Debating The Value Of Eastern Medicine (Ayurveda) | Healthy Gamer Dr. K

Debating The Value Of Eastern Medicine (Ayurveda) | Healthy Gamer Dr. K



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00:00 Intro
01:30 Risks Of YouTube Medicine / Mental Health Stigma
27:25 Mindfulness and Enlightenment
32:30 Ayurvedic Medical Tests
54:45 The Weaknesses Of Ayurveda
01:11:10 Why Ayurveda Is So Popular
01:21:26 Why I Don’t Like Ayurveda
1:39:00 The Advantage of Ayurveda / Placebos
1:56:32 How Much Time Matters
2:07:26 How Do We Know “Thought” Exists?

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– What frustrates you so much
about Ayurvedic medicine? – It leads to a fundamental
misunderstanding of healthcare. It opens room for health gurus and hucksters to take advantage of people. – Now I'm understanding this
conversation a lot better. So, I noticed that this was
becoming very antagonistic, which was really weird, because I actually agree with the majority of what you're saying. I'm not talking to someone
who has an open mind. – If you presented some data or information here that showed Ayurvedic
medicine is way more accurate than you think it is, I
would've changed my mind today. Dr. K, more commonly known by
his channel tag, HealthyGamer, is a popular psychiatrist who has found success online educating on the intersection of
mental health and gaming. He has a viral twitch stream where he interviews creators about their spiritual and
mental health, myself included. Today, we are planning to dive in and speak about his new book, “How to Raise a Healthy
Gamer,” which is available now, but we actually found ourselves in a somewhat contentious discussion about Ayurvedic medicine. Ayurveda is an ancient
Indian medical system based on ancient writings
that rely on a natural and holistic approach to
physical and mental health. For what it's worth, I think as an expert, Dr. K's one of the most honest, if not the most honest voice
when discussing the benefits and harms of Ayurvedic practice. So I was ecstatic to speak and learn about what's
valuable verse what's not about the Eastern practice, I actually learned a lot
in this conversation, and I hope you will too. Dr. K. – Dr. Mike. – It's very rare that I
sit in front of someone who has significantly more experience discussing health to a
huge audience online, because there's not many
people doing it, period. But to do it for the amount
of time that you've done it, not just years that you've been online, but also when you stream, you spend a lot more hours
in front of the audience. For me, when I make
content online, you know, we hyper edit a fast-paced
moving video, 10, 15 minutes. Now I'm entering a little bit
more into the podcast space. How do you do it and not get in trouble? – So I, you know, it's a great question. So we'll see how much trouble I get into. – Well, let's get into
troubles today, that'll be fun. – And so I think a couple of
things to keep in mind, right? So I think just being super
careful about what you say, what you don't say, I think steering clear
of, like, medical advice. So I think what I, the way
that I kind of frame things is when I make content online, I almost think about my target
audience as, like, residents. So, if I'm talking about,
let's say, a clinical condition like borderline personality disorder, I frame it in the way of, “Okay, if I was teaching
a group of residents or medical students or even pre-meds, how would I explain this condition?” So that's really what we,
what I usually think about. And then I'll prepare lectures and just keeping it more educational. – What about when you're having
conversations with a guest? And I've struggled with this myself a lot. I've had difficult
conversations on this podcast where someone brings
up either a past trauma or you could see that they
wanna talk about a past trauma, and I get uncomfortable, and I'll explain what I
mean by uncomfortable, that I don't want to become
their doctor on camera, right? So I know what next question
my doctor mind wants to ask, but I also need to be hyper aware that I don't ask that question
and become their doctor. So how do you kind of ride that line and make sure you're doing this ethically? – Yeah, so it's a great question. So I think we have a pretty rigorous informed consent process that
not many people are aware of. So, you know, most people will
see, like, the final product, but we go through a rigorous
informed consent process. We also have, like, a
boundary setting call at the, before we meet someone, or we offer a boundary setting call for anyone who wants to
take advantage of it. And that usually is a
chance for people to say, “We don't wanna talk about this,” or, “I do want to talk about this.” And I think the main thing to keep in mind is that if you think about
your job as a physician, you know, the process of
a diagnostic interview is very different. So it's, you're usually thinking about what are these, the alternate diagnoses, you exclude certain kinds of things. You assess every patient. So for example, like,
for psychiatric intakes, we assess for suicidality, homicidality, you know, psychotic symptoms. So if you really look at
the process of diagnosis, it's not just talking to
someone about their life, it's literally assessing for
any number of conditions. And I think that's where the,
it gets a little bit tricky, because talking to
someone about their life, which is usually what we do, and then sometimes we'll also
educate about conditions. So there's absolutely,
like, a concern there. I think we try to get through it by using a rigorous
informed consent process, really taking a more educational approach. And it seems to have
worked pretty well so far. – Yeah, I, there's many times where I know that there's a question to be asked that will be very powerful and
would create some emotions, but it feels manipulative
to ask it if you will. – Yes.
– So I'm like, “Ugh, I don't think I should do it, because I don't think this is, now I'm crossing that boundary.” And I can even talk about a specific episode where that happened. I was interviewing Steve-O and he was talking about his childhood, and he was talking about
how it's impacted him and his decision-making to
be a daredevil on “Jackass.” And I, there was probing
that I wanted to do to figure out how he got to
this place where he's at, but I felt, like, if I did that, I would be putting my doctor hat on. Do you agree with that notion, or do you think I, that's a safe space? – So, I think we have, we
have a challenge, right? So, like, everyone says, so we
have a mental health crisis, suicide rates are increasing,
depression, anxiety. We're seeing an evening out of body dysmorphia between men and women. We're seeing an even out of
ADHD, equality in all things. So we've got this mental health crisis, and the question is why, right? And this is where we have,
you know, organizations that will advocate for
de-stigmatization of mental illness. So the question becomes
how do we do that, right? So now, because mental illness
is a little bit different, because we've been so
careful about talking about, which I'm all for, right? So I don't conduct clinical interviews, I never have my patients on
stream or anything like that. And at the same time, like, what is de-stigmatizing mental
illness literally look like, like, how do we do that? So people can have awareness campaigns, which is, like, fine, but I
don't think that that's worked because that's what we've been doing, and this mental health crisis has happened on the watch of everyone who is focused on public health, medicine or whatever, right? We've got advances in neuroscience, we've got all this kind of stuff, and it's not working quite
the way it's supposed to. So part of what I think
is really important is that if we sort of think about it, and we think about the concept of mental health, like, equity, right? So physical illness and mental illness should not be treated differently. So a lot of people, like, would you be thinking that question if you were talking to someone about their experience of
being a cancer survivor? Right, so we don't have
those same hesitations if someone has a heart
attack or if someone, you know, has a complication with labor or is raising a special needs child. We're not, like, very, very
touchy feely about that. We're open to discussing
some of our struggles if people feel comfortable.
– Of course. – And the whole point is, I think that's the way we
should be around mental illness is that people should be able to discuss, “Hey, I struggled with this. I struggled with anxiety,
I struggled with trauma. Here's my story.” And then to also recognize
that the practice of medicine is different from talking
about your experience of life. And so the North Star that we try to use is people should be able to come on and talk about whatever they
feel comfortable talking about, that we don't wanna say, oh,
we don't wanna put guardrails that, “Okay, you can talk about
your difficulties at work, but the moment that you mention something that touches mental illness, we're actually gonna muzzle you.” Because that's sort of
what goes on right now. And, like, no wonder we have
a stigma on mental illness when literally no one talks about it. – I guess I have two follow ups on that, one, for the mental
health stigma of it all. I definitely think that if
you look back 30, 40 years, it was viewed as a weakness. If you talked about mental health, if you said you had a mental health issue, you were labeled certain
adjectives that were not nice. Is that the sole reason that we have, or the major reason
that we have this spike in mental health conditions
and diagnoses right now? – Not at all. I mean, I don't think,
nothing is sole reason. – Well, majority, like, the
heaviest reason if you will. – So, I think it's a big reason, right? So if we sort of think about, let's look at, like, men for instance. So men are very reluctant
to engage in psychotherapy. Like, historically, 70% of
patients have been women, and there's, and so the question is why? So we absolutely have a
stigma against mental illness, especially when it comes to sort of, like, some masculine identity things. So men are expected to be independent, they're expected to be self-sufficient. So the concept of getting help is almost we're conditioned
to not get help. And then the other problem is that we tend to have very poor
understanding of mental illness. So on the one hand, you
know, we'll have people who will not really understand what it's like to truly be
in a depressive episode. So from the outside, the
best that they can do is relate it to their struggles, which is that, “When it's
hard for me to get outta bed, what I need to do is just give myself a swift kick in the
ass and get outta bed.” – Yep.
– And that works for you unless you're struggling with something like a real mood disorder. So a lot of people don't understand that. And that's part of the reason
that we have the conversations that we have is because when
you have a full conversation with someone about their experience of whatever it is that they're
wanna talk about in life, whether that's spirituality or career or mental health,
whatever, then we start to, I think what we've seen in our
community is people are like, “Wow, this is, like, a
very humanizing experience. This isn't bad. I never realized, holy
crap, I am this way. This is something I've
been struggling with. I thought I was always alone, because the two or three
people that I tried to talk to seem to have no experience of this.” – Okay. The, and by the way, I don't
disagree with the notion of that it's important
to break the stigma. I'm kind of just playing devil's advocate. – Yeah, yeah, no, that's great. – [Mike] Creating the conversation. – Push, bro. – For the idea of talking about, let's say cancer or heart attack in comparison to talking
about mental health. On one hand, I see the
value of that, right? That we should treat mental
health like a physical symptom. Like, you have a broken bone,
you need to go get it fixed. The same way that if you
have a mental health issue, you could get it fixed and talk about it. But on the other hand, there's
really subtle differences that are super important. For example, if a primary care doctor who saw a patient in urgent
care for a sore throat ends up dating that patient, there's less of an ethical
dilemma than if a psychologist or psychiatrist ends up
dating their patient. Do you agree with that? – I don't know on a technical
sense if I agree with that, but on a practical sense, sure. I think there's a very different level of clinical relationship. If you're evaluating a sore throat, which in a one time clinical scenario versus generally speaking, if you look at a psychiatrist who, or a therapist who has
a long-term relationship with a patient, I think
there's a big difference there. – Right, like, you would, like, I guess one would
would check for conflicts before taking a patient on, whereas, like, I would never do that
as a primary care doctor seeing someone for a sore throat. So I feel like there are
some intimate differences between the two. – Oh, absolutely. So, I don't think that they're
one-to-one by any means. Yeah, I mean, I, so I
think that oftentimes, especially with psychotherapy,
psychiatry, psychology, you're discussing more intimate and vulnerable things
that have to do with more, they're more intimate and vulnerable. – Yeah. – So, but I would sort of say that a, a better analogy would be
like, do you think that, let's say I'm your
oncologist for two years and I help you overcome cancer, and in that process I
get to know your family and things like that, versus I'm your therapist for two years. Do you think that those
are ethically comparable or do you think there's
still a difference there? – I think they're more comparable, but still with mental health, I think in knowing the
influence one can have with the power of words
in an intimate setting, the mental health situation
is still different. – Okay, I think that's– – And do you feel like that's
fair or do you think I wrong– – Yeah, I think it's very fair. No, no, no, I think it's very fair. – Yeah, that's why, like, I don't know, like, when I watch your
interview that you did with Graham Stephan and
Jack, and I'm watching it, and there was, like, a section where you were doing some
psychoanalysis of them, and I'm like, “How do you do that?” Because, like, I wouldn't
even feel comfortable discussing a sore throat on a topic. Where's that line for you
basically is my question? – Yeah, so if we look at what
I did with Graham and Jack, so I wouldn't call that psychoanalysis. – Okay.
– So, like, I think this is where a lot of people don't know what psychoanalysis is. So people will sort of, so I, specifically I was pointing
out certain dynamics that they have and I was
talking about Ayurveda and a couple of these other, like, things, and I was educating about
that, using them as examples. But if you look at that, you
know, I'm not assessing them. If you kind of think about that,
if, let me put it this way. Let's say that that is the
interaction that I have with someone who is presumably a patient. Would you consider that medical care? Like, did I, would you say that that is, so if someone comes to you and that's the kind of
interaction that you have, right? Does that qualify as diagnosis
or treatment in your book? – I think it partially is, yeah. – How so? – I think when you're getting a history of present illness from
a mental health condition and as a trained individual in that area, asking questions about mental health and then giving your read on it is partially a history
assessment, et cetera. – What would be the condition that you would say I was
assessing for in that situation? – Personality disorder potentially, mood, asking those questions. – [Alok] Yes, so–
– And then giving your read of it, again, I think when you're interpreting what someone is saying from your state and they're looking for
you to have the answers, I feel like, is that
potentially making a diagnosis? And maybe I'm wrong– – No, no, no, so no, I think this is a fantastic conversation. It's something I've thought about a lot and I really appreciate your perspective. So let's just think through that, right? So here's the way that I think through it. The first is that I, like, if I was precepting a
medical student or resident and they did what I did, and they said, “I've assessed this person
for a personality disorder,” I would fail them. – Well, of course, that's
why it's not complete. – Right, so, and I, but I
think there's a difference, because if that is, if you're saying that this is not sufficient for
a personality assessment, then it is also not sufficient
for a personality assessment. So if someone did that and they said, “I assessed this
person for a mood disorder,” I was like, “No, you didn't. You didn't assess their sleep, you didn't assess their anhedonia, you didn't assess their guilt, you didn't assess their energy levels, you didn't assess their concentration, psychomotor, suicidality.” I didn't assess any of those things. So if we really look at
the, this is my read on it, the technicality of what it means to do a diagnostic interview, right? We have a, we literally
have textbooks that say, “These are the questions
that you should ask.” So the DSM-5 has sample, you know, algorithms for assessing
diagnostic interviews. And I think the big difference
is if we sort of say, “Okay, what constitutes
the practice of medicine?” Assessing someone for a mood disorder, if you do what I did and I
bill an insurance company and I say, “I assessed
you for a mood disorder,” I could be sued for malpractice, because I didn't actually
assess for a mood disorder. – Sure.
– Right? And so that's kind of the
way that I think about it is if we say assessing for a mood disorder or a personality disorder,
and I'll get to your point, because I think there's validity there. If we say that this is
what it is, did I do that? And the answer is, in my opinion, no, therefore I didn't do that. Does that kinda make sense? – Yeah, that you're
saying it's not complete so that therefore it's
not actually happening. – I would even say that it,
not only is it not complete, it's not like I did, assessed eight out of the nine criteria. Usually speaking, I'll assess zero to one
out of the nine criteria, because I still won't do
a clinical assessment. I may ask them, you know, I
won't assess for anhedonia, for example, or things like that. And that's where I think
there is a valid concern about, so if I'm a mental
health professional and I talk to people about their mind or their mental health, does
that qualify as clinical care? That's your concern, right? – It's not a concern, I'm just
curious how you toe the line. – Yeah.
