travel has shaped my medical career

Lex Fridman (1:32:20.600)

and being a doctor does give you these opportunities

Lex Fridman (1:32:23.500)

to go to places and travel in a unique way

Jonathan Reisman (1:32:27.120)

through the medical profession.

Lex Fridman (1:32:30.120)

You know, there's a documentary,

Jonathan Reisman (1:32:31.340)

Happy People Here in the Taiga or something like that.

Lex Fridman (1:32:35.760)

I think Warner Herzog voices it.

Jonathan Reisman (1:32:39.600)

It tells a story of a simple life of survival in the taiga

Lex Fridman (1:32:43.880)

and I think they're trapping for food

Lex Fridman (1:32:47.200)

and there's an alcoholism problem too as well.

Lex Fridman (1:32:51.760)

There's like a very basic life of survival,

Jonathan Reisman (1:32:57.560)

of loneliness, of desperation,

Lex Fridman (1:32:59.560)

but also there's a, I think the underlying claim

Jonathan Reisman (1:33:04.940)

of the documentary is that that simple life

Lex Fridman (1:33:09.940)

that simple life actually has a kind

Jonathan Reisman (1:33:12.660)

of simple happiness to it, hence the name Happy People.

Lex Fridman (1:33:20.540)

Can you speak to the life that people live in those places

Jonathan Reisman (1:33:24.900)

when it may be simpler than you would

Lex Fridman (1:33:28.660)

in a sort of big city life?

Jonathan Reisman (1:33:32.540)

It's definitely very different for sure.

Lex Fridman (1:33:36.100)

You know, I guess I found like in some

Jonathan Reisman (1:33:38.740)

of the remote villages of Kamchatka,

Lex Fridman (1:33:41.260)

I was actually surprised how similar they were

Jonathan Reisman (1:33:44.760)

in that I saw the same family strife,

Lex Fridman (1:33:48.860)

the same fights, the same kind of pairing of relationships

Lex Fridman (1:33:55.020)

and bickering and politics.

Lex Fridman (1:33:58.140)

In a way, I'm from the New Jersey suburbs

Lex Fridman (1:34:01.060)

and being in this remote village of Northern Kamchatka,

Lex Fridman (1:34:05.700)

I remember writing an email to my friend

Jonathan Reisman (1:34:07.240)

about how just it seemed so similar,

Lex Fridman (1:34:08.980)

even though on the surface it was this exotic other world,

Jonathan Reisman (1:34:12.540)

the incredible material know how they must have

Lex Fridman (1:34:15.540)

to get their food from the land.

Jonathan Reisman (1:34:17.540)

You know, that the number of animal species,

Lex Fridman (1:34:19.980)

plant species, the behaviors of the animals,

Jonathan Reisman (1:34:22.260)

seasons, how to live that way.

Lex Fridman (1:34:25.220)

In a way, it's more complicated in a way

Jonathan Reisman (1:34:27.000)

that I find fascinating how people live on the land

Lex Fridman (1:34:29.620)

and the knowledge and experience it takes

Jonathan Reisman (1:34:31.420)

to do it well and survive.

Lex Fridman (1:34:33.380)

You know, obviously other aspects of modern life

Jonathan Reisman (1:34:35.900)

in a city are much more complicated

Lex Fridman (1:34:38.820)

than they would be there, but I guess it's,

Jonathan Reisman (1:34:41.100)

that was something that struck me too,

Lex Fridman (1:34:42.420)

that it's simpler in some ways,

Lex Fridman (1:34:43.740)

but more complicated in other ways.

Lex Fridman (1:34:45.820)

So some of the complexity that happens in life

Jonathan Reisman (1:34:48.500)

is originated from humans, not from the technology

Lex Fridman (1:34:52.060)

or all that kind of stuff around us.

Jonathan Reisman (1:34:55.500)

You can take the human out of modernity,

Lex Fridman (1:34:57.220)

but they're still human.

Jonathan Reisman (1:34:58.380)

They're still human, and they fill the empty space

Lex Fridman (1:35:01.080)

with their own human complexities.

Jonathan Reisman (1:35:03.340)

Are there people that just stand out,

Lex Fridman (1:35:07.220)

memorable people, memorable experiences from those places?

Jonathan Reisman (1:35:13.720)

Some people that maybe made you smile, made you cry,

Lex Fridman (1:35:19.020)

changed who you are as a man, changed who you are

Lex Fridman (1:35:21.200)

as a doctor, anything jumps to mind?

Lex Fridman (1:35:24.100)

I think, you know, when I was, it was interesting,

Jonathan Reisman (1:35:26.180)

when I was in Russia, I found that most of the people

Lex Fridman (1:35:29.800)

I hung out with were old women.

Jonathan Reisman (1:35:31.780)

I'm not sure why.

Lex Fridman (1:35:32.840)

I mean, actually I didn't meet a lot of old men in Russia,

Jonathan Reisman (1:35:36.060)

which might speak to kind of life expectancy there

Lex Fridman (1:35:39.520)

for men in particular.

Lex Fridman (1:35:41.140)

But I found women, older Russian women,

Lex Fridman (1:35:44.380)

including, you know, Russian from St. Petersburg

Jonathan Reisman (1:35:46.980)

or some of the elderly women in Kamchatka,

Lex Fridman (1:35:49.860)

who were, you know, some were Koriak,

Jonathan Reisman (1:35:51.580)

some were half Koriak, half Russian, some were Chukchi.

Lex Fridman (1:35:55.320)

I just found them to be so enlightening

Jonathan Reisman (1:35:58.060)

the way they talked about history, about people,

Lex Fridman (1:36:02.000)

so insightful about humanity, you know,

Jonathan Reisman (1:36:03.900)

all they've lived through in the last 50 years

Lex Fridman (1:36:05.860)

in some of these parts of Russia,

Jonathan Reisman (1:36:07.940)

like the upheaval, societal upheaval,

Lex Fridman (1:36:10.400)

the destruction, the building up.

Jonathan Reisman (1:36:12.480)

It's just something I could not even imagine.

Lex Fridman (1:36:15.820)

And I think their insights were just very,

Jonathan Reisman (1:36:18.500)

I'm not thinking of anything in particular,

Lex Fridman (1:36:19.940)

but I just remember I could listen

Jonathan Reisman (1:36:21.840)

to some of these elderly women talk about their lives

Lex Fridman (1:36:24.140)

for hours and hours.

Jonathan Reisman (1:36:25.400)

I remember there was this older,

Lex Fridman (1:36:26.860)

elderly blind Koriak woman who you would have thought

Jonathan Reisman (1:36:31.300)

was the, you know, most country bumpkin of country bumpkin,

Lex Fridman (1:36:34.140)

and yet she couldn't stop talking about

Lex Fridman (1:36:35.580)

how much she loved reading Dostoevsky and Tolstoy,

Lex Fridman (1:36:38.380)

which might also speak to the Soviet education system.

Lex Fridman (1:36:41.680)

And it was just sort of surprising and fascinating,

Lex Fridman (1:36:43.860)

and just those stories and perspectives on life

Jonathan Reisman (1:36:46.920)

really stayed with me.

Lex Fridman (1:36:48.780)

Yeah, with babushki.

Jonathan Reisman (1:36:53.740)

There's a wisdom, there's a kindness.

Lex Fridman (1:36:57.440)

I mean, I suppose that's true for older people in general,

Lex Fridman (1:37:06.160)

but there's something about, it's not just Russia,

Lex Fridman (1:37:09.440)

it's Eastern Europe, it's like this kind of look of wisdom,

Lex Fridman (1:37:17.320)

and not just like sort of middle class wisdom

Lex Fridman (1:37:22.460)

or something like that.

Jonathan Reisman (1:37:23.720)

It's like I have seen some shit wisdom, I've seen it all.

Lex Fridman (1:37:30.120)

And on the other side, I'm left here with a pragmatism

Lex Fridman (1:37:35.640)

and a compassion, and also an ability to cook really well.

Lex Fridman (1:37:39.680)

That's for sure, absolutely.

Jonathan Reisman (1:37:41.520)

There's just this balance of just deep intelligence

Lex Fridman (1:37:44.880)

and deep kindness, and yeah, I mean I part much of who I am

Jonathan Reisman (1:37:50.720)

is because of the relationship I had with my grandmother

Lex Fridman (1:37:53.080)

who was a Russian, Ukrainian born Russian grandmother.

Lex Fridman (1:38:01.920)

Did you learn the Russian language?

Lex Fridman (1:38:03.820)

I did, it's quite rusty at this point,

Lex Fridman (1:38:05.880)

but I did, one of these wonderful elderly Russians

Lex Fridman (1:38:10.160)

in St. Petersburg sort of adopted me.

Jonathan Reisman (1:38:12.600)

I think that was another thing that a lot of these

Lex Fridman (1:38:15.200)

elderly women on every side of the country

Jonathan Reisman (1:38:18.200)

kind of adopted me or saw me as this real curiosity.

Lex Fridman (1:38:21.760)

This was around 2002, 2003, it just wasn't common

Jonathan Reisman (1:38:26.320)

for this sort of strange American to suddenly show up

Lex Fridman (1:38:29.520)

in the middle of Kamchatka or even St. Petersburg,

Lex Fridman (1:38:32.120)

and just absolutely ravenously curious

Lex Fridman (1:38:34.840)

about everything they had to say.

Lex Fridman (1:38:36.520)

So I often got adopted and one of them taught me Russian

Lex Fridman (1:38:40.240)

and how to ride a horse, so the same babushka

Jonathan Reisman (1:38:44.880)

taught me both of those things.

Lex Fridman (1:38:46.640)

And like you said also, I should mention

Jonathan Reisman (1:38:48.680)

that there's something about the Soviet education system

Lex Fridman (1:38:51.180)

where yeah, everybody reads Tolstoy, Dostoevsky,

Jonathan Reisman (1:38:54.680)

it's exceptionally well read.

Lex Fridman (1:38:56.640)

No matter where life has taken you,

Jonathan Reisman (1:38:58.560)

no matter where you come from,

Lex Fridman (1:39:00.320)

the literature, the mathematics, the sciences,

Jonathan Reisman (1:39:02.880)

they're all like extremely well educated

Lex Fridman (1:39:06.520)

and that creates a fascinating populace.

Jonathan Reisman (1:39:12.240)

Like then you take that education,

Lex Fridman (1:39:15.180)

that excellent early education,

Lex Fridman (1:39:18.400)

and you throw a bunch of hardship at those people

Lex Fridman (1:39:22.080)

and then they kind of cook in that hardship

Lex Fridman (1:39:26.420)

and come out really fascinating people on the other end.

Lex Fridman (1:39:30.580)

It makes me surprised sort of that, for instance,

Jonathan Reisman (1:39:32.600)

like Russian medical science is not,

Lex Fridman (1:39:35.820)

doesn't, you don't see a lot of sort of studies,

Jonathan Reisman (1:39:38.920)

medical studies, advancing of medical science

Lex Fridman (1:39:41.160)

come out of Russia.

Jonathan Reisman (1:39:42.440)

It's just sort of, I'm surprised sort of,

Lex Fridman (1:39:44.680)

I wish that it would.

Jonathan Reisman (1:39:45.920)

I visited Akademgorodok outside Novosibirsk,

Lex Fridman (1:39:49.440)

which is an entire city the Soviets created

Jonathan Reisman (1:39:51.340)

just for the study of science

Lex Fridman (1:39:52.600)

and it's like there's the geology building

Lex Fridman (1:39:54.520)

and there's the biology building

Lex Fridman (1:39:55.920)

and there's the chemistry building

Lex Fridman (1:39:57.460)

and I just feel like Russia has this potential

Lex Fridman (1:40:00.360)

to be a science powerhouse or even in the medical sciences

Lex Fridman (1:40:03.120)

but I guess you just, I don't see it.

Lex Fridman (1:40:05.660)

I'm not sure why.

Jonathan Reisman (1:40:07.680)

I mean, you can certainly guess as to why

Lex Fridman (1:40:10.600)

and I see the same thing in the other,

Jonathan Reisman (1:40:13.640)

in the sciences I hold the dearest sort of,

Lex Fridman (1:40:15.880)

in computer science, in engineering fields.

Jonathan Reisman (1:40:20.780)

I kind of long held this desire, by long,

Lex Fridman (1:40:25.060)

I mean, last couple of years

Jonathan Reisman (1:40:27.060)

because a bunch of people reached out to me

Lex Fridman (1:40:29.440)

from Yandex and Moscow State to give lectures there

Jonathan Reisman (1:40:33.080)

to sort of connect.

Lex Fridman (1:40:34.320)

You know, why so little science is coming out of there?

Lex Fridman (1:40:37.720)

Why so little that we hear about?

Lex Fridman (1:40:41.500)

And it feels like we should be able

Jonathan Reisman (1:40:42.640)

to bridge the scientific community.

Lex Fridman (1:40:44.800)

Like science, let's even say,

Jonathan Reisman (1:40:49.740)

even in turmoil of geopolitics, even in global conflict,

Lex Fridman (1:40:53.680)

I feel like science should be bigger than that.

Lex Fridman (1:40:56.720)

But why do we not hear from the scientists

Lex Fridman (1:41:00.400)

is because of the limitations on human freedoms,

Jonathan Reisman (1:41:03.480)

on scientific freedoms.

Lex Fridman (1:41:05.060)

I feel like in China, in Russia,

Jonathan Reisman (1:41:09.120)

in any regime of its sort, you should give freedom

Lex Fridman (1:41:14.080)

to scientists to flourish and to interact with others

Lex Fridman (1:41:19.200)

and you can only grow from that.

Lex Fridman (1:41:20.880)

You shouldn't suppress that.

Jonathan Reisman (1:41:23.320)

The sort of Cold War ideas, we should put those aside.

Lex Fridman (1:41:27.400)

As somebody who spent time in Russia,

Jonathan Reisman (1:41:31.160)

as somebody who learned Russian,

Lex Fridman (1:41:35.560)

do you have some thoughts that you want to say

Lex Fridman (1:41:38.600)

about the war in Ukraine currently?

Lex Fridman (1:41:41.920)

It's tragic, of course.

Jonathan Reisman (1:41:44.560)

Seemingly pointless to watch the destruction

Lex Fridman (1:41:47.520)

of a country in real time.

Jonathan Reisman (1:41:51.560)

I guess it's, you know, when you read Russian history

Lex Fridman (1:41:53.800)

and Ukrainian history, I guess it just,

Jonathan Reisman (1:41:55.840)

it's sort of, you know, destruction is a big part of it.

Lex Fridman (1:41:59.960)

The populace being beaten down is a big part of it,

Jonathan Reisman (1:42:02.780)

you know, from the Mongolian hordes

Lex Fridman (1:42:05.600)

through the Tsar and the Soviets and Putin.

Jonathan Reisman (1:42:09.160)

I guess, you know, it's just,

Lex Fridman (1:42:11.680)

in science in particular, medical science,

Jonathan Reisman (1:42:13.520)

it feels like this sort of unrealized potential.

Lex Fridman (1:42:15.920)

You know, the culture is so beautiful,

Jonathan Reisman (1:42:18.160)

the people are so smart and well educated.

Lex Fridman (1:42:20.600)

I think the word unrealized potential

Jonathan Reisman (1:42:23.100)

is kind of how I feel.

Lex Fridman (1:42:24.400)

That's why I wanted to celebrate that part of the world

Jonathan Reisman (1:42:27.580)

is there's so many beautiful people,

Lex Fridman (1:42:29.380)

so many brilliant people.

Lex Fridman (1:42:31.920)

And I just happen to know the language

Lex Fridman (1:42:33.640)

so I'm able to appreciate the beauty of those people.

Jonathan Reisman (1:42:36.520)

I'm sure the same is true in China.

Lex Fridman (1:42:38.680)

I'm sure, that's one of the things that makes me sad

Jonathan Reisman (1:42:40.760)

is there's all these cultures that I don't know about.

Lex Fridman (1:42:44.680)

I can't fully appreciate their brilliance.

Jonathan Reisman (1:42:46.400)

Even Japan and places like that

Lex Fridman (1:42:48.640)

that are sort of, there's channels of communication

Jonathan Reisman (1:42:52.280)

wide open and there's a lot of interaction.

Lex Fridman (1:42:54.240)

It's still, not knowing the language,

Jonathan Reisman (1:42:56.300)

I feel like I miss some of the culture.

Lex Fridman (1:42:58.640)

Or Portuguese and, you know, looking at South America

Lex Fridman (1:43:01.920)

and all that kind of stuff.

Lex Fridman (1:43:03.760)

But anyway, in Russia there certainly is

Jonathan Reisman (1:43:06.920)

that unrealized potential.

Lex Fridman (1:43:08.400)

In Ukraine, so many brilliant scientists,

Jonathan Reisman (1:43:12.060)

engineers came from Ukraine, from Russia.

Lex Fridman (1:43:14.520)

And I hope they get to flourish soon.

Lex Fridman (1:43:18.500)

And I hope we put this,

Lex Fridman (1:43:23.000)

I hope we stop this war, because all war is hell.

Jonathan Reisman (1:43:29.140)

Is there something to comment about the biology

Lex Fridman (1:43:31.720)

of war, is there echoes of the emergency room experience?

Jonathan Reisman (1:43:41.880)

Have you dealt with patients

Lex Fridman (1:43:46.760)

that have been touched by war time?

Jonathan Reisman (1:43:49.920)

Definitely, war and medicine has a very intricate

Lex Fridman (1:43:53.200)

and complex relationship.

Jonathan Reisman (1:43:54.920)

I don't know if it was Walt Whitman who said it,

Lex Fridman (1:43:57.120)

though he was a nurse during the Civil War,

Jonathan Reisman (1:43:59.520)

that war is the best medical school.

Lex Fridman (1:44:01.480)

But some people have said that.

Lex Fridman (1:44:03.820)

And even advancements in medicine come from war.

Lex Fridman (1:44:08.720)

The wars in Iraq and Afghanistan have, in some ways,

Jonathan Reisman (1:44:12.200)

really revolutionized certain aspects

Lex Fridman (1:44:14.180)

of the way we treat trauma patients

Jonathan Reisman (1:44:15.920)

in the civilian world as well.

Lex Fridman (1:44:17.640)

The importance of tourniquets,

Jonathan Reisman (1:44:20.080)

the importance of transfusing whole blood

Lex Fridman (1:44:22.160)

instead of red blood cells isolated from serum

Lex Fridman (1:44:25.300)

and platelets, et cetera.

Lex Fridman (1:44:27.040)

The importance of pain control in the battlefield,

Jonathan Reisman (1:44:29.240)

that's changed dramatically.

Lex Fridman (1:44:30.520)

Everything from ketamine injections

Jonathan Reisman (1:44:32.300)

to fentanyl lollipops in the battlefield.

Lex Fridman (1:44:35.600)

So war has really improved medicine in many ways.

Jonathan Reisman (1:44:39.080)

In another way, the Department of Defense

Lex Fridman (1:44:42.640)

spends a lot of money on medical research

Lex Fridman (1:44:44.520)

and really pushes the envelope.

Lex Fridman (1:44:46.800)

DARPA is one aspect of the military budget

Jonathan Reisman (1:44:50.120)

that really funds these moonshot experiments

Lex Fridman (1:44:52.780)

that are really fascinating and really push the frontiers

Jonathan Reisman (1:44:56.720)

more than seemingly most kind of universities

Lex Fridman (1:45:00.720)

doing doctors and researchers doing their research.

Lex Fridman (1:45:04.280)

So in a way, the space program,

Lex Fridman (1:45:06.860)

which sort of was military initially

Jonathan Reisman (1:45:08.520)

then became civilian under NASA,

Lex Fridman (1:45:10.400)

also has led to a lot of advances and understandings

Jonathan Reisman (1:45:13.600)

of health on Earth and in space.

Lex Fridman (1:45:16.840)

So the military or war in general is a huge way

Jonathan Reisman (1:45:20.560)

that medicine advances,

Lex Fridman (1:45:23.080)

not to mention the epidemics that come.

Jonathan Reisman (1:45:25.560)

My grandmother was from what's today Moldova,

Lex Fridman (1:45:28.480)

what was then Romania.

Jonathan Reisman (1:45:29.680)

She got typhus during World War II.

Lex Fridman (1:45:33.240)

So there's typhus outbreaks, there's cholera outbreaks,

Jonathan Reisman (1:45:35.520)

you know, all these, even infectious disease things

Lex Fridman (1:45:38.920)

can advance in war, which you wouldn't expect.

Jonathan Reisman (1:45:40.960)

You expect sort of trauma to be the sort of main problem,

Lex Fridman (1:45:43.660)

but actually infection is a huge problem

Jonathan Reisman (1:45:45.920)

throughout history and war.

Lex Fridman (1:45:46.980)

So we can learn a lot.

Jonathan Reisman (1:45:48.660)

It's this kind of horrific natural experiment

Lex Fridman (1:45:51.380)

in medical care.

Jonathan Reisman (1:45:53.760)

Yeah, and I've recently been reading about

Lex Fridman (1:45:56.400)

some of the horrific medical experiments

Jonathan Reisman (1:45:59.200)

performed by Nazi scientists, Nazi Germany.

Lex Fridman (1:46:03.640)

I'll talk about it another time perhaps,

Lex Fridman (1:46:05.800)

but nothing reveals the honesty of human biology like war.

Lex Fridman (1:46:13.180)

Just to stay on your wild journeys for a little bit longer,

Jonathan Reisman (1:46:17.700)

you have a tweet about Shackleton saying,

Lex Fridman (1:46:19.980)

here's a photo of Shackleton's medical kit

Jonathan Reisman (1:46:22.400)

from his storied expedition to Antarctica in the 1910s.

Lex Fridman (1:46:26.360)

Some perigoric for pain, some laxative.

Jonathan Reisman (1:46:30.000)

Only the essentials.

Lex Fridman (1:46:33.880)

Would you put laxative under the essentials?

Jonathan Reisman (1:46:36.560)

Anyway, sorry to interrupt.

Lex Fridman (1:46:39.680)

When I worked as a ship doctor in Antarctica in 2018,

Jonathan Reisman (1:46:44.040)

I had a huge cabinet full of meds and even EKG machine.

Lex Fridman (1:46:48.640)

So if you can comment sort of on that contrast.

Lex Fridman (1:46:54.000)

First of all, your own journey, how harsh was it?

Lex Fridman (1:46:56.640)

How difficult was it?

Lex Fridman (1:46:58.360)

And given that context, can you think about

Lex Fridman (1:47:02.640)

how hard Shackleton's journey was?

Jonathan Reisman (1:47:06.400)

I think the difference is unimaginably stark.

