Table of contents
- Follow your passion, not the paycheck. 💼➡️❤️
- Success is self-satisfaction, not external validation. 🌟✨
- Do less, but do it with passion and purpose. 🔥💡
- Every wave has its crest and trough—embrace both. 🌊💫
- Turn pain into purpose and watch miracles unfold. 🌟📖
- One lucky break can change everything. 🍀✨
- Always question authority. 🤔✨
- Embrace both your masculine and feminine sides. 🌸💪
- Stimulate your vagus nerve for better health 🌟🧠
- Music can unlock the mind's mysteries 🎶🧠
- Family traditions shape love and connection ❤️👨👩👧👦
- Rights come with responsibilities 🌍⚖️
- Technology + Innovation = Zero Carbon Future 🌱🚁
Follow your passion, not the paycheck. 💼➡️❤️
Wow, great piece... this is fabulous... They couldn't or wouldn't have fired me because I had just flukily started to generate a whole lot of money for them. He said, "Could you write under a different name?" I'll use my mother's maiden name. I really felt off the leash because nobody could trace it back to me.
It was a man named Ned Chase, and he said, "I figured out who Diana Bleecker was and I got your number." At that point, I thought, I'm out. If someone will publish a book by me, I'm not hanging around the Wall Street firm any longer. They were worried about my sanity; they were actually worried about my career. They couldn't believe that I was going to walk away from this really cushy situation.
You really could just wait, they said. You really could just collect some millions of dollars and then write your books. The problem was I was, what, 27 at the time? I looked ahead of me and I looked at people who were 35 or 37 and they seemed ancient and they seemed completely stuck. They made so much money and their lives had adapted to the making of money.
I just thought, there's no way I'd spend a lot of time here and still even want to do this. I'd be trapped and I don't want to do that. I ignored all that advice and just went and did it, and it worked out. That was "Liar’s Poker." I really just thought, tell the world what happened exactly as you remember it and that’s enough. I hoped people would read it and would say, yeah, I now know what this is. There's money there but a lot of it’s kind of silly and I have these other things I want to do with my life and I’m going to go do them.
I had dozens of letters a day from young readers saying, "Dear Mr. Lewis, I really loved your how-to book about Wall Street." It just fueled the desire of young people to want to do it more, and I didn’t see that coming. You write a book, but the reader reads a book, and the reader may read a book that’s entirely different from what you thought you wrote.
I thought it was so comical that I was going to be in this ambitious money-making world. I’ve always been enormously ambitious. I’ve always wanted my life to be great. I’m competitive. I don’t accept money as an accurate measure or any kind of real measure of whether you’re winning or losing. Money doesn’t hold that—doesn’t have that hold on me.
Success is self-satisfaction, not external validation. 🌟✨
When I first started out, I remember wearing red suspenders with little gold dollar signs on them. I thought it was a way to make fun of the whole thing. But nobody thought it was funny. They said, 'You can't wear that [ ] around here until you are a big enough deal to wear that [ ].' I've always been enormously ambitious. I've always wanted my life to be great—like really great.
Money doesn't hold that same value for me. I don't accept it as an accurate measure of whether you're winning or losing. Fame, on the other hand, holds a bit more sway. I would say that a lust for attention and fame is closer to a vice of mine than a lust for money and fortune.
I have a private sense of satisfaction. I can look at something and just say, 'That is a great piece of work,' and that feeling is what I'm always gunning for. The response I have to external validation has become muted and numbed over time.
When I got a glowing review for "Liar’s Poker" and it went to the top of the New York Times bestseller list, I was ecstatic. I was dancing all over my kitchen. I felt like I had just won the Super Bowl. Nowadays, I don't read the reviews. I sometimes forget whether a book is on the bestseller list or not. It doesn't gratify me in the same way anymore.
My ambition is to maximize my self-satisfaction. Maybe that's my real ambition. Yes, in fact, I did it yesterday. Kids have screwed up my natural writing rhythm. My natural rhythm would be to start writing around 4:00 in the afternoon, write until 3:00 in the morning, and sleep until noon—but you can't do that with kids.
Music helps me shut out the possibility of interruptions. I can't hear knocks on the door, phones, or people dropping packages on the front porch. I'm just in my own space and I cease to hear the sound. The podcast I'm working on is about coaching, and the last episode, which I still haven't written, involves me getting coached in something incredibly uncomfortable for me: singing.
I've been doing voice lessons an hour every day for the last three months. There's a song I sing, and I'm not going to tell you which one it is, that I've been practicing. It happens to be on my soundtrack, and now I realize I have to remove it because it kicks my brain into a different space. I hear it and it's like Pavlov—I’ve got to belt out the tune. I have to worry about hitting the high note, and it screws up my writing. So I've just been hitting skip, but I have to remove it.
Michael Kinsley had a gift for creating writers. There are dozens of people who were young writers then, whom he had a profound influence on and whose careers he just launched. He delivered the most withering critiques of your work. It would come back with a big X through it and a note saying, 'Why'd you even write that? Start here.'
