Can Ozempic end addiction? | Dhruv Khullar | Your Body on Tech

[00:00:00] [SPEAKER_00] Hey everyone, Sherrell here. This year on TED Tech, we've dug deep into ideas that are changing our world. But over the next few weeks, I want to turn the focus into how technology is changing ourselves. To do this, I'm enlisting the help of my colleagues from the TED podcast world. Journalist and TED Radio Hour host Manoush Zomorodi took over the TED Talks Daily feed earlier this year.

[00:00:27] [SPEAKER_00] She produced a special series examining how our digital habits and changing technologies are rewiring our minds and our bodies. Over the next few weeks, you'll be hearing from Manoush and the speakers she curated at this year's TED conference.

[00:00:44] [SPEAKER_00] Today, physician Dhruv Khullar talks about the surprising science of GLP-1s that could go beyond tipping the scales. I'd love to know what you think about the series and our show in general, so feel free to leave us a review or a Spotify comment. Thanks for listening and enjoy the show.

[00:01:03] [SPEAKER_03] You are listening to TED Tech, where we bring you new ideas and conversations to spark your curiosity every day. I'm Manoush Zomorodi, sitting in for Elise Hugh this week with a special series of episodes all about how you can live a healthier life in our high-tech era.

[00:01:24] [SPEAKER_03] You may know my voice from the TED Radio Hour podcast over at NPR. I'm also an author, two-time TED speaker, and this past April, a guest curator for the TED 2026 conference. My session was all about my obsession with technology, the human body, and what is keeping us human in this digital age. And that included the speaker you're going to get to know today, Dr. Dhruv Khullar.

[00:01:50] [SPEAKER_03] Dhruv is a practicing physician and associate professor at Weill Cornell Medical College. He also writes for The New Yorker, where he investigates all kinds of topics at the intersection of medicine, policy, and being human in this hyper-accelerating world. I love reading his articles, and I love his measured take on hot topics in health. He brings the perfect mix of science and just kindness and empathy.

[00:02:18] [SPEAKER_03] You'd want him to be your doctor, you know? Anyway, his talk is about a hot topic in medical innovation. GLP-1s. Drugs like Ozempic and Wagovi that millions of people are taking to treat diabetes, and more controversially, to jumpstart their weight loss journeys.

[00:02:38] [SPEAKER_03] And while these drugs have been around for a while, we are still learning a lot about how they work, and the many ways that they can impact us beyond the number on a scale.

[00:02:49] [SPEAKER_01] Now, for a long time, GLP-1 was thought to be mainly about digestion. But it's now clear that the medications affect much more than eating. They might have some of their most surprising effects not in the gut, but in the brain.

[00:03:02] [SPEAKER_03] As Dhruv explains, GLP-1s are starting to show real signs of treating addictions. All kinds of addictions, from alcoholism to gambling. And the way that these drugs work is changing how physicians and researchers think about how they treat people with addictions. But also, as you'll hear, for some people, it's more. Taking a GLP-1 can change the way that they think about themselves and how they actually live their life.

[00:03:30] [SPEAKER_01] There's still a lot of stigma that's preventing people from coming forward when they have an addiction. I don't want to say that, you know, our behavior, our will has no role in these conditions. Of course, we need to encourage and help people make decisions that are in line with their health. But I think that needs to be paired with an understanding that a lot of these processes are neurobiological. And shaming people because they have these conditions is not going to be a productive way to go about it.

[00:03:55] [SPEAKER_03] I called up Dhruv at his office at New York Presbyterian Hospital in New York City. You will hear all the action going on. You'll hear some of the emergency room sirens going off right outside his window. So coming up, Dhruv's talk and our conversation afterwards about living in a GLP-1 world.

[00:04:14] [SPEAKER_02] Now, our TED Talk and conversation of the day.

[00:04:25] [SPEAKER_01] Last year, I met a woman I'll call Mary. Mary was 13 when she started drinking. And soon, she could drink 18 beers in a sitting and barely seen bust. Her days became a blur of inebriation and hangover. Mary wanted to stop drinking. She tried alcohol rehab, Alcoholics Anonymous, a medication called Antabuse.

