Ground Truths

Eric Topol
Ground Truths
Latest episode

90 episodes

  • Ground Truths

    Elisa Port: Discuss THE BREAST ADVICE Book

    26/06/2026 | 1h 3 mins.
    “I may be the expert in cancer, but you are the expert in you.”—Elisa Port, MD

    Ground Truths is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

    Dr. Elisa Port is Professor of Surgery, Icahn School of Medicine at Mount Sinai; Chief of Breast Surgery for the Mount Sinai Health System; Director of the Dubin Breast Center; and Director of the Center of Excellence for Breast Cancer at the Mount Sinai Tisch Cancer Center, a NCI-Designated Comprehensive Cancer Center. She is remarkably well qualified to provide guidance for prevention and treatment of breast cancer, and runs a model program at Mount Sinai in New York (←we’ll get into why I say that).
    She has just published a terrific book that centers around the concept of informed optimism. Many of her patient stories are integrated.
    We tried to cover the waterfront during our conversation including:
    —4 Ws for reduction of risk: weight, walking, wine, and working out (especially in Nature, “green exercise”)
    —Only 10-12% of women will ever develop breast cancer during their lives
    —Role of adipocytes (fat cells), aka estrogen and inflammation factories
    —Misinformation (underlying the need for this book)
    —Pervasive myths of magic supplements, with safety issues of unregulated intravenous drips and others when analyzed turned out to be crushed up, dried house plants
    —Total body MRI: mixed results from her patients
    —Breast cancer on the rise in young women. Dr. Port relates about recent patients diagnosed in their 20s. Some without BRCA or other pathogenic mutation. Why?
    —Mammograms in non-dense breasts pick up 80-90% of breast cancer. It’s the 40-50% women with dense breasts, which the scan is trying to find a polar bear in a snowstorm, is a problem. The problem with false-positives.
    —Use of AI with mammography for increased initial detection, prevention, detect high-risk in women with a “normal” mammogram, and risk of heart disease (see my recent Ground Truths and piece in The Lancet on this important topic)
    —Mount Sinai provides Transpara AI (the one validated by the big Sweden trial of >100,000 women) to all women getting mammograms FOR FREE. That is the best validated AI tool in medicine today!
    —How a mammogram saved a patient’s life, not about breast cancer!
    —Hormone replacement and birth control pills. How to assess benefit and risk in women young and older? Differences in the hormone risks.
    —Tamoxifen for primary prevention in high-risk people. Reduction of breast cancer in 50% or more in these women. In some subgroups reduction as high as 80%!
    —GLP-1 drugs may reduce breast cancer risk and this may not just be related to weight loss
    —Lack of utilization of Genetic testing (it could be your father). I disagreed with respect to use of polygenic risk scores, as I wrote about in SUPER AGERS
    —“I just wanted to scream out on top of the mountain about genetic testing, family history, and early screening.” Tennis legend Chris Evert

    —The lack of our ability to assess the immune system in the clinic and how that could change the face of prevention and very early detection of breast cancer
    An infographic summary I made on Dr. Port’s book with the help of NotebookLM
    ****************************************
    Thank you YOUR DOCTOR KLOVER, Diane Romero, Bob Fleischman, Danielle, MagnaAnimus, and 450+ others for tuning into my live video with Elisa Port! Join me for my next live video in the app.

    A big thanks to all the Ground Truths subscribers from every US state and 212 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. If you’re not a subscriber, please join!
    If you found this interesting PLEASE share it!
    Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.
    Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support a record number of 51 summer interns coming in 2026! These are high school, college and medical students selected from thousands of applicants. We couldn’t do this expanded program without the funds coming in through Ground Truths.



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  • Ground Truths

    Helen Pearson: What Constitutes Real Medical Evidence?

    06/06/2026 | 51 mins.
    Helen Pearson, PhD, is an award-winning biomedical journalist at Nature, named European Science Journalist of the Year in 2025. She teaches science writing at University College London. BEYOND BELIEF is her second, just published book. THE LIFE PROJECT was her first.

