Join Raise the Line from Elsevier host Lindsey Smith for a provocative and lively conversation with Dr. Zeke Emanuel of the University of Pennsylvania whose new book, Eat Your Ice Cream: Six Simple Rules For a Long and Healthy Life, offers a refreshing counterpoint to the elaborate fitness regimens and proliferation of products pushed by wellness influencers in their quest for longevity.
"Throw a dinner party. It's the best wellness thing you can do." That surprising prescription comes from Dr. Zeke Emanuel, whose book, Eat Your Ice Cream: Six Simple Rules For a Long and Healthy Life, offers a refreshing counterpoint to the elaborate fitness regimens and proliferation of products pushed by wellness influencers in their quest for longevity.
An oncologist, prominent bioethicist, and one of the key figures behind the Affordable Care Act, Dr. Emanuel was motivated to write the book by a need to respond to a bestselling longevity guide that all but ignored what he considers the most important factor in a long, healthy life: social interaction. “Not having friends is about the equivalent of smoking fifteen cigarettes a day, but when you ask doctors to rate the most important wellness and longevity intervention, social interaction is very close to the bottom of the list.”
In this special 600th episode of Raise the Line from Elsevier, Dr. Emanuel also makes the case that the race to add years misses the point. "A meaningful life isn't just about living a long time. It's about what you do with your life.”
This lively and provocative conversation with host Lindsey Smith also offers insights on:
Mentioned in this episode:
Lindsey Smith
Hi, I'm Lindsey Smith. Welcome to Raise the Line from Elsevier, an ongoing exploration about how to improve health and healthcare.
If you've spent any time on social media, you've probably encountered a flood of conflicting advice about how to live a longer, healthier life, from wellness influencers promoting elaborate routines to products promising to transform our health.
Our guest today offers a refreshingly different perspective. His latest book, Eat Your Ice Cream, argues that living well doesn't require following every regimen we're sold, and it also challenges an increasingly intense focus on longevity.
Dr. Zeke Emanuel is Vice Provost for Global Initiatives at the University of Pennsylvania, a bioethicist, physician, and one of the country's most influential voices in health policy. He has authored more than 350 publications and numerous books, served as a special advisor to the Director-General of the World Health Organization, and played an instrumental role in drafting the Affordable Care Act.
He has also co-authored a new study examining the use of artificial intelligence in medicine, adding an important and provocative perspective to the debate over whether AI can outperform physicians. We'll ask him about that as well.
I had the pleasure of hearing Dr. Emanuel speak at the Aspen Ideas conference earlier this year, and we're delighted to welcome him back to Raise the Line for his second appearance.
Dr. Emanuel, thank you so much for joining us today.
Dr. Zeke Emanuel
It's my pleasure. Thank you for having me.
Lindsey Smith
So let's jump right in. Given everything that is on your plate -- which is a lot, as a physician, professor, researcher, and health policy leader -- what inspired you to write Eat Your Ice Cream, a book that offers a refreshingly simple perspective on living a healthy life?
Dr. Zeke Emanuel
There are a number of motivations. The first is, like every doctor, I think, I get lots of questions about, you know, should I be drinking alcohol? What about this supplement? Lately it's a lot about, what about peptides? So part of it was to sort of do a more general answer to those questions.
But the real proximate cause occurred in December 2023 when Peter Attia's book Outlive landed on my desk at home. I thought my brother sent it to me, but he swears he did not send it to me. Anyway, I began reading it and it just made me livid. I was really mad, and anger can be a fantastic motivation to write a book. In the next three weeks I wrote about 35,000 words, which was the first draft of the book. So there you have it. That's what made me write it.
Lindsey Smith
That makes sense. So the goal is really to kind of cut through some of the noise and offer a practical framework for thinking about health.