[00:04:54] [SPEAKER_01] None of them worked for her. One day, Mary was at a bar with a friend who also drank heavily. But that evening, Mary noticed that her friend had hardly sipped her drink. Her friend told her that she'd started taking Ozempic. And now, she could barely drink two beers at a time. Mary was perplexed. She'd always thought of Ozempic as an obesity medicine. What did it have to do with drinking? But she decided to enroll in a nearby clinical trial

[00:05:23] [SPEAKER_01] that was studying whether GLP-1 medications like Ozempic could help people with alcohol addiction. Every week, researchers blindfolded her and injected her with a solution, either Ozempic or a placebo. Within weeks, Mary lost her taste for beer. She switched to white wine. Then she stopped drinking altogether. Many people talk about Ozempic

[00:05:51] [SPEAKER_01] as getting rid of the food noise inside their heads, those intrusive, unwanted, repetitive thoughts about eating. For Mary, it cleared out alcohol noise. It started to moderate her desire for drinking. It turned what was an overpowering emotional response into something that could be seen from a distance. Suddenly, she had the mental space to make changes in her life that she'd long wanted to. She started exercising.

[00:06:20] [SPEAKER_01] She improved her diet. She ended a difficult relationship. People know how much GLP-1s affect your body, she told me. I don't think they realize how much they affect your mind. Now, as a doctor, I have long wished that we had more to offer people who are struggling with an addiction. And hearing Mary's story, it's hard to overstate just how striking it was.

[00:06:47] [SPEAKER_01] GLP-1, or glucagon-like peptide 1, was first discovered way back in the 1980s. Scientists thought that it might be helpful to manage diabetes. But because the naturally occurring version of the molecule broke down within minutes, it was hard to turn into a drug. The big break didn't come until years later, when a scientist who was studying Gila monsters, of all things, found that the lizard's venom contained a similar peptide,

[00:07:15] [SPEAKER_01] and that peptide could hang around for hours. His discovery catalyzed what would become the GLP-1 revolution. Now, for a long time, GLP-1 was thought to be mainly about digestion. But it's now clear that the medications affect much more than eating. They might have some of their most surprising effects not in the gut, but in the brain. Stories like Mary's have led scientists to consider whether these medications could be helpful

[00:07:44] [SPEAKER_01] for all sorts of addictions, from alcohol and cocaine to gambling and compulsive shopping. Research has found that GLP-1s might help people stop smoking, reduce their cravings for opioids, lead them to consume fewer drinks. As one neuroscientist put it, GLP-1s might be telling us that there is some type of universal pathology when it comes to addiction and that they are part of how we fix it.

[00:08:14] [SPEAKER_01] Now, that is a tantalizing prospect, that there's a general-purpose key that unlocks the path to moderation. But that's what GLP-1s seem like they could be, moderation molecules. They don't extinguish our desires, but they help us keep them in check. And no one knows exactly why. One possibility is that they modulate what's called the brain's mesolimbic pathway, sometimes referred to as the reward system.

[00:08:44] [SPEAKER_01] Alcohol, nicotine, cocaine, social media, they all increase dopamine release in that pathway. And GLP-1s, they might be limiting the spikes of dopamine. So mice that are on the medications and given cocaine, they have smaller surges of dopamine, but they otherwise seem to maintain adequate amounts of the neurotransmitter. GLP-1s could be calming the water without draining the pool. At the other end, GLP-1s might make it easier

[00:09:13] [SPEAKER_01] to stop using a drug. Research that's currently under review has found that animals that are addicted to opioids and given a GLP-1, they have less activity in a part of the brain that's involved with withdrawal. So again, these medications could lead to moderation not just because they make a drug less pleasurable, but because they make abstinence less painful. Now at this point, we should probably moderate our own enthusiasm about the moderating effects of these medications.