    The points we covered include:
    —The evolution of evidence over 8 decades, moving from rationalism, expert opinion, hunches (eminence-based) to empiricism, evidence-based
    —The enormous devastating adverse impact of Dr. Spock’s Baby and Child Care book from a single sentence change, leading to an epidemic of sudden infant death syndrome. And how it ultimately got corrected.
    —The term evidence-based medicine was coined in 1991 at McMaster University
    —Iain Chalmers, Archie Cochrane and the Cochrane Collaboration
    “The scandalous failure of science to cumulate evidence scientifically”—Iain Chalmers
    —Systematic reviews
    —Natural experiments (such as with Shingles)
    —Resistance to change
    “Challenging a doctor’s conventional way of practice is like hitting him in the intellectual testicles”—Drummond Rennie, past JAMA editor
    —Evidence-based practice (and not) in the Covid pandemic
    —Recent examples of challenging dogma (kindly stones, thymus involution)
    —AI and misinformation, false evidence
    Thank you Harshi Peiris, Ph.D., Ageless Mind Project, Anthony Higgins, E West, MagnaAnimus, and many others for tuning into my live video with Helen Pearson! Join me for my next live video in the app.

    A big thanks to Ground Truths subscribers from every US state and 212 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. If you’re not a subscriber, please join!
    If you found this interesting PLEASE share it!
    Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.
    Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support a record number of 51 summer interns coming in 2026! These are high school, college and medical students selected from thousands of applicants. We couldn’t do this expanded program without the funds coming in throughGround Truths.



    Get full access to Ground Truths at erictopol.substack.com/subscribe
  • Ground Truths

    Assessment of the Hantavirus with Prof Donald Milton

    14/05/2026 | 52 mins.
    Get full access to Ground Truths at erictopol.substack.com/subscribe
  • Ground Truths

    Joanna Stern: An AI Immersion for 365 Days

    13/05/2026 | 58 mins.
    Joanna Stern was the Wall Street Journal technology journalist for 12 years. She’s an Emmy award winner for her documentary E-Ternal, and recently started her own company New Things, with added advice from ChatGPT!
    Over the years at WSJ, I relied on Joanna’s reviews of technology for many purchases (and things I avoided) reflecting her keen and brutal assessments. I also had fun working with her on some of her video assessments of health technologies.
    Her book I AM NOT A ROBOT is both hilarious and highly informative. It is a terrific primer for those who are not fully grounded in AI getting into the history of AI and right up to date with generative AI’s progress.
    To get a sense for why AI thought she was the next Tina Fey, check out the back cover! No surprise she got me laughing hard throughout the conversation, no less while reading the book.

    Here is a short YouTube video she posted on her All In AI year of 2025, referred to during the podcast.
    Much of her testing of >100 AI products related to medicine and health care, which is what we especially got into during our conversation. She has 3 major rules in her assessment of AI: (1) Ruthless testing; (2) Benchmark vs human; and (3) Costs, which include “compute cost” that we discussed.
    Here are some of the things we covered:
    * AI of her blood work
    * AI of mammogram and breast ultrasound, and overall experience as a person with increased risk of breast cancer
    * AI at the dentist (and ”Dentist Deep Clean”)
    * Assessment of Dr. GPT
    * Bill Gates on health AI
    * Her AI Trainer (Chris)
    * Waymo vs Uber
    * Her AI Therapist (Ash)
    * Nothing Bot Sex (her 2 digital lovers)
    * Impact on her children (including 6 F*****g Hamsters, the robodog Sirius)

    A big thanks to Ground Truths subscribers from every US state and 212 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. If you’re not a subscriber, please join!
    If you found this interesting PLEASE share it!
    Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.
    Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support a record number of 51 summer interns coming in 2026! These are high school, college and medical students selected from thousands of applicants. We couldn’t do this expanded program without the funds coming in through Ground Truths.

    Thank you Tara Parker-Pope, MPH, Tracy Paeschke, MD, FACC, Chip Hughes, Bob Fleischman, Gretchen Faucett, and >400 others for tuning into my live video with Joanna Stern! Join me for my next live video in the app.



