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

what frustrates you so much about ayic medicine it leads to a fundamental misunderstanding of healthcare it opens room for health gurus and husters to take advantage of people now I'm understanding this conversation a lot better so 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 auratic medicine is way more accurate than you think it is I would have changed my mind today

Dr K more commonly known by his channel tag healthy gamer 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 is one of the most honest if not the most honest voice when discussing the benefits and harms of uretic practice so I was ecstatic to speak and learn about what's valuable versus 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 hype edit a fastpac 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 uh so I you know it's a great question um so will'll see how much trouble I get into

well let's get into troubles today that'll be fun um and and so I I I think uh a couple of things to keep in mind right so I I think um just being super careful about what you say what you don't say um I think steering clear of like medical advice so I think what the way that I kind of frame things is when I make content online I almost think about my target audience as like residents MH so if if I'm talking about let's say a clinical condition like borderline personality disorder i i i

frame it in the way of okay if I was teaching a group of residents or medical students or even preds 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 mhm what about when you're having conversations with a guest and I I struggle with this myself a lot uh I've had difficult conversations uh on this podcast where someone brings up either a past trauma or you could see that they want to 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 might 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 um we also have like a boundary setting call at the before we meet someone or we offer a boundary setting call from anyone who wants to take advantage of it and that usually is a chance for people to say we don't want to talk about this or I do want to talk about this um and I think the main thing to keep in mind is that if you think about your job as a physician uh 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 psych psychiatric intakes we assess for suicidality homicidality um 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 it's literally assessing for any number of conditions and I think that's where the 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 um 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 worked pretty well so far yeah I I uh 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 I 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 steo and he was talking about his childhood and he was talking about how impacted him and his decision- making to be a daredevil uh on jackass and I there was 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 safe space I I think we have

we have a challenge right so like everyone says so we have a mental health crisis um suicide rates are increasing depression anxiety we're seeing an evening out of body dysmorphia between men and women we're see an evening out of ADHD equality and all things so we've got this Mental Health crisis and the question is why right and and this is where we have uh you know organizations that will advocate for destigmatization 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 four 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 destigmatizing 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're 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 someone you

know has a 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 mentalness 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 the 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 want to say we don't want to put guard rails that okay you can talk about your difficulties at work but the moment that mention something that touches mental illness we're actually going to 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 uh 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 diagnosis right now not at all I mean I don't think nothing is sole reason well majority like the heaviest reason if you so I I I I think

it's a 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 um 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 out of bed what I need to do is just give myself a swift kick in the ass and get out of bed 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 um 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 want to talk about in life whether that's spirituality or career mental health whatever then we start to I think what we've seen in our communi 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 seemed 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 or creating the conversation BR um 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 can 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 uh 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 uh if you if you're evaluating a sore throat which in a one-time clinical scenario versus generally speaking if you look at a psychiatrist um who or therapist who has a long-term relationship with 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 I I don't think that they're one to one by any means um yeah I mean I so I think that often times 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 um but I I would sort of say that a a better analogy would be like do you think that um let's say I'm 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 do you feel like that's fair or do you wrong evaluation I I think it's very fair yeah that's why like I don't know like when I watch um

your interview that you did with uh Graham Stefan and Jack and I'm watching it and there was like a section where there 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 on a topic where's that line for you basically is my question yeah so if we look at what I did with with Graham and Jack so I wouldn't call that psychoanalysis so like I think this is where a lot of people don't know what psychoanalysis is so

people will sort of so I 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 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 it partially is yeah I think when when you're uh 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 Etc what would be the condition that you would say I was assessing for in that situation personality disorder potentially um mood ask those question and then