[00:09:44] [SPEAKER_01] Like any drug, GLP-1s won't work for everyone. In fact, for some people, these so-called moderation molecules, they could have an alter ego as a desire dampener. Maybe some people lose interest in drugs or alcohol or food because they lose interest in pretty much everything, a condition known as anhedonia. It's also true that addiction is often a lifelong battle, but many people who start on a GLP-1,

[00:10:13] [SPEAKER_01] they come off it within months, whether because of side effects or costs or access. and even people who do manage to stay on the medications might ultimately develop a tolerance to them such that their cravings for a drug ultimately return. And yet, it is hard not to get excited about the potential for GLP-1s to treat addiction when you consider how little progress we have made. Every year, tens of thousands of Americans

[00:10:43] [SPEAKER_01] die of an opioid overdose. Since the turn of the century, alcohol-related deaths have more than doubled. And it has been 20 years since the FDA last approved a medication for alcohol use disorder. The winding path of GLP-1s from Gila monster peptide to diabetes medication to obesity drug to potential addiction treatment, it is a story of hope. But it is also a story with a lesson.

[00:11:13] [SPEAKER_01] The hope is that more people will gain the power to bring their wants and their motivations and their behaviors into greater harmony and they will live many more years in good health as a result. The lesson is about the unpredictability of medical progress. Discoveries like this one remind us why scientific curiosity, especially the kind that can seem obscure or impractical, why it matters so deeply. Because we don't know

[00:11:43] [SPEAKER_01] where the next big innovation will come from. We might not even recognize it when we first see it. But now, GLP-1s are forcing us to reconsider not just the modern science of addiction, but ancient wisdom about restraint. For thousands of years, we have seen moderation as a moral achievement. Aristotle argued that the path to a life well lived runs through moderation.

[00:12:11] [SPEAKER_01] Courage rests somewhere between cowardice and recklessness. Generosity between stinginess and extravagance. He's often quoted as saying, it is best to rise from life as though from a banquet, neither drunken nor thirsty. Well, Aristotle never had a Dorito. He didn't have Krispy Kreme or McDonald's. He couldn't flip open TikTok and Instagram. There were algorithms that were fracking his attention.

[00:12:42] [SPEAKER_01] And ancient Greece was not beset by fentanyl and oxycodone. We have a society today in which the fundamental problem for many people has shifted from scarcity and boredom to excess and distraction. Our technology often seems purpose-built to tap into our most basic vulnerabilities. And the question now is how to bring our minds and our bodies and our environments into a more natural balance.

[00:13:12] [SPEAKER_01] GLP-1s, they suggest that Aristotle's moderation is not just a virtue, it is a physiological state. It isn't just about character, it is about biology. And none of this is to suggest that we should somehow give up on the struggle to bring about a more healthful society, that we shouldn't do the hard cultural and political work to bring about a better world in which we can address the drivers of addiction and other social problems, things like loneliness

[00:13:42] [SPEAKER_01] and trauma, pain, poverty, exploitation. But it does suggest that we should welcome a promising new tool into our toolkit. Now, over the years, I have cared for many patients in the moments when an addiction has taken almost everything from them. the young woman whose post-surgery opioid use turned into a heroin addiction and then into

[00:14:11] [SPEAKER_01] the heart infection that took her life. The father, whose liver failed after decades of alcohol use, who was slowly dying on a transplant list. Every morning, I entered his room and was greeted by his children, age six and eight. And they would ask me when their dad could go home. those were some of the hardest conversations I have ever had.

[00:14:42] [SPEAKER_01] In recent months, I have returned again and again to something that Mary told me. She said that GLP once enabled her to act not just on her immediate desire to stop drinking, but on her deeper desire to reinvent the person she wanted to be, to change her habits, her relationships, even how she saw herself. She gained a kind of freedom to live alongside her desires instead of being ruled by them. Because alcohol

[00:15:12] [SPEAKER_01] was no longer an issue, she told me, I finally had the chance to think, what type of life do I want? And that is a question that every person deserves a chance to ask. Thank you.

[00:15:28] [SPEAKER_03] That was New Yorker writer, Dr. Dhruv Khullar. When we come back, Dhruv and I discuss why there's still a stigma around addiction, even though we have been talking about the genetic and biological reasons behind addiction for decades. Will GLP-1s finally change that? And what about the people for whom GLP-1s don't work?

[00:15:51] [SPEAKER_02] What are their options? Be back in a sec. So did you

[00:16:01] [SPEAKER_03] meet Mary because you were doing research for your journalism? Or she wasn't your patient, right?

[00:16:07] [SPEAKER_01] No, she wasn't my patient. She was someone that I had met through a clinical trial researcher. And she was a patient who was enrolled in one of his trials.