– So, like, when do you decide that you will talk about anhedonia or you've talked about one, now you don't wanna stray into the two, three, four, or five. – Yeah, so it's a good question. So a couple of other
mental things that I do is if there's a conversation that I would have with
my kids or a loved one, that's something that
I would consider okay in a weird way, right? So, like, for example,
when I'm teaching someone about their personality and the way that they react to things, I have those conversations with my kids. I think it is a part of my
parental duty to teach people, like my kids, like, how their mind works and how they respond to situations. – [Mike] Sure.
– Now, if we say that that qualifies as
the practice of medicine, that means that I'm
committing a ethical problem every single time I try to
teach my kids about their mind. – Right. – So I think that this
is where you're spot on that mental health is different, because the lines are blurrier, right? Where do you draw the line between teaching someone about their mind? Another good example of this
is, like, if we look at people who are, like, spiritual
counselors or coaches. – Yep.
– And they, they're in the profession
of teaching people about how they work and
asking them questions and helping them understand themselves. Are all of these people
practicing medicine? And I think the answer is, we actually have a clear idea of this, that the answer is no, we don't consider that
the practice of medicine. So then the question becomes, okay, so if I'm a psychiatrist, can I do something like
spiritual counseling or something like coaching and it be separate from
the practice of psychiatry? And there the answer is yes. So as part of how do I get okay with this, so we had conversations with the American Medical Association, the American Psychiatric Association, the Massachusetts Medical Board, where we basically asked them
these kinds of questions. And the answers that we generally get are that yes, you can do this. And there are many psychologists that will also be executive
coaches and stuff like that. So it's possible. I think the main thing to consider though is that even as a physician, we are held to a ethical standard even in the non, how can I say this? We're held to the ethical
standard of a physician even in nonmedical space.
– In nonmedical medical space. – [Alok] Yeah.
– Yeah, like the same way when I read an ad, I
have to be very careful, because I'm putting that ad,
not as just an influencer, but with someone with a license. – Yeah.
– [Mike] So same principle there. – Absolutely, so I think
that's the standard and we basically checked
with people about that. – And the reason I'm
so curious about this, just to give you some
background, is for me, A, doing this podcast, I
run into the same dilemma of, like, when should I pull back? When should I keep going? Two, as you mentioned with your kids, I've had people in my personal life, friends, loved ones, et cetera, that we would either get into an argument or they would come to see me for advice. And I'm like, I don't know
where the line is here of should I be doing this? Because there's such a clear conflict of, you know, you might be my girlfriend, you might be my close childhood friend, you might be my brother. How far can I go without saying that I'm
practicing medicine? – Yeah, so, like, let's
ask that question, right? So let's say that you're dating someone and they just had a bad day at work. Are you allowed to use
reflective listening and empathic statements when
you're talking to this person that you're in a relationship with? What do you think? – I think empathic
listening would be fine. I think when you cross into
the line of them asking, “Well, you're trained, why do
you think this is happening? Do you think this is related to episode X that happened 10 years ago?”, and now it's starting to cross into more medical questions
I would ask my patients. – Yeah, so, I think that's where, the line that I use is we have clear, very clear diagnostic questions, right? So, in that diagnostic process, that is what the practice of medicine is. So if you also look at, like, you know, medical boards,
they will define the, so the American Medical Association defines the practice of medicine as, like, diagnosis and treatment. And then diagnosis is not
just talking to someone about their mental health, otherwise we wouldn't be
able to do that, you know? Does that make sense, we can… – Yeah, I mean, like, if we look at the evidence of
who has success with patients, whether it's a counselor,
whether it's a social worker, a psychiatrist, a psychologist, a family medicine doctor,
a friend, a priest, the results are not that far different. Would you agree? – I think it depends on what
you're looking at, but sure. – Yeah, I just mean in terms of, like, success of what the patient
deems success or satisfaction. – Well, so satisfaction of a person, sure. Satisfaction of a patient, I don't know. I don't know that a patient
with a mental illness gets the comparable outcomes from speaking to a priest
compared to a therapist. And so I think the other
thing is that, you know, once you do therapy, I think
there's a big difference between talking to someone
about their problems and the practice of psychotherapy. – And you think that's because
of the specific defined guidelines that you have to
hit within the conversation? – Not just the guidelines. It's also things like, if we think about, like, so when I'm doing psychotherapy, I have to put together a formulation. So this is usually a
bio-psychosocial formulation of what's going on with a patient. And this kind of is, like, a map. This is really, like, analyzing everything from their upbringing to
biological genetic factors. And we kind of put that together. So there's a lot more
formal robustness to it, because we have guidelines kind of like you said, right?
– Sure. – So the practice of psychotherapy is, like, you spend usually a long amount of time with someone, you do an intake with them,
you spend, like, two hours running through all kinds
of different questions, then you put together a formulation, then you put together a treatment plan. And as part of that treatment plan, you do, like, A, B, C, D, and E. I think having conversations
about mental health does not touch that. Like, what I do with my
patients in my practice is very different from
what I do on stream. – And when you talk about,
like, the spiritual aspect of it or the coaching aspect of it, where you would take on
consultations online, not as a doctor, how is that different? – I mean, so I spent seven
years studying to become a monk and I learned a lot about the nature of happiness and suffering. And so I think we're starting to see that blend into clinical practice. So we'll see things like
dialectical behavioral therapy or psychotherapists
will teach mindfulness. So let me kind of ask you, so do you think
mindfulness is a treatment? – Of course. – Okay. So does, so if mindfulness is a treatment, do you need a license to practice medicine
to deliver treatments? – No. And if you have a license, you delivering the treatment
carries different weight. – So you don't, you think
that it is okay for people to give treatments without a
license to practice medicine? – Correct. – So how do you decide, so for example, like, if I'm a random
person on the street, I can give IV fentanyl to people and that's okay in your book? – I think that there's a difference between medications that
are supplement form. It's basically based on the regulation. – What do you mean by that? – So prescription medications are not gonna be given by
someone on the side of the road. But can someone give you a
Tylenol, which is a treatment, yeah, they can. – I see what you mean.
– And I don't think that's unethical. – Okay.
– Mindfulness is like Tylenol, it's an over-the-counter. – [Alok] I see, I see what you mean. – Yeah.
– So it's, like, an over the, you would qualify it as treatment. – [Mike] Correct. – So do you think that mindfulness should be regulated as a treatment? Because treatments usually are– – When you say regulated, you mean should it be treated
as a controlled substance? – No, so, like, if we
look at Tylenol, right? Sure, it's over-the-counter and you can give someone a Tylenol, but there is still a
regulation of Tylenol, because it's a medical treatment. – I think it should be regulated as much as the supplement
industry is regulated. – Okay. But so would you consider
supplements as treatment? – Yeah, of course. – Okay, interesting. – Well, vitamin D deficiency and you're giving someone vitamin D, anemia, you're giving them iron. Diet is a treatment, then you could recommend
someone with that. – Yeah, so you'd consider exercise a treatment as well? – Sure, yeah. – [Alok] Okay. – But I also, like, for example, Sam has a friend and he
wants to become more fit. Sam will tell his friend, “You should exercise this, exercise that. Dude, it's wonderful.” That's a treatment His friend didn't get checked
by a doctor beforehand, has a heart attack, dies. Is Sam liable? No. I tell a patient, “Go exercise,
go high intensity, do this.” Didn't check them for cardiac disease, they have a terrible blockage. I am liable. – Yeah, that's very interesting. Yeah, so I think it makes sense. I think we're basically, we would agree, I would use different terminology, but I think your
terminology, I like better. – In what regard, what do you mean? – So I would not, so I think just because
something has therapeutic value, I think we're basically
saying the same thing. So I think that just because
something has therapeutic value does not make it a treatment in my mind. So I think that what makes
something a treatment is whether you are using it to treat a medical condition, right? So exercise, mindfulness in that way I think is a evidence-based
treatment for mental illness. But I do not consider it
a medicine at its root. – Interesting, how come? – Because it's not designed
to treat a medical condition. That's not what, why
it was ever developed. – But if DBT uses mindfulness as a tool, you consider DBT a form of treatment? – Yes, absolutely. – So how do you draw that distinction? – Because DBT is not meditation. Right, so DBT is literally
dialectical behavioral therapy. So it is a protocolized treatment that includes something that is from a spiritual
tradition like meditation. – Sure.
– So what we're doing is we're taking this tradition
of spiritual development, we are distilling it down into
a certain set of practices which are then tested and used
for a clinical improvement. – So is, like, a life coaching session or a spirituality session a
diluted medical treatment? – I think medical treatment is oftentimes a diluted spiritual pursuit. – Oh, tell me more. – So if you look at meditation, right? So we use mindfulness for,
you know, clinical treatment. But if you really look at the
development of meditation, the meditation was designed
to help people attain moksha, enlightenment, nirvana. This is why we developed it. So they were not interested in treating depression or anxiety. That's not why they did it. They did it to attain a state of superhuman bliss, let's say. – Can I ask you a question about that? – [Alok] Yeah. – I don't wanna lose your track though. – [Alok] Yeah. – So we'll come back to that. Isn't, like, it's hard to judge why things were created in the past. It's hard to even look back
at history 100 years ago and try and gauge, like, for example, why I did something yesterday
is hard for me to judge. – Yeah.
– So I'm wondering how much more difficult it is to judge why someone created something
thousands of years ago. So I'm gonna pose a question
to you to be more specific. Is it possible that the
reason meditation was created was to ease symptoms
of anxiety, depression, even though they didn't
have these diagnoses and they called it enlightenment? – It's possible. – I mean, isn't it reasonable to say that? – Well, it depends. I mean, do you trust
the people who made it? And if they give you a reason, so if Invent something and I say, “Invented this bottle and this bottle is to drink water from,” would you, how much faith would you put that the reason I invented this bottle is to drink water from, if I
tell you this is why I made it? As opposed to this is a bottle for my piss if I can't find a toilet. – Yeah, I think that I
applies in the present or in the recent past. I think when you look
back so far, time-wise, their definitions and understanding is gonna be greatly different. So they would never have said, “Mindfulness is a treatment
for anxiety and depression,” 'cause they didn't have
those terminologies. – I hard disagree there. – Really, so you think that existed, like, the idea of major
depressive disorder, generalized anxiety disorder? – Oh, absolutely, right? So, we have, for example,
Ayurvedic medicine, which diagnoses mental health conditions. Right, so you have systems– – I'm not familiar with those, so tell me about those systems. – Yeah, so you have medical systems. So this is the big thing
is that medical systems would diagnose things like depression, bipolar disorder, stuff like that. And the reason that I say that meditation was not developed to
treat a mental illness is because they say
that it's, they're like, “I invented this thing to help
people attain enlightenment, get rid of suffering,”
and then along the way, you will treat your mental illnesses. But that's not the goal. That's, so the way that I understand it, and the reason I trusted it, because that's what they say, right? So, they were very clear about, and then who are we to say, “Oh, they didn't understand these terms,” and things like that. I think that's actually
sort of judgmental, and I'm not calling you that, but I'm just saying to look back at them and say they didn't know better or they didn't use this language and we are interpreting what they said based on our understanding, I think is not a good idea. So what I would say is
they're very clear, right? So if you read something
like Patanjali's Yoga Sutras, so this is sort of, like,
the seminal text on yoga. And he kind of says like, “Okay, here's how we are
gonna talk about enlightenment and here are the different
ways to attain liberation. Here's, like, some of the challenges from attaining liberation. Here are the malfunctions of the mind,” or not malfunctions, but the ways in which the
mind can operate poorly. And then on the flip side,
we have a comparable text of Ayurveda or something like
traditional Chinese medicine. Well, they'll talk about mental illnesses. So they'll talk about things like, even things like cerebral palsy
or malfunctions of the brain or things like bipolar disorder. And they'll have treatments,
like, usually herbal treatments and other kinds of things
where they separate these two. One is a rog or an illness. And the way that I kind of understand it is the use of medicine is to get you from negative 100 to zero, to remove something
that is malfunctioning. Meditation is a process
to go to from zero to 100. So you can still increase your number. So if you start meditating
at negative 100, you can get to zero. But the practice was not
designed as a treatment, it was not designed to
bring people to baseline. It was designed to
bring people at baseline to above baseline. – They had diagnoses that many
years ago of cerebral palsy? – Absolutely. – How did they describe
cerebral palsy 1,000 years ago? And by the way, I'm saying 1,000 years completely uneducated. – 5,000.
– I have no idea, 5,000 years ago. – Yeah, so I don't know speci, let me just think about
what examples to use. So, like.
– ‘Cause I just, the reason why I'm so skeptical about this is I look at how mental health
was discussed in the 1900s, of, like, histrionic personality disorder versus hysteria in women. Like, very judgmental, very
culturally-based at that time. You're saying that didn't
exist 5,000 years ago? – No, no, no. So dude, East and West are
completely different, man. Like, it's like, it's like night and day. – Okay. – So let's, let me just give
you a couple of examples. So, like, if you look at
an Ayurvedic textbook, they had a super cool
diagnosis for diabetes. – Okay.
– They had, they say, “Go pee next to an anthill. If the ants drink your
urine, then you're diabetic.” – Okay.
– Right, so they had a lot of understanding of physiology. – What did diabetes mean to them? Because to me, it means checking
someone's hemoglobin A1C and seeing it fall in a specific range. But if I'm trying to put
myself in their shoes, I have no measurements of that. I have no, I'm not even
aware of bacteria, right? Antibiotics don't exist. – I don't know, I think
they have certain herbs that have antimicrobial properties. They understand the
process of sterilization. So I think they had–
– They do? – Oh yeah. – I mean we just did
a video on the history of the first gentleman who recommended washing hands in between
treating morgue patients and delivering babies in the 1800s–
– That's in the West. – When was that?
