00:00:00
our first big story and we've got to get to it uh is a uh a Wall Street Journal piece it's a new piece that came out
00:00:06
last night um Elon Musk has used illegal drugs worrying leaders at Tesla and SpaceX the article cites people close to
00:00:13
musk who say his drug use is ongoing that includes board members it feels like and and one one name specifically
00:00:19
but it looks like they were all talking particularly the ketamine and there are concerns it could cause a Health crisis
00:00:25
or damage the business uh musk has a lot of business um with uh with the government and he is already I don't
00:00:32
know if he was sanctioned but he had to do drug tests after he smoked weed on Joe Rogan this is seemingly more serious
00:00:38
and it's interesting that um you know this has been around we've talked about it uh Ronan phoh wrote about it like
00:00:44
lots of people have cited this issue not so much in Walter isaacson's book uh which it should have uh had more about
00:00:51
it um but it's a it's sort of an Open Secret about this and the Wall Street Journal obviously has lawyered up to to
00:00:58
be able to say this um in a minute we're going to bring on uh my brother Jeff swisser to help us talk through this one
00:01:05
uh just first reaction Scott and that I'll bring on Jeff First Reactions look I we talk a lot about substances uh the
00:01:13
majority of people I believe who use substances manage them and I'm not an anti-substance person but um along those
00:01:21
same lines there's just no free lunch and when I saw um when I saw Elon Musk in that interview at the times dealbook
00:01:29
I'm like he's [ __ ] up yeah and and there it all comes back to one saying what I tell young people around their
00:01:38
use of substances is there's just no free lunch there and what I have and I'll stop here but the thing that really
00:01:44
struck me was when I was in Aspen this summer um I was alone and I was bored and a friends that I have a bunch of
00:01:50
friends there and we all went to dinner like 12 of us bunch of total players and
00:01:55
technology and private equity and we went to this lounge and I said said what can I get every when I'm headed to the
00:02:01
bar and they said and this guy goes they all kind of nodded or laughed and said we're all on ketamine and I thought oh
00:02:08
my God everybody this is like six men Six Women and the tech The Tech Community likes to believe they have
00:02:14
found a free lunch and and we said this before no repercussions like no such thing there's no such thing I haven't
00:02:23
found it yet maybe caffeine caffeine's supposedly the closest thing to a free launch but I haven't found it I'm sure
00:02:28
I'm curious with Dr swisser thanks yeah we'll bring him on it was interesting because you know this was the holiday
00:02:34
season this came out um where he has some time off um I had heard rumors there was rumors running around Silicon
00:02:41
Valley that they had him in Hawaii last year same thing um and obviously he's talked about it let's be clear he's
00:02:48
talked about his use of ketamine he's talked about his mental health issues um obviously smoked weed on Joe Rogan and
00:02:54
nothing wrong with that except he has government contracts which is is a big problem and I think away from his own
00:03:00
health which makes you worry um because there's been history of a lot of tech people like this getting into real
00:03:06
trouble like Tony Shay um and uh you know I think it's been an ongoing discussion among and between people in
00:03:14
Silicon Valley and this one example in the piece was him being incomprehensible during uh a SpaceX meeting um and I
00:03:22
think you're right that interview I I looked at it and I thought what he's on something I mean I I don't have any
00:03:30
reported knowledge of it but it really was such a bizarre um interview it seemed either mental health or something
00:03:36
else was happening anyway we're not experts so we're bringing on my brother Dr Jeffrey swisser to help us talk
00:03:42
through this one hey Cara how you doing in the house by the way whose idea whose
00:03:47
idea was it to bring on the good doctor whose idea was it you you it was not my idea it was your idea but it's a good
00:03:52
idea thank you Scott and it's good to see you when it's not Scott free August and uh it's fantastic you look great man
00:03:58
um I do Cara I do have unfortunately one Scott joke for you so Scott a Scotsman goes to the doctor's office right and he
00:04:06
goes into the doctor and he lifts up his uh Kilt and he says Doctor I don't know
00:04:10
I think I'm going crazy and the doctor says I don't know about crazy but I can sure see your
00:04:17
nuts oh is like oh is like swi oh is like SC Scott are you on ketamine Jeff cuz that's what it sounds like no you're
