Dr. Eric Topol on the science of longevity when science is in peril
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This is a CBC Podcast. I'm Dr. Brian Goldman. This is White Coat Blackheart. We have a treat for you. On this and our sister podcast, The Dose, I'm speaking with American Heart Specialist, Dr. Eric Topol. He's the founder of the Scripps Research Institute at La Jolla, California.

Topol is one of the top 10 most cited medical researchers in the world. GQ named him one of the 12 rock stars of science. And last year, he made the inaugural Time 100 list of most influential people in healthcare in the world. All the fanboy stuff aside, I actually know him.

You know, this is a very auspicious day. You and I met exactly six years ago today. Oh, wow. Yeah, at the Southeastern Ontario Academic Medical Organization, CIMO Conference at Queen's University in Kingston, Ontario. Hi.

I do remember that meeting with you. I just didn't remember that it was exactly six years ago. Wow. I remember you showing a slide, you know, showing your own kidney stone with your own portable ultrasound machine. Yep. Do you remember that? I sure do. I'll never forget it. Yeah. Well, of course, because you had renal colic. You had a kidney stone. Yeah. And then when I went to the emergency room and showed the ER doc,

He thought I was an alien, you know, that I had imaged my dilated kidney. And I told him, I think I have a stony net, seen that before. I'm not sure if he's seen it again either. I don't know. That demonstration was, you know, obviously you're a physician and you understand, you know, you know what the image means. But there was something in that, a transcendent comment about the democratization of diagnosis.

Yeah, we could be doing a lot more actually, but I hope eventually we'll get there. I failed at arithmetic. The last time me and Topol met in person was actually seven years to the day of this interview. The idea of patients being able to diagnose themselves has stuck with me and with Topol. He's written four best-selling books about the future of medicine. His latest is called Super Agers, An Evidence-Based Approach to Longevity.

Topol has assembled a trove of impressive research on how to live longer and healthier. The kind of research that might be far less achievable in the future, given the gutting of government grants that we're witnessing in the U.S. More about that later in the show. Here's part one of our conversation. Hello, I'm Dr. Eric Topol. I'm a cardiologist and I'm a researcher at Scripps Research in La Jolla, California.

Dr. Eric Topol, welcome to White Coat Blackheart. Thank you, Brian. Great to be with you. Eric, who are the super agers that you talk about in your book? Well, they are the people who have reached an age of at least 85. They have no age-related diseases of cancer ever, cardiovascular disease or neurodegenerative disease. So for example, the woman who I present, patient of mine in the book, first one, is 98, totally intact.

And that, I think, is emblematic of what we would consider a super ager. We're not talking about lifespan. We're talking about healthspan that is intact health.

In the book, you know, you presented this one patient who's 98 years old, who has never had a serious illness or has seldom had a serious illness in her life. And you presented another patient who's the same age, who has been, I guess, a product of modern medicine. And, you know, I don't know what impresses you more, that this woman can sail to the age of 98 with almost no illness, or that modern medicine can help somebody who has multiple chronic diseases, including, you know, cancer and heart disease, live as long.

Yeah, well, I think the other patient who's now 99 and his wife just called me to save the date for his 100th birthday party.

He is very different. He's had heart disease since his 60s, where he had to have an emergency bypass operation. And then subsequent to that, I put in a couple of stents in one of his bypass grafts. But he's done exceptionally well. I just talked to him yesterday, and he's amazing. The difference, though, is cardiovascular heart disease, like he has, is eminently preventable.

If he had known before he had bypass surgery, this could have been largely preempted or delayed for multiple decades. So on the other hand, Lee Russo, who was the first woman we were talking about, she had never had any chronic illness. So they're both super agers in that they reached this age remarkably intact. The point being is we have the means to

to get many more super-agers, particularly those without these three age-related diseases in the future. That's what's so unique now. That is the sea change in medicine before us. You know, it's interesting. You quoted JFK in your book. It's not enough for a great nation merely to have added new years to life. Our objective must also be to add new life to those years. So this idea has been around for a while, hasn't it?

Long time. And we've not fulfilled it. We've not prevented diseases. And as you well know, in practicing medicine, we are the reactive people. You know, person has a heart attack for me or some other heart problem, that's when we show up. We do not do an adequate job of preventing heart disease. And that's the one that has the most near-term preventability.

But the other two, cancer and neurodegenerative, we do nothing to prevent these from occurring in people, even though we now can determine their high risk and do all sorts of things that we're not doing.

So those are the three main chronic diseases that you talk a lot about in the book, cancer, heart disease, neurodegenerative diseases like Parkinson's and dementia of various kinds, including Alzheimer's. What's the common thread between those diseases that will end up plaguing us in our later years? Well, there's two common threads of note. One of them is really good.