Dr. Zeke Emanuel
Yeah. That's part of the motivation. The other part of the motivation, based upon Peter Attia, is that he heavily emphasizes exercise. That's most of the book. There’s a little bit about nutrition and sleep, but nowhere except the last two pages does he say anything about social relationships and social interaction, and then in the last two pages he says, "Look, you can be in great shape, you can bench press a lot, but if your wife doesn't like you, if you don't have close friends, you know, what's it worth?" And it's like yeah, jerk. Duh! You know, it's a lot more than just a lot more exercise. Do ten hours a week of exercise. That ought not to be the priority.
So it was the sort of absence, the blindness to the health and longevity importance of social relationships that really drove me to write this book because they're so central to what we do and how healthy we actually are and feel. So that, that's what motivated the book. It was really a reaction to the absence in his book of thinking about, you know, keeping your mind sharp, your social interactions, things that are really important to longevity and the quality of life.
Lindsey Smith
I'm glad you mentioned that because that kind of leads me right into my next question for you. So for listeners who haven't picked up the book, there are six rules in the book: don't be a schmuck, talk to people, expand your mind, eat your ice cream, move it, and sleep like a baby.
Dr. Zeke Emanuel
Yep, that's it.
Lindsey Smith
I've gotta ask you a tough one: of those six, which one do you think is the hardest for people to actually follow, and why?
Dr. Zeke Emanuel
Which one's the hardest to follow? It probably is social interaction these days. I mean, we know that loneliness is going up, and eating meals alone is going up. The number of people who don't have more than one close personal friend has skyrocketed from 6% about fifteen or twenty years ago to almost 20% today.
So social interaction, again, that was the big motivation. That's really what we're missing. That's the first thing.
The second thing I would say is physicians and healthcare professionals also do not think of social interaction if you mention wellness or longevity to them. There was a study done that showed that when you ask doctors to rate the most important wellness and longevity intervention, social interactions are very close to the bottom of the list. They're, like, the second from bottom, and that just shows that even as medical professionals, we are blind to the health benefits of social relationships.
Lindsey Smith
So just to kind of play that back a little bit, you've said previously that you think building social relationships may be the single most important thing for long-term health and happiness. Can you explain to us why that outranks things like diet and exercise?
Dr. Zeke Emanuel
Yes. We've had more than three million people studied on the importance of social interaction to health and wellness. Let me just give you a few data points.
First, there’s the Harvard Adult Development Study, which is the longest going study that I know of. It’s been going on for almost eighty-five years, maybe even more than eighty-five years now, begun in the late 1930s and looks at what makes Harvard students, when it began, happy and successful. They enrolled people like John F. Kennedy in it and then followed them. It was then merged with a less privileged group of Boston's immigrant children. It turns out that the single best predictor of people who live a long, healthy, and happy life is social interactions, marital status, and having a lot of friends.
Second, there are lots of studies, but I'll just cite one. In the Health and Retirement Study, which is funded by the U.S. government, they followed people fifty years and older over time and gathered a lot of data on them. One of the big predictors for mortality over the subsequent eight years is the number of friends and the frequency with which people interact with the friends. So both a quantity and a quality element.
The more friends you have, the lower your mortality rates. There’s about a 25% decreased mortality rate for people who have the most friends versus people who have the least friends. Then when you summarize all the data, and this has been done by researchers at a Brigham Young University, not having friends is about the equivalent of smoking fifteen cigarettes a day.
So, you know, it's not good for your health, and it goes on for a very long time. So social interactions is where it's at, in my opinion, and it's also something that, again, the medical profession and a lot of people don't think about when you say health and wellness.
Lindsey Smith
It's a really important point, and thank you for taking us through those studies. It makes total sense. So let's shift gears a little bit and talk about your work as an oncologist. How has your experience with patients shaped what you think actually matters for a good life?
Dr. Zeke Emanuel
Well, I don't know if it's shaped so much, but it's confirmed my view. You know, one of the most important things to understand in treating cancer patients is that the worst part of cancer for patients is uncertainty. That comes across loud and clear. Prior to a CT scan or an MRI scan, they are nervous. Is it gonna recur? What's that pain? what's that thing I feel? And even if the result is positive and the cancer has come back, there is a calm that enters because now they know what the problem is and they can formulate a response. The uncertainty is what really eats them up.