00:04:26
not a ketamine user explain I you use ketamine ketamine uh let me talk to you a little bit about ketamine so ketamine
00:04:33
is what's known as a dissociative anesthetic and that's really important to understand you know what it does it
00:04:39
it dissociates you from essentially reality um it was first uh synthesized in 1962 the year you were born Cara and
00:04:48
um it um was FDA approved in around 1970 for use in anesthesia um and I use it uh really pretty much on a daily
00:04:58
basis it's a very very useful anesthetic and in fact the World Health Organization lists it as one of the you
00:05:04
know invaluable drugs uh in the world it's really good because it has a lot of um beneficial effects from an anesthetic
00:05:12
standpoint it's not a respiratory depressant uh in usual doses it's not cardiac depressant um in fact it
00:05:19
slightly increases blood pressure and heart rate and it doesn't uh blunt Airway reflexes so it can be used uh in
00:05:26
a prehospital setting let's say in the emergency room to sedate children uh I use it as an adjunct anesthetic uh I use
00:05:33
it to because it helps uh decrease the amount of opiates I use in the operating room uh I use it for procedural sedation
00:05:40
if I'm going to be doing something painful uh let's say a regional anesthetic block of the upper extremity
00:05:45
I will give somebody you know 30 or 40 milligrams of ketamine and it allows them to actually participate but
00:05:51
essentially not be there um in the sense that they feel calmer right what's yeah
00:05:57
actually they do they do you know depending on the person they do sort of you know leave their their body in a
00:06:04
sense in fact some people describe aaman experiences similar to a near-death experience where they can actually see
00:06:11
themselves let's say floating above their body um I the best description of ketamine from a patient that I ever had
00:06:18
was uh he told me afterwards he says imagine that you're driving a car toward a beautiful sunset and the Grateful Dead
00:06:24
is playing on the radio and it's a fantastic wonderful day uh with the breeze blowing through the window now
00:06:30
for a second imagine that you're not driving the car but you are the car and you're driving and all of a sudden
00:06:35
you're not driving the car you're a passenger in the car and uh and that's really a really great description of
00:06:40
ketamine people describe a feeling of melting you know you've heard the expression khole um K people sort of
00:06:48
fall into this kind of warm molasses pit when they're on it and it's a very pleasant experience for most people not
00:06:54
everybody some people do get you know you know frightening dreams Etc on it for most part it's a great anesthetic
00:07:01
short happen with surgery where they get dreams or anything oh yeah all the time
00:07:05
I mean people describe you know one of the most common uses for it is um when I'm doing let's say a little old lady U
00:07:13
with a hip fracture and it's very painful to put someone on their side uh to do a spinal anesthetic so I'll give
00:07:20
them 10 or 20 milligrams of ketamine and they love it I mean they wake up afterwards and they say that's the best
00:07:26
experience I've ever had so it's a very euphoric drug and I can understand why people would use it for recreational
00:07:32
purposes uh not that it's safe to do so um because talk about it in a recreational
00:07:39
context out outside of the medical context and that is my understanding is in contrast with alcohol or opiates it's
00:07:45
not physically addictive but it can be psychologically addictive and that's exactly right what we were saying before
00:07:51
is that Tech Bros or the Tech Community or just successful people in general like to believe they found a better
00:07:59
blueberry or a better solar panel like their Tech their diet is better and I have found the same thing is true here
00:08:08
that people feel that ketamine is a safer High talk about it in the context of addiction and you know recreational
00:08:17
use sure so you know ketamine a it's widely available it's very inexpensive to make and therefore you can get it
00:08:24
fairly easily uh on the street um it is a you know relative ly safe drug in in the sense that you know as opposed to
00:08:33
methamphetamine which can be really dangerous if you have you know you know cardiac issues ETC or cocaine um the the
00:08:41
problem is that like any recreational drug uh people tend to binge it uh they like the feeling of it and then they
00:08:48
need to start upping their doses um of ketamine and I mean you know the really unfortunate situation that happened
00:08:54
recently is Matthew Perry um and Matthew Perry was legitimately getting therapy with ketamine for depression and we can
