Deepak Chopra:

The physical bodies that you’re using to sit on these chairs, for example, aren’t the ones that you walked in with a little while ago. Even with one breath you take in 10 to the power of 22 atoms. An astronomical amount of raw material that ends up as your heart, brain and kidney cells, your neurons, your DNA. With each breath you breathe out 10 to the power of 22 atoms. It’s an astronomical amount of raw materials that is coming from every bit of your body. You are literally breathing out bits and pieces of your brain tissue and heart and kidney. Actually, technically speaking, we are intimately sharing our organs with each other all the time.

If you do radioactive isotope studies which have been done very elegantly, you can prove beyond a shadow of doubt that you replace 98% of all the atoms in your body in less than one year. You make a new liver every 6 weeks, a new skin once a month, a new stomach lining every 5 days, a new skeleton - it seems so hard and solid, but the skeleton you have now you didn’t have three months ago. Even the brain cells that you think with as carbon, hydrogen, nitrogen and oxygen, as those basic elements, they weren’t there one year ago. And the DNA that holds memories of millions of years of evolutionary time, in fact hundreds of millions of years; the actual raw material of it comes and goes every six weeks. Those atoms drift in and out like migratory birds every six weeks.

And if you want to be a real stickler about it and account for the last atom and every little sinew and collagen and cartilage, then in less than two and a half years you replace every atom in your body down to the last single atom. So if you think you are your material body then you certainly have a dilemma. Which one are you talking about? The 1991 model is not the same as the 1990 model or even the one from a few months ago.

Photo by me.

EMA. Breakfast. One of my favorite albums of the year.

I need an intern.

Next month, we’ll be launching a new company, Sherpaa. I’m looking for a medical student who wants to learn a few things about starting a health company. You must be:

• tech savvy and can navigate your way around web apps
• entrepreneurially-minded
• in NYC
• curious
• ready to go ASAP

Send me an email if you’re interested. Let’s talk.

UPDATE: I found a really great intern. Thank you for reading and for those who were interested. If not now, maybe we can work together in the future.

I spoke at Stanford a few months ago and one of the speaker’s gifts was sitting for a daguerreotype portrait. 

Download a hi-res pdf here. No surprises here, but smoking and being overweight are the two biggies that’ll get you in the end.

Here’s a snippet from a wonderfully written piece, called How Doctors Die. Please read all of it.

But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

The first photo is how many people die nowadays— in a hospital surrounded by nurses and doctors and beeping machines. The second is a self-portrait I took the day my grandmother died peacefully in her own home in July 2009. It’s really up to you to choose.

As doctors, we have pills to treat infections and high cholesterol. We have scalpels to replace hips and open clogged arteries. But beyond pills and scalpels, what tools do we have? Walking out of the doctor’s office without a prescription is a rare occurrence these days. And the famous surgeon tagline has always been “a chance to cut is a chance to cure.” We see people when they’re sick and we’re trained and expected to do something. But do we want more than one of every five kids and nine of ten older Americans taking prescription drugs? Do we really think that more heart stents are the secret to longevity? Of course they are if we believe our job as physicians is to treat the symptoms rather than the cause.

I’m trained in Preventive Medicine, one of the twenty four specialties recognized by the American Board of Medical Specialties. Out of the nearly 16,000 medical students that graduate every year, only about 120 choose Preventive Medicine. Does that really mean that less than one percent of doctors think preventing disease is more important than treating it? I’m afraid so. Maybe it’s because our medical culture hasn’t figured out how to profit off health, rather than sickness? Or maybe it’s because our doctors simply aren’t creative enough to think beyond pills and scalpels? Of course it’s a mixture of both and many more, but I think the main reason is we’re absolutely clueless how to treat bad lifestyle from the confines of the 8 minute office visit. It’s a horribly outdated tool for the problem at hand. 

Health happens in your home and in your neighborhood, not in the exam room. Health is all the little routines you have in your life, some of them good and some of them bad. But in order to lead a wonderfully fulfilling life, we have to look at health as being the optimal mix of good food; fun movement; real relationships with people you love; financial success; a job that leverages your best skills; a neighborhood that makes health easy; and the wild card— sex, drugs, and rock & roll. I threw that last one in because health has traditionally been so burdensome and black and white. But in real life, health is grey and life is fun. And being a good doctor is much more than writing prescriptions and doing procedures, it’s about knowing your patients and inspiring them.

My first practice was strictly a house call practice where I’d see patients in their apartments here in Brooklyn and follow up with them via email or Skype. It was lean and cost $1500 to launch. I was profitable in the first month because my overhead was only about 10%. My patients paid me via PayPal and my visits were typically less than $100. I couldn’t have done any of this without my iPhone and my MacBook. I used today’s technology to practice yesteryear’s medicine. It enabled me to be real-time traveling somewhere in my neighborhood awaiting my iPhone to alert me of my next appointment. Granted, I couldn’t see 40 patients a day like other doctors. But I wanted quality, not quantity. I wanted a real relationship with good, respectful communication. And 6 to 8 house calls a day in your neighborhood gives you way more information about people than 40 harried visits in some faraway institution. But that’s just the business side of things.

Most importantly, I saw how people lived. I could see the chubby person’s potato chips on the counter, the mice droppings in the asthmatic’s ultra-cool Williamsburg loft, or the depressed person’s evidence they spent a lot of lonely time by themselves staring at glowing rectangles. My neighbors were my patients and I couldn’t walk more than two blocks without someone saying “Hey Doc!” I liked to think that every time someone said that, they were reminded about living healthier. They saw me at the farmer’s market on Saturdays, going to the gym, having barbecues in the backyard with friends, and drinking at the corner bar. I became a regular fixture in their neighborhood. Hopefully, I was this occasional little familiar nudge that inspired them to chase the good life. And if you ask me, that’s what we as doctors need to be asking ourselves the next time we write a prescription— am I inspiring or am I perpetuating a broken system?

According to recently published NYC DOT report, bike riding in NYC has increased 102% compared to 2007 and by 289% compared to 2001. Good work, city. It’s a combined effort. More bike lanes and a culture that’s slowly believing bicycling is a more healthy and fun means of transport. 

Print by Thomas Yang.