– Dude. – [Crew] That was 1850s. – 1850s, yeah. – I mean, so I may have
rose-tinted glasses when I look at Eastern medicine, I don't think Eastern medicine
is perfect by any means. But they absolutely, like, dude, like, so even if you look at in Indian culture, this is how well they
understood microbiology. So in Indian culture, we
eat with our hands, right? Okay, so, you know we also
don't have toilet paper. So anytime– – I don't know that actually. – So, like, if you look
at, like, ancient India, like, not, I'm just, you know, toilet paper is a
relatively recent invention. – Of course. – So how did people in India clean themselves after
having a bowel movement? They would wash with their hands. So you, and then this is how well
they understood microbiology. You never eat with your left hand. You always eat with your right hand and you always wash with your left hand. – That's funny to me, because
you view that as, like, them practicing microbiology. I view that as them stereotyping and being rude to people
who are left-handed. No, I'm just saying. – Fair, yeah, no, I mean,
but there's a reason. – Like, they were aware of the bacteria but they weren't aware that some people preferred to use their other hand? – No, they were absolutely aware that there were left-handed people. – [Mike] Okay, got it, okay. What they realized is, “I don't
care if you're left-handed, there needs to be a convention.” – [Mike] Got it, okay. – “Where bacteria that come outta your ass should not be put in your mouth.” – Sure. – And that is more important
than the handedness, because they literally lived in a society where there were endemic diseases like cholera and stuff like that. So for the sake of sanitation, they would always have
you eat with one hand and you never use this hand. And this is your washing hand and these are completely separate. So one hand touches the
back of the GI tract and one hand touches the front. So they had an understanding
of microbiology in that way. I don't know if they– – Well, was it microbiology or did they just see cause and effect? – Probably more of cause and
effect than microbiology, because this is where they also developed something very similar
to the theory of humors. So they have, like, these
concepts of elements. But the really interesting thing is that what they basically, I think what they did is notice
all kinds of correlations and then developed a heuristic system to explain those correlations. – My question is now is this a radical form
of survivorship bias where we're remembering the
ones that turned out to be right and are not pointing out
the hundreds of correlations that they deemed as cause and effect and they were magically wrong, like? – Could be, could be. So now let's get into that, this is great. Okay, so let's look at that
in a couple of different ways. So it's absolutely a possibility
of survivorship bias. So let's also remember that there are a lot of
things in Ayurvedic medicine that are not correct. Right, so this is where, and what tends to happen is
we don't propagate those. So, and then what ends up
happening is a survivorship bias where the stuff from Ayurvedic medicine, like, let's say ashwagandha or brahmi or meditation, these are the
things that we now associate, because we remove things like heavy metals in the usage of medicine. So there's something called Rasashaastra in which they'll use things
like, arsenic, mercury, things like that as treatment. But that is not nearly as popular. But that's absolutely a
part of Ayurvedic medicine. So to say that Ayurvedic
medicine is right, I think is a gross overgeneralization, because there are eight
branches of Ayurvedic medicine. Some of them have scientific support, some of them have scientific evidence that they're actually harmful. Now there's even a
counterargument to that, which is that they may
have known something about the usage of these
chemicals that we don't. So a good example of this is
if you go back 60 years ago and someone shows up and says, “Hey, you don't need to take an SSRI for your mental illness, you
can sit there and meditate,” and what would science
have said 60 years ago about meditation? – That it's useless. – Absolutely, right? And that's what we did say. And so they figured something out that based on our modern understanding of biology at the time was literally useless, was
so antithetical to everything that there was a revolution
in biological psychiatry. We're like, “This is complete
BS,” and we were so confident. And today, it turns out
that we were grossly wrong about meditation. – Well, yes, but again, are we just pointing out
the one time we were wrong and we were actually right the huge majority of the time? – That is what I think makes
Western medicine the best. So what makes Western medicine
the best is we are the best at pointing out when we're wrong. That's what makes– – But that's a scientific
method, is it not? – Sure. – So that's why think
people were mad during COVID that guidelines changed
and it's like, well, 'cause we're pointing
out when we were wrong. – Yeah, so yeah, that's
the scientific method. So I think this is the weakness. I was, I helped organize a conference at Harvard a couple years ago, and one of my mentors was on the panel. And so this was a conference
on integrative medicine. So there were a bunch of, like, Eastern medical practitioners there, and they kind of asked this question. They said, like, “What do
you think needs to happen for Eastern medicine to
be more widely accepted?” And my mentor, brilliant
guy named John Dangers said, “You guys need to let
your treatments fail.” The problem is there's
such a pissing contest between Western medicine and
Eastern medical practitioners that no one on the East is willing to say, “Yeah, this treatment sucks.” So, the way, the one thing
that we do really, really well, which is I think why allopathic medicine, talking about selection biases, but let's talk about not
selection biases in a, the reason that Western
medicine is dominated so much is because we are so good at pointing out when our medicine is wrong. So if you look at things like thalidomide or, you know, like, that's
such a great example of, oh my God, revolutionary
medicine, solves nausea, and by the way, we're never
gonna use it ever again, right? And so we are really good at that. And the biggest problem
in Eastern medicine is they are so hung up on
getting widespread acceptance. There's this ego battle going on between Eastern medical practitioners and Western medical practitioners that Eastern medical practitioners
are not willing to say, “Oh, hey, by the way, this
treatment actually sucks.” – Is that because a
lot of those treatments are less based on the scientific method and are more culturally-based? – So I think they're based
on the scientific method, but they don't look at the mechanism in the same way that we do. So if we look at scientific method, what is scientific method? It is having a hypothesis, testing that hypothesis,
observing results. So I think they did that. That's not how meditation was developed, which is a whole different conversation about sources of transcendental knowledge and all this good stuff. But they absolutely applied
the scientific method. So I don't think that you can develop as robust of a system of medicine. The big difference though is that we are really
good at instrumentation. So in the West, our, a big, it's not even technically a
part of the scientific method. You can just, you know, a
child can make observations, test hypotheses, and
come up with conclusions. – I mean, every time a
child's learning to walk, that's what they're doing, yeah. – Absolutely, right? But they don't use a microscope, they don't not understand
anything about anatomy. So one of the things that I
think we've actually mistaken is that in the East, they use the scientific
method quite robustly. They just don't use instrumentation. So what they did is figured
out all of these correlations and causations and developed these kind of heuristic systems. Even something like
the concept of an organ is actually an abstract concept, right? It's not, you can make an argument that there's no such thing as an organ, that's just, everything is just cells. – You can just say that
about anything about a cell. – Yeah, right? – That's like, I feel like
Deepak Chopra's main thing is, like, “What is HIV? That's a concept that you've
created in your mind.” It's like, “Well, wait, hold on a second.” – Yeah, so I'm not quite there. – I think it's very easy to go. – So, I think they applied
the scientific method, but what they didn't have
was good instrumentation to elucidate the mechanisms, right? So they didn't have
microscopes, they didn't have, but they were still able
to make observations that when you have a diabetic, they're gonna have sugar in the urine. And if you have sugar in the urine, you can test for that by
if ants drink your urine, – Right, I think a lot of their
scientific method approach is more so finding correlations
and things that happen, which can a form of scientific method and an introductory form
of scientific method. But then in order to
see if your correlation is valuable, can you affect it? Can you reproduce it,
can you generalize it? That is always missing. – In Eastern medicine? – [Mike] Yeah.
– I disagree. – Really? – [Alok] Yeah.
– So tell me more about that. – Yeah, so like, I mean
that's how they came up with these things like
ashwagandha and brahmi and some of these things that we use in psychiatry, turmeric. So for example, the usage of bitter herbs in the treatment of diabetes. So what they did is I think, right, so I wasn't there, you
just have these texts where they'll say, “Okay,
if you've got someone who's a diabetic, they
need to eat bitter melon.” So I think what they discovered is that when you feed someone a food that has an impact on
their insulin metabolism, has an impact on their blood sugar. Once this person eats
bitter melon twice a day or drinks the juice of a
bitter melon on a daily basis, the amount of sugar in the urine that the ants get attracted to goes down. They'll even taste urine to detect the sugar
content using their tongue. And then I think they see that this leads to better
outcomes over time. So I would not call that a correlation. I think at some point in
the system of medicine, what you always have is an intervention and then you measure
that outcome in some way. – I guess to me, unless you randomize it in
control for biases, it's not… – That's a huge problem. But in the opposite way. So here's the key thing. So when you randomize, so we view the RCT as the hallmark, right? There's a huge problem with the RCT. So let's say I show you an RCT
that says that cholesterol, well, let's say, like,
cholesterol lowering medication. What is the outcome for an individual patient
when you prospectively give them a cholesterol med? – You're talking about
number needed to treat? – No, I'm not talking, sure. But so if I come to you today– – That, like, 99% of the
time for the individual, it's not gonna have an impact. But for the general
population, you will see. – So this is really
important to understand. So our system of medicine does not make predictions
about individuals. It makes predictions about populations. So Ayurvedic system of medicine
is completely different, because they don't care about populations, they care about individuals. So their whole system, so if you think about
randomized controlled trials, what we're literally doing in that trial is removing the individuality
from our system of medicine. – Yep.
– Which then creates a problem of external validity. So the basic problem of our studies is that we can do a
study on 10,000 people, but you know this as a clinician, this is why we need clinicians. Because your human brain
needs to take all of this data and then translate it to
apply it to an individual. So in the Ayurvedic system of medicine, they think that randomized
controlled trials are the antithesis of practicing medicine. – Can I explain why I heavily disagree? – [Alok] Yeah. – Well, I agree with, first of all, the notion of why we need clinicians, of taking generalized concepts and individualizing it to the person in front of us 1,000%. And I think that's what
my residents get wrong the majority of the time. I just did a video on this, because the idea of
number needed to treat, just why I brought that up is 'cause it's a topic where, for example, lowering blood pressure, we see population-based, controlling it to a certain number will prevent 30% of heart
attacks and strokes. But for the person
sitting in front of you, 98, 99% of the time, it's
not gonna do anything. So the question of why I still, or the reason why I think
randomized controlled methods are still the best for the individual is because we're throwing out
the baby with the bath water. – What does that mean? – We're throwing away
randomized controlled studies, because they're imperfect
to the individual. I think we need to look at it deeper and say, “Right now, this is
the best knowledge we have for the general public, which will ultimately be the best for you, because this is the best
information we have. In the future, as algorithms,
as information gets better, I think we can better individualize randomized controlled studies so that we can run
simultaneously thousands, millions of experiments to know instead of 80 patients I need to give
this blood pressure medicine to prevent the heart attack, only 10.” So now I'm targeting the therapy
more towards the individual and less towards the general public. – But so then ideally what you would want is not even a randomized controlled trial, you would want trials
on an individual, right? Because that's when you
produce perfect correlation between your scientific methodology. – Absolutely not. – Explain that to me. – Too much bias when you're
treating a single person. – But isn't that what you're looking for? Is you want an amount of bias that is specific to the person. So lemme give you an example. – I think bias works both ways. – So let me ask you a question. So let's say, like, so we now have some of these services in psychiatry where you can do genetic
testing on a person. – Correct, to see which
medication is gonna have the best. – Yeah, so do you think
that those kinds of, these are not recommended by the American Psychiatric Association. – [Mike] Correct. Yeah, I just had a patient
bring this in last week. – Yeah. So I don't use them usually
in clinical practice, because the data does not
show that using these services in randomized controlled
trials, which is hilarious. – Okay.
– Right? So I'm with you there. But let's say, like, theoretically, you know, if we could get to
a point where that did work and we can recognize
that, “Okay, this person has this kind of
serotonin transporter gene and this kind of medication is effective.” Do you think that is that the kind of goal of personalized medicine is to create a system of understanding this person as an individual, not worrying about the population. It's what are your polymorphisms so we can figure out the
perfect medicine for you? – Yes, but the only way we can get there is with randomized controlled trials. – How so? – In order for us to know that
this works on this person. – Oh, we have to see, yeah, a randomized controlled trial that this is effective for lots of people. Yeah, so the methodology is personalized. And then we are doing a
randomized controlled trial on personalized methodologies. – [Mike] Correct.
– To see that personalized, that I'm with you 100%. – Okay. – So when I look at the Ayurvedic system, I think they're closer to
that personalized methodology. – Don't you feel like there's so much bias in
that approach though? When they try, like, for example, I had Dr. Gundry on my podcast who makes a lot of claims that disagree with a lot
of the big institutions, the American Academy of Family Physicians, United States Preventive Task Force, the American College of
Cardiology, et cetera. And when someone presents information that disagrees with
large bodies of evidence or large bodies of medical groups, you need to show me amazing
evidence to show why you know, but the rest of the people don't. Like, you need to show me
corruption on their side. You need to show me why you
believe what you believe, what evidence you're
looking at, et cetera. But when you're treating one person, to make your treatment successful doesn't require a lot of evidence. – How are you, I mean, what, how are you, what is, how are you defining evidence? – In the statement that I made? Evidence that I need to know
that they're telling the truth is randomized controlled data. – So how can you have
randomized controlled data on an individual? – By scaling it. – But then it's not on an individual, then it's on a population. – It's individual population medicine. Because that's what an algorithm would do. – Oh, so you're talking about doing an RCT on individualized medicine
versus population-based medicine. – Correct. – Yeah, but I mean, I think, I don't think we're disagreeing here, but what I'm kind of pointing out is, so let's talk about
clinical practice, right? So when you know what
works for this person, you have a pile of RCTs, but then you as a clinician
individualize your treatment. – Of course.
– Deviate for protocols to get the best clinical outcome. – Correct, and this is a practice, it's an art, two doctors may recommend two different treatments
and both be acceptable. – Yeah, so in this situation, how would you describe what you're doing? Would you call this individual
practice of medicine? Would you call this… – The art of medicine. – Okay, so I think Ayurveda
leans more into that. – [Mike] Got it.
– So Ayurveda basically says, “Okay, if we look at individuals, there is no such thing as an
independent disease process that exists outside of an individual,” that every disease
process gets personalized when you stick it in a person. And so their approach,
so I personally think that if we wanna see proper
outcomes from Ayurveda, we can never do an RCT, because their whole system of medicine is that depression in me and
depression in you is different. Which by the way, it's really fascinating that we're moving in that direction. I'll get to that in a second.