00:09:02
talk about that if you want at some point but but the uh the problem is he he also was using it recreationally and
00:09:09
and he also had other substances in his body on the Corner's report yeah so the piece quotes uh an attorney uh for musk
00:09:16
saying that he is quote regularly and randomly drug tested at SpaceX and has never failed a test but we don't know
00:09:23
can you talk about and the attorney said there are other false facts In The Wall
00:09:27
Street Journal but didn't have any details so um this is Alex SPO who who is sort of musk's lawyer front man but
00:09:35
um what do you how do you think about drug testing on this on this kind of thing well you can there are ways of
00:09:42
testing for ketamine the the metabolite it's metabolized by the liver and there's several metabolites of ketamine
00:09:47
which are detectable uh it's cleared uh by the liver but it's excreted in urine and feces so you can certainly test for
00:09:53
it uh the problem is it's a fairly short acting medication and um uh it depends when you use it and what the levels are
00:10:01
clearly with Matthew Perry for instance they had it immediately because you know
00:10:04
he wasn't metabolizing anymore after he died but um but for people who are using
00:10:10
it you have to catch it fairly soon after they use it to detect it uh which is one of the reason Scott uh you
00:10:16
mentioned that I think a lot of these uh Tech Bros and stuff are using it um but
00:10:20
you know great caution because dosing is very important the other thing about ketamine I want to mention is that it
00:10:26
can be given via a variety of routes uh so you can inject it intravenously you can subcutaneously inject it you can
00:10:33
intramuscularly inject it you can snort it you can swallow it you can put it up your behind if you want uh there's a lot
00:10:40
of ways of taking ketamine and so it's very um bioavailable as put it that way you know intravenously yeah bioavailable
00:10:48
100% intravenously down to about 50% if you take it orally or or sorted it's about 50 to 70% how do most people when
00:10:56
you you give it you do it intravenously because you're in an operating I do both
00:10:59
people recre when I give it I give it intravenously and intramuscularly it's a very useful drug let's say if you have a
00:11:06
person with a um you know severe mental disorder who is combative uh prior to anesthesia and I want to start an IV uh
00:11:14
I can give people intramuscular ketamine in that situation uh and it takes a little bit but then they'll sort of fall
00:11:19
asleep but usually I give it intravenously but I think most people who using it recreationally are probably
00:11:25
snorting it snorting it okay so um let's talk about the Matthew Perot you were referencing he the the corner said he
00:11:32
died from the acute effects of ketamine um uh he was on ketamine infusion therapy as you noted um talk a little
00:11:40
bit about these therapies because you know I I'm about to interview Joe Green tomorrow there's a lot of people trying
00:11:46
very hard to replace opiates and other things with ketamine and other psychedelics um is it is that
00:11:54
problematic or is just the abuse problematic um I I think it's the abuse a problematic I mean ketamine um for for
00:12:02
depression is an off-label use I mean and not that off Lael uses are wrong in fact we we every day doctors use
00:12:09
medications in an off-label manner it just means it's not FDA approved for that indication um they actually did
00:12:15
make a what's called an an Anan of ketamine uh called esketamine which is a nasal spray which was approved by the
00:12:23
FDA I think in 2019 uh it's called spado and that's that that was the indication for that is
00:12:31
depression and it's and as I said it's a mirror isomer of ketamine it's the same
00:12:35
drug but the mirror isomer of it um but ketamine clinics have popped up like Kudzu you know all over the place and uh
00:12:43
it's very very expensive I mean thousands of dollars for uh a couple sessions of injecting now keep in mind
00:12:49
that the injection of ketamine in these clinics is a very small dose it's typically a half a milligram per
00:12:55
kilogram so usually 30 to 40 Mig in used over about a 40-minute period that's not
00:13:01
a lot it's not a lot to get you super high um a little dissociative but not super high when you're using it
00:13:07
recreationally you know who knows how much people are using they you know you can't really regulate your dosage right
00:13:13
now now one thing Elon tweeted about ketamine last June depression is overdiagnosed in the US um but for some
00:13:19
people it is really brain chemistry issue he went on to say zombifying people with
