1 00:00:00,146 --> 00:00:01,824 I'll never forget that day 2 00:00:01,824 --> 00:00:05,723 back in the spring of 2006. 3 00:00:05,723 --> 00:00:07,302 I was a surgical resident 4 00:00:07,302 --> 00:00:09,733 at The Johns Hopkins Hospital, 5 00:00:09,733 --> 00:00:11,510 taking emergency call. 6 00:00:11,510 --> 00:00:14,873 I got paged by the E.R. around 2 in the morning 7 00:00:14,873 --> 00:00:16,900 to come and see a woman with a diabetic ulcer 8 00:00:16,900 --> 00:00:18,694 on her foot. 9 00:00:18,694 --> 00:00:22,395 I can still remember sort of that smell of rotting flesh 10 00:00:22,395 --> 00:00:26,022 as I pulled the curtain back to see her. 11 00:00:26,022 --> 00:00:28,367 And everybody there agreed this woman was very sick 12 00:00:28,367 --> 00:00:29,719 and she needed to be in the hospital. 13 00:00:29,719 --> 00:00:31,319 That wasn't being asked. 14 00:00:31,319 --> 00:00:33,461 The question that was being asked of me was a different one, 15 00:00:33,461 --> 00:00:37,390 which was, did she also need an amputation? 16 00:00:37,390 --> 00:00:40,357 Now, looking back on that night, 17 00:00:40,357 --> 00:00:45,522 I'd love so desperately to believe that I treated that woman 18 00:00:45,522 --> 00:00:48,658 on that night with the same empathy and compassion 19 00:00:48,658 --> 00:00:52,893 I'd shown the 27-year-old newlywed 20 00:00:52,893 --> 00:00:54,838 who came to the E.R. three nights earlier 21 00:00:54,838 --> 00:00:56,452 with lower back pain 22 00:00:56,452 --> 00:01:00,701 that turned out to be advanced pancreatic cancer. 23 00:01:00,701 --> 00:01:02,864 In her case, I knew there was nothing I could do 24 00:01:02,864 --> 00:01:04,632 that was actually going to save her life. 25 00:01:04,632 --> 00:01:06,681 The cancer was too advanced. 26 00:01:06,681 --> 00:01:09,361 But I was committed to making sure that 27 00:01:09,361 --> 00:01:11,784 I could do anything possible to make her stay 28 00:01:11,784 --> 00:01:14,207 more comfortable. I brought her a warm blanket 29 00:01:14,207 --> 00:01:16,927 and a cup of a coffee. 30 00:01:16,927 --> 00:01:19,112 I brought some for her parents. 31 00:01:19,112 --> 00:01:22,258 But more importantly, see, I passed no judgment on her, 32 00:01:22,258 --> 00:01:24,155 because obviously she had done nothing 33 00:01:24,155 --> 00:01:26,329 to bring this on herself. 34 00:01:26,329 --> 00:01:29,142 So why was it that, just a few nights later, 35 00:01:29,142 --> 00:01:32,300 as I stood in that same E.R. and determined 36 00:01:32,300 --> 00:01:35,711 that my diabetic patient did indeed need an amputation, 37 00:01:35,711 --> 00:01:39,615 why did I hold her in such bitter contempt? 38 00:01:39,615 --> 00:01:42,080 You see, unlike the woman the night before, 39 00:01:42,080 --> 00:01:44,479 this woman had type 2 diabetes. 40 00:01:44,479 --> 00:01:46,031 She was fat. 41 00:01:46,031 --> 00:01:47,944 And we all know that's from eating too much 42 00:01:47,944 --> 00:01:50,299 and not exercising enough, right? 43 00:01:50,299 --> 00:01:52,983 I mean, how hard can it be? 44 00:01:52,983 --> 00:01:55,344 As I looked down at her in the bed, I thought to myself, 45 00:01:55,344 --> 00:01:58,232 if you just tried caring even a little bit, 46 00:01:58,232 --> 00:02:01,222 you wouldn't be in this situation at this moment 47 00:02:01,222 --> 00:02:02,999 with some doctor you've never met 48 00:02:02,999 --> 00:02:06,814 about to amputate your foot. 49 00:02:06,814 --> 00:02:10,456 Why did I feel justified in judging her? 50 00:02:10,456 --> 00:02:13,025 I'd like to say I don't know. 51 00:02:13,025 --> 00:02:15,061 But I actually do. 52 00:02:15,061 --> 00:02:17,392 You see, in the hubris of my youth, 53 00:02:17,392 --> 00:02:20,496 I thought I had her all figured out. 54 00:02:20,496 --> 00:02:22,326 She ate too much. She got unlucky. 