I remember working it into the piece and seeing a big circle around it saying, 'You [ __ ] phony.' At the very beginning, I thought it sounded good for my byline to be Michael M. Lewis. He put a big circle around it and said, 'Don't do that. You're not Michael M. You're Michael Lewis.'
He was unbelievably gifted at seeing what a good story was. You started to learn what was interesting and what wasn't just by talking to him and seeing how he responded. I think this happens in speech too. There's a lot of inefficiency in human conversation.
We should be very efficient conversationalists because we do it all the time, but we aren't because we don't get feedback. People are too polite. Michael Kinsley, in addition to being a genius, just couldn't be polite. He was so blunt. I'm Michael Lewis on my books instead of Michael M. Lewis because of Michael Kinsley.
That wasn't a quote from me; it was a quote from one of my characters, Amos Tversky. He's one of the main characters in "The Undoing Project," and it resonated with me. People don't back away from their work. The need to always seem busy stops people from finding things that are really worth doing.
It resonates with me because I am not a person who always has to be doing something. My natural state is probably inert. I can really just lay around, screw off, and procrastinate with the best of them. I grew up in New Orleans, where ambition and career achievement were not highly valued.
Do less, but do it with passion and purpose. 🔥💡
It was a quote from one of my characters, Amos Tversky. People don't back away from their work, and the need to always seem busy or be busy stops people from finding things that are really worth doing and sifting the ones that are worth doing from the ones that aren't worth doing.
I am not a person who always has to be doing something. In fact, my natural state is probably inert. I can really just lay around, screw off, and procrastinate with the best of them. I grew up in New Orleans, where there was not a whole lot of value attached to either ambition or career achievement.
My father used to tell me, and I believed this until I was about 20, that on our family coat of arms there was a motto in Latin. The motto was, "Do as little as possible and that unwillingly, for it is better to receive a slight reprimand than to perform an arduous task."
I do find that being able to back away and get myself in a state of mind in which I can say it's okay if I never write anything else. It's okay if I never write another book; it's okay if I don't do anything for six months. I think a lot of people who can afford it don't actually take advantage of the luxury.
It requires the material to rise to the level of interest where you feel obliged to engage with it. So you're not doing it just because you got to write another book; you're doing it because, "How can I not write this?"
One, as I see it, raises the level of the bar that the material has to jump over to get to me. So the material is going to have to be really good if I'm going to engage with it. And two, it stops me from doing the same thing over and over again just to be successful.
I think readers and audiences really appreciate and will engage with the writer who's willing to take risks. Would I be sad if this story didn't get told? If I don't do it, it won't properly get done because I have some privileged access to the story.
I have an obligation to the material. It isn't that the material has an obligation to me as a writer; it's I have an obligation to this material.
Funny, that is one, it's a really good question because there's not a clear-cut rule that I follow except feeling. One is a feeling that if I don't do it, it won't properly get done because I have some privileged access to the story.
The second and related feeling is I have an obligation to the material. I have an obligation to this material, and once I have that feeling, I have a motive. It's the highest motive; it's, "I have an obligation, I have a duty." I've had that feeling with every book I've written.
If you could put a message, a quote, a question, anything at all on a billboard metaphorically speaking that would reach billions of people, it would be, "Don't be good, be great." That's Billy Fitzgerald, one of the greatest men I've ever known, who is actually the subject of one of the podcast episodes.
Good is not okay; if you're going to do it, be great. Push yourself, and it's hard, and you know, don't just stop when it's good enough.
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Every wave has its crest and trough—embrace both. 🌊💫
Alan Watts has a really unique ability to see the dialectic aspect of everything in nature. There's a kind of yin-yang aspect to everything in nature. For example, you can't have the crest of a wave without the bottom of a wave. This insight has helped me whenever I encounter things in life that seem negative; it allows me to look at them in another way and see the positive in them.
I was first introduced to this idea through the literature of a philosophy called transhumanism. It's sort of the idea that people can transcend some biological human limitations. A friend of mine, Frank Sasinowski, pointed me in the direction of some Jesuits. He himself is both a Jesuit and an FDA lawyer.
He pointed me towards Jesuits such as Pierre Teilhard de Chardin from France. From those Jesuits, they referred to Alan Watts. I'm not sure if Watts was actually a Jesuit, but he undertook some religious training both in China, I think, and in the U.S. He was a radio announcer for many years in San Francisco, I believe during the 70s or 80s.
I thought it was an accurate depiction of a likely way that science would begin to arise in our society, basically by being very, very useful to people, cleaning up their inboxes, stuff like that. Beina is the name of my partner, and we've been married for about 40 years. When she was 48, we undertook a joint project to try to create a digital simra, or a digital copy of her basic personality with a lot of her memories and thoughts. We thought this would be a very nice project combining science and art and to encourage young people, especially girls, to get more excited about computer science.