00:13:24
ssris uh for sure happens way too much from what I've seen with friends ketamine yeah my best some of my best
00:13:30
friends use ketamine ketamine taken occasionally is a better option um how do you when you hear him say that I mean
00:13:37
a lot of people have problems with SSRS ssris yeah Ser selective serotonin reuptake Inhibitors um is what that
00:13:46
stands for so ketamine is in the class of drugs that are called nmda antagonists and there's a lot of uh of
00:13:54
um very useful uh work that's being done understanding nmda and agonists in general for depression and the research
00:14:02
on it is it's a I wouldn't say it's definitive but it's definitely statistically significant that ketamine
00:14:09
definitely improves symptoms of both unipolar and bipolar depression um in the short term the question is is it a
00:14:16
lasting effect that's hard to know and I think that's ongoing research and personally I think you know Mr musk is
00:14:23
correct in that sense I mean ssris are very different uh and um then ketamine still though ketamine is not a first
00:14:31
line therapy for depression it's probably like a third line therapy but a lot of people they're trying to get it
00:14:36
to be one for people with post-traumatic stress Etc sure yeah PTSD is a good indication for it um and you know I
00:14:43
personally know people whove had ketamine therapy who swear by it who say that it's really improved them um and so
00:14:50
I do think that you know shutting down any kind of research on this that's why I don't really like that Matthew Perry
00:14:55
article or even this Wall Street Journal article because it demonizes uh a very useful drug uh and ketamine is a very
00:15:01
useful drug I mean similar what happened with Michael Jackson and propal I mean every day people tell me you're not
00:15:08
going to give me that propofol drug it's like yeah basically it's the most common
00:15:11
anesthetic in the world yes I'm going to give it by the way it's amazing you know
00:15:14
when it is oh it's amazing it's amazing whenever I've had a colonoscopy I take that thing and 30 minutes later I'm I'm
00:15:22
I mean it's amazing yeah no it's it's it's literally probably the greatest invention in
00:15:28
anesthesia in its history um but but K not for daily nightly use no so that's the
00:15:34
problem is that you you know using propofol in your living room by someone who did not admit you know so they they
00:15:39
it's not the drug that's the problem it's the person giving it or the person taking it my sense is more generally as
00:15:45
it relates to drugs in our society and I don't know if it's the far right or an attempt to use drugs as a tool to keep
00:15:52
people of color down through incarceration and Drug bill whatever it might be but we have a tendency to go
00:15:58
very black and white uh marijuana helps people sleep helps people with anxiety helps kids with glaucoma but we just
00:16:05
decided oh it was all bad and it strikes me that no one wants to have a Nuance conversation around what is an
00:16:12
appropriate use of a drug and the fact that something like 85% of people who use alcohol and drugs are functioning
00:16:19
it's not impacting them in a terribly negative way having said that alcohol is a menace and terrible for tens of
00:16:27
millions of homes in America America but nobody wants to have really what I would
00:16:31
describe as a thoughtful conversation they want to assign something is only used in a medical context but when it's
00:16:37
used outside of a medical context it's immediately it must be all negative and all bad and we demonize it criminalize
00:16:43
it and in my view just make make things you know much much worse anyways it wasn't a question it was a TED Talk yeah
00:16:50
I mean it's you're right the most commonly abused drug by far in way is alcohol and you know more people drown
00:16:56
because they uh are you know know drunk and you know doing stupid things in boats than than have ever been you know
00:17:03
drowned by ketamine it was not even close right right but this creates a situation when they're trying to bring
00:17:09
ketamine and other psychedelics into really good medical uses and then it gets you know either glamorized and
00:17:16
demonized both glamorized and demonized by people like musk and others um which is you know before it's a cart before
00:17:23
the horse because I think they will be using these um it's an intriguing drug correct um Scott what's what's the
00:17:29
responsibility of a board member in this situation it looks like several board members talked here someone's worried
00:17:35
this is why I can't imagine the journal would move forward this uh you know rert
00:17:40
Murdoch and the Murdoch family would move without some level of assurance that they and I have to tell you
