Episode Transcript
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Speaker 1 (00:07):
You're listening to the Wellington Mornings podcast with Nick Mills
from News Talk SEDB.
Speaker 2 (00:13):
This morning, we are joined by one of the most
influential thinkers in global health, doctor Ezekiel Emmanuel. Now that
name might not ring a bell with you, but by
the time this interview's over, it will do, and you'll
be a fan. He's advised presidents, helped shaped healthcare reform
in the United States, and remains one of the most
outspoken voices on how we live longer and more importantly,
(00:37):
how we live better. He was part of the Joe
Biden's COVID advisory Board. He's also comes from one of
the most powerful families in America. His brother Rahman Emmanuel,
a former Chicago mayor, huge white House Lynx, and his
brother Aria Emanuel, who sits at the very top of
Hollywood power structures. This is an incredible family and we're
(01:01):
blessed to have Ezekiel on the show this morning. He's
working come to New Zealand to help us with our
healthcare systems for a couple of days, particularly the role
of AI. Now listeners to the show know how I
think AI is the future. His recent book Eat Your
Ice Cream is six Simple Rules for long and a
(01:23):
Healthy Life has just been released in New Zealand, and
when someone like Ezekiel arrives in New Zealand, we've got
to talk to him. Good morning, Ezekiel, welcome to Wellington.
Speaker 3 (01:32):
Well, thank you. I wish my mom could have heard
that introduction.
Speaker 2 (01:38):
You know, I just got to start by saying that
a family member of mine, because I was raving about
your interview on Q and A, tried to buy your
book for me over the last couple of days. There
is one shop in Auckland that's got it, and that's
all sold out everywhere else. Did you know that?
Speaker 3 (01:53):
No, I didn't know that. I signed about fifty copies yesterday,
so we'll make sure you get one.
Speaker 2 (02:00):
Tell me about advising presidents. You've advised presidents, You've helped
shape health care systems at the highest level. When you
look at a country like New Zealand, what do you
think we're doing right and what if we got wrong?
Speaker 3 (02:13):
Well? I think there's a lot to like in New Zealand.
You have a strong primary care base, although that needs
to be bolstered. The metrics are pretty good. You know,
the life expectancy is eighty two years, here. You've got
a very low smoking rate in the country, not very
many people. Only about three percent of people classify their
(02:34):
health statuses or so that's a very good base. There
are a number of reforms I think need to be made.
I think there has to be some grand bargain with
the physicians and probably other health clinicians. I will be honest.
I think the salaries are too low in this country
(02:54):
by a lot, and I think they need to go up.
But I think similarly the doctors need to be willing
to do more and work harder, and work most importantly
for outcome. So we need to evaluate not how many
patients did they see. That's not the real metric. The
real metric is how healthy are their patients? Is their
blood pressure under controllers, their diabetes under control, and things
(03:17):
like that. The other thing I would suggest strongly is
the healthcare system. You know, we often forget about the infrastructure,
both physical infrastructure and the human infrastructure needed to deliver healthcare,
and I think that's been ignored. I went around Auckland
City Hospital the other day, talk to the doctors, looked
(03:40):
in at equipment and things, and there are some vital items.
I was talking to a major cancer surgeon. My area
of expertise I breast oncologists. You know she doesn't have
a robot to help her with these very complicated gynecological
obarian cancer surgeries. That seems like, you know, a mistake frankly,
(04:02):
and something that needs to be remedied. Yes they're expensive,
but yes they also increase productivity because you can do
the job better. It increases the chances for patients to
get a cure. And the last thing I would say,
the third probably big reform, is you need to get
a dedicated funding source for your healthcare system. A levy
(04:24):
that specifically for healthcare doesn't go to all the other
items that are demanding in a budget. And you need
an independent commission to oversee the spending and the long
term planning. Healthcare can't be done in three year cycles
when the government's in power. That's just a mistake. You
need long term planning, You need to really think through
(04:47):
where the demands are, and you, frankly, in this country
need a better relationship between the public and the private arrangement.
I think there are lots of countries that can serve
as good models for that. Yesterday, when I was talking
at the NIV summit. I said, you know, one of
the easy comparisons for New Zealand is is Norway. Yes,
(05:09):
Norway's richer because it has oil. But your five point
five million people in a very large country with a
big rural population, very similar life expecting to these similar ideas.