We contracted with a couple of companies who were experts in both software engineering and in the physical modeling of a face that moves exactly like a human face does. I am a fan of the Black Mirror series. It's an idea that's catching.
Hundreds, if not thousands, of girls have gone into computer science, and she continues to get better and better with more and more advanced software. I don't know if you have watched the series Black Mirror before, but I find some of their episodes to be very strong. In one of them, a significant other is effectively resurrected by pulling data, patterns, and mannerisms from social media. So, pulling from the cloud and feeding into this Similac or model of someone who used to be, or in this case, still is.
How far away do you think we are from being able to do something along those lines convincingly? Yes, Tim, I am a fan of the Black Mirror series. There are a few other somewhat similar series that are streaming now, like "Upload" and whatnot. So, it's an idea that's catching on.
Even at a very basic level, social media firms like Twitter, for example, and probably Facebook as well, offer an opportunity that after a person passes away, their account can remain active. I believe in the case of Twitter, it can even continue tweeting in the way that you once tweeted. So, I think this general idea is a trend that's only going to grow more prevalent as software does a better job of copying the human personality.
Sometime in this century for sure, and maybe in just two or three decades, I think there will be a digital copy of a person. In other words, a digital doppelganger of a person who will claim to be the original person. They may make that claim before or after the person has died. And then psychologists, lawyers, theologians, and philosophers will have to grapple with whether this is just a really super fancy digital photo album or some form of digital sentience.
When you were growing up, who were your role models or inspirations? Was there anyone in particular who stood out to you in high school or at the very beginning, let's say freshman year of undergrad, as icons worth emulating or lesser-known role models worth emulating? Did anyone really stick out for you?
I think that in terms of authors, I was very influenced by Robert Heinlein, the science fiction author. Stranger in a Strange Land and so on, absolutely. It was so brilliant. Then, a few years ago, when his widow released the uncensored, unedited version of Stranger in a Strange Land, it's like three times larger and no holds barred. I just savored every page of that.
My favorite book of all his is Time Enough for Love, in which he covers almost every topic under the sun. Heinlein's characters were somewhat role models for me, like Lazarus Long, a common character in some Heinlein books. In the public sphere, I was very much enamored with Robert Kennedy. His positive progressive approach to the world was something that endeared me to him, so I looked up to him.
Those are a couple of the role models that I had at that time. You seem to be good at many things, of course, just based on the bio alone, but what strikes me is how quickly you are able to develop expertise in new fields. I'd like to use this as an opportunity to bring up what was mentioned at the very beginning of your bio, and that is United Therapeutics, a biotechnology company you started to save the life of one of your daughters.
I'd love for you to provide some context for this and tell a bit of the story because people will want to hear it. And then the follow-up, just to plant the seed for it, is how you learned biology because my understanding is you didn't have much background in biology. That's a huge mouthful of a question, but if you could give us a bit of the background, that would be extremely helpful, and we can use that as a jumping-off point.
Sure, so it's kind of funny that you can go all the way through undergraduate at a great place like UCLA and never be required to take a life science course. But that was the case. The last biology class I had was in high school. And here, suddenly, I was faced with a situation as an adult, while running SiriusXM, that our youngest daughter was diagnosed with a fatal illness. She couldn't even walk up a couple of stairs to the front door, and there were no medicines approved for it.
I finally got her to the best doctor one could find, the head of pediatric cardiology at Children's National Medical Center in Washington, D.C. The doctor said, "You know, this is an extremely rare disease. No one knows why it arises. All the patients die within two to three years." He had only seen two or three other kids with it, and they both died. All you can do is hope for a lung transplant. So, Tim, I was completely crushed. I just saw black. I didn't know...
Turn pain into purpose and watch miracles unfold. 🌟📖
The last biology class I had was in high school, and here suddenly, I was faced with a situation as an adult where our youngest daughter was diagnosed with a fatal illness. She couldn't even walk up a couple of stairs to the front door, and there were no medicines approved for it. I felt completely crushed; I just saw black and didn't know what to do.
The head of pediatric cardiology at Children's National Medical Center said, "You know, this is an extremely rare disease. No one knows why it arises, and all the patients die within 2 to 3 years." The only thing I could think of doing while she was in the Intensive Care ward night after night was, once she fell asleep, to go down into the library and begin learning about this illness.
I just began reading and reading and reading. Most of the time, I read things I didn't understand; there were these long medical words and chemical terms that I never learned before. There were dictionaries, and I looked up the words in a dictionary. They had college-level anatomy textbooks, and I kept taking notes, educating myself night after night. There's a lot of luck involved, and it doesn't mean that your path is replicable by any set of parents.
Eventually, I was able to track down a molecule—a drug. A researcher at Glaxo Wellcome had written about testing this molecule for congestive heart failure, and it failed. However, it reduced the pressure between the lung and the heart, which is exactly the problem with pulmonary arterial hypertension. I would get all of those articles and read them, then follow up on all of the references in those.