Lex Fridman (1:47:09.760)

One thing I do wanna point out is that

Jonathan Reisman (1:47:11.720)

the use of laxatives early in the 20th century

Lex Fridman (1:47:14.240)

and before that, they were used for a surprising

Jonathan Reisman (1:47:17.720)

number of ailments where they probably did not help at all.

Lex Fridman (1:47:21.100)

But I think that was a holdover from sort of

Jonathan Reisman (1:47:23.640)

the old theory of medicine, the humoral theory

Lex Fridman (1:47:26.080)

where you have to balance the fluids in the body.

Lex Fridman (1:47:28.720)

And so causing people to vomit,

Lex Fridman (1:47:30.480)

causing them to have diarrhea or purposely taking blood

Jonathan Reisman (1:47:34.000)

out of them in bloodletting was a big part.

Lex Fridman (1:47:36.760)

And I think that crazy use of laxatives

Jonathan Reisman (1:47:38.960)

was maybe a holdover from that time.

Lex Fridman (1:47:41.800)

But that being said, they were probably not eating

Jonathan Reisman (1:47:44.600)

very high fiber food on that expedition.

Lex Fridman (1:47:47.120)

So perhaps laxatives could have been helpful.

Jonathan Reisman (1:47:49.800)

There's a lot of seal, penguin and seal meat being eaten,

Lex Fridman (1:47:54.320)

which is not super high in fiber.

Lex Fridman (1:47:56.840)

So I don't wanna discount the importance

Lex Fridman (1:47:58.560)

of laxatives in that setting.

Lex Fridman (1:48:00.320)

But that wouldn't be the essential thing.

Lex Fridman (1:48:02.120)

If you're thinking of a tiny kit

Jonathan Reisman (1:48:04.980)

that has only the essentials, I mean pain, yes.

Lex Fridman (1:48:09.240)

Laxatives, I don't know, maybe not.

Jonathan Reisman (1:48:11.600)

I think the medical kit possibilities

Lex Fridman (1:48:13.720)

were much narrower back then.

Jonathan Reisman (1:48:16.260)

This was before antibiotics,

Lex Fridman (1:48:18.600)

before I think germ theory might've been,

Jonathan Reisman (1:48:22.520)

it was known, but there wasn't much to do about it.

Lex Fridman (1:48:25.440)

So the availability of medicines,

Jonathan Reisman (1:48:27.640)

I mean, that's something that exploded

Lex Fridman (1:48:29.040)

over the course of the 20th century.

Lex Fridman (1:48:30.440)

So what I can put in a backpack today

Lex Fridman (1:48:33.240)

filled with modern medications, whether injectable

Jonathan Reisman (1:48:35.580)

or to be taken orally is just many orders of magnitude

Lex Fridman (1:48:39.700)

greater than what they had back then.

Lex Fridman (1:48:42.400)

So when I went, my expedition was nothing like Shackleton's.

Lex Fridman (1:48:46.520)

I was on a huge cruise ship with 160 Japanese passengers

Jonathan Reisman (1:48:51.600)

who came with their own translators.

Lex Fridman (1:48:53.720)

And as I said, I had cabinets, not just one cabinet,

Jonathan Reisman (1:48:58.280)

many cabinets full of medications,

Lex Fridman (1:49:00.520)

both injectable, some patches, some pills.

Jonathan Reisman (1:49:04.800)

I was very impressed actually with what was available there.

Lex Fridman (1:49:08.640)

And I didn't have to use a lot of it, thankfully,

Jonathan Reisman (1:49:11.160)

though I did use some of it for people.

Lex Fridman (1:49:14.760)

And I slept and I got free room and board on the ship.

Lex Fridman (1:49:19.080)

So every Southern summer cruise ships

Lex Fridman (1:49:22.440)

go take people to Antarctica,

Jonathan Reisman (1:49:24.680)

the Southern Atlantic islands like the Falklands

Lex Fridman (1:49:26.760)

and other parts of the South Pacific.

Lex Fridman (1:49:29.200)

And then in the Northern summer,

Lex Fridman (1:49:30.580)

the same kind of cruise ship explosion happens

Jonathan Reisman (1:49:34.160)

going to Greenland and Iceland and Svalbard

Lex Fridman (1:49:36.440)

and Franz Josef Land and other parts of the North Alaska.

Jonathan Reisman (1:49:40.360)

So, and every ship needs a doctor.

Lex Fridman (1:49:42.900)

So it's a great opportunity.

Jonathan Reisman (1:49:44.800)

They want specifically ER doctors to deal with emergencies,

Lex Fridman (1:49:48.680)

but you're really working in the middle of nowhere.

Lex Fridman (1:49:51.920)

And all you have is the medications there on the ship

Lex Fridman (1:49:55.000)

and supplies and your knowledge and experience.

Lex Fridman (1:49:57.600)

And so it's a very different experience

Lex Fridman (1:49:59.840)

than working in a high tech modern hospital

Jonathan Reisman (1:50:02.000)

with every bit of technology

Lex Fridman (1:50:03.340)

and every sub specialist consultant available.

Lex Fridman (1:50:06.520)

But I sort of liked that challenge.

Lex Fridman (1:50:08.120)

I mean, I like going to the ends of the earth.

Jonathan Reisman (1:50:09.720)

It's beautiful, it's exciting, it's fascinating.

Lex Fridman (1:50:12.920)

Practicing medicine in those settings is extra challenging

Lex Fridman (1:50:15.820)

and really makes you hone some of your skills,

Lex Fridman (1:50:18.720)

which is part of the reason that I sought them out.

Lex Fridman (1:50:22.320)

Do you see echoes of some of that same effort?

Lex Fridman (1:50:25.160)

I've gotten a chance to interact with astronauts

Lex Fridman (1:50:27.400)

and those kinds of folks working on space missions.

Lex Fridman (1:50:30.800)

Do you see some of those same echoes of challenging efforts

Jonathan Reisman (1:50:34.800)

going out into space and maybe landing on Mars

Lex Fridman (1:50:37.800)

and maybe beginning to build a small colony on Mars?

Jonathan Reisman (1:50:42.240)

Yeah, I think the healthcare that is needed

Lex Fridman (1:50:44.560)

will be a big part of that.

Jonathan Reisman (1:50:46.080)

Obviously, we're probably gonna send

Lex Fridman (1:50:47.960)

overall quite healthy people,

Lex Fridman (1:50:49.880)

but there's a lot of medical decisions to make

Lex Fridman (1:50:51.640)

about what should be brought, what should be expected.

Jonathan Reisman (1:50:54.600)

To some extent, I've had a lot of doctors say,

Lex Fridman (1:50:57.320)

oh my goodness, I can't believe you work

Jonathan Reisman (1:50:58.720)

in the middle of nowhere.

Lex Fridman (1:50:59.540)

What do you do if someone gets a brain bleed,

Lex Fridman (1:51:02.280)

like falls, hits their head, needs a neurosurgeon?

Lex Fridman (1:51:04.460)

I mean, the obvious answer is they die.

Jonathan Reisman (1:51:06.620)

You know, when you're in the middle of Antarctica,

Lex Fridman (1:51:09.540)

things kill you that wouldn't

Jonathan Reisman (1:51:11.340)

if you're inside a university hospital

Lex Fridman (1:51:13.640)

that's fully equipped to help with every problem that arises.

Jonathan Reisman (1:51:16.860)

Mars takes that to a crazy extreme, obviously.

Lex Fridman (1:51:20.360)

I know that even going to Antarctica,

Jonathan Reisman (1:51:22.140)

different countries have had different strategies.

Lex Fridman (1:51:24.320)

I believe it was Australia used to kind of just,

Jonathan Reisman (1:51:28.380)

in anticipation, remove people's gallbladders

Lex Fridman (1:51:31.780)

just so that it wouldn't get inflamed

Jonathan Reisman (1:51:33.580)

because that is a very common medical emergency.

Lex Fridman (1:51:36.060)

So they would just remove it beforehand,

Jonathan Reisman (1:51:37.980)

even though it was not diseased at all,

Lex Fridman (1:51:39.780)

just so that while they're stuck in Antarctica

Jonathan Reisman (1:51:41.420)

over the winter, for instance, that wouldn't be a problem.

Lex Fridman (1:51:44.660)

You know, there's many other issues that can arise.

Lex Fridman (1:51:47.300)

But so those are some decisions to make.

Lex Fridman (1:51:49.700)

Maybe the people who go into Mars

Jonathan Reisman (1:51:51.140)

should have their appendix removed,

Lex Fridman (1:51:52.440)

their gallbladder removed.

Jonathan Reisman (1:51:53.860)

Maybe they should have a cardiac cath

Lex Fridman (1:51:55.280)

to see if they have coronary artery disease

Jonathan Reisman (1:51:56.940)

just to know their chances of getting a heart attack there.

Lex Fridman (1:51:59.040)

Though it's not always predictive.

Jonathan Reisman (1:52:00.660)

You know, it's hard to predict

Lex Fridman (1:52:01.740)

who's gonna get a heart attack,

Lex Fridman (1:52:02.720)

but maybe with all the data around today,

Lex Fridman (1:52:05.020)

we'll get better at predicting.

Lex Fridman (1:52:06.740)

But that will be a huge part.

Lex Fridman (1:52:07.940)

You know, we can't have people,

Jonathan Reisman (1:52:09.300)

the few pioneers in a Mars colony

Lex Fridman (1:52:11.700)

dying of heart attacks and things like that.

Jonathan Reisman (1:52:13.100)

Don't anticipate stuff.

Lex Fridman (1:52:13.940)

Would you go?

Jonathan Reisman (1:52:15.620)

You've gone to some harsh conditions to be a doctor.

Lex Fridman (1:52:18.620)

Would you go to Mars to be a doctor?

Jonathan Reisman (1:52:21.180)

It would definitely be amazing, I think,

Lex Fridman (1:52:24.660)

because I have a wife and two small children,

Jonathan Reisman (1:52:26.580)

probably not in the cards for me at this point, but.

Lex Fridman (1:52:30.460)

You humans with your human attachments.

Jonathan Reisman (1:52:33.140)

Sex and death.

Lex Fridman (1:52:35.140)

If you just put more priority on the death than the sex,

Jonathan Reisman (1:52:39.220)

I think we would be better off.

Lex Fridman (1:52:42.420)

No.

Jonathan Reisman (1:52:44.020)

I would love to go to Mars.

Lex Fridman (1:52:45.020)

And actually, you know,

Jonathan Reisman (1:52:45.900)

I practice high altitude medicine in Nepal.

Lex Fridman (1:52:48.540)

Space medicine is sort of an extension of that.

Jonathan Reisman (1:52:50.540)

You know, the air is just much thinner, like nonexistent.

Lex Fridman (1:52:53.260)

You know, as you go higher in the mountains,

Jonathan Reisman (1:52:54.980)

the things that happen to human physiology

Lex Fridman (1:52:56.700)

are very bizarre and strange

Lex Fridman (1:52:59.100)

and still not well explained by science.

Lex Fridman (1:53:01.980)

And in space, it's just like a crazy extension

Jonathan Reisman (1:53:04.300)

of high altitude.

Lex Fridman (1:53:07.140)

If I could just return to the, we didn't really,

Jonathan Reisman (1:53:10.100)

I think we mentioned a little bit about the food you had.

Lex Fridman (1:53:13.260)

Just if we can high level say,

Lex Fridman (1:53:15.500)

what is the greatest meal you've ever had?

Lex Fridman (1:53:18.620)

So your last meal, let's go.

Jonathan Reisman (1:53:21.020)

If one more meal, I get to murder you after this.

Lex Fridman (1:53:26.060)

This is your last day.

Jonathan Reisman (1:53:27.100)

We get to spend it together.

Lex Fridman (1:53:28.180)

Where in the world would you go?

Lex Fridman (1:53:29.580)

What would you eat?

Lex Fridman (1:53:30.820)

I would say the most delicious thing is bone marrow.

Lex Fridman (1:53:36.180)

And I would love a full meal of bone marrow

Lex Fridman (1:53:38.100)

for my last, last dish.

Jonathan Reisman (1:53:39.980)

I did on my birthday in 2002,

Lex Fridman (1:53:43.060)

ate a kilogram and a half of crab meat in Kamchatka.

Lex Fridman (1:53:46.740)

And that was also amazingly delicious.

Lex Fridman (1:53:50.220)

The king crab they have there is incredible.

Lex Fridman (1:53:52.500)

But I would go with bone marrow,

Lex Fridman (1:53:54.860)

which is I think just one of the most delicious foods.

Lex Fridman (1:53:57.900)

And it's sort of this weird body part.

Lex Fridman (1:53:59.820)

You know, it's basically all your stem cells,

Jonathan Reisman (1:54:01.980)

not all of them, but the stem cells

Lex Fridman (1:54:03.260)

that produce all your blood cells.

Lex Fridman (1:54:04.940)

So they are spitting out billions of white blood cells,

Lex Fridman (1:54:07.580)

red blood cells and platelets every day.

Lex Fridman (1:54:09.700)

And there's a bunch of fat in there as well.

Lex Fridman (1:54:12.500)

Just one of the places the body stores fat.

Lex Fridman (1:54:14.380)

And so you basically add heat and that's all you need.

Lex Fridman (1:54:17.300)

It's like the perfect food.

Jonathan Reisman (1:54:18.700)

You add heat.

Lex Fridman (1:54:19.540)

The fat for frying the stem cells is already there.

Jonathan Reisman (1:54:22.180)

There's naturally a bone vessel to contain it all.

Lex Fridman (1:54:25.460)

Probably add some flavor too.

Jonathan Reisman (1:54:27.580)

It's like the perfect food.

Lex Fridman (1:54:29.100)

Does it matter which animal?

Jonathan Reisman (1:54:33.300)

I prefer a larger animal just so there's more of it.

Lex Fridman (1:54:35.700)

I actually like, well that's true.

Jonathan Reisman (1:54:37.300)

I actually really like sort of bone marrow

Lex Fridman (1:54:39.140)

from like chicken bones.

Jonathan Reisman (1:54:40.660)

Right, just sucking it out of the bone.

Lex Fridman (1:54:42.540)

Yes, I'm known for leaving absolutely nothing edible

Jonathan Reisman (1:54:46.660)

on the plate except bone itself.

Lex Fridman (1:54:48.820)

There's one other human I know that loves bone marrow

Jonathan Reisman (1:54:54.620)

as much as you do and that's Joe Rogan.

Lex Fridman (1:54:57.100)

So go, it's unnatural how much that man loves bone marrow.

Jonathan Reisman (1:55:01.460)

I understand why.

Lex Fridman (1:55:02.420)

It's amazing.

Jonathan Reisman (1:55:03.260)

I love the steak part.

Lex Fridman (1:55:04.100)

The bone marrow, you know what, let me argue with you

Jonathan Reisman (1:55:07.580)

because I don't know, it could be an acquired taste

Lex Fridman (1:55:12.100)

but there's just too much, it's like too much

Jonathan Reisman (1:55:17.540)

with too little work for it.

Lex Fridman (1:55:20.380)

Like it's as if you gave me lobster meat

Jonathan Reisman (1:55:23.700)

without the lobster having to clean the lobster.

Lex Fridman (1:55:27.540)

I just feel like I'm spoiling myself.

Lex Fridman (1:55:30.540)

So it's very fatty, it's, I don't know,

Lex Fridman (1:55:33.460)

maybe I wanna work for something that tastes like that.

Jonathan Reisman (1:55:36.140)

Well if you start from the whole animal,

Lex Fridman (1:55:37.540)

you do have to work to get at it, right?

Jonathan Reisman (1:55:39.300)

A lot of animals have the teeth and the jaw muscles

Lex Fridman (1:55:43.220)

to chomp through bone, we do not.

Lex Fridman (1:55:45.020)

So when you buy it from the store, it's already sawed up

Lex Fridman (1:55:49.300)

but I've definitely gotten marrow out of deer bones

Jonathan Reisman (1:55:52.220)

with a hatchet, just chop off the fat end

Lex Fridman (1:55:55.260)

and start spooning it out.

Jonathan Reisman (1:55:56.500)

Or maybe I'll revisit it, that's fascinating.

Lex Fridman (1:55:59.020)

And where, where would you eat it?

Lex Fridman (1:56:01.820)

Where and which place of the world?

Lex Fridman (1:56:04.180)

Is there something about who cooks it, who you eat it with?

Jonathan Reisman (1:56:10.740)

You're not allowed to pick your family.

Lex Fridman (1:56:12.340)

Right.

Jonathan Reisman (1:56:13.180)

Uh.

Lex Fridman (1:56:14.020)

Uh.

Jonathan Reisman (1:56:14.860)

Uh.

Lex Fridman (1:56:15.700)

Uh.

Lex Fridman (1:56:17.340)

So like which place in the world, rural or in the city,

Lex Fridman (1:56:21.340)

those kinds of things, you've been

Jonathan Reisman (1:56:22.460)

to so many fascinating places.

Lex Fridman (1:56:25.780)

I would say I'm, Antarctica I would say

Jonathan Reisman (1:56:28.180)

is one of the most picturesque places I've ever been.

Lex Fridman (1:56:31.260)

I really did not, I didn't know how mountainous it was

Lex Fridman (1:56:34.900)

and I guess I knew there'd be ice

Lex Fridman (1:56:37.220)

but just I didn't know how much ice it was.

Jonathan Reisman (1:56:39.540)

You know, it's ice and mountains just overwhelming.

Lex Fridman (1:56:42.140)

I just, you know, as kind of overwhelming bone marrow

Jonathan Reisman (1:56:45.180)

might seem to you, sort of that feast for your eyes.

Lex Fridman (1:56:48.160)

And just ice in general is amazing,

Jonathan Reisman (1:56:51.680)

like the icebergs floating around Antarctica

Lex Fridman (1:56:54.040)

is just astounding, like the different shapes,

Jonathan Reisman (1:56:56.640)

the sizes are incredible.

Lex Fridman (1:56:59.560)

There's actually a, I believe it's a US Navy website

Jonathan Reisman (1:57:02.120)

that tracks the largest icebergs

Lex Fridman (1:57:03.960)

and you can read about each of them and how big they are

Lex Fridman (1:57:06.480)

and just the formations you see, similar up near Greenland,

Lex Fridman (1:57:10.080)

though I have not been to Greenland.

Jonathan Reisman (1:57:12.560)

Just ice in general is just amazing.

Lex Fridman (1:57:14.380)

So I could just look at its different forms

Jonathan Reisman (1:57:16.280)

while eating bone marrow forever, until you kill me,

Lex Fridman (1:57:18.560)

that is.

Jonathan Reisman (1:57:19.400)

Yeah, and afterwards we go.

Lex Fridman (1:57:21.560)

There's back to the death, the death and sex.

Lex Fridman (1:57:25.360)

What is it about the ice?

Lex Fridman (1:57:26.880)

Is it sort of the enormity of nature

Jonathan Reisman (1:57:29.720)

that just reminds you that it's going to be there

Lex Fridman (1:57:33.360)

before you and after?

Lex Fridman (1:57:35.120)

And then you get to partake in the eating

Lex Fridman (1:57:37.160)

of the thing you need for maintaining of your biological,

Lex Fridman (1:57:42.780)

temporary biological organism?

Lex Fridman (1:57:44.460)

Yeah, I think it's a few things.

Jonathan Reisman (1:57:47.160)

One is just the shapes that you see,

Lex Fridman (1:57:49.400)

the wave action, just eating away at these pieces of ice.

Jonathan Reisman (1:57:53.520)

You get these arches and just these shapes.

Lex Fridman (1:57:55.940)

I mean, it's just like.

Jonathan Reisman (1:57:56.780)

Geometry.

Lex Fridman (1:57:57.620)

The geometry alone is amazing.

Jonathan Reisman (1:57:59.400)

I studied math as an undergrad

Lex Fridman (1:58:01.200)

and I've always appreciated geometry

Lex Fridman (1:58:04.840)

and just the shapes alone are just look like brilliant works

Lex Fridman (1:58:07.980)

of modernist art and just obviously no two

Jonathan Reisman (1:58:10.980)

are ever the same.

Lex Fridman (1:58:12.660)

Not to mention a lot of them are this unearthly blue color

Jonathan Reisman (1:58:16.100)

that is just really startling and fascinating.

Lex Fridman (1:58:18.960)

The same color of glaciers in various parts of the world,

Jonathan Reisman (1:58:22.920)

that blue color is just really amazing.

Lex Fridman (1:58:26.260)

And I also just love how it's sort of this constant shedding

Jonathan Reisman (1:58:29.800)

from our Antarctic continent, from Greenland.

Lex Fridman (1:58:32.120)

It's this constant process of snow falling inland

Lex Fridman (1:58:34.480)

and pushing the glaciers further out to sea

Lex Fridman (1:58:37.000)

and them breaking loose.

Jonathan Reisman (1:58:38.600)

I mean, obviously it seems to be happening faster these days,

Lex Fridman (1:58:41.080)

but it's sort of this constant shedding

Lex Fridman (1:58:43.280)

and sort of, I always like thinking about

Lex Fridman (1:58:45.080)

how the body has something similar.

Jonathan Reisman (1:58:46.560)

We're constantly shedding and renewing

Lex Fridman (1:58:48.560)

and rebuilding everything.

Lex Fridman (1:58:51.400)

And so ice is sort of this constant similar process.

Lex Fridman (1:58:56.920)

Yeah, I did not know you were a math undergrad.

Lex Fridman (1:59:00.600)

So that, I mean, you just keep getting more fascinating.

Lex Fridman (1:59:05.360)

Can you maybe take a small step into that direction?

Lex Fridman (1:59:08.200)

What do you find beautiful about mathematics?

Lex Fridman (1:59:11.960)

Why did you journey into that part of the world for a time?

Jonathan Reisman (1:59:15.520)

I liked math.

Lex Fridman (1:59:16.680)

I especially liked, so college math,

Jonathan Reisman (1:59:18.560)

I did some calculus in high school.

Lex Fridman (1:59:20.680)

When I got to college math,

Jonathan Reisman (1:59:22.000)

I was amazed that there were no more numbers.

Lex Fridman (1:59:25.200)

The digits disappeared.

Jonathan Reisman (1:59:26.660)

It was just variables, concepts.

Lex Fridman (1:59:30.480)

There was almost no more numbers at all.

Jonathan Reisman (1:59:32.300)

It was like this totally abstract kind of way of thinking.

Lex Fridman (1:59:37.300)

But that sort of reflects the natural world

Lex Fridman (1:59:39.160)

and teaches you about the natural world,

Lex Fridman (1:59:40.840)

though it's sort of this perfect platonic ideal,

Jonathan Reisman (1:59:44.160)

perhaps, of the natural world

Lex Fridman (1:59:45.600)

that can still sort of help explain

Lex Fridman (1:59:47.840)

what happens in the natural world.