– [Mike] Yeah. – But what I think we really need to see for Eastern medicine, the right kind of study is
actually a cohort study. So what we really need to do
is take a cohort of people, give them Eastern medicine, cohort of people, give
'em allopathic medicine, and see who has better outcomes. – Well, that's not a cohort. – What do you mean? – In a situation where
you'd randomize people and you'd say some of your, oh, you mean it's a, you
wanna do a comparison cohort? – Yeah, yeah, yeah. – As opposed to give someone
true Ayurvedic treatment versus a sham. – No, no, yeah, I'm talking
about cohort studies. – [Mike] Got it, okay. – So a non-inferiority trial between traditional allopathic treatment and Ayurvedic treatment. Because the whole point is that when we, their system of diagnosis presumes that there is not a
treatment for depression. And then what we do is we take that thing, we remove all the individuality, which is a core part of
their system of medicine. So their whole system of medicine is that, so there's even like, so for
example, they believe that, you know, I'm extrapolating
here based on my expertise, but if you look at, like, depression, there are three subtypes of depression. So there is neurovegetative
depression, right? So difficulty getting outta
bed, things like that. Then we have anxious depression. We recognize these as
two clinical entities. There's a really interesting
third subtype of depression called depression with anger attacks. Where the primary manifestation
is frustration and anger as opposed to feelings of sadness. Now the really interesting thing is if you look in Ayurvedic medicine, they say that there are
three dominant elements. There's, like, the earth element,
there is the wind element, and then there's the fire element. So if you take this
depressive pathophysiology and you stick it in someone who
is a predominant earth type, you will end up with a
neurovegetative depression. If you stick it in a
person who's a wind type, you will end up with
an anxious depression. And if you stick it in a fire
type, these are like Pokemon, you'll end up with a
depression with anger attacks. So even in their literature, they have these three subtypes
of depression built out and they say that it
correlates with something about your alleles and how
they manifest, your phenotype. – I think we're talking
about two different things. I think Ayurvedic medicine
does fantastic observation. – Yeah. – Like, what you're describing is they've observed different subtypes.
– Yes, 100%. – And I think that's, you're gonna get amazing validation even when you check individuals, when you do good observation. I think when you say we
should do a cohort study to see if it is non-inferior, to me, that's the same thing as an RCT. Like, it's not the gold, like, for us, an RCT is the gold standard, right? – Yeah.
– But we have levels, a hierarchy of evidence, and
cohorts are still up there. It's not just mechanistic, right? Like, if you do a cohort study– – But a cohort study and RCT are two completely
different study designs. – I agree. But in terms of weight of
evidence, they're high levels. – No, no, but a weight
of evidence is fine. But what I'm saying is that
the RCT as a study design is antithetical to this
system of medicine. – Sure, and I'm just using RCT, 'cause it happens to be the gold standard. Let's take cohort, let's take RCT, all the
higher levels of evidence. They're not done for Ayurvedic medicine. At least the majority of it. – [Alok] Yeah. – So granted we can't do
RCT, but we can do cohort. Those things aren't done. So I feel like we are
taking what they're doing and you're seeing it as a leaning towards story towards observation, away from the evidence-based model. And I see it as full one-sided. – Well, I don't follow you. – You said earlier a statement that it leans towards the
story-based, the individual-based versus the group randomized controlled. I think it doesn't just
lean in that direction. I think it's fully in that direction. – Absolutely. Right, so I think Ayurvedic medicine is not about populations. It's very different. So I think that that's fair. – Well, for example, you were talking about
the art of medicine. I think that there needs
to be a cautious balance between taking good quality evidence, whether that's RCT, cohort, et cetera, and then balancing that with
the individual in front of you. But I think in Ayurvedic medicine, we're just having full on art. – 100%. So there are– That's not 100%, 'cause they are taking into
observations and all that. – So, so I mean, I'm sort of addressing the
questions you're asking, but I am not a proponent of Ayurvedic medicine
even as it stands today. I know it sounds kind of weird
'cause I'm talking about it. So my, before this whole
HealthyGamer thing, my actual area of interest
was evidence-based complimentary alternative medicine. So there are all kinds of problems that we haven't even touched on. I mean here you are saying, “What about this, what about this?” I can dismantle our Ayurvedic medicine, because there are fundamental weaknesses. The first fundamental
weakness of Ayurvedic medicine is that you have no way to
gauge practitioner reliability. – Yep. – The good thing about allopathic medicine is that at least in the United States, if you finish a medicine program, there are standards
that people can expect. If you go, you're a family
physician, I'm a psychiatrist, but two people have a heart
attack on an airplane, they're gonna get some
comparable care, right? Even I can handle that some. So the biggest problem
with Ayurvedic medicine is when you have this individuality, how do you judge the
quality of a practitioner? How do you know ahead of time whether this person is good or bad? Whether there's biases in
their patient population, if their patient population
has high socioeconomic status and this practitioner is very charismatic, so they're engaging the placebo effect. How do you even know that their treatments are working at all? This is a fundamental problem
with Ayurvedic medicine, which is that the good thing that we get, this is why I think allopathic medicine has grown so well, is
because it is reliable. Ayurvedic medicine, I do not know that it is even 10% as reliable as the practice of Western medicine. – So if you think that, why do you discuss Ayurvedic
medicine principles often? – Because I think there is a
huge amount of utility to it. And just because the systems, so if we can improve reliability
on the Ayurvedic side, then I think we have
something very potent. Right, so, and the other reason is because I think that like– – What is the thing that
you think that's potent? – What do you mean? – You said that if we improve reliability, we'll have something on the
Ayurvedic side that's potent. What would be potent? – So I think that they take
this individualized approach. So in my clinical
practice, the more that I, so I think we get taught, in Western medicine or in medical school, we tend to get taught the population-based medicine way more. And like you said, we call it the art. Why do we call it the art? Because we don't have explicit systems. So the whole point is in Ayurvedic– – There's subjectivity to it. That's what art means, right? – Well, that's, the reason we call it art is because we haven't made it scientific. Does that make sense? We haven't conceived of a way to make the art of medicine scientific, which is why we call
it the art of medicine. But there is absolutely a logical scientific method going on in your head.
– I don't think, I think it's an art, not
because it's not scientific, I think it's an art 'cause
it's not standardized. And maybe I'm just mixing words. – Exactly, so we have, no, no, no. But that's exactly my point is we have not developed
a standardization. We have not scientifically broken apart the art side of medicine. – I don't think that that can happen. – Yeah, well, so I, there's a system of
medicine that's done it. – Which is what, Ayurvedic? – That's what I'm saying is they've taken the individuality. – Do you believe that though? – Yeah, absolutely. There's lots of flaws. But I think that there
is, they've done it, yeah. – You mentioned we need to
bring some of Western medicine into Ayurvedic practice. – [Alok] 100%.
– To improve Ayurvedic practice. I view that as not an optimal use of, time is probably the wrong word. I would view, based on how you
describe Ayurvedic medicine, that there's a lot of problems. 90% of it has issues,
et cetera, et cetera. Why not take what works
of Ayurvedic medicine, the art aspect of it, and bring it to Western medicine as opposed to bringing Western medicine and trying to fix something that is really very problematic,
already so far gone? – It's a great question. So the first thing is that I think the question is sort of moot, because I think both are
happening simultaneously. So I think as we progress in our scientific
understanding of medicine, we are moving closer to Ayurveda. So that's happening automatically, because I think that it, as
we're discovering more of truth, we're just moving in
a particular direction of individualized medicine,
which is the whole backdrop. So if you look at our
Western system of medicine, the idea is that a disease process is independent of an
individual and has a treatment. So our whole, the whole point of an RCT is let's remove all of the individuality, all of the specificity
from an individual patient. Because if we take an individual patient, we treat cholesterol in
this individual patient, we have no idea how that's gonna apply to the other 9,000 people we treat, because this person is an individual. So let's remove individuality
from the equation. Let's look at high blood pressure and let's try to isolate
this disease process. Then we run into a problem
in Western medicine, because you can isolate
this disease process in a laboratory, but the moment that you have
a real person in front of you, things get complicated, agreed? – 100%. – So Ayurvedic medicine just looks at it from
the opposite direction. They kind of say, “Okay,
let's start with an individual and let's understand what
works for this person.” And then they also generalize. They sort of also have,
you know, diagnoses, right? Which obviously means that it's not, there's diagnoses that are
shared amongst individuals, but they start from a
more individual lens. We are starting at a population level and we are trying to narrow
down to personalized medicine. They start at personalized medicine and they sort of extrapolate
out to a more general way. – Isn't that flawed by design? – No. It's only flawed by design if you presume that the population base and the system, the existence
of a disease process that is independent of people exists. – Wait, say that again. – So do you think that
hypercholesterolemia can exist outside of a person? – Like, exist in what way? Like, on a definition of a
text, in a textbook it can. – Okay, so, like, can you have hypercholesterolemia
outside of a person? – Yes, in a Petri dish. – Okay, right? So when you translate that to a person, it becomes individualized, right? And then our core pathophysiology, completely agree that you
can say, okay, whatever. There's something that
can exist in a Petri dish. When you translate it into a person, you are adding individuality to it. Maybe the word bias is
good here, I don't know. The way that you're using
it, I'm not 100% sure. So all I'm saying is that
our, the whole art of medicine is we have these general principles that are scientifically true and we apply them to an individual and then things get muddy and we have to include the
art of medicine, right? All Ayurveda does is they
start with the presumption that a disease process and an individual, that every disease process is going to manifest in a unique way. And that that is the
foundation of how are we, we are going to approach treatment. So if you say, is that biased in the sense that every
treatment is individualized? Yes. – I'm gonna make a comparison. Are you familiar with “Bro Science?” – No. – So when you go to the gym and you hang out in the gym environment, there's a lot of guys that walk around to claim that they have the
right way of exercising, the right way.
– [Alok] Yeah. – And it might be the right way for them. But if I in medicine try and
take what worked for one person and try and scale it, I'm
gonna run into a disaster. – Yeah. – That's why I think it's
better to look at population and then try and narrow it. That's why I think the
principle of starting with one and going up and generalizing. – No, no, no, no. – [Mike] Is way more problematic. – No, no, yeah, but, so this is a
fundamental misunderstanding. The whole point of Ayurveda is you don't generalize one
to the broader population. You develop a system that
works for each person, ideally. That's what their approach is. There's no generalization, or there, I mean, there's
some generalization, some necessary generalization. But their whole point is that you, when someone comes to you and
this guy is a bro science, and he says, “This works for you.” The Ayurvedic doctor says,
“This worked for you. Let me try to figure out,”
the next person comes along and they try to figure out what will work for you specifically, what will work for you specifically. They don't care about populations, they care about individuals. – And you don't think that's fraught with forever reliability issues. – What do you mean by reliability? – Again, like, the practitioner
reliability issues. – Oh no, no, it's
fraught with reliability. – Like, that that will never get solved. – I don't know that. – How can you have reliability when cults can lead people to do the most ridiculous
things, feel certain ways, because of the power of
the mind to be manipulated? How can we ever measure what
one individual is doing, whether or not that's valuable? Because I feel like it's
so easily corruptible when we're just treating everyone as one, one, one, one, one. – So I think maybe I'm
foolish, maybe I'm optimistic. So here's where I'm coming from. Here's why I don't think it
is an unsolvable problem. So if you look at the history of humanity, we've been faced with unsolvable
problems that get solved. – [Mike] Of course.
– So I have faith that if we were to leverage even 10% of the brain
power in scientific weight that we have in allopathic
medicine towards Ayurveda, I think we could, it'd be
amazing what we would accomplish. That's my gut instinct. I don't know that that's true. Is it potentially an unsolvable problem? Absolutely. So what I think though is
that what I've seen already is that it doesn't take a whole lot. So, like, I think that if we were to put, let's say, like, put together,
like, cohort treatments and we were to start to measure outcomes. So I do think we need to add some of this population-based stuff and evidence-based medicine. So let's compare Rasashaastra
where someone gives arsenic and all this kind of
stuff to, for example, like Ayurvedic herbs or the
inclusion of yoga and Tai Chi. Let's actually take
cohorts of these people and study and see what's
better and what isn't. And then what we'll, I
think what we'll discover is there can be a methodology, because they still teach
general methodologies, but the focus of the general methodology is not on a disease. It is on a person. So in Western medicine, what
we do is we make a diagnosis and then we treat the diagnosis. We don't treat a person. We don't ask, and then
clinically we end up doing this, which is that we start
to treat a diagnosis. But then as we actually
treat a human being, this treatment of a diagnosis
doesn't work like that. The person doesn't take their
blood pressure medication. So now you have to have
this conversation with them or they have this kind of side effect, you have to change to this medication. So we end up individualizing and that's what makes a good doctor. All I'm saying is, if you think about it, the actual theoretical, if
you read a pathology textbook, which has all of our
understanding of medicine, you will not find any
art of medicine in there. You'll find it in other textbooks, but not in a pathology textbook. Then in the practice of medicine, we are adding what you call the art. And all I'm saying is there
is a whole system of medicine where we take the RCTs and
the population-based stuff and the pathology of
textbook, we add the art. But this is not the bulk of
our approach to medicine. This is the bulk of our approach. Does that make sense? Ayurvedic medicine says this
is the bulk of our approach. That's the big difference. – Yeah, I'm just viewing starting points. Western medicine, we
have the starting point of randomized controlled
data, population-based data that we can then tailor an
art and improve our art. We definitely need to improve our art, I will never not support that. Ayurvedic medicine has
such a fraught foundation and we're like, “Let's
bring randomized controlled and evidence and all that to this fraught concept already.” Why? – I don't think that the
fundamental concept is fraught. In fact, I– – But you said there's, like, 90, like, 10% of it's only valuable. – Yeah, so, but I don't think the fundamentals are fraught. I think the fundamentals
are actually, I think, the reason we practice, the more we practice the art of medicine, the closer we are to the Ayurvedic system, because that's what their system is. It's an individual treatment. – But we end up there. – [Alok] Yeah.
– Versus starting from there. I think that's a drastic distinction. – Yeah, it is a drastic distinction. But I don't think that that one is necessarily worse than the other, I mean, I would even say– – I don't think that they're worse. I just think if you're trying to start, like, if I was creating a civilization and I was like, “Okay, let me
find the most effective way to bring the best medical care.” If I'm making a “Sims” game out of this, I would create randomized population data and then I would bring
in Ayurvedic principles, individualizing it later. – So let me, that's fine,
so that's your prerogative. And I would encourage you to– – But I'm curious what
you think about that. – Yeah, so let me ask you this. Do you think, what do you think is a better system of medicine? A system that is population-based or a system that gets outcomes that are tailored to the individual? Let's say that I could
perfectly diagnose you. I did all the genetic stuff. I could analyze all of your phenotypes. I could analyze even
things like your digestion. – I think that's a– – Hold on. Digestion, your absorption of nutrients, what kind of absorption
difficulties you have. And I understood all of
this information about you. Which one do you think would be better? – Of course, you created
a perfect example, but that doesn't exist. – So the foundation of
Ayurveda starts with that. – Yeah, but it's nowhere
near it, it's not even close. – Oh, this is that, that's where you gotta be careful, right? So I think that it's way closer than what we give it credit for. – You're saying they have
a perfect understanding of each individuals? – They do not, they do not
have a perfect understanding. What I'm saying is that the direction that they are moving in is
to focus on the individual. So we don't even focus on the individual, we focus on a population. So we have, let's say we,
like, use a video game analogy. So we've leveled up to level 100 on population-based medicine. And then the reason that we have good clinicians
and bad clinicians is that the good clinicians
are the ones who've leveled up to level 50 on individualized medicine. In Ayurveda, they've leveled
up individualized medicine to level 100, but their population-based
medicine is level 10. – I think when you individualize,
when you use that example, when you individ, when you level up to 100
on the individual level, your data is fraught with error and bias. – How so?