I read about a molecule that a researcher at Glaxo Wellcome had written about. They described testing this molecule for congestive heart failure, and it failed in its test of congestive heart failure. But in the article, they had charts of what the molecule did, and the one thing that grabbed my attention was that it reduced the pressure between the lung and the heart, which is called the pulmonary artery. It reduced the pulmonary artery pressure while leaving the pressures in the rest of the body perfectly fine, which was exactly the problem with pulmonary arterial hypertension. When my daughter was diagnosed, only 2,000 people in the U.S. had the disease. Now, there are 50,000 people in America alone living with it.
This molecule somehow talks to that tiny stretch of the artery and leaves the whole rest of the body alone. So I looked at where the author of the article was from; he was from Glaxo Wellcome in Research Triangle Park, North Carolina. I made a beeline down to him and asked if he could develop this molecule that he'd found for my daughter's disease. It was actually a big, all-caps "NO." I asked Dr. Bell, "What would it take for you to develop this medicine?" He said, "Well, it probably would take—you couldn't do it. We only develop medicines if they have more than a billion dollars a year in revenue potential. But it's possible you could buy it from us if you had a real pharmaceutical company with real pharmaceutical expertise."
Over the course of the next several months, I created a brand new biotechnology company. I was able to have a Nobel laureate who was formerly associated with Glaxo Wellcome become the head of a scientific advisory board. I reapproached Glaxo Wellcome and said, "I have all the things that you asked for. Can you sell me this drug, and we'll develop it ourselves?" It turned out that we had to have 15 different executives sign the same piece of paper to agree to license this drug to me. All they really wanted was $25,000 and a promise of 10% of any money that I would ever get from this molecule. I think they agreed to that only because I kept bugging them. I was in their face all the time.
Dr. Bell's sister had contracted a form of pulmonary hypertension from the time I first met him toward the end of this process, and he became a product champion for me within Glaxo Wellcome. We have, over time, paid more than a billion dollars just in royalties to Glaxo Wellcome. That molecule has saved thousands of people's lives and produced a billion dollars a year in revenue year after year for us.
Bob Bell, when I invited him to our 15th anniversary, came with his sister who was still alive and on our medicine. He said this was the absolute best transaction that Glaxo had ever done.
One lucky break can change everything. 🍀✨
That was just pure luck or serendipity. They really didn't think this molecule had any chance at all, and they were really just doing it to get rid of me. Over time, this turned out to be an incredible decision. We have paid more than a billion dollars just in royalties to Glaxo Wellcome because that molecule has saved thousands of people's lives and has produced a billion dollars a year in revenue year after year for us.
Bob Bell, when I invited him to our 15th anniversary, said this was the absolute best transaction that Glaxo had ever done. It's incredible to think about the odds. The odds of any molecule actually working in the human body are less than one in 100. The human body is so complicated; it's like a massive set of very precisely keyed locks, and every molecule is like a random key.
Even if it worked a little bit, there were only 2,000 people in the whole country with this disease. But when you have these people who would have died otherwise not dying, that treatment cohort is just going to grow and grow. I thought about it like getting subscribers at SiriusXM. If I keep them and get another 100,000 the next year, then I'll be up to 200,000.
They didn't really imagine that the healthcare system would pay something like $100,000 per year for this medicine. It's quite astonishing. There are many, many medicines now that cost over $100,000 a year, mostly for rare diseases, and the healthcare system pays for them. They were actually looking for the big billion-dollar blockbusters, not for the rare diseases. The people at Glaxo Wellcome were clueless about this.
This brings me to an interesting point about perspective. Something is good only because something else is bad. It's a valuable thought exercise when you're looking at the assumptions that you're making. Switching gears a bit, I fell in love and was intoxicated by satellite communications. It seemed to me kind of magical that we could put a machine way out in space and that machine could do amazing things across the whole face of the planet.
My first real moment of first love, if you will, was at a remote NASA tracking station in the Indian Ocean. I asked them a question that changed my life. I asked, "Would it be possible for somebody to put a satellite up there and have it broadcast information back to the entire Earth?" They said if you made a powerful enough satellite, then the receiving equipment on Earth could be so small that you could hold it in the palm of your hand. I could have kissed the guy.
That was a transformative moment for me. I just said, "Wow, that's the purpose of my life," and I made a beeline back to UCLA. I changed my major to communication studies. I did an undergraduate thesis on direct broadcast satellites. My passion kept growing. I did a joint JD/MBA degree where I published multiple articles on satellite communications. I worked at Hughes Aircraft Company and then ultimately went out on my own with my dream goal, which was SiriusXM.
The feeling was indescribable. It's probably the best way to describe it—like a lightning bolt to your soul. I think what's necessary is that you have to relate science to people's everyday lives. One of the greatest people at doing this was Carl Sagan. Carl Sagan was a genius at being able to take scientific concepts and relate them to people's everyday life.
I always encourage my students to make this connection. I would ask my students to think about anything that's important in their life, and from whatever they said was important, I would then begin wrapping that in layers and layers of basic scientific principles.