giving your of it again I I think when you're interpreting what someone is saying from your state and they're looking for you to have the answers I I feel like is that potentially making a diagnosis and maybe I'm wrong and no so I think this is this is fantastic conversation 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 have a assess this person for a personality disorder I would fail them well of course that's why it's not complete right so 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 any of those things so if we really look at the the this my read on it the technicality of what it means to do a diagnostic interview right we we have a we literally have textbooks that say these are the questions that you should ask so the dsm5 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 right um 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 I'll get to your point because I think there's validity there um 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 kind of 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 assess 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 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 clinical care that's your concern right it's not a concern I'm just curious how you tow the line yeah like when do you decide that you will talk about an anonia or you've talked about one now you don't want to 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 now if we say that that qualifies as the practice of medicine that means that I am 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 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 um another good example of this is like if we look at people who are like spiritual counselors or coaches Y 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 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 assoc Association the American Psychiatric association um the Massachusetts Medical Board where we've 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 um 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 space 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 the same princi ible 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've 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 Etc that we would either get into an argument or they would come to see for 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 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 I I think that's where the line that I use is we have clear very clear diagnostic questions right so in 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 if we look at the evidence of who has success with patients whether it's a counselor whether it's a um social worker a psychiat 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 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 MH 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 a so when I'm doing Psychotherapy I have to put together a formulation so this is usually a bioc psychosocial formulation of what's going on with a patient and this kind of is like a 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 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 mhm I think having conversations about mental health does not touch that like what I do with my patience and 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 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 uh

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 going to be given by someone on the side of the road but can someone give you a Tylenol which is a treatment yeah they can and I don't think that's une ethical mindfulness is like Tylenol it's over the I see what you mean so it's like an over the you would qualify it as treatment correct so do you think that mindfulness should be regulated as a treatment because treatments usually when you say regulated you mean should it be treated as a controlled substance no so like if we look at Tylenol

right sure 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 so so you'd consider exercise a treatment as well okay but I also like for example uh um Sam has a friend and

he wants to become more fit Sam will tell his friend you should exercise this exercise that do 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 that's very interesting yeah so I 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 me so I would not cons 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 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 uh 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 often times a diluted spiritual Pursuit oh tell me more so if you look at meditation right so we use mindfulness for um you know clinical treatment but if you really look at the development of meditation the meditation was designed to help people attain Moka 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 yeah I don't want to lose your track though so we'll come back to that isn't like it's hard to judge why things were created in the past um it's hard to even look back at um history a hundred years ago and try engage 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 going to pose a question to you

in 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 I invent something and I say I 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 I think that applies in the present or in the recent past I think when you look back so far TimeWise their definitions and understanding is going to be greatly different so they would never have said mindfulness is a treatment for anxiety depression because 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

absolutely right so so we have for example like ayurvedic medicine which diagnoses mental health conditions right so you have system I'm not familiar with that so tell me about those system yeah so 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 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 and the reason I trusted because that's what they say right so they 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 back at them and say they didn't know better 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 they're very clear right so if you read something like panel's yoga sutras um so this is sort of like the seminal text on yoga and he kind of says like okay here's how we're going to 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 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 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 they separate these two one is a rogue or an illness and the way that I kind of understand it is the use of medicine is to get you from 00 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 not was not designed as a treatment it was not designed to bring people to Baseline it was designed to bring people at basine to above basine mhm they had diagnosis that many years ago of cerebral paly absolutely how did they describe cerebral paly a thousand years ago and by the way I'm saying A Thousand Years completely uneducated I no idea 5,000 years um so I don't know

spec let me just think about um what examples to you because 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 uh 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

ayic textbook they had a super cool diagnosis for diabetes okay they had they say go pee next to an ant hill 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 um 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 I'm not even aware of bacteria right antibiotics don't exist uh I don't know

I think they have certain herbs that have antimicrobial properties they understand the process of sterilization um so I think they do oh yeah I mean we just did a video on the history of the first gentleman who recommended um washing hands in between treating morg patients and delivering babies in the 1800s what was that it was the 1850s 1850s yeah I mean so so I may have a a a 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 mhm 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 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 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 now yeah no I mean but but but there's a reason they were aware of the bacteria but they weren't aware that some people preferred to use other no they were absolutely aware that they were left-handed people what they realized is I don't care if you're left-handed there needs to be a convention where

bacteria that come out of 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 CER 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 the GI tract and one hand touches the front so they had an understanding of microbiology in that way

