Written by Christopher Kelly
April 1, 2016
Tommy.Wood.on.2016-03-22.at.10.15
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Christopher: Hello, and welcome to the Nourish Balance Thrive podcast. My name is Christopher Kelly and today I'm joined by Dr. Tommy Wood. Hi, Tommy.
Tommy: Hi.
Christopher: I bet your mom is dancing around in little circles because she's so happy because your paper has been published.
Tommy: Yeah, I think so. She's been working really hard recently so I haven't heard from her for a while. She kind of disappears into -- she's like possibly one of the busiest people in the world by literally trying to save the world. One of their professors here, he used to be the president of the European Academy of Sciences which is a pretty big deal. He works directly on a group but he's still very active in that kind of scene, sort of the European Research Council kind of scene. Often, he'll just be like, "Tommy, do you know where your mom is because I can't get hold of her?" And then I don't even know where she is either. She's always in some other country flying somewhere at some conference telling people how to save the world. Once she hears about my paper, I'm sure she'll be happy about it.
Christopher: Yes. So, for people obviously listening don't know that Tommy just had his -- it's the main paper from your Ph.D. thesis on neonatal neuroprotection?
Tommy: Yeah.
Christopher: And it is published yesterday. Why don't you tell us a little bit about the study because I think it's really interesting?
Tommy: Yes. So, what I researched is basically a model mainly of how to treat babies, newborn babies with brain injury. So usually term babies or neo term babies, newborn are 36 to 40 weeks, something like that, often who we think are perfectly happy and healthy and then they're born and they sort of deteriorate very quickly and they have some kind of brain injury or something can happen, traumatic birth or they get stuck on the way or something happens and they get deprived of oxygen or deprived of blood. Some of them might also have an infection or something like that. And then they have some brain injury, what we call encephalopathy. And then what we do is we cool them down. We treat them with something called therapeutic hypothermia so we cool them to 33 to 34 degrees Celsius.
Christopher: Which is not as cold as I thought it was going to be. When you say hypothermia, I think much colder than that.
Tommy: Yeah, absolutely. So, it's only two or three degrees lower than they probably would be normally. But it's enough to have quite a significant effect on metabolism and cell health. But what we don't know really is what the best temperature to cool babies at is. Historically, a lot of this stuff was done by my current boss. They did some pilot studies. They did some studies in a number of different animal models. And then they kind of [0:02:43] [Indiscernible] temperature and that was used in the first trials and that works so that's just what everybody has been using.
But there's always been a question of whether we should cool more as in cool deeper or cool for a longer period of time. And nobody had really kind of looked into that in that much depth. They kind of assumed like most people tend to that more is better because that's what everybody, that's what they lean towards. So then the main idea of my study was to actually be one of the first studies where in a model of this brain injury we actually compare multiple different treatment temperatures and see whether we can sort of start to tease out how much cooling is going to be ideal.
Christopher: And the figure one in the paper I thought was just beautiful, the scatter plot, in particular. So, you actually plot all of the data point. How is that? Is that all of the rats that are in the study or is it just some of them?
Tommy: Yeah, that's all. So, we have two models. So, we have what we call a moderate injury model and a severe injury model. And the most of the work is done on the moderate model because that's where we know hypothermia works and that sort of then where we like we can sort of move up and down and see how that changes things. And so that's all of the -- every data point is, I give every data point in the paper so that nothing is kind of hidden from the reader, which I think is really important.
Christopher: This reminds me of something that Richard Feinman said which is nobody loses an average amount of right weight and so the same is true here with the brain injury. Like no rat has an average amount of brain injury after you've done something nasty to it. And so you really want to see all of the data.
Tommy: Yeah, yeah, absolutely.
Christopher: Awesome. Well, I will link to that in the show notes, if anyone wants to see the paper, I hope they do especially those scatter plots I think are great. I'll link to those in the show notes. The main thing we wanted to talk today about was science. Tommy is here to throw science under the bus, in fact.
Tommy: Sort of various topics and that we're left talking about, I guess, in the world of science and hopefully we'll cover a lot of them. And, I guess, I don't -- at certain points, it could sound like I'm being very anti-science and anti-research but in reality I'm not. This is my day job. I'm a scientist. And all I can hope to do is try to do it a bit better than maybe is the norm or just try and kind of -- I've kind of got to the point where now I feel like if I can leave science in just a tiny slightly bit better state than I came into then I feel like I've done a good job.
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And I do a lot of reviewing of papers. I often ask people to, instead of having a bar chart or something, I ask them to plot all the points so we can see all the data and make sure that doing their statistical analysis in a robust way. All these things kind of add up and then hopefully will mean that people start to do things a little bit better. But there's a lot of different areas where people just either their biases mean that they only pick a certain -- they just sort of cherry pick their data. And this is often in terms of people who are interpreting research, so either in the media or people who are doing research to them, blog about it or share on social media, all those kinds of things.
And there's a lot of issues that we have in medicine that nobody is really willing to talk about until, obviously, there's a study they didn't like and then they'll dig into that study and find all the problems with it and then say, "Actually, I don't agree with this study and that's because it's a terrible study." But they're never willing to turn that same microscope onto the studies that they do support and they do sort of throw out there as evidence for the things that they suggest people should do. So, it's kind of we're left struggling at the moment really in terms of how to kind of get the best out of science and that's what, I think, in some way we should be striving to change.
Christopher: Right. So, I just wondered, do we need like someone almost third party, an independent, to review the science? Isn't it that what the Cochrane Association does?
Tommy: Yeah. So, the Cochrane Association is this huge collaboration that's kind of rooted in evidence-based medicine, which is this really good idea to kind of make sure that everything we're doing is based on the best available medicine. And what they tend to do is systematic reviews and what we call meta-analysis. So, you basically take a lot of studies or trials on one topic and you kind of bring these together and synthesize them and you give them a certain weight based on the quality of the study or the number of participants that they have.
And eventually, you can kind of look at the big picture and see whether, say, a certain treatment is beneficial or harmful or whether something has an effect on overall mortality or some disease or something like that. And the idea is really good. The problem is that in order to do that, you have to have some reasonable studies to work with in the first place. And there's a big problem in terms of bias in the research which is that when we do a study we tend to show anything interesting. Nobody is really interested in publishing it.
So then if you say investigating a treatment and you find that that treatment doesn't really work, you're most less likely to get that paper published versus somebody who finds that treatment does work. So then there's a shift in the research, the body of research towards that being beneficial when maybe it's not. And they do have ways to kind of sort through that and see if there's some bias in the research. But in reality, if you're doing a meta-analysis but all your original studies are crap, that doesn't make for much meta-analysis good. They can only be as good as the data that goes into it while it's the same with anything.
So, in theory, yes, that should begin to fix things. But anybody can sign up and learn how to do a Cochrane meta-analysis. You just go on a course and they teach you how to do it. So, in reality, if you have a bias in terms of what you think is important or what you want to try and promote, it's very possible for you to go and, as a researcher or a doctor with an academic background, to go learn how to do a Cochrane review and then do some Cochrane reviews and you have to tickle the boxes and follow the rules but it's very possible that there's some bias there as well.