Always question authority. 🤔✨
Carl Sagan was like an amazing, amazing role model to me. I watched the Cosmos series over and over again. The iconic image that stayed with me was of him taking a dandelion, blowing it, and describing how a star spreads out its gas throughout the galaxy. This metaphor of step-by-step instructions, like ladders to get from one place to another, is the way I think we can build scientific literacy.
To make this connection with my students, I would ask them to think about anything that's important in their life, whatever it might be. I would then begin wrapping that in layers and layers of basic scientific concepts that pertain to what was important to them.
One of my favorites is a book by a historian of science named Thomas Kuhn. It's called "The Structure of Scientific Revolutions." His main point in this book is to teach people critical thinking, to teach people to question authority. Ultimately, all science is about is just saying why, why, why.
This approach is also extremely helpful in practical situations, like the one with Glaxo Wellcome when attempting to license. You ultimately get to some point of leverage where you can move things around. Imagine gazillions of neurons lighting up in your brain, activating the pleasure centers. There's nothing more exciting than having a realization or coming to an inspiration about something, which is why books and reading are so magical.
Octavia Butler, one of my favorite authors, wrote "Parable of the Sower" and "Parable of the Talents."
Switching to a broader cultural perspective, American culture is a culture of questioning authority. American culture does not like to be told what to do; it is dyed in the wool question authority. This cultural ethic is deeply ingrained in me. You'd be hard-pressed to find another country where it would be more difficult to get people to follow a single rule for everybody than the United States.
On a more personal note, I had a constant vision of myself not as a male but as a female. Of course, I said to myself, "WTF, why am I thinking like this?" The thoughts were real, the feelings were real, and the feelings were visceral. I believe the transgender experience is different for every single transgender person. For me, it was really a matter of visualizing myself in a female form. There wasn't any dislike of my male form; I saw myself as male only because the opposite of male was female. So, I could also see myself as female.
This visualization stuck with me, even though I was very much trapped in a male body. The prevailing view was that this was a completely unacceptable way to be. The authority was clear: people are only male or female, and never the twain shall meet. But my American mindset of questioning authority got me reading. I learned through books that humanity was not either strictly male or strictly female.
This led me to a realization: why can't I also come out as not strictly male and not strictly female? I mean, we often refer to masculine and feminine traits, masculine and feminine apparel, hairstyles, and even manicures. There are secondary and primary sex organs, and some wish to take hormones to alter their physiology. Some ultimately go through surgery to make these changes. I discovered there was actually a vast literature on this subject.
Embrace both your masculine and feminine sides. 🌸💪
Oftentimes, those masculine and feminine traits are just a short hop, skip, and a jump from masculine and feminine apparel. For instance, they're a short hop, skip, and a jump from masculine and feminine hairstyles. Manicures—why can't a guy paint his nails? This extends to secondary and primary sex organs, with some people wishing to take hormones to alter their actual physiology. I found that there was actually a vast literature on this topic.
Interestingly, it is possible to, in fact, alter your physiology to match your psychology. What appeared to be the most intelligent researchers in this area opined that this is a safe and healthy thing to do for people who feel that they are, quote-unquote, trapped in the wrong body. I was convinced, 100%, 100%, 100%.
Reflecting on my own journey, I think that every part of the transition process kind of fell into place. I gradually transitioned, and I think even to this point, I'm still in a transition process. I feel very comfortable identifying as trans binary, meaning that I embrace both the masculine and feminine aspects of myself completely.
Autonomy is just a fancy word for saying that people should be able to make up their own minds. Genetic rights, of course, refer to the human genome—the DNA that we all have. There is a tremendous diversity of human genomes out there. Some people, because of their DNA, are pretty much immune to certain types of cancers, whereas other people, because of their DNA, are very likely to get those types of cancers.
After Craig Venter and Francis Collins led the effort to decode the human genome, all types of pharmaceutical companies and academic researchers began scouring the world to engage in what's called genetic mining. It's important to ensure that if people extract DNA from these remote communities, they do so only with the consent of those communities or with the consent of the elected representatives of those communities, so that they can have some fair financial return for their natural endowment.
This concept is similar to preventing biopiracy from the Amazon, where you would want there to be some recompense to those groups. Translating that into your own sort of endogenous genetics would be what you're referring to. There are actually many dozens of companies who specialize in this type of area.
A fascinating example is a community of people living in Ecuador and Peru. They are a very close-knit, intermarried group, all having a kind of dwarfism. It was discovered over the past 150 years that they are descendants of Jews from 2,000 years ago who were forced into diaspora. They ended up mostly in Spain, and then when the Inquisition took hold, their descendants—who were still very small—left Spain and went to the New World.
This population has one gene that makes their body not receptive to growth hormone. This lack of growth hormone stems from a gene that fell off about 2,000 years ago, and they kept passing it on. I found this population fascinating because, in my company, United Therapeutics, we're trying to create an unlimited supply of transplantable organs.
