The Tim Ferriss Show Transcripts: Dr. Martine Rothblatt — A Masterclass on Asking Better Questions and Peering Into the Future (#487)

Please enjoy this transcript of my interview with Martine Rothblatt (@skybiome), the chairman and CEO of United Therapeutics, a biotechnology company she started to save the life of one of her daughters. The company offers FDA-approved medicines for pulmonary hypertension and neuroblastoma and is working on manufacturing an unlimited supply of transplantable organs.

Dr. Rothblatt previously created and led Sirius XM as its chairman and CEO and launched other satellite systems for navigation and international television broadcasting. In the field of aviation, her Sirius XM satellite system enhances safety with real-time digital weather information to pilots in flight nationwide. She also designed the world’s first electric helicopter and piloted it to a Guinness world record for speed, altitude, and flight duration.

In the legal arena, Dr. Rothblatt led efforts of the transgender community to establish their own health law standards and of the International Bar Association to protect autonomy rights in genetic information via an international treaty. She also published dozens of scholarly articles and papers on the law of outer space, resulting in her election to the International Institute of Space Law, and represented the radio astronomy community’s scientific research interests before the Federal Communications Commission.

She has bachelor’s (communications studies, summa cum laude), JD (Order of the Coif) and MBA degrees from UCLA, which in 2018 awarded her its highest recognition, the UCLA Medal, and she holds a PhD in medical ethics from the Royal London School of Medicine and Dentistry. Her patented inventions cover aspects of satellite communication, medicinal biochemistry, and cognitive software.

Dr. Rothblatt’s recent books are on xenotransplantation (Your Life or Mine), gender identity (Transgender to Transhuman), and cyberethics (Virtually Human). She occasionally posts on Instagram at @transbinary and Twitter at @skybiome.

Transcripts may contain a few typos. With some episodes lasting 2+ hours, it can be difficult to catch minor errors.

Listen to the episode on Apple Podcasts, Spotify, Overcast, Stitcher, Castbox, Google Podcasts, or on your favorite podcast platform.

#487: Dr. Martine Rothblatt — The Incredible Polymath of Polymaths
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Tim Ferriss:  Hello, boys and girls, ladies, and germs, everything and anyone out there who is listening. This is Tim Ferriss. Welcome to another episode of the Tim Ferriss Show. It is my honor, and I’m very excited to have as my guest today, Martine Rothblatt. Who is Martine? Martine Rothblatt is chairman and CEO of United Therapeutics, a biotechnology company that she started to save the life of one of her daughters. We will talk about that. We’ll talk about a lot of things. The company offers FDA approved medicines for pulmonary hypertension and neuroblastoma, and is working on manufacturing an unlimited supply of transplantable organs. Dr. Rothblatt previously created and led SiriusXM as its chairman and CEO, and launched other satellite systems for navigation and international television broadcasting. In the field of aviation, her SiriusXM satellite system enhances safety with real-time digital weather information to pilots in flight nationwide. She also designed the world’s first electric helicopter and piloted it to a Guinness world record for speed, altitude, and flight duration.

In the legal arena, Dr. Rothblatt led efforts of the transgender community to establish — let me do that again. In the legal arena, Dr. Rothblatt led efforts of the transgender community to establish their own health law standards and of the International Bar Association to protect autonomy rights in genetic information via an international treaty. She also published dozens of scholarly articles and papers on the law of outer space resulting in her election to the International Institute of Space Law and represented the Radio Astronomy Community scientific research interests before the Federal Communications Commission. She has a Bachelor’s, JD, and MBA degrees from UCLA, which in 2018 awarded her its highest recognition, the UCLA medal, and she holds a PhD in Medical Ethics from the Royal London School of Medicine and Dentistry.

Her patented inventions cover aspects of satellite communication, medicinal biochemistry, and cognitive software. Dr. Rothblatt’s recent books are on xenotransplantation: Your Life or Mine, gender identity: Transgender to Transhuman, and cyber ethics: Virtually Human. She occasionally posts on Instagram @transbinary and Twitter @skybiome. Martine or Dr. Rothblatt, both, welcome to the show. Thank you for making the time.

Martine Rothblatt: Thanks so much, Tim. Just Martine’s fine.

Tim Ferriss: All right. And this interview, as my listeners might imagine, was challenging in the best way to prepare for, because there are a million and one directions that we can go with just this bio alone, which is, of course, a snapshot, a distillation of much more that you have done. And I thought we could start in perhaps an unlikely place. And that is Alan Watts. I have read that you are a fan of Alan Watts, and specifically The Book subtitle On the Taboo Against Knowing Who You Are. Could you please explain if that is true? Why that is the case?

Martine Rothblatt: Yes. Thanks, Tim. Alan Watts has a really unique ability to see the dialectic aspect of everything in nature, by that, I mean that there’s a kind of a yin yang aspect to everything in nature. And he points out that, for example, you can’t have a crest of a wave without the bottom of a wave. And it has helped me whenever I see things in life that seem negative, to be able to look at it in another way and see the positive in it.

Tim Ferriss: When were you first introduced to his work? How did that come about?