I don't know 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 develop something very similar to the theory of humor so they have like these concepts of elements um but the really interesting thing is what they basically I think what they did is notice all kinds of correlations and then developed a heris 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 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 um 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 ayurve medicine like let's say ashwag gandha or me or meditation these are the things that we now associate because we remove things like heavy metals in the usage of medicine so there something called rasashastra 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 aortic medicine so to say that aortic medicine is right I think is a gross overgeneralization because there are eight branches of ayurve 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 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 MH and today it turns out that we're grossly wrong about meditation 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 West W 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 it's that's a scientific method is it not sure that's why people were mad during Co that guidelines changed and it's like well because we were pointing out when we were wrong so so so yeah that's the scientific method so I think this is the weakness I was um I I helped organize a conference at Harvard a couple years ago and uh one of my mentors was on on the panel and so this was a 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 M and my mentor brilliant guy named John ders 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 M so the the way the one thing that we do really really well which is I think why alpath medicine the talking about selection biases but let's talk about

not selection biases in a 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 going to use it ever again right and so we're 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 that way that we do so if we look at scientific method what is scientific method it is obser having a h hypthesis 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 I I don't think that you can develop as robust of a system of medicine the big difference though is that we're really good at instrumentation so in the west are 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 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 AR argument that there's no such thing as an organ there's just everything is just cells

you can just say that about anything about a cell yeah right that's like um I feel like deepo Cher'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 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 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 going

to 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 be 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 uh reproduce it can you generalize it that is always missing in eastern medicine yeah I disagree really so tell me more about yeah

so like I mean that's how they came up with these things like ashwagandha and brami and some of these things that we use in Psychiatry turmeric um so for example the usage of bitter herbs in the treatment of diabetes so what they did is I 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 is that when you feed someone of 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 um 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 and what you always have is an intervention and then you

measure that outcome in some way mhm I guess to me unless you randomize it and control for biases it's not that that's a huge problem but in 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 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 talk oh you're sure but so so if I come to you today like 99% of the time for the individual it's not going to 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 ayurve 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 Y 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 is 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 to an individual MH so in the ayurve system of medicine they think that randomized control trials are the antithesis of practicing medicine can I explain why I heavily disagree 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 a th% 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 because it's a topic where for example example lowering blood pressure we see populationbased 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 going to do anything so the question of why I still 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 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 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 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 you want a a ount of bias that is specific to the person so let me 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 we you can do genetic testing on a person correct to see which medication is going to have the best so do you think that those kinds of these are not recommended by the

American Psychiatric association 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 control proces is 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 is 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 control Charles how so in order for us to know that this works on this person oh we have a randomized control trial that this is effective for lots of people yeah so the methodology is personalized and then we we are doing a randomized control trial on personalized methodologies 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 uh Dr gundry on my podcast who makes a lot of claims that disagree with uh a lot of the big institutions the American Academy Family Physicians United States prevented task force the American College of Cardiology Etc 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 Etc but when you're treating one person to make your treatment successful doesn't require a lot of evidence uh how are you I how are you what is how are you defining evidence in the statement that I made uh evidence that I need to know that they're telling the truth is randomized Control Data so how

can you have randomized control 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 so you're you're talking about doing an RCT on individualized medicine versus populationbased medicine correct yeah but I mean I I think I don't think we're disagreeing here but what 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 an 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 so 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 ayurva leans more into that so ayurva 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 want to see proper outcomes from ayurva 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 I'll get to that in a second 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 him alpath medicine and see who has better outcomes well that's not a cohort what do you mean in in a situation where you'd randomize people and you say some of you are Oh you mean it's you want to do a comparison cohort as opposed to give someone true ayurvedic treatment versus a sham no no yeah I'm talking about cohort studies so so a non-inferiority trial between Al traditional alpath treatment and ayic 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 medicine is that so there's even like so for example they believe that you know the man I'm extrapolating here based on my expertise but if you look at like depression there are three subtypes of depression so there is neurovative depression right so difficulty getting out of 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 mhm now the really interesting thing is if you look in ayurve medicine they say that there are three dominant elements there's like the Earth element there is the wind element and then there is 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 neurovative 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 will end up with a uh 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 your alals and how they manifest your phenotype I think we're talking about two different things I think aortic medicine does fantastic observation yeah like what you're describing is they've observed different and I

think that's you're going to 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 but we have levels of hierarchy of evidence and cohorts are still up there it's not just mechanistic right like if you do but a cohort study and RCT are two completely different study designs I agree but in terms

of weight of evidence fine they're high levels no no I I 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 because 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 ayurve medicine at least the majority 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 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 so I I think ayurve medicine is not about populations it's very different so I I think that that's fair well for example you were talking about the art of medicine I think