– And subjectivity. Because you're not studying it in mass. – [Alok] Yeah.
– And there's so many mistakes that you could make when you're
just treating an end of one. – Very true, right? So, but you're thinking from
a population-based standpoint. But when you kind of think about it and when you treat an individual, you can make so many mistakes. There's so, because that's what you do
in your practice, right? – [Mike] Of course.
– You don't treat populations. You treat individuals. So how do you figure out what is best for your individual patient
who's sitting in front of you? It's fraught with errors,
it's fraught with bias. – All of healthcare will
always be fraught with error. Our job is to take the
best worst approach. And to me, the best worst approach is seeing what works that's generalizable. Continually fine-tuning it as oppo, if I was building a pencil
or I was building a house, it's much better to have the foundation of randomized control generalized data and then building upwards to get the subjectivity of how
you want the house to look, whether it's pretty. But without a good foundation,
that house is gonna crumble. And I feel like Ayurvedic principles are built on a weak foundation. – So I think that's very, very, it's a very reasonable view, right? So, and I think that there's, like, good data to support that view, because there's a reason
why allopathic medicine has spread all over the world and apathic medicine is not. – Well, that's a good
question here to be had. Why do you think in Eastern culture, we never got, well, not we, but why hasn't it moved
to a labeling system, a randomized control? Why has there been so much disconnect between randomized
controlled stuff happening in Western medicine, but that is firmly pushed
against in Eastern medicine? – Why do Eastern people not like randomized controlled trials? – Yeah, like, why didn't, throughout time, like, the way Eastern
medicine is talked about now is more similar to how Eastern medicine was talked about 500 years ago. – Okay, yeah. – Than Western medicine talked about now than how Western medicine– – [Alok] Completely agree. – Why is that? Why is it seemingly stuck in the past? – So there–
– [Mike] For lack of a better word. – What do you think are, what's
the differential diagnosis for why something doesn't
change over 500 years? – My… – [Alok] Oh boy. – Skewed skeptical belief is that it's based on culture. – What's the differential– – [Mike] Religion. – What, okay, so culture is part of it. Religion is, what's the, what
else is on the differential? – Lack of refinement. – Okay, that is also on the– – It's on the differential, I'm not saying it's the cause. – Yeah, yeah. – That it works. – Absolutely. Right, so that's what's really tricky. – Well, well, hold on. We have that it fully doesn't
work, lack of refinement, and that it can work. – Absolutely. – Those are possibilities. – Yes, so they're– – We can't give them equal weight here and say, “Well, look.” – But so it's good, right? So, now you ask a question, right? That's on the differential. – Maybe the reason–
– Maybe when a patient comes in with two days of cough, cancer is on the differential, but we don't talk about it,
'cause that's not valuable. – Sure, but I think in the
case of let's say, like, let's look at these Eastern traditions. So these are the traditions
that gave us meditation, right? So this is where I
think part of the reason and like, I don't… – When you say a statement like
that, you know what I hear? – [Alok] What? – When a patient comes in
with two days of cough, if I say that it's cancer,
I'm gonna be wrong so often, but I will be right sometimes. Ayurvedic medicine, you're
showing came up with meditation. That's that one time
they called cough cancer. – Fair enough. – [Mike] And it turned out to be cancer. – So, I don't even
disagree with you there. So this is exactly where,
like, I think that's why, I mean I gave this example
where Dr. Genninger was like, “The biggest problem
with Ayurvedic medicine,” I'll be the first one to say this, right? So I'm sort of, I feel like I'm adopting a pro Ayurvedic stance because of the way
you're asking questions. But I don't use Ayurvedic medicine with the majority of my patients. I use evidence-based techniques with the majority of my patients,
because they're reliable. – [Mike] Right. – And at the same time I'm
with you that I don't know, so if you look at this text
called “Garga Samhita.” There's, like, tons of
treatments in there. I have no idea how many of those are
effective as meditation. We even have evidence that
some of them are harmful, like Rasashaastra, right? So I steer clear of that, because, but then the problem
in the Ayurvedic system is if you go talk to an Ayurvedic doctor, many of them will not say,
“Oh yeah, this doesn't work.” That's a huge problem, right? They'll say like, “Oh, we
don't understand it well,” or they'll, like, kind of poo poo and maybe they're right, maybe
we're right, I don't know. So I'll be the first
of my area of expertise is evidence-based complementary
and alternative medicine. So the whole point is that there's something
very valuable here, this is my belief, something
very valuable here. And we need to separate
the chaff from the wheat. We need to figure out what is
actually really useful here. One of the things that I
think we can learn a lot from is that I do believe that
their generalized approach, because this is what we end up doing in clinical medicine anyway,
is we focus on an individual. But there is always a translation problem from the RCT down to the individual. But there are some major
advantages that we get for that. The biggest advantage that we get for that is that on the human race, we have outperformed Ayurvedic medicine on the level of population
we have outperformed, because in these Eastern systems, they do not have ways of testing validity. They do not have ways of
separating the good from the bad. They do not have ways of measuring a good
person and a bad person. So this used to be there theoretically, if we wanna be optimistic. This used to be there historically, because of the way that it was taught. So there's this concept
of barambara or lineage where, like, if you had a good teacher, like, and now things have changed, we can get to this with meditation. So you had this lineage where, like, you basically have, like,
a system of mentorship where if you trained under this person, you're, like, gonna be good, because this person would not let you out unless they were good. There's still problems with bias there, but I think the biggest challenge that we've had in Ayurvedic medicine is we've lost some of their
fundamental safeguards like lineage. And then we've replaced it with, like, standardized education, because that's what we do in the West. And so now we have a
system that from its bones is open to things like validity, open to things like not
being critical of itself. And then we are removing
the one safeguard, which is this concept of
barambara, our lineage. Now we're giving people degrees and certificates from universities. I have no idea how to tell
whether someone is good or bad. And what I have seen as a medical doctor, like, part of the reason that, you know, I studied Ayurveda, fell in love with it, and then I went to medical school. Because what I saw is that I have no idea what's the quality of
education I'm gonna get. I have no idea what's the reliable, of what the reliability of some
of these methodologies are. I've seen things that are
medical impossibilities from Ayurveda with my own eyes, I've talked to patients, that
are medical impossibilities, like paralysis being able
to, polio paralysis, right, which is a permanent condition. That's not something that
generally speaking gets better. These people are able to walk. And so when I look at
that, it gives me pause, and it says to me,
there is potential here. So what did I do? Did I say, “Oh my God,
there's potential here, let me go to an Ayurvedic doctor and I'm gonna indoctrinate myself.” No, I went to medical school, focused on evidence-based
complementary alternative medicine realized that in the grand scheme of being a doctor in the world today, each of us can make a contribution. What do I want my contribution to be? I saw something that I
thought was very worth. I saw something that I saw potential in and I said to myself, “Even
if 90% of it is shit,” I can't judge whether
90% is good, 10% is good, 50, I have no idea, but there's something here that we in the West can benefit from. And that's been what my focus is on. – What do you like about
Ayurvedic medicine? What is that part? – So I like that they
focus on the individual. – Got it, what else? – So I like that they look at, so just as a psychiatrist, so, like, one thing that
I really appreciated was this concept of, like,
a cognitive fingerprint. So we have this in some ways in terms of, like, five factor model
and stuff like that. We have these personality assessments, but these personality assessments are usually done at the population level. And so the translation
down to the individual is not as clinically useful as some of these Eastern conceptions of cognitive fingerprint. So when I work with a patient, doing a five factor assessment has very little bearing
on my clinical practice, but doing more of an Ayurvedic
personality assessment has a lot more utility in
my limited biased experience compared to some of these generalizable personality assessments. There are some cases
where those can be good, but I think that some of this
stuff is quite revolutionary, because it helps me understand. So even like, for example,
depression, understanding, like, okay, what is this
person's Ayurvedic dosha? It helps inform me about how
to approach this kind of thing. Also in my clinical
practice, what I've seen is if people adopt a Ayurvedic diet, they're more likely to
have sustained remission at lower medication doses or be able to come off of medication. That is nothing magical by the way. I think they just sort of figured out gut microbiome observationally and that now we're
discovering the mechanism. But it's really interesting
that their first line treatment for mental illnesses seems to be diet. And my guess is the
mechanism has got microbiome modification to support, I mean neurotransmitter
precursor production. That's my take. And what I've seen very clinically is when I apply some of these principles to my clinical practice, that
patients tend to do better. – So I'm gonna keep track of it. Individualism, stratifying
personality types. – [Alok] Yeah.
– Cognitive fingerprinting as you called it. And then diet lifestyle I guess. – Yeah.
– Is one of them. It seems to me based on this conversation, Ayurvedic medicine is fraught
with a lot of bias issues, et cetera, that you pointed
out reliability, all that. Since so much of it is inaccurate and there's a few things that
you think is very valuable that are missing for modern medicine, why not take the concepts of those things, like, improving the
cognitive fingerprinting of modern tools, focusing more on the individual approach and stop calling it and talking
about Ayurvedic medicine. ‘Cause it's sexy to talk
about Ayurvedic medicine, 'cause people are passionate
about it, but 90%+ is crap. And yet I feel like
we're keeping it afloat. – Well, I don't know that it's crap and you don't know that it's crap. – Well, we know that it's crap, because of how it got to where it is, because of the lack of
reliability, the randomization. – No, but we don't know it's crap, we just don't know that it's not crap. – Right.
– [Alok] There's a big difference. – And when someone makes a claim that this water will
prevent you from dying or this is the anti-aging water, do you know that this
is not gonna prevent you from living forever? Like, do you know that
I'm lying about this? – No, I don't. – Right, you need to do a trial, but I'm very comfortable
as a doctor now saying. – I'm with you, yeah. – No, that's not happening. – Yeah, so.
– Because mechanistically, it's not there. The evidence isn't there. And I've gotten to the point where even though I don't
have the evidence to say– – Well, so Mike, what frustrates you so much
about Ayurvedic medicine? – I'll tell you why. It leads to a fundamental
misunderstanding of healthcare for a large percentage of patients. It opens room for health gurus and hucksters to take advantage of people. And it actually diverts our attention from ways that we can improve medicine. – Okay. So now I'm understanding this
conversation a lot better. So I noticed that this was
becoming very antagonistic, which was really weird, because I actually agree with the majority of what you're saying. – Yeah, I see that. – Yeah, right, so I'm
the first to kind of say, like, I'm the one who said, “Hey, like 90% of it I
think could be crap.” And so I was kind of struck a little bit. And then that's when I realized, like, I'm not talking to someone
who has an open mind. I'm talking to someone
who has a mind made up. – I'm talking about it from
a truth-seeking perspective. So my mind's not made up. If you presented some
data or information here that showed Ayurvedic
medicine is way more accurate than you think it is, I
would've changed my mind today. – Yeah, so that's, it's interesting. But I think what I'm– – I definitely have a bias. – [Alok] Yeah, so.
– From what I've learned so far. – So how is this conversation
for you emotionally? – Exciting. – In what way? So do you feel anything
besides excitement? – Full excitement that we're finding a way
to truth-seek together. Because I, unlike many people who talk about Ayurvedic
medicine in this space, I think you do it incredibly honestly. – So, 'cause I agree with you, but I think there are a couple
of things to keep in mind. So when you make a statement like, you know, 90% of it is crap, that indicates bias to me,
because we don't know that. You make a very good
argument that we can't, we have to be skeptical based on our understanding of things, that if I say I show up today and I say like, “Oh,
like, here's a pyramid. If you meditate under the
pyramid, like, it could work.” And then you can always
make the counterargument that, “Until you study it, we don't know. They could be right.” – [Mike] Right. – And what I'm also
detecting from you is, like, I think I'm detecting this
emotion of frustration, because of hucksters and
these kinds of people. So I think your understanding of Ayurveda comes from these people. And so that's why I was kind of surprised, because usually in conversations, I am representing your view a lot more. – Yeah.
– Right, so I'll go to these academic conferences with a lot of Ayurvedic practitioners and I'll say, like, “Hey,
like, we don't know, there are eight disciplines of Ayurveda. We have some limited evidence
of this particular thing. Brahmi, turmeric, ashwagandha,
like, a set of herbs. We don't have a whole
lot of stuff on this.” And so I think it's just
been really interesting. Now I understand a lot
more why this conversation is going the way that it is, which is that you're asking
me all these questions, which I get the sense that you're sort of open to the answer, but I think you're asking questions that are not open-ended questions. You're asking questions where
you already have a hypothesis and you are asking me to
reflect upon that hypothesis or even counter that
hypothesis or support it. – That's fair. – Which is, I was just– – And I think our hypothesis is similar. – Yeah, so I think though– – [Mike] And our standpoint is similar. – I think that you would benefit from studying Ayurvedic medicine. – Agreed, which is what I'm
hoping in this conversation I can learn more about it. – Yeah, so I think just this
individualized approach, it's so axiomatically different. I think there's value to it. – Without a doubt. – And in terms of why
not translate it over, I think there are a couple
of, I think that's good, and I think that's part of the
direction we should move in. And I think there's a
slight problem with that, which this rubs me
emotionally the wrong way, which is that there's a certain amount of cultural appropriation to it. So if we look at meditation, let's go back to meditation for a second. So we look at meditation and we kind of say, “Okay,
mindfulness is scientific, this is good, this is
good, this is all woo woo.” But if we kind of think about it, what's happening is we're taking
the, all of it was woo woo, and then we're taking this and we're saying the
rest of it is woo woo, we're taking this and we're saying the
rest of it is woo woo, we're taking this and we're saying the
rest of it is woo woo. Now this is very reasonable from the sense of how
does science progress? We have the unknown, we take a chunk, and now this is known
and here's the unknown. We take a chunk, it's very reasonable. On the flip side, I think
what ends up happening is if this was our original chunk and we say that this much is, and I don't think we're here,
we're nowhere near that. We're, like, right here in meditation. If we say that this much is valid, there is a certain bias
that can set in of, we're not sort of recognizing that 60% of this stuff was correct. We're sort of saying 100%
of it is always wrong, because we move the stuff
that is scientifically valid over to science and we remove it from the realm of let's say, spiritual tradition. – But have we done that? – That's what's happening, absolutely. – In what way, can you gimme
a specific example of that? – Yeah, so, like, cardiac
coherence breathing. So, for example.