I don't think health professionals pay enough attention to the cost and the mental anguish that uncertainty creates for patients. So I think that is something that I've really learned a lot about, and I've learned a lot about just in my regular life in dealing with other people. Try to remove uncertainty as much as possible.
I know, for example, when I'm sitting on an airplane and we're sitting on the tarmac, and you're like, what's going on? When the pilot doesn't come on and explain things to you, you get a lot more anxious and you get a lot more aggravated. But if they come on every ten minutes and say, ‘here's where we're at, nothing much has changed,’ it's reassuring because at least you know what's happening.
The second thing I notice from my oncology patients is when you get cancer and you have an existential crisis, what happens is that you begin to say, ‘this is what's important to me in my life, and this is trivial and I'm just not gonna spend any more time on it.’ When you focus on the high-value things that are happening to me and here's what's really meaningful to me, what you find out is a lot of that is personal relationships. It's reconnecting to people and putting aside all those worthless meetings or, you know, annoyances that creep into life. People just begin to ignore them and absent themselves from that.
So watching my patients reaffirm their relationships as so critical to them...that really has been one of the most important things I've learned.
Lindsey Smith
Uncertainty and nervousness and the mental burden it brings for patients is a great call-out for professionals to pay a lot more attention to, and I also like that you mentioned patients that have been recently diagnosed have a new found focus and really can kind of dial into what is actually important and meaningful in life.
So in your book, you also push back on the idea that we should all be chasing longevity, that life isn't a competition to see who lives the longest. Tell me more about that.
Dr. Zeke Emanuel
Yes. You know, if you just ask the average person -- and I've done this thousands of times now -- what is most important to you, quantity of life or quality of life, almost everyone will talk about quality of life. Then you say, "well, are you living that decision?" and it turns out often they're not. So part of the book is, you know, here's what you really mean. This is how you get to quality of life, not just quantity of life. Staying mentally engaged, that's about quality. So I think that's super important and we need to think through that.
The other is, you know, a meaningful life isn't just about living a long time. It's about what you do with your life, and I think that is something that these people who are trying to max the amount of time -- we're gonna live to 120, 150, whatever their myth or dream is -- that's not what's important. The important thing is, in the time you're taking, are you actually leading a fulfilling life? And what does that do?
Well, if you're trying to live as long as possible, you're really narcissistic. You're focused on yourself, me, me, me. If you're living a meaningful life, you're focused on other people, you're focused on doing good in the world, and I think that reorients what is important in your life and how you construct your life and the decisions you make. That's why I think it's so, so important to sort of put ‘I want to live as long as possible’ away and focus on ‘I'm really gonna focus on what's meaningful to me.’
The other thing I've noticed is all the longevity influencers are in their forties and fifties, maybe even younger, and they haven't gotten to that tipping point when the body begins to break down. I'm a big bicyclist and I notice that recovery times are longer. If I have an accident, the recovery time for it is longer. Things just don't work as smoothly at sixty-five as they work at twenty-five, and when you meet older people in their nineties or hundreds...you can count on one hand the number of people who are zipping along, still working, still being creative after ninety-five. It is very, very, very rare.
My mom's ninety-two going on ninety-three. After forty-five minutes, she's pretty exhausted. I had a dear friend and collaborator who I wrote a lot of papers with, and when he got past ninety-five, he's tired and at some point he said to me, "You can't visit because I just don't have the energy." You wanna live like that? I think the answer for most people is no.
Lindsey Smith
That's a great way to frame it. A meaningful life is what you do with your life. You mentioned influencers, so let's go there. In today's world, there's a lot of noise. For people trying to sort through science and misinformation, what's your advice to them?