that there's needs to be a cautious balance between taking good quality evidence whether that's RCT cohort Etc and then balancing that with the individual in front of you but I think in aric medicine we're just having fullon art 100% so there are it's not 100% because they are taking into observations and all that so 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 because I'm talking about it so my before this whole

healthy gamer thing my actual area of Interest was evidence-based complimentary alternative medicine so there are all kinds of problem that we haven't even touched on I mean here you are saying what about this what about this I can dismantle ayurve medicine because there are fundamental weaknesses the First Fundamental weakness of ayurvedic medicine is that you have no way to gauge practitioner reliability y the good thing about Al apathic medicine is that at least in the United States if you finish a medicine 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 who have a heart attack on an airplane they're going to get some comparable care right even I can handle that some so the biggest problem with ayic 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 Si 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 ayurve medicine which is that the good thing that we get this is why I think alpath medicine has grown so so well is because it is reliable ayurve 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 uretic medicine principles often because I think there is a huge amount of utility to it and just because the so if we can improve reliability on the ayurve side then

I think we have something very potent right so and the other reason is because I I think that like what is the thing that you think that's potent what do you mean you said that if we approve reliability we'll have something on the ivetic 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 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 an there's subjectivity to it that's what art means right well that that 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 which is why we call it the art of medicine but there is absolutely a logical scientific method going on I I think it's an art not because it's not scientific I think it's

an art because it's not standardized and maybe I'm just mix 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 that I there's a system of medicine that's done it which is why I so that's what I'm saying is they've taken the individual believe that though yeah absolutely there's lots of flaws but I think that that there there is they've done it yeah you mentioned we need to bring some of

Western medicine into ayurvedic practice to improve ayurvedic practice I view that as not an optimal use of time is probably the wrong word um I would view based on how you describe atic medicine that there a lot of problems 90% of it has issues etc etc why not take what works of aortic 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 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 mhm 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 going to 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 ayurve 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 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 the the existence of a disease process that is independent of people exists wait say that again so do you think that hyper cholesterolemia can exist outside of a person like exist exist in what way like on a definition of a te in a textbook can okay so like can can you have hyper cholesterolemia outside of a person yes in a Petri dish okay right so when you translate that to

a person it becomes individualized right MH 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 mhm 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 ayurva 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 going to make a comparison you're 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 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 going to 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 is way more problematic no no yeah but so this is a fundamental misunderstanding the whole point of ayurva

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 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 aurbic 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 MH and you don't think that's fraught with forever reliability issues what do you mean about again like the practitioner reliability issues oh no no it's fra with reliability 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 corruptable when we're

just treating everyone as one one11 so so I 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 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 ayurva 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 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 I do think we need to add some of this populationbased stuff and evidence-based medicine so let's compare rasa shastra where someone gives Arsenic and all this kind of stuff to for example like ayurvedic herbs or the inclusion of yoga and taichi let's actually take orts 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 diagnos nois 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 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 in the pathology 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 itic medicine says this is the bulk of our approach that's the big difference yeah I I'm just viewing starting points Western medicine we have the starting point of randomized Control

Data populationbased data that we can then tailor and art and improve our art we definitely need to improve our art I will never not support that ayurve medicine has such a fraught foundation and we're like let's bring randomized controll and evidence and all that to this fraught concept already why I don't think that the fundamental concept is fraught in fact but you said there's like 90 like 10% of it is only valuable yeah so so but I don't think the fundamentals are fraught I think the the the fundamentals are actually I think the reason we

practice the more we practice the art of medicine the closer we are to the aurbic system because that's what their system is it's it's individual treat but we end up there 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 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 ayurve principles individualizing it later so let me that that's fine so that's your prerogative and I would encourage you to but I'm curious what you think about that so so so let me ask you this do you think what do you think is a better system of medicine A system that is populationbased or a system that gets outcomes that is 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 your absor 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 ayurva starts with that yeah but it's nowhere near it it's not even close oh this that that's where that's where you got to be careful right so I

