#73 – AMA #9: NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more

In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #9 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

AMA #9 Sneak Peak:

We discuss:

• The story of how Peter almost worked for Theranos [2:00];
• The trend of lower testosterone and higher estrogen in men: Why is it happening and what to do about it? [10:00];
• Takeaways from Peter’s recent hunting trip in Hawaii [14:45];
• What books are you currently reading/listening to? [21:30];
• What advice would you give to the 25 year-old Peter? [24:00];
• What is your emergency protocol if you start getting sick? [27:45];
• How have your thoughts changed on NAD precursors, and also on metformin, in the past year or so? [30:30];
• What are your thoughts on “fat burning” zones for cardio workouts? — A lesson in relative vs. absolute fat combustion [34:15];
• What mental models do you use and how do you go about solving problems and approaching difficult questions? [49:00];
• Creatine supplementation—Yay or nay? Why? [49:30]; and
• More.

The story of how Peter almost worked for Theranos [2:00]

⇒ For a primer on Theranos and why this is even interesting…

• Give the wiki page a quick read
• Also, check out this HBO documentary
• Or the best selling book by John Carreyrou

An offer from Theranos

• In 2006, Peter was working at McKinsey & Company in Palo Alto
• Theranos contacted him and he was offered their Chief Medical Officer position
• He met with Elizabeth Holmes
• They looked at the black box machine together and discussed business and technology

Decided not to take the job for several reasons

• First, someone Peter trusts did not say anything good about one of the investors in Theranos
• Secondly, loved his job at McKinsey
• Third, wasn’t convinced that what you could test in a box that size was interesting
  • “I knew enough about diagnostics and…chemistry that I knew that there was…not going to be anything you could do on a drop of blood, in a box that size, that was clinically interesting.” 

8 years later

• In 2014, 8 years after declining the job, Forbes valued Theranos at $9 billion
• Calculated the money he would be worth if he had taken the job, “life changing money”

In 2015 

• Peter was at a fundraising event where Elizabeth was the top speaker (ahead of Mark Zuckerberg) 
• Elizabeth saw Peter and remembered him from 9 years prior
• They exchanged contact info and kept in touch for a while
• 2 days after this event, John Carreyrou put on an article in the WSJ exposing some of the fraud going on at Theranos

Cognitive dissonance

• Here is Elizabeth as the headliner at this “who’s who” event
• Simultaneously, she knows her world is about to get super messy was the WSJ article releases
• From a psychology standpoint, Peter says he doesn’t believe that Elizabeth ever thought she was doing anything wrong
• Which is not for a moment to say, she shouldn’t be held accountable for what happened
• She should be absolved of the responsibility of what she’s done
• But it’s a very important distinction… you can be so delusional that you really believe that the lies you’re telling are for the better good

Did Peter ever suspect fraud from Elizabeth and/or Theranos?

• “I never suspected [fraud]. . .I just thought it was the world’s most uninteresting business in the history of civilization. Like point of care testing in a drug store for Chem-7, and CBC? I would have more interest in a business that specialized in removing hangnails and nose hairs.”

The trend of lower testosterone and higher estrogen in men: Why is it happening and what to do about it? [10:00]

Lower T, Higher E

• If you took blood samples from a group of men in the 1950s, and did the same for a similar group of men today… 
• You would notice that, in today’s men, testosterone is lower, and their estrogen is higher

The question is, WHY?

{end of show notes preview}