So, the theory is very nice but this reminds me of -- Here in Oslo, there's a couple of professors of nutrition who are very big into the cholesterol heart hypothesis. Basically, they go around telling everybody that LDL is going to cause atherosclerosis and kill them from heart disease. I've tried to not confront them but approach them and actually get them into a discussion about this stuff a number of times.
They might write something on the popular media and I'll send them an email. One of them recently published a meta-analysis about low carb diets and cardiovascular disease and basically said that because a high fat diet might slightly increase your LDL cholesterol even though everything else got better, more weight loss, better improvement in triglycerides, better improvement in HDL, then low carb diet is bad. So then I previously tried to engage with this guy and he hadn't responded. So instead, me and some friends wrote a letter which is published in the British Journal of Nutrition kind of commenting on why we felt they were wrong.
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Christopher: And I'll link to that too.
Tommy: Yeah. But the problem is -- so one of these other guys, so there's two of them and his colleague, I've heard him speak a number of times. I go to various courses here at the university or I go to days of seminars. And the other day I was at a seminar that he was giving and at some point he said that LDL is the killer. But he also said that in fields of research what you need is an expert to really look at it all and synthesize it.
In his mind, what that means is that he is the expert and, therefore, he has decided what's important and, therefore, what anybody else thinks is incorrect. And immediately you start to see where the problem is because he is a well known professor, he's been researching this for a very long period of time. And he has decided he is the expert but he's not impartial. He isn't a third party. He has just decided what's important and that's what he's going to push.
Christopher: And it's probably very difficult for him to be wrong at this stage. He's got like a lifetime of work behind him that's kind of his reputation is riding on.
Tommy: Absolutely. He cannot be wrong. And I'm not saying that, I'm not promising that I'm right but I am at least open to the idea that I am wrong and he is also wrong. Or actually we don't know as much as we think we do. But when you get to that stage in your career, it's very understandable. You don't want to do 20 years of research and then actually find out that most of what you're peddling for that period was just completely incorrect. So, you do kind of understand why people get into that corner. But in reality, we really have to be more open to being wrong essentially and discussing ideas with people who disagree with us.
Christopher: And how does the funding fit it to all of this? So, this guy that you've just been talking about, he is a senior guy. He probably holds some of the purse strings. How does the funding fit into it?
Tommy: Well, there are a number of different places you can get funding from. So, here in Norway, they have their research council, the European Research Council, the university has some funds. You can get some private funds as well. And he himself won't hold his own purse strings. That's very rare that that happens. But he's well-known in the field. He is known to have produced a lot of what is thought to be very good data. And that will always benefit you in terms of applying for more money.
So, if you have a track record of what's thought to be very good research, then you're more likely to get more money in the future. That's the big problem that they're talking about a lot in the US at the moment which is that a lot of NIH money is going to very established senior researchers because they have good track records of both research and publishing. So then if you give them money, yes, you're likely to get good research out of it but then you're not giving money to new up and coming researchers who are maybe doing something different, thinking a little bit differently. It's more of a risk to give them finance, give them grants, send money their way.
But again, you're sort of missing out on those people who are maybe coming at things from a different direction. And I think it was Max Planck who was a very famous German physicist that said that science moves along one funeral at a time.
Christopher: Wow.
Tommy: So basically, for things to shift and change, basically you have to wait for the old guy to stop doing science so that new people can come and adopt new ideas and then find new things out.
Christopher: And would you say it's hard to get money then?
Tommy: It really depends. I mean, because there's a huge amount of science being done and I'm -- I don't write grants directly from my own research yet. I'm actively involved in writing grants for the lab that I work in. And lots of people are getting funding just from the knowledge that a huge, I mean a huge amount of science is being done. I mean, just look at the number of papers that are published every day and all those people are getting funding.
The problem is that it's very difficult to delineate the quality of the work that's going to come out. And I think one of the problems is that we don't know what people are doing that they don't publish. So you can do as many experiments as you like, until you get the answer you want and then publish it. And that's very cynical way to think of things but I know that that's how it works. That's what people do. I've sort of been in the world long enough to know that -- not everybody. I'm not saying that this is something that everybody does. But it's very easy to kind of manipulate things particularly for doing cell work or animal work. You can have a lot of go's at that without spending too much money unless it's some sort of expensive genetic models or something in mice.
[0:15:05]
And you can kind of work on things and eventually, by chance -- statistics basically is just a way of telling us whether what we found is true, the probability of what we found was true. But we're never certain that a positive result is correct. We just think that there's very low chance that it's incorrect but statistics never says anything is true. It just gives you a probability of whether it's likely to be correct or not.
It's very easy to sort of keep going, change things and find, end up sort of supporting your own views and then everything can be written in that direction. But equally, if you want money, you have to be doing noble work. You have to be trying to come up with new treatments or view things that then sound really sexy on a grant proposal because otherwise they're not going to give you the money because the focus is always on driving things forward but what happens a lot of the time is that actually you haven't really investigated the other stuff. You haven't really investigated the basics necessarily.
So, when the paper that just got published, I submitted it to a number of like fairly big journals to start with because obviously I felt it was important. And even one of the editors replied and said that why are we testing this on animals because they were already doing clinical trials on humans testing it? So, we moved on past the animal point and we're doing it in humans. But why would you start doing something on humans if that hasn't even tested in animals in the first place? That just doesn't make any sense to me.
You spend millions of dollars on a clinical trial and actually you haven't even just done the real basics. But that's the problem because you're always trying to do something novel and new then you end up just glossing over the basics and trying to do something else. And then you sort of miss the big picture.
Christopher: Right. So, it's almost like you're ignoring the work that's been done or hasn't been done before you.
Tommy: Yeah, exactly.
Christopher: And do you think that's really happening then? So people creating cell or mouse models of some problem and then just keep doing experiment until they get the answer they're looking for?
Tommy: It's certainly not outside the realm of possibility. I know that there are people who do that. I'm not saying -- again, I'm not saying that this is just the norm. But if you look at the number of papers that are retracted from big journals like Science and Nature, just because somebody fiddled the data, manipulated something, just plain made something up. There's at least one a year if not more than that. And these are in the big, big journals that have very, very stringent peer review processes.
Because you aren't in the lab of the persons checking on the work that they do. So you don't -- You kind of have to trust, everybody else has to trust the process. And sometimes that fails. In that kind of drive to always be novel and produce very new and interesting data, often people are just making it up.
Christopher: Yeah, it's crazy. Is the problem finance as well, I think. The quantitative analysts, they're trying to create a model of a financial market and if they just back fit it to get the answer they think they're looking for, so if you just took a couple of days worth of S&P 500 data, say, and then just create a model that fitted that back data perfectly, then guess what, in the future you're going to get crushed.
Tommy: Yeah.
Christopher: Companies, hedge funds, other financial institutions go to great lengths to make sure that the quants are not doing, right? They're not back fitting and they really are doing something that's going to come up with an answer in the future other than just the answer they were looking at that time. But tell me about how those models translate? So, you've just done a study of hypothermic rats. Now, how can we expect that to translate to hypothermic babies?