I think that it's way close ER than what we give it credit for you're saying they have a perfect understanding of each individ 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 m in ayurva they've leveled up individualized medicine to level 100 but their populationbased medicine is level 10 I think when you individual when you use that example when you individ when you level up to a 100 on the individual level your data is fraught with error and bias and subjectivity because you're not studying an N mass and there's so many mistakes that you could make when you're just treating an N of one very true right so but you're thinking from

a populationbased 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 you don't treat populations you treat individuals so how do you 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 healthc care 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 AO 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 going to 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 M right so and I think that there's like good data to support that view

because there's a reason why alpath medicine has spread all over the world and iric medicine is not well that's a good question uh 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 W Western medicine but that is firmly pushed against an Eastern medicine why do Eastern people not like randomized control 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 then Western medicine talked about now how Western medicine why is that why is it seemingly stuck in the past 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 oh boy skewed skeptical belief is that it's based on culture what's the differ what okay so culture is part of it religion what's the what else is on the differential lack of refinement okay that is also it's differential

I'm not saying it's the C yeah [Music] um that it works absolutely M right so that's what's really tricky hold on we we have that it fully doesn't work lack of refinement and that it can work those are possibilities yes we can't give them equal weight here and say but so so it's good right so so now now you ask a question right that's on the differential comes in with two days of cough cancer is on the differential but we don't talk about it CU that's not valuable sure but I 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 I think part of the reason and and like I don't when you say a statement like that you know what I hear what when a patient comes in with two days of cough if I say that it's cancer I'm going to be wrong so often but I will be right sometimes ayurvedic medicine you're showing me Med came up with meditation that's that one time they called cough cancer fair enough 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 Jinger was like the biggest problem with ayic medicine I'll be the first one to say this right so I'm sort of I feel like I'm adopting a pro ivetic stance because of the way you're asking questions but I don't use ivetic medicine with the majority of my patients I use space techniques with the majority of my patients because they are reliable right and at the same

time I'm with you that I don't know so if you look at this text called jarak Sam MH 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 rasashastra right so I steer clear of that because but then the problem in the aurc system is if you go talk to an ayic 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 so 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 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 ivetic 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 want to be optimistic this used to be there historically because of the way that it was taught so there's this concept of par 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 a system of mentorship where if you trained under this person you're like going to 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 ivetic 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 Barum 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 as a medical doctor like part of the reason that you know I studied ayurva 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 going to get I have no idea what's the reliable of what the reliability of some of these methodolog are I've seen things that are medical impossibilities from Iva 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 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 to ayurve doctor and and I'm going to indoctrinate myself no I went to Medical I went to medical school focused on evidence-based complimentary alternative medicine realize 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 I saw something that I saw potential in and I said to myself even if 90% of is 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 ayur vtic medicine what is that part so I like

that they focus on the individual got it what else um so I like that they look at uh 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 ceptions 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 ayur veic 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 um so even like for example ression understanding like okay what is this person's ayurvedic DOA it helps inform me about how to approach this kind of thing also in my clinical

practice what I've seen is is if people adopt ayur veic diet um 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 firstline treatment for mental illnesses seems to be diet and my guess is the mechanism is got microbiome modification to support serat I mean uh 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 going to keep track of it individualism stratifying personality types cognitive fingerprinting as you called it and then diet lifestyle I guess is is is one of them it seems to me based on this conversation ayurvedic medicine is fraught with a lot of bias issues ETC 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 from 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 cuz it's sexy to talk about ayurvedic medicine cuz people are passionate about it but 90% plus 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 but we don't know it's crap

we just don't know that it's not crap there's a big difference and when someone makes a claim that this water will prevent you from dying or this this is the anti-aging water do you know that this is not going to prevent you from living forever like do 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 no that's not happening yeah so because mechanistically it's not there the evidence isn't there and I'm I've gotten to the point where even

though I don't have the evid so Mike what frustrates you so much about ayurve medicine I'll tell you why it leads to a fundamental misunderstanding of health care for a large percentage of patients it opens room for health gurus and husters 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 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 I see that

yeah right so 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 atic medicine is way more accurate than you think it is

I would have changed my mind today yeah so so that's it's interesting but I think I definitely have a bias yeah 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 auratic medicine in this space I think you do it incredibly honestly so because I I agree with you but I 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 pyamid 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 right and what I'm also detecting from you is like

I think I'm detecting this emotion of frustration because of husters and these kinds of people so I think your understanding of ayurveda comes from these people MH and so that's why I was I was kind of surprised because usually in conversations I am representing your view a lot more right so I'll go to these academic conferences with a lot of ayic practitioners and I'll say say like hey like we don't know there are eight disciplines of ayurva we have some limited evidence of this particular thing brummi turmeric ashwagandha like a set of herbs we don't

have a whole lot of stuff on this and so I 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 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