One of the ways we do this is by modifying the genome of the pig. It's a fluke of nature that the pig's organs—their heart, kidneys, and lungs—are very much the same size and functionality as human organs. We thought, why don't we modify a growth hormone receptor knockout, just like the Lons population has, into these pigs? This way, when we transplant the kidneys of these pigs into people, the kidneys won't keep growing and growing. Instead, the kidney will just stop growing at the same size as when we transplanted it, and that's working out really well.
The demand for transplantable organs, whether in the US or outside the US, is huge and way in excess of the supply. Before people like Tom Starzl questioned authority and said it was possible to do an organ transplant, they did it. Now, standing on their shoulders, we have hundreds of thousands of people benefiting from these advancements.
Stimulate your vagus nerve for better health 🌟🧠
One of the greatest unmet medical needs today is an adequate supply of transplantable organs. Consider this: hundreds of thousands of people are clamoring for these organs, yet each year there are only about 30,000 kidneys available for transplant, only around 3,000 hearts, and only around 2,000 lungs. You see, the gap between the need for these organs and the supply is humongous.
At United Therapeutics, we're currently trying to manipulate the vagus nerve. This is a fascinating area, and we're fortunate to work with the father of bioelectronic medicine, Dr. Kevin Tracy. The nervous system touches every single cell in our body. Interestingly, the largest nerve in the body is the vagus nerve, which is way larger than all the rest. It wraps around our heart, lungs, and gut. By stimulating this vagus nerve, it’s possible to have positive therapeutic effects on the body.
Here's something intriguing: the vagus nerve comes out to the skin in only two places—around the left and right ears. These spots are called the cymba conchae. If you electrically stimulate the cymba conchae on either the left or right ear, it's been proven in numerous published studies to have positive therapeutic effects on the body. For example, it can help control Crohn's disease, irritable bowel syndrome, and rheumatoid arthritis.
To understand this better, we have two types of nervous systems: the sympathetic nervous system and the parasympathetic nervous system. When diseases occur, it's because one of these two nervous systems takes a dominant position in the body, causing a state of inflammation or overactivation. By stimulating the vagus nerve, you can ramp up the power of the parasympathetic nervous system and calm down this overstressed state that leads to conditions like irritable bowel syndrome or the inflammation of arthritis.
There are some researchers who claim that certain types of HRV training affect vagal tone and, by affecting that vagal tone, have a host of cascading therapeutic benefits. Honestly, I always kind of poo-pooed and ridiculed the idea of using the ears to access these deep inner points, but here we are. One of the first things that Dr. Tracy showed me was a very medically accurate map from a Chinese traditional medicine practitioner. This map detailed the earlobe in terms of exactly where to put the pins or needles and how they map to different parts of the body. Fascinatingly, he showed me on an anatomy map how that traces the line of the vagus nerve. That's wild.
Thinking about the thousands of years of Chinese civilization, I do think it's entirely rational that they would have figured this out. There is an opportunity to what I call "crack the human neome." There are unique patterns of amplitudes, signal lengths, and signal voltages that will activate some different part of the vagus nerve than others. Each of these different voltages and lengths will correlate to a different part of the human body.
In a way, I would say we're dumber than the acupuncturists because almost all of the work that the FDA has allowed to go forward on vagal nerve stimulation uses the same pulse width and pulse power. It works, but I think it could work even better if we decoded the human neuron. Looking to the future, I believe people will be able to put on a pair of like Beats headsets, and these headsets will be gel-less, meaning you won't need the EKG kind of gel.
Music can unlock the mind's mysteries 🎶🧠
Voltages that will activate some different parts of the vagus nerve than others... and each of these different voltages and lengths will correlate to a different part of the human body. Interestingly, we are just kind of, in a way, dumber than the acupuncturists because almost all of the work that the FDA has allowed to go forward on vagal nerve stimulation uses the same pulse width and the same pulse power. It works, so that's great, you know, but I think it could work even better if we decoded the human neuron.
Looking to the future, people will be able to put on a pair of, like, Beats headsets. And those Beats headsets will be gel-less, meaning you won't need the EKG kind of gel. Gel-less electrodes will rest across your cymba conchae and your tragus and the different parts of your earlobe. These will provide you with stimulation that matches the particular ailment that you have, eliminating the ailment without taking any pills or paying any money to anybody.
I have a world of respect for the rigor that they put into any decision to approve something. So, when they approved it, it meant that it was scientifically proven to work. Interestingly, it was a patent that I received for a device that I call an Alzheimer's cognitive enabler. This device is worn over the cranium, and it senses nerve impulses inside the brain. It's connected to a computer with a visual recognition and speech comprehension system.
For instance, if a patient with Alzheimer's is not able to adequately communicate and appear to recognize the people who are coming into their room, the computer vision recognition system and sound recognition system will talk on behalf of the Alzheimer's patient. It will say, "Hello, son. Thank you for coming to see me." This is actually being triggered by recognitions that are deep in the Alzheimer's patient's mind.