55 00:02:22,326 --> 00:02:25,695 She got diabetes. Case closed. 56 00:02:25,695 --> 00:02:27,098 Ironically, at that time in my life, 57 00:02:27,098 --> 00:02:29,496 I was also doing cancer research, 58 00:02:29,496 --> 00:02:31,839 immune-based therapies for melanoma, to be specific, 59 00:02:31,839 --> 00:02:35,812 and in that world I was actually taught to question everything, 60 00:02:35,812 --> 00:02:37,848 to challenge all assumptions 61 00:02:37,848 --> 00:02:41,658 and hold them to the highest possible scientific standards. 62 00:02:41,658 --> 00:02:45,034 Yet when it came to a disease like diabetes 63 00:02:45,034 --> 00:02:48,583 that kills Americans eight times more frequently than melanoma, 64 00:02:48,583 --> 00:02:52,011 I never once questioned the conventional wisdom. 65 00:02:52,011 --> 00:02:55,057 I actually just assumed the pathologic sequence of events 66 00:02:55,057 --> 00:02:57,642 was settled science. 67 00:02:57,642 --> 00:03:01,042 Three years later, I found out how wrong I was. 68 00:03:01,042 --> 00:03:03,642 But this time, I was the patient. 69 00:03:03,642 --> 00:03:07,473 Despite exercising three or four hours every single day, 70 00:03:07,473 --> 00:03:10,038 and following the food pyramid to the letter, 71 00:03:10,038 --> 00:03:12,195 I'd gained a lot of weight and developed something 72 00:03:12,195 --> 00:03:14,480 called metabolic syndrome. 73 00:03:14,480 --> 00:03:16,464 Some of you may have heard of this. 74 00:03:16,464 --> 00:03:19,909 I had become insulin-resistant. 75 00:03:19,909 --> 00:03:22,358 You can think of insulin as this master hormone 76 00:03:22,358 --> 00:03:26,421 that controls what our body does with the foods we eat, 77 00:03:26,421 --> 00:03:28,535 whether we burn it or store it. 78 00:03:28,535 --> 00:03:31,349 This is called fuel partitioning in the lingo. 79 00:03:31,349 --> 00:03:34,525 Now failure to produce enough insulin is incompatible with life. 80 00:03:34,525 --> 00:03:37,181 And insulin resistance, as its name suggests, 81 00:03:37,181 --> 00:03:39,861 is when your cells get increasingly resistant 82 00:03:39,861 --> 00:03:43,374 to the effect of insulin trying to do its job. 83 00:03:43,374 --> 00:03:45,550 Once you're insulin-resistant, 84 00:03:45,550 --> 00:03:46,925 you're on your way to getting diabetes, 85 00:03:46,925 --> 00:03:48,989 which is what happens when your pancreas 86 00:03:48,989 --> 00:03:52,312 can't keep up with the resistance and make enough insulin. 87 00:03:52,312 --> 00:03:54,940 Now your blood sugar levels start to rise, 88 00:03:54,940 --> 00:03:57,572 and an entire cascade of pathologic events 89 00:03:57,572 --> 00:04:01,273 sort of spirals out of control that can lead to heart disease, 90 00:04:01,273 --> 00:04:04,882 cancer, even Alzheimer's disease, 91 00:04:04,882 --> 00:04:09,764 and amputations, just like that woman a few years earlier. 92 00:04:09,764 --> 00:04:12,725 With that scare, I got busy changing my diet radically, 93 00:04:12,725 --> 00:04:14,902 adding and subtracting things most of you would find 94 00:04:14,902 --> 00:04:17,982 almost assuredly shocking. 