I was just and I think our hypothesis is similar yeah so I I I think though 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 so so I I think just this individualized approach it's so axiomatically different I think there's value to it without a doubt and 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 woow woo MH but if we kind of think about it what's happening is we're taking the all of it was woowoo and then we're taking this and we're saying the rest of

it is woooo we're taking this and we're saying the rest of it is woooo we're taking this and we're saying the rest of it is wo 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 is 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 what's happening absolutely in what way can you give me a specific example of that yeah so like cardiac coherence breathing so for example

what's that so we have this in the East we have this system of Brana 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 nais like this heard of them but I don't really understand 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 might not just have the tools to currently measure yeah 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 um tissue difference there's a change at the level of the electrical conductance but there isn't like a physical like you know yeah so it could be there sure um but I I think what's

really interesting is we have no scientific evidence for that so then we have these systems of something called Bram which is you do these techniques which are designed to um 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 BR am 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 what are

what is a cardiac breathing a cardiac coherence breathing is basically alternate nostril breathing it's this old yogic practice called Bram I mean or nii and what we kind of do is we try to figure out okay what is the distillation of the scientific principles and we're going to 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 good reason to do that because I think you 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 something that's growing a lot which is nonsleep deep rest have you heard of this okay Micron naaps no okay so it's it's a it's a practice that's called yoga NRA so Yoga Nidra is yogic sleep

so it's this like ancient yogic technique and we basically medicalized it by protocolized it in some ways and what they actually do is intentionally remove a lot of the spiritual woooo 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 taichi outperform standard exercise when it comes to things like osteoarthritis or mental illness there are rcts you're familiar with that familiar with that resarch that they outperform it I'm not sure so there's some studies that show that um so and then

that 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 um so there's one uh paper from I think 2016 the New England Journal of Medicine on taii 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 um then exercise should be the same as taichi 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 simp I'm not I have to really dump things down in my mind for me to understand them and I'm going to 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 yeah so I think that there are mechanisms at play so let's here's let me try to explain it better so we have a study you can look at the paper I'll send you the reference so taichi and osteoarthritis outperforms physical exercise okay so now let's understand taii is based on this theory of vital Life Energy which we have no scientific evidence for 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 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 said into 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 change strengthening they're all movements but they're going to yield radically different results yeah perfect right so that's what

I'm saying is that there could be there's something about the theoretical 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 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 either this

is the most technical conversation about this I've had in Long great I love this they it's it's a very heady conversation because we're talking about tertiary level Concepts right now of imaginary concept so um where my mind is going is that you feel that the way taichi was created we shouldn't just focus on taiichi we should focus on how taiichi 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 uh when I was at like mlan hospital I

was developing protocols for specific broni or breathing practices to Target specific illnesses MH 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 um silers swag 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 nonjudge 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 going to 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 non-judgmentally 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 Brana this practice will cool the Brana they use all these weird heuristics and

what I have observed in my clinical practice this is small sample size my 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 Marshall inh handed with DBT in some form we can actually accelerate the rate of our scientific research because we have these answers already here mhm so what is where is the cultural uh 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 we lose that value generating aspect right so the 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 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 so 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 want to 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 no you'll see section the back that taii is an practice based this you have a single line about what is actually happening to theqii 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 have to ask the journal 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 mhm 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 taichi works M there's other problems that we get into but then what we're also doing is we're we're not it's not about credit but we're the 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 let let me put it this way let me give you an analogy so let's say that there's a group of aliens MH 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 um 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 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 MH 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 an antibiotic resistance is just a good example right so that was like I knew what you were going to 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 of rcts on antibiotic resistance but that's where they're understanding the theoretical basis of our treatments becomes critical to avoid pitfalls like this and what can you give me an example of something like that within the field of ayurvedic medicine or spirituality yeah so um 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 where do you think neurons blood flow firing creating action potentials okay so neurons blood flow Fir and creating Action potentials are all the same right M like you're okay so you having a thought right now yeah where is 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 Etc so the simple idea so one of the places that

thoughts in our brain come from this is based on the yoga concept so sure it's translated through the brain but we know that our sense organs are a source of thoughts 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 Etc yeah so memories of sensory experiences so how do I want a hamburger