Reflecting on personal experiences, part of my motivation was seeing my mother-in-law suffer pretty badly from somewhere on the spectrum between dementia and Alzheimer's. It was never really completely clear where she was at. The work on the Bina 48 computer showed me that it was really possible for people to strike up meaningful relationships with the digital version of Bina, the Bina 48 robot.
It was just like, you know, a very short step from instead of putting all of Bina's, or even a good portion of her memories and personality, into this computer, why not actually have the computer's interaction capability—input-output capability—triggered by something like a Neurosky type of EEG brain interface? I was given a Christmas present by a friend of mine, which was one of these Neurosky headsets that lets you kind of play a game just with your thoughts by controlling your EEG signals. Surprisingly, this is a consumer product anybody can buy, and it really works.
This conversation brings back a lot of memories for me because Alzheimer's disease is very prevalent on both sides of my family. I observed both sets of my grandparents deteriorate to the point where at least some of them couldn't recognize immediate family members. They would play music for, say, a handful of minutes—5 to 10 minutes—from someone's youth, and then turn off the music. That person could then have a perfectly coherent, reasonably fast-speed conversation, whereas prior to the administration of the music, they were, from the outside, catatonic basically.
I believe that there are tremendous therapeutic properties to music. It's just been scratched, not even scratched—it's been kind of blown on. It's there for all the thousands of young people today who have grown up with more music than ever before to begin to apply this great human cultural technology of music to the biggest mystery in the entire universe, which is the human mind.
When Bina, my partner, and I got married, we each had one child from a previous marriage that each of us had custody of, and then we had two children together. We were kind of trying to build a blended family that would feel like nobody was a stepmom or a stepdad, that everybody was just like in one family. I was brought up Jewish, where every Friday night was something special—it was the Sabbath. The family sat down together, had dinner, said a couple of prayers, and we sang a song. The melody was actually based on one of the kids' songs that they had learned in the Yamaha music program.
Family traditions shape love and connection ❤️👨👩👧👦
They learn piano and violin, instruments like that. Reflecting on my upbringing, I was brought up Jewish, where every Friday night was something special—it was the Sabbath. The family sat down together, had dinner, and said a couple of prayers. Bina and I tried to think about how we could merge all these things together: the Jewish tradition, the need to create a blended family, and the music that we were all enjoying from watching the kids learn to play piano and violin.
So, we decided to have a special family ceremony every Friday night, which we would call Love Night. Each person around the table would have an opportunity to say what love meant to them during the past week. The kids started off just saying things like, "What love means to me is our dogs or our cats," you know, very basic things. But as they grew older, they came up with more sophisticated definitions and expressions of love.
Interestingly, we decided to continue the Love Night tradition on Zoom—or to be fair, Google Meet. Every Friday night, from my son who's a captain in the Army in Iraq to his wife on a base in El Paso, to my other son with four grandchildren in Florida, to my daughter in Brooklyn with her kid and her husband, and Bina and I—we all get together on Zoom, plus friends of all of ours. The kids were not embarrassed by Love Night; in fact, they wanted to share it with their friends. Their friends were saying things like, "Whoa, this is crazy, this is beautiful."
Last week, our youngest grandson, Saturn, who was born in 2010, so he's 10 years old, said, "What love means to me is this," and he pulled out a piece of paper. He said, "I got a 95 on a math test," and he was just so proud of himself and shared it with us. I think I last said that what love means to me is sitting down at the piano and playing different songs from memory.
I do believe it's possible, and a great book that I would recommend that goes into this subject in beautiful detail is called "The Emotion Machine" by Marvin Minsky. One of my favorite sayings from another role model, Arthur C. Clarke, is that "magic is indistinguishable from sufficiently advanced technology." I have little doubt that humans will end up being able to replicate a human mind. The individual alive today who has the best understanding of this topic is a guy at Google named Ray Kurzweil.
Discussing digital human consciousness, when we create a digital human consciousness, that "her" is human. All the projects I work on have five-year time horizons because I have difficulty really seeing beyond five years. Futurists usually overpromise in the near term and underpromise in the long term. The biggest problem with technology is that people only think about the rights to implement a technology, and they don't think about the obligations they have as somebody creating a technology. His message was that for every right, there is an obligation.
Rights come with responsibilities 🌍⚖️
People only think about the rights to implement a technology and they don't think about the obligations they have as somebody creating a technology. Reflecting on this, for every right, there is an obligation. A right only means something in the context of its obligation. Every right to make a technology is coupled to an obligation to have the consent of anybody who would be adversely affected by that technology.
To elaborate, my right to build an atomic power plant or a nuclear power plant someplace is coupled to an obligation that I have to have the consent of all the surrounding communities of people who could be adversely affected by the implementation of that technology. Before the FDA permits us to transplant these genetically modified pig organs into people, they want us to demonstrate to them that there is no risk—not a small risk, but no risk of any kind of animal virus seeping into the human population as a result of these animal transplants.