Tommy: So, that's a really good question and I sort of, in general, the more time I spent in basic, what we call pre-clinical research, which is basically animal and cell models, for human disease, the more time I spent on it the more I realize that actually most of the models we use don't really reflect what happens in the humans at all. And there had been many, many studies looking at how just -- we're not the same species, right? I mean, it sounds obvious to say that. But in terms of the way the body responds to an insult, in terms of the way the body can deal with stresses or changes in metabolism, are very different from something say like a rat or a mouse up to a human.
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There's one really interesting paper. I refer to it quite a bit. It was in the Annals of Neurology -- when was it? 2006 maybe. Basically called 1,026 Experimental Treatments for Stroke, which basically was up until that point, there were over a thousand different treatments that if you did a model of a stroke in a mouse or a rat -- and what I work with is technically a type of stroke but in babies -- and there are over a thousand different ways that you could treat that in animals. But none of those work in humans, not a single one.
And the problem is, that you can do pretty much everything to a mouse and have a big effect. But none of that really seems to translate into humans. Now, where I kind of feel slightly better about the particular model I use is the fact that it was a model which was sort of part of creating the treatment that we now give to babies and we know works in babies. And it also works in some similar models in larger animals.
So, there's a model in sheep. There's a model in pigs. Some people have done them in nonhuman primates. So, we know that what works in rats -- and this model does actually work in humans. And there aren't that many, really not aren't that many examples where that's true actually. So, people are doing lots of different research and lots of different models of lots of different diseases in mice and rats but pretty much very, very few of them are actually translated into a real life treatment in humans. I feel slightly better about the model that I worked and just because it has been part of creating a treatment that works in humans. But in reality, that might be a lot less common than we hope.
Christopher: So you've taken something you know already works and now you're just exploring like can we tweak this a little bit and see if we can make it any better? It may be unethical or expensive or impossible to do that in humans and so you do that tweaking in the rats and there's a good chance that that's going to extrapolate out into humans.
Tommy: Yeah, exactly. We're fairly confident that if we start to explore the mechanisms in smaller animals then that can -- and because we know, in this particular disease we know the line of progression. So, it starts in smaller animals then you're going to slighter bigger animals and then you can try in humans. And we know that it has worked before. So that at least gives us some confidence that if we start to tweak it at the lowest level then we can start to move up and actually we're more likely to, we're less likely to be wasteful in terms of both animals and money along the way because we've started with the basic.
Christopher: And do you think it's reasonable? Should we be looking at -- so when I say we, I mean, me, the consumer of science, not a scientist -- should we be looking at the rat or rodent studies or cell studies at all or should we only be interested in human studies?
Tommy: Yeah. It's really difficult to tease that out but I find it very difficult to get excited that a mouse or a rat study -- and probably just because I've read so many and been part of a few and I know how poorly they correlate. So, there are some genetic mutations that cause Alzheimer's disease, Familial Alzheimer's Disease, very young, maybe in the 30s and 40s you start to get cognitive decline. And you can do models of those in animals and they get what we think is like dementia type picture.
But a few of them, 1% of people that have Alzheimer's have that mutation. So, if that's where you're getting the body of your information about testing things in Alzheimer's in animals, I mean, you're already so far away from what's happening in humans. Similarly, there's a really good study done three or four years ago now -- it's published in PNAS -- where they basically looked at the genetic response of white blood cells to an insult. So, it was trauma, infection. And in humans, actually, across those big sort of insults, the response was very similar in terms of what the genes that the white blood cells turn on and off.
And they kind of thought that it's all sort of part of this one big inflammatory response syndrome which is what we call SIRS. And so depending on, even though that the insult was different, the kind of the response of the body was very similar just for that kind of big inflammatory insult. But if you look at animal models of those same problems, so infection, sepsis or trauma, they were very, very different from what happens in humans. And interestingly, they're also very different between species and between models.
So, what's actually happening in the body in response to these kinds of things in small animals is very, very different from what's happening in humans. So particularly in something like anything involving the immune system, which is an exceptionally complicated system that I challenge anybody to explain and truly understand but at this moment and time I think it's almost impossible to extrapolate upwards. I think there's a lot of danger in doing so.
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Christopher: And then so we see this a lot on the blogs. You and I, we talk about links getting batted backwards and forwards from various different blogs and some of the people that write them are talented writers and scientists but you quite often see a rat study cited and maybe three or four rat studies cited and, I mean, I think we shouldn't really get excited about that evidence at all.
Tommy: No, no. And I often don't. I think it's interesting, right? I will read those studies because I think they're part of the body of evidence. But using that as kind of one line of--
Christopher: I'm going to take this supplement because I read this blog post and it cited three rat studies.
Tommy: Absolutely. So, one of my favorite things actually was -- it wasn't a rat study. It was a cell study. And I was reading -- I'm personally not going to throw anybody under the bus but I was reading a blog post by a very famous person in our sphere writing about detox and they were talking about spirulina as an aid to detoxing. One of the main studies they cited -- So there were a few studies where you kind of if you put spirulina into a solution with heavy metals then they will kind of absorb it. So, that was kind of to kind of tell us that spirulina was good at detoxing heavy metals.
But there was this one particular way. If you take a rat, a chunk of rat liver and you incubate it in a solution with arsenic and then you take that chunk of rat liver which is now full of arsenic and you basically wash it with an extract of spirulina and alcohol and another solvent called hexane then you can extract the arsenic out of that liver tissue which is like not in a living animal. It's not in anything even remotely close to what would be happening inside an intact human being. But that's what was being used as the evidence to support spirulina as a detox aid. And it's just so far from what's happening in you when you are trying to reduce your toxic burden. I mean, I think it's not even related.
Christopher: It's really hard for people like me to try and distinguish between the quality evidence and the not so good because we almost need your education to be able to know that they are so far away from what really goes on inside the human beings.
Tommy: Yeah. Sort of there's huge benefits to everybody being able to have access to all this information. There are a number of ways now that anybody can get access to almost any research study and a lot of research that's done in many places is part of public record so you can go and find out everything that everybody is doing supposedly. And I think this is really important because it allows anybody who's interested to actually go in and maybe start to put together the big picture. But it's also, the downside of that, is that unless you are familiar with the particular field, you don't necessarily know the caveats that you have to apply to the information that's coming out of it.
Christopher: Yeah, I know. And I won't link to this in the show notes for fear of a reprimand but I'll spell out the URL. It's sci-hub. So, if you'll type that into Google, it will just go to sci-hub.io, you'll find yourself a website that allows you to access pretty much all of the scientific literature for nothing. Normally, you run into these payables where they want you to pay $40 or something to access that one paper. Well, some Russian scientist, I don't know exactly what they've done. Probably they put a computer behind some firewalls somewhere and nobody knows where it is yet. And that's giving the whole world, the whole internet access to all of the scientific literature.