Lex Fridman (1:59:49.280)

But just these concepts are so abstract from life

Lex Fridman (1:59:53.800)

and from the natural world.

Lex Fridman (1:59:56.280)

I was actually getting interested in the natural world

Jonathan Reisman (1:59:58.360)

at the same time when I was at NYU studying math.

Lex Fridman (20:01.660)

Is there ways to get more data about the human body

Jonathan Reisman (20:05.540)

as we look into the future of medicine biology

Lex Fridman (20:08.760)

that will be helpful to fill in some of the gaps

Lex Fridman (20:11.260)

of the story?

Lex Fridman (20:12.680)

So, you know, you have companies,

Jonathan Reisman (20:17.120)

you have research that looks at, you know,

Lex Fridman (20:20.580)

collection of blood over long periods of time

Jonathan Reisman (20:23.540)

to see sort of, you know, paint the picture

Lex Fridman (20:26.780)

of what's happening in your body,

Jonathan Reisman (20:28.120)

mostly to help with lifestyle decisions,

Lex Fridman (20:29.980)

but also just, you know, to anticipate things

Jonathan Reisman (20:33.500)

that can go wrong and all that kind of stuff.

Lex Fridman (20:35.420)

Is there, can you just speak to a greater digital world

Jonathan Reisman (20:40.020)

that we're stepping in,

Lex Fridman (20:40.860)

how that can help tell a richer story?

Jonathan Reisman (20:45.140)

I certainly think that we have more data

Lex Fridman (20:48.740)

than we know what to do with right now,

Jonathan Reisman (20:50.380)

especially with kind of direct to consumer medical devices,

Lex Fridman (20:54.300)

you know, smartwatches, et cetera,

Jonathan Reisman (20:55.900)

that are just collecting these reams of data.

Lex Fridman (20:58.780)

I have not seen them put to,

Jonathan Reisman (21:01.220)

I think the eventual use that they will.

Lex Fridman (21:04.220)

I think that the potential is sort of just, you know,

Jonathan Reisman (21:08.420)

unimaginable and I hope we're heading into a new age

Lex Fridman (21:11.700)

where, you know, you can determine, for instance,

Jonathan Reisman (21:14.420)

is a person gonna have more of the dangerous side effects

Lex Fridman (21:17.120)

to a drug based on their genetics

Jonathan Reisman (21:19.140)

or are they gonna tolerate one drug better than the other,

Lex Fridman (21:22.800)

you know, based on their genetics?

Lex Fridman (21:24.620)

And we are slowly moving into that age

Lex Fridman (21:27.760)

and especially the age of kind of

Jonathan Reisman (21:29.500)

completely synthesizing drugs in the lab,

Lex Fridman (21:34.080)

you know, much like, for instance,

Jonathan Reisman (21:36.260)

some of the COVID vaccines actually,

Lex Fridman (21:38.020)

like Moderna never had the virus in their lab.

Jonathan Reisman (21:41.140)

They made that vaccine completely

Lex Fridman (21:42.580)

without ever having the virus themselves

Jonathan Reisman (21:44.180)

just by having the genome, which is sort of astounding.

Lex Fridman (21:46.580)

And there's a lot of potential going forward, you know,

Jonathan Reisman (21:49.260)

based on that technology and some others.

Lex Fridman (21:51.180)

Well, I didn't know that.

Lex Fridman (21:52.020)

So they basically, it's all in the computer,

Lex Fridman (21:53.980)

it's computational.

Jonathan Reisman (21:54.980)

Right, you have the genetic code,

Lex Fridman (21:56.300)

you have tremendous power,

Jonathan Reisman (21:57.580)

even if you don't have the organism itself.

Lex Fridman (21:59.900)

What do you make of Elizabeth Holmes and efforts like that?

Jonathan Reisman (22:04.660)

First of all, I'm a curious,

Lex Fridman (22:11.840)

I'm drawn to the darkness in human nature

Jonathan Reisman (22:16.300)

because that somehow reveals

Lex Fridman (22:20.420)

the full spectrum of what humans could be.

Lex Fridman (22:23.180)

So there's a lot of sort of controversial thoughts

Lex Fridman (22:25.540)

about who she is and her efforts and so on.

Jonathan Reisman (22:28.620)

I think you may have even tweeted about it,

Lex Fridman (22:30.980)

but I've read a lot of your tweets, so I'm now forgetting.

Lex Fridman (22:33.980)

But what do you make of her and both those efforts

Lex Fridman (22:37.480)

and the charlatans that sort of snake oil salesmen

Jonathan Reisman (22:42.480)

that promise those efforts to do more

Lex Fridman (22:49.180)

than they currently can?

Jonathan Reisman (22:51.300)

I think that her, you know, that goal that she had

Lex Fridman (22:55.020)

that she created Theranos to try to achieve,

Jonathan Reisman (22:58.000)

to use less blood in tests is a very worthy goal

Lex Fridman (23:01.500)

and a huge frontier that we have not achieved

Lex Fridman (23:04.780)

and that I hope we will achieve.

Lex Fridman (23:06.240)

So I understand why, you know,

Jonathan Reisman (23:09.160)

someone describes what a huge step forward that would be

Lex Fridman (23:12.200)

and it would be indeed.

Jonathan Reisman (23:13.180)

I understand why people put a ton of money behind it.

Lex Fridman (23:15.660)

Can you describe what was the promise?

Lex Fridman (23:17.860)

What are we even talking about with Theranos,

Lex Fridman (23:20.540)

just for people who don't know?

Lex Fridman (23:22.340)

So Theranos is a company that was basically started

Lex Fridman (23:25.580)

to revolutionize the way medical blood tests are done,

Jonathan Reisman (23:29.700)

both to use a whole lot less blood in doing it.

Lex Fridman (23:33.020)

You know, if anyone's ever been to the doctor

Lex Fridman (23:34.820)

and had five to 10 tubes of blood removed from them,

Lex Fridman (23:37.600)

it can be quite surprising how much they take out.

Lex Fridman (23:41.460)

And it's, you know, that's the limitation of our technology

Lex Fridman (23:45.080)

that we need those volumes of blood

Jonathan Reisman (23:46.460)

to run all the tests that we want to.

Lex Fridman (23:47.860)

And so the promise of Theranos was that perhaps

Jonathan Reisman (23:50.560)

with a single drop of blood, we would be able to know

Lex Fridman (23:53.140)

as much about the person's, the condition of their body

Jonathan Reisman (23:57.380)

without drawing all that blood and thereby, you know,

Lex Fridman (24:00.060)

there would be these devices she was gonna create

Jonathan Reisman (24:02.500)

that would sort of do it.

Lex Fridman (24:03.800)

You put a drop of blood in and it spits out everything

Jonathan Reisman (24:05.700)

you ever wanted to know about what's in your bloodstream.

Lex Fridman (24:07.560)

And in a way that would make it so much easier,

Jonathan Reisman (24:09.940)

you know, it could be, you could have one in your home

Lex Fridman (24:11.860)

theoretically, and you, I don't know why you'd wonder

Lex Fridman (24:14.300)

what your potassium level is on any given day,

Lex Fridman (24:16.240)

but you could check if you wanted to.

Lex Fridman (24:19.020)

And so that goal is very worthy.

Lex Fridman (24:21.340)

You know, I put that goal up there with the frontier

Jonathan Reisman (24:25.500)

of making painkillers that are as good as opioids

Lex Fridman (24:27.620)

without the addictive quality.

Jonathan Reisman (24:28.920)

You know, that would be such a huge revolution

Lex Fridman (24:30.700)

if we did have that in medicine.

Jonathan Reisman (24:32.140)

But, and particularly for me,

Lex Fridman (24:34.460)

cause I trained in both pediatrics and internal medicine.

Lex Fridman (24:37.460)

So I learned to care for both children and adults.

Lex Fridman (24:40.300)

In children, we do draw much less blood.

Jonathan Reisman (24:42.180)

They have a much lower blood volume.

Lex Fridman (24:43.900)

And we use these tiny little tubes to draw their blood.

Lex Fridman (24:47.400)

And we seemingly get equivalent information

Lex Fridman (24:50.040)

out of the larger tubes we draw from adults.

Lex Fridman (24:52.220)

And I'm still unclear to be honest,

Lex Fridman (24:53.660)

why we can't draw that little amount of blood from adults.

Jonathan Reisman (24:56.340)

It seems technically possible.

Lex Fridman (24:58.260)

I don't know what the barriers are.

Jonathan Reisman (24:59.440)

I'm sure there are, or else we'd be doing it.

Lex Fridman (25:02.260)

But I do think that that is a very important goal.

Lex Fridman (25:04.860)

And if Theranos had done it,

Lex Fridman (25:06.100)

it would have really revolutionized the practice of medicine.

Lex Fridman (25:09.000)

So to return to that cadaver,

Lex Fridman (25:13.900)

that first day when you got to meet with the dead,

Jonathan Reisman (25:18.300)

with a human body that's no longer living.

Lex Fridman (25:21.100)

So how quickly did it take for you to get used to sort of,

Lex Fridman (25:27.900)

you said, looking at the surface muscles of the back?

Lex Fridman (25:31.000)

I mean, that can be overwhelming as a thought.

Lex Fridman (25:34.980)

And people listening to this that have never dissected

Lex Fridman (25:37.460)

anything might be overwhelmed by that thought.

Lex Fridman (25:40.180)

So like, how quickly were you able to get used

Lex Fridman (25:43.620)

to the brutal honesty of the biology before you?

Jonathan Reisman (25:48.500)

For me, it did not take long at all.

Lex Fridman (25:50.260)

I guess I've never been a squeamish person.

Lex Fridman (25:53.060)

So for me, it was kind of riveting and fascinating

Lex Fridman (25:55.820)

right from the first moment.

Lex Fridman (25:56.960)

But I do know some of my fellow classmates

Lex Fridman (26:00.240)

did have some trouble with it.

Jonathan Reisman (26:01.780)

Some of them I heard had nightmares in the first few weeks

Lex Fridman (26:05.740)

of anatomy lab.

Lex Fridman (26:08.060)

But then everyone, as far as I know, got used to it.

Lex Fridman (26:10.620)

And that was also actually a big lesson for me

Jonathan Reisman (26:13.500)

that it's pretty amazing what people can get used to

Lex Fridman (26:15.860)

in their daily lives.

Lex Fridman (26:16.700)

And I kind of extrapolated that to people living through war

Lex Fridman (26:20.180)

and through just terrible situations

Lex Fridman (26:23.220)

and living under oppressive regimes.

Lex Fridman (26:26.860)

And it really is amazing what people can get used to,

Jonathan Reisman (26:30.060)

almost anything.

Lex Fridman (26:31.500)

Well, you know, in war, people often come back

Lex Fridman (26:35.740)

and they have nightmares.

Lex Fridman (26:37.300)

They suffer through it.

Jonathan Reisman (26:38.220)

There's PTSD.

Lex Fridman (26:39.140)

There's a lot of complicated feelings with that.

Jonathan Reisman (26:43.880)

Are echoes of those same complicated feelings possible

Lex Fridman (26:47.760)

in the case of training to be and becoming a doctor?

Jonathan Reisman (26:51.960)

That's a good point.

Lex Fridman (26:52.800)

Yeah, I think sometimes, just as a barbed wire fence

Jonathan Reisman (26:56.340)

can leave a scar on your skin,

Lex Fridman (26:58.580)

emotional, psychological experiences

Jonathan Reisman (27:01.040)

can leave a mark on your brain or your memory.

Lex Fridman (27:03.860)

And I think that that definitely could be a problem

Jonathan Reisman (27:09.740)

in medical training.

Lex Fridman (27:10.760)

You do see a lot of things that are very shocking,

Jonathan Reisman (27:14.180)

very repulsive, things that you'd never forget.

Lex Fridman (27:17.000)

I know one of those students that had nightmares initially

Jonathan Reisman (27:20.020)

went on to be a surgeon.

Lex Fridman (27:21.460)

So I imagine she's not having the PTSD

Jonathan Reisman (27:23.820)

of kind of seeing inside her first dead body

Lex Fridman (27:25.980)

because she sees inside them all day, every day now.

Lex Fridman (27:28.580)

But I'm sure it could.

Lex Fridman (27:30.180)

You know, we go on to see so many kind of grosser

Jonathan Reisman (27:34.380)

or more shocking things in medical training

Lex Fridman (27:37.160)

through medical school and then by working

Jonathan Reisman (27:38.620)

with actual living patients,

Lex Fridman (27:40.460)

not just dead and embalmed bodies.

Lex Fridman (27:43.540)

So I do think that things can leave a mark,

Lex Fridman (27:46.640)

but I don't think that initial cadaver

Jonathan Reisman (27:48.980)

would be the most traumatic.

Lex Fridman (27:51.880)

Yeah, but maybe some of that trauma,

Jonathan Reisman (27:54.580)

the demons make you a better surgeon,

Lex Fridman (27:56.980)

just like some of your own psychological trauma

Jonathan Reisman (28:00.540)

might make you a better psychiatrist.

Lex Fridman (28:03.100)

Returning to the ordering, is it order or is it chaos

Jonathan Reisman (28:07.960)

to the ordering of the chapters from throat and heart

Lex Fridman (28:12.480)

and feces and genitals all the way

Lex Fridman (28:14.340)

to fingers and toes and blood?

Lex Fridman (28:16.740)

So I did mention that, you know,

Jonathan Reisman (28:18.500)

throat was the first one because I kind of wanted

Lex Fridman (28:20.340)

to throw the reader right into the brutal honesty of death.

Lex Fridman (28:24.540)

And I followed it up with feces as the third chapter

Lex Fridman (28:27.220)

and in a way, partly to also throw them right

Jonathan Reisman (28:30.220)

into the deep end of how I like discussing parts

Lex Fridman (28:33.980)

of the body and revealing their gross

Lex Fridman (28:36.340)

and fascinating aspects.

Lex Fridman (28:37.860)

So I didn't want to hide anything.

Jonathan Reisman (28:39.620)

You know, when you train to be a doctor,

Lex Fridman (28:41.220)

everything is on the table, literally in the cadaver lab,

Lex Fridman (28:44.500)

but also just, you know, you deal with blood

Lex Fridman (28:46.860)

and piss and vomit and feces.

Lex Fridman (28:48.780)

And that's kind of the medium of your craft.

Lex Fridman (28:51.240)

And yes, the medium of the craft, that's right.

Jonathan Reisman (28:55.300)

Like if you're a painter, this is the paint.

Lex Fridman (29:00.180)

Exactly.

Lex Fridman (29:01.020)

And then you have to create a masterpiece with it.

Lex Fridman (29:04.500)

Like almost like a dance because there's multiple painters.

Jonathan Reisman (29:06.860)

One of the painters is the biology.

Lex Fridman (29:08.860)

So let's return to throat.

Jonathan Reisman (29:10.360)

You mentioned it's a weird one.

Lex Fridman (29:12.020)

So first of all, a friend of mine said,

Jonathan Reisman (29:14.740)

I just see humans as like a bunch of holes

Lex Fridman (29:19.620)

that just walk around.

Jonathan Reisman (29:24.060)

Not untrue.

Lex Fridman (29:25.820)

It's a funny way to look at humans.

Lex Fridman (29:27.440)

So we have ears, we have nose, we have mouth,

Lex Fridman (29:31.700)

we have the sexual holes, vagina, penis.

Lex Fridman (29:36.980)

And then, you know, what's the medical term

Lex Fridman (29:40.540)

for your asshole?

Jonathan Reisman (29:42.700)

Anus.

Lex Fridman (29:43.540)

Anus, thank you.

Jonathan Reisman (29:45.500)

This is a very technical discussion.

Lex Fridman (29:47.220)

The rectum's further in, don't confuse the two.

Jonathan Reisman (29:49.740)

Oh, that's very important.

Lex Fridman (29:51.620)

Is there a difference between throat and mouth?

Jonathan Reisman (29:54.020)

By the way, so when you say throat,

Lex Fridman (29:56.100)

are we talking about when that hole actually becomes tubular?

Jonathan Reisman (2:00:02.560)

I took a tour of Central Park that was pointing,

Lex Fridman (2:00:05.320)

the guy, Steve Brill, was pointing out

Jonathan Reisman (2:00:07.440)

these wild edible plants.

Lex Fridman (2:00:09.120)

And I was learning to identify the first plants

Lex Fridman (2:00:11.360)

and knowing what's edible, what's not.

Lex Fridman (2:00:13.280)

That was totally fascinating.

Lex Fridman (2:00:15.160)

And sort of this kind of thing

Lex Fridman (2:00:16.800)

that I felt like was connecting me to nature.

Lex Fridman (2:00:18.640)

And it was balanced with this utterly abstract science,

Lex Fridman (2:00:23.160)

or utterly abstract lessons I was getting in math class

Jonathan Reisman (2:00:26.600)

where I was thinking through series.

Lex Fridman (2:00:28.520)

As we approach infinity, what happens to these equations?

Lex Fridman (2:00:31.080)

And concepts of like rings and abstract algebra,

Lex Fridman (2:00:34.560)

I don't know, it was just this dichotomy

Jonathan Reisman (2:00:37.120)

that I enjoyed both aspects of.

Lex Fridman (2:00:40.080)

Yeah, the concepts.

Lex Fridman (2:00:41.860)

But so different, this kind of logical,

Lex Fridman (2:00:48.520)

rigorous view of the world and the world of biology.

Lex Fridman (2:00:52.040)

Why the big, how did that feel to take the leap

Lex Fridman (2:00:55.640)

into the biological, the mushy mess of the human body

Lex Fridman (2:01:00.640)

from the mathematical, which is all very clean?

Lex Fridman (2:01:04.760)

Right, it does feel like a big step.

Jonathan Reisman (2:01:07.320)

I think there's more connection than you think.

Lex Fridman (2:01:09.760)

We talked about symmetry of the body earlier.

Jonathan Reisman (2:01:12.520)

That is a real thing.

Lex Fridman (2:01:13.880)

Fluid dynamics of how our various bodily fluids flow

Lex Fridman (2:01:18.180)

and what makes them not flow as well

Lex Fridman (2:01:20.100)

and what makes them flow better.

Jonathan Reisman (2:01:21.600)

All these different aspects of science go into the body.

Lex Fridman (2:01:26.060)

Everything from hard bone to softer kind of flesh

Jonathan Reisman (2:01:31.980)

to liquids of various consistencies.

Lex Fridman (2:01:36.220)

A lot of science and math does teach you

Jonathan Reisman (2:01:38.980)

about kind of how the body works, how it can work better,

Lex Fridman (2:01:41.500)

what happens in sort of disease states.

Jonathan Reisman (2:01:45.660)

Yeah, I suppose there's a connection.

Lex Fridman (2:01:49.100)

There's also kind of a sort of computational biology

Jonathan Reisman (2:01:54.100)

of this computational equivalence of each of the disciplines

Lex Fridman (2:01:58.540)

which are becoming more and more fascinating

Jonathan Reisman (2:02:00.740)

with all the work that DeepMind is doing

Lex Fridman (2:02:02.780)

and the work of genetics, all that kind of stuff,

Jonathan Reisman (2:02:04.860)

simulating different parts of the body

Lex Fridman (2:02:06.940)

to try to gain an intuition understanding of it.

Jonathan Reisman (2:02:09.840)

That to me is super fascinating,

Lex Fridman (2:02:12.740)

but sometimes it does feel like an oversimplification

Jonathan Reisman (2:02:15.260)

of the way the body really does it

Lex Fridman (2:02:16.620)

because the body is an incredibly weird complex system

Lex Fridman (2:02:21.620)

and it finds a way.

Lex Fridman (2:02:25.020)

The adaptability, the resilience,

Jonathan Reisman (2:02:27.320)

the redundancy that's built in, it's weird.

Lex Fridman (2:02:31.140)

It's incredibly powerful and so unlike

Jonathan Reisman (2:02:34.760)

the kind of computer based systems that we build,

Lex Fridman (2:02:38.500)

at least we engineer in the software engineering world,

Jonathan Reisman (2:02:41.220)

which kind of starts to make you think

Lex Fridman (2:02:43.820)

how can we engineer computer systems in a different way

Lex Fridman (2:02:47.840)

that make them more resilient in the real world?

Lex Fridman (2:02:50.540)

That's sort of the robotics question.

Lex Fridman (2:02:53.900)

What do you think about that?

Lex Fridman (2:02:55.400)

What does it take to build a humanoid robot

Lex Fridman (2:02:59.100)

or robots that are as resilient as the human body?

Lex Fridman (2:03:02.420)

How difficult do you think is that problem?

Jonathan Reisman (2:03:04.100)

Having studied the human body,

Lex Fridman (2:03:06.540)

how hard is the engineering problem of building systems

Jonathan Reisman (2:03:10.620)

like that guy over there, the legged guy

Lex Fridman (2:03:13.000)

that is as resilient as the human body

Lex Fridman (2:03:15.640)

to the harsh conditions of the real world?

Lex Fridman (2:03:18.460)

I think it's very hard

Lex Fridman (2:03:20.860)

and we definitely haven't gotten there yet.

Lex Fridman (2:03:22.340)

I think we could probably learn lessons

Jonathan Reisman (2:03:23.860)

from people who are trying to grow artificial organs

Lex Fridman (2:03:26.460)

in the lab to eventually transplant into people,

Jonathan Reisman (2:03:29.700)

which would solve a huge problem

Lex Fridman (2:03:31.300)

of needing to get those organs from others

Lex Fridman (2:03:33.360)

and the rejection of putting a foreign material

Lex Fridman (2:03:35.900)

inside your body.

Jonathan Reisman (2:03:37.180)

Your immune system tends not to like that.

Lex Fridman (2:03:39.340)

That has advanced a lot recently.

Jonathan Reisman (2:03:42.700)

I think some advances actually have been

Lex Fridman (2:03:46.740)

where we pay a lot of attention to stem cells,

Jonathan Reisman (2:03:48.980)

stem cells, stem cells.

Lex Fridman (2:03:49.940)

We can grow whatever we want out of stem cells,

Lex Fridman (2:03:51.820)

but now there's sort of a recognition

Lex Fridman (2:03:54.220)

that what we call the extracellular matrix,

Jonathan Reisman (2:03:57.140)

which is sort of the foundation of the body,

Lex Fridman (2:04:00.200)

the thing that holds all the cells into their proper shape

Lex Fridman (2:04:02.900)

and keeps them where they should be,

Lex Fridman (2:04:05.940)

that is actually crucial.

Lex Fridman (2:04:07.100)

And there's probably a lot of signaling that goes on.

