Brad Gerstner：每年100美元的检测，或可挽救5万条生命

Okay, we are here at the All-In Summit, at an amazing trailer that Brad Gerstner brought. You bought this how long ago?

About a year ago.

Okay. So, Brad, tell us what we're standing—

Yeah.

—in front of.

1. The Heart Screening Moonshot

Yeah. So, we're standing in front of a mobile calcium CT scanner. Most of the folks who follow us on the All-In pod, the BG2 pod, et cetera, know that one of the moonshots I'm working on is that we have 800,000 people die in this country every year from heart disease. It's the number-one killer in the world.

If we turn the calcium CT scan into the mammogram for the heart, we will save 50,000 lives a year. That's like ending a Ukraine war every year in the United States. It will save the government $20 billion in care for people.

But most importantly, we're losing our most important friends, brothers, and dads at the prime of their lives to something that's totally preventable. This has a calcium CT scanner in it. We've had hundreds of people coming through here, and we've found scores over the last 2 days that most definitely have saved people's lives. It costs $100 and takes 15 minutes.

I lost my father too early, and my good friend here, Rob Goldberg, I want you to hear from him. This is the type of moonshot that we need to have. We're working with Washington. We want to get this covered by insurance so that we get 40 million people to take this scan.

Mammograms, which are super important in this country, have 40 million a year. CT scans, which are for the number-one killer, have 1 million a year. We need to have 40 million CT scans—

Damn.

—in this country every year. But, Rob, we're going to do a tag-team pod here.

Too much, Brad.

Yeah. You are a key inspiration. Your family was a key inspiration for me in wanting to do this, along with Jason Chang and the rest of the besties. Talk a little bit about how this touched your family.

2. A Preventable Family Loss

Thank you, Brad, and thank you and Jason for doing this and for showcasing it. My unfortunate connection to this is that my brother, a number of our friends, and I were on vacation for a friend's 50th birthday—another bestie, Phil Deutsch. That afternoon, we saw him. We were all hanging out by the pool, and then, at 6:00 or 6:30, we couldn't find him.

My sister-in-law and I started looking for him, and we unfortunately found him collapsed in the gym of the house. My adrenaline was going so fast, I couldn't tell if it was his heartbeat or mine. I just started doing CPR, and we unfortunately brought him to the hospital. He had been dead for hours because he had undiagnosed heart disease.

My sister-in-law is Sheryl Sandberg. She wrote a book called Option B about his death and about grieving. He had top medical concierge doctors. This is a really important point.

My brother had passed a running EKG 5 months before he dropped dead from heart disease—from undiagnosed heart disease. Unfortunately, EKGs have a 4% rate of either false positives or false negatives. He had done so much cardio that he taught his heart to overcome the heart disease, so it was pumping harder and harder and harder. Then, eventually, when we were in Mexico, it just stopped.

He died of ventricular arrhythmia. I gave the report: We found him next to the treadmill. He did not fall off the treadmill and die. He died of heart disease. Thankfully, due to Sheryl, due to Chamath, and due to some other folks, we were able to bring him back so we could do a full autopsy and find his heart disease. But it's—

And—

—truly tragic, and it was completely unnecessary. He was 47.

Yeah.

My niece and nephew were 7 and 10. They're growing up without a biological father. They have a great stepfather now. But, as Brad just said, we are losing people in the prime of their lives who have no need to die from something that is completely preventable and screenable.

And Dave was such a legend, so loved, and an inspiration in many ways for All-In and the bestie group. I mean, Chamath would say he was the original—who got everybody together for—

He might argue a few points with everyone onstage, but yes.

—to get together for poker. What better, more fitting way to honor Dave, but also to take this and say, “We can do something. We can be biased to action. We don't have to sit here as though we can do nothing. We have agency. Why aren't we doing 40 million CT scans a year? Why don't Americans know about this? Why are they all tracking their cholesterol and doing EKGs and thinking—

Right.

—or doing stress tests and thinking they're totally fine?” We've served people up some stuff that's just not accurate. This tells you dispositively: Do you have calcium in your arteries, yes or no? Calcium is a precursor and a predisposition to building plaque. You don't have a heart attack if you don't have plaque.