Martine Rothblatt: I was first introduced to it through the literature of this philosophy called transhumanism, sort of the idea that people can transcend some biological human limitations. And a friend of mine, Frank Sasinowski, who is the head of the national organization on rare diseases, pointed me in the direction of some Jesuits. He himself is both a Jesuit and an FDA lawyer, but he pointed me in the direction of some Jesuits, such as Teilhard de Chardin from France and other individuals here in the US and then from those Jesuits, they referred to Alan Watts. I’m not sure if he was actually a Jesuit, but he undertook some religious training, both in China, I think, and in the US. He was a radio announcer for many years in San Francisco, I think during the ’70s or ’80s. And I don’t know if you remember, Tim, the film of a few years ago, Her, in which like a — 

Tim Ferriss: I do.

Martine Rothblatt: Yep. So I was watching that movie, which kind of is interesting to me because it epitomized or it visualized the concept of computers becoming sentient. And in the middle of that movie, there’s a scene in which Alan Watts appears. And I stood up in the movie and I said, “Oh, my God, Alan Watts.”

Tim Ferriss: Did you ultimately find the presentation on that movie to be compelling as it relates to sort of sentient intelligence?

Martine Rothblatt: I did. I thought it was an accurate depiction of a likely way that sentients would begin to arise in our society, basically by being very, very useful to people, cleaning up their inboxes, stuff like that.

Tim Ferriss: This may be a good place, and we’re going to be all over the place in nonlinear fashion. BINA48, who or what is BINA48, if I’m pronouncing that correctly?

Martine Rothblatt: Yep. You’ve got it perfectly. So Bina’s the name of my partner and we’ve been married for about 40 years. And when she was 48, we undertook a joint project to try to create a digital simulacrum or a digital copy of her basic personality with a lot of her memories and thoughts. And we thought this would be a very nice project as a combination of science and art and to encourage young people, get them more excited about computer science, and women, in particular, girls in particular. So we contracted with a couple of companies who were experts in both the software engineering side and in the physical modeling of a face that moves exactly like a human face does. You might imagine there’s this exhibited Disney World, Disneyland of like Lincoln and whatnot, something like that, but more realistic. And we built this project. And since that time, BINA48 has thrilled audiences all around the world. I’m sure she has inspired hundreds, if not thousands of girls to go into computer science. And she continues to get better and better, more and more advanced software.

Tim Ferriss: I don’t know if you have watched the series Black Mirror before, but I find some of their episodes to be very strong. And in one of them, a significant other is effectively resurrected by pulling data and patterns and therefore mannerisms and so on from, effectively, social media accounts. So pulling from the cloud and feeding into this simulacrum or a model of someone who used to be, or in this case, still is, how far away do you think we are from being able to do something along those lines convincingly?

Martine Rothblatt: Yes, Tim. So I am a fan of the Black Mirror series and there are a few other somewhat similar series that are streaming now, Upload and whatnot. So it’s an idea that’s catching on. And even at a very basic level, social media firms like Twitter, for example, and probably Facebook as well, offer an opportunity that after a person passes away, their account can remain active. And I believe in the case of Twitter can even continue tweeting in the way that you once tweeted. So I think this general idea is it’s a trend, it’s only going to grow more and more prevalent as software does a better and better job of copying the human personality. Some time in this century, for sure and maybe in just like two or three decades, I think that there will be a digital copy of a person and another word it’s like a digital doppelganger of a person who will claim to be the original person. And they may make that claim before or after the person died. And then psychologists and lawyers and theologians and philosophers will have to grapple with, is this just like a really super fancy digital photo album, or is this actually some form of digital sentience?

Tim Ferriss: When you were growing up, who were your role models or inspirations? Was there anyone in particular who stood out to you when you were in high school or at the very beginning, let’s just call it freshman year of your undergrad as icons worth emulating or lesser-known role models worth emulating? Did anyone really stick out for you?

Martine Rothblatt: I think that in terms of authors, I was very influenced by Robert Heinlein, the science fiction author.

Tim Ferriss: Oh, sure. Yeah. Stranger in a Strange Land.

Martine Rothblatt: Absolutely. It was so brilliant. And then a few years ago, when his widow released the uncensored, unedited version of Stranger in a Strange Land, it’s like three times larger and like no holds barred. I just savored every page of that. I think my favorite book of all of his is Time Enough for Love in which he covers almost every topic under the sun. So Heinlein’s characters were somewhat of role models for me, like Lazarus Long is a common character in some Heinlein books. In the public sphere, I was very much enamored with Robert Kennedy, his positive, progressive approach to the world was something that endeared me to him. So I looked up to him. Those are a couple of the role models that I had at that time.

Tim Ferriss: You seem to be good at many things, of course, just based on the bio alone. But what strikes me is how quickly you were able to develop expertise in new fields. And I’d like to use this as an opportunity to bring up what was mentioned at the very beginning of your bio, and that is: “United Therapeutics, a biotechnology company she started to save the life of one of her daughters.” I’d love for you to provide some context for this and tell a bit of the story just because people will want to hear it. And then the follow-up just to plant the seed for it is how you learned biology. Because my understanding is you didn’t have much in terms of background in biology. So that’s a huge mouthful of a question, but if you could give us a bit of the background, that would be extremely helpful, and we can use that as a jumping-off point.