They all take over 20 years incubating in our body before they manifest any symptoms. So we got a long lead time to work on this that we're not doing, right? So that's one thing. The other big advance we've made is that they have a common thread of involving the immune system and inflammation. And so that is what is the real issue as we age underpinning these three diseases.

And if we can keep a person's immune system perfectly fit through their life and not have untoward inflammation, we're going to get a whole lot more super agers going forward.

I want to talk for a moment about nature versus nurture. LR, the super-ager you talk about, who's 98 years old, she has lived a long time and she's lived really well, but which has had the greatest impact on her longevity and other super-agers, nature or nurture? Yeah, I mean, that's a big myth that it's all genetic, that we're pre-programmed to have these diseases in short health span.

Because when we looked at the Welderly, our study of 1,400 people like Mrs. L.R. Lee-Russell, they, just like her, their parents, their siblings died 20, 30, 40 years younger than them. Now, there were some familial patterns that you would say, okay, this is definitely something that genetics are having an influence, a significant influence perhaps, but for the most part,

These were people that had like the last people standing in their family and they'd lost all their other, well, their parents and their siblings at ages that would tell us this is not genetic at all or very little contribution. This is liberating for a lot of people like me where I have a just terrible family history, largely of cancer in my family, but we're not destined to have these diseases.

And nurture, lifestyle, plays a very significant role. And the way it plays a significant role is largely by controlling and promoting inflammation and health of our immune system throughout our life. In your book, you refer to something called Lifestyle Plus. What is that and what's its role? Well, that's a term I struggled to come up with, Brian, because

Everyone knows, oh, diet and exercise. And now, of course, sleep has become of equal footing. But what they don't know about are things like the pro-inflammatory effects of ultra-processed food or high-protein diets or air pollution or microplastics and nanoplastics or forever chemicals or the benefits of social interaction and engagement.

or of being out in nature. And there's more to these various other factors that are important. I just roam into this rubric of lifestyle plus because I couldn't come up with any other term that brings them all together. They all have a very substantial influence or link to our health span.

So it's really just a much longer list of environmental factors. I'm thinking of microplastics and there's nothing that you and I can do about microplastics except lobbying the government to ban them. So what's in our control and

What's in the control of larger forces? Well, you're right. In order to deal with air pollution and the plastics, forever chemicals, we need help from governments. But there are some things we can do. Like for the microplastics that are in our air and our water supply, having a filtered water, but also trying to avoid plastic storage, like

like whether it's plastic bottles for drinking water, people that store food in plastic containers, and then they put it in the microwave to heat it up. That's like a quadruple whammy because, you know, heat with these plastics, even more ingestion occurs. So we have to take this stuff seriously, but we're not doing anything.

There are, as you've already suggested, a lot of things that people can do. They can exercise. That, I believe, is the first step that you would recommend. They can also change their diet to a more Mediterranean diet, moderate their alcohol consumption. So there are a lot of things that people can do. But I wonder, is super aging successful?

something that's easier to do if you're well off financially? Well, not really, because unlike these longevity clinics that have cropped up throughout North America, particularly in the U.S., that charge people ridiculous amounts of money for things that have no proof, whether it's like plasmapheresis, transferring young person's blood to older people, or, you

you know, stem cells and anti-aging supplements and all these tests and total body MRIs. I mean, it's a circus. And these are for the rich people, right? There's funding of companies to come up with a reverse aging pill. And they are funded largely by billionaires. You know, when these people were young, they wanted to be rich. And now they're rich, they want to be young, right? The point being is that the things that work

like the diet and exercise and sleep, these are not expensive things to work on. These are inexpensive or free. The other point about this, though, which is really critical, is that we don't get most people to adopt these changes. But when you give them specifics about them,

then you can say, you know what, in the next 15 years, if you don't change these things, the risk is there. But if you do go after this with prevention, and we're going to help you, not just these lifestyle things that are very easy to start to work on, but there's going to be other ways to help prevent the diseases. You will have much better success. And it's something for everyone, not just for people who are in the affluent category.

As Dr. Topol just said, increasing what he calls your health span is less about your DNA and more about how you live. We'll be right back.

All right, look, are you looking for someone who can maybe explain why everyone is so excited about this new Judy Blume show on Netflix? Or maybe you're looking for a place where you can hear about, you know, which movies are actually worth seeing in theaters this summer? Well, that's kind of Commotion's specialty. Commotion is a podcast hosted by moi, Elamin, where we dive deep into the big pop culture stories of the day, both here in Canada and around the world. Find us and follow us wherever you get your podcasts.