95 00:04:17,982 --> 00:04:21,861 I did this and lost 40 pounds, weirdly while exercising less. 96 00:04:21,861 --> 00:04:24,902 I, as you can see, I guess I'm not overweight anymore. 97 00:04:24,902 --> 00:04:27,069 More importantly, I don't have insulin resistance. 98 00:04:27,069 --> 00:04:29,113 But most important, I was left 99 00:04:29,113 --> 00:04:32,962 with these three burning questions that wouldn't go away: 100 00:04:32,962 --> 00:04:35,411 How did this happen to me if I was supposedly 101 00:04:35,411 --> 00:04:38,108 doing everything right? 102 00:04:38,108 --> 00:04:41,143 If the conventional wisdom about nutrition had failed me, 103 00:04:41,143 --> 00:04:44,930 was it possible it was failing someone else? 104 00:04:44,930 --> 00:04:46,830 And underlying these questions, 105 00:04:46,830 --> 00:04:50,076 I became almost maniacally obsessed 106 00:04:50,076 --> 00:04:52,803 in trying to understand the real relationship 107 00:04:52,803 --> 00:04:56,433 between obesity and insulin resistance. 108 00:04:56,433 --> 00:04:59,249 Now, most researchers believe obesity 109 00:04:59,249 --> 00:05:02,641 is the cause of insulin resistance. 110 00:05:02,641 --> 00:05:04,756 Logically, then, if you want to treat insulin resistance, 111 00:05:04,756 --> 00:05:06,648 you get people to lose weight, right? 112 00:05:06,648 --> 00:05:09,412 You treat the obesity. 113 00:05:09,412 --> 00:05:12,118 But what if we have it backwards? 114 00:05:12,118 --> 00:05:15,489 What if obesity isn't the cause of insulin resistance at all? 115 00:05:15,489 --> 00:05:19,409 In fact, what if it's a symptom of a much deeper problem, 116 00:05:19,409 --> 00:05:22,231 the tip of a proverbial iceberg? 117 00:05:22,231 --> 00:05:24,874 I know it sounds crazy because we're obviously in the midst 118 00:05:24,874 --> 00:05:28,093 of an obesity epidemic, but hear me out. 119 00:05:28,093 --> 00:05:31,307 What if obesity is a coping mechanism 120 00:05:31,307 --> 00:05:34,909 for a far more sinister problem going on 121 00:05:34,909 --> 00:05:36,391 underneath the cell? 122 00:05:36,391 --> 00:05:38,757 I'm not suggesting that obesity is benign, 123 00:05:38,757 --> 00:05:41,060 but what I am suggesting is it may be the lesser 124 00:05:41,060 --> 00:05:43,771 of two metabolic evils. 125 00:05:43,771 --> 00:05:46,790 You can think of insulin resistance as the reduced capacity 126 00:05:46,790 --> 00:05:48,777 of our cells to partition fuel, 127 00:05:48,777 --> 00:05:51,068 as I alluded to a moment ago, 128 00:05:51,068 --> 00:05:52,990 taking those calories that we take in 129 00:05:52,990 --> 00:05:56,429 and burning some appropriately and storing some appropriately. 130 00:05:56,429 --> 00:05:58,071 When we become insulin-resistant, 131 00:05:58,071 --> 00:06:01,438 the homeostasis in that balance deviates from this state. 132 00:06:01,438 --> 00:06:03,566 So now, when insulin says to a cell, 133 00:06:03,566 --> 00:06:05,611 I want you to burn more energy 134 00:06:05,611 --> 00:06:08,046 than the cell considers safe, the cell, in effect, says, 135 00:06:08,046 --> 00:06:12,478 "No thanks, I'd actually rather store this energy." 136 00:06:12,478 --> 00:06:14,380 And because fat cells are actually missing most of 137 00:06:14,380 --> 00:06:17,182 the complex cellular machinery found in other cells, 138 00:06:17,182 --> 00:06:19,953 it's probably the safest place to store it. 139 00:06:19,953 --> 00:06:24,922 So for many of us, about 75 million Americans, 140 00:06:24,922 --> 00:06:28,537 the appropriate response to insulin resistance 141 00:06:28,537 --> 00:06:33,466 may actually be to store it as fat, not the reverse, 142 00:06:33,466 --> 00:06:38,810 getting insulin resistance in response to getting fat. 143 00:06:38,810 --> 00:06:40,985 This is a really subtle distinction, 144 00:06:40,985 --> 00:06:44,352 but the implication could be profound. 