Lex Fridman (2:04:09.220)

Like you stick a stem cell

Jonathan Reisman (2:04:11.140)

on the right extracellular matrix,

Lex Fridman (2:04:12.760)

it will turn into the kind of cell that you want

Lex Fridman (2:04:14.860)

and take the right shape and position

Lex Fridman (2:04:16.400)

and start functioning.

Jonathan Reisman (2:04:17.940)

I think that's been a huge, huge advance

Lex Fridman (2:04:21.260)

knowing that it's not just these celebrity stem cells

Jonathan Reisman (2:04:24.640)

that are the answer.

Lex Fridman (2:04:25.480)

It's this kind of part in the background,

Jonathan Reisman (2:04:27.900)

this sort of just like laying the foundation,

Lex Fridman (2:04:29.700)

the system that you put these cells onto.

Lex Fridman (2:04:32.180)

And we're not there yet,

Lex Fridman (2:04:33.280)

but there's definitely a lot happening,

Jonathan Reisman (2:04:35.500)

a lot of research happening.

Lex Fridman (2:04:36.620)

And I think there'll be some advances probably soon.

Lex Fridman (2:04:39.660)

So now on the topic of interaction

Lex Fridman (2:04:42.700)

of computational systems with biology.

Lex Fridman (2:04:47.500)

So if you look at a company like Neuralink

Lex Fridman (2:04:49.620)

or the whole effort of brain computer interfaces,

Jonathan Reisman (2:04:53.180)

now there's a neurosurgery component there.

Lex Fridman (2:04:56.660)

We have to connect electrical systems

Jonathan Reisman (2:05:02.020)

with biological systems.

Lex Fridman (2:05:04.460)

So just even the implanting is difficult.

Jonathan Reisman (2:05:09.100)

Then the communication is difficult.

Lex Fridman (2:05:11.060)

But what would you say from what you know about the brain,

Lex Fridman (2:05:13.660)

what you know about the human body

Lex Fridman (2:05:15.300)

and all the beautiful mess that's there,

Lex Fridman (2:05:18.300)

how difficult is the effort of Neuralink?

Lex Fridman (2:05:20.580)

Do you think it's feasible?

Jonathan Reisman (2:05:22.380)

I think it's definitely feasible.

Lex Fridman (2:05:24.860)

I think we need to probably know more than we do

Lex Fridman (2:05:27.980)

and know how to connect it in all these ways.

Lex Fridman (2:05:31.500)

I think some advances, for instance,

Jonathan Reisman (2:05:34.940)

much less sexy, but really already impacting medical care

Lex Fridman (2:05:38.100)

is something called deep brain stimulation,

Jonathan Reisman (2:05:40.300)

which is done for Parkinson's disease and others

Lex Fridman (2:05:42.260)

where neurosurgeons implant this device

Jonathan Reisman (2:05:45.820)

that's electrically stimulates the part of the brain

Lex Fridman (2:05:48.980)

that is not functioning in Parkinson's disease.

Lex Fridman (2:05:51.620)

And it's quite dramatic how effective it works.

Lex Fridman (2:05:53.740)

And I remember as a med student,

Jonathan Reisman (2:05:55.220)

watching a neurologist literally like turn the electricity

Lex Fridman (2:05:58.940)

up on this handheld thing,

Lex Fridman (2:06:00.360)

and you could see the person's Parkinson tremor go away

Lex Fridman (2:06:03.060)

and you could see them start to walk

Jonathan Reisman (2:06:04.660)

in a more steady fashion.

Lex Fridman (2:06:06.640)

And I know there's studies, there's actually studies

Jonathan Reisman (2:06:09.380)

or there may be studies in the future

Lex Fridman (2:06:11.980)

studying the same deep brain stimulation

Jonathan Reisman (2:06:14.140)

for everything from eating disorders to severe,

Lex Fridman (2:06:18.420)

like severe OCD, like paralyzing OCD,

Jonathan Reisman (2:06:21.080)

not just like I wanna wash my hands three times,

Lex Fridman (2:06:23.260)

but and so I think the potential is there,

Lex Fridman (2:06:29.100)

but I guess connecting the brain in a microscopic way

Lex Fridman (2:06:33.500)

in sort of a multifaceted way,

Jonathan Reisman (2:06:35.500)

there needs to be sort of a million connections

Lex Fridman (2:06:37.300)

or some very high number of connections

Jonathan Reisman (2:06:39.460)

for them to work fluidly.

Lex Fridman (2:06:40.500)

As far as I know, I'm not an expert in the area.

Jonathan Reisman (2:06:43.300)

First of all, I believe and I trust

Lex Fridman (2:06:45.640)

in the adaptability of the biological system

Jonathan Reisman (2:06:47.820)

to whatever crazy stuff you try to shove in there.

Lex Fridman (2:06:50.900)

So it's going to potentially reject things,

Lex Fridman (2:06:54.020)

but it's also going to, if it doesn't reject things, adapt.

Lex Fridman (2:06:57.740)

And if we can create computational systems that also adapt,

Jonathan Reisman (2:07:01.860)

AI systems that adapt and can kinda,

Lex Fridman (2:07:05.140)

both of them reach towards each other

Lex Fridman (2:07:07.260)

and figure stuff out.

Lex Fridman (2:07:08.820)

But actually our current AI systems are not very adaptable

Jonathan Reisman (2:07:13.260)

to the what, like in the wild way

Lex Fridman (2:07:15.980)

that biology is adaptable, like adaptable to anything.

Lex Fridman (2:07:19.540)

And if we can build AI systems like that,

Lex Fridman (2:07:21.820)

I feel like there's some interesting things you could do,

Lex Fridman (2:07:24.040)

but of course there's ethics

Lex Fridman (2:07:25.820)

and there's real human lives at stake.

Lex Fridman (2:07:29.900)

And there you can't quite experiment.

Lex Fridman (2:07:32.860)

You have to have things that work

Lex Fridman (2:07:35.060)

and maybe simulation can help, but reality is,

Lex Fridman (2:07:40.260)

it's a dangerous playground to play on.

Jonathan Reisman (2:07:44.220)

It is messy.

Lex Fridman (2:07:45.560)

You tweeted that quote,

Jonathan Reisman (2:07:46.880)

"'If you look back from far enough into the future,

Lex Fridman (2:07:49.720)

"'every doctor today will look like a total quack.'"

Jonathan Reisman (2:07:56.660)

First of all, that's humbling to think about.

Lex Fridman (2:08:00.100)

Like we don't know what we're doing in the great,

Jonathan Reisman (2:08:03.500)

like there's been so much progress

Lex Fridman (2:08:05.840)

that we kinda have this confidence

Jonathan Reisman (2:08:07.660)

that we figured it all out.

Lex Fridman (2:08:09.500)

If you look at history and you read how people thought,

Jonathan Reisman (2:08:13.100)

I mean, there's so many moments in history

Lex Fridman (2:08:14.740)

where people really thought that they figured it all out.

Jonathan Reisman (2:08:18.260)

It's almost like there's nothing else left to do

Lex Fridman (2:08:21.640)

at every stage in history.

Lex Fridman (2:08:23.760)

And then you realize no,

Lex Fridman (2:08:25.820)

progress often happens like exponentially.

Lex Fridman (2:08:30.120)

And every moment you continue to think

Lex Fridman (2:08:32.140)

you figured it all out.

Lex Fridman (2:08:33.540)

But if you're being honest, if you're being humble,

Lex Fridman (2:08:37.540)

then you realize we're just shrouded in mystery.

Lex Fridman (2:08:39.500)

So what do we make of this?

Lex Fridman (2:08:41.620)

Like how should we feel that?

Lex Fridman (2:08:42.860)

How should you feel as a doctor?

Lex Fridman (2:08:44.980)

How should we feel as scientific explorers

Lex Fridman (2:08:49.020)

of the human body?

Lex Fridman (2:08:50.100)

The fact that we're probably going to be wrong

Jonathan Reisman (2:08:52.020)

about everything we currently know.

Lex Fridman (2:08:54.740)

Right, there's a saying actually,

Jonathan Reisman (2:08:56.740)

by the time you finish med school,

Lex Fridman (2:08:58.100)

half of what you learned is wrong,

Jonathan Reisman (2:09:00.620)

which is quite illustrative.

Lex Fridman (2:09:02.460)

And becoming more true as time goes on,

Lex Fridman (2:09:05.780)

so much medical research going on,

Lex Fridman (2:09:07.360)

so much learning going on, it's really wonderful in a way.

Lex Fridman (2:09:10.780)

But in some ways we still learn these concepts

Lex Fridman (2:09:13.720)

from the past.

Lex Fridman (2:09:14.560)

And I know when you take a test as a medical student,

Lex Fridman (2:09:17.640)

sometimes you know they want you to give the old answer,

Lex Fridman (2:09:22.100)

but you know there's a new answer

Lex Fridman (2:09:23.380)

because of recent science,

Lex Fridman (2:09:24.460)

but you know to give the old answer,

Lex Fridman (2:09:26.020)

that's now incorrect to get the question right on the test.

Jonathan Reisman (2:09:28.500)

That happens actually quite a bit

Lex Fridman (2:09:30.260)

because things change so quickly.

Jonathan Reisman (2:09:33.340)

Yet, you know, when I look back at doctors

Lex Fridman (2:09:35.580)

from centuries past, I mean, it's absurd

Lex Fridman (2:09:38.020)

what they were doing to their patients.

Lex Fridman (2:09:39.580)

I mean, for probably for most of human history,

Jonathan Reisman (2:09:41.420)

they were doing more harm than good.

Lex Fridman (2:09:43.300)

You know, they're draining people of their blood.

Jonathan Reisman (2:09:46.340)

That was, you know, bloodletting was a huge part

Lex Fridman (2:09:48.380)

of medical care.

Jonathan Reisman (2:09:51.040)

You know, George Washington died of a paratonsular abscess,

Lex Fridman (2:09:55.300)

an abscess right next to the tonsil,

Jonathan Reisman (2:09:57.220)

which has the great name of Quincy,

Lex Fridman (2:09:59.220)

and they bled him to death.

Jonathan Reisman (2:10:00.300)

You know, I mean, kind of adding insult to injury.

Lex Fridman (2:10:02.820)

Doctors are a menace and do a lot of harm.

Jonathan Reisman (2:10:05.740)

I mean, hopefully not intentionally.

Lex Fridman (2:10:07.580)

You know, even medical errors are still a huge problem,

Jonathan Reisman (2:10:10.740)

cause of death and morbidity.

Lex Fridman (2:10:13.660)

So we do a lot of things that are not great,

Lex Fridman (2:10:16.460)

but you know, our knowledge, yeah,

Lex Fridman (2:10:18.100)

it's very imperfect at this point.

Jonathan Reisman (2:10:19.700)

I do have some confidence.

Lex Fridman (2:10:21.520)

You know, I guess perfect scientific studies

Jonathan Reisman (2:10:24.980)

that try to get at the reality of the universe are essential

Lex Fridman (2:10:29.000)

because when I think of why a certain medication works

Jonathan Reisman (2:10:33.380)

for a certain condition,

Lex Fridman (2:10:34.380)

it might make perfect sense in my head,

Jonathan Reisman (2:10:36.140)

knowing the biology, the biochemistry, the anatomy,

Lex Fridman (2:10:38.980)

it makes perfect sense, it must work.

Jonathan Reisman (2:10:40.820)

I gave it to the patient, they got better,

Lex Fridman (2:10:42.340)

and that's happened 20 times in the last year,

Lex Fridman (2:10:44.920)

but it's, you know, I'm wrong.

Lex Fridman (2:10:46.700)

Like when you actually do a study,

Jonathan Reisman (2:10:48.360)

it actually doesn't help, maybe it hurts.

Lex Fridman (2:10:51.180)

And that's really, I think the way we explain medications

Jonathan Reisman (2:10:55.340)

working in our minds is often wrong

Lex Fridman (2:10:57.980)

when you end up finally doing the study.

Lex Fridman (2:11:01.100)

And some of the most interesting experiments

Lex Fridman (2:11:03.780)

involve what we call sham surgery.

Lex Fridman (2:11:06.020)

So for instance, people who injure their knee,

Lex Fridman (2:11:08.380)

you know, arthroscopy where an orthopedic surgeon

Jonathan Reisman (2:11:10.740)

goes in there with a scope, gets bits of bone out,

Lex Fridman (2:11:13.820)

shaves down the cartilage, you know, cleans things up,

Lex Fridman (2:11:17.060)

and it helps some people,

Lex Fridman (2:11:18.140)

but they actually did some studies where one group of people

Jonathan Reisman (2:11:21.560)

got the true arthroscopy and others just got sham surgery

Lex Fridman (2:11:24.620)

where they put them to sleep,

Jonathan Reisman (2:11:26.100)

made little cuts in the skin so they woke up with scars.

Lex Fridman (2:11:29.340)

And then it turned out that it's not clear

Jonathan Reisman (2:11:31.700)

arthroscopy is actually helping.

Lex Fridman (2:11:33.580)

And the same, there was a recent huge study

Jonathan Reisman (2:11:37.260)

of putting a stent in someone's coronary arteries

Lex Fridman (2:11:40.540)

if they have stable chest pain,

Jonathan Reisman (2:11:41.900)

not like I'm having a heart attack,

Lex Fridman (2:11:43.260)

you need a stent like right then,

Jonathan Reisman (2:11:44.940)

but, you know, kind of chronic coronary artery disease

Lex Fridman (2:11:48.040)

where every time I run up the stairs, I get chest pain,

Lex Fridman (2:11:50.100)

and then when I rest, it goes away.

Lex Fridman (2:11:52.580)

Like obviously you put a stent,

Jonathan Reisman (2:11:54.620)

you increase blood flow to the heart,

Lex Fridman (2:11:56.240)

like how could that not work?

Lex Fridman (2:11:57.520)

But then when they did the sham catheterization,

Lex Fridman (2:12:00.340)

it actually looks like it might not actually help

Jonathan Reisman (2:12:02.980)

better than the sham.

Lex Fridman (2:12:04.720)

So I think those placebo controlled studies are essential.

Jonathan Reisman (2:12:07.300)

I mean, it is shocking,

Lex Fridman (2:12:09.140)

and this has been driven home during the last two years,

Lex Fridman (2:12:12.080)

how hard it is to figure out

Lex Fridman (2:12:13.540)

what the hell's going on in the universe,

Jonathan Reisman (2:12:15.180)

especially with our bodies.

Lex Fridman (2:12:16.700)

Like it is really hard to get at the truth

Lex Fridman (2:12:18.860)

and what you think makes sense, like often turns out,

Lex Fridman (2:12:21.680)

I mean, the history of modern medicine

Jonathan Reisman (2:12:23.260)

is littered with examples where it made perfect sense

Lex Fridman (2:12:26.220)

and it seemed to help some patients,

Lex Fridman (2:12:27.740)

and it turns out it's not doing anything or it's harmful.

Lex Fridman (2:12:31.300)

Yeah, there's all kinds of narratives swimming around.

Jonathan Reisman (2:12:33.340)

We convince ourselves as a human civilization

Lex Fridman (2:12:36.300)

that something is true.

Jonathan Reisman (2:12:37.740)

There's a propaganda machines, there's just self delusion.

Lex Fridman (2:12:41.500)

There's a centralized communities,

Jonathan Reisman (2:12:45.380)

like there's a scientific community

Lex Fridman (2:12:47.040)

that believes a certain thing.

Jonathan Reisman (2:12:48.060)

There's the conspiracy theories

Lex Fridman (2:12:49.280)

that believe a certain thing.

Lex Fridman (2:12:51.320)

Sometimes the scientific community, right?

Lex Fridman (2:12:52.940)

Sometimes the conspiracy theorists are right

Jonathan Reisman (2:12:56.300)

throughout human history, I mean.

Lex Fridman (2:12:57.580)

And we now think the scientific community,

Jonathan Reisman (2:13:00.300)

well, now the science has really figured it out.

Lex Fridman (2:13:02.740)

We're way smarter than we were in the past.

Lex Fridman (2:13:04.780)

And then there's these like interesting studies

Lex Fridman (2:13:08.260)

that I've seen, I think Robin Hansen mentioned it to me,

Jonathan Reisman (2:13:12.500)

that if you look at the entirety of medication,

Lex Fridman (2:13:16.760)

like the effect of medication on human health,

Jonathan Reisman (2:13:19.340)

if you do those kinds of broad studies,

Lex Fridman (2:13:21.900)

does it actually help?

Jonathan Reisman (2:13:24.460)

Like does quality of life,

Lex Fridman (2:13:26.940)

lifespan, certain measures of the wellbeing,

Jonathan Reisman (2:13:30.340)

does if you, and you look at human society as a whole,

Lex Fridman (2:13:34.100)

does taking medication or not actually help?

Lex Fridman (2:13:37.380)

And those studies find there's no positive

Lex Fridman (2:13:39.860)

or negative effect with medication.

Lex Fridman (2:13:42.020)

And that's a very kind of interesting perspective.

Lex Fridman (2:13:46.680)

That mean you could probably argue a lot of ways,

Lex Fridman (2:13:51.460)

but the point is, because you can bring up

Lex Fridman (2:13:56.740)

literally a billion cases where medication

Jonathan Reisman (2:13:58.980)

has significant positive impact on a particular patient,

Lex Fridman (2:14:01.940)

but you have to kind of zoom out

Lex Fridman (2:14:03.960)

and honestly look at the positive effects of medicine,

Lex Fridman (2:14:08.020)

of lifestyle choices, diet choices, of exercise or not.

Jonathan Reisman (2:14:12.540)

Maybe we'll find eventually

Lex Fridman (2:14:13.740)

that exercise is actually bad for you.

Jonathan Reisman (2:14:15.740)

Maybe like there's all kinds of things

Lex Fridman (2:14:20.060)

that we're going to, I feel like we're going to figure out.

Jonathan Reisman (2:14:24.180)

One of the things I think we're going to figure out,

Lex Fridman (2:14:26.860)

everything I've learned about my body,

Jonathan Reisman (2:14:30.660)

is that aside from it being adaptable,

Lex Fridman (2:14:34.600)

there's a lot of very unique parameters

Jonathan Reisman (2:14:37.260)

that are opaque to me that I'm measuring

Lex Fridman (2:14:39.740)

through this feedback mechanism

Jonathan Reisman (2:14:41.140)

by trying stuff and learning about it.

Lex Fridman (2:14:43.460)

And one of the things we might learn

Jonathan Reisman (2:14:46.580)

is that medicine cannot be done without collecting

Lex Fridman (2:14:50.440)

a huge amount of data about each individual human.

Lex Fridman (2:14:53.360)

So it's absurd to be, like if I show up and see a doctor,

Lex Fridman (2:14:59.540)

it's absurd for that doctor

Jonathan Reisman (2:15:00.660)

to have just a couple of minutes with me.

Lex Fridman (2:15:03.100)

Like just looking at basic symptoms,

Jonathan Reisman (2:15:07.500)

looking at such crappy data.

Lex Fridman (2:15:12.500)

Like first of all, no long term data,

Jonathan Reisman (2:15:17.620)

no longitudinal data, no historical data,

Lex Fridman (2:15:20.980)

no detailed analysis of all the possible things.

Jonathan Reisman (2:15:25.460)

Not just the related to your symptoms,

Lex Fridman (2:15:27.500)

but related to other things that you're not complaining about.

Jonathan Reisman (2:15:30.980)

Just giving you a full picture of the data

Lex Fridman (2:15:33.140)

and then using AI to help the human doctor

Jonathan Reisman (2:15:37.300)

highlight the things that you should perhaps

Lex Fridman (2:15:39.900)

pay extra attention to.

Jonathan Reisman (2:15:41.540)

I think we'll look back at this time as ridiculous

Lex Fridman (2:15:44.380)

that doctors were expected to help anybody whatsoever

Jonathan Reisman (2:15:47.460)

without having the data,

Lex Fridman (2:15:49.100)

without having a huge amount of data about the human body.

Jonathan Reisman (2:15:52.380)

Like you have to do so much with so little data.

Lex Fridman (2:15:55.580)

It's very 19th century.

Jonathan Reisman (2:15:57.300)

It's very 19th century.

Lex Fridman (2:15:58.580)

So it relies on the brilliance of doctors

Lex Fridman (2:16:00.900)

and of course the intuition,

Lex Fridman (2:16:02.980)

the instinct you build up over time.

Lex Fridman (2:16:05.100)

And that's quite powerful.

Lex Fridman (2:16:06.660)

The human brain is pretty damn good

Jonathan Reisman (2:16:09.500)

for using experience to teach you

Lex Fridman (2:16:11.140)

how to make a good decision.

Lex Fridman (2:16:12.180)

But still it's, you might as well be bloodletting.

Lex Fridman (2:16:16.740)

Like it's humbling to think about that.

Jonathan Reisman (2:16:21.460)

It's humbling.

Lex Fridman (2:16:22.420)

It is humbling and it's important.

Jonathan Reisman (2:16:24.060)

I think doctors sometimes lose that humble perspective

Lex Fridman (2:16:28.900)

on what they do.

Lex Fridman (2:16:30.020)

And I think it's very important

Lex Fridman (2:16:31.860)

because as I said, medical history is just,

Jonathan Reisman (2:16:34.060)

medical dogma has been tossed into the trash bin

Lex Fridman (2:16:36.620)

so many times.

Jonathan Reisman (2:16:37.900)

Something doctors were sure of was the case is not.

Lex Fridman (2:16:40.860)

And it's important to be cognizant of that.

Jonathan Reisman (2:16:46.660)

You tweeted about somebody that had a big impact

Lex Fridman (2:16:52.220)

just by reading about him on my life as well.

Jonathan Reisman (2:16:56.140)

Still think about him.

Lex Fridman (2:16:58.180)

Rest in peace, Dr. Paul Farmer.

Jonathan Reisman (2:17:00.420)

A big inspiration to me.

Lex Fridman (2:17:01.860)

His medical career was a testament

Jonathan Reisman (2:17:04.100)

to what one person can do to improve the world.

Lex Fridman (2:17:07.300)

So who was Paul Farmer?

Lex Fridman (2:17:09.500)

And what made him a great doctor and a great man

Lex Fridman (2:17:12.140)

and somebody who was an inspiration to you?

Lex Fridman (2:17:15.540)

So Paul Farmer was a kind of pioneer of global health.

Lex Fridman (2:17:19.740)

He started Partners in Health,

Jonathan Reisman (2:17:23.020)

which is kind of an international health organization

Lex Fridman (2:17:25.660)

that operates originally in Haiti,

Jonathan Reisman (2:17:28.140)

also Rwanda and elsewhere.

Lex Fridman (2:17:30.580)

And I think he was just so a zealot

Jonathan Reisman (2:17:34.260)

for getting healthcare to some of the poorest people

Lex Fridman (2:17:37.820)

in the world.