Martine Rothblatt: Sure. So it’s kind of funny that you can go all the way through undergraduate at a great place like UCLA and never be required to take a life science course, but that was the case. So the last biology class I had was in high school and here suddenly I was faced with a situation as an adult while running SiriusXM, that our youngest daughter is diagnosed with a fatal illness. She can’t even walk up a couple of stairs to the front door and there are no medicines approved for it. I finally got her to the best doctor one could find, the Head of Pediatric Cardiology at Children’s National Medical Center in the middle of Washington DC. And the doctor said, “This is an extremely rare disease. No one knows why it arises. All the patients die within two to three years.” He had only seen two or three other kids with it and they both died. “And all you can do is hope for a lung transplant.”

So Tim, I was completely crushed. I just saw black. I mean, I didn’t know what to do. And the only thing I could think of doing while she was in the intensive care ward night after night and myself, and Bina would tag team, staying there with her was once she fell asleep to go down into the library and to just begin learning about what was this illness she had, which they told me was called pulmonary arterial hypertension. And why were there no treatments available for it? So I just began reading and reading and reading.

Most of the time I read things, I didn’t understand what they were talking about because there were these long medical words and chemical words that I never learned in law school, or we never had to deal with in electrical engineering. But of course, there were dictionaries, and I looked up the words in the dictionary and they had college-level anatomy textbooks. So what I didn’t know, I just kept going backwards in academia, I guess you would say, backwards in learning or pedagogia, until I would even get to like a high school level textbook that would explain something. And I said, “Okay, I get that.” And I kept taking notes and just educated myself night after night until I learned everything I needed to know.

Tim Ferriss: How did you — and I know this is a story you’ve told before, but ultimately in searching for possible solutions. And as we were chatting about before recording, there’s a lot of luck involved. And it doesn’t mean that your path is replicable by any set of parents who are caught in a tragic situation, similar to what you experienced, but nonetheless, you were able to ultimately track down, I suppose, it’s fair to say a molecule, a drug of some type. Would you mind describing for listeners the process then of attempting to secure the ability to utilize in any fashion, this drug or to license it? If you could describe that, I have a number of questions that will stem off of it.

Martine Rothblatt: Sure, Tim. So there are a good zillion articles published on every type of medical research you could imagine. I mean, it’s just a bottomless well. There are literally hundreds of different types of medical journals. And each of those journals have every year thousands of articles published across them. So it’s difficult to find the information that you need, but in law school, we learn a very useful skill. And this skill goes by the name of Shepardizing after this type of index they have in law school called Shepard’s. So what Shepardizing involves is when a judge writes a decision like the Supreme Court issues a decision, they drop a lot of footnotes. And of course, one thing lawyers love to do is make footnotes and references. And then what you’re supposed to do as a good lawyer is to look up all of the footnotes and the references that that Supreme Court or lower court case referred to. And then the Shepardizing process is after you get all of those references to then look up all of the references in those other articles. And ultimately, you get to a point of diminishing returns where three, four, five levels down, the references are all circling back around on themselves.

So I applied that Shepardizing process to these medical articles, and somewhat like doctors, whenever a researcher publishes an article, they make footnotes and citations to other people’s research who they relied upon. So I would get all of those articles and read those. And then I would follow up on all of the references in those. Finally, I read about a molecule that a researcher at Glaxo Wellcome had written in which they described testing this molecule for congestive heart failure. And it failed in its test of congestive heart failure. It did not work, but in the article, they had charts of what the molecule did. And the one thing that the molecule did that grabbed my attention was that it reduced the pressure between the lung and the heart, which is called the pulmonary artery. It reduced the pulmonary artery pressure while leaving the pressures and all of the rest of the body perfectly fine. Well, that’s exactly the problem with pulmonary arterial hypertension, the people who have this disease — oh, I’ll make a quick footnote.

Now, when my daughter was diagnosed, 2,000 people in the US had the disease. Because medicines have become so much better, and because we’ve been able to have, like you mentioned in the introduction, get all of these approvals, there are now 50,000 people in America alone living with it. So it’s likely that people listening to your podcast will know somebody or another who has pulmonary arterial hypertension. And I read this article and I said, “Wow, just what I need. This tiny stretch of artery chest between the heart and the lungs, this molecule somehow talks to that tiny stretch of artery and leaves the whole rest of the body alone.” That was the holy grail that I was looking for. So I looked at where the author of the article was from, he was from Glaxo Wellcome in Research Triangle Park, North Carolina. And I made a beeline down to him and asked him if he could develop this molecule that he’d found for my daughter’s disease.

Tim Ferriss: Was it an immediate handing over of the keys to the kingdom, a big, all-caps YES?