Correct.

To me, we started the Center for Heart Attack Prevention, and we have 3 missions with that. One is awareness. It's doing this, bringing a trailer so that more people talk about it and more people know about it.

I can tell you, while the scores are anonymous, we had scores from people who took their exam yesterday who are definitely in the danger zone. These people—

It's amazing.

No, here's the great thing.

Yeah.

Here's the great thing: A high score is not a death sentence—

Mm.

—because you can do something about it. Heart attacks are almost totally preventable. It's not like brain cancer, for which we don't have a lot of treatment. We can do everything with statins, with ezetimibe, et cetera. We can lower your ApoB, we can lower your LDLs, and we can get you on a path to heart health.

Number 1 is just awareness. Number 2 is making this more accessible to people. We need to have changes in Washington that make this the standard of care in the country. Cholesterol as a standard of care is ludicrous. We are way past this.

3. Why Cholesterol Missed The Problem

How did we get to that? Why is cholesterol—how did cholesterol become the key—

Yeah.

—marker? Where did we go so wrong?

If Bill Gurley were here—he is here somewhere—he'd say, “Regulatory capture.” Fifty years ago, heart health became a really national issue. I believe it was Eisenhower who had a heart attack in the Oval Office. There was a race in Silicon Valley to see who could solve heart health.

One path that people went down was to invent the stent. The other one was the calcium CT scanner. Who do you think won the lobby in Washington?

The stent.

The stent lobby won. They said, “Don't worry. Cholesterol is good enough to track. That's what we already do, and if you have a heart condition, we'll solve it with a stent.” Wrong. Wrong answer.

So here we are, many years later. My father died too early from heart disease, so I hijacked a session—the Science Corner—on the All-In Podcast in 2022. That's when I first started talking about this. Over the course of the last 3 to 4 years, we've made amazing progress.

Once I started talking about it, people went out and got their CACs, and I started getting hundreds and then thousands of letters from my dear friends to total strangers saying, “You saved my life. I found that I had…” I gave it for free at my investor day at the Rosewood Hotel on Sand Hill Road, and famous CEOs in Silicon Valley found 98% blockage and had 3 stents put in within 3 weeks of having the CAC done.

Wow.

This only costs $100. We have a live audience here.

I know we do.

So, I'm talking to the—

And they're going, “Who are you?”

It only costs $100.

Please, no.

It's noninvasive. It can be done in 10 minutes, and the fact that people don't know about this—

Yeah.

—is the highest ROI in health care, not only to the country, but to each of us—

Right.

—and to our friends. In our group, it's nonnegotiable.

Right.

Everybody has to get this. I appreciate your interest in this. To finish up on this, I say to my kids all the time—and this really inspired the Trump Accounts as well—

Right.

—we can sit around at the All-In Summit and talk about the problems. But what do we do in Silicon Valley so well? We start movements.

Do things.

We start companies. We do things. We have agency. We have a bias to action, and now we have a connection to Washington, D.C. You can bring these pillars of policy together, along with pillars of action and reeducation through podcasts and other things, to help people help themselves. I'm really thrilled you are here today.

I just want to thank Brad for having me, but more importantly—much more importantly—what Brad and Jason are doing. Brad, overall, whether it's Trump Accounts or this, is the epitome of putting words to action, thoughts to action, and passion to action.

And I just love having you out in the world doing more of what you're doing. It's amazing. My brother would love this, obviously, were he here. You're continuing to do this to help others. You have a day job, and it's a pretty important day job, and you're doing that one pretty well, too. To spend the time to go out and do this is amazing. I just want to thank you and call you out for it, and the Trump Accounts as well.

Yeah.

It's just helping people, helping future generations with health and wealth. This is amazing.

You're amazing. You know, I went to the heads of preventative cardiology at Stanford, Harvard, and Columbia, and they would start giving me their corporate speak.

Yeah.

And I said, “I don't want to hear the corporate speak. What do you do for yourself, your friends, and your family?” I would just push them on this. What do you do? Every single one of them said, “At 30 or 35, I have them all take a CAC. If they have a non-zero score, I get them on a statin. I get their LDLs below 40,” which is way below the national standards.