Lex Fridman (2:17:38.780)

And I remember reading some of his books

Lex Fridman (2:17:41.260)

and a book about him by Tracy Kidder

Jonathan Reisman (2:17:43.020)

that's really great, Mountains Beyond Mountains,

Lex Fridman (2:17:45.820)

about how even when he was a medical student,

Jonathan Reisman (2:17:47.780)

he was flying back and forth to Haiti in between exams

Lex Fridman (2:17:50.660)

and just with this really intense focus and interest

Jonathan Reisman (2:17:55.620)

in getting healthcare to where it's not.

Lex Fridman (2:17:58.500)

And I think traveling around the world,

Jonathan Reisman (2:18:00.500)

especially to poor places like India, Calcutta, Nepal,

Lex Fridman (2:18:05.220)

you really see how unevenly the benefits

Jonathan Reisman (2:18:07.900)

of modern medicine are spread

Lex Fridman (2:18:09.220)

over the surface of the earth.

Jonathan Reisman (2:18:10.220)

Not only if you're,

Lex Fridman (2:18:11.220)

cause if you're in Antarctica and have a heart attack,

Jonathan Reisman (2:18:13.540)

you're in serious trouble,

Lex Fridman (2:18:14.940)

but just medications that cost pennies a day

Jonathan Reisman (2:18:19.820)

can help people.

Lex Fridman (2:18:21.420)

A lot of children in India under five die of diarrhea

Lex Fridman (2:18:25.340)

and all they need is oral rehydration solutions

Lex Fridman (2:18:27.660)

to stay hydrated.

Jonathan Reisman (2:18:30.100)

Most of them can't afford IV fluids, for instance,

Lex Fridman (2:18:32.460)

to get admitted to the hospital.

Lex Fridman (2:18:33.540)

And really dehydration just kills hundreds of thousands

Lex Fridman (2:18:37.100)

of kids throughout the world.

Jonathan Reisman (2:18:38.860)

Not to mention bacterial pneumonia also is a major cause

Lex Fridman (2:18:42.900)

of death in children under five.

Lex Fridman (2:18:44.660)

And many of them, not all, would be saved by amoxicillin,

Lex Fridman (2:18:48.060)

which is just pennies.

Lex Fridman (2:18:50.340)

And I, for me, I took a, had a path

Lex Fridman (2:18:54.180)

and I wanted to have a career in global health.

Lex Fridman (2:18:56.420)

And I started traveling abroad to India and elsewhere

Lex Fridman (2:18:59.060)

when I was a medical student and continued doing that.

Jonathan Reisman (2:19:01.780)

Paul Farmer was sort of one of the first

Lex Fridman (2:19:03.540)

to kind of open everyone's eyes, I think,

Jonathan Reisman (2:19:05.820)

about the good you can do with just money

Lex Fridman (2:19:09.540)

that we would, you know, change that we would throw away,

Jonathan Reisman (2:19:12.340)

just, you know, put in a person, forget it,

Lex Fridman (2:19:14.100)

or wherever we accumulate change these days.

Lex Fridman (2:19:16.820)

So that's very eye opening.

Lex Fridman (2:19:18.700)

And while medical science advances and that's good,

Jonathan Reisman (2:19:21.660)

you know, we shouldn't forget

Lex Fridman (2:19:23.020)

that 100 year old treatments could save lives

Jonathan Reisman (2:19:25.140)

in parts of the world where they're just not available.

Lex Fridman (2:19:27.540)

People should definitely read Mountains Beyond Mountains.

Jonathan Reisman (2:19:30.940)

Just, for me at least, sort of a person from outside

Lex Fridman (2:19:35.700)

all of it, it was the first person to make me realize

Lex Fridman (2:19:39.860)

how difficult and the amount of humanity

Lex Fridman (2:19:43.660)

that's involved in being a doctor.

Lex Fridman (2:19:46.380)

So it's not some kind of cold economics based argument

Lex Fridman (2:19:50.180)

about where to send treatments and so on.

Jonathan Reisman (2:19:52.780)

That is there too, like you said,

Lex Fridman (2:19:55.860)

basic treatments can help hundreds of thousands,

Jonathan Reisman (2:19:59.300)

millions of people in many parts of the world.

Lex Fridman (2:20:02.060)

But it's also when you have a patient in front of you,

Jonathan Reisman (2:20:08.700)

there's some aspect of you that's willing to give

Lex Fridman (2:20:11.500)

a lot of your time, a lot of your money,

Jonathan Reisman (2:20:13.420)

a lot of your effort to saving them,

Lex Fridman (2:20:16.900)

even though it doesn't make any sense.

Jonathan Reisman (2:20:20.300)

It's irrational in some sense, but it's also human.

Lex Fridman (2:20:23.820)

And that's the struggle of every doctor.

Jonathan Reisman (2:20:25.500)

Like when you have to choose how to allocate your time,

Lex Fridman (2:20:27.940)

how to allocate your mental energy.

Jonathan Reisman (2:20:30.620)

It's a tough choice that a doctor has to make

Lex Fridman (2:20:34.180)

and it's a human choice.

Jonathan Reisman (2:20:35.340)

It's not some kind of cold game theoretic choice.

Lex Fridman (2:20:39.660)

It's also a human choice and it can be irrational

Jonathan Reisman (2:20:42.820)

in some sense.

Lex Fridman (2:20:44.300)

People are asking you for help.

Jonathan Reisman (2:20:45.900)

That's basically what every patient interaction is.

Lex Fridman (2:20:48.340)

Someone's asking you for help.

Lex Fridman (2:20:49.620)

So your inclination is to help them.

Lex Fridman (2:20:52.140)

And even if it means going above and beyond,

Jonathan Reisman (2:20:54.340)

I mean, a lot of factors affect how compassionate

Lex Fridman (2:20:57.780)

a doctor might be on any given day or point in their career,

Jonathan Reisman (2:21:02.660)

their own stress and burnout, et cetera.

Lex Fridman (2:21:05.260)

But it's someone asking you for help

Lex Fridman (2:21:06.740)

and so you do what you can to help them.

Lex Fridman (2:21:11.380)

You've done quite a lot of things in your life.

Jonathan Reisman (2:21:15.500)

It's been an interesting journey.

Lex Fridman (2:21:18.100)

Of course, there's a lot of story yet to be written.

Lex Fridman (2:21:21.140)

But what advice would you give to young people today?

Lex Fridman (2:21:24.260)

In high school, maybe undergrad, college,

Jonathan Reisman (2:21:28.260)

starting out on that journey.

Lex Fridman (2:21:30.500)

Maybe trying to pick majors, trying to pick jobs,

Jonathan Reisman (2:21:34.900)

careers, dreams and goals they can pursue.

Lex Fridman (2:21:38.620)

What advice would you give them to have a career

Jonathan Reisman (2:21:40.820)

they can be proud of or to even have a life

Lex Fridman (2:21:43.420)

they can be proud of?

Jonathan Reisman (2:21:45.500)

Well, I think having passion,

Lex Fridman (2:21:48.180)

which isn't always a voluntary thing.

Jonathan Reisman (2:21:50.300)

You just have it or you don't perhaps.

Lex Fridman (2:21:52.140)

But becoming passionate about something

Lex Fridman (2:21:54.500)

and following it wherever it takes you,

Lex Fridman (2:21:57.660)

I think is really important.

Jonathan Reisman (2:21:59.660)

You know, when I finished college

Lex Fridman (2:22:01.820)

and sort of went to Russia for the first time,

Jonathan Reisman (2:22:03.900)

that was in some ways the beginning of my whole career

Lex Fridman (2:22:06.740)

and passions in my life.

Lex Fridman (2:22:09.140)

And I didn't know what I was going for,

Lex Fridman (2:22:11.700)

what was gonna happen,

Lex Fridman (2:22:12.580)

what kind of career it would turn into,

Lex Fridman (2:22:14.140)

what kind of job would it help me get when I got back.

Jonathan Reisman (2:22:16.020)

I wasn't thinking about any of that.

Lex Fridman (2:22:17.740)

I mean, I'm very fortunate I got that opportunity.

Jonathan Reisman (2:22:20.460)

I'm very fortunate to be able to go and see those places

Lex Fridman (2:22:24.660)

and have my mind opened.

Lex Fridman (2:22:25.740)

And I think that really just the fuel from that passion

Lex Fridman (2:22:29.380)

that was created during that time

Jonathan Reisman (2:22:30.540)

is still 20 years later going strong.

Lex Fridman (2:22:33.820)

I'm partial to healthcare.

Jonathan Reisman (2:22:35.020)

I love being a doctor.

Lex Fridman (2:22:36.660)

I think it's the perfect combination

Jonathan Reisman (2:22:39.460)

of kind of intellectual problem solving,

Lex Fridman (2:22:41.660)

being a detective while also working with your hands.

Jonathan Reisman (2:22:44.660)

You know, when you do procedures,

Lex Fridman (2:22:46.220)

especially in the ER, it's sort of the perfect combination.

Jonathan Reisman (2:22:49.220)

I'm not a surgeon, but I do use my hands quite a bit

Lex Fridman (2:22:54.100)

for a variety of reasons.

Lex Fridman (2:22:55.380)

And so I always loved working with my hands.

Lex Fridman (2:22:57.900)

I loved crafts, especially prehistoric crafts

Jonathan Reisman (2:23:01.940)

before medical school.

Lex Fridman (2:23:03.420)

And I just love kind of problem solving,

Jonathan Reisman (2:23:06.060)

getting clues, figuring out what's going on,

Lex Fridman (2:23:08.860)

following your nose, using your instincts, your knowledge,

Lex Fridman (2:23:12.340)

and also just keen observation of the patient.

Lex Fridman (2:23:15.020)

After seeing patient after patient, hundreds of patients,

Jonathan Reisman (2:23:17.700)

maybe thousands over years, you do get this sort of

Lex Fridman (2:23:20.780)

innate kind of sense, this gestalt

Jonathan Reisman (2:23:22.900)

about what might be going on.

Lex Fridman (2:23:24.260)

And, you know, it's not always a numbers thing.

Jonathan Reisman (2:23:26.100)

That's the thing.

Lex Fridman (2:23:26.940)

There's always, gestalt is actually a big part of medicine.

Jonathan Reisman (2:23:30.620)

You know, you often in ERs or in hospitals,

Lex Fridman (2:23:33.300)

hear a nurse or a doctor say something like,

Jonathan Reisman (2:23:35.860)

this patient just doesn't look good.

Lex Fridman (2:23:37.940)

And it's sort of, you can't point to a number, a value,

Jonathan Reisman (2:23:40.820)

a level in their blood, you know, a test,

Lex Fridman (2:23:43.660)

but something about them.

Lex Fridman (2:23:45.100)

And a lot of that I think has to do

Lex Fridman (2:23:47.420)

with the color of their skin, believe it or not,

Jonathan Reisman (2:23:49.860)

which can change in certain disease states.

Lex Fridman (2:23:52.980)

But I think that it's just,

Jonathan Reisman (2:23:56.220)

medicine combines this observation, the skills,

Lex Fridman (2:23:59.700)

the knowledge, it's art and science, it's human,

Lex Fridman (2:24:02.980)

and it's robotic, you know, algorithmic at the same time.

Lex Fridman (2:24:06.900)

And I think it just, yeah, combines kind of

Jonathan Reisman (2:24:10.020)

all my passions all in one.

Lex Fridman (2:24:11.700)

And I would, you know, if anyone's going into healthcare,

Jonathan Reisman (2:24:14.060)

I'd strongly encourage them to do so, but I'm very biased.

Lex Fridman (2:24:16.380)

So with that early passion, whatever that little flame was

Jonathan Reisman (2:24:19.620)

that brought you to Russia, were you able to vocalize it

Lex Fridman (2:24:24.980)

or was it just something like a gut

Jonathan Reisman (2:24:27.140)

that's pulled you towards some exploration

Lex Fridman (2:24:30.740)

of the unknown or something like this?

Jonathan Reisman (2:24:33.020)

I think it was a combination of things.

Lex Fridman (2:24:34.860)

One was just going to a different place

Jonathan Reisman (2:24:36.920)

that was different from where I grew up, you know.

Lex Fridman (2:24:39.920)

The suburbs, you know, when you're in high school,

Jonathan Reisman (2:24:42.140)

you hate them, later on they don't seem so bad.

Lex Fridman (2:24:44.220)

But, you know, I just wanted to get,

Jonathan Reisman (2:24:45.940)

I mean, I'm very fortunate how I was raised

Lex Fridman (2:24:48.220)

and never wanted for anything that wasn't rich,

Lex Fridman (2:24:51.520)

but just to get out and see a different place,

Lex Fridman (2:24:54.500)

a different people with a different culture

Lex Fridman (2:24:56.540)

and history and language and literature

Lex Fridman (2:24:58.540)

and to see different climates and geographies

Lex Fridman (2:25:00.700)

and ecosystems, I just wanted to see something different.

Lex Fridman (2:25:03.560)

And that, I guess that's what I've sought after ever since.

Lex Fridman (2:25:07.360)

So just that was just so fascinating.

Lex Fridman (2:25:09.580)

Like my trip to Kamchatka in 2003,

Jonathan Reisman (2:25:12.460)

where I was there for four months

Lex Fridman (2:25:14.100)

and I didn't speak English for, I think,

Jonathan Reisman (2:25:16.180)

two months out of it.

Lex Fridman (2:25:17.700)

And just, I remember lying on the floor,

Jonathan Reisman (2:25:20.380)

some wooden floor in a hunter's cabin

Lex Fridman (2:25:22.260)

in the middle of Northern Kamchatka,

Lex Fridman (2:25:23.700)

just being like, what am I doing here?

Lex Fridman (2:25:26.180)

This is, I'm just so grateful for like the experiences

Jonathan Reisman (2:25:28.780)

I was having, what I was seeing and realizing and learning.

Lex Fridman (2:25:32.020)

It was just, I was so grateful,

Jonathan Reisman (2:25:33.540)

even though I was lying on this hard, uncomfortable floor,

Lex Fridman (2:25:35.460)

it's just like, this is so amazing.

Lex Fridman (2:25:37.600)

And that, I don't think I'll ever have another travel

Lex Fridman (2:25:40.500)

as meaningful and life changing

Jonathan Reisman (2:25:41.980)

as that particular trip to Kamchatka was.

Lex Fridman (2:25:46.100)

Though I'm still striving after it.

Jonathan Reisman (2:25:47.620)

You never replicate that first high, but you always try.

Lex Fridman (2:25:51.260)

So I just think that seeing something different

Jonathan Reisman (2:25:54.440)

is kind of the game.

Lex Fridman (2:25:56.080)

And there wasn't really a plan.

Jonathan Reisman (2:25:57.940)

Cause I got a chance to talk to the CEO of Qualcomm recently

Lex Fridman (2:26:02.140)

and his advice is, always have a plan.

Lex Fridman (2:26:07.140)

And it sounds like you're saying don't have a plan.

Lex Fridman (2:26:13.900)

Don't need to have a plan.

Jonathan Reisman (2:26:16.100)

Just listen to your gut, your passion and follow that

Lex Fridman (2:26:19.580)

and see where that takes you.

Jonathan Reisman (2:26:21.380)

Cause it's telling you something.

Lex Fridman (2:26:23.260)

Yeah, I think, I guess the plan could be specific

Jonathan Reisman (2:26:26.820)

or it could be as general as I just wanna go far away

Lex Fridman (2:26:29.580)

and see something very different, that's my plan.

Lex Fridman (2:26:32.260)

And I did just one line.

Lex Fridman (2:26:33.620)

Yeah, just followed my nose from one thing to the next,

Jonathan Reisman (2:26:36.660)

just being interested, following my passion.

Lex Fridman (2:26:38.620)

And again, very fortunate I could do that.

Jonathan Reisman (2:26:41.500)

Are there places in the world you're kind of thinking

Lex Fridman (2:26:45.820)

about that your life might take you at some point

Jonathan Reisman (2:26:52.760)

to be a doctor there for a time,

Lex Fridman (2:26:55.040)

to explore for a time that you haven't yet?

Jonathan Reisman (2:26:58.580)

I have some colleagues who do kind of global health work

Lex Fridman (2:27:01.620)

in various countries in Africa and Central and South America.

Jonathan Reisman (2:27:05.740)

I would really love to go to some of those places,

Lex Fridman (2:27:09.940)

not just for a short trip,

Lex Fridman (2:27:11.220)

but hopefully for an extended period of time

Lex Fridman (2:27:14.520)

with sort of the healthcare being the ticket in,

Lex Fridman (2:27:17.540)

but then maybe even bringing my children or just,

Lex Fridman (2:27:20.580)

I guess at this point, some of the travel I dream about

Jonathan Reisman (2:27:23.520)

is sort of replicating what I did

Lex Fridman (2:27:25.080)

and showing it to my kids in a way.

Lex Fridman (2:27:27.820)

But there's still a lot I haven't seen

Lex Fridman (2:27:29.540)

and would love to see as well.

Lex Fridman (2:27:30.980)

But I think those opportunities sort of lend themselves well

Lex Fridman (2:27:35.820)

as a doctor with kind of the ability to go there

Lex Fridman (2:27:37.980)

and sort of help patients,

Lex Fridman (2:27:39.780)

but also teach medical students and residents.

Jonathan Reisman (2:27:42.580)

Teaching is actually a huge part of being a doctor

Lex Fridman (2:27:45.460)

that's underappreciated,

Lex Fridman (2:27:47.080)

but that's actually part of the fun of being a doctor

Lex Fridman (2:27:48.860)

is that you're also a teacher.

Jonathan Reisman (2:27:50.100)

Of course, the word doctor means teacher,

Lex Fridman (2:27:52.100)

but it's come to mean something else.

Lex Fridman (2:27:55.260)

But in some of my jobs,

Lex Fridman (2:27:57.900)

I'm working alongside medical students and residents

Lex Fridman (2:28:00.660)

and I'm giving them my knowledge, my wisdom,

Lex Fridman (2:28:03.020)

sharing with them stories.

Lex Fridman (2:28:04.300)

And so that's a very satisfying part of the job.

Lex Fridman (2:28:08.620)

If we could take a brief step

Jonathan Reisman (2:28:10.860)

into a dark place together for a time,

Lex Fridman (2:28:15.300)

is there, what is a dark place you've gone in your mind

Lex Fridman (2:28:21.460)

in your life?

Lex Fridman (2:28:22.540)

What would be the darkest place you ever gone

Lex Fridman (2:28:26.580)

for a time, for a moment?

Lex Fridman (2:28:32.580)

And how did you survive?

Lex Fridman (2:28:34.260)

How did you overcome it?

Lex Fridman (2:28:36.900)

That's a very good question.

Jonathan Reisman (2:28:39.340)

I would say I haven't had as dark moments

Lex Fridman (2:28:45.460)

as many of the people who I care for in the emergency room.

Jonathan Reisman (2:28:49.580)

I'm fortunate in that way.

Lex Fridman (2:28:51.180)

I've had a pretty enjoyable, satisfying life.

Jonathan Reisman (2:28:56.140)

I think everybody has dark moments though, including me.

Lex Fridman (2:29:00.820)

One of the most shocking things I feel like

Jonathan Reisman (2:29:03.740)

becoming an adult, my two big realizations have been,

Lex Fridman (2:29:07.100)

one, no one knows what they're doing.

Lex Fridman (2:29:08.680)

And two, suicide is incredibly common,

Lex Fridman (2:29:12.260)

like in all humans and all societies.

Jonathan Reisman (2:29:14.400)

That I just find shocking.

Lex Fridman (2:29:16.180)

I mean, I've never seriously contemplated myself,

Lex Fridman (2:29:18.540)

but I wouldn't say it hasn't crossed my mind

Lex Fridman (2:29:20.940)

during some more stressful times of life.

Jonathan Reisman (2:29:24.500)

I think it crosses everyone's mind.

Lex Fridman (2:29:27.580)

And sort of as a kid, I found that I never would have guessed

Lex Fridman (2:29:31.100)

how common suicide is.

Lex Fridman (2:29:32.860)

It's an important question to sort of the Camus question,

Lex Fridman (2:29:37.700)

like why live?

Lex Fridman (2:29:40.360)

Why?

Lex Fridman (2:29:41.720)

Why?

Lex Fridman (2:29:42.820)

Because like life, especially when you're struggling,

Jonathan Reisman (2:29:46.180)

especially when life is shit,

Lex Fridman (2:29:48.820)

like why am I doing any of this?

Lex Fridman (2:29:51.340)

And then on top of that, chemistry of your brain,

Lex Fridman (2:29:55.420)

it could be as simple as diet and nutrition

Lex Fridman (2:29:58.580)

and aforementioned exercise and things like this

Lex Fridman (2:30:02.460)

that affect the chemistry such that you're more predisposed

Jonathan Reisman (2:30:05.940)

to go to the places of asking the question why,

Lex Fridman (2:30:09.980)

and maybe struggling to find a good answer.

Jonathan Reisman (2:30:14.560)

Because it's actually a question with no good answer,

Lex Fridman (2:30:17.980)

except something in your chemistry says,

Jonathan Reisman (2:30:21.460)

well, I kind of like it.

Lex Fridman (2:30:23.420)

But there's no good intellectual answer.

Lex Fridman (2:30:26.140)

And especially if day to day, it's pain.

Lex Fridman (2:30:29.920)

You get to see these stories of Robin Williams,

Jonathan Reisman (2:30:34.540)

these people that are on top of the world

Lex Fridman (2:30:36.440)

from an external perspective,

Lex Fridman (2:30:38.100)

but from an internal perspective, it's struggle.

Lex Fridman (2:30:42.880)

Every day is pain, feels hopeless,

Lex Fridman (2:30:46.180)

and yeah, that's a question we all have to struggle with

Lex Fridman (2:30:51.700)

or learn how to ignore.

Jonathan Reisman (2:30:53.500)

Maybe because if you ask the question too much,

Lex Fridman (2:30:55.620)

you're not going to find a good answer.

Jonathan Reisman (2:30:59.180)

That's a choice you make.

Lex Fridman (2:31:00.380)

I personally think you should ask that question a lot.

Lex Fridman (2:31:05.780)

But maybe because I have the luxury of the chemistry I have

Lex Fridman (2:31:08.940)

where I'm not in danger of seriously contemplating suicide.

Lex Fridman (2:31:13.940)

But why live is an important question to answer constantly

Lex Fridman (2:31:18.060)

and struggle to answer that constantly.

Lex Fridman (2:31:21.700)

But people, I've been extremely fortunate

Lex Fridman (2:31:25.940)

to meet people over the past couple of years

Jonathan Reisman (2:31:29.500)

that are really struggling.