I have to say it has accelerated my learning. I used to bother you a lot more asking for papers until I discovered this website. And it doesn't have everything but it has most things especially if it's not brand new I found. If it's brand spanking like somebody just posted it and it was published two days ago, you'll probably be going out of luck. But definitely the older stuff. That's been really helpful for me. It's kind of strange.
As a computer scientist, I don't actually do science. I'd never read one of these scientific studies before I started this business and I've just been really trying to figure out how these things work. I feel like I might not have gotten anywhere if it had not been for your help. Imagine if I'd just been doing this by myself and I had not known all these caveats, how long would it have taken me to figure this out? I'm not sure I ever would.
Tommy: Yeah, it's difficult. I'm not saying that you need some kind of fancy education to do it. It just requires time to kind of sit through stuff and maybe like you go through and go back and you learn a bit of the basic science that you do at the Khan Academy or some other things. And maybe you read a little bit about basic statistical methods. And it's not really that difficult but you get an idea of how data should look and then how you should treat it. And then you can -- it's very easy to see when somebody isn't doing that. And then all of a sudden you're like, okay, well hang on. Maybe it's worse. So sort of really considering what they're doing and how I should interpret that.
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Christopher: No. I think it's true. I realize that. I'm not sure exactly at what time I realized that. But I just got so much more out of the reading that I did once I'd gone back and actually studied the organic chemistry and the biochemistry and some of the statistical stuff as well actually. I just understood some of the really basic things. And it kind of reminds me of that -- Is Abraham Lincoln that said if I had six hours to chop down a tree I'd spend the first four, is it, sharpening the axe? You don't go straight into the studies. You spend all of your time on the Khan Academy and then only at the very last minute do you start looking at the actual science that's being done.
Tommy: Yeah, absolutely.
Christopher: Let's talk about an evidence-based approach. One of the doctors that trained me is Dan Kalish and I remember him saying once that he was the least evidence driven person that he knew. He was really not into diving into the literature and dissecting it and ruminating over that and all of that. He was much more of a kind of a hands-on. He was a practitioner. He is a clinician. So, he's worked with maybe 20,000 people over 20 years and he just knows. He's seen what's worked.
He didn't make it all up from scratch I'm sure. He was influenced by people from the outside as he went along. But he's really not allowed himself to be dragged into this debate and he's getting great results and nobody gets great results. I mean, what's the right thing to do here? I listened to some of the podcasts and they're almost making it sound as if like, well, if you're not 100% evidence-based then it's crockery and you should go away. How do we strike a balance here?
Tommy: Yeah, that's a really difficult question that lots of people have actually talked about in the last maybe ten years or so. There's been a number of things published. There's a very famous paper from PLoS Medicine from 2005 written by a guy called John Ioannidis who's a professor at Stanford and it's basically Why Most Published Research Findings are False. And he goes through why basically bias kind of affects everything and how he can't -- actually, even though it's supposedly evidence, actually like I was saying earlier, the evidence maybe isn't really telling you that much at all.
And there was another paper published in the BMJ more recent than that called something like Evidence-Based Medicine in Crisis or something like that. And basically, the problem is that actually evidence-based medicine is now just used as this kind of wall which you can kind of use to protect yourself. So, you say that you're evidence-based and evidence-based medicine has basically become a fancy buzz word, but like we kind of alluded to, it doesn't really, it hasn't really lived up to what we thought it might. It's not as robust and it's not as open and honest as maybe we hoped it would be.
And the other problem that it comes down to is the fact that as soon as you're talking about being purely evidence-based, and it is important to be evidence-based, and I do think that it's important, somebody tells me something, if they have a study or at least something that kind of supports what they're doing, I'm much more likely to get into it and read more of it and sort of look at it in the bigger picture as much as possible.
If people are just giving random assertions, that's very difficult to evaluate that. But when you have somebody who has been working for a long period of time and they've got this huge body of experience, I don't think that should be discounted. And actually personal experience and anecdotes I consider to be the lowest form or one of the lowest forms of scientific evidence. But the other side of that is the fact that if you are purely saying that everything has to have a meta-analysis and this many clinical trials have been done, all that stuff, then actually you're removing your critical thinking from a situation.
You're removing your ability to gain experience, gain knowledge actually from, say, the patient population you're working with to actually see stuff happens, see whether it works, see if it doesn't. Actually, there's a big trend in medicine which is important in a lot of scenarios particularly emergency scenarios, you just follow the protocols because in emergency situations you want to get everything done without having to think because as soon as people are stressed and they stop thinking and then the patient is going to suffer.
But in terms of more complicated chronic stuff, I think there's a real need for experience and critical thinking just because, A, the evidence might not exist and, B, because only you can know what your patients are experiencing and how they respond to certain things.
[0:34:59]
So, while evidence is important, particularly if things get more complex, you have to use the gray matter the brain or otherwise you're just working from the brain stem and everything is reactionary and then you can sort of learn as you go and adopt and improve.
Christopher: Right. And that's kind of much more aligned to the way I've been thinking in the past. As a computer scientist or a software engineer, inevitably, as you get more experience as a software engineer, you spend more time looking for other people's stuff than your own stuff like and less time building new things. And so you become more of a problem solver rather than a creative type. It's not really anything you've ever written but you just have like a system that works in your head.
Like when something goes wrong like in the middle of the night like some server breaks or something goes bad, I mean, the first thing you think about was what changed? Did somebody push some new code? Or if not, it must be the input. And so you have the system in place in your brain where you start debugging this thing. You may be putting some watch points which is basically almost like a way that you can kind of sneak inside of the program and look at the inputs and outputs at a given time.
That's kind of like what the testing does for really, isn't it? And so it's almost like the same thing. But, yeah, you have to be -- you have to use some critical thinking. You can't just follow a protocol to the letter and expect to solve each and every problem. You just could never create enough protocols. It would always be different.
Tommy: Exactly.
Christopher: I think this might be quite a nice segue to talk about some of the health coaching that we've been talking about. So, no doubt, I think the diet and lifestyle modification is by far the most powerful set of tools that we have in order to help people feel and perform better. We've got to a point now where we've got a lot of knots and bolts. We have a lot of tips and tricks that we know work really well for people. And most of it is evidence-based. Can you think of anything that's not really evidence-based that we recommend people do?
Tommy: I don't think so. I think there's a few sort of maybe newer supplements that don't have the largest evidence base behind them but the theory is very good. But whenever I discuss them with anybody, I am very open about that fact.
Christopher: Right, right.
Tommy: Usually, when I recommend things to people, I will send studies and talk about the weight of evidence and they kind of get to make their own decision. And I think that's kind of part of the process. But other than that, I don't think there's anything particularly outside of the realms of evidence.
Christopher: Right. So, the problem that I've kind of got to now is that I have this gigantic file, this document inside of Google Docs called Protocols and in the beginning it was quite a small document. And the one I was handed when I was going through this whole functional medicine thing to get better was very small and it was almost like my three-step program which is don't eat wheat, don't eat dairy, fire your gastroenterologist. And that worked really well for me. You could have that as a wellness program.