– [Mike] What's that? – So we have this in the East, we have this system of prana. Okay, so this is chi or vital life force. There's no scientific evidence of this. The best example that I've
ever heard is, once again, researchers at Harvard discovered that there are channels
of electrical conductance in the interstitial
space that are variable. So they were like, oh, have you
heard of meridians or nadis, like, this in Tai Chi. – I've heard of them, but I
don't really understand them. – So there's this idea that
we have this vital life energy that flows through us, it
flows through these channels. We biologically looked for it and it doesn't, we can't find anything. – Well, we can't measure it yet, right? We might in the future. – We might.
– We might not just have the tools to
currently measure it. – Yeah, so that–
– [Mike] So I'm open to that. – Yeah, so, and that's where
some people are looking for it. And one person, for example, discovered that there are
interstitial channels basically that don't have a tissue difference. There's a change at the level
of the electrical conductance, but there isn't, like, a
physical, like, you know? – Anatomical thing. – [Alok] Yeah.
– Yeah. – So it could be there, sure. But I think what's really interesting is we have no scientific
evidence for that. So then we have these systems
of something called Pranayam, which is you do these
techniques which are designed to basically stimulate
this vital life energy, which we have no scientific
evidence for, okay? So when we move something, and so then we'll take this
Sanskrit practice of Pranayam, and then we'll turn it
into a scientific term like non-sleep deep rest, or
cardiac coherence breathing or things like that. These are all yogic practices. – What do they mean? Just so I can follow along better. Like, what are the, what
is a cardiac breathing? – Cardiac coherence breathing is basically alternate nostril breathing. It's this old yogic
practice called Pranayam. I mean, or Nadi Shuddhi. And what we kind of do
is we try to figure out, okay, what is the distillation
of the scientific principles? And we're gonna kind
of give it a new name. And then I think something is lost there, because the moment that we
denude it of spirituality, there's a good reason to do that, because I think you
sort of need to do that, because from a scientific RCT perspective, you need some way to
standardize the protocol and you need to make sure that everyone is, like, working with the same thing. So there's good reasons to do that. But there's also losses in that, which is that we're removing it from the spiritual tradition,
which I think is actually where a lot of the therapeutic value is. So one example of this is there's a, something that's growing a lot, which is non-sleep deep rest. Have you heard of this? Okay. – Like micro naps? – No. – [Mike] Okay. – So it's a practice
that's called yoga nidra. So yoga nidra is yogic sleep. So it's this, like,
ancient yogic technique and we basically medicalized
it by protocolizing it, sort of reducing it in some ways. And what they actually do
is intentionally remove a lot of the spiritual woo woo stuff. So then, and then we do studies on it and non-sleep deep rest has good outcomes. So we know, for example,
that yoga and Tai Chi outperform standard exercise
when it comes to things like osteoarthritis or mental illness. There are RCTs, you're familiar with that? – Familiar with that research? – [Alok] Yeah.
– That they outperform it? I'm not sure, yeah. – Okay, so there's some
studies that show that. So, and then that, so actually
let's do a quick aside. So that's what makes me really wonder about the value of some
of these traditions, because if we look at studies that show that yoga is superior
to physical exercise. So there's one paper from I think 2016, the New England Journal of Medicine on Tai Chi and osteoarthritis that basically showed that
it was very effective. So then interestingly, from
a scientific perspective, if we say, okay, like, if
all that exists is physical, then exercise should
be the same as Tai Chi. The other way to think about it is that even if it's still physical, it's not necessarily
that that energy exists, but when you use this heuristic
or this concept of energy and you develop a practice
based on that concept, the physical biological
postures that you do are somehow superior to
this other set of postures that is exercise. Does that make sense or
did I lose you there? – No, and I'm simple. I'm not, I have to really
dumb things down in my mind – [Alok] Yeah.
– For me to understand them. And I'm gonna tell you
how it's landing for me and you tell me if it's accurate. When you put meaning
into what you're doing, spirituality is a form of meaning, you get better outcomes. – I don't think that's it at all. – Oh. – [Alok] Yeah.
– Okay. – So I think that there
are mechanisms at play. So let's, here's, lemme
try to explain it better. So we have a study, you can look at the paper,
I'll send you the reference. So Tai Chi and osteoarthritis
outperforms physical exercise. Okay, so now let's understand. Tai Chi is based on this
theory of vital life energy, which we have no
scientific evidence about. So then the question becomes how do we explain this
result, that this practice, which is based on a non-real thing, outperforms a seemingly
comparable practice. They're both just moving around. So there are two explanations for this, one, or probably more. One is that this thing does
exist and is not measurable. The second is that even
if it doesn't exist, the concept of this existing and something about the way that they developed those
practices based on this concept, it's still just completely biological, but because we were considering chi, we developed this
different set of movements. And if you look at someone
who just does stretching or calisthenics or whatever,
these other physical practices, that there is a difference
in the physical practice. Does that make sense? – Yeah, I mean I could send a
patient for physical therapy and the physical therapist can target, like, let's say someone
has a low back strain and I send 'em to physical therapy, they can focus on massage and movements of their thoracic
spine and loosening that up. They can focus on glute strengthening and hamstring tightness and
posterior chain strengthening. They're all movements, but they're gonna yield
radically different results. – Yeah, perfect, right? – [Mike] Yeah.
– So that's what I'm saying is that there could be, there's something about the theoretical– – [Mike] The movement, yeah. – There's something about
the theoretical backdrop that they developed, whether
it's real or not real, that leads to a particular protocol which outperforms our
understanding of exercise. – Right. – So I think that even if
we assume that latter case, I think we could be losing something, because if we even remove that theory that gave us the practices
in the first place, we could be depriving ourselves
of a certain methodology that leads to interventions
that are quite good. I don't know if I lost you there. This is the most technical
conversation about this. I've had a long time. – [Mike] This is great.
– This is fantastic. – I love this. They, it's a very heady conversation, 'cause we're talking about tertiary level concepts right now. – Yeah.
– Of imaginary concepts. So where my mind is going is that you feel that the
way Tai Chi was created, we shouldn't just focus on Tai Chi, we should focus on how
Tai Chi was created, because there's value there. – Potentially, right?
– Right. – Focus on in terms of investigation. – Right. – So, what, just to give
you another example. So, like, I was, when I was
at, like, McLean Hospital, I was developing protocols for specific Pranayam
or breathing practices to target specific illnesses. So if you look at the RCTs, what we see is RCTs on mindfulness. But if you look at what
is the actual thing that people are doing,
it's wildly different. – Of course. – And what we see is that in DBT, we'll call something mindfulness, but these are very
different from mindfulness for, like, stress reduction. So for something like MBSR, these are open awareness techniques and there's some great research that Silbersweig out
of Brigham and Women's has done about sort of the
different types of meditation. So not all mindfulness is the same. And what I've sort of found is that if you do traditional mindfulness for people with a history of trauma, it has the opposite effect. So traditional mindfulness is just open non-judgmental awareness of
the flow of your thoughts. If you have a patient
who has BPD or trauma and you just tell them
to openly non-judge, open awareness of non-judgmental
appraisal of your thoughts, we have all these psychological
defense mechanisms that are keeping these traumas at bay. As soon as that opens up, they're gonna get
overwhelmed by their trauma. So if you look at the mindfulness in something like dialectical
behavioral therapy, these are not open awareness techniques. These are grounding techniques. These are things like ice diving where you're not nonjudgmentally
observing anything. You are actually inducing
a particular sensory focus that is so demanding that
you can no longer think. So when we look at these two
things now in Western science, we don't really have a good understanding of that differentiation. So I absolutely think we need that. What I'm saying is that when you take it from a theoretical process
from where it was developed, and you sort of consider that, it gives us a lot of basically lead time into scientific investigation. Because when I'm developing a particular set of breathing practices or meditative practices for anxiety versus depression versus trauma, I have this Eastern conception, which has this whole thing
where they basically say, “This will work for anxiety,”
but they don't call it that. So they'll say, for example, “This practice will slow down
the thoughts in the mind. This practice will energize the prana. This practice will cool the prana.” They use all these weird heuristics. And what I have observed
in my clinical practice, so this is small sample size, my path took me in a different direction. But what I was really
working on is trying to see, okay, if we use this theory and we develop a set of protocols, this is basically what Marsha Linehan did with DBT in some form, we can actually accelerate the rate of our scientific research, because we have these
answers already here. – So what is, where's the
cultural misappropriation or appropriation come in
that you have a problem with? – Yeah, so the moment that we remove that spirituality from it, I think we lose that
value-generating aspect, right? So the moment that– – But why, why do we have to lose that? Like, for example, you took the principles of those breathing practices of slow the mind or energize the mind and you adapted them to modern
medical defined conditions. – Yeah. – Why does it, why in
this scenario do you feel like you're losing the
spiritual connection? – Because when we publish papers about it, the more that I include that information, which is really where I
got my answers from, right? The more that I include that, the less likely it is to be published. – [Mike] Why? – [Alok] Because people
don't publish that. – Why? – I don't know, because
it's not scientific. – But the science mechanisms, theories are not scientific in nature. – Yeah. – So I could have a thought today that I would put up
for scientific testing. How in the world would a company not wanna publish something
if something works, simply because the beginnings of it weren't scientifically valuable? – If you look at the studies, the evidence-based studies, right? These are studies that are published. So if you look at, like, New England Journal of
Medicine thing on Tai Chi, you'll find almost no, you'll see a small
section in the background that Tai Chi is an ancient
practice based on this theory, you won't have a single line about what is actually happening to the chi in your body when
you do this kind of thing. – Correct. – So there is a strong publication bias against this kind of stuff. I don't know why, I mean you'd have to
ask the journal editors. – Well, what is the value of
including the history of it? – It's not history. What I'm talking about is
they have a mechanism, right? So they have a theoretical mechanism with which they develop a practice, and we know from evidence RCTs that the practice is quite effective. – Right. – So what I'm saying is that the moment that we publish that paper and we remove the theoretical basis, it's kind of okay because we
still see that Tai Chi works. There's other problems that we get into. But then what we're
also doing is we're not, it's not about credit, but we're, the way that
this practice was developed was based on this theoretical model. And if we remove the theoretical model, we don't have that theoretical model to generate other practices or to work with that theoretical model. So lemme put it this way,
lemme give you an analogy. So let's say that
there's a group of aliens and I introduce to them microbiology and I say, “Here are the
principles of microbiology.” And then I give them, let's say, I don't know, penicillin, okay? So if I do an RCT on penicillin,
“I say penicillin is great, but by the way, microbiology is all BS. We just can study penicillin,
we know penicillin works.” And then this alien civilization starts just delivering penicillin, because they, but they don't understand anything about microbiology, what are the problems in that? We have an RCT that penicillin works and then we give them and they start administering
penicillin, what's the problem? – Resistance? – Absolutely, right? So this is one example where understanding the underlying theory, it becomes very important for the implementation of the practice. And what we are losing in Western medicine is we are removing that underlying theory, which opens us up to different
perspective problems. And antibiotic resistance is
just a good example, right? So that was like, I knew
what you were gonna say, I knew what the answer was, that's why I picked that example. So it's not sufficient to just do an RCT, because there are other principles at play and there are RCTs involved
in those principles. We have RCTs on antibiotic resistance, but that's where there, understanding the theoretical
basis of our treatments becomes critical to
avoid pitfalls like this. And what I'm– – Can you gimme an example
of something like that within the field of Ayurvedic
medicine or spirituality? – Yeah. So, man, this is where things get fun. So let me ask you this, where do the thoughts
in your mind come from? – I don't know if I
have the answer to that. – What do you think? – Neurons, blood flow, firing creating action potentials. – Okay, so neurons, blood flow, firing creating action potentials
are all the same, right? Like, you're, okay, so you
having a thought right now? – Yeah. – Where's that thought coming from? – My brain. – Okay, but is there any other
thing in the causal chain that is creating that thought? – Is there anything
else in the causal chain creating the thought? Sensation, receptors, et cetera? – Okay, right, so the simple
idea, so one of the places that thoughts in our brain come from, this is based on the yogic concept. So sure it's translated through the brain, but we know that our sense
organs are a source of thoughts. So this is why advertising is a thing. If I show something to your eyes over and over and over again, it will trigger certain thoughts, it will trigger certain desires. Agreed? Okay. So where else do thoughts come from? So we can also have thoughts. I'll speedrun this, you're
welcome to question it. – Memories, et cetera. – Yeah, so memories of
sensory experiences. So how do I want a hamburger? So later tonight when
you're relaxing at home, you're gonna be thinking to yourself, “Man, I wish Dr. K would
touch my toes again.” You know, right. And so where does that thought come from? That thought comes from a memory. So we can have a thoughts sometimes come from sensory impressions and sometimes come from memories. We can also think about
something like studying, right? So I'm asking you questions,
you're asking me questions. Where does this information comes from? It comes from our memories. So let's take someone like
anxiety, someone who has anxiety, or someone who has something like trauma. So these people literally
have thoughts in their brain. They have, let's say, low self-esteem. But what does low self-esteem mean? There is a mechanism of low self-esteem. It is maybe there's activation
of the default mode network. We understand the neurology of this. But from a experiential standpoint, there is something in their, let's call it subconscious mind, I can go into more detail if you want, that generates low self-esteem thoughts. So if someone gets me a nice gift, my mind will, this is
a sensory input, right? So I hand you a gift, you hand me a gift. Your mind can say, “Oh, this is wonderful, this is great, thank you so much.” Someone else's mind can say, “Oh I don't deserve this,” right? So the thought is coming from somewhere. So along comes yoga nidra. And what people both
yogis basically discovered is that the more empty your,
or non-active your mind is, the less activity that is in your mind, the deeper something
will sink into your mind. Does that make sense? – Well, I don't know what
deeper into your mind means. – Oh, give you a simple example. So let's say you're
studying for a test, right? So your licensing exam. And you're in your, let's say you're looking at a textbook. The more activity is in your mind. If you're thinking about this, let's say the library's on fire, there's gonna be so much mental activity that what you are trying
to absorb does not sink in. It doesn't enter your mind,
it kind of bounces off. So you have to read the page again. – [Mike] Retention is not there. – Yes, attention is not there. – Retention. – Retention and attention. – [Mike] Yeah. – So a one-pointedness of attention correlates with retention. Okay, agreed? – Yeah.