00:17:46
Discovery would be fascinating because I don't think you know the stories of elon's wild Hardy life are really quite
00:17:53
out there all the time and they just are they just the governance question here is complicated because supposedly there
00:17:59
was a director who resigned over concerns of of most because they weren't doing anything about it but I would
00:18:05
argue he doesn't and this goes to a broader issue here I I would argue that he doesn't have any governance that it's
00:18:11
family members and people who have made so much money because of his genius and his bold innovations that effectively
00:18:17
they have no power they're there to have dinner once every three months and collect a big check because his behavior
00:18:23
would not be tolerated across anything resembling what you would call a real Board of Governors are supposed to
00:18:28
represent fiduciaries they just they just wouldn't allow it so he doesn't have the the the duties the the the duty
00:18:37
and care that is levied on fiduciaries in the form of boards of directors does not and has not applied to Elon Musk for
00:18:44
a long long time the fact that he's still on Twitter that would never be allowed of a CEO who had done what he
00:18:51
has done a CEO incorrectly accuses former employees of being pedophiles would never be allowed to be a SE o he
00:18:58
plays by a different set of standards and whether you think he should be allowed to or not but it goes to a much
00:19:04
broader issue and I think the key issue here and what I would describe as the learning or the takeaway for young
00:19:08
people and that is the most important thing you can have in your life is people who love you and serve as
00:19:15
guardrails and to have people idolize you is different than having people who love you and I think the guy has a lot
00:19:21
of the former and not a lot of the latter and as someone who has participated in interventions they don't
00:19:27
invite powerful important people to those interventions they invite people who love you and this is turning into a
00:19:35
cautionary tale along the lines of Tony Shay because you have a guy who as far as I can tell is living alone doesn't
00:19:43
have a close relationship with a romantic partner or his children and is quite frankly just [ __ ] off the rails
00:19:52
and if if at the age of 52 you don't have people in your life who can sit you down and you listen to cuz because you
00:19:58
know that it's not that they got rich because of you it's not because they think you're just so [ __ ] awesome and
00:20:04
can land rockets on two surfboards it's because they just full stop care about you if you don't have that especially
00:20:12
men you you literally can lose it all what happens with extended use of ketamine if you use it a lot and there's
00:20:21
no guard rails as Scott says there should be and I agree um what happens over time to your mental state or do we
00:20:29
not know this I guess we probably do right well yeah I mean there's some research on chronic long-term use of
00:20:35
ketamine effects on the liver and on the kidney I mean there are there are you know physiologic effects of it which you
00:20:41
know large large scale use of it can be toxic to your liver and kidney more importantly I think though is then what
00:20:47
happens than well you could get I mean anything can damage your liver I mean there's there's so many well alcohol
00:20:53
number one is the biggest but uh so the the big problem I think with ketamine is
00:20:58
uh the psychological as Scott mentioned before the SK the psychological dependence on it and it is a
00:21:04
dissociative anesthetic so you're not going to behave normally if you're doing high doses of ketamine it just will make
00:21:11
you not functional as a you know human being you'll be you know high and and then Scott as Elon also has a lot of
00:21:18
government contracts which was mentioned in the journal article as CEO and founder of SpaceX and he's also the key
00:21:24
man there musk has a security clearance that gives him access to classified information I think the journal was
00:21:29
trying to pin a like here's why we're writing this thing um and obviously the government has already uh objected when
00:21:36
he was doing the weed on Rogan this is a Quantum level of problem I would think yeah but again he's he's an exceptional
00:21:44
person that people and organizations make exceptions for so for example he can put a breakthrough heavy rocket he
00:21:52
can launch it and it can blow up and he just puts another one up in a few weeks NASA could never do that NASA could
00:21:59
never send projectiles into space to blow up he is willing to take risks and has access to Capital such that he can