You're listening to White Coat Blackheart. This week, a conversation with Dr. Eric Topol, a cardiologist, scientist, and best-selling author. His new book, Super Agers, distills decades of research on how to make us all healthier for longer. Topol's new book comes out as the U.S. government makes sweeping cuts to government-sponsored research. For Topol alone, this could mean hundreds of millions of dollars. Part two of our conversation inevitably gets into current politics.

And the irony is that in your book, you've assembled a treasure trove of medical research, much of it carried out at labs across the United States. And I want to ask you how much of that research that you cite would exist if Donald Trump had been or somebody like him had been president all this time? Very little. We're seeing massive, profound cuts.

you know, just the NIH budget, which is 47 billion and considered the crown jewel of biomedical research for the world, it's undergoing a $18 billion cut. It's already lost, you know, thousands of people and the morale is just horrendous and more people will be leaving. And that's the case for all the agencies and the status of

The frontal attack on universities. So what we're seeing is a destruction of the whole commitment to doing high quality medical research in this country just at the wrong time.

at the time when we are right at the precipice of being able to prevent diseases that we've never been able to prevent. And now we have the leadership of Health and Human Services, which oversees all these agencies by RFK Jr., who is, you know, the anti-evidence based. It's farcical, right?

On the one hand, RFK Jr. says we're going to go after big food about the ultra processed food and we're going to go after all these environmental plastics and forever chemicals. On the other hand, you've got the Trump administration taking away the Environmental Protection Agency and all efforts to deal with climate crisis and things that would

help to reel this in. So, you know, it's not only the chaos, the lack of any coordinated effort, and we're going to suffer. The research will suffer and the health of Americans will suffer. And by inference, will the health of Canadians suffer and people in other countries?

Well, I hope not. You know, I think you're in a far better position. Your health agencies have not been taken over by people who are anti-science and misdirected. You also have a much more equitable type of system whereby all people in Canada are viewed that it's a civil right to have health care. This is a big defect in the American system where

It's still a private practice. It's not a system at all. And so even more, millions of people are going to not be accessing health care if all the cuts that are on the table go through here. So Trump is president and RFK Jr. is his health and human services secretary. The latter is a flag carrier for anti-science, and Trump doesn't mind having RFK Jr. where he is.

Doesn't that mean that anti-science is in its ascendancy in the United States?

Yes, it was already getting a tremendous amount of momentum through the pandemic. What's happened, of course, is the people that were the most contrarian, they're now leading the various parts of health and human services. RFK Jr. being one of them who was against vaccines. And now, of course, with measles and all the other actions that have been taken, getting rid of mRNA vaccine research completely, that

spills over for cancer, for genome editing, for autoimmune diseases, you know, getting rid of readiness for pandemics. All these things are just putting us in a very precarious position. I want to, if we can, just talk about vaccines for a moment. You believe that new vaccines are going to be critical to extending the human lifespan and for healthspan.

This is really important because, you know, I've emphasized about the immune system and its relationship with inflammation in our body. And one of the great ways we're going to prevent these diseases in the future is controlling our immune system. First, being able to diagnose that it's not as functional as it should be, particularly as we get older, and then using a vaccine to amp it out. Now, a perfect example of that

is a shingles story. So three huge natural experiments conducted in Wales, in the US, and in Australia, all independent, all about the shingles vaccine. And they all showed the same thing, that when people got shingles vaccine, not only had the suppression of getting shingles, which nobody would want to get that, but much bigger is that they had the 20 to 25% reduction across all three studies in preventing shingles.

dementia. That's extraordinary. Now, why did that occur? Well, it revs up the immune system. This is a really good vaccine for doing that. And that's what we can learn from this is that we are going to be able to prevent these diseases with the help of vaccines in people whose immune system is not where it should be as they get older.

Why do you think the anti-vaccine movement has taken hold so strongly in America? Well, there's been lots of reasons. It's hard to pin just one. I mean, there's been more and more questioning of the medical

community and the establishment. Patients don't have that kind of intimate relationship with doctors they used to have years ago. They have a harder time to feel that the doctor actually cares for them. Very little time with a doctor, hard to get in to even have an appointment. So that part, there's been degradation.

And then all these secrets that these influencers have without evidence, they have all this kind of magic. And that is not even just a conspiracy theory. It's an admixture of some things where there is some truth and evidence and facts and things that are completely false or without any evidence, like all these anti-aging supplements or getting a total body MRI or hundreds of blood tests that could actually cause...

cause more trouble than they're worth.