145 00:06:44,352 --> 00:06:46,850 Consider the following analogy: 146 00:06:46,850 --> 00:06:49,819 Think of the bruise you get on your shin 147 00:06:49,819 --> 00:06:53,411 when you inadvertently bang your leg into the coffee table. 148 00:06:53,411 --> 00:06:56,298 Sure, the bruise hurts like hell, and you almost certainly 149 00:06:56,298 --> 00:06:59,279 don't like the discolored look, but we all know 150 00:06:59,279 --> 00:07:02,732 the bruise per Se is not the problem. 151 00:07:02,732 --> 00:07:06,474 In fact, it's the opposite. It's a healthy response to the trauma, 152 00:07:06,474 --> 00:07:09,235 all of those immune cells rushing to the site of the injury 153 00:07:09,235 --> 00:07:12,219 to salvage cellular debris and prevent the spread 154 00:07:12,219 --> 00:07:14,917 of infection to elsewhere in the body. 155 00:07:14,917 --> 00:07:18,639 Now, imagine we thought bruises were the problem, 156 00:07:18,639 --> 00:07:21,507 and we evolved a giant medical establishment 157 00:07:21,507 --> 00:07:24,647 and a culture around treating bruises: 158 00:07:24,647 --> 00:07:27,930 masking creams, painkillers, you name it, 159 00:07:27,930 --> 00:07:30,156 all the while ignoring the fact that people 160 00:07:30,156 --> 00:07:33,776 are still banging their shins into coffee tables. 161 00:07:33,776 --> 00:07:36,979 How much better would we be if we treated the cause -- 162 00:07:36,979 --> 00:07:38,544 telling people to pay attention 163 00:07:38,544 --> 00:07:40,147 when they walk through the living room -- 164 00:07:40,147 --> 00:07:43,420 rather than the effect? 165 00:07:43,420 --> 00:07:45,297 Getting the cause and the effect right 166 00:07:45,297 --> 00:07:47,776 makes all the difference in the world. 167 00:07:47,776 --> 00:07:50,855 Getting it wrong, and the pharmaceutical industry 168 00:07:50,855 --> 00:07:53,535 can still do very well for its shareholders 169 00:07:53,535 --> 00:07:57,451 but nothing improves for the people with bruised shins. 170 00:07:57,451 --> 00:08:00,295 Cause and effect. 171 00:08:00,295 --> 00:08:02,132 So what I'm suggesting is 172 00:08:02,132 --> 00:08:04,889 maybe we have the cause and effect wrong 173 00:08:04,889 --> 00:08:07,523 on obesity and insulin resistance. 174 00:08:07,523 --> 00:08:09,300 Maybe we should be asking ourselves, 175 00:08:09,300 --> 00:08:13,185 is it possible that insulin resistance causes weight gain 176 00:08:13,185 --> 00:08:15,251 and the diseases associated with obesity, 177 00:08:15,251 --> 00:08:16,781 at least in most people? 178 00:08:16,781 --> 00:08:19,781 What if being obese is just a metabolic response 179 00:08:19,781 --> 00:08:22,002 to something much more threatening, 180 00:08:22,002 --> 00:08:24,213 an underlying epidemic, 181 00:08:24,213 --> 00:08:26,770 the one we ought to be worried about? 182 00:08:26,770 --> 00:08:28,242 Let's look at some suggestive facts. 183 00:08:28,242 --> 00:08:30,728 We know that 30 million obese Americans 184 00:08:30,728 --> 00:08:33,701 in the United States don't have insulin resistance. 185 00:08:33,701 --> 00:08:35,638 And by the way, they don't appear to be at any 186 00:08:35,638 --> 00:08:38,718 greater risk of disease than lean people. 