00:22:06
put together Communications um low orbit Communications networks that the government at least in this current
00:22:12
infrastructure or current regulatory environment isn't able to do so he plays a really valuable role and I I don't
00:22:17
want to be an apologist for the guy but to think that he's going to be subject to anything resembling the same
00:22:22
standards as other contractors you might find it unfair and it is he there are there are so many things he would have
00:22:30
lost all security clearances for that the government has made exceptions around he just plays by a different set
00:22:35
of rules and and I don't I'm not saying that's right or wrong but you could never see the head of the forestry
00:22:43
service or the CIA going on podcast smoking a joint that person wouldn't be allowed in the government a government
00:22:49
building again I I think it'll be interesting to see how we react so last question for each of you Scott how do
00:22:54
you think a musk is going to react I haven't seen anything yet yet I have no ability to predict his actions Cara I
00:23:01
just don't I don't understand um he'll threaten to Susan yeah but I I don't that's his goto and I think all his fans
00:23:09
will come to his come to his defense and say that he's being persecuted and it's
00:23:15
bad reporting but I don't I you know actually when I read that I felt bad because I I I have had some people in my
00:23:23
life who have an addiction and I find that slowly but surely when you know you've lost them
00:23:28
is when they choose I remember one of the interventions I was in one of the most rattling moments I've ever had
00:23:34
everyone went around kid was addicted um to heroin everyone around said their peace said I love you all your heart's
00:23:41
in the right place I know this is going to kill me I choose heroin I mean no one knew what to say so if he in
00:23:51
fact is I think he plays an important role I don't like the man I think he abuses his power but as it relates to
00:23:57
the Govern government Innovation he does play an important role and you just got
00:24:01
to Hope a guy with 11 or 12 kids like that gets help and you also hope that the right way to react is if in fact he
00:24:10
is struggling that he's open about his struggles and people can learn from it because I do think a lot of people are
00:24:16
fighting these demons in quiet and and a guy like that who is literally the idol
00:24:22
of of billions of people you know optimistically you'd like to think he could play a key role in educ about it
00:24:28
how he's what he's actually going to do I have no idea you know him better than I do car I back I think his tweets have
00:24:34
become I think this article means a lot of people close to him are worried again
00:24:38
as they were last Christmas time um and when there's a little downtime and I think that's what it looked like to me
00:24:45
when I was I was like oh I know who that who said that you know what I mean like
00:24:48
I could guess um so I think a lot of people are worried um and they're worried for a bad outcome in lots of
00:24:55
ways um not just economically and maybe this was their way of talking to him um his tweets recently have been
00:25:03
pretty unhinged or or juvenile recently they're not they've not been I'm spending some time thinking or anything
00:25:09
like that and so Jee that's my last question if you were I know some of his doctors um if you were his doctor what
00:25:16
would you say to him if he were to listen well I would say that you know any kind of poly substance abuse uh is
00:25:26
not necessarily in your best health interests and uh you know clearly you don't go around uh doing fairly powerful
00:25:35
um psychoactive medications and drive a car or fly a plane or buy multi-billion dollar uh social media companies um and
00:25:45
I think that um that's what I would tell them it's just like you know like the old adage everything in moderation I
00:25:51
mean one thing I just want to be clear that you your listeners understand that ketamine is not a dangerous drug in the
00:25:58
right hands uh but like any drug it can be misused and it's a very useful drug and I would hate to see a drug like
00:26:06
ketamine which is so useful being demonized and there'll be government reaction against it etc etc that would
00:26:12
be the worst possible thing that could happen uh because it is a very useful medication but I would just tell him you
00:26:18
know like Al I mean the same thing that would if somebody came in and they were showing signs of alcoholism I would say
00:26:24
this is really bad for you uh and this is why you just give them information he clearly is a very smart man and um you
00:26:31
know you try to appeal to people's reason