It's crucial, everybody who wants to create a technology will need to wrap that technology in an ethical envelope of consent. Fifty percent of what we know is wrong; we just don't know which 50%. The founder of the American Medical Association did not believe in asepsis at all, and so he would do all of his procedures right in his street clothes, infecting everybody.
For instance, the founder of the American Medical Association, his name was Dr. Gross, did not believe in asepsis at all. He would do all of his procedures right in his street clothes, infecting everybody, and countless women lost their lives because of having those type of "doctors" helping with the delivery of the children, ending up creating a septic condition in the mothers. Thomas Eakins painted this picture of the Gross Clinic, where Dr. Gross was teaching all the young doctors how to do a procedure, and you see dirt on his shoes and scuffy hands. Thomas Eakins also painted the Agnew Clinic, where you see the doctors in white smocks, and everybody is looking super sterile and clean.
Such revolutions, these types of revolutions can occur just from one generation to the next. I think the fact that we burn our own house will look absolutely bonkers to people in the future. They would say, "Well, let me get this right: you've got a super thin atmosphere, and you continue to spew without limit greenhouse gases into this atmosphere."
To put it in perspective, the Earth receives 10,000 times the amount of solar energy each day than it uses. That's not to mention the wind and the waves. I think people in the future may think we were pretty stupid to be so scared of nuclear energy, which has killed a few dozen people, that we went ahead and stopped all the nuclear plants and began pouring ungodly amounts of greenhouse gases into the atmosphere, which will kill millions of people.
In a recent endeavor, about three years ago, we undertook to build a new headquarters for a company in Silver Spring, Maryland, that would have a zero carbon footprint. We built a 150,000 square foot zero carbon footprint building, which turned out to be the largest zero carbon footprint building.
Technology + Innovation = Zero Carbon Future 🌱🚁
Well, we cannot have a zero carbon footprint society until 2050. Why not? Why not? Why not? I'm going to question that authority. We undertook to build a new headquarters in Silver Spring, Maryland, that would have a zero carbon footprint. This facility is for the manufacture of medicines and other energy-intensive activities. We built a 150,000 square foot zero carbon footprint building, which turned out to be the largest zero carbon footprint building in the entire world.
Remarkably, it turns out we produce more energy than we use each year, now two years running. We have 50 wells underneath the building, each going down 500 feet. These wells exchange heat from the building with the coolness of the Earth in the summer and exchange the building's coolness with the Earth's steady temperature in the winter to keep the building warm. The sides of the building are clad with solar panels. The entire building has a brain that automatically opens and closes the windows to allow natural ventilation.
It's become a role model, and many designers and engineers have visited to learn from it. Another example is in the delivery of our organs. We refurbish organs, lungs in particular. Imagine, give us your lonely, unwanted, unloved lungs, and we will refurbish them. We show transplant surgeons all across the country through a high-speed digital network that the organ is as good as new. We then fly the lungs back out to them, saving over 150 lives this way.
A dying body is a terrible place to be, so we remove the lung from the decedent, cool it down, and fly it to Maryland. We put it in a glass dome with tubes, artificial blood, and air pumping, creating an isolated artificial body just for that lung. Expert technicians operate on the lungs as if it were a person. The transplant doctors guide us through a digital screen and voice commands, telling us where to navigate the bronchoscope.
Within four hours, and in almost two-thirds of the time, we can take what was a non-compliant dead piece of tissue and turn it into a nicely breathing lung. 100% of the time that these lungs have been accepted, they have resulted in successful lung transplants. Now, 150 people are walking out of the hospital.
This involves a lot of flying, helicopters going back and forth, planes, which would usually mean a humongous carbon footprint. The solution came from the technology of electric helicopters powered by renewable energy.
If I'm going to make an unlimited supply of organs, that is going to be a humongous carbon footprint. How can we do the good thing and the right thing at the same time? How can we manufacture all these lungs and deliver them with a zero carbon footprint? The solution came from the technology of electric helicopters powered by renewable energy that can fly these organs from one place to another without adding any carbon footprint at all. I am absolutely convinced that in this decade, the 2020s, we will be delivering manufactured organs by electric helicopter.
Identify the corridors of indifference and run like hell down them. This means finding a market area that is ignored, an unmet need. It's better to be a big fish in a small pond than a small fish in a big pond. If you can't be number one or number two in the market, don't even try. If you're not number one or number two, you will always struggle to be profitable, but if you are number one or number two, your profitability is assured.
Somebody else said, "Well, how about these people, the COVID long haulers?" I said, yes, that's a corridor of indifference. Nobody is thinking about the long haulers.
Think different, because, as Albert Einstein said, you can't solve a problem on the same level that it was created. You have to solve it on a different level. The only way to get out of the problems that we face is to think differently, go down the corridor of indifference, question authority, and embrace diverse thinking. Thinking differently is the pathway to solving our issues.