    Get full access to Ground Truths at erictopol.substack.com/subscribe
  • Ground Truths

    Roxanne Khamsi: We Are All Genetic Mosaics

    25/04/2026 | 51 mins.
    “You are a slightly different genetic version of yourself today from yesterday, and will be different yet again tomorrow.”—Roxanne Khamsi

    “Each neuron really is a beautiful and unique snowflake”—Ed Yong

    Roxanne Khamsi is one of the leading life science journalists, a contributing writer at The Atlantic, recognized with multiple awards for notable publications. Her new book is entitled BEYOND INHERITANCE. It tells the story about us all being genetic mosaics, chock full of somatic (acquired) mutations, and the implications of those mutations for our health. The myth of a single genome, carbon copy, master blueprint, but instead a dynamic, shifting mosaic in constant internal evolution.

    And here’s the back cover. I was delighted to endorse this book, and reread it to prepare for our podcast. It’s extraordinary and mind-bending.
    Here are the topics we covered:
    —The Math. 330 billion cells of our ~37 trillion turnover each day, which yields trillions of mutations per day.
    —Cellular competition. Winners and losers of an “endoevolution,” Darwinian selection inside us whereby healthy or super-fit mutated cells can crowd out the unfit ones.
    This was theorized in 1881 in a book THE STRUGGLE OF PARTS, by Wilhelm Roux
    which led to Friedrich Nietzsche’s famous quote “Uniformity is pure delirium.”

    —Single-cell sequencing. How this field catapulted forward owing to the ability to zoom in on genomic mutations at the cellular level.
    —Cancer chemotherapy overkill. The routine scorched earth, carpet bombing approach can promote resistance and deleterious mutations, leading to an adaptive strategy of leaving some cancer cells behind, as has been shown to be effective in prostate cancer for improving survival.
    —The immune system somatic hypermutation. B cells have the theoretical capacity to produce 1 quintillion unique antibodies (a million trillion). If this weren’t possible, we could die from a common cold. In the Covid pandemic, even before the Omicron variant appeared, Covid booster shots induced hundreds of unique antibodies with neutralization capacity against Omicron. The anticipatory “Red Queen” effect.
    —Autocorrection of mutations. They can revert, cure a rare genetic disease from within. It can be considered “Natural Gene Therapy.” Example below of a skin condition Epidermolysis Bullosa with revertant mutations (→ normal skin appearance)
    —Different role of acquired mutations through the lifespan. Examples: At embryonic stage, Lines of Blaschko (Image below). In mid-life endometriosis, and in older adults Loss of the Y chromosome (LOY) and Clonal Hematopoiesis of Indeterminate Potential (CHIP). Note these 2 somatic mutation clone conditions are associated with risk of diseases; CHIP-cardiovascular and cancer; LOY-heart failure and Alzheimer’s. I’ve written about CHIP extensively here and here.

    —Phenocopy. How a somatic mutation can look the same as a germ-line, inherited mutation, with respect to a disease, and how that is determined.
    —Environmental effects inducing somatic mutations: UV light, air pollution, plastics

    —and 3 new papers in the past week!
    * Somatic mutations in the microglia cells of the brain, same as cancer mutations, drive inflammation and are enriched in the Alzheimer’s brain
    2.. The potential of “promolytic drugs” to be used to prevent cancer in people who exhibit precancerous somatic mutations
    3. How somatic mutations can be the basis of autoimmune diseases

    We also spoke about the role of somatic mutations in aging and super aging
    A related excerpt at The Atlantic
    A Quick Poll

    Thank you YOUR DOCTOR KLOVER, Stephen Pribut, Elizabeth J., Maureen Susannah, Gretchen Faucett, and more than 500 others for tuning into my live video with Roxanne Khamsi! Join me for my next live video in the app.
    And a big thanks to Ground Truths subscribers (> 205,000) from every US state and 212 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. Please join!
    If you found this interesting PLEASE share it!
    Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered.
    Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. We just accepted 51 interns for the 2026 summer, a new record, from thousands of high school, college, and med school student applicants. Our fully loaded cost to do this program is ~$300,000 per year. We’re deeply appreciative for your support of Ground Truths that has enabled this program to prosper and expand.
    One more thing:
    SUPER AGERS was featured on the CBS Morning Show this week in a segment with Dr. Jonathan LaPook, Chief Medical Correspondent, on the meaning and measurement of biological aging.



    Get full access to Ground Truths at erictopol.substack.com/subscribe
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Facts, data, and analytics about biomedical matters. erictopol.substack.com
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