And so I think looking at some of the models
out there, and Norway's not the only one. You can
look at the Netherlands or Germany, which all have strong
(05:32):
primary care focie, I think that would be very, very productive.
And I said to them, I was fortunate to meet
the Minister of Help and I said, I'm happy to
help and really focus on this, but you know there
are some improvements that could be made.
Speaker 2 (05:48):
Al dollar per person spend on health how does that
compete to the rest of the world. Do you know that?
Speaker 3 (05:56):
Yes, I absolutely know that. I showed a graph yesterday.
There's a line that depending on how rich you are
as a country, it really shapes how much you spend
on healthcare. And New Zealand's right on the line. And
one of the things I said is, you know, as
you get richer, you end up spending more and you
sort of go on the top side of that line,
(06:18):
and I think New Zealand could, I said this very explicitly,
spend about half a percent of GDP, which is about
one point five billion US dollars more on healthcare and
it would go a long way. That's about three hundred
dollars more per person. You spend about six thousand. Norway,
for example, spends about nine thousand, three hundred. We in
(06:38):
the United States are you know, stratospheric at a nearly
fifteen thousand, but you know, just a little bit more
spent wisely with as I mentioned, a deal to increase
productivity of the doctors for increase in pay I think
would go a long way in this country. But you know,
like everything, and you you know, you know, you have
(07:00):
to spend the money wisely, not just sprinkle it around.
Speaker 2 (07:04):
How do you what do you think about fomic Like,
I mean, we are so behind and summon you're you know,
I've had a personal experience with cancer of the family
member luckily survived it. But the drugs in New Zealand
we're just nowhere near the cutting edge, are we.
Speaker 3 (07:21):
So I'm actually a fan of the way Farmax goes.
I think one of the big again, this is one
of the questions that the country has to wrestle with.
You give it a finite budget and then you say,
you know, cover the drugs, and I think they do
a very good job under that circumstance. If the country
thinks that people think we need more drugs for things
like cancer, which are super expensive. I'm a cancer doctor.
(07:44):
I know these are super expensive drugs, then you have
to raise the amount of money. And I know that
the government has added six hundred million more dollars to
farm chs. But you know, one of the things that
I think stands out about New Zealand is the high
value drugs, the drugs that really do improve healthcare and
(08:04):
improve health outcomes. You know, farremus covers those drugs. It's
the lower value drugs that drugs said, you know, give
you a few more months on average, where I think
firemacs is more rigorous frankly and cuts the line. So
I think I think the country is going to have
to decide what's the amount we want to spend on
(08:25):
drugs compared to all the other demands in healthcare.
Speaker 2 (08:29):
Now, I love your stance. Sorry to interrupt, but I
love your stance on your own health. And I'm I'm
now going to be a follow over it if you
you've come out I don't know where or how, but
you've said that if your mind's not perfect, if you're
not going to you just don't want to live. You've
had your life and you don't want to carry on
if you're not one hundred percent? Am I right with that?
Speaker 3 (08:51):
Yeah? So I say, listen, I know what hell is.
Right from my standpoint, Hell is the heart's working, the
lungs are working, the body's really in great shape, but
the mind isn't you have dementia. I don't want to
be in that circumstance. And you know, the challenge for
all of us in the world is as we get
past seventy five, the rate of dementia goes up very
(09:14):
very fast, exponentially, and you know, by the early eighties
or third of people have some form of dementia. I
don't want to be that person. And that's my philosophy
of life. My children know it, my wife knows it,
and I think I think it's a reasonable philosophy. You know,
a lot of people have written me that they agree,
and a lot of people think I'm crazy, But I
(09:37):
think every person needs to figure out what their philosophy
of life is to lead a good life.
Speaker 2 (09:43):
I want to talk to you about AI. I'm a
huge fan of New Zealand. We are really struggling to
get our heat around it. We are really struggling with
some of us to trust it. Can we trust AI
in healthcare?
Speaker 3 (09:59):
I've just spent about the last six months really diving
into this question and writing and writing a lot that's
going to come out soon. I agree with you. I'm
a big fan of AI. I think it can do
many things better. That's not every AI. It's not just
go and get check GPT four point zero or whatever
it is. And there's things that AI has to do.