187 00:08:38,718 --> 00:08:41,602 Conversely, we know that six million lean people 188 00:08:41,602 --> 00:08:45,039 in the United States are insulin-resistant, 189 00:08:45,039 --> 00:08:48,106 and by the way, they appear to be at even greater risk 190 00:08:48,106 --> 00:08:50,261 for those metabolic diseases I mentioned a moment ago 191 00:08:50,261 --> 00:08:52,083 than their obese counterparts. 192 00:08:52,083 --> 00:08:54,320 Now I don't know why, but it might be because, 193 00:08:54,320 --> 00:08:57,010 in their case, their cells haven't actually figured out 194 00:08:57,010 --> 00:09:00,295 the right thing to do with that excess energy. 195 00:09:00,295 --> 00:09:03,614 So if you can be obese and not have insulin resistance, 196 00:09:03,614 --> 00:09:05,485 and you can be lean and have it, 197 00:09:05,485 --> 00:09:09,918 this suggests that obesity may just be a proxy 198 00:09:09,918 --> 00:09:12,942 for what's going on. 199 00:09:12,942 --> 00:09:15,357 So what if we're fighting the wrong war, 200 00:09:15,357 --> 00:09:19,157 fighting obesity rather than insulin resistance? 201 00:09:19,157 --> 00:09:22,400 Even worse, what if blaming the obese 202 00:09:22,400 --> 00:09:25,125 means we're blaming the victims? 203 00:09:25,125 --> 00:09:28,844 What if some of our fundamental ideas about obesity 204 00:09:28,844 --> 00:09:30,702 are just wrong? 205 00:09:30,702 --> 00:09:34,825 Personally, I can't afford the luxury of arrogance anymore, 206 00:09:34,825 --> 00:09:37,408 let alone the luxury of certainty. 207 00:09:37,408 --> 00:09:40,254 I have my own ideas about what could be at the heart of this, 208 00:09:40,254 --> 00:09:42,166 but I'm wide open to others. 209 00:09:42,166 --> 00:09:44,885 Now, my hypothesis, because everybody always asks me, 210 00:09:44,885 --> 00:09:46,502 is this. 211 00:09:46,502 --> 00:09:49,631 If you ask yourself, what's a cell trying to protect itself from 212 00:09:49,631 --> 00:09:51,358 when it becomes insulin resistant, 213 00:09:51,358 --> 00:09:54,033 the answer probably isn't too much food. 214 00:09:54,033 --> 00:09:57,683 It's more likely too much glucose: blood sugar. 215 00:09:57,683 --> 00:09:59,977 Now, we know that refined grains and starches 216 00:09:59,977 --> 00:10:02,033 elevate your blood sugar in the short run, 217 00:10:02,033 --> 00:10:03,941 and there's even reason to believe that sugar 218 00:10:03,941 --> 00:10:06,742 may lead to insulin resistance directly. 219 00:10:06,742 --> 00:10:10,837 So if you put these physiological processes to work, 220 00:10:10,837 --> 00:10:14,310 I'd hypothesize that it might be our increased intake 221 00:10:14,310 --> 00:10:17,173 of refined grains, sugars and starches that's driving 222 00:10:17,173 --> 00:10:21,824 this epidemic of obesity and diabetes, 223 00:10:21,824 --> 00:10:23,662 but through insulin resistance, 224 00:10:23,662 --> 00:10:27,574 you see, and not necessarily through just overeating and under-exercising. 225 00:10:27,574 --> 00:10:30,159 When I lost my 40 pounds a few years ago, 226 00:10:30,159 --> 00:10:32,759 I did it simply by restricting those things, 227 00:10:32,759 --> 00:10:36,215 which admittedly suggests I have a bias 228 00:10:36,215 --> 00:10:38,576 based on my personal experience. 229 00:10:38,576 --> 00:10:41,231 But that doesn't mean my bias is wrong, 230 00:10:41,231 --> 00:10:45,184 and most important, all of this can be tested scientifically. 