[00:16:14] [SPEAKER_03] Got it. So you got introduced to her and so she finds out about this clinical trial and she's like, huh, this could be interesting for me.

[00:16:22] [SPEAKER_01] That's right. You know, in Mary's case, she also experienced pretty significant reduction in her appetite. And so there were days where she was eating, you know, three, four, five hundred calories a day. And she lost 55 pounds in just five months. And she ended up having to come off the medication because she lost so much weight so quickly. But she was able to maintain her sobriety afterwards. So even after she came off the medication, really, she's had a much

[00:16:52] [SPEAKER_01] healthier relationship with alcohol and she's maintained her lower weight and she's maintained her healthier lifestyle. For her, it's been a really positive experience.

[00:17:01] [SPEAKER_03] I mean, I think for normal people hearing that get a shot of Ozempic and you can turn your life around, that seems amazing. But as a physician, what was it about these stories connecting GLP-1 medication to addiction that struck you as so, I mean, I guess, strange and unprecedented? Well, I think you have to think back

[00:17:24] [SPEAKER_01] about the history of Ozempic. It was first discovered many years ago. And glucagon-like peptide-1, which is a naturally occurring hormone, I mean, that was discovered nearly half a century ago now. And it was always thought to have effects for diabetes and then later weight loss. But the idea that it could modulate the way that people were experiencing the rewards of drugs and other types of behaviors, that is a much more recent discovery. And so, this kind of came about because there were just so many stories

[00:17:53] [SPEAKER_01] of people saying that they wanted to drink alcohol less. They didn't want to smoke as much. People who had been taking opioids weren't having the same types of cravings that they had in the past. And, you know, some of that, you take as anecdotal evidence, you're not sure exactly what to make of it. But over the past year or two, there has been a good amount of trial work that has shown and is increasingly showing that there are pretty substantial effects here. Here, GLP-1s, they seem to be

[00:18:22] [SPEAKER_01] acting across these different types of addictions, which is quite novel and interesting. The prior thinking had been that they are modulating mostly our desire for food and creating a sense of satiety. And now, the thinking is that maybe these effects are much broader than we previously thought. Things like alcohol or nicotine or cocaine, even social media, they seem to increase dopamine release in the pathway. And at least the theory is, and there's some animal work to support this, is that

[00:18:52] [SPEAKER_01] the spikes of dopamine are being blunted by GLP-1s, but the kind of baseline levels of dopamine are being drained fully. And so, it may be that this class of medications will be an important adjunct to people who are struggling with addiction.

[00:19:08] [SPEAKER_03] So, I mean, we've been told in the last couple years, this is so interesting, like dopamine, dopamine is the problem here, that you're getting these squirts of dopamine and that's what's making you behave irrationally. As you said, whether it's like Doritos or TikTok or whatever else it is, is it that simple? Or tell us more about how this like mesolimbic pathway actually works and whether dopamine is the culprit.

[00:19:33] [SPEAKER_01] Well, dopamine is involved in all sorts of processes in the brain. I think, you know, today in modern parlance has become kind of synonymous with this idea of addiction, whether it's to social media or to a drug or other substance. But dopamine is involved in all sorts of things from motor function, you know, people with Parkinson's disease, for instance, have disrupted dopamine in some of the motor parts of the brain as well as motivation. And so, our desire or our motivation to seek out things, whether those are positive rewards or negative

[00:20:02] [SPEAKER_01] rewards, those are also being influenced by dopamine. So, sometimes there is this kind of reductive sense that it's just a matter of dopamine spikes and if we just blunt those spikes we'll be able to overcome much of what's ailing us today. And I don't think it's as simple as that. And some of the ways in which these medications are actually operating are still mysterious. And so, you know, one of the interesting things I came across in my reporting is that it's still kind of a question mark how exactly these medications are even

[00:20:32] [SPEAKER_01] affecting the brain, you know, as they become these longer lasting, more powerful medications. And it's not even clear exactly how or if they get into the brain. And so, you know, there's a lot that we still have to learn about the exact ways in which GLP-1s are affecting not only the brain but the body more generally. But from what we're seeing from trials that are being published not only on addiction but on other types of disorders, they seem to have a number of positive effects.