– Okay, so now enter non-sleep deep rest. So this is a practice
originally called yoga nidra. Now people are doing studies on it, lowers your cortisol level,
all this good stuff, right? All these physiologic parameters. But the whole point of yoga nidra is not to do any of these things. The whole point of yoga nidra is to enter into such a state of rest, that's not the point of the
practice, that's the prep. And then to implant thoughts
into your deep, into your mind so that they generate
into your conscious mind. So what I mean by that is you, take something called
a Sankalp or a resolve. So whatever Sankalp you
use during yoga nidra gets implanted into your mind and then starts populating your mind during your regular time. So when I use this with
patients, for example, who have a history of trauma
and have self-esteem problems, so, like, you know, we
came up with one Sankalp, which is like, “I deserve to be whole.” So it's not that, “I am a good person, I'm gonna manifest
things in the universe.” And there's interesting signs
on manifestation and stuff, which we can get to, but. And it's just this idea that if you literally look at
a patient who is struggling, their mind will have 100 thoughts over the course of the hour. And there is a particular practice that allows us to add 10
thoughts of whatever we want. So this is sort of the
spiritual value of a Sankalp. And even there's even more non even psychological benefits to it. There's spiritual benefits
and transcendental benefits and all this kind of stuff, which is really what a Sankalp is about. But the point is that when we, when we just do non-sleep deep rest, you can look at all the studies on that. No one's gonna say
anything about a Sankalp. But when you do the practice the way it was designed to be done and you add something like a Sankalp, from a Western standpoint, there may be some kind of auto suggestion or something like that, some
kind of cognitive reframing. We're not quite sure
what the mechanism is, but there's something to
put your state of mind into something that is like
a hypnotic state of mind. And then whatever you
implant generates thoughts. So when I do this practice
in my clinical practice, which by the way, I usually
do proper informed consent with my patients, I say,
“Here's what the science shows. I spent seven years in India. This is what I'd like to try with you. Here's what I think will happen, but there's no data to support that.” So I go through all that
with all my patients. And what I find is that there
is immense therapeutic value in adding the Sankalp. That's an example. – And modern science doesn't yet do that? – No. – And why do you think they don't? – Because it's spiritual in nature. Well, two reasons. One is because it's spiritual and there's no basis for it, right? There's no mechanism to
understand what a Sankalp is. So it just gets removed
from, literally what happens is you'll get people who
will study this stuff and then they'll remove all
the spiritual woo woo for it, because we don't have a mechanism for it. Because really what a Sankalp is about is not the psychological manifestation. It's even an external manifestation or a spiritual manifestation. – In Western medicine, now that we've proven this non-sleep deep rest.
– [Alok] Sleep deep rest. – Has some benefits, that's step one. Wouldn't then be step two testing whether or not
adding this Sankalp? – Absolutely, so that's why I said there's two reasons for that. One is, and this is why I think
it's a double-edged sword. So if you look at
something like mindfulness, I think we've lost a whole lot. But it is a absolutely necessary step, because without the
discovery of mindfulness and the protocolization and the removal of the spirituality, you've got this guru who's
doing this mantra over here. You've got this guru's doing this, you've got transcendental meditation. So now we have a research problem. Which all these people are
doing different things. What is responsible for
the therapeutic change that we see in transcendental meditation or this kind of meditation
or this kind of meditation? So we have to distill it
down to some kind of protocol and then we grow from there. So that is literally what
the work that I try to do. And at the same time, what I notice is that while that work is being done in my clinical practice, if I lean on just non-sleep
deep rest in terms of, instead of yoga nidra,
what I find is a lack of, I'm leaving something behind clinically. But I think it's the way
that we have to do it. – I think you and I see
eye to eye on this topic really pretty much one-to-one. – [Alok] Yeah.
– Maybe 99.9% of the way. – I think we see eye to eye
on Ayurvedic stuff almost. – Yeah, that's what I'm
saying, really, really close. My question is, when
you're doing that practice and you're doing the informed consent and you're doing it
before the evidence is, hasn't caught up to it yet, how would you feel if when you, let's say a patient comes
into a doctor's office and the doctor says, “Hey look, this medicine has never
been proven to work for your condition
through scientific rigor, but I'm gonna give it to
you anyway, just trust me.” Do you have an issue with that? – What do you mean by issue? – Do you think that's ethical? Because you can go down the line and say there is off-label
prescription, yes, there is. – Yeah, no, so here's a fascinating study by a guy named Ted Kaptchuk. So he's a placebo
researcher out at Harvard and was a mentor to my PI. So he did a super
interesting placebo study. He said, “I'm gonna give you a placebo.” This is a placebo, but we
know that placebos work. And he said, “I think this will help you.” And turns out that the placebo helps even
if people know it's a placebo. – [Mike] Sure. – So I think that, you
know, off-label prescribing, as long as you do it with informed consent and the doctor has some kind of rationale behind why they're prescribing it, I think that's reasonable. – So what is your rationale
for adding the Sankalp? Sorry, I'm saying it wrong probably. – So I have some experience, and I also believe that,
like I'm kind of saying, some of the roots have value. So then what I'll do is I'll
even explain to my patients. So I'll, I'm pretty clear about, you know, “This is what the data shows. So this technique will
absolutely be in line with what we understand is the evidence-based
practice of mindfulness. Based on my spiritual training, there is an additional component, which if you're interested in, we can do. Secondly, here are the two or three, I've seen this to be very effective. Here are the mechanisms that I would hypothesize
from a Western standpoint. Here's what I think could be
going on with neuroscience, with this, with this.” And then I'll put it to the
patient and let them decide. – Right. Aren't you just giving them a placebo and calling it a placebo by doing that? – What is a placebo? – You're giving them
something that is unproven so far by our Western methods and saying there's no evidence for it. So you're saying it's a placebo, you're admitting that
to them, to the patient. But you're saying you think it would help. – What is a placebo? – How would you define? – To me, the, the description of placebo is something that we do not feel like would help the patient through a mechanism by
which we understand. – Yeah, so here's how I
would describe placebo. Placebo is things that work that we just don't have mechanisms for. – That's what, yeah. – Yeah, right, so, and that's where I would say, “Here is the hypothesized mechanism, but I think we have to do it.” I wouldn't call it a placebo, but you could absolutely make the argument that you are engendering
the placebo effect. But I think that that
is absolutely necessary. You have to do that, right? Because as a, for talking about ethics, you can recommend things
that are off-label that we may not understand
the mechanism for. That's actually okay. So whether you call it placebo or off-label prescribing, I think it's somewhere in there, are people engendering the placebo effect? Almost certainly. And this is where there's even a, I'm in a worse position for this to kind of support your point, which is that there's
a huge selection bias of people who come to my practice. So people who come to my
practice are looking for, they already have a preset idea of, “Okay, this guy's gonna
teach me something special.” I give something special. It fulfills their expectations and they see a clinical benefit. The clinical benefit is,
the reason people come to me is because people who have been to 10 psychiatrists before, I'm not trying to toot
my own horn or anything. A lot of people will come to me and they've tried other things. I mean, I even started
a consult service at MGH where the majority of my patients were from other psychiatrists, because they wanted to learn this stuff. So there's even a selection bias, which I absolutely have to consider. My take though is that there is a very
real mechanism to this. So I don't think, and that
could still be the placebo. – Yeah, my question is, yeah,
my question is how do you, you're so honest with
this, and I love this. – [Alok] Yeah.
– So I have to give you huge props to this, because I can't tell you how many doctors will claim, “I've helped 10,000 people.” And I'm like, “But selection, like the people who are coming to you.” – No, I have a bigger placebo problem than the average person. – So that's amazing that you're. – [Alok] Yeah. – Like, taking that into consideration. – Terrifies me, Mike. – So now the question is how do you decide or decipher between what you're doing being truly beneficial versus
is this a placebo effect or does it not matter? – So I can't decipher. – And does it matter? Does it, is it important to decipher? – In a theoretical
perspective? Absolutely. – So how would we get there? – So that's where I'm trying to do, like, so before this whole HealthyGamer thing, I was trying to develop clinical protocols for specific meditation regimens for particular diagnoses, right? So we'll have studies on
mindfulness for anxiety and mindfulness for depression. But my whole belief is if you
have an energizing Pranayam, these people who figured
this mindfulness crap out also had other things
that they figured out. And they said certain kinds of breathing practices are energizing. And we even have some physiologic evidence of the support of this. And this is why I do it basically, because we know that
some breathing practices will activate your
sympathetic nervous system. Some practices will activate your parasympathetic nervous system. And oh shit, they seem
to have figured that out. So then when I look at that, I think that, “Okay, so here's kind of where I am,” which is like, okay, this much is correct. Oh, it's interesting. There's, like, some stuff
that's correct here. One really fascinating thing, I was talking to a cardiologist
who teaches Pranayam. And I was asking him, like, you know, “What do you
think about this stuff? ‘Cause you're a cardiologist.” This was back before I was in med school. And so he said, “Oh, like, I think this stuff works really well.” And he says that the
particular practices that I, maybe even you can figure
this out, you know, practices that I do involve
very low respiratory rates. So if I have a very low respiratory rate, what does that do to my… – Parasympathetic nervous system? – Can activate parasympathetic
nervous system. So we're dropping our O2 levels, we're increasing our CO2 levels. You're practicing this
for a long period of time. What his observation was is
that when he has patients who do Pranayam and they
induce transient low O2 levels and high CO2 levels for
extended periods of time over the course of years, that when he ends up doing
bypass surgery on them, they have a lot more
collateral circulation around the heart. So he believes that the mechanism through which Pranayam
protects against heart attacks, transient O2, oh crap. Our blood vessels are
vasculature around the heart is, like, we're running outta
O2, we need collaterals. – Of course, yeah. – Right, so physiologically
inducing collateral circulation. – Neovascularization. – [Alok] Yes.
– Okay. – Right, by transiently decreasing O2. – Acute stress a lot of
times yields great outcomes for the human body. That's… – Yeah, yeah, so– – [Mike] The principle of that. It's acute stress in a controlled and safe way that doesn't tip you past to the point of what
your heart can't handle. – Correct.
– Right? So I think that there's, I've seen enough mechanistic support to where I think that this is
not just what we call placebo, but then the flip side is, is placebo just mechanisms
that we don't understand yet? – Well, yeah.
– [Alok] Right? – It can be. – Yeah, so I think that for me, it's fine. So the other thing for me is that I think informed
consent is very important. I think letting people know
what is scientifically supported and what isn't is very important. The other thing that I personally feel, so here's, I think one thing that we haven't really gotten to, because you're like, “Why
don't we do research? Why don't we do research on it?” Here's why I don't do it
or why I haven't done it. So I have a sense of desperation. So, like, especially when
it comes to HealthyGamer and, like, all this stuff
on video game addiction, it's like, so I got two amazing job offers from two just amazing people. And, you know, one of 'em was like, “Here's the academic track
at Harvard Medical School,” and like, “You're gonna apply
for this grant and this grant and this grant, and 10 years from now, 15 years from now,
you're gonna be the guy.” And this is amazing, it's beautiful. I had such amazing
mentors who were so kind to give me this opportunity. In the back of my mind, I was thinking, “What happens to all the people who are struggling over the
course of those 10 years?” Right, so what what
really bothers me about it as a clinician is that, like, it's fine that I think we
should do all this research. And you're absolutely correct. I agree with you 100% that we
start by studying the basics and then we study the next mechanism and then we study the next mechanism and eventually we elucidate
all of these Eastern principles and, “What are the biological mechanisms? Can we discover something
like prana or chi?” But here's the question is what happens to the
people in the meantime? How much time will that take? And I don't think it's an either or. I think we need to do both. It's just, for me personally, I find a lot more value, enjoyment. And I think that, like, I
just worry about my patients. I worry about all these people who are addicted to video games or all these people
who are being loaded up with, like, psychotropic medications. And I think medication is good. I'm not anti-medication, but I do think that there
are other mechanisms that we can harness that will impact someone's
life this year, this month. – Where does that come from for you? – That's an interesting question. So, I think part of it comes
from my own understanding or my own experience of how much a month, three months or a year costs. So when I was an undergrad,
I was a freshman in college, and I wanted to go to
Harvard Medical School, because I was an Indian kid
and my parents were doctors and, “Everyone wants to go to
Harvard and you're so smart. Oh, you're so smart, go to Harvard. You're gonna be best doctor in the world and save lots of lives,” right? And then what happened is I
started failing my classes and then, like, the
damage from a single F, like, it, you're, like, there's
nothing you can do, right? So that transcript is forever. And so what I started to,
and then it took me time and I wound up there
anyway, paradoxically, and then, so what I really
started to appreciate was, like, how much time matters. That one month, for someone who has a mental
illness that is out of control, if you are in college
and you lose one month because you have a depressive
episode, that is light in the grand scheme of we're
talking about 12 months, 15 months for some people, even
one month, one failed test, one month you don't go to class, the trajectory of your life is altered. So for me, it took me, like, I mean, I started med
school at the age of 28, and it took me time to
quote unquote catch up. I don't really see it that way. It's all for the better of it. And so what I really recognize is when I work with my patients, that they're living their lives and their lives are passing them by. And frankly, like, I don't know
that they can afford to wait for me to spend 15 years to do research. It's very noble and I think
it's great that people do that. And the reason that I'm able
to do the work that I do is other people, thankfully researchers, have made, not that sacrifice, but they've done 15 years of research so that I can now read that paper, like, think about how many years of effort goes into one publication that
you or I just read, right? And then we apply it clinically. So I think that just
an appreciation of time and, like, I think
patients don't have time. They don't, they can't afford
to be sick, mentally ill, you know, it's tough, so
that's a big part of it. – Why do you put a heavy
weight, a heavier weight on time as opposed to the magnitude of impact that research could have longer term? – I think it's just personal. So, yeah.