And there's some people that would definitely feel better if they did that. I'm sure of it. And I would certainly be one of them. And as we've learned more things -- I've interviewed over 100 people now for the podcast so I have all these tips and tricks and they're all stored away in this little Protocols document and it is getting to the point where it could be a practitioner training program that we could teach other practitioners to do what we do based on what's on this file that I'm looking at right now.
But the problem is, it's way too much stuff. So, when I get someone that comes to me in the beginning and they've not listened to 800 podcasts and all of it is new, it's just totally overwhelming to start from scratch with all of the diet and lifestyle stuff. Even just that is completely overwhelming. So we've been thinking about ways in which we can do better at changing behavior and I've been somehow reconnected, in fact, I should acknowledge Gary Ralston who is a business consultant I've been working with who said to me, "Why don't you use Agile?" I'm like, "Oh, yeah, Agile. I kind of remember that from university."
So, that's what he's doing with me. I'm working with him as a business consultant. A couple of weeks ago, Julie and I sat down and talked about how the business had gone and the answer was not great. And so rather than just letting the whole thing crash and burn I hired someone to help me. And so, Gary is now helping me. We have this system in place now by which we're managing this project. And suddenly at some point I realize it was perfect for what we do with people's health and diet and lifestyle.
So, to fill you in a little bit of a back story, it started with software engineering and there was this huge problem which was the process kind of went -- So, imagine you were the government and you wanted somebody to write the software for an airplane and you approached someone like Lockheed Martin and Lockheed Martin would talk to you and then say, "Yeah, I think we can do this." And you would sign a contract then Lockheed Martin, they would disappear for one, two, three, five, maybe even ten years writing a specification for something like the software that runs an aircraft.
[0:40:05]
There may even be a formal specification, so a mathematical specification that could be proven formally. And for someone to come in, in the middle of that, and change the requirements was a disaster, like an apocalyptic disaster. And so, the people who are writing the specifications in designing the software, they were incredibly resistant to change. It was the last thing they wanted to happen. And so, many companies or many projects went awry and even failed because these specifications, although required, it's a complex system designing a software that controls an aircraft, it was just too inflexible. You'd always run into trouble at some point along the line and so it didn't work.
And so a lot of people started looking at this problem in computer science and they started to think of new ways in which engineers could be more productive and more flexible in the way that they worked. And one of the things that emerged from this was a system called Agile. And I'm sure that there are some software engineers listening to this who knows exactly what I'm talking about and they might even know what I'm going to say next. Are you with me so far, Tommy? Am I rumbling a bit here? Does any of this make sense?
Tommy: Yeah, I know. It makes perfect sense. You've already told me this before.
Christopher: Okay. All right. I'm really keen to know. So, if people listening to this, if they think it's a terrible idea or if they think it's a good idea, then please do let me know. And if you're kind of indifferent, I guess you don't need to say anything. But I will only know if you tell me whether you think it is a terrible idea or a good idea. Anyway, let me explain how this could work for health coaching.
We know we've got this problem that it's very difficult to have somebody execute some behavior change and we know that I have lots of changes that I'd like you to make. So, imagine if we were to sit down on Skype or on -- I have this new platform called Zoom now which is pretty awesome. It allows me to share my screen and so I can just show you what I can see. I can draw on your test results. It's really cool platform. Zoom is the name of that. It's really good.
And then imagine there was a white board and this white board is divided into four columns, four vertical columns. So, picture that right now. So, white board, four vertical columns. And in the far left, the column is labeled "to-do." And then the next column along is labeled "doing" and then after that you've got a "review" column and then finally "done." What I would do is I would start with your overarching goals.
So, maybe as a marathon runner, you want to qualify for Boston and that's the whole point of you working with me. So, what I'm going to do is break that down into sub-tasks and maybe one of those sub-tasks would have something to do with your sleep. So, maybe you'll tell me you're not sleeping well. Maybe I've done a test result that shows you're not producing much melatonin. And I know that in order for you to recover better I'm going to need you to sleep better. And so you may be complaining about the sleep a little bit but it's really a huge problem for your overarching goal which is to qualify for Boston.
So, what we're going to do is we're going to break that down into a sub-project called Awesome Sleep. And then I'm going to take from my Protocols file that already exists, like all these tips and tricks I've got I know really help people with their sleep, and then I'm going to write those down on virtual. So, they're not real post it notes but you get the drift. Like I'll write each one of those things as little tasks on a post it notes and then I stick it on your white board in the to-do column. So now maybe you've got things like eat dinner earlier, because we know that the time of day that you eat food that affects circadian rhythm.
And then the same with hot and cold. So maybe your bedroom used to be cooler. And then maybe the blue lighting. So maybe you're wearing the blue light blockers or maybe you just need to stop watching the TV so late at night. Anyway, there's all these little sub-tasks and I stick those little sticky notes in your to-do column. Then we have what we call a [0:43:52] [Indiscernible]. So, we're locking heads. We're kind of deciding which of your sticky notes are going to be, which is the most important thing to work on first. And then we set a to-do date and then I say, "Go, just do it."
And then you can like take each one of those sticky notes and it says something like, "Buy blue blocking gases from Amazon." Well, that's easy. I can just go onto Amazon, buy the blue blocking glasses and then I can move that sticky note from the to-do to the done. Like I don't even need for you to review it. So, maybe I've got something more complex and I was thinking specifically of Julie where she works with food diaries for three days, only for three days. So, she'll have the person log their food for three days and then when the person has completed that, they'll put a sticky note in the review column.
And then Julie would know to go back and look at that person's food diary and then maybe she'd put a sticky note back into the to-do column or maybe she'll say that task is now done. And so, rather than this being some hideous overwhelming totally unfathomable project that nobody can really get their head around, now suddenly we've got these little boat size pieces and these little sticky notes that we can drive between columns and having worked with this system myself recently, it works absolutely fantastically.
[0:45:03]
And the thing I love about it the best is you can helicopter in somebody else and they'll know exactly what's going on. So, it's not just me doing this diet and lifestyle coaching. It's also Amelia. It's Julie. And then in some instances it's Tommy as well. You think when Tommy first comes and opens somebody's file, he's like, "What the heck! I don't know what this person is being asked to do. I don't know what they've done. I don't know what they should do next."
And it's a massive job to try and get up to speed with all of the person's history. Whereas now, we have this virtual white board with all the sticky notes on it, Tommy could then say, "Okay, I see he's asked him to check his blood glucose and that is now done and here are the readings. I can see that he's asked him to get to bed earlier and that's now done." So, there's a way. The system is stateful. Yeah, I think it's an awesome idea. I know that Tommy thinks it's good.
But I don't know what you think. So maybe I'll just put a one question survey and link that in the show notes for this episode and the question is: Do you think this is a good idea or not, yes or no? So, it would really help me out if you were to just do that one question survey then I'll know and I'll go away and build this thing. I think that's going to be fun actually, really fun. I think the athletes will like it as well.