[00:20:59] [SPEAKER_03] Yeah, I was just seeing that there's research into like the relationship between the gut and the brain as well. That it's not just the brain that these drugs affect when it comes to eating and addiction but the conversation that's going on between the intestines and the brain.

[00:21:15] [SPEAKER_01] Yeah, I mean, for a long time GLP-1s were thought to affect primarily the gut. They have their receptors all over the body, their receptors in the pancreas, in the gastrointestinal tract, the brain. Of course, GLP-1s, they stimulate the release of insulin, they slow the passage of food through the stomach, they're signaling to the brain that we are full. So there's a lot of crosstalk between the gut and the brain and there's some thought that maybe some of what we're seeing both in terms of addiction but also other types of conditions

[00:21:45] [SPEAKER_01] is related to the ways in which the medications are affecting both the gut as well as the brain.

[00:21:52] [SPEAKER_02] We're going to take a quick break and then we'll be right back. I mean,

[00:22:02] [SPEAKER_03] with all of this, as you point out in your talk, it makes us rethink sort of assumptions we've made about people's morals or their personality for centuries that someone is weak-willed or has no discipline that they can't stop themselves from drinking, smoking, etc. I remember the shift in thinking like in the 90s, I guess it was, where people were like, you know, you're not a bad person if you're addicted. Addiction can run in your family. It's genetic. It's

[00:22:31] [SPEAKER_03] a chemical imbalance that's happening in your brain. It's not your fault. That was a flip that happened in terms of not blaming people who have addictions but blaming sort of the way their brains work. Do you think that we're being set up for a new way of thinking about addiction and the way we talk about or treat people who struggle?

[00:22:55] [SPEAKER_01] I think so. I mean, some of the estimates are that 108 people in the United States have been on a GLP-1 medication at some point. So these are millions, tens of millions of people who are using these medications and are seeing the effects of them in their lives. I mean, I think because these medications are so widely used. There's going to be a different relationship both towards obesity as well as addiction but I think there's still a lot of stigma that's preventing people from coming forward when they have an addiction. We have,

[00:23:25] [SPEAKER_01] as you said, made a lot of strides towards recognizing that a lot of this is biological, that it's happening even unconsciously and that people really struggle in ways that they shouldn't be blamed for what's happening some of this really came home during my reporting for this piece. I underwent an MRI scan similar to what trial participants would have gone through and I went into this MRI they were

[00:23:54] [SPEAKER_01] showing me photographs of all sorts of things whether it's Big Macs or mountains or alcohol like beer wine whiskey and they were basically seeing how my brain reacted to these various images and afterwards they showed me in response to photographs of alcohol there was very little activity in the relevant centers of my brain and they compared them to people who are struggling with alcohol use disorder and those areas just lit up in those people and for me it kind of drove home

[00:24:24] [SPEAKER_01] this point that so much of our behaviors downstream of these processes that are happening inside of our brains before we even have an opportunity to make a reasoned decision about what we're going to do and so I don't want to say that our behavior our will has no role in these conditions of course we need to encourage and help people make decisions that are in line with their health but I think that needs to be paired with an understanding that a lot of these processes are neurobiological and

[00:24:54] [SPEAKER_01] shaming people because they have these conditions is not going to be productive way to go about it

[00:24:58] [SPEAKER_03] I

[00:25:14] [SPEAKER_01] these are just a few of the conditions for which this class of medications is being studied I mean people seem to have beneficial effects for cardiovascular health or stroke risk there have been studies published that individuals with fatty liver disease or chronic kidney disease those things either slow down or even reverse on GLP-1 medications interestingly even osteoarthritis seems to have some evidence so things that we would not have anticipated seem to

[00:25:44] [SPEAKER_01] be amenable to treatment with GLP-1 medications and some of that is independent of the weight loss one reason might be that GLP-1 are having some type of anti-inflammatory effect so there's a change in the amount of inflammation in the body and that's what's contributing here I don't want to come off as a total booster of these medications I think there are things that we should talk about in terms of cost and side effects that may limit the use of the medications in some people but I have

[00:26:30] [SPEAKER_03] come around but let's talk about everything has downsides what are the downsides for GLP-1 as far as we know now