Oh.

The green zone in cholesterol, I think, is between 80 and 120.

Right.

So we would go get our cholesterol test, and it would say that we're in the green zone. I was in the green zone at 100. You feel good. You talk to your general practitioner, and they're saying, “You don't need a CAC. You're good. You're in the green zone. You run marathons. You do whatever. You're in incredible health.” Wrong.

Right.

Take control of your own heart health, right? It's the number-one killer in this country for a reason, because we're complacent about it.

Right.

If we're not complacent and we turn it into the mammogram for the heart, we're going to have a transformation in heart attack prevention in this country, and we're on a mission to see that through.

4. Making Heart Screening Standard

So I have to ask, because with many new health protocols or treatments, and just testing in general, people get afraid of it. People might be afraid to know the results. They might be afraid to do it in general. How do you help break down those barriers, and how does this get brought into the standard of care for doctors?

Yeah, no, it's a terrific question. I find that increasingly, because people have Oura rings on and Apple Watches on, we're breaking down the barriers to health data. People now want health data. Of course, there are those people who say, “I don't want to have the information.” I always say to people, data is power.

Right.

If you get information and you can't do anything about it, that's a real bummer. This, you can totally do something about, right? If you have 98% blockage, you get stents. If you don't have serious blockage, then you can get on a statin to reduce your LDLs, reduce your ApoB.

So because there is that power to do something about it, I find that many, many people want to do it. We have our tech over here who came all the way from Florida. He's also got 4 kids who each got their Trump account. We hooked them all up with $100 in their Trump accounts yesterday. But this guy knows what I'm saying: when people come here and are empowered with that information, they can now take action. They can now do something about it.

But yes, that's part of our mission. We have to explain to the country that there is nothing unsafe about this. This is effective for mass screening. I've met with Dr. Oz several times. I've talked to many leaders on Capitol Hill. I've talked to many people in the White House about it. I think by the end of this year—knock on wood—I think CAC scans for diagnostic purposes will be approved and covered by Medicaid and Medicare. If that happens, then that's how it becomes a standard of care.

Mm.

Because doctors ultimately practice according to the standard of care based on what's covered by insurance.

I was just going to add that people being afraid of the results and afraid of testing—it's like, why do you wear a seatbelt? Why do you eat anything healthy? Why do you have greens? Why do you exercise at all? If you're trying to preserve your life, this is literally one of the few tests where the alternative is death.

Yeah.

It's not just, “Oh, I'm going to live 3 months longer when I'm 90.” This is literally—you could drop dead if you get a negative result, and if you get a negative result, you can still fix it. So it's: take the test and hopefully survive.

Right.

A lot of people have asked me, and we could go through all the common questions.

Yeah.

One of the number-one questions I get is this: “Should I take the calcium CT scan or should I take the angiogram?”

5. Choosing The Right Heart Scan

The calcium CT scan—you’re in and out of the tube in about 2 minutes. It's not invasive at all. The angiogram puts dye in your bloodstream so that they can see more specifically the level of stenosis in your arteries. They can see the soft plaques, et cetera. That costs well over $2,000, and it's a little bit invasive. So it's not really needed for mass screening.

What I would recommend to people—and again, I'm not a doctor, and some people who are doctors think I have no business talking about this—but I'm an analyst. I can read all the information. By the way, I think we've been misled by the medical community about not doing this.

Correct.

My answer is: take the CAC if you're over 35. Obviously, if you have any family history or high cholesterol, then it's a must, must, must-do. But I would do it as a preventative measure anyway.

If you have a non-zero score, which demonstrates you have a propensity to gather plaque, then I would say take the angiogram. The angiogram then gives you a lot more information about soft plaques and the level of blockage, if any, in your arteries. Get a baseline.

Now we have great AIs, like Cleerly and other services that can sit on top of this. They're radiology AI systems that give you really refined readings. I did the Science Corner 3 years ago. I'm going back in on Friday, and I have almost no plaque, almost no stenosis, but I'm going back in on Friday. I'm having another angiogram just so I can biohack myself and share.

I shared on Twitter a picture of my heart through Cleerly, so that everybody could see exactly my level of stenosis. I will reshare that again after my angiogram on Friday.