So, if you're an executive, an athlete, I think you probably enjoy ticking boxes, right? I know that training plans are very popular. People program a training plain in TrainingPeaks even though the person who is programming it has no idea how you're going to feel on that day and whether that is really the right workout for you to do on that day. Athletes do love that stuff. I used to love that stuff. And the reason is I like checking boxes. I like going out and doing exactly what it says on the calendar and then saying, "Yeah, that's done now." And so that's what this Agile system of health coaching enables us to do too. I think it's going to be popular but, yeah, please do let me know. So, should we talk about how much this stuff cost? I think it's time.
Tommy: Yeah, certainly.
Christopher: I've done a lot of these podcasts and I talk a lot about the testing a lot and I've just done a podcast with Dr. William Shore on organic acids and that was fantastic. We talked about the cost of an individual test which is around $400, it was for the organic acids. And I came clean and talked about in public how much this stuff really costs because I think I've been setting the wrong expectation that maybe causing both me and other people disappointment and kind of problems down the road. How much do you think? All this stuff we talk about, the diet and life style coaching and all the testing and the supplements and all of that, how much do you think that people are spending, Tommy?
Tommy: If they're paying for everything over, say if it comes a few months, it should be in the realm of thousands of dollars, $5,000 to $10,000.
Christopher: It's difficult because it is expensive. You're right. It is in the thousands range. It is a lot of money. But something I've been thinking about a lot recently, and Julie and I had been talking about this a lot, is the cost of opportunity. So, my story was I was lucky, really lucky that I was in this job at hedge fund and I had the most terrible brain fog and I would literally go a whole week without doing any work. And nobody said anything. They didn't seem to care. I guess, they found the proposition of managing me and the social awkwardness of that situation to be worse than me not doing any work and so they didn't really say anything. How crazy is that? But that's exactly what went down.
And so I was extremely lucky that I got into this job where it didn't really matter that I had a terrible brain fog and wasn't getting anything done. And then the same was true with my athletic performance. I'm on the mountain bike and I'm trying to win this mountain bike races and I really want to do well at that. And I'm no spring chicken. I didn't do my first race until I was in my 30s. And so how many more years have I got before I'm done?
I'm not going to be doing -- I don't want to be getting my heart rate up to 192 for two hours when I'm 70. At some point, my career is probably going to end not too long from now. And so, I think there's this cost of opportunity by not investing in this thing and sorting these problems out, I think you could end up like costing you more than if you didn't do anything at all. Does that make sense?
Tommy: Yeah, absolutely.
Christopher: And the other big one was getting married. So, not long after I found the Paleo diet and changed that up was I met Julie and Julie kind of, if anything, she accelerated that process by what she just learned at university. She was like, "Oh, yeah, you probably shouldn't be eating eggs because they're one of the most common food allergens." And I'm like, "Really?" I just started eating ten of them a day. And she said, "Yeah, you should not do that."
And she was right. That was causing me a huge problem even though technically it was Paleo. Julie helped me out tremendously. But before then, I'd always been single. And I'd always been kind of a dick to be around. There was definitely some kind of emotional thing going on there where I didn't really want any woman to get too close to me because I didn't want to them to know that I was actually a real dick.
[0:50:09]
It's kind of hard for me to say this but it's true. That's what I was thinking. And so I saw it myself out especially with Paleo diet and did this functional medicine thing that cost me a lot of money. But, yeah, what's the cost of opportunity? If I had not done it and was still eating my pasta and baking my own bread and all that kind of stuff, would I still be sat in the studio apartment in San Francisco, age 40, still single, no Ivy? I mean, that just sounds unfathomable, isn't it? I can't even imagine what that would be like now.
But, yeah, I know. So, we've done, we've sat down and we looked at some of the numbers. Tell me if you think this is reasonable. My thought was, so if you're coming to me, if you're listening to this now and you've got some specific problems that you're dealing with, some health complaints, or maybe you've got this goal, this overarching goal that we talked about, like say maybe you want to qualify for the Boston marathon, I think you should do an initial round of testing, which is the urinary hormones, the DUTCH, the organic acids, the blood chemistry and two stool tests, because the stool tests kind of suck. They're not perfect. And so you have to do two of them to make sure that there's really nothing there.
I really can't recommend the stool test. Sometimes the Doctor's Data test comes up, sometimes it's BioHealth. I see another people have sent me this other test emerging, like the GI map test. People sent me their results and that's found something very significant like Entamoeba histolytica where I saw one last week that wasn't found anywhere else. So, yeah, I mean, the stool test are not perfect so I think you should do at least two of them.
And then for me to spend all of the time with you. So, if I spend six hours with you talking about your diet and lifestyle, we're going to project manage the whole thing, that initial [0:51:43] [Indiscernible] cost is about $5,500. But again, I think, when I see that number, I'm thinking, "Well, that's a mountain bike right there." That's about how much I spend on a nice mountain bike or a nice cyclocross bike.
Tommy: And in terms of, particularly if you're working with athletes, which a lot of them are, many people wouldn't blink at, or hopefully they blink a little bit, of spending $5,000 on a new mountain bike. But actually, if they want to go faster and then live a lot longer potentially, in terms of performance, they'll probably going to do a lot better from actually making sure their body is performing up to many rides rather than just making sure their carbon fiber is as low as possible.
Christopher: Yeah, absolutely. Absolutely. And it's kind of stupid. People just like shiny things. I'm no different. I'm not as bad as some of the equipment Master Baiter's out there but I definitely enjoy some nice carbon fiber. Like my wheels, the retail price of my wheels is $2,500 and I think I got a deal which was like $2,000 or something like that. And a lot of my equipment dates back to the days before I started my own business. Like the ultimate financial relief is to go get a job I think for some people.
Yeah, I know, definitely. I would almost guarantee. In fact, I would. I would guarantee that the round of testing and the Agile health coaching that I just described will make you faster. And I would be happy to refund the cost of all of my time if you're not completely happy after eight months. I would totally -- we do not have anyone that is not totally delighted after eight months. I'm really sure of that.
The only reason that it might go wrong is because you're not doing it. And so the behavior change thing is tough. So, maybe someone -- So, I'll tell you a scenario that's gone wrong in the past. Somebody with a weight loss goal, he feels like death. And then I get him feeling good. So now they're ready to do some weight lifting, be more a bit active. Not necessarily running or anything like that, just walking and then lifting weights. And that's where I lose him.
For some reason, I can't get him to lift weights. And so they kind of they stalled in their weight loss goal. That's the only kind of scenario where someone is not completely happy. But I see that almost as my problem and not theirs because somehow I failed to elicit the behavior change piece. It's not that I didn't have the right answer. I just didn't have the power to make them change their behavior.
Tommy: Or it wasn't presented in the way that then made sense to them or something along those lines.
Christopher: Right. And maybe I didn't set expectations correctly at the beginning as well as the possibility. I think people don't like having stuff sneaked upon them. At the same time, you can't talk about dead lifts to somebody that like can barely get out of bed in the morning. That's really mean. But, yes, there's that initial round of testing and then because I'm a kind of quantified sort of guy, I think it makes to redo all of the tests afterwards, right?