Dr. Zeke Emanuel
Stick to the simple stuff. Really. If there's gonna be a big breakthrough, it's not like it's gonna be hidden or quiet. Everyone is going to know about it. Most of the stuff -- whether it's peptides or the latest additive or proteins -- you can ignore it. There is no evidence behind them. Yes, you need protein, and as you get older, you need more protein because after about sixty years old the body loses about 10% of its muscle mass every decade, and so you have to have more protein and you have to work out harder to keep the muscle mass on. But these aren't secrets, they're all in the book. I would not bother to read all of the, you know, newsletters or listen to the influencers because if it's going to make a big difference, if it's gonna make a real difference to your life, it'll be covered a lot in the news.
So, let me give you a couple of things that have become really important since writing the book. The first is the shingles vaccine. It just doesn't get enough airtime, and this is one of those things where if you're over fifty, get the shingles vaccine and don't wait. Why? Well, first of all, it prevents shingles, which is a really painful illness and sometimes can even land you in the hospital. I've had friends who've ended up in the hospital from, from shingles.
Second, it diminishes your risk of getting dementia by about 20%, and third, just a couple of weeks ago, a report that the shingles vaccine also reduces your cardiovascular risk factors and reduces your risk of having a heart attack or stroke. So what's not to like? You know, for two shots -- yes, the second one is painful -- but two shots and a temporary pain, you get all those benefits. That's well worth it. So that's one of the things that I think is going to be really good, and there aren't enough influencers broadcasting that.
Second one is multivitamins. Now I’m negative about supplements in the book. Yes, there are some people who need supplements. If you're a vegan, you might need vitamin D or B12. Other people with certain diseases may need some specific additional supplementation of their vitamins or minerals. It's rare. The average person reading this book won't need that. On the other hand, recent data have come out that taking multivitamins may reduce your risk of dementia. There are a couple of studies that have been published in the last year about that.
So is there a harm to taking a multivitamin? No. Is there a benefit? Maybe. Not definitive – but maybe. So what's the big risk? A little money. That seems like it's a good deal. Okay, you can have something with no risk, take it, spend a little money on it. It's not a whole lot of money. You're not spending $100 a month or anything outrageous like that, much less $500 on peptides. Okay? There’s no harm, and maybe a gain. Sounds like a reasonable investment if you're so inclined. If you're not inclined, okay.
Lindsey Smith
Thank you for sharing that. So stick to the simple stuff is great advice. You also mentioned getting the shingles vaccine for folks over fifty, and multivitamins as items that deserve more airtime.
Staying on the news theme a little bit here, not many developments are generating more discussions right now than the growing use of AI in medicine. So I want to talk to you about
the AI study I mentioned at the top that was recently published in the Journal of the American Medical Association. In it, you and your co-authors assert that in the relatively near future, artificial intelligence may perform better than physicians at some tasks. Can you fill us in on the case you're making and how you came to that conclusion?
Dr. Zeke Emanuel
Well, the way we came to the conclusion is, like good researchers, we looked at every study -- and there are about fifty-one published since January 1, 2024 -- and we looked at the data in them. There are a variety of ways of looking at the data, but let me emphasize a few.
The first is, Google's got an AI program called AMIE. With patient actors using it -- and I admit it's patient actors, not real patients -- it performs better than human doctors at eliciting information and getting information from patients, involving patients in their care, and patients felt that it was more emotionally supportive.
One of the more interesting studies was done on patients who interacted with AI for a diagnosis and for treatment recommendations, 471, I believe, is the number, and then a doctor interacted with the patient and had the AI result. So AI first, then doctor with AI. They had access to the AI recommendation. AI got the diagnosis and treatment right 77% of the time. Doctor with the AI got it right 67% of the time. Less frequently, okay? It illustrates lots of things.
First of all, AI is good, not perfect, but good. Two, better than doctors, and three, better than doctors with AI, and you might ask yourself, well, why are doctors with AI performing worse than AI? And one of the reasons, there are multiple reasons, but one of them is doctors often overrule AI, and the better AI gets, the more doctors actually introduce error rather than solve errors. That's a very common thing that is experienced when AI gets into areas, whether it's chess or other functions.
So our conclusion is, look, there are gonna be a lot of places where AI, autonomous AI, is going to be as good, if not better, than doctors, and those are places we ought to be introducing it. And by the way, AI is gonna get better and better and better pretty rapidly. It's been less than four years since ChatGPT came out, and AI is pretty amazing today.