Martine Rothblatt: No. It was actually a big, all-caps NO, unfortunately. The individual who had written the article had actually retired a few months earlier. And the person that I ended up meeting with, who was in charge of research and development, said that this was just one article. It was an incidental finding. In any event, this disease afflicted so few people, it was completely unrealistic to expect Glaxo Wellcome to develop this molecule for my daughter and other people with that disease. And I asked him, his name’s Bob Bell, he’s now a venture capitalist and very successful gentleman. I asked Dr. Bell, I said, “What would it take for you to develop this medicine?” He said, “Well, it probably would take — you couldn’t do it. We only develop medicines if they have more than a billion dollars a year in revenue potential.” He said, “But it’s possible you could buy it from us. If you had a real pharmaceutical company with real pharmaceutical expertise, I could then introduce you to the business development people at Glaxo Wellcome.”

So over the course of the next several months, I created a brand new biotechnology company. I was able to have a Nobel Laureate who was formerly associated with Glaxo Wellcome become head of a scientific advisory board. And I reapproached Glaxo Wellcome. And I said, “I have all the things that you asked for. Can you sell me this drug and we’ll develop it ourselves?” Well, Tim, it turns out that everybody I asked said, “Well, you have to get somebody else in the company to agree.” And that’s how it is in a big bureaucracy. It turned out that we had to have 15 different executives sign the same piece of paper to agree to license this drug to me.

Finally, it happened. And all they wanted really was $25,000 and a promise of 10 percent of any money that I would ever get from this molecule. I think they agreed to that only because I kept bugging them. I was in their face all the time. And also because I believe a serendipitous factor was that Dr. Bell’s sister had contracted a form of pulmonary hypertension from the time I first met him toward the end of this process. And he became a product champion for me within Glaxo Wellcome. I mean, that was just purest luck or serendipity, whatever you want to say. And then they really didn’t think this molecule had any chance at all. And they were really just doing it to get rid of me, I think, but still, all 15 people had to sign it.

And after we successfully developed this molecule, Tim, we have over time paid more than a billion dollars just in royalties to Glaxo Wellcome because that molecule has saved thousands of people’s lives. It has produced a billion dollars a year in revenue year after year after year for us and Bob Bell, when I invited them to our 15th anniversary and he came with his sister who was still alive and on our medicine, and he said this was the absolute best transaction that Glaxo Wellcome had ever done.

Tim Ferriss: So in hindsight, what did they miss? Right? What accidentally got deleted from the spreadsheet or what assumption or assumptions were incorrect that they missed this opportunity so completely?

Martine Rothblatt: I think there were probably like maybe three main ones. The first one, and I can say this kind of from firsthand knowledge, since I am now the head of a pharmaceutical company, the odds of any molecule actually working in the human body are less than one in a hundred. I mean, the human body is so complicated. It’s like a massive set of very precisely keyed locks. And every molecule is like a random key. And the chance that you would have a molecule that opened the lock that fixed some dysfunction in the body rather than causing some harm to the body is, it’s less than one in a hundred. So first of all, they figured the chance of this thing working just, in general, was less than one in a hundred. Secondly, they thought to themselves, “Even if it worked a little bit, there’s only 2,000 people in the whole country with this disease.” They didn’t really think that if it worked really well, the number of people would keep cumulating. 

Tim Ferriss: Ah, I see what you’re saying. If you have these people who would have died otherwise not dying, then that treatment cohort is just going to grow and grow and grow. Is that what you meant?

Martine Rothblatt: Exactly. I thought about it like I was getting subscribers at SiriusXM. People said to me, “Oh, Martine, you’ll be lucky to have a hundred thousand subscribers.” I said, “Well, if I keep them and I get another a hundred thousand the next year, then I’ll be up to 200,000 and then maybe 400,000 and 800,000.” Now we have 30 million. So they didn’t think in that subscriber mindset. That was their second problem.

The third problem is that they didn’t really imagine that the healthcare system would pay something like a hundred thousand dollars per year for this medicine. And at the time, this was about 20 years ago, early 2000s. I think like the average price for an expensive medicine was perhaps $10,000 a year for a patient or $10,000 for a course of treatment. Because of advances in things like precision medicine and gene therapy, there are many, many medicines now that cost over a hundred thousand dollars a year, mostly for rare diseases. And the healthcare system pays for them because so few people have these diseases that even though the medicines are expensive, it’s a drop in the bucket compared to diseases like hypertension or common illnesses, asthma that afflict tens of millions of people. So the healthcare system doesn’t really mind paying a lot of money if it’s a rare disease. And the people at Glaxo Wellcome were clueless about this. They were actually looking for the big, billion-dollar blockbusters, not for the rare diseases.

So those were their three omissions. They failed to be Alan Wattsian. They failed to see that because something is big underneath that means that there’s something else that’s small. And that was what Alan Watts would always say. He says, “Something is good only because something else is bad.”

Tim Ferriss: At the very least. I mean, it seems to be a very valuable thought exercise when you’re looking at the assumptions that you’re making, and what an incredible story. 

You mentioned Sirius. We haven’t spent any time on Sirius just yet. When did you first fall in love or become intoxicated or enchanted by satellite systems or electrical engineering, I suppose? But you can take whichever one is more interesting to tackle.