– Well, yeah, that's what I'm saying, why? – So, I think for me it's
just an appreciation of that. And what I see and what we
see in our community is, like, the reason I started doing
the work that I was doing is I see a generation of people who are getting screwed by technology and, like, some, and,
like, what I see around me is that there's lots of people studying, doing mindfulness
research, which is great. And what I saw around me was
that a lot of people are not, like, solving this mental health crisis. And I don't blame them, it's just that the
institutions can't keep up. So if we think about,
like, my academic mentors, which are awesome and brilliant, and even to this day, I am
where I am because of them. Like, I even reach out to
them on a monthly basis asking for guidance and stuff. So, it's wonderful work and it absolutely needs to be done. But I saw that there was
work that was not being done, which is that if you look at our mental, the mental health right
now, people say, you know, there's, like, people are
falling through the cracks. It's not cracks, it's,
like, the Grand Canyon. The majority of people
are falling through. So therapists are burnt out, overworked. I'm not sure that psychotherapy is an, part of the reason that I think we see an explosion in the field of coaching is because I think
psychotherapy does not address, or we have not been trained to address a lot of issues in a very good way. So if we look at something
like dating or getting promoted or achieving financial
independence, what I was taught, and maybe this is a sample size issue, but I don't think it is. You know, what I was
taught when I was training, because in psychotherapy is
if, so if a patient comes in and says, “Can you help
me get a girlfriend?” What do you think the right answer is? – No. Do you want a girlfriend? – Huh? – Do you want to get a girlfriend? – Yeah, why do you want a girlfriend? Help me understand where that comes from. So, like, in the field of psychotherapy, we as psychotherapists
no longer hold ourselves to the outcomes of our patients. – Right, I think it ties
back to something you said at the beginning of this interview of we're in healthcare
trained to go from zero, a negative 100 to zero as
opposed to zero to 100. – And what happens is a lot of therapists are very good at going from zero to 100. So if, even if you look at, for example, the Institute of Coaching
at McLean Hospital in Harvard Medical School Institute of Coaching
started by psychologists, started by therapists who
focused in positive psychology. So the reason that I
went the road that I did is because I saw that there's, like, no one helping these people and that the existing
institutions were not good enough. Student health services isn't good enough. If you go to a psychotherapist,
I heard this so many times, someone's addicted to pornography, they're addicted to video games. The mental health practitioner
doesn't even ask them, like, “Do you play video games?” It's not a part of our
standardized interview. And so what happens is
they meet clinical criteria for depression, they get some
medication, they go home, they take their SSRI and they
play video games all day. So what I saw was that there's a lot
of people doing research and it's amazing the kind of
research that people are doing. But that if you look at
any individual institution, whether it's the office
of the surgeon general who's, it's great, they
do amazing work there, but, like, they're not
shouldering the responsibility of clinical care because
that's not their job. An individual therapist is not shouldering the responsibility of
fixing video game addiction. We have teachers are struggling,
there's a lot of people. And so what's happened is our institutions are responsible for their thing, but what's happened is the problems are in those gaps and
those gaps are widening, which is why I think we
have a mental health crisis. And this is what's so tricky, is I don't think you can blame anyone. I mean, what is the responsibility of, like, a medical board? It's to do licensure. What is the responsible of
the surgeon general's office? It's to raise awareness, do policy stuff. What's the responsible of a clinician? It's to help this person. What's the responsibility of a researcher? It's to do research. But even though all of these
people are doing these things, there is a lot of stuff
that still needs to be done. And that's what I chose to focus on. – Yeah, I think you gave a really clear sort of architecture
blueprint, if you will, of the current system. But I'm curious about
yourself, why you chose, like, all of it needs work, you're saying, but you chose the clinician work, so I'm curious why that speaks to you so. – Yeah, so a couple of things. One is I enjoy clinical
work more than research. – Okay. – So my first PI at this place called the OSHA Research Center, I told her when I was going to med school, I was like, “You know,
I'm sorry to say this, but I don't really like research.” And she was like, “I
wouldn't, keep an open mind.” She says, “You may like research. What you don't like is
being a research assistant” – Fair. – Right, because I was her research, and she's a brilliant woman,
so just an amazing mentor. So that's, I just like clinical work. I like sitting with people. The other thing is I do believe I have, it's part of my spiritual path. So I believe I have a dharma or a duty, the way that I conceptualize my life is, like, I'm really lucky. So I got to spend seven years studying yoga and meditation,
like, in all corners of India, South Korea, Japan. So I studied with a ton
of different teachers, a ton of different gurus. I learned so much different
stuff, really high value stuff, transformed my life from
being, like, 2.5 GPA failure to, like, literally being faculty
at Harvard Medical School. So I found it personally very helpful. And then I also had the chance to train with amazing mentors. And I went to medical school at Tufts and, like, had some just
brilliant psychiatrists that inspired me to become a psychiatrist, trained at these amazing institutions. And so what am I supposed
to do with this, right? So I have this very unique advantage, the world has invested 15 years into me and what am I supposed to do with this? So I did what most people usually do. So I'm complimentary alternative medicine, a lot of people from
famous people and CEOs and I was in Boston, so HBS and MIT and all these, like, fancy people who are very wealthy started coming to me. And then I realized that there's, like, literally millions of people
out there that no one is, and these people that were coming to me, like, they have no shortage of people who wanna help them, right? Because they, cash practice,
you pay out of pocket, you charge a lot of money, right? And so, but there's no one
helping these other people. So I sort of view it as my
dharma, which means duty, or karmic goal to try to
disseminate this information. I was, the world has
invested, like, 15 years of understanding the mind from both Eastern and
Western perspectives. And am I supposed to use
this to enrich myself and fly first class and go on vacations? No, right, I'm supposed
to disseminate this, try to help people in the world and that's what really drives me. – Yeah, that. – [Alok] Debt. – That's really interesting. Your, you mentioned earlier
when you were talking about the benefits of spirituality, no, the benefits of Tai Chi having
benefits within the spiritual and transcendental realm,
what does that mean? ‘Cause you said you would
touch on it, I'm curious. – Yeah, so I think one
of the weirdest things, so let me ask, like, so do we have scientific
existence of the proof of thought? Or scientific proof of the
existence of thought, sorry. – I mean that's so abstract that I guess you could
answer it both ways, I guess, yes and no. – What would you say? – I would say yes.
– [Alok] How so? – Because you can speak to a human, you can give them commands,
they can follow them. And so to me, cognition is thought. – Yeah, so, but how do we
know that cognition exists? – Because we can test it. – How can we test it? – By asking someone a question, by giving them a command
and seeing an outcome. – Right, but so then what
are we actually measuring? We're measuring words and actions. – [Mike] Correct.
– We're not, we can't detect a thought. So for all you know, so,
like, am I thinking right now? – Like, to me, the definition
of a thought is a signal. – So you have an experience
of thoughts, right? – Correct. – But we don't have, so we
can do EEG, we can do FMRI, but this measures electrical activity. It measures blood flow to the brain. We can observe the impact of thought, but we actually have no, and maybe someone will prove me wrong. I've been asking this to a lot of neuroscientists
and psychiatrists. We don't have any exist, we don't have any proof of
the existence of thought. So we just can't measure thoughts, right? So I can't detect thoughts, I can't verify for you
that thoughts exist. We have a lot of implications
that are based on thought. – How do we–
– We have a strong, like, for example, we don't have randomized
controlled studies that smoking is really problematic, but we have such strength
and correlational data that we don't need the
randomized controlled data. – [Alok] Sure. – Same that I feel about thoughts. There's enough correlational
data that thoughts exist that I'm sufficient with. – I completely agree,
but we have no proof. It was sufficient evidence,
fine, for the faith of it. But we have no proof that
thoughts actually exist. They have no material form. We don't know if, they may have a correlation
with electrical activity. We know we can stimulate
certain parts of the brain to trigger some kinds of thoughts. That's how we know which
parts of the brain do what. Because we ask people, “What are you thinking when
your amygdala is active? Oh, that's where anxiety
or fear comes from.” – Or injuries in those
areas leading to deficits. – Absolutely, right? So if we have bilateral amygdala lesions, people have the stress freest life on the planet, it's amazing. So if we kind of look at it, there's a whole dimension to existence. And this is where I go off the rails. There's a dimension to existence, which is kind of this dimension of thought and other things which we actually don't, or not scientifically,
there's no material to it. There's an energetic correlation sure, there's tissue activation, sure. But that's biology, that's not actually the
subjective experience of thought. So if you look at a lot of the ways these spiritual techniques were developed, they weren't looking at the biology and that's why they didn't
develop instrumentation. They were looking at this
subjective realm of experience. And in that subjective
realm of experience, if you explore that and refine your mind and other parts of you, you are capable of experiencing
things that will be, will have all kinds of different effects so you can gain knowledge. So this is sort of like the concept of, like, intuition, right, which we also have some
degree of access to, but what are the practices which hone your intuition, let's say? And then that's on the more
believable or scientific. – Like visualization, et cetera. – [Alok] Yeah.
– Yeah. – So, there's visualization
that maybe does something. And we have some of those mechanisms. We have intuition, which is different from,
like, logical thinking. But then as you experience
particular things in meditation, these are what I would call
transcendent experiences, because they're not of the mind. So they're not a thought or an emotion, but they are, like, a raw experience. And this can be transformative. And depending on what you believe or what your experience is, you can even, like, work on
some weird manifestation. Now we're getting into
Deepak Chopra realm, which I think some of that
is legitimate by the way. And then, like, you can
start to affect change. So just as a simple example, I think a big thing that is
responsible for my trajectory, which is a statistical very improbability. So what's the likelihood of
getting into medical school with, like, a 2.5 GPA? My MCAT score was pretty good. So there's still, like, a chance, that was, like, a one in 10,000. I looked at the, you know, the
AMC publishers of that data. So I looked at it, so I'm,
like, a one in 10,000 chance. And so there's just a lot of things that are statistical improbabilities. – I mean the fact that
the sperm chose the egg is already.
– [Alok] Yeah, sure. – The most wildest. – Statistical, yeah.
– Yeah. – Right? So for me though, I started
a spiritual practice, which my teacher, my guru told
me like, “If you do this, I,” he said, “Do you want a spiritual practice that will help you in the material world or help you in the spiritual world?” And I said, “Can I have
one that does both?” And he's like, “Absolutely,
we can do that for you.” So I think a lot of
my, I really do believe that a lot of my success comes from the utilization of a mantra that harnesses this weird
transcendental energy stuff. Now when you come to science, we have some mechanisms of this
and it may not be so crazy. So we know for example, that if you look at the
healing power of psychedelics, first thing to understand is that psychedelics activate circuitry that exists in the brain, right? So you, psychedelic
can't make something new. All we can do is activate receptors in a potentially non-endogenous way. But the circuitry is there, which also means that there are ways to theoretically activate it through practices like meditation, which is I think basically what goes on. And then we also know from
science or from studies that deactivation of
the default mode network correlates with, like,
a sense of wellness. We can also predict what
kind of trip you have and whether that will be healing
for mental health concerns. So if you have a trip where
you're just flying around, that doesn't actually lead to, or doesn't appear to lead to
mental health improvement. If you have a trip where you
have a sense of ego death, that's what correlates with
mental health improvement. And so then we have some of
these transcendental practices which dissolve your sense of identity. So, like, you have this
sense of, “This is who I am,” and with that comes all kinds of problems. Because now if you're a person, I'm tall, I'm short, I'm this, I'm that. So there's a bunch of spiritual practices that are designed to dissolve the ego. And in that process, you, once you dissolve your sense of self, then you get access to
transcendental states. So some of this stuff we know
is scientifically correct, some of this stuff we have
some scientific theory of mechanism, like, default
mode or psychedelics, ego death and meditation. And then even beyond that
though, the transcendental stuff, we have no idea what's going on there. – What is going on on a practical level, like, maybe not on a measurable level, but how would you describe it to me? – So. I would describe
it to you as the nature, the basic unit of
existence is consciousness, and consciousness coalesces into energy and energy coalesces into matter. So we can affect things
in the material world by working on the level of matter, or we can access the consciousness level, which will then dribble down into manifestation in the real world. And I'll be the first to admit that that makes no scientific sense. – I think it does, why not? It's the same way that, you know, when people incorrectly. – This coming from you, Mike? – What, wait, why? – I just expected the staunchest. – That's the thing. That's why you think I'm a
disbeliever, but I'm not. I think also you have to remember I'm not an allopathic physician. – Oh, that's your deal. – [Mike] I'm an osteopathic physician. – Nice. – So that there is, there's value here that's unmeasurable to some degree with our current tools. And that's why I don't always throw out the baby with the bath water. It's the worst example,
the worst saying ever, but. When we incorrectly say depression is a disease of
chemicals in your brain, right? That's not really what's going on. And our serotonin
hypothesis been disproven and all this stuff and some people say, “Well, you have to take
medications for it, 'cause you have a chemical issue and if you take the medicine, it would change your neurochemistry,” and et cetera, et cetera. When you meditate, when
you go through CBT, when you take certain
actions in your life, those aren't medications and yet it changes your neurobiology. Why is it unreasonable to say that when you experience this
higher state of consciousness, you're not also impacting
your neurobiology? – Oh, you absolutely are. So I think the only thing
that is unreasonable is, and also I'll be the first to say this and apologies if I misjudged you. The only thing that I
think is unreasonable is positing the existence
of consciousness. Positing the– – But these are just terms,
and I hate that about science. – What do you mean? – We get caught up on the
nomenclature of things instead of talking about
what's actually going on. Like, two people can
talk about the same thing and they'll argue about
the word for three hours. It's, like, who cares that
it's called consciousness. There's clearly something
going on, whatever we call it, it's clearly having some impact. We can't yet measure it, but there's something happening
and we're observing it. – Yeah, so I mean, I'm
with you there, like, 100%. So I think just in my experiences of higher states of consciousness and, like, that's hard to describe, but, like, we can sort of say that, you know, when you're asleep,
there's a lack of awareness. When you're dreaming, there's
a lower level of awareness, although there's mental activity. When you're consciously awake, there's also variations in the degree of consciousness and mental activity. When we see things like thought fusion, when someone is having a panic attack, their thoughts are forming their reality. – Yep. – So if you literally
look at, I have a video that I made about this about, so if you look at the
states of consciousness, the more you think that
your thoughts are real, the more mentally ill you will be. So if you look at someone
who is in psychosis, their thoughts and the
reality are one and the same. If you look at someone
who has a panic attack, this isn't quite psychosis, but their thoughts are
so likely to be true that they feel real. And then you have
generalized anxiety disorder, then you have every, then
you have your breakup, where even in a breakup, if
you have no mental illness, you will think, “I will be alone for the
rest of my life,” right? And then what happens is we
start to detach from our mind, we become more and more, we change our level of consciousness. So then you have everyday thought where your thoughts are kind of real. Then you have things like the flow state where you lose track of time, your mind is completely
absorbed in one thing, and you're not, it's a
different level of flow. And then even beyond flow,
you have a no mind state. So flow is a one-pointed mind state. And so the more that we separate our awareness from our thoughts, the higher we go on the
consciousness realm. And then there are even
practices to go beyond flow. That's usually what we call
a meditative state of Dhyana. And then even beyond that is samadhi, which is temporary enlightenment. And those are, these are these blissful or ecstasy kind of states
where you also start to, like, see weird things and and stuff like that. – Got it, okay. Well, I thought that was
a awesome conversation. – Yeah, thanks a lot. – Thank you for enlightening me, 'cause I think there's a lot
of learning opportunities here for us. – It was awesome, Mike, thank you so much. – We have room for part two. Speaking of video games, I actually reacted and
played some video games. Click here to check that out. And as always, stay happy and healthy.

#Debating #Eastern #Medicine #Ayurveda #Healthy #Gamer

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