I think probably, in my view, the first place that AI is really going to make a big difference, besides the administrative nonsense in medicine, is going to be managing chronic illness -- hypertension, diabetes, high cholesterol -- and similarly managing pregnant women who might have preeclampsia or might have gestational diabetes. Why is it a place that AI is gonna work? Because those are places where doctors don't do a very good job. It's a place where having AI that can interact with a patient on a daily basis, and we know that can lead to much better management of these chronic conditions. Bad management of chronic conditions is something that is endemic certainly to American medicine, and this is a place where I think we'll have a lot of positive impact pretty quickly.
Lindsey Smith
It's a really complex topic, and I think this conversation has generated a wide range of opinions across healthcare, but I really appreciate you sharing your perspective with us there.
So let's bring the conversation back to Elsevier. So as you are familiar, Elsevier is an education company. We're always looking to fill knowledge gaps. Is there a topic you think we should create content about that you feel deserves more attention? I know you mentioned some earlier, but are there any others?
Dr. Zeke Emanuel
Well, I think human interaction is one of those places that is super important. I think another place that I would focus on really relates to phones, computers, and their impact on the brain. Are they making us smarter or are they making us stupider? I think that is a super important topic that has not really had as much devoted to it. Like, for example, when you have a conversation on Zoom versus a conversation with a person, as I understand it, much less of the brain lights up when it's on Zoom compared to face-to-face. You're scanning for a lot more, you're more engaged in the conversation, assuming that electronics isn't distracting you. I think understanding those subtleties is one area that we need a lot more thinking and research on.
Lindsey Smith
Human interaction and the technology impact on the brain are great knowledge gap ideas.
So, in our audience, we have many students and early career professionals. What advice do you have for them about building a career in healthcare?
Dr. Zeke Emanuel
Building a career in healthcare? I don't know. I mean, look, healthcare is changing quite rapidly now and I think figuring out how you can be part of that change would be very, very important. I would say compared to when I trained forty-plus years ago, there were fewer options then. People didn't think about doing a startup in healthcare, didn't think about AI, didn't think about public health as frequently.
So, I actually think the options that are in front of a younger healthcare professional are much wider than they were just a generation or two ago, and I would embrace that. I think there are a lot of exciting possibilities. There's also global health, which never even appeared when I was training in medical school. It just wasn't on the list.
Lindsey Smith
To play that back, you said healthcare is changing. Figure out how you can be part of the change and explore all of the exciting options available today. That is great advice. Before we wrap up today, the floor is yours. Is there anything that we didn't get to that we should have?
Dr. Zeke Emanuel
I don't know if there's anything we didn't get to, but here's what I would recommend to young professionals in health. Throw a dinner party. It's the best wellness thing you can do now. Easy. No prep. You don't need special shoes for it, right? You cook a nice meal, so you're guaranteed good food. You can finish that meal with ice cream if you want. Invite some friends over, have good conversation, good human interaction, and after the meal go out for a walk and get some exercise. It's a great way to do wellness stacking.
So that's what I would do, and again, no special prep required.
Lindsey Smith
That’s a fitting way to bring this conversation full circle. We started the episode talking about social interaction, and we finished right where we started. I'm glad we were able to tie that all together, and for the conversation we had today. Thank you so much, Dr. Emanuel.
Dr. Zeke Emanuel
Thank you for having me again. It was lovely.
Lindsey Smith
And that does it for today's episode. We started today's episode pushing back on the wellness industrial complex, worked through Dr. Emanuel's six rules, and why relationships may matter more than any diet or workout plan. We also challenged the idea that a longer life is automatically a better one, among other topics. We covered a lot of ground today, but if there's a thread running through it all, it's this: stop chasing the complicated answers when the simple one will do. Or, as the book title puts it even better, eat your ice cream.
If you're interested in checking out Dr. Emanuel's book, we'll include the links in the show notes. I'm Lindsey Smith. Thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.