[00:26:39] [SPEAKER_01] anytime people start talking about a wonder drug we should approach that with some skepticism and I have approached that with skepticism and I've been surprised at how many times the evidence actually has supported their use for various conditions but that being said there are things that should still give us caution so I think the first is that it can be hard for a lot of people to stay on these medications drugs only work if you take them but at least in some studies half or more of people come off these

[00:27:09] [SPEAKER_01] medications within a year of starting to take them and so of course that is going to limit how effective they can be if people aren't able to stay on them it's also possible that some people experience psychological side effects there have been reports not a lot of great research yet but at least reports that people feel kind of a blunted mood or even anhedonia they're not interested in doing the things that they used to do and of course that is potentially quite concerning if people aren't interested in living the life that they

[00:27:39] [SPEAKER_01] want to be living that's something that needs to are going to be able to afford that and finally I would say GI side effects in clinical trials they seem to be pretty well tolerated so maybe 5 or 10% of people have significant enough GI side effects to come off them but that is potentially higher in the real world and one reason that

[00:28:09] [SPEAKER_01] people are coming off the medications the

[00:28:11] [SPEAKER_03] thing that I keep hearing about is oh they have the ozempic look it's the gauntness and that is because why what happens to muscles when people are on GLP-1 well

[00:28:22] [SPEAKER_01] one of things that happens when you're on GLP-1 is that often people are losing a lot of weight and with that weight is going to be part loss of fat but also loss of muscle and losing a lot of muscle very quickly can be concerning for all sorts of reasons but one of which is it can lead to frailty and people might be at higher risk for falls and other problems and so the recommendation really is not just to take the GLP-1 in isolation but to do it along with the diet and exercise regimen the diet should be a high protein diet that allows you

[00:28:52] [SPEAKER_01] to much muscle as possible and

[00:29:04] [SPEAKER_03] what about long term we just don't know right some of the side effects

[00:29:24] [SPEAKER_01] may and that had to be taken twice a day and it didn't have as powerful effects on weight loss and so it wasn't the phenomenon that these newer GLP-1s have become and we haven't seen those really concerning side effects that have sometimes cropped up with other medications over the course of five or ten years that's not to say that these specific formulations couldn't have

[00:29:54] [SPEAKER_01] other types of side

[00:30:02] [SPEAKER_03] reassuring in some ways part of me is like put me on it now coach you know what I mean like what why not if it's going to prevent you know all the things that come with aging right those inflammation based chronic diseases but two experiences have given me pause one was that I was at an American Heart Association meeting and some researchers were talking about using GLP-1s preventively in populations of kids where they don't get enough exercise or eat proper food

[00:30:32] [SPEAKER_03] or just this idea that obesity and diabetes are hitting younger people at younger and younger ages school age children that maybe if diabetes type two is rampant in a population that this should be used preventively and that kind generally I

[00:30:57] [SPEAKER_01] think that's a really important point especially when it comes to children or adolescents it's one thing to commit someone who is in their 50s or 60s to a medication that they're going to need to take for the rest of their life it's quite different when someone is 10 or 15 or 20 years old and so I do think it raises a really other

[00:31:27] [SPEAKER_01] types of interventions I think the other thing that this raises for me is that of course as you're saying when a medication is so powerful it becomes tempting to use it and not continue to push on the more societal factors that are creating the epidemic that we're in we're not addressing the root causes of obesity and diabetes and addiction and that's the reason that we are using these medications in the way

[00:31:57] [SPEAKER_01] that we are of course I'm the first to want to change the food system or the built environment or many of the other levers that we might want to work on to create a more healthful society but it's also the case that we have been trying to do that for decades and not made a lot of progress and so in the short term

[00:32:26] [SPEAKER_03] yeah it reminds me of the other example or experience I had which was I was invited to speak at a conference with a lot of very wealthy people many of whom were on GLP-1s and it just felt like there was this other extreme at the other end of people who are all about taking whatever shortcuts necessary whether it is to have 10x returns on a company whether it is to look as skinny and think as sharply as possible that this is the 1% and they want to

[00:32:55] [SPEAKER_03] stay the 1% again it was preventive it was about optimization rather than like managing anything you