Lex Fridman (2:31:31.740)

And you have probably met people

Jonathan Reisman (2:31:39.220)

who are really struggling, like orders of magnitude

Lex Fridman (2:31:42.380)

more people who are really struggling.

Jonathan Reisman (2:31:45.220)

Some of it is psychological, a lot of it is biological.

Lex Fridman (2:31:49.460)

And man, life is a motherfucker.

Jonathan Reisman (2:31:53.100)

It's pretty tough.

Lex Fridman (2:31:54.060)

Very true.

Jonathan Reisman (2:31:55.620)

I do think also past trauma plays a big role there

Lex Fridman (2:31:59.280)

like we talked about, war wounds and PTSD.

Jonathan Reisman (2:32:03.420)

A lot of people grew up with just horrific childhoods.

Lex Fridman (2:32:06.940)

They were abused in one way or another.

Lex Fridman (2:32:09.060)

And I think a lot of people who have not,

Lex Fridman (2:32:12.740)

I'm not saying a majority, but a lot of people,

Jonathan Reisman (2:32:14.860)

for instance, who I see in the ER coming in

Lex Fridman (2:32:17.860)

for threatening suicide or actually trying and failing

Lex Fridman (2:32:20.780)

and being brought to the ER,

Lex Fridman (2:32:22.220)

a lot of them just have really traumatic experiences,

Jonathan Reisman (2:32:26.540)

saw their parent commit suicide, were abused.

Lex Fridman (2:32:30.060)

These leave scars in the human brain and mind.

Lex Fridman (2:32:32.860)

And a lot of their subsequent lives

Lex Fridman (2:32:35.940)

of whether it's substance abuse, alcoholism, et cetera,

Jonathan Reisman (2:32:38.580)

is almost trying to escape from their own memories.

Lex Fridman (2:32:40.700)

And it's sort of such this overwhelming battle sometimes.

Jonathan Reisman (2:32:45.460)

Like sometimes people get ruined, it seems,

Lex Fridman (2:32:48.780)

and just can't be fixed, you know what I mean?

Jonathan Reisman (2:32:51.300)

Yes, you can improve diet and health and your life choices

Lex Fridman (2:32:54.620)

and seek out your passion and exercise.

Lex Fridman (2:32:57.540)

And those definitely will help.

Lex Fridman (2:32:59.140)

But sometimes just like, you know,

Jonathan Reisman (2:33:00.820)

you bear the scars of the past

Lex Fridman (2:33:02.180)

and there's no getting rid of them.

Jonathan Reisman (2:33:04.260)

Yeah, I think it's possible to live with them.

Lex Fridman (2:33:08.860)

I think so too. To the struggle.

Jonathan Reisman (2:33:10.020)

I would never say give up, you know.

Lex Fridman (2:33:12.220)

Keep fighting.

Jonathan Reisman (2:33:13.740)

It is a constant, it can be a constant battle

Lex Fridman (2:33:15.740)

for some people.

Jonathan Reisman (2:33:16.660)

I know it can be, and I've talked to many of those folks,

Lex Fridman (2:33:20.340)

I know it can feel hopeless, but keep up the good fight.

Jonathan Reisman (2:33:24.580)

Hopelessness. Keep up the good fight.

Lex Fridman (2:33:26.260)

Hopelessness is kind of one of the big suicide risk factors

Jonathan Reisman (2:33:29.540)

that you sort of ask about as a doctor, you know,

Lex Fridman (2:33:32.380)

do you feel hopeless? And that sort of can be a harbinger.

Jonathan Reisman (2:33:37.220)

I have quite a few dark moments.

Lex Fridman (2:33:39.700)

So if you're listening and you're struggling,

Jonathan Reisman (2:33:44.900)

we're in this together, brother and sister,

Lex Fridman (2:33:47.500)

keep up the good fight.

Jonathan Reisman (2:33:51.060)

Life is a motherfucker, as you said.

Lex Fridman (2:33:52.820)

It's really harder.

Jonathan Reisman (2:33:55.060)

I think as a kid, you know, in a joy free childhood,

Lex Fridman (2:33:57.940)

you don't realize, like, obviously there's a ton

Jonathan Reisman (2:34:00.140)

you don't realize about life,

Lex Fridman (2:34:02.020)

but then when you get to be an adult,

Jonathan Reisman (2:34:03.380)

you realize just how complex and hard it is.

Lex Fridman (2:34:07.140)

Is it this hard for adult animals?

Jonathan Reisman (2:34:08.860)

I don't know. I don't think it is.

Lex Fridman (2:34:13.060)

So I haven't seen the honesty of biology before you.

Lex Fridman (2:34:18.940)

Do you think about your own death?

Lex Fridman (2:34:22.700)

Do you contemplate death?

Lex Fridman (2:34:25.300)

Are you afraid of your own death?

Lex Fridman (2:34:26.860)

How do you make sense of it?

Jonathan Reisman (2:34:29.780)

I've definitely thought about it,

Lex Fridman (2:34:31.700)

especially maybe while doing certain risky things,

Jonathan Reisman (2:34:35.420)

ice climbing and others where every time I looked down,

Lex Fridman (2:34:37.940)

I thought about my own death.

Lex Fridman (2:34:39.020)

But I think, you know,

Lex Fridman (2:34:41.820)

I think having kids changes the equation for sure,

Jonathan Reisman (2:34:46.860)

should change the equation perhaps.

Lex Fridman (2:34:48.620)

So I think a lot of,

Jonathan Reisman (2:34:50.660)

now when I think about what will happen when I die,

Lex Fridman (2:34:53.300)

you know, there's a lot of worrying about

Lex Fridman (2:34:56.260)

what will happen to the people I care for.

Lex Fridman (2:34:58.340)

You know, you think about things like insurance policy,

Jonathan Reisman (2:35:00.940)

life insurance and, you know, disability insurance,

Lex Fridman (2:35:04.980)

that's not related to death, but more just injuries.

Lex Fridman (2:35:07.260)

And that's part of the weight, I guess,

Lex Fridman (2:35:09.900)

that you feel as an adult,

Jonathan Reisman (2:35:13.380)

that I think grows rapidly when you have kids.

Lex Fridman (2:35:16.540)

Though not only, you know,

Jonathan Reisman (2:35:17.420)

there's other people you can care for,

Lex Fridman (2:35:19.020)

your own parents and loved ones.

Jonathan Reisman (2:35:20.860)

Like a lot of people depend on individuals.

Lex Fridman (2:35:23.740)

And so you think about what will happen

Jonathan Reisman (2:35:25.380)

to the other people when you die.

Lex Fridman (2:35:27.740)

But also, to push back, that weight

Jonathan Reisman (2:35:31.780)

might be something you've convinced yourself to think about.

Lex Fridman (2:35:35.660)

It's an important weight to think about.

Lex Fridman (2:35:37.660)

But you focus on that weight to escape the other weight,

Lex Fridman (2:35:43.300)

which is, at one point,

Jonathan Reisman (2:35:48.460)

this consciousness just comes to an end.

Lex Fridman (2:35:51.580)

And it's hard to make sense of that.

Jonathan Reisman (2:35:54.580)

We kind of delude ourselves in thinking,

Lex Fridman (2:35:56.380)

okay, it just, yeah, it ends.

Jonathan Reisman (2:35:58.100)

That's the natural way of things and so on.

Lex Fridman (2:35:59.900)

That makes sense, so we're good.

Jonathan Reisman (2:36:01.220)

Okay, that's the way of life.

Lex Fridman (2:36:03.700)

But I don't think it's cognitively easy

Jonathan Reisman (2:36:07.580)

to just realize how terrifying that is.

Lex Fridman (2:36:12.260)

We love life so much that the end of it,

Jonathan Reisman (2:36:18.500)

it just, it's something that makes no sense.

Lex Fridman (2:36:24.780)

And if you linger on that thought,

Jonathan Reisman (2:36:26.300)

I think it's a painful, I would say even terrifying thought.

Lex Fridman (2:36:31.460)

Not scared of like, in a way that's

Jonathan Reisman (2:36:34.300)

almost like philosophically terrifying.

Lex Fridman (2:36:36.660)

Like, it just reminds you, maybe humbles you

Jonathan Reisman (2:36:39.540)

that you don't know anything about anything.

Lex Fridman (2:36:44.340)

But one of the things we do as humans really well

Jonathan Reisman (2:36:47.020)

is we, especially with kids, you realize,

Lex Fridman (2:36:50.620)

okay, we start caring for others in the community,

Jonathan Reisman (2:36:53.500)

in the family, and so on, and that distracts us.

Lex Fridman (2:36:56.260)

So then we can at least focus on other people's problems

Lex Fridman (2:36:58.540)

and not deal with our own.

Lex Fridman (2:37:02.860)

When I was a medical student, I was particularly

Jonathan Reisman (2:37:05.180)

fascinated with kind of what actually happens

Lex Fridman (2:37:07.700)

as people die, like in the last minute, seconds of life.

Jonathan Reisman (2:37:10.820)

It's sort of surprising sometimes,

Lex Fridman (2:37:12.220)

like what actually kills people.

Jonathan Reisman (2:37:13.820)

You know, like you can get, let's say, a bad head injury

Lex Fridman (2:37:17.160)

and you know, what kills you.

Jonathan Reisman (2:37:18.880)

Sometimes it's just your consciousness decreases

Lex Fridman (2:37:22.260)

and you become kind of comatose, you aspirate,

Jonathan Reisman (2:37:26.900)

your oxygen plummets, and you get cardiac arrest.

Lex Fridman (2:37:28.980)

You know, that kind of sequence of events.

Jonathan Reisman (2:37:31.500)

Or, you know, a heroin overdose,

Lex Fridman (2:37:34.700)

let's say you stop breathing.

Jonathan Reisman (2:37:36.080)

Similarly, your oxygen goes down,

Lex Fridman (2:37:37.620)

then you get a cardiac arrest.

Lex Fridman (2:37:38.580)

So I was really fascinated with what actually happens,

Lex Fridman (2:37:41.380)

what makes people die.

Lex Fridman (2:37:43.380)

And it was sort of a morbid fascination, obviously,

Lex Fridman (2:37:45.940)

like most of med school is.

Lex Fridman (2:37:47.740)

And I had many instances where I've had patients pass

Lex Fridman (2:37:52.280)

and as a medical student, I was sort of learning

Jonathan Reisman (2:37:55.600)

what's actually happening, watching it happen

Lex Fridman (2:37:57.540)

and not always being able to prevent it.

Jonathan Reisman (2:37:59.980)

It was sort of a scientific exploration.

Lex Fridman (2:38:03.240)

Then the patient's family comes in and are just devastated.

Lex Fridman (2:38:06.220)

And then it's like, rips you out

Lex Fridman (2:38:08.580)

of this scientific perspective

Lex Fridman (2:38:10.060)

and you just realize how horrible death is,

Lex Fridman (2:38:12.620)

but the person's fine.

Jonathan Reisman (2:38:14.180)

You know, it's the family, I guess.

Lex Fridman (2:38:15.540)

And that's why it's always, I guess that pointed out

Jonathan Reisman (2:38:18.780)

just how what people leave behind

Lex Fridman (2:38:20.740)

is often kind of the horribleness of death.

Jonathan Reisman (2:38:22.940)

Like just becoming unconscious and staying that way

Lex Fridman (2:38:25.200)

doesn't seem, I guess to me personally, so bad.

Jonathan Reisman (2:38:28.140)

Sort of like going to sleep, not waking up,

Lex Fridman (2:38:30.920)

not counting the pain and stuff that precedes it.

Lex Fridman (2:38:33.140)

So the actual pain, the actual suffering

Lex Fridman (2:38:35.420)

is often felt by the people who love the person who died.

Lex Fridman (2:38:39.300)

So both financial pain, psychological pain,

Lex Fridman (2:38:43.980)

for years missing them, all those kinds of things.

Jonathan Reisman (2:38:46.820)

Right, never forgetting the anniversary of their death.

Lex Fridman (2:38:50.020)

You know, just having flashbacks or something reminding you.

Jonathan Reisman (2:38:54.180)

That sort of brought home to me sort of what death means.

Lex Fridman (2:38:57.780)

And it was more about what people leave behind

Jonathan Reisman (2:39:00.060)

than what happens to them specifically.

Lex Fridman (2:39:01.900)

See, I like those concerns

Jonathan Reisman (2:39:04.260)

because I feel like I can do a lot about those.

Lex Fridman (2:39:07.900)

Those make sense to me.

Jonathan Reisman (2:39:09.180)

Then just be, if you're a father, just be a good father.

Lex Fridman (2:39:12.020)

If you're sort of, you mentioned sort of insurance.

Jonathan Reisman (2:39:15.980)

Yeah, there's like financial stuff to take care of.

Lex Fridman (2:39:18.380)

What I don't know what to do with

Jonathan Reisman (2:39:19.900)

is the philosophical existential crisis

Lex Fridman (2:39:26.280)

of the fact that this fricking thing ends.

Jonathan Reisman (2:39:28.980)

It doesn't, I don't know how to deal

Lex Fridman (2:39:32.500)

with the mystery that's beyond death.

Lex Fridman (2:39:35.560)

Why are we here?

Lex Fridman (2:39:36.620)

Why are we born at all?

Lex Fridman (2:39:38.020)

What is consciousness?

Lex Fridman (2:39:39.540)

And you just look at yourself.

Lex Fridman (2:39:41.160)

What is this?

Lex Fridman (2:39:42.000)

Why do I have the capacity to suffer?

Jonathan Reisman (2:39:45.800)

Why, why, all these kinds of why questions

Lex Fridman (2:39:47.940)

that don't have answers.

Jonathan Reisman (2:39:49.140)

Speaking of which, let me ask you a why question.

Lex Fridman (2:39:52.540)

The biggest ridiculous one.

Lex Fridman (2:39:54.260)

What do you think is the meaning of life?

Lex Fridman (2:39:58.220)

Having, with this book, studied the incredible,

Jonathan Reisman (2:40:01.780)

beautiful biology of life, the components,

Lex Fridman (2:40:06.060)

the engineering components that make up this human body.

Lex Fridman (2:40:09.880)

But when you look at the entirety of it,

Lex Fridman (2:40:13.100)

what is why?

Lex Fridman (2:40:15.160)

Why are we here?

Lex Fridman (2:40:16.180)

Sometimes, probably more often than not,

Jonathan Reisman (2:40:17.960)

feel like the question of why is a trick

Lex Fridman (2:40:20.280)

of the human brain.

Lex Fridman (2:40:21.640)

And outside of our thoughts, there is no why.

Lex Fridman (2:40:25.780)

Why is not something that's in the universe.

Jonathan Reisman (2:40:28.060)

It's just this trick happening inside our brain.

Lex Fridman (2:40:31.720)

So why is a game that the human brain plays on itself?

Lex Fridman (2:40:36.260)

And then the reality of life doesn't have why's.

Lex Fridman (2:40:40.980)

I do wonder if asking why

Jonathan Reisman (2:40:42.980)

is sort of an evolutionary adaptation.

Lex Fridman (2:40:44.940)

Like why, you know, maybe hunting, gathering.

Lex Fridman (2:40:48.980)

Why does this plant grow there and not there?

Lex Fridman (2:40:51.260)

Why do I see the same deer tracks

Lex Fridman (2:40:53.220)

and by the same tree every three days?

Lex Fridman (2:40:55.540)

Why, you know, why is this, why is that?

Lex Fridman (2:40:59.540)

Why does this plant make me vomit and that plant doesn't?

Lex Fridman (2:41:03.460)

I guess those why's are very practical

Lex Fridman (2:41:06.100)

and oriented towards survival.

Lex Fridman (2:41:08.260)

But then obviously, you know, we not only use why,

Jonathan Reisman (2:41:11.540)

you know, we use it to maybe hunt better,

Lex Fridman (2:41:13.780)

gather better, survive better,

Lex Fridman (2:41:15.320)

but then we sort of extrapolate it

Lex Fridman (2:41:16.780)

into these unanswerable questions, you know,

Lex Fridman (2:41:21.300)

about why, like why does life exist?

Lex Fridman (2:41:23.900)

And it's possible that they're not unanswerable

Jonathan Reisman (2:41:26.920)

in the long arc of science and history.

Lex Fridman (2:41:30.100)

It's we're just striving for the really difficult questions.

Jonathan Reisman (2:41:33.320)

Right now, we just don't know much about anything

Lex Fridman (2:41:36.340)

and so we're striving.

Lex Fridman (2:41:37.840)

But there's a long, so most of human history,

Lex Fridman (2:41:41.300)

you were asking why questions

Jonathan Reisman (2:41:43.340)

for which we now have very precise answers,

Lex Fridman (2:41:47.140)

including with biology and physics

Lex Fridman (2:41:48.980)

and all those kinds of things.

Lex Fridman (2:41:50.780)

And maybe the why's, this cutting edge of science,

Jonathan Reisman (2:41:54.040)

of the explorer of the curiosity of the human mind.

Lex Fridman (2:41:57.880)

Like man's search for meaning

Jonathan Reisman (2:42:00.060)

is the sort of the ultimate driver of the why.

Lex Fridman (2:42:04.220)

And it's almost like it could be an evolutionary adaptation

Jonathan Reisman (2:42:07.920)

of asking exceptionally hard why questions

Lex Fridman (2:42:11.380)

that will never get answered.

Jonathan Reisman (2:42:15.040)

Like, so you should always have,

Lex Fridman (2:42:17.500)

like it's like a queue, it's a stack of questions,

Lex Fridman (2:42:20.540)

why questions, and that thing should never come

Lex Fridman (2:42:23.140)

to the bottom, should always be striving.

Lex Fridman (2:42:26.260)

And that's useful for humans to come up

Lex Fridman (2:42:28.520)

with better and better ways of survival.

Lex Fridman (2:42:30.980)

And maybe from in a bigger perspective

Lex Fridman (2:42:34.100)

for the universe to figure out something about itself.

Lex Fridman (2:42:37.140)

And it's just humans, just a useful tool for that.

Lex Fridman (2:42:40.860)

Or life on Earth is a useful tool for that.

Jonathan Reisman (2:42:42.900)

Well, John, this, you're,

Lex Fridman (2:42:47.580)

for people who should know, you're from Philadelphia.

Jonathan Reisman (2:42:50.160)

I'm from Philadelphia, so it's an honor

Lex Fridman (2:42:52.900)

that you would travel all this way

Jonathan Reisman (2:42:54.820)

from a place I love to the new place I love

Lex Fridman (2:42:57.500)

and that you'll write this really incredible book

Jonathan Reisman (2:43:00.420)

that celebrates the human body in the most honest of ways.

Lex Fridman (2:43:04.140)

And thank you for everything you do,

Jonathan Reisman (2:43:05.700)

for being a great educator, for being a great doctor,

Lex Fridman (2:43:08.060)

for being a great person, and for spending

Jonathan Reisman (2:43:10.140)

your really valuable time with me today.

Lex Fridman (2:43:11.980)

Thank you, John.

Jonathan Reisman (2:43:12.820)

Thanks for having me, Lex.

Lex Fridman (2:43:14.780)

Thanks for listening to this conversation

Jonathan Reisman (2:43:16.300)

with Jonathan Reisman.

Lex Fridman (2:43:17.700)

To support this podcast, please check out our sponsors

Jonathan Reisman (2:43:20.060)

in the description.

Lex Fridman (2:43:21.540)

And now, let me leave you with some words from Paul Farmer,

Jonathan Reisman (2:43:24.820)

a doctor who has inspired both Jonathan and me

Lex Fridman (2:43:27.800)

with the way he practiced medicine

Lex Fridman (2:43:29.500)

and the way he lived his life.

Lex Fridman (2:43:32.440)

The idea that some lives matter less

Jonathan Reisman (2:43:35.520)

is the root of all that is wrong with the world.

Lex Fridman (2:43:38.880)

Thank you for listening, and hope to see you next time.

Jonathan Reisman (30:00.900)

The throat I would count as just sort of the very back

Lex Fridman (30:03.640)

of the back of the mouth, where the nose also comes down

Lex Fridman (30:07.780)

and meets it, where the tonsils are and the uvula.

Lex Fridman (30:11.460)

But you're right that we are a bunch of holes.

Lex Fridman (30:13.240)

But more accurately, we're a tube, right?

Lex Fridman (30:15.180)

We start in the womb as kind of this microscopic little disc,

Jonathan Reisman (30:18.620)

almost like a flatbread.

Lex Fridman (30:21.980)

And then we roll almost like a burrito into this tube.

Lex Fridman (30:25.980)

And we're a simple microscopic tube.

Lex Fridman (30:27.660)

And from there, we grow into this bigger and bigger tube

Lex Fridman (30:30.220)

and we become more complicated.

Lex Fridman (30:32.180)

And each end of the tube does split into various holes.

Lex Fridman (30:35.140)

So all the holes you mentioned at the front end of the tube,

Lex Fridman (30:37.180)

the front end of our body, right?

Jonathan Reisman (30:38.380)

It splits into the nose, the mouth, the ears, the sinuses,

Lex Fridman (30:42.340)

the tube to the lungs, which is the windpipe,

Jonathan Reisman (30:46.060)

the tube down to the stomach, which is the esophagus.

Lex Fridman (30:48.780)

And then the other end of the tube splits as well.

Jonathan Reisman (30:51.860)

Men end up with two holes and women end up with three holes.

Lex Fridman (30:56.760)

The urethra, the vagina, and the anus, and men.

Jonathan Reisman (30:59.620)

The urethra and kind of the reproductive system,

Lex Fridman (31:02.380)

they share a hole.

Lex Fridman (31:03.380)

So I'm learning a lot today.

Lex Fridman (31:05.860)

It really is incredible that you start from a sperm and an egg

Lex Fridman (31:10.200)

and you have some DNA information.

Lex Fridman (31:12.380)

And from that, the building project begins.

Lex Fridman (31:15.540)

And then what that leads to is like pizza dough

Lex Fridman (31:20.900)

and then you roll it into a tube.

Lex Fridman (31:24.120)

And that tube then eventually sort of becomes

Lex Fridman (31:29.460)

more and more complicated and gets eyes and a brain

Lex Fridman (31:34.660)

and then can create a Twitter account.

Lex Fridman (31:38.500)

So it's really incredible that we're just a fancy tube.

Jonathan Reisman (31:43.620)

Right, we are.

Lex Fridman (31:44.620)

And we sprout eyes and a brain and a sense of smell

Lex Fridman (31:48.200)

and taste pretty much to regulate what comes in

Lex Fridman (31:50.820)

the front of the tube.

Jonathan Reisman (31:52.220)

We don't wanna eat anything dangerous or poisonous.

Lex Fridman (31:55.300)

We wanna choose what we eat, even choose who we kiss.