so later tonight when you're relaxing at home you're going to 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 thoughts sometimes come from sensory Impressions and sometimes come from memories um 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 or someone who has anxiety or someone

who 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 neur 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 G 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 what the yogis basically discovered is that the more empty your or nonactive your mind is the less activity that 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 we 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 uh you 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 is on fire there's going to be so much mental activity that what you 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 attention is not there yes attention is not there so the retention retention and attention so a

one-pointedness of attention correlates with retention MH 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 you you take something called a sun Culp or a resolve so whatever Sun Culp 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 you know we we came up with one Sun Culp which is like I deserve to be whole so it's not that I am a good person I'm going to

manifest things in the universe and there's interesting science on manifestation and stuff which we can get to but and and it's just this idea that if you literally look at a patient who is struggling their mind will have a hundred 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 sun Culp and even there's even more non even psychological benefits to it there spiritual benefits and transcendental benefits and all this kind of

stuff which is really what a sun Culp is about um but the point is that when we when we just do non-sleep de deep rest you can look at all the studies on that no one's going to say anything about a sun Culp but when you do the practice the way it was designed to be done and you add something like a sun Culp 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 um and what I find is that there is immense

therapeutic value in adding the sun Culp that's an example and modern science doesn't yet do that nope 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 sun Culp 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 woowoo for it because we don't have a mechanism for it because really what a sun gulp 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 uh non s deep rest has some benefits that's step one wouldn't then be step two testing whether or not adding this sun absolutely so that's what 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 manthra over here you've got this Guru who's doing this you've got Transcendental Meditation so now we have a research problem right which is 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 yeah so we have to distill it down to some kind of protocol and then we grow from there MH so that is literally what the work that I try to do M 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 [Music] clinically um but I think it's the way that we have to do it I think you and I see I ey on this topic really pretty much one to one 9 I think we see ey yeah that's what I'm say really close um my question is when you're doing that practice and you're

doing the informed consent um 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 through scientific but I'm going to 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 cuz you can go down the line and say there is off lab prescription yes there is

yeah so so so here's a fascinating study by a guy named Ted cap chuk 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 going to give you a placebo uh this is a placebo but we know that placebos work MH and he said I think this will help you and turns out that the placebo helps even if people know it's a placebo sure so I I think that you know off Lael prescribing is 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 sun Kip sorry I'm saying it wrong probably so I have some EXP experience and I also believe that like I'm kind of saying some of these root some of the roots have value so then what I'll do is I'll even explain to my patients so 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 um 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 method meod 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 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 what how I would describe Placebo Placebo is things that work that we just don't have mechanisms for that's right yeah yeah yeah right so and

and that's where I would say here is the hypothesize mechanism but I think we have to do it I I wouldn't call it a placebo but you could absolutely make the argument that um you are engendering the placebo effect but I think that that is absolutely necessary you have to do that right because as a 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 Lael prescribing I think it's some where in there are are people

engendering the placebo effect almost certainly and this is where there's even a I'm in a worse position for this uh 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 going to teach me something special I give something special it fulfills their expectations and it 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 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 and that could could still be my question is yeah my question is how do you

you're so honest with this and I love this 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 I have a bigger Placebo problem the average person so that's amazing that you're yeah like taking that into consider teries me Mike so now the question is how do you decide or decipher between what you're doing being truly beneficial versus is is this a placebo effect or it does

it not matter so I can't decipher and does it matter does is it important to decipher in a theoretical perspective absolutely so how would we get there so that that's where I I'm trying to do like so before this whole healthy gamer thing I was trying to develop clinical protocols for specific meditation regimens for particular diagnosis mhm right so we'll have studies on mindfulness for anxiety and mindfulness for depression but my whole belief is if you have an energizing Brum 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 they seem to have figured that out M 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 branam and I was asking him like you know what do you think about this stuff because you're a cardiologist this is back before I was in med school and so he said oh like I think I 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 who do pram 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 PR protects against heart attacks transient O2 oh crap our our blood vessels