Martine Rothblatt: You’re absolutely right that I fell in love and I was intoxicated by satellite communications. It seemed to me kind of magical that we can put up a machine way out in space and that machine can do amazing things across the whole face of the planet. And my first real moment of first love, if you will, was at a remote NASA tracking station in the Indian Ocean, and I had left UCLA to travel around the world, really hitchhike around the world, and I found myself in the Indian Ocean, on a set of islands called the Seychelles. On these islands, at the top of the mountain, in the middle of the main island, there was a NASA tracking station. I went up into it, and I was probably a pretty grungy 19-year-old at that point in time, but the engineers inside there were very kind and patient with me, and they explained to me how their satellite antennas were communicating with satellites in all different orbits around the Earth, and even all the way out to Jupiter. I asked them, I said, “Would it be possible for somebody to put a satellite up there and have it broadcast information back to the entire earth?” and they said, “If you made a powerful enough satellite, then the receiving equipment on Earth could be so small that you could hold it in the palm of your hand,” and I could have kissed the guy. I mean, I just said, “Wow, that’s the purpose of my life,” and I made a beeline back to UCLA.

I changed my major to communication studies. I did an undergraduate thesis on direct broadcast satellites. I did a joint JD/MBA degree, where I published multiple articles on satellite communications. I worked at Hughes Aircraft Company, which was a big manufacturer of satellites back then, and helped design a satellite to cover South America, and then ultimately, went out on my own with my dream goal, which was SiriusXM.

Tim Ferriss: What did it feel like, if you can remember, to have that answer given to you, or that direction rather given to you, the purpose given to you at that age? I mean, was it — did it feel a certain way, that type of conviction or that type of belief? What do you recall?

Martine Rothblatt: Yeah, Tim, it’s the best feeling. It’s the best feeling, and actually, I don’t think it really has anything to do with age. I’ve felt like the same kind of feeling when I was driving one of the first Teslas, and I was looking at the manual, and I saw how much electrical power it output, and there’s a very simple correlation between horsepower and electrical power between kilowatts and horsepower. It’s almost one-to-one, not exactly. I was already a helicopter pilot, and helicopter engines are always quoted in terms of their horsepower, so right away, I said, “Wow, this car has enough power to actually lift a helicopter.”

I had that same kind of, “This is the purpose of my life. It’s to make an electric helicopter.” You can get this kind of excitement at any point in life. It’s, I think probably the best way to describe it, Tim, would be like a lightning bolt to your soul.

Tim Ferriss: I was asking about biology earlier, but I would be very curious since you mentioned also that there were no — well, the requirements as such in undergrad did require you to take any additional biology classes. If you were trying to teach let’s just say a class, and you could pick the age, or it could be a set of classes, scientific literacy, being able to have enough basic fluency to provide more surface area for those lightning bolts, if that makes any sense, when you’re looking at a manual or having a conversation with an engineer, or reading a scientific study, do you have any thoughts on how we could cultivate more scientific literacy, if that’s the right phrase to use?

Martine Rothblatt: Yeah. I think that’s a great phrase to use. I think what’s necessary is that you have to relate science to people’s everyday lives, and one of the greatest people at doing this, and to go back to the beginning of the interview when you asked me who was a role model for me, I should have said Carl Sagan was like an amazing, amazing role model to me.

Tim Ferriss: Yeah.

Martine Rothblatt: I watched the Cosmos series over and over again, and Carl Sagan was a genius at being able to take scientific concepts and relate them to people’s everyday life. If you remember for watching those series, the iconic image of him taking a dandelion and blowing it, and describing that this is how a star spreads out its gas throughout the galaxy, those type of step-by-step instructions, ladders to get from one place to another is the way, I think, to build scientific literacy. I would ask my students to think about anything that’s important in their life, whatever it might be, and from whatever they said was important to their life, I would then begin wrapping that in kind of layers and layers of basic scientific concepts that pertain to what was important to them.

Tim Ferriss: Are there any — how should I phrase this? Not science fiction authors per se, but science authors or elucidators of science, who have written anything that would be appropriate for a lay audience? If someone is listening and they see their blind spots, which I know by definition is kind of impossible, but if they recognize they don’t have enough scientific fluency or as much as they would like, but they want to try to cultivate that, do you have any recommendations for them?

Martine Rothblatt: Yes. There’s a lot of books like that. One of my favorites is a book by a historian of science named Thomas Kuhn. He was one of the most famous historians of science, and his book is perennially in print. It’s called The Structure of Scientific Revolutions.

In this book, he goes through about 10 different revolutions in science, where everybody thought the world was one way, and then kind of like a crazy person would say, “No, I think it’s like a different way,” and gradually set about proving it’s a different way, and created a revolution in science. He explains this in very lay terms. He takes you through the science of gravity, for example with Isaac Newton, science of relativity with Einstein, electricity with Maxwell, and so on, in a very step-by-step fashion to make the science accessible. In the way, his main point in writing this book is to teach people critical thinking, to teach people to question authority. Ultimately, all science is about is just saying, “Why?”