Jonathan Reisman (31:58.500)

Well, we seem to be motivated by what comes out

Lex Fridman (32:01.140)

of the tube as well in part.

Jonathan Reisman (32:04.020)

That's not just output, it's a feedback mechanism seemingly.

Lex Fridman (32:07.900)

Like we're also monitoring the functioning of the output.

Jonathan Reisman (32:11.100)

We're not just obsessed about the input.

Lex Fridman (32:14.300)

We're very obsessed with the output.

Jonathan Reisman (32:15.700)

You're absolutely right about that.

Lex Fridman (32:17.940)

People have medical complaints about their output

Jonathan Reisman (32:21.460)

very often that are, I never cease to be surprised

Lex Fridman (32:24.880)

by a new kind of complaint or observation about the output.

Jonathan Reisman (32:28.060)

I think people have gone to wars over the output

Lex Fridman (32:32.360)

and maybe sometimes the lack of the output

Jonathan Reisman (32:35.020)

or the desire for output for the particular other humans

Lex Fridman (32:39.460)

that you fancy, the brain and the eyes that sprouted

Jonathan Reisman (32:44.380)

somehow convinced the rest of the body

Lex Fridman (32:48.140)

that this one particular other tube is fanciful.

Lex Fridman (32:51.820)

So you're going to go to major wars

Lex Fridman (32:53.440)

and lead global suffering because of the fancy

Lex Fridman (32:57.460)

and the desire for additional output with the other tube.

Lex Fridman (33:01.660)

Okay, so on the throat, that part of the tube,

Jonathan Reisman (33:09.500)

is it, you said the design is not,

Lex Fridman (33:13.580)

you could have thought of maybe a little bit better options

Jonathan Reisman (33:16.260)

because it's too multifunctional.

Lex Fridman (33:18.340)

Is that, can you sort of elaborate

Lex Fridman (33:20.820)

on the multifunctional nature of this part?

Lex Fridman (33:23.780)

Are a lot of parts of the human body multifunctional

Jonathan Reisman (33:26.460)

or do you find that more specialization

Lex Fridman (33:29.500)

is going to get the job done better?

Jonathan Reisman (33:32.260)

There is a lot of organs, for instance,

Lex Fridman (33:34.060)

do have multiple functions.

Jonathan Reisman (33:35.780)

The pancreas is like two organs in one.

Lex Fridman (33:39.540)

One secretes hormones like insulin into the bloodstream

Lex Fridman (33:42.460)

and the other aspect of it secretes digestive enzymes

Lex Fridman (33:45.940)

into the gut to help you digest and absorb food.

Jonathan Reisman (33:49.180)

The liver is like 15 organs in one.

Lex Fridman (33:51.060)

It's just amazing how many different things it does.

Lex Fridman (33:53.840)

But the throat, so basically the problem with the throat

Lex Fridman (33:57.500)

is as I said, we have two tubes

Jonathan Reisman (33:59.940)

that are right next to each other in the throat.

Lex Fridman (34:01.880)

One is for food, drink, saliva, mucus, snot,

Jonathan Reisman (34:05.420)

whatever you're gonna swallow,

Lex Fridman (34:07.120)

all of that stuff must go down the esophagus,

Jonathan Reisman (34:09.300)

the food tube and end up in the stomach.

Lex Fridman (34:11.460)

And right next to the esophagus millimeters away

Jonathan Reisman (34:14.460)

is the windpipe or the trachea,

Lex Fridman (34:16.340)

which goes down to the lungs.

Lex Fridman (34:18.420)

And your throat does these daily gymnastics

Lex Fridman (34:21.900)

to keep everything but air out of the windpipe

Jonathan Reisman (34:26.360)

because you slip up once and you can die.

Lex Fridman (34:30.240)

You can choke, you laugh or speak while eating

Lex Fridman (34:32.820)

and it's curtains, unfortunately.

Lex Fridman (34:35.100)

So it seems like every aspect of the body

Jonathan Reisman (34:37.400)

when I was learning about it in med school

Lex Fridman (34:38.820)

seemed so brilliant and so perfectly designed

Jonathan Reisman (34:42.660)

by evolution or whoever you might think designed it

Lex Fridman (34:46.340)

to favor survival, to enhance life,

Lex Fridman (34:51.660)

but the throat seemed the opposite.

Lex Fridman (34:53.700)

It seemed set up almost for failure.

Lex Fridman (34:56.700)

And we developed all these mechanisms as a compensation.

Lex Fridman (35:00.380)

We have the gag reflex whenever food or something

Jonathan Reisman (35:04.020)

is headed towards your air pipe, your windpipe

Lex Fridman (35:07.100)

or down to your lungs,

Jonathan Reisman (35:08.140)

your throat has this sort of like rejection of it.

Lex Fridman (35:10.660)

It pushes it away in a gag reflex.

Jonathan Reisman (35:13.180)

At the same time, we have a cough,

Lex Fridman (35:14.480)

which is something our body does

Jonathan Reisman (35:16.380)

when something inappropriate does get down the windpipe.

Lex Fridman (35:19.060)

When we get a little food down the wrong pipe,

Jonathan Reisman (35:22.260)

we end up coughing and the coughing does

Lex Fridman (35:24.780)

usually flush it out and get rid of it.

Jonathan Reisman (35:27.340)

We even have something called the mucus elevator

Lex Fridman (35:29.940)

in our lungs, which is this constant flow of mucus

Jonathan Reisman (35:33.740)

up the airways, up to the trachea, dragging with it

Lex Fridman (35:36.700)

all kinds of particulates that we've inhaled

Lex Fridman (35:38.780)

and perhaps some food that went down the wrong pipe

Lex Fridman (35:41.220)

and drags it up into the throat and we swallow it

Jonathan Reisman (35:44.260)

kind of unconsciously all day, every day is the truth.

Lex Fridman (35:47.120)

Even the mechanism of swallowing is super complicated.

Jonathan Reisman (35:50.140)

It uses a number of cranial nerves.

Lex Fridman (35:52.260)

It uses over 15 different muscles.

Jonathan Reisman (35:55.540)

It's this coordinated act to keep food out of the airway.

Lex Fridman (36:00.340)

You can see someone's Adam's apple in their neck

Jonathan Reisman (36:02.420)

kind of jump upward when they swallow,

Lex Fridman (36:05.160)

which helps lift the airway up against the epiglottis,

Jonathan Reisman (36:09.240)

which plugs it closed and allows food or swallow drink

Lex Fridman (36:13.000)

to kind of skirt just past it.

Lex Fridman (36:15.020)

But every time we swallow, those things do come

Lex Fridman (36:17.500)

within millimeters of going down the wrong pipe

Lex Fridman (36:19.780)

and it's just thanks to these kind of compensations,

Lex Fridman (36:22.420)

these adaptations we have to the danger of the throat

Jonathan Reisman (36:25.020)

that keeps us alive.

Lex Fridman (36:27.300)

As I actually took a sip of water,

Jonathan Reisman (36:30.380)

it's kind of, it makes you appreciate

Lex Fridman (36:34.260)

the wonderful machinery of it all.

Jonathan Reisman (36:36.960)

By the way, we have pulled up your Instagram

Lex Fridman (36:39.560)

that people should follow.

Jonathan Reisman (36:41.060)

You have a post about the throat

Lex Fridman (36:44.100)

and just showing so many different components

Jonathan Reisman (36:47.620)

from the tongue to the trachea, the esophagus,

Lex Fridman (36:52.320)

just the entire machinery of it all.

Jonathan Reisman (36:56.460)

The teeth for the chewing, it's so interesting.

Lex Fridman (37:00.420)

And so a lot of the structure of this,

Jonathan Reisman (37:02.780)

the anatomy and the physiology,

Lex Fridman (37:05.460)

does it echo other mammals?

Jonathan Reisman (37:07.900)

Are we just basically borrowing a lot of stuff

Lex Fridman (37:11.300)

from evolution and maybe making small adjustments

Jonathan Reisman (37:14.460)

maybe due to the fact that we're not using our mouth

Lex Fridman (37:17.260)

to murder things as other predators might?

Jonathan Reisman (37:22.460)

We use our thumbs.

Lex Fridman (37:23.740)

Exactly, we have hands, we don't need to bite them.

Jonathan Reisman (37:26.780)

Yeah, there's a lot of overlap between different animals

Lex Fridman (37:29.780)

which I find very comforting and fascinating.

Jonathan Reisman (37:32.900)

Someone asked me, is there any animal

Lex Fridman (37:34.660)

in which the throat is better designed?

Lex Fridman (37:36.620)

And my first thought was whales

Lex Fridman (37:38.500)

because the blowhole's kind of up on the top of their head.

Lex Fridman (37:40.700)

So I was thinking, oh, maybe they are more separate.

Lex Fridman (37:44.220)

But when I looked into it, actually no,

Jonathan Reisman (37:46.140)

the paths do come very close, just like in us.

Lex Fridman (37:48.900)

And I saw a paper about some new discovered organ

Jonathan Reisman (37:53.220)

that actually helps keep food and drink

Lex Fridman (37:55.300)

out of the airway in whales

Jonathan Reisman (37:56.700)

that they hadn't ever noticed before.

Lex Fridman (37:58.220)

So it's a different mechanism,

Lex Fridman (37:59.940)

but the same kind of basic problem is that

Lex Fridman (38:02.940)

we're tubes and the air tube and food tube

Jonathan Reisman (38:05.060)

are right next to each other.

Lex Fridman (38:06.500)

How well do we understand,

Lex Fridman (38:07.940)

so just even linger on this little part,

Lex Fridman (38:10.340)

is there still mysteries about the complexity

Lex Fridman (38:13.140)

of the system?

Lex Fridman (38:13.980)

You mentioned just even for swallowing

Jonathan Reisman (38:16.380)

all these parts in the brain that are responsible

Lex Fridman (38:18.500)

and all the different things that have to,

Jonathan Reisman (38:20.700)

like an orchestra play together.

Lex Fridman (38:22.740)

Do we have a good sense from both a medical perspective

Lex Fridman (38:26.300)

and a biology perspective or is there still mysteries?

Lex Fridman (38:29.060)

There's definitely still mysteries.

Jonathan Reisman (38:30.420)

We understand a lot about, for instance,

Lex Fridman (38:32.440)

how the swallowing mechanism is coordinated

Jonathan Reisman (38:35.860)

in the brainstem,

Lex Fridman (38:37.140)

sometimes using some higher levels of the brain,

Lex Fridman (38:40.100)

but it is a very thoughtless thing

Lex Fridman (38:42.020)

as you mentioned when you drank the water.

Jonathan Reisman (38:44.020)

It's not something we have to think about, thankfully,

Lex Fridman (38:45.840)

or we'd be thinking about it all day.

Jonathan Reisman (38:49.080)

There's a lot we don't understand

Lex Fridman (38:50.140)

about the basic mechanisms,

Jonathan Reisman (38:51.440)

perhaps about how the nerves fire

Lex Fridman (38:53.980)

and how they kind of coordinate on the microscopic level,

Lex Fridman (38:58.280)

how ions rush into and out of nerve cells

Lex Fridman (39:01.260)

to kind of create that electrical signal,

Lex Fridman (39:03.200)

but we sure understand a heck of a lot

Lex Fridman (39:05.700)

and it's very fascinating.

Jonathan Reisman (39:07.020)

So, moving on to chapter two and we'll jump around.

Lex Fridman (39:12.100)

And you actually said the liver does a lot of things.

Jonathan Reisman (39:17.180)

I also saw you retweet something

Lex Fridman (39:21.100)

where it said, you know,

Jonathan Reisman (39:23.420)

showing that the liver is bigger than the heart,

Lex Fridman (39:25.900)

which is the body or the universe's way of saying

Jonathan Reisman (39:28.980)

you should drink more and care less,

Lex Fridman (39:31.140)

which is a good line.

Jonathan Reisman (39:32.740)

So, you give props, like you said, to the kidney,

Lex Fridman (39:37.500)

to the liver, to the maybe, to the organs,

Jonathan Reisman (39:40.580)

to the parts that don't often get as much credit

Lex Fridman (39:44.020)

as they deserve, but let us go for time to the human heart.

Jonathan Reisman (39:50.260)

We get chest pain.

Lex Fridman (39:52.820)

We talk about it when we talk about love for some reason.

Lex Fridman (39:55.660)

Why do we talk about the heart when we talk about love?

Lex Fridman (39:58.660)

There sometimes can actually be

Jonathan Reisman (40:00.060)

some chest pain involved in love.

Lex Fridman (40:01.820)

I remember when I was a med student,

Jonathan Reisman (40:03.740)

I was very smitten with another medical student

Lex Fridman (40:06.780)

who was totally brilliant and beautiful.

Lex Fridman (40:09.260)

And it actually does cause

Lex Fridman (40:10.620)

this kind of burning in your chest.

Jonathan Reisman (40:12.540)

I don't know what that is.

Lex Fridman (40:13.900)

I don't think it's from the heart itself.

Jonathan Reisman (40:16.020)

I don't know if it was like acid reflux

Lex Fridman (40:17.740)

because I was so nervous.

Jonathan Reisman (40:18.580)

I'm not really sure,

Lex Fridman (40:20.020)

but I definitely felt something in my chest

Jonathan Reisman (40:22.500)

whenever I saw her.

Lex Fridman (40:23.660)

I don't know what that is,

Lex Fridman (40:24.700)

but you could see why someone might think,

Lex Fridman (40:26.740)

oh, you know, maybe it is your heart.

Jonathan Reisman (40:28.140)

That's kind of the most prominent organ in your chest.

Lex Fridman (40:30.620)

When people come to the ER with chest pain,

Lex Fridman (40:32.380)

the big question is, is it my heart?

Lex Fridman (40:33.940)

And that's my main job is figuring out if it is or not.

Lex Fridman (40:36.900)

So I could see why.

Lex Fridman (40:39.460)

The way ancients saw the functions of different organs

Jonathan Reisman (40:42.260)

is fascinating, but often hard to explain.

Lex Fridman (40:46.300)

Would it be fair to say

Jonathan Reisman (40:48.380)

that if you look at the entirety of human history,

Lex Fridman (40:51.100)

the way most people die has to do with the heart?

Jonathan Reisman (40:55.460)

Well, like in America today,

Lex Fridman (40:58.100)

cardiovascular disease and coronary artery disease

Jonathan Reisman (41:01.420)

is one of the most common,

Lex Fridman (41:02.540)

perhaps the most common cause of death.

Jonathan Reisman (41:04.780)

You know, 100 years ago, 200 years ago,

Lex Fridman (41:07.260)

it was probably not.

Jonathan Reisman (41:08.420)

People were not living as long

Lex Fridman (41:09.660)

and people were dying of infections

Jonathan Reisman (41:11.380)

that we tend to die less of these days.

Lex Fridman (41:14.180)

Sure, that's true, but in terms of things to stab,

Lex Fridman (41:18.940)

so I'm trying to sort of introspect

Lex Fridman (41:20.860)

like why talk about the heart and love?

Jonathan Reisman (41:24.540)

My thought would be that it's because

Lex Fridman (41:28.220)

the heart was seen as the most important organism.

Jonathan Reisman (41:31.740)

It would be like the origin of life comes from the heart.

Lex Fridman (41:35.740)

The originator of life and the way you figure that out

Jonathan Reisman (41:38.340)

from sort of an ancient perspective

Lex Fridman (41:40.620)

is when you stab things,

Lex Fridman (41:43.780)

what is likely to lead to issues?

Lex Fridman (41:46.120)

It's like, it's possible to imagine

Jonathan Reisman (41:48.140)

that the brain is not as special as we might think

Lex Fridman (41:50.980)

from when you don't understand modern biology

Jonathan Reisman (41:54.620)

or physiology or neuroscience, all those kinds of things,

Lex Fridman (41:58.660)

especially because pain, you know, it's painless too,

Jonathan Reisman (42:02.860)

if you stab it, the brain, I mean.

Lex Fridman (42:07.500)

Yeah, anyway, so that's really interesting.

Jonathan Reisman (42:09.880)

I'm sure there's a kind of a poetic answer to

Lex Fridman (42:13.460)

maybe the way people wrote about it,

Lex Fridman (42:15.240)

but what to you is the wisdom in the design of the heart?

Lex Fridman (42:20.240)

I mean, the main function of the heart basically

Jonathan Reisman (42:22.440)

is to push blood through the cardiovascular system,

Lex Fridman (42:25.240)

through the branching blood vessels

Jonathan Reisman (42:27.760)

to feed every cell in the body.

Lex Fridman (42:30.380)

You know, when I believe our ancestors

Jonathan Reisman (42:32.760)

started off as single celled organisms

Lex Fridman (42:34.640)

floating in some ancient brew,

Lex Fridman (42:37.300)

and they were surrounded by the medium

Lex Fridman (42:39.360)

that would bring them all the nutrients they needed,

Lex Fridman (42:41.040)

so there's no issues there.

Lex Fridman (42:42.520)

And then once you start getting multicellular organisms,

Jonathan Reisman (42:45.360)

the kind of that are thicker and the ones on the inside

Lex Fridman (42:47.760)

aren't in contact with that sort of nutritious brew

Jonathan Reisman (42:50.560)

that they're growing in,

Lex Fridman (42:52.280)

you kind of need a way to distribute those nutrients

Jonathan Reisman (42:54.720)

to every cell, and so that's what the heart

Lex Fridman (42:56.560)

and the branching vascular tree do.

Lex Fridman (42:58.560)

So the heart, you know, it's the biggest disconnect

Lex Fridman (43:02.440)

between how the organs talked about in poetry

Lex Fridman (43:04.560)

and through history versus its actual function

Lex Fridman (43:06.840)

is probably the heart,

Jonathan Reisman (43:07.800)

because we ascribe all these things like love and passion

Lex Fridman (43:11.000)

and life itself sometimes to the heart,

Lex Fridman (43:13.240)

but actually it's just a simple mechanical pump,

Lex Fridman (43:15.720)

you know, that's all it is.

Jonathan Reisman (43:17.160)

I don't wanna downplay it, it's amazing,

Lex Fridman (43:18.600)

but you know, it just pushes.

Jonathan Reisman (43:20.340)

It fills with blood and then squeezes it,

Lex Fridman (43:22.480)

fills with blood and squeezes it,

Lex Fridman (43:23.500)

and just that squeezing, that pushing,

Lex Fridman (43:25.180)

creates the blood pressure that you need

Jonathan Reisman (43:27.680)

to get blood to every cell in your body,

Lex Fridman (43:29.680)

especially when you're standing upright

Jonathan Reisman (43:31.120)

to get blood to your brain,

Lex Fridman (43:32.680)

you need a certain amount of pressure to get it up there.

Jonathan Reisman (43:35.440)

Isn't it amazing to you how much volume of blood

Lex Fridman (43:39.240)

just gets pushed through by this pump?

Jonathan Reisman (43:42.920)

Absolutely, they say every red blood cell

Lex Fridman (43:45.080)

takes about five minutes to circulate

Lex Fridman (43:47.240)

and come back to the heart,

Lex Fridman (43:48.760)

and that circulation kind of starts in the womb

Lex Fridman (43:52.040)

and continues kind of until the moment that we die,

Lex Fridman (43:55.520)

but the volume is tremendous,

Lex Fridman (43:56.820)

and it can never take a break, basically.

Lex Fridman (44:00.120)

And it's sort of propagating all kinds of stuff

Jonathan Reisman (44:03.840)

throughout the body, it's a delivery mechanism,

Lex Fridman (44:06.080)

blood for all kinds of good stuff and bad stuff,

Jonathan Reisman (44:09.680)

nutrition, drugs, all that.

Lex Fridman (44:13.760)

Right, medications too.

Jonathan Reisman (44:15.200)

Medications, such a fascinating design.

Lex Fridman (44:19.000)

And it also takes the waste away,

Jonathan Reisman (44:21.040)

it kind of brings the nutritious stuff,

Lex Fridman (44:22.920)

brings the nutrients, especially oxygen,

Lex Fridman (44:24.600)

but many other things, and then it also,

Lex Fridman (44:26.840)

as it passes the cell, takes the cell's waste,

Lex Fridman (44:29.060)

so it's sort of the fresh water

Lex Fridman (44:30.960)

and the sewage system in one.

Lex Fridman (44:33.480)

So about blood, what do you use fascinating about blood?

Lex Fridman (44:38.840)

So we talk about the pump that spreads the blood,

Lex Fridman (44:41.760)

but the blood itself.

Lex Fridman (44:43.200)

Right, so the blood itself is sort of,

Jonathan Reisman (44:44.920)

I mean, it's the most important bodily fluid, of course.

Lex Fridman (44:48.040)

From moment to moment, every cell in the body

Jonathan Reisman (44:50.400)

needs a flow of blood to bring it,

Lex Fridman (44:54.160)

most importantly, oxygen, but also, again,

Jonathan Reisman (44:56.120)

all the other nutrients and to take away waste,

Lex Fridman (44:57.980)

and if that stops for even a few moments,

Jonathan Reisman (45:00.220)

you can be in big trouble.

Lex Fridman (45:02.360)

So blood is sort of the most important medium.

Jonathan Reisman (45:05.740)

It's also, doctors use it to kind of evaluate the body.

Lex Fridman (45:09.280)

It does have this kind of all seeing quality to it,

Jonathan Reisman (45:12.580)

where we can evaluate organs through the blood.

Lex Fridman (45:16.740)

I can tell you about your liver, your heart, your kidney

Jonathan Reisman (45:18.920)

just by taking a sample of your blood.

Lex Fridman (45:21.240)

So it's sort of like this crystal ball in a way,

Lex Fridman (45:23.860)

and we use it kind of all the time

Lex Fridman (45:26.000)

to assess someone's health, to assess their disease.

Jonathan Reisman (45:29.080)

Is it also the attack vector for diseases,

Lex Fridman (45:34.540)

for bacteria, for viruses and all that kind of stuff?

Lex Fridman (45:37.720)

So viruses seem to attack either the throat,

Lex Fridman (45:40.500)

maybe you can correct me,

Lex Fridman (45:41.520)

but they seem to attack different parts of the body,

Lex Fridman (45:44.140)

depending on how easy it is to access

Lex Fridman (45:46.180)

and how easy it is to get in deep,

Lex Fridman (45:50.560)

depending on what you prefer.

Jonathan Reisman (45:52.280)

If you want to do a little bit of hard work,

Lex Fridman (45:54.400)

but you get in deep,

Jonathan Reisman (45:55.880)

or you don't want to do the hard work,

Lex Fridman (45:58.520)

but you don't get in deep,

Jonathan Reisman (45:59.840)

those are the choices viruses have.