our vasculature around the heart is like we're running out of o2 we need collaterals of right so physiologically inducing collateral circulation vascularization yes right by transiently increas uh decreasing O2 it acute stress a lot of times yields great outcomes for the human body that's yeah yeah so so so that's where it's it's acute stress in a controlled and safe way that doesn't tip you past the point of what your heart can't handle corre right so I think that there's I've seen enough um 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 right it can be yeah so I I I think that for me it 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 support what 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 healthy gamer and like all the stuff on video game addiction it's like so I I got two amazing job offers from two just amazing people and you know one of them was like here's the academic track at Harvard Medical School and like you're going to apply for this Grant and this Grant and this Grant and 10 years from now 15 years from now you're going to 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 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

elus all of these Eastern principles and what are the biological mechanisms can we discover something like BR AR 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 patience I worry about all these people who are addicted to video games or all these people who are being 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 from you um that's a 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 was screwed to Harvard and you're so smart beta you're so smart go to Harvard I was going to be the 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 you're like you're 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 um 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 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 go to uh 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 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 um you know it's tough so that's a big part of it why do you put uh a heavy weight a heavier weight on time as opposed to the magnitude of

impact that research could have longer term I I think it's just personal so so I'm saying why so 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 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 G it's like the Grand Canyon the majority of people are falling through MH so therapists are burnt out overworked I'm not sure that Psychotherapy isn't 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 uh 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 so 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 we as psychotherapists no

longer hold ourselves to the outcomes of our patients right I think it it ties back to something you said at the beginning of this interview of we're in healthcare trained to go from Z negative 100 to zero as opposed to 0o 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 mlan hospital and 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 pra 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 uh get some medication they go home they take that

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 and 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 MH but what's happened is the problems are in those Gap 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 any anyone I mean what is a responsibility of like a medical board it's to do lure 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 responsible 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 so yeah so a couple of things one is um I enjoy clinical work more than research okay

so my first Pi um at this place called the oser research center I I I told her when I was going to med school I was like you know I'm sorry to say this but I I don't really like research mhm and she was like all I wouldn't I keep an open mind she says you may like research which you don't like is being a research assistant right that's her research and she's brilliant woman um 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 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 the chance to train with amazing mentors and I I went to medical school at tfts 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 advant 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 complimenting 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 were very wealthy started coming to me and um and then I realize that there's like literally millions of people out there that no one is and and these people that were coming to me like they have no shortage of people who want to help them right because they cash practice you pay out a pocket you charge a lot of money right and and so but there's no one helping these other people so I I sort of view it as

my dharmic which means Duty or karmic goal to try to disseminate this information I was the world has invested like 15 years of in the mind from both eastern and western perspectives and am I supposed to use this to enrich myself and 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 meh yeah that's really interesting you're um you mentioned earlier when you were talking about the benefits of spirituality no the benefits of taiichi having benefits within the spiritual

and transcendental real what does that mean because you said you would touch on it 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 can answer both ways I guess yes and no what would you say I would say yes how so because you can speak to a human you can give them commands they can follow them and to me cognition 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 what are we actually measuring we're measuring words and actions 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 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 MH 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 in correlational data that we don't need the randomized Control Data 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 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 something 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 amydala 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 amygdalar lesions people have the stress freest life on the planet it's amazing um 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 a that's biology that's not actually the subjective experience of thought MH so if you look at a lot of the way 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 scien visualization Etc yeah yeah so 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 Deepu choer realm which I think some of that is legitimate by the way um and then like you can start to affect change so just as a simple example I think a big uh thing that is responsible for my trajectory which is a statistical varium probability 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 I 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 firm chose the egg is already the most wildest statistical yeah right so for me though I 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 harm FES this weird transcendal 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 MH 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 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 there's a b 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 Network 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 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 no why I just expected the the St that's the thing that's why you think I'm a disbeliever but I'm not I I think also you have to remember I'm not an allopathic physician oh that's your deal I'm an osteopathic physician so that there's there there's 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 serotone hypothesis has been disproven all this stuff and some people say well you have to take medications for it because you have a chemical issue and if you take the medicine it would change your neurochemistry and etc etc 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 I I'll be the first to say this and apologies if I misjudged you um the only thing that I think is unreasonable is positing the existence of Consciousness positing 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 so I I mean I I'm with you there like 100% so I 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 is mental activity um 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 y so if you literally look at um I I have a 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 in the reality

are one and the same if you look at someone who has 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 danan and

then even beyond that is samadi 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 awesome conversation thank you for enlightening me cuz 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