You do this maybe in the beginning, you did this initial round of tests and then you do some follow-up testing and then you see what's changed. And that is a powerful, powerful motivator. When you put in a lot of work to something, you've moved all those sticky notes around on your white board and you put a lot of effort into it and probably a lot of money, like doing the follow-up testing and having the confirmation that your levels of oxidative stress have reduced and your C-reactive protein has gone down and your fasting glucose is looking better and your liver enzymes look better and the cryptosporidium is gone, I think that is like a really powerful thing.
[0:55:12]
And then we should keep doing the retesting. But maybe I'm wrong about that. What do you think, Tommy? Do you think it's a good idea to retest?
Tommy: I think that's important but also because almost it adds a layer of both -- so you can confirm that things are working but often people will know they're working because they'll feel better. It almost gives a degree of accountability because if you know you're going to retest in six months, that doesn't really give you two or three months to not really do anything and then sort of half-heartedly do some of the stuff that had been recommended as part of the protocol be that improving sleep or movement or whatever, say treating something that's going on in the gut. So, it gives you that kind of, I think, both you can prove that it's actually something beneficial has happened but also you can get some accountability to sort of get on top of things as early as possible.
Christopher: Right. And I thought the accountability part was going to be huge with this Agile system of health coaching. So, we set a date. This whole idea of a sprint is sometimes called like an iteration and there's a deadline associated with it. So, there's all these sticky notes that are up on the white board and this is the deadline. This is where I'm going to get you back on the phone, back on Skype, back on Zoom, and we're going to talk about all the things that you're done.
And I'm not going to have to ask you what you've already done because I can see it there on the white board. So, I'll know. Like if the meditation thing is still in the to-do column, I'm not going to have to ask you that. I'm going to see it right away. I think there's a level of accountability. I certainly would feel accountable if I was on the flipside of that equation. And then, of course, that allows me to instantly drill down, "Okay, what is it about meditation? Do you hate meditation? Is there something else that we can do instead of meditation that's going to serve the same purpose?" And then get this sticky note out of the to-do column and into the done column.
Maybe that's true of weights as well. Maybe the person who's not had great results in the past doesn't enjoy dead lifting but maybe they really love TRX and TRX is good enough to get the job done. Yeah, I think that's a really strong accountability piece with this Agile system that I'm thinking about.
Tommy: Yeah, absolutely.
Christopher: So, what's happened recently with me is -- and I'm only telling you this because I think it might be useful for other people listening. I've continued to do tests on myself throughout this whole period that I've been in practice. And the main reason I do that is so that I can keep abreast of the latest and greatest in testing. So, I feel like at the moment in particular the stool testing is moving in very rapid pace. It's getting better and better all the time. And so whenever I see something new and shiny I want to do it just to see what it is.
I did another round of testing quite recently and I found a bunch of problems that I know cause people significant issues. So, I found a Blastocystis hominis infection. I found a yeast overgrowth. I found a clostridia overgrowth. I found a B6 deficiency and a carnitine deficiency. And I feel pretty good. I don't really know what good is. When you spend the first 30 years of your life feeling like crap then you don't really know what good is. And so I'm just going to fix those problems not really because I have any specific complaints but I know they may cause me problems in the future.
I sometime wonder that with people that come to us. Do you think there's any chance of that? Like when someone -- So, let's say insulin resistance, for example. If someone comes to us and say, "Well, I've just been diagnosed with type II diabetes." When do you think the insulin resistance started in that person, Tommy? Let's say, they're in their 50s now.
Tommy: There's some reasonably good data just from basic population to do a snapshot supposedly of a healthy population so you can actually see insulin resistance starting in their 20s or 30s. So, maybe somebody by the time they are full blown diabetes, type II diabetes, they've been hyperinsulinemic, was also high insulin or insulin resistant for potentially decades.
Christopher: And so that's why I think it's going on with a lot of this stuff is by the time you're showing a lot symptoms and you go to the doctor's office and get a blood test done and get a proper diagnosis, like the problem could have been nipped in the bud an awful long time ago. And so I think it makes sense to continue doing what I've done which is kind of yearly maintenance testing. So, I'm thinking once a year do a DUTCH, once a year do an organic acid, maybe do two blood chemistries a year, once a year do a stool test, make sure you've not picked up any bug at that last Iron Man competition. And so then that comes out about $1700 again.
Again, you're talking about -- it's like that set of wheels I talked about, a set of carbon fiber wheels per year. And that's going to get you a really nice sweep of test. And if I spend two hours teaching you what the results mean on Zoom or Skype then that's a bit more money.
[1:00:00]
And then maybe Julie does a tune up on your food diary once a year, just spends an hour or so. I see people typically spend about $1500 a year on supplements, seems to be a sort of ballpark figure, really depends on the individual. I bet I spend more than that. And so then that comes out to $4,000 a year of yearly maintenance.
These numbers, I'm not making them up actually. So, I run my own backends. The database is mine. I control it completely. It was written by me in Python. And so I have the ability to run queries, custom queries and find out how much people are spending on stuff. I think it's not a coincidence that the people that spend the most money are also the people that give me really great testimonials. They're like, "Yeah, okay, I'm fine. I'll come on the podcast. I'll give you, do a follow-up call that you can publish on your website."
And I'm trying to tease out whether it's like kind of -- I think part of the effect is people just want more of the same. Like if they think it's working really well they just want everything you've got. But I'm sure it's in part because they're doing all of it. They're using all of my tips and tricks and there's kind of the linear relationship between the number of things that you do and the results that you get.
Tommy: And there'll be a part of that, I think, money spent is almost a proxy for engagement in the process. So, we talk a lot about or you and I talked a lot about sort of offline about how if people don't actively engage in the process, then often that involves say paying somebody for their time to help you work through things. If you just sort of -- a lot of people will flit around, get information from various places, try things for maybe a couple of weeks or just get confused because people have conflicting advice and all that stuff and they never really engage in the process, and that's where you'd stall and don't really make any progress. That's not the case for anybody. Some people can just work it all out on their own and great, that's fantastic. But some people sort of need that process of actually engaging and then that gives you something to work with.
Christopher: Definitely. I'm really, really interested in this whole idea of behavior change, like getting people to actually do this. Because I feel like a idiot sometimes looking at this list of stuff and saying I can't give you all of that. This is just snowing you. I'm not going to get you to do all of this. But at the same time I don't want to hide it all from you either.
Tommy: I think that's hopefully -- I feel like something that we do very well is actually teach people how to figure out themselves. So when somebody is sent or their blood chemistry is discussed with them or their organic acid is discussed with them, you put it up on the screen and explain what everything means and explain how that works and why you might want to do something about it or why it's just part of a bigger picture and a bigger pattern and individual things don't matter less than patterns and things.
And actually, you're getting taught in the process how to debug yourself. So you kind of get -- you're being armed with that information for the future. It's not like this black box that you sort of turn up, get some test and we tell you to go and take some supplements and then come back and that kind of thing. It's kind of a process where you're taught how to look after your body at the same time.