[00:33:03] [SPEAKER_01] a lot of the health benefits that we have been talking about today those have been shown in people who are overweight or struggling with a chronic condition of

[00:33:33] [SPEAKER_01] health benefits associated with them this has really become kind of a cultural phenomenon where people are using these in all sorts of ways as a doctor I'm looking at the evidence I'm seeing kind of where we

[00:34:03] [SPEAKER_03] would you say based on what you've been seeing I

[00:34:06] [SPEAKER_01] think there's going to be more and more options for people on these medications and so right now we have maybe two major types of GLP-1s that people are taking semaglutide and terzepatide there's already another medication that hits not just one receptor or two receptors but three receptors that has completed phase three trials by Eli Lilly I think there will be more versions that are oral versions as opposed to injectable versions and so I just think there's going to be a lot more activity in this space

[00:34:35] [SPEAKER_01] whether it's route of administration or trying to mitigate side effects or try to reduce some of the muscle loss that sometimes people experience so I can see you know in the next five or ten years that there are many versions of these medications and they're much more widely used I

[00:35:01] [SPEAKER_03] mRNA vaccines are kind of a technology and genetic CRISPR etc like you know you write about a lot of different ways that health trends intersect with medicine and technology how do you think about it

[00:35:17] [SPEAKER_01] yeah I mean I think we are in an era where we are seeing enormous advances in technology and biomedicine I think artificial intelligence is going to play a larger and larger role not just in the delivery of healthcare but also the development of new medications this raises a couple thoughts for me I mean the first is that we should do our best to harness the positive aspects of these technologies and that requires rigorous study of them there will be any number of claims

[00:35:47] [SPEAKER_01] that are out in the public sphere but without doing the controlled careful study of these types of interventions it's going to be very hard to say which claims are true and which are not and I

[00:36:24] [SPEAKER_03] getting their hands because they think medical research technological research moves too slowly and that by the time something gets approved they could have been using it for several years and mitigated many of the symptoms that they had whether that is muscle loss or cognitive abilities or just you know getting older yeah I mean I think

[00:36:49] [SPEAKER_01] people are excited about the potential to take advantage of new technologies or interventions they want to lean more into health and longevity and I think that in a way is a great thing I think if we're going to have a market in which people are accessing medicines in the way that they are today then there's going to be any number of claims that are made about these types of things and I think it's incumbent on us to make sure that people have the information that they need to make those decisions

[00:37:18] [SPEAKER_01] about their health

[00:37:19] [SPEAKER_03] so how does it change the patient physician relationship AI to make more rapid diagnoses this means that doctors can be more hands on and do the human part of the job or I could also see that it goes the opposite way is that everything gets outsourced to tech and the humans get extracted from the equation entirely where do you think things are going

[00:37:49] [SPEAKER_03] I

[00:37:49] [SPEAKER_01] think both are going to happen I mean I think there's going to be a lot more insistence that people are able to access these things even outside of the traditional medical system I think one thing that drives home for me is that as doctors or other clinicians it's no longer going to be effective simply to state the evidence or to state a recommendation that really has to come paired with a rationale a perspective demonstration of why it

[00:38:21] [SPEAKER_01] is going to be a really important part of the future but really because there's so much information out there there's so much disparate information it's very hard for people to sift through it all it's also possible to get abstract in your thinking and not tie it

[00:38:51] [SPEAKER_01] in a way so many of the challenges that are in society not just medical but more general they find their way into the emergency room they find their way into the hospital whether it's misinformation or homelessness whatever it might be if you're able to tell a compelling story if you're going to put together synthesize things into a narrative that can be really helpful in helping people put it all together and the other thing I mentioned sometimes it's very helpful to just reach back to history and help people understand this new

[00:39:21] [SPEAKER_01] medication sounds like it's going to be amazing or that intervention that device is something I want to get my hands on today and we don't want to wait for the studies to prove them effective there have been many claims that have been made in the past about similar things that turned out to be either not effective or harmful I think it's important to point out that even something like 90% of drugs that make it to phase one clinical trials let alone drugs that never even make it to phase one clinical trials

[00:39:50] [SPEAKER_01] they end up failing before they become medications and so just because something looks interesting or has some suggestive data let's say in animal studies doesn't mean that it's going to be effective in people