“Why?” Like every two, three, four-year-old kid knows how to do that, right? “Why? Why? Why?” I think Thomas Kuhn does a great job of that in his book.

Tim Ferriss: I should also point out, and please feel free to correct me if I’m oversimplifying, but the, “Why, why, why?” is not just for four-year-olds. It’s not just for scientists in lab coats or whatever people envision scientists to be, it’s also extremely helpful in situations like those you found yourself in with Glaxo Wellcome, and attempting to license, I mean, constantly pushing for explanation and clicking on those footnotes to go to the footnotes to go to the footnotes to ultimately get to some point of leverage where you can move things around. It seems like it’s also not just an intensely interesting and academically rewarding approach to thought, but an immensely practical approach to life. At least that’s how it seems from reading so many of your stories.

Martine Rothblatt: Yeah. When you discover something, what’s happening is that gazillions of neurons are lighting up in your brain, and it’s lighting up the pleasure centers too, so I really believe that there’s nothing more exciting than having a realization about something, coming to an inspiration about something, which is why books and reading are so magical. Another science fiction writer who I feel does such a great job of explaining concepts that can inspire people is Octavia Butler. She wrote a lot of books. One of them, very well-known, is Parable of the Sower, Parable of the Talents.

In these books, she gives people an appreciation of questioning authority. I’m not sure what it was that my parents did. I don’t really remember them specifically encouraging my questioning of them, and in fact, I do remember my father discouraging it, but nevertheless, what happened to me was I absorbed the American culture, and the American culture is a culture of questioning authority. I recently heard one of the latest interviews with Tony Fauci when he was, people were asking him, “Why is it that Americans won’t do these basic public health steps to stop the pandemic?” and he said, “You know, American culture does not like to be told what to do. American culture is dyed in the wool to question authority,” so there could probably — you’d be hard-pressed to find another country where it would be more difficult to get people to follow like a single rule for everybody than the United States. It’s that American cultural ethic of questioning authority that I know is like deep in my mental DNA.

Tim Ferriss: We were chatting just a few minutes ago about realizations, inspiration. I’d like to ask if we flash back to — well, we could flash back to any point in time that you choose, really. How did you relate to or think about gender in your youth, and you can choose what youth means? I guess I’m wondering if there were any flashes of realization or if you came sort of pre-installed with a certain orientation or way of thinking about it or feeling about it, whatever you could say to speak to your experience of gender when you were younger. I would love to hear it.

Martine Rothblatt: Sure. It is related to this questioning of authority, Tim, around teenage years. I had a constant vision of myself, not as a male, but as a female. Of course, I said to myself like, “WTF, why am I thinking like this?” I can’t imagine anybody else is thinking like this, but nevertheless, it was, the thoughts were real, and the feelings were real and the feelings were visceral, I could say.

Tim Ferriss: What — could you describe the feelings because I think it — I’m certainly very interested in what form that takes. Is it a discomfort of some type? Is it a longing? How did it feel for you?

Martine Rothblatt: First, I should say that I think the transgender feeling is different for every single transgender person, and talking about my feelings, I don’t want to give the impression that these are going to be the feelings of other transgendered people because as a community, we’re as heterogeneous as anybody else. For me, it was really a matter of just visualizing myself in a female form, and there was not any dislike of my male form. Again, it was kind of very Alan Wattsian in that I saw myself as male only because the opposite of male was female, so I could also see myself as female. This was the way my mind was working, and when I say I saw myself, it was just kind of like a physiologic embodiment. Obviously, I knew boys and girls, and men and women’s bodies were different, so I was stuck with this visualization of myself as a woman when I was very much trapped in a male body.

It was the prevailing view that this was a completely unacceptable way to be, so the authority was, “No. This is not possible. People are only male or female, and never the twain shall meet.” Again, this American, Paul Revereish “Question authority” mindset got me reading, and I found once again that there was a vast literature on transgenderism, transsexualism, Native American people who were two-spirited, communities in India and other parts of Asia that identified as neither male nor female. Even though this was never something I learned in junior high, or high school, or elementary school, or really anywhere in American culture in say the 1990s, I learned through books that humanity was not either strictly male or strictly female. As I began to question authority, I began to say to myself, “Why can’t I also come out as not strictly male and not strictly female?”

Tim Ferriss: I’d love to ask a follow-up question to that, which is when, I think a lot of listeners hear the words male and female, they think of the physiological differences that you might put side-by-side, looking at physical characteristics. When you say not totally male or female, or not cleanly bifurcated into solely those two categories, do you mean to say masculine and feminine traits are what we would often find labeled as such, or do you mean something else?

Martine Rothblatt: I mean, predominantly, the masculine and feminine traits that you refer to. Now, oftentimes those masculine and feminine traits are just a short hop, skip, and a jump from masculine and feminine apparel, I would say, depending on how people dress.

Tim Ferriss: Right.