231 00:10:45,184 --> 00:10:48,291 But step one is accepting the possibility 232 00:10:48,291 --> 00:10:50,663 that our current beliefs about obesity, 233 00:10:50,663 --> 00:10:53,669 diabetes and insulin resistance could be wrong 234 00:10:53,669 --> 00:10:56,544 and therefore must be tested. 235 00:10:56,544 --> 00:10:58,935 I'm betting my career on this. 236 00:10:58,935 --> 00:11:03,060 Today, I devote all of my time to working on this problem, 237 00:11:03,060 --> 00:11:06,233 and I'll go wherever the science takes me. 238 00:11:06,233 --> 00:11:09,764 I've decided that what I can't and won't do anymore 239 00:11:09,764 --> 00:11:12,808 is pretend I have the answers when I don't. 240 00:11:12,808 --> 00:11:16,916 I've been humbled enough by all I don't know. 241 00:11:16,916 --> 00:11:19,073 For the past year, I've been fortunate enough 242 00:11:19,073 --> 00:11:22,486 to work on this problem with the most amazing team 243 00:11:22,486 --> 00:11:25,890 of diabetes and obesity researchers in the country, 244 00:11:25,890 --> 00:11:27,195 and the best part is, 245 00:11:27,195 --> 00:11:31,094 just like Abraham Lincoln surrounded himself with a team of rivals, 246 00:11:31,094 --> 00:11:32,590 we've done the same thing. 247 00:11:32,590 --> 00:11:35,853 We've recruited a team of scientific rivals, 248 00:11:35,853 --> 00:11:39,298 the best and brightest who all have different hypotheses 249 00:11:39,298 --> 00:11:40,912 for what's at the heart of this epidemic. 250 00:11:40,912 --> 00:11:43,293 Some think it's too many calories consumed. 251 00:11:43,293 --> 00:11:45,672 Others think it's too much dietary fat. 252 00:11:45,672 --> 00:11:49,142 Others think it's too many refined grains and starches. 253 00:11:49,142 --> 00:11:51,750 But this team of multi-disciplinary, 254 00:11:51,750 --> 00:11:54,734 highly skeptical and exceedingly talented researchers 255 00:11:54,734 --> 00:11:57,022 do agree on two things. 256 00:11:57,022 --> 00:12:00,671 First, this problem is just simply too important 257 00:12:00,671 --> 00:12:03,414 to continue ignoring because we think we know the answer. 258 00:12:03,414 --> 00:12:06,198 And two, if we're willing to be wrong, 259 00:12:06,198 --> 00:12:08,735 if we're willing to challenge the conventional wisdom 260 00:12:08,735 --> 00:12:11,798 with the best experiments science can offer, 261 00:12:11,798 --> 00:12:14,103 we can solve this problem. 262 00:12:14,103 --> 00:12:17,158 I know it's tempting to want an answer right now, 263 00:12:17,158 --> 00:12:21,655 some form of action or policy, some dietary prescription -- 264 00:12:21,655 --> 00:12:23,384 eat this, not that — 265 00:12:23,384 --> 00:12:25,064 but if we want to get it right, 266 00:12:25,064 --> 00:12:27,298 we're going to have to do much more rigorous science 267 00:12:27,298 --> 00:12:30,151 before we can write that prescription. 268 00:12:30,151 --> 00:12:32,750 Briefly, to address this, our research program 269 00:12:32,750 --> 00:12:35,993 is focused around three meta-themes, or questions. 270 00:12:35,993 --> 00:12:38,888 First, how do the various foods we consume 271 00:12:38,888 --> 00:12:41,689 impact our metabolism, hormones and enzymes, 272 00:12:41,689 --> 00:12:44,507 and through what nuanced molecular mechanisms? 273 00:12:44,507 --> 00:12:46,757 Second, based on these insights, 274 00:12:46,757 --> 00:12:49,716 can people make the necessary changes in their diets 275 00:12:49,716 --> 00:12:53,447 in a way that's safe and practical to implement? 