Or treatments like plasmapheresis to get young blood, even though we don't know if it's safe and we don't even know how it works. On and on. So we have at this point, because the anti-science or lack of science has moved from the pandemic, where there was mistrust of public health. And frankly, there's the lack of the medical community showing up as an anti-force. We've been crowded out.

And what we needed to do and still need to do is to show up and have a voice. And we don't do that. And that's a real problem because we're so outvoiced by people who are coming up with proclamations that have no basis.

Last season on White Coat Black Art, we had Dr. Peter Hotez on our show talking about the rise of anti-science in the U.S., talked about his book. He gets death threats for his pro-vaccine opinions. Yeah. Do you?

I have, yes. I know Peter, we're very close friends and I'm a big admirer. I call him a physician warrior taking on the anti-vax. He's been doing it for years with autism and of course during COVID as well. So he's a hero of mine and a good friend. You know, we agree. We've talked about this frequently. We have a culture of fear right now in the U.S. because if you really object to what's going on right now, then you could become a target

You could have your grants pulled or your institution be punished or who knows what. It's not rational. It's not based on merit. It's also, as far as I can tell, not following the congressional authority that a president or an administration would override the congressional authority for research and grants and programs. So,

All these things are making things worse because whoever might have stood up at this juncture is afraid to for, and even their institutions are telling them that you better take a low profile because, you know, we don't want to get, we don't want to become the next, you know, Harvard or Columbia, that sort of thing. It's a horrible, horrific nightmare situation. So when are you moving with your lab to Canada? Yeah.

Well, I certainly would consider moving to another country like Canada. The problem is we have an extended family here.

How do you just move a whole family? If it was just my wife and I, we probably would do that. But no. And also, I love my job and love all the people I get to work with. But more and more people are going to emigrate to other parts of the world, including Canada, because of the situation that's at hand. There's an opportunity here for Canada to step into the breach, isn't there? Oh, no question about it. I mean, I think...

there might never be a better opportunity. Your ability to get support, whether it's through government or agencies, nonprofit organizations and whatnot, to recruit individuals and programs to Canada, I think you'll be successful. You already have. Because if these cuts continue, many great labs and programs throughout the U.S. are going to be shut down. Some of them already have been.

And people want to do the work. They're excited about what they're doing and where are they going to go? I want to conclude our conversation, which I've enjoyed thoroughly, on a bit of a philosophical note. At the end of your book, you say that Ray Kurzweil, the very famous American computer scientist, believes that the first person who will live to 1,000 years has been born.

What is the value in humans living 1,000 years or 200 or 250 years? Well, it's not going to happen. We've had some really good science to show that our limit in life would hardly be beyond 120.

The oldest person in history was 122, and we haven't had anybody live that long documented for almost 30 years. So no, we're not going to have some big change in lifespan in my view. We just have a great chance to get a much more extended healthspan.

And if you look at Ray, who takes, you know, hundreds of supplements every day, and he doesn't look too healthy. Nor does, you know, Brian Johnson, who takes an equal number of supplements and gets plasmapheresis from the young son and all kinds of ridiculous stuff. These people are extremists. They don't have the science to back up what they are writing and saying. But I do think if we took, just took the environmental toxin thing seriously, climate change,

that would have a big effect on planetary health, that is, for the 8-plus billion people

but we're not doing it. And in this country, you know, we're denying it. So there are ways that we can improve health for everyone. And, you know, I think let's get on it and let's get on it specifically for defining risk in people way in advance. We got 20 years to work with or more and prevent those diseases like we've never had that opportunity before. So I, despite all of the challenges,

I remain very optimistic that we'll get through this. We're obviously going to take a while, but we'll get there. Well, the book is Super Agers. The author is Dr. Eric Topol. And Eric Topol, thank you so much for coming on to White Coat Black Art to talk about this. Oh, great to be with you. I really enjoyed our conversation. Look forward to more in the future.

Dr. Eric Topol says humanity is on the cusp of developing vaccines and other treatments that can help tame cancer, dementia and other chronic diseases, just as political forces are lined up to shut down that research. The void in scientific research that the U.S. is about to leave could be filled by countries like Canada. As Topol says, there might not be a better opportunity.

That's our show this week. Check out our sister podcast, The Dose, where Dr. Topol doles out practical advice on how you can live a longer, healthier life. Look for The Dose wherever you get your podcasts. White Coat Blackheart was produced this week by Jennifer Warren and me, with help from Stephanie Dubois and Samir Chhabra. Our digital producer is Ruby Buiza. Our senior producer is Colleen Ross. I'm Brian Goldman, and I'm proud to bring you stories from the Canadian side of the gurney. See you next week.

For more CBC Podcasts, go to cbc.ca slash podcasts.