Christopher: It's very different, yeah, from what I did. Exactly it was a black box. I was handed a Word document that had a list of supplements in it and I took them and I got better and that was it. And I was like that kind of inspired me to try and figure out what was inside the black box. And so I know that can work for some people. But I think if you're listening to this podcast, you're probably the type of person that likes to delve inside that black dot box and see how it works. And then, yeah, I mean, maybe. And that does happen.
Several people that I've worked with have gone on to become FDN practitioners or maybe they've done the Kalish training or we've got some people on our concierge clinical coaching group that are doing Chris Kresser's training. So definitely like the teaching part, I think, is really important and that's certainly what I aspire to do. And yet that knowledge, I think, can help you make better decisions so you don't need to get someone else involved. So, yeah, I think that's a really valuable thing.
Tommy: I think there's a lot of very good friends -- we've been on a podcast together, Chet Morjaria. He's a strength coach in the UK. And he always talks about the best coach should be trying to get him, work himself out of the job. If we do our jobs properly, we should be able to set you up over a period of time to kind of go run off and look after yourself and then we have somebody else who we can do the same thing with, right?
Christopher: Right. So eventually, with my yearly maintenance then, really I'm just acting as a vehicle for you to get the testing that you need and then maybe some accountability. So we're still doing the Agile thing. I'm still assigning you your task and you're still executing on that plan. But really the interpretation means to become less and less as time go by. And, of course, I will accommodate that as that happens.
Tommy: But then the important thing about the beginning of that is something that I know you have struggled with is making people pay you for the time you spend with them. Because the knowledge that you have to work with somebody is invaluable and pretty unique and people are often very willing to pay for tests and pay for supplements that run into the thousands of dollars.
[1:05:00]
And by supplements, when you say supplements, you also mean maybe a protocol to treat an infection or something like that. It's not just sort of supplements in terms of how we think of sports supplements.
Christopher: Right, exactly. Exactly. They would almost be taking the place of a prescription antibiotic or something.
Tommy: Yeah, exactly. So people are often very willing to spend money on that but then as soon as you actually ask them to pay for the time that it takes you to both work through their previous history and work through the results and explain them to them then all of a sudden there seems to be a bit of a block there. But out of all the things in that whole package, I think your time is the most valuable thing.
Christopher: Right.
Tommy: Because you can get a test from anywhere.
Christopher: I think the tests are actually more expensive on direct labs just because I'm not being paying attention to closely like what the retail price should be. Yeah, absolutely. Absolutely. I think in the beginning, I made, the mistake I made was I just didn't ask people to pay for my time at all. I was just so excited about what I had and just was so eager to share that I didn't actually ask people to really pay me at all. I just thought I'd make money selling supplements. And guess what, you can't earn a living in California selling vitamin C. That's not going to happen. You have to sell a lot of vitamin C before you can afford to pay your rent.
So, that was obviously an extremely flawed business model. And then more recently, what I'd been doing is just charging people for my time, an hourly rate, which is $250 per hour. But the reason that's still not working for me is because I only bill for a tiny fraction of the time that I have somebody on the phone or on Skype or on Zoom. So, I'll spend maybe some time doing some research if somebody has something specific to them that's going on that I've never seen before. Maybe I'll pay Tommy to do some research.
And then I construct the health plan in Google Drive and then we do a ton of backend support like getting the testing done and I have to employ a registered nurse to ask people's questions and all of that. And then finally, I get the person on the phone. And sometimes I'm able to explain the whole thing in like 30 minutes. And so I bill $125 or something.
Tommy: And even working for the best part of the day, if not the whole day.
Christopher: Exactly.
Tommy: Just not that half an hour.
Christopher: I know. So, I've been finding myself doing that all the time. Like I'll only have one call that day but I've really been working on that person's stuff most of the day even though I've only billed for an hour. So, that's the main reason that I've not been making money, I think. I mean, obviously, that's not sustainable. And I want to do bigger and better things that's probably going to take more time but will get better results like this Agile health coaching thing.
I think in the future that's what I'm going to be doing, is just billing upfront for the whole package rather than just dripping things on people as they go along. Like when you go to buy an airplane ticket now. Like do you wish to board the plane?
Tommy: That will be an extra $50.
Christopher: Yeah, exactly. So, that's what I'm kind of being like at the moment, like dripping things on. Well, we did this DUTCH test where we can see that your testosterone is low. We need to rule out you're having a gut infection. And so then there's this other test and then this other test, this other test. So rather than I just want to execute a plan from the beginning like do it all at once. So, yeah, the cost of that, I think, is going to be around $8,000. I haven't ironed out completely but I think that's what people are going to expect.
I want to tell people about that now because I think it's a change that's coming soon. And so, if you've been thinking about just ordering a DUTCH or an organic acid and just doing that one test by itself and then paying me to look at the results afterwards, then I would probably do that sooner rather than later because I'm not sure how much longer I'm going to be doing that kind of work because I just can't make a living doing it.
Tommy: Yeah. That's very interesting, to do that and to have that information. You're like, oh, that sounds interesting. I want to do it. But in reality, both you as in, Chris, you and whoever is working with you will end as a team who will do much better if people sort of do everything and do all the testing they need to do which isn't necessarily all the tests but do the testing they need to do, do everything they need to do and sort of have that as a plan to start with then you're much likely to get better results than sort of doing things piecemeal as they sort of sound interesting.
Christopher: And I think of the test as being like tools. So, if you're clutch were to go on the car and you just rolled your car into the shop, you wouldn't say to the mechanic, "I want you to work on my car but you can only use spanners. That's the only tool I want you to use." And then if that doesn't work in two months time we'll think about pulling out some socket sets. You just would never do that. Especially when you're an athlete and you just want to get it done.
I mean, we talked about the cost of opportunity earlier. You just want to get this done and move on. I think it's much better just to -- I see people get better results when they do all of the tests at once and, yeah, sure there's a chance like I said you're going to do two stool tests and there's a chance that you've just wasted $370 because one of the stool tests found nothing. But the cost of opportunity, I think, is worth it.
[1:10:01]
Tommy: And if this model doesn't work, then you can go work with Google and I'll go work for a big pharma.
Christopher: A big pharma, yeah.
Tommy: I'm sure they'd love to give me a job.
Christopher: Yeah, I'm sure they would too. I keep thinking about that. Like I try and stop myself from looking to see how much a software engineer's salary is in Silicon Valley at the moment and think about how fulfilling my work is. I do love it, actually. I hope that comes across in this interview so much. I love doing what I do right now. It is a hobby job. It's like so much fun.
Tommy: Yeah. We have a lot of fun. We haven't made any money yet but…
Christopher: Haven't made any money yet. I just love it. Like at the moment, I've got a photograph my [1:10:37] [Indiscernible], and she has given me her permission to publish on my website her little testimonial interview that she did with Julie because she's feeling so great. And that's awesome. That really motivates me to continue this work and we've done so many of those now, so.
Okay. So, thanks very much for your time. Please do have a look in the show notes this episode and you'll find that little one question survey if you think my Agile health coaching idea is a good one. And, yeah, see you in the next episode.
[1:11:07] End of Audio
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