Martine Rothblatt: They’re a short hop, skip, and a jump from masculine and feminine hairstyles in an age, that was the time of Prince and Boy George and whatnot. Then, you get to masculine and feminine manicures like, “Why can’t a guy paint his nails?” Then, you get to next questions of secondary and primary sex organs, and some people wishing to take hormones to alter their actual physiology and ultimately go through surgery to alter their physiology. I found that there was actually like a vast literature following, again, footnotes to footnotes, references to references. I was like, “Oh, my God, it is possible to in fact alter your physiology to match your psychology,” and what appeared to be the most intelligent researchers in this area are opining that this is a safe and healthy thing to do for people who feel that they are kind of “trapped in the wrong body.”

Tim Ferriss: Do you, from, let’s say zero to 100 percent, how well do you feel you have your physiology matching your own psychology at the moment?

Martine Rothblatt: 100 percent. 100 percent.

Tim Ferriss: 100 percent. What were the biggest or the most important decisions, actions that you took? Did any surprise you to have a disproportionate effect on increasing that percentage?

Martine Rothblatt: No. Nope. I think that every part of the transition process kind of fell in place. It was not something that happens on a day. It’s kind of you get to a point of diminishing returns, so over a period of years, I gradually transitioned. I think even to this point, I’m still in a transition process.

I kind of went from a pure male to a more, I would say not pure, but I would say knocking on the female door, to a point today where I feel very comfortable identifying as trans binary, and meaning that I embrace both the masculine and feminine aspects of myself completely.

Tim Ferriss: Looking at the introduction, which I read at the top of the show, so to speak, there’s a line about leading efforts of the transgender community to establish their own health law standards and of the International Bar Association to protect, and this is the part I want to ask you, to elaborate on autonomy rights and genetic information via an international treaty. What are autonomy rights and genetic information?

Martine Rothblatt: Sure. Autonomy, it’s just a fancy word for saying that people should be able to make up their own mind, that people should have the power, the authority, the freedom to decide what to do with their own body, and genetic rights, of course, refers to the human genome, the DNA that we all have. Now, there is a tremendous diversity of human genomes out there. There are people who, because of their DNA, they are pretty much immune to some kind of cancers, whereas other people, because of their DNA, it’s very likely that they’ll get those type of cancers. There are some people, because of their DNA, they almost cannot feel pain.

They have an extremely high tolerance for pain. There are other people, because of their DNA, that the slightest pinprick will send them screaming. Once Craig Venter and Francis Collins led the effort to decode the human genome, and about the year 2000, all types of pharmaceutical companies and academic researchers began scouring the world to engage in what’s called genetic mining or genome mining, meaning, going to different populations of people around the world often that have been intermarried for quite a while so their genomes are kind of concentrated, and trying to learn something from those communities’ DNA that can then be translated into useful pharmaceuticals to help everybody else have some of the strengths or less of the weaknesses of those isolated populations. What I was concerned with is that if people extract the DNA from these remote communities, that they in fact do so only with the consent of those communities or with the consent of the elected representatives of those communities so that they can have some fair financial return for their natural endowment.

Tim Ferriss: I see, so it’s similar in a sense to preventing say biopiracy from the Amazon, where you have these tribes who are not providing their own human genetic information, but are, say, acting as a wellspring of ethnobotany in providing source materials for creating pharmaceuticals.

Martine Rothblatt: Exactly.

Tim Ferriss: You want there to be some recompense to those groups, translating that into your own sort of endogenous genetics would be what you’re referring to. That’s fascinating.

Martine Rothblatt: Absolutely.

Tim Ferriss: What types of groups — are there any examples you could give of these sort of tightly knit clusters? Maybe the clusters is too small word, of people who are being studied for this reason or — 

Martine Rothblatt: Yes, there are actually many, many dozens and there are quite a few companies who specialize in this type of area. The population that comes top of mind to me, Tim, right now is a, because that’s such a fascinating story and it relates to my own activities in organ manufacturing, is a community of people living in Ecuador and Peru. Very close-knit, intermarried, that are all a kind of dwarfism. These individuals, they rarely grow taller than four-feet tall, and it was discovered just over the past 15, 20 years that they are descendants of Jews from 2,000 years ago, who were forced into a diaspora across the Mediterranean after the Roman occupation of Palestine, and in that ancient time, these people were of very small stature, but it was just part of the human diversity. They ended up as a group, mostly ending up in Spain, and then when the Inquisition took hold, their descendants, who are still very small, they left Spain.

They went to the New World, and because the Inquisition still had some type of a hand in the larger population centers of what’s now Peru and Ecuador, they went out into the rural areas, and there they lived for several hundred years, and it turns out that this population, they have one gene that makes their body not receptive to growth hormone. All of us naturally, we produce growth hormone, and the cells of our bodies have a receptor for that growth hormone, and when the growth hormone locks into the receptor, we begin growing. This population of people in Peru and Ecuador, they lack the growth hormone. That gene fell off like 2,000 years ago, and they kept passing it on and on, not much growth hormone receptor. Not much growth hormone receptor, so they’re perfectly intelligent, they live normal lives, they just don’t grow very large. I found this population fascinating because in my company, United Therapeutics, we’re trying to create an unlimited supply of transplantable organs, and one of the ways we do this is by modifying the genome of the pig.