That's wonderful.

Because there's nothing to be afraid of. Data is power, and I know because of all the messages that we've received, we've saved hundreds and hundreds of lives. If you save 1 life, it's enough. But the fact of the matter is, if we can get this done at scale in the country, the mammogram for the heart will save 50,000 lives a year.

Incredible.

Yes. Thank you.

Thank you both so much. I really appreciate it. Where can you find the trailer next?

Oh, so that's a great question. We bought this trailer because I was frustrated with all my friends in Silicon Valley saying, “Where do I get one of these?”

Yeah.

I rented a trailer for my investor day at the Rosewood.

Mm.

That was too much of a hassle, so I said, “Let's just buy one of these.” Then we had this idea that we could take it to companies around Silicon Valley, and we could do a buy-one, give-one.

Mm.

We could get Marc Benioff at Salesforce to give it to all of his employees for free, and then he would pay twice as much. So instead of paying $100, he would pay $200. Then we could go give free CAC scans in East Palo Alto and other neighborhoods where they couldn't afford it or they were afraid of it or whatever.

Now we have lots of companies in Silicon Valley. I don't want to dox any of the companies that are doing it. But I would say major companies in Silicon Valley are doing the buy-one, give-one. We did it with the NFL when the Super Bowl came to San Francisco.

Oh, wow. Yeah.

So, yeah, we're moving it all around, slowly but surely. I have a tentative agreement to take it to Capitol Hill and to give it to all members of Congress.

They definitely need it.

I know. By the way, I probably now am responsible for 40 or 50 members of the House and the Senate having taken the CAC scan, and I can tell you that they are a target-rich population.

People are dismissive of it until they find something or their family finds something, and then they become very devoted because they know that this is a lifesaver.

Amazing. Okay, well, thank you guys so much.

Yeah, it's so great.

It's great to learn more about this. I really appreciate it.

All right. Great. Thank you.

Appreciate it. Thank you.

I'll follow you.

Okay, great.

What's up, buddy?

All right, we're going to go—

Thank you so much.

Hopefully that was good.

6. Inside The Mobile Scanner

Inside the CAC scan. Well, maybe he will.

Okay. Here, you stand over here.

Okay. Prenuvo scan.

Yeah. It's great. Stand there. Yeah.

So I spent a long time—

Yeah. Right, right, right, right, right.

In a machine.

But by the way, Molly, we're in here. You said you did a Prenuvo scan, as I did.

Yeah.

Prenuvo scans take a long time, a lot of banging, et cetera. Remind us, how long are you in the tube here for the calcium CT scan?

Yeah, for the cardiac scan, you're in here for maybe around 5 to 10 minutes—

Right.

Tops.

In the trailer or on the bed?

In the trailer.

So how long are you on the bed for a calcium scan?

On the bed for 5 minutes.

5 minutes. So this is in and out, no noise. You get your results very quickly, et cetera, like I said. We can come in here. I mean—

All right.

This is pretty standard equipment. Siemens CT scanners—calcium CT scanners—have been around for a long time. Proven technology. We're now deep into generations of this technology. There are newer ones even than this one. But the reality is, you can run in and out of this. How many of these can we do a day?

So yesterday, in about a 9-hour window, we did 33.

Yes.

So that was 33 lives.

Exactly. And the results yesterday—we haven't shared them yet, so anonymously—but it looked like a distribution of the population writ large.

Yeah. We have men, women, old, young.

Yes. And some who have higher scores and some who have lower scores, like a distribution of scores.

Yes, a wide distribution.

Right.

Some were severe, and some had none.

Right. And so, with a calcium CT, zero means that you don't have any calcified plaque. Now, that doesn't mean you have no plaque, right? Because this does not read soft plaque. But what it does do is, when you get soft plaque, it calcifies, so it's a good indicator as to whether or not you are part of the population that is gathering plaque.

Some people criticize me and say, “Oh my gosh, you're telling people they're 100% safe.” No. In life, you are never 100% safe, but you get 90-plus percent of the way home by doing a CAC scan, and it's something that everybody can do. As you heard yesterday, we had some people who took it. I'm sure they had no idea they had severe scores. We'll share that information through a cardiologist.