[00:40:02] [SPEAKER_03] I want to end by circling back to Aristotle who you brought up in your talk Aristotle yes of course

[00:40:11] [SPEAKER_01] all talks should end with Aristotle right

[00:40:13] [SPEAKER_03] absolutely but you talked a lot about moderation and Aristotle's calling for it do GLP ones and talking about societal structures that make them necessary like I guess are we taking people's agency away where does the conversation for personal responsibility and modulation and finding your own sort of balance between extremes

[00:40:43] [SPEAKER_03] where does that fit into this conversation moderation

[00:40:47] [SPEAKER_01] is so important there are so many things in life that we want a little of maybe quite a bit of but not too much of Aristotle obviously had this insight many centuries ago and I think what I wanted to point out in the talk is that our world is kind of designed for too much these days it's just inundated with content and food and desire and all sorts of things and a lot of the challenges that we have whether it's around our mental

[00:41:17] [SPEAKER_01] health or physical health is trying to bring ourselves into greater harmony with health and health and health is a really

[00:41:46] [SPEAKER_01] important kind of frame shift just to think about how we should be engaging with all the delights around us and I surgery but he was really high risk for surgery because

[00:42:16] [SPEAKER_01] of his weight and other medical problems and the recommendation from the surgeon was that he needs to lose some weight and come back and maybe they'll consider surgery at a weight loss and getting the surgery he needed certainly I think it

[00:42:46] [SPEAKER_01] would have given a much better shot than he had at the time

[00:42:50] [SPEAKER_03] I love that we're hearing the sirens in the background I'm sorry no it's all good so the bottom line is proceed cautiously make sure you have a plan to manage the side effects and don't think that maybe this is a forever plan that's right and

[00:43:06] [SPEAKER_01] I don't think it's a magic bullet I think it's one part of a set of comprehensive changes that people should be undertaking to improve their health

[00:43:14] [SPEAKER_03] thank you Dr. Kular thanks

[00:43:17] [SPEAKER_01] for having me

[00:43:22] I

[00:43:22] [SPEAKER_03] find this conversation fascinating thinking about how medical innovations could change the fundamental ways we think about people and their personalities that's a big change that could happen in society but I also appreciate that Dhruv is very cautious in his approach to writing and speaking about medical innovations he doesn't write them off he takes them very seriously but he also is skeptical and that is exactly what I want

[00:43:52] [SPEAKER_03] in my doctor right because there are of course people who think that physicians are too cautious to the point that they are keeping people from trying treatments that could change their life I keep thinking about the current peptide craze for example which Dhruv actually wrote about recently in the New Yorker there are people on social media proselytizing about the effects of shooting unregulated synthetic proteins into

[00:44:26] [SPEAKER_03] health as we also discussed in the previous episode with geneticist Michael Snyder it's about playing the long game not just optimizing for quarterly results and there is so much we don't know about the safety and side effects of these peptides so high level what do we take from all of this I feel like the old adage remains that if it sounds too good to be true it probably is nothing is ever perfect but the right mix of

[00:44:56] [SPEAKER_03] treatment and care may improve your health it may even make you happier moderation is generally a talk at ted.com thank you so much for being here on the next episode the role of art in

[00:45:25] [SPEAKER_03] helping us understand the connection between our health tech and humanity Yi Yun Kong wants people to feel how AI is affecting their lives through massive interactive art that brings you inside the algorithms that's what our conversation tomorrow is going to do too so don't miss it if you're curious about ted's curation visit ted.com slash curation guidelines ted talks daily is a podcast from ted this episode was produced by matthew

[00:45:55] [SPEAKER_03] cloutier lucy little and katie bontilleone it was edited by alohandra salazar with fact checked by avery keithley the ted talks daily team includes martha estefanos oliver friedman lucy little emma tobner and tanzika sungmarni vong with support from daniela ballarezzo valentina bohanini

[00:46:25] [SPEAKER_03] ban man chang and laney lot special thanks to sanaz mesh kinfor and my can hear more from these speakers on the ted radio hour with episodes coming out throughout the summer i'm manusha zamrodi i'll be back tomorrow with a fresh idea and conversation for your feed thank you so much for listening