276 00:12:53,447 --> 00:12:56,456 And finally, once we identify what safe 277 00:12:56,456 --> 00:12:59,484 and practical changes people can make to their diet, 278 00:12:59,484 --> 00:13:03,159 how can we move their behavior in that direction 279 00:13:03,159 --> 00:13:05,412 so that it becomes more the default 280 00:13:05,412 --> 00:13:07,268 rather than the exception? 281 00:13:07,268 --> 00:13:09,688 Just because you know what to do doesn't mean 282 00:13:09,688 --> 00:13:11,197 you're always going to do it. 283 00:13:11,197 --> 00:13:13,325 Sometimes we have to put cues around people 284 00:13:13,325 --> 00:13:15,628 to make it easier, and believe it or not, 285 00:13:15,628 --> 00:13:19,269 that can be studied scientifically. 286 00:13:19,269 --> 00:13:21,853 I don't know how this journey is going to end, 287 00:13:21,853 --> 00:13:26,066 but this much seems clear to me, at least: 288 00:13:26,066 --> 00:13:31,062 We can't keep blaming our overweight and diabetic patients 289 00:13:31,062 --> 00:13:33,974 like I did. 290 00:13:33,974 --> 00:13:36,253 Most of them actually want to do the right thing, 291 00:13:36,253 --> 00:13:39,622 but they have to know what that is, 292 00:13:39,622 --> 00:13:42,668 and it's got to work. 293 00:13:42,668 --> 00:13:47,364 I dream of a day when our patients can 294 00:13:47,364 --> 00:13:49,099 shed their excess pounds 295 00:13:49,099 --> 00:13:51,912 and cure themselves of insulin resistance, 296 00:13:51,912 --> 00:13:54,642 because as medical professionals, 297 00:13:54,642 --> 00:13:56,612 we've shed our excess mental baggage 298 00:13:56,612 --> 00:13:59,938 and cured ourselves of new idea resistance sufficiently 299 00:13:59,938 --> 00:14:03,028 to go back to our original ideals: 300 00:14:03,028 --> 00:14:07,445 open minds, the courage to throw out yesterday's ideas 301 00:14:07,445 --> 00:14:10,773 when they don't appear to be working, 302 00:14:10,773 --> 00:14:13,892 and the understanding that scientific truth isn't final, 303 00:14:13,892 --> 00:14:16,640 but constantly evolving. 304 00:14:16,640 --> 00:14:19,932 Staying true to that path will be better for our patients 305 00:14:19,932 --> 00:14:23,180 and better for science. 306 00:14:23,180 --> 00:14:26,174 If obesity is nothing more than a proxy 307 00:14:26,174 --> 00:14:28,100 for metabolic illness, 308 00:14:28,100 --> 00:14:33,397 what good does it do us to punish those with the proxy? 309 00:14:33,397 --> 00:14:37,941 Sometimes I think back to that night in the E.R. 310 00:14:37,941 --> 00:14:40,254 seven years ago. 311 00:14:40,254 --> 00:14:43,878 I wish I could speak with that woman again. 312 00:14:43,878 --> 00:14:47,133 I'd like to tell her how sorry I am. 313 00:14:47,133 --> 00:14:50,020 I'd say, as a doctor, I delivered 314 00:14:50,020 --> 00:14:53,680 the best clinical care I could, 315 00:14:53,680 --> 00:14:57,577 but as a human being, 316 00:14:57,577 --> 00:14:59,985 I let you down. 317 00:14:59,985 --> 00:15:04,230 You didn't need my judgment and my contempt. 318 00:15:04,230 --> 00:15:08,728 You needed my empathy and compassion, 319 00:15:08,728 --> 00:15:10,723 and above all else, you needed a doctor 320 00:15:10,723 --> 00:15:13,352 who was willing to consider 321 00:15:13,352 --> 00:15:16,416 maybe you didn't let the system down. 322 00:15:16,416 --> 00:15:19,634 Maybe the system, of which I was a part, 323 00:15:19,634 --> 00:15:22,073 was letting you down. 324 00:15:22,073 --> 00:15:24,874 If you're watching this now, 325 00:15:24,874 --> 00:15:29,112 I hope you can forgive me. 326 00:15:29,112 --> 00:15:33,112 (Applause)