Lex Fridman (46:01.320)

But is blood one of the sort of attack vectors?

Jonathan Reisman (46:04.340)

What's like, if you were trying to break into the human body,

Lex Fridman (46:07.340)

like a parasite, a virus, a bacteria, how would you do it?

Lex Fridman (46:13.040)

Like what would be the attack vectors you would explore?

Lex Fridman (46:16.240)

Right, so you got to look for the body's weaknesses,

Jonathan Reisman (46:18.140)

of course, you know, we have inherent weaknesses,

Lex Fridman (46:21.040)

for instance, like our respiratory tract,

Jonathan Reisman (46:22.880)

we have to breathe,

Lex Fridman (46:23.880)

we have to get air in from the outside.

Lex Fridman (46:26.640)

And so that's one of the entries into the body.

Lex Fridman (46:28.640)

And so, you know, when we inhale,

Jonathan Reisman (46:30.520)

let's say a poisonous gas, you know,

Lex Fridman (46:32.360)

it's an easy way in, you have to breathe,

Jonathan Reisman (46:34.440)

can't hold your breath very long,

Lex Fridman (46:35.880)

but, you know, air in our lungs is still kind of contiguous

Jonathan Reisman (46:39.800)

with the external atmosphere,

Lex Fridman (46:41.360)

it's not really inside the body until it does cross

Jonathan Reisman (46:44.440)

across the lining of the alveoli into the blood,

Lex Fridman (46:47.400)

as you said, that's when it really gets inside.

Lex Fridman (46:49.960)

And the other besides the respiratory tract,

Lex Fridman (46:51.460)

the gastrointestinal tract is another way,

Jonathan Reisman (46:53.940)

kind of a chink in the armor,

Lex Fridman (46:55.160)

you know, we have to eat, we have to drink,

Lex Fridman (46:57.480)

and therefore we're taking the external world

Lex Fridman (46:59.400)

into ourselves, into our gut,

Jonathan Reisman (47:01.320)

in order to extract from it what we need

Lex Fridman (47:03.120)

and let the rest kind of flow out.

Lex Fridman (47:05.340)

So those two, the gastrointestinal and respiratory tract,

Lex Fridman (47:08.080)

you know, there's a reason that, you know,

Jonathan Reisman (47:09.440)

respiratory tract infections

Lex Fridman (47:11.280)

and gastrointestinal infections are kind of the most common

Jonathan Reisman (47:14.200)

that afflict us because those are the ways in to the body.

Lex Fridman (47:17.780)

So I would definitely pick one of those,

Jonathan Reisman (47:20.120)

not just be a lazy cold in the nose,

Lex Fridman (47:22.080)

but really a more aggressive pneumonia down deep

Jonathan Reisman (47:24.440)

in the lungs and get across that barrier into the blood.

Lex Fridman (47:27.040)

But also the whole sex thing that humans do.

Lex Fridman (47:32.040)

So speaking of which, let us go for time

Lex Fridman (47:36.200)

to the genitals chapter.

Lex Fridman (47:38.440)

So what are genitals?

Lex Fridman (47:41.280)

I think I've heard of those.

Jonathan Reisman (47:43.360)

I think I've read about a penis and a vagina.

Lex Fridman (47:45.960)

Can you explain to me how those work?

Jonathan Reisman (47:48.920)

Just asking for a friend,

Lex Fridman (47:50.200)

but also what do you use fascinating about it

Lex Fridman (47:54.200)

and maybe what's misunderstood or little known about them?

Lex Fridman (47:58.820)

Sure, so they're very unique organs, I would say.

Jonathan Reisman (48:03.420)

One of the things that I like to point out is that,

Lex Fridman (48:06.060)

you know, while every organ from moment to moment

Jonathan Reisman (48:08.660)

keeps us alive and ensures our survival,

Lex Fridman (48:10.820)

the genitals are in a way the opposite.

Jonathan Reisman (48:12.740)

You know, we don't need them from moment to moment.

Lex Fridman (48:15.660)

You don't even have to use them at all.

Lex Fridman (48:17.420)

And in fact, they often make us do stupid things

Lex Fridman (48:20.020)

that are the opposite of kind of enhancing survival.

Jonathan Reisman (48:23.100)

So, and they, you know, they've affected the brain

Lex Fridman (48:26.420)

and you can become sort of focused and nuts

Jonathan Reisman (48:29.140)

based on those desires that kind of stem from the genitals.

Lex Fridman (48:31.940)

So they can be dangerous organs too.

Lex Fridman (48:34.920)

But you know, I mean, sexual dimorphism

Lex Fridman (48:36.860)

helps with genetic variability,

Jonathan Reisman (48:39.540)

as it does in so many other organisms.

Lex Fridman (48:41.560)

You know, you take two people

Lex Fridman (48:42.780)

and mix them together, their genetics,

Lex Fridman (48:44.320)

you just get a lot more variation

Lex Fridman (48:46.100)

and more opportunities to try different genetic codes

Lex Fridman (48:50.460)

and see what'll enhance survival

Jonathan Reisman (48:52.180)

as we talked about sex and death.

Lex Fridman (48:54.380)

I talk about in the book, a lot of,

Jonathan Reisman (48:55.980)

for instance, the female genital tract,

Lex Fridman (48:57.740)

how the uterus is very unusual

Jonathan Reisman (49:00.100)

because, you know, it doesn't even sort of wake up

Lex Fridman (49:02.780)

and start doing its thing until the second decade of life.

Jonathan Reisman (49:05.540)

You know, it's even though babies,

Lex Fridman (49:09.500)

female babies are born with all of the eggs

Jonathan Reisman (49:12.140)

they'll ever have in their ovaries already.

Lex Fridman (49:14.260)

They're just sort of in this stasis

Jonathan Reisman (49:15.940)

until they start waking up kind of once a month.

Lex Fridman (49:18.980)

And it's this cycle, you know,

Jonathan Reisman (49:20.480)

there's so much in our bodies that are cyclical and rhythmic,

Lex Fridman (49:23.060)

the heartbeat, the breathing, but menstruation

Jonathan Reisman (49:26.240)

is kind of a very strange rhythm

Lex Fridman (49:28.660)

that takes over a decade to start.

Lex Fridman (49:31.360)

And only, you know, the rhythm beats once a month,

Lex Fridman (49:34.140)

which is very slow compared

Jonathan Reisman (49:35.740)

to every other rhythm of the body.

Lex Fridman (49:37.520)

The other unusual thing is, you know, in medicine,

Jonathan Reisman (49:40.380)

when rhythms of the body cease, when they stop,

Lex Fridman (49:43.320)

those are emergencies, right?

Jonathan Reisman (49:44.780)

When your heart stops, that's a cardiac arrest.

Lex Fridman (49:47.060)

You need CPR, maybe an electric shock to restart it.

Jonathan Reisman (49:50.200)

When your breathing stops, you know,

Lex Fridman (49:51.980)

you need a breathing machine to breathe for you

Jonathan Reisman (49:53.740)

or something to reverse whatever might be causing

Lex Fridman (49:56.100)

the suppression of your breathing.

Lex Fridman (49:58.100)

But when menstruation stops,

Lex Fridman (49:59.980)

it's the point of menstruation in the first place.

Jonathan Reisman (50:03.500)

The whole reason that the uterus grows a lining

Lex Fridman (50:06.180)

and sheds it each month is to one day, you know,

Jonathan Reisman (50:09.380)

get fertile, the ovum to get fertilized

Lex Fridman (50:11.700)

and for it to implant in the lining,

Lex Fridman (50:13.460)

and then the rhythm ceases.

Lex Fridman (50:14.540)

And that's obviously not a medical emergency,

Jonathan Reisman (50:16.620)

unlike most other rhythms, you know, cessations,

Lex Fridman (50:19.140)

it's the point of the whole thing in the first place.

Lex Fridman (50:21.520)

So these particular penis and vagina are that whole thing,

Lex Fridman (50:25.900)

the uterus, whatever.

Lex Fridman (50:26.940)

Am I not using the wrong terms?

Lex Fridman (50:28.980)

I don't know.

Jonathan Reisman (50:29.820)

I'll just keep saying.

Lex Fridman (50:31.100)

You use those terms.

Jonathan Reisman (50:32.220)

There's more technical, there's parts, various, various parts.

Lex Fridman (50:35.320)

In medical school, you learn every bump

Jonathan Reisman (50:38.020)

and, you know, every little part of every little organ

Lex Fridman (50:41.260)

including the genitals, so.

Jonathan Reisman (50:43.860)

I never really thought of it this way, as you said,

Lex Fridman (50:47.900)

is that most organs are kind of full time employees.

Jonathan Reisman (50:51.500)

Like 24 seven, they're doing something.

Lex Fridman (50:54.300)

And then there's some organs,

Jonathan Reisman (50:57.540)

penis, vagina being representative of this,

Lex Fridman (51:00.940)

they're not functioning all the time.

Jonathan Reisman (51:03.300)

They're only functioning every once in a while

Lex Fridman (51:05.420)

and then get us to do stupid stuff or awesome stuff

Lex Fridman (51:08.540)

and all that kind of stuff.

Lex Fridman (51:09.580)

But they're not essential for human survival

Jonathan Reisman (51:11.740)

on a second by second basis.

Lex Fridman (51:14.260)

And that the whole cyclical nature of the human body,

Lex Fridman (51:18.340)

how many other cycles are on a monthly basis?

Lex Fridman (51:20.940)

Like that far apart.

Jonathan Reisman (51:23.420)

That's a fascinating design

Lex Fridman (51:25.860)

that the human body would do that

Lex Fridman (51:27.140)

and wouldn't start until the second decade of life.

Lex Fridman (51:32.500)

It's almost like, what do I want to say?

Jonathan Reisman (51:35.780)

There's some kind of meta planning going on.

Lex Fridman (51:39.980)

Like this is the optimal solution

Jonathan Reisman (51:41.940)

for the sexual selection mechanism

Lex Fridman (51:44.460)

among like somewhat intelligent species.

Jonathan Reisman (51:48.420)

Like it's useful to after the brain has developed

Lex Fridman (51:53.380)

sufficiently long to now be making

Jonathan Reisman (51:57.100)

sexual selection decisions.

Lex Fridman (51:58.940)

Like you need time for this computer,

Jonathan Reisman (52:01.540)

this really powerful computer to load in the info.

Lex Fridman (52:05.780)

Interesting.

Jonathan Reisman (52:06.620)

You also need the body to develop.

Lex Fridman (52:08.420)

A child simply isn't big enough

Jonathan Reisman (52:10.780)

to be pregnant and deliver another baby.

Lex Fridman (52:14.400)

I wonder if there's animals in which this happens

Jonathan Reisman (52:16.540)

at a much more accelerated pace in different stages.

Lex Fridman (52:19.260)

Definitely, especially certain kinds of insects,

Jonathan Reisman (52:21.700)

like Drosophila, a lot of the fruit fly,

Lex Fridman (52:25.380)

a lot of experiments are done on

Jonathan Reisman (52:26.660)

because their life cycle is so rapid.

Lex Fridman (52:28.780)

A lot of kind of insects and other creatures

Jonathan Reisman (52:31.420)

are almost ready to mate as soon as they're born.

Lex Fridman (52:34.580)

Not us.

Jonathan Reisman (52:35.640)

Not us.

Lex Fridman (52:36.660)

Is there any improvements to the design?

Lex Fridman (52:42.820)

So a lot of people are very interested

Lex Fridman (52:45.420)

in these particular body parts.

Jonathan Reisman (52:47.820)

If you were to sort of step back

Lex Fridman (52:49.660)

as a geneticist, biological designer,

Jonathan Reisman (52:52.980)

or maybe a computer scientist, computer engineer

Lex Fridman (52:55.500)

trying to build human 2.0 or maybe a robot,

Lex Fridman (53:00.660)

how would you improve the penis and the vagina?

Lex Fridman (53:05.380)

Well, the penis for starters,

Jonathan Reisman (53:06.780)

I mean, let's also discuss the testicles.

Lex Fridman (53:09.460)

They're very important too.

Jonathan Reisman (53:10.820)

I mean.

Lex Fridman (53:11.660)

Okay, so they're fragile and they're important

Lex Fridman (53:14.740)

and yet they're hanging off the body in danger basically.

Lex Fridman (53:18.060)

So does that make sense?

Jonathan Reisman (53:20.260)

You know, they begin in the womb,

Lex Fridman (53:22.000)

they begin inside the abdomen and they slowly descend

Lex Fridman (53:25.260)

and sometimes before birth,

Lex Fridman (53:26.620)

sometimes in the first year of life, sometimes never,

Jonathan Reisman (53:29.100)

they pop out of the body and end up hanging in the scrotum.

Lex Fridman (53:32.700)

There's a reason because the chemical reactions

Jonathan Reisman (53:35.060)

that create sperm function best

Lex Fridman (53:37.700)

at a few degrees cooler than body temperature.

Lex Fridman (53:40.860)

And so that's why you might notice in the warm weather,

Lex Fridman (53:44.620)

they might hang further down and in the cold weather,

Jonathan Reisman (53:47.540)

they scrunch themselves up to get closer to the body

Lex Fridman (53:50.340)

to maintain that ideal temperature a few degrees cooler.

Lex Fridman (53:55.160)

So it's hard, you know,

Lex Fridman (53:56.240)

if you could create a sperm production mechanism

Jonathan Reisman (53:58.280)

that did not rely on that lower temperature,

Lex Fridman (54:00.100)

that would be great.

Jonathan Reisman (54:00.940)

Keep them inside the body protected like the ovaries are.

Lex Fridman (54:04.940)

Oh, then you wouldn't rely on the lower temperature.

Jonathan Reisman (54:07.140)

I thought you meant create some kind of weird internal

Lex Fridman (54:10.780)

cooling mechanism.

Jonathan Reisman (54:11.940)

No, well, I guess that would be one solution,

Lex Fridman (54:14.500)

but just maybe a different type of chemical reaction

Jonathan Reisman (54:17.580)

or, you know, would not be reliant

Lex Fridman (54:19.660)

on the lower temperature, let's say.

Jonathan Reisman (54:21.860)

You know, it'd be great to design a spermatogenesis

Lex Fridman (54:25.140)

or a sperm production process that would function best

Jonathan Reisman (54:28.460)

at body temperature and then we can keep

Lex Fridman (54:30.460)

those delicate organs inside the body

Lex Fridman (54:32.540)

and not have them hanging out in danger.

Lex Fridman (54:35.180)

Or maybe the argument for this design

Jonathan Reisman (54:37.780)

is maybe it's nice to put them in danger

Lex Fridman (54:42.380)

so you are constantly concerned about it.

Jonathan Reisman (54:46.100)

Could be, maybe that's beneficial for male psychology,

Lex Fridman (54:49.100)

I'm not really sure.

Jonathan Reisman (54:50.140)

There's a psychological element here

Lex Fridman (54:51.620)

about the evolution that could be.

Lex Fridman (54:53.340)

So that's the testicles.

Lex Fridman (54:56.540)

Penis?

Lex Fridman (54:58.780)

A better way to do it, you know?

Lex Fridman (55:00.460)

I mean, it's pretty good as it is.

Jonathan Reisman (55:03.060)

You know, it kind of, when it's time for it to work,

Lex Fridman (55:05.740)

it grows and stiffens and when it's time for it not to work,

Jonathan Reisman (55:08.980)

it kind of shrinks and hangs out.

Lex Fridman (55:12.940)

Saw this on a Seinfeld episode, so I know how it works.

Jonathan Reisman (55:17.300)

Shrinkage.

Lex Fridman (55:18.220)

Yeah, that was a good one.

Lex Fridman (55:19.460)

But you know, that's also a bit unique,

Lex Fridman (55:22.980)

I suppose, that the way it has this erectile tissue.

Jonathan Reisman (55:26.580)

Actually, they're similar in the mouth

Lex Fridman (55:29.260)

of certain baleen whales, there's a certain similar

Jonathan Reisman (55:32.880)

kind of erectile tissue that helps cool them off

Lex Fridman (55:37.620)

because they have so much blubber

Lex Fridman (55:39.780)

and create so much heat in moving around and feeding

Lex Fridman (55:42.660)

that they have actually a similar,

Jonathan Reisman (55:44.020)

similar to the penis organ in their mouth

Lex Fridman (55:45.700)

that helps cool their bodies, because it's a big problem.

Jonathan Reisman (55:48.140)

They have to store all that blubber for fuel,

Lex Fridman (55:51.020)

but it makes them too hot, so as a compensation,

Jonathan Reisman (55:53.140)

they have this kind of erectile organ in their mouth.

Lex Fridman (55:55.320)

Okay.

Lex Fridman (55:57.540)

What about vagina?

Lex Fridman (55:59.160)

You know, the fact that miscarriages sometimes happen

Jonathan Reisman (56:02.900)

because of sexually transmitted diseases,

Lex Fridman (56:05.800)

because of trauma, you know, it'd be great

Jonathan Reisman (56:08.060)

if the uterus where the growing fetus is

Lex Fridman (56:11.340)

is sort of even more protected from those things.

Jonathan Reisman (56:15.760)

You know, I guess that's a side effect of the fact

Lex Fridman (56:18.680)

that people still have sex when they're pregnant

Jonathan Reisman (56:20.820)

or still, you know, exposed to injury.

Lex Fridman (56:23.200)

If there was a way to make it more protected,

Jonathan Reisman (56:25.420)

perhaps that would be even better.

Lex Fridman (56:27.500)

I did see an article recently about artificial wombs,

Jonathan Reisman (56:30.500)

which are rapidly becoming a reality,

Lex Fridman (56:33.740)

and in animal studies, they're able to prolong

Jonathan Reisman (56:36.540)

the gestation of a fetus by a month in an artificial womb.

Lex Fridman (56:40.780)

Can you explain the artificial aspect

Lex Fridman (56:42.740)

of the artificial womb?

Lex Fridman (56:43.700)

Sure, it's, I believe it acts almost

Jonathan Reisman (56:46.860)

like a heart lung bypass machine,

Lex Fridman (56:49.120)

so when someone's getting like bypass surgery,

Jonathan Reisman (56:51.980)

their heart is stopped, literally they throw ice

Lex Fridman (56:54.460)

in the chest and they give a potassium infusion

Jonathan Reisman (56:58.240)

through the blood, which stops the heart,

Lex Fridman (57:01.040)

but the blood is run through a machine

Jonathan Reisman (57:04.220)

that basically does the work of the heart

Lex Fridman (57:07.100)

and lungs together, gets oxygen into the blood

Lex Fridman (57:09.380)

and then pushes it back into the body.

Lex Fridman (57:11.820)

So I believe it's a sort of similar mechanism

Jonathan Reisman (57:14.100)

to keep blood and nutrition flowing to this fetus,

Lex Fridman (57:18.140)

and so it's just not inside the body of a parent,

Jonathan Reisman (57:20.900)

it's in some kind of other device,

Lex Fridman (57:23.340)

but I think that science is gonna rapidly improve.

Jonathan Reisman (57:27.180)

One benefit is, you know, babies are born premature,

Lex Fridman (57:29.960)

and while, you know, neonatology is able

Jonathan Reisman (57:33.140)

to continuously kind of lower the age of viability

Lex Fridman (57:36.140)

through better technology and understanding

Jonathan Reisman (57:38.060)

how, what you can, medicines and other things

Lex Fridman (57:40.700)

you can do to premature babies when they're born,

Jonathan Reisman (57:42.940)

you know, ideally, if let's say premature labor begins,

Lex Fridman (57:46.220)

you can't stop it, that baby's coming out one way

Jonathan Reisman (57:49.260)

or the other, if you could just then stick it

Lex Fridman (57:50.860)

into an artificial womb where it can continue

Jonathan Reisman (57:52.740)

its development, that would save a whole host

Lex Fridman (57:55.580)

of problems, often those babies born very early

Jonathan Reisman (57:57.820)

suffer from damage to various organs,

Lex Fridman (58:00.540)

including the brain, you know, for the rest of their life,

Lex Fridman (58:02.580)

so that could be a very important technology.

Lex Fridman (58:04.980)

So some aspects of the human body,

Jonathan Reisman (58:07.760)

we can develop technologies that outsource them,

Lex Fridman (58:10.380)

sort of offload some of the stress

Lex Fridman (58:16.140)

and the workload from the human body to do it elsewhere.

Lex Fridman (58:19.780)

Like dialysis does that for kidneys, you know,

Jonathan Reisman (58:21.820)

people can live decades without kidneys

Lex Fridman (58:25.220)

as long as they get dialysis, which does the work for them.

Jonathan Reisman (58:29.020)

Not every organ can do that, for instance,

Lex Fridman (58:31.180)

the liver, there's no dialysis version for the liver,

Jonathan Reisman (58:34.180)

like if your liver fails, you need a liver transplant

Lex Fridman (58:36.940)

and that's the only thing that's gonna do it for you.

Lex Fridman (58:40.620)

So that's the world's first artificial womb for humans

Lex Fridman (58:45.620)

and we're looking at a picture of what looks like

Jonathan Reisman (58:48.580)

gigantic balloons.

Lex Fridman (58:50.300)

Matrix, here we come.

Jonathan Reisman (58:51.900)

This is very matrixy.

Lex Fridman (58:53.740)

How are they floating?

Lex Fridman (58:55.420)

What are we even looking at?

Lex Fridman (58:57.220)

There's giant red spheres.

Jonathan Reisman (59:00.340)

This really looks like the matrix.

Lex Fridman (59:03.860)

I wonder where it's from,

Lex Fridman (59:04.740)

so there seems to be a paper on this too.

Lex Fridman (59:07.660)

I don't know too much about it, but I did see that there,

Jonathan Reisman (59:10.620)

it's advancing very rapidly.

Lex Fridman (59:12.740)

The world's first artificial womb for humans.

Jonathan Reisman (59:14.940)

Scientists in the Netherlands say they're within 10 years

Lex Fridman (59:18.700)

of developing an artificial womb

Jonathan Reisman (59:20.340)

that could save the lives of premature babies.

Lex Fridman (59:22.920)

Premature birth before 37 weeks is globally

Jonathan Reisman (59:25.420)

the biggest cause of death among newborns,

Lex Fridman (59:27.640)

but the development also raises ethical questions

Jonathan Reisman (59:31.340)

about the future of baby making and so on and so forth.

Lex Fridman (59:36.260)

Wow, we're going to be facing a lot of ethical questions

Jonathan Reisman (59:41.380)

as we start to mess with human biology.

Lex Fridman (59:45.780)

In an effort to help human biology,

Jonathan Reisman (59:50.460)

we might start to mess with it.

Lex Fridman (59:52.540)

That's going to be very interesting.

Jonathan Reisman (59:54.540)

Let's take steps towards the matrix.