The way this works is, we give them their CAC scan. He shares the scores with cardiologists, who will then call the patients, and they will work through whatever they need to work through. But—

So how often should you be doing this, and how often—or how long—does it take for meaningful buildup to accrue?

It just depends. Age has a huge impact on it. A 30-year-old is less likely to have plaque buildup, but if they do have plaque, it's a lot more telling because that means they're gathering plaque early. A 50- or 60-year-old is much more likely to have plaque, but we can tell by the quantity of plaque whether it's a problem or not.

The reality is, a lot of Americans—we just know it's the number one killer in America, okay? It's not like we're trying to create scare tactics for something that doesn't exist. This kills 800,000 people a year. It dwarfs the number of people who die every year from breast cancer, which is devastating, but I think we have about 40,000 people a year die of breast cancer. 800,000 people die of heart disease, and yet we have 40 times as many mammograms as we have calcium CTs.

I think breast cancer screening and mammograms invented the playbook for preventative medicine, and I would like to copy that playbook for heart health. If we do the same thing, we're going to save a lot of lives. It's very, very preventable.

Dr. Mark Hyman and Dr. Sanjay Dixit actually brought up longitudinal data. To your point, one scan is great. Having some more in the future—3 to 5 years down the road, depending on your score, depending on your genetic outlook, and depending on your lab values—is important.

The pastor at my church had a father whose labs looked great. However, he had a massive, massive heart attack, completely unknown, and he never had one of these done. So going simply based on labs isn't enough, but having that longitudinal data based on genetics and labs is critical. It's very important.

7. Why Cholesterol Tests Fall Short

I feel like the thing to overemphasize is that you cannot rely on cholesterol data or traditional data alone, because I brought this up to so many people. I've told my dad about this so many times.

Yes.

I'm a health nut. I'm like, “Dad, you have to get the calcium scan.”

Yeah.

“You have to get the calcium scan.” He's like, “Oh, my labs are fine.”

Yes.

“I'm good. I just went to the doctor.”

Yes.

“I did a full workup.” I'm like, “It's totally different. You have to get this done.”

Yes.

So, to overemphasize that, what did we miss with cholesterol and traditional health analysis?

I have a great tweet on this that shows the red, green, and yellow of cholesterol. It turns out that half of the people who have heart attacks every year have cholesterol in the normal zone.

Wow.

Half of the people who have heart attacks every year have cholesterol in the normal zone. So the fact of the matter is, if you have a nonzero score, that means I have a predisposition to gather plaque. Then cholesterol becomes very important because that is the agent that carries the plaque to my arteries.

If I have plaque, I want to get my LDLs below 40. Remember, I think I told you the standard zone is 80 to 110 or 120, and so getting it below 40 is new information. Not a lot of cardiologists 5 or 10 years ago were saying this, and frankly, we didn't have the mechanisms to get it below 40.

But if you talk to the heads of preventive cardiology today at Stanford, Harvard, or Columbia, that's exactly what they would tell you to do. I'm not saying that all doctors are involved in a grand conspiracy by telling us to track our cholesterol. What I'm telling you is that the evidence on the street—that 800,000 people a year are dying of this—tells you that that's not enough. If it were enough, then we wouldn't have all these people dying.

Mm.

Do this as well. Even if you don't have insurance, this costs $100 out of pocket. Give up some Starbucks. Do what you need to do. Go talk to your friends. Get the $100 so that you can get this done.

It's far worse to have a dad or a mom die, and then look back at that and see how preventable it was. I've said it's a dumb way to die. Heart attacks are a dumb way to die because they're preventable, and you can do this.

I asked the head of preventive cardiology at Stanford, if everybody does this, are we going to eliminate all heart attacks? He said, of course not. But you'll eliminate 80% to 90% of them. You can eliminate 80% to 90% of the number one killer just by doing simple scans. So thank you for bringing attention to it. I really appreciate it, Molly.

Happy to. Incredible work. Keep it up, honestly. Between this and the Trump Accounts, we can't—

Let's go. Moonshots.

We can't talk about it enough.

Moonshots.

Real moonshots.

Yeah.

Thank you.