(10:21):
You need to train it on medical data. You need
to have guardrails for safety. There are lots of things
and the best AI and here there's a lot of
models out there, but the best AI is very good
at making differential diagnosis. What could this set of symptoms
be telling you here are the tests you need, giving
(10:42):
you a definitive diagnosis and based on the test results,
and then giving you the best care that doctors have
identified either through guidelines or research, and then helping to
manage a lot of chronic conditions. I think it is
AI ready for prime time today in some circumstances. Yes, overall,
it's going to be a few more years. But I
(11:03):
agree with you Nick, it is coming and you need
to be prepared. And one of the things I've said
to the leaders here is, you know, New Zealand can
either be a consumer of whatever AI other countries produce,
or it can be a producer and help refine the AI,
make sure it's safe and things like that. And I
urged or urged the leaders here in the in the
(11:24):
health field, you know, New Zealand has an opportunity. The
whole world is trying to figure out AI. New Zealand
could participate with companies and get into some of these
tests of AI. Especially it can be helpful in rural
areas where it's hard to get the doctors. There's a
lot of traveling. You know, AI over the internet can
(11:46):
get everywhere and at a very low cost. And I
think that's going to be for the future. And you
know I've been working with some companies. I should make
that very clear. We have one company in particular that
works with children who have developmental delays. And you know,
the results in other parts of the world are pretty amazing.
(12:06):
But I think, you know, a test in New Zealand
would be perfect. And I think there are lots of
companies like that that are really doing I think very
very good work are at the cutting edge. And New Zealand,
you know, you know, you guys came all the way
out here, right, you're intrepid. I think this is a
place to be intrepid.
Speaker 2 (12:26):
We're talking to Ezekiel Emmanuel and I had an ice
cream last night before I went to bed. Now, I
don't eat ice cream at night. I'm exactly the same
We're months apart in age, so I'm exactly the same
age as you, and I don't need ice cream at night.
Speaker 3 (12:45):
Well, did it give you joy?
Speaker 2 (12:48):
I was thinking of you and your slim buddy frame
and thinking how does he do it?
Speaker 3 (12:55):
Well, I'll tell you one thing is because you have
to do all of the wellness activities right. You have
to cook well and eat a good diet. And I
noticed in New Zealand there's a lot of fresh vegetables
and fruits here. It's fantastic. You have to, you know,
also exercise well, and I try to exercise. This morning,
I did twenty minutes of yoga and some strength training.
(13:18):
And the other morning I went out for a fifteen
mile bike ride, fantastic riding along the lake shore here
in Auckland. And we're about to go to Queenstown and
I expect to do some biking there and some kayaking
and hiking. Yeah, and you know, the most important thing
that is you got to be social, interact with your
fellow friends. And one of the great things I have
(13:40):
found in New Zealand is people are very friendly, very
happy to talk, and very interested in you, but also
interested in my trying to find out, you know, what
brought them to New Zealand. For example, why are they here,
what do they find exciting about New Zealand, What do
they recommend to me that I should do in New Zealand?
And I think that social interaction, you know, you notice
(14:01):
it here. I will tell you. Compared to the United States,
people talk to each other much less on the phones,
and I think that's a very good thing.
Speaker 2 (14:11):
I really appreciate you taking time out to talk to us.
I know your schedules here. You're only here for a
few days and it's very busy. I appreciate it. The
book is called Eat Your ice Cream. Six Simple Rules
for a long and healthy life. I will be buying
it as soon as I can. But I just I'm
really interested in your ideas. They're very similar to mine
with AI and health and longevity. So I appreciate you
(14:36):
taking the time this morning to speak to us.
Speaker 3 (14:38):
It's my great honor. Thank you for interviewing me. I
appreciate it.
Speaker 2 (14:41):
I have a great rest of your stay in New
Zealand and a very healthy life.
Speaker 3 (14:48):
Thank you, sir, you too. I hope you enjoyed the book.
Speaker 2 (14:52):
I will. That's doctor Ezekiel Emanuel, great pleasure by his book.
It's not an ad, but by his book.
Speaker 1 (15:01):
For more from Wellington Mornings with Nick Mills, listen live
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