That’s kind of like a fluke of nature, Tim, that the pig’s organs, their heart, their kidneys, their lungs are very much the same size and functionality as human kidneys, hearts, and lungs. The only problem is that if you leave a pig on its own, they’ll actually grow extremely large, and when these first transplants were done, they had to euthanize the animal recipients of the transplants because the organs from the pig had grown too large, so what we did is we took a page from this population of people in Peru and Ecuador. The Western medicine gives them a disease name. It’s called Laron’s Disease, L-A-R-O-N, after this Israeli scientist who discovered what’s going on here, so we said, “Well, why don’t we modify a growth hormone receptor knockout just like the Laron’s population has into these pigs, so when we transplant the kidneys of these pigs in the people, the kidneys won’t keep growing and growing as a normal pig can be many hundreds of pounds? Instead, the kidney will just stop growing at the same size as when we transplanted it.” And that’s working out really well.

Tim Ferriss: Let’s talk more about organ manufacturing. What are some of the other precursors or requirements for having a sufficient supply of organs to meet whatever demands there are in the US or in the world today?

Martine Rothblatt: The demands, whether it’s in the US or outside the US are huge, and are way, way in excess of the supply. I would say that one of the greatest unmet medical needs today is an adequate supply of transplantable organs. Now, it’s a beautiful thing that before people like Tom Starzl questioned authority and said it was possible to do an organ transplant, I mean, in our parents’ teenage years and adult years, that would have just been like crazy stuff. Like you take an organ from a dead person, you put it in a live person who has a bad organ, and the person comes back to health, I mean, that’s about as crazy as it gets, but they did it. They did it.

Now, standing on their shoulders, we have hundreds of thousands of people clamoring for these organs, yet each year, there are only about 30,000 kidneys available for transplant, only around 3,000 hearts, only around 2,000 lungs, and so the gap between the need for these organs and the supply is humongous.

Tim Ferriss: Are you still, or I should say United Therapeutics currently trying to manipulate the vagus nerve? Is that in process?

Martine Rothblatt: Yes. That is in process and it’s a fascinating area, Tim. We are very fortunate to work with the Father of Bioelectronic Medicine, Dr. Kevin Tracey. He’s the Chief Medical Officer at the Northwell Medical Complex up in the New York area, and he had a great — by the way, that reminds me, speaking of how can laypeople get access to scientific knowledge easily — 

Martine Rothblatt: Subscribe to Scientific American. I’m sorry to put an advertisement in here, but I find Scientific American and National Geographic to have like the greatest ways for laypeople, which I do consider myself a layperson, to learn about all different types of science that they might not know anything about. So, one day, I got my Scientific American in the mail, and on the cover, it was “Using Electronics to Cure Diseases.” Well, here I am, like my whole career has just been like electronic engineering, building satellites, and now, because of my daughter, I’m in this medical field. So, I’m like so excited. It was one of those lightning bolts to the soul. Now, I have a chance to bring my male and female side together, to bring my satellite and my biology side together and merge them.

So I got very excited, and I had the chance to meet and now work with and support the work of Dr. Tracey. He taught me a very simple sentence, Tim, which I’ve subsequently found to be absolutely true in all the research I’ve read. It is that the nervous system touches every single cell in your body. The nervous system touches every single cell in our body. The largest nerve in the body, there’s one nerve that is way, way larger than all the rest of them, it’s the vagus nerve. It starts in our mind. It wraps around our heart, our lungs, our gut. It’s an immense nerve.

By stimulating this vagus nerve, it’s possible to have positive therapeutic effects in the body. By a fluke of nature, a positive fluke, the vagus nerve comes out to the skin in two and only two places around the left and right ears. There are like a couple of different ridges in your earlobe and or your ear, I guess how you would say it. One of them called the cymba conchae is the place where the vagus nerve comes out. If you electrically stimulate the cymba conchae on either the left or the right ear, it’s been proven now, and again in lots of published literature, to have positive therapeutic effects on the body.

Tim Ferriss: What are some of those positive therapeutic effects?

Martine Rothblatt: Sure. So one which has been documented quite extensively is the ability to control Crohn’s disease and irritable bowel syndrome, which are two gastrointestinal problems, as well as very high priced and, I would say tinged with potential side effect, biologic medicines that are approved by the FDA to treat Crohn’s disease and irritable bowel syndrome. Another illness that has been shown to mediate against is rheumatoid arthritis.

The common factor here is that we have two types of nervous systems. We have a fight or flight nervous system, which is the sympathetic nervous system. We have a rest and digest nervous system, which is called the parasympathetic nervous system. When diseases occur, it’s because one of those two nervous systems, the sympathetic one, the fight or flight, takes more of a dominant position in the body and causes a state of inflammation or over-activation. By stimulating the vagus nerve, you can ramp up the power of the parasympathetic nervous system and calm down this kind of overstressed state that leads to an irritable bowel syndrome or to the inflammation of arthritis.

Tim Ferriss: This is, in the course of doing all the reading for this conversation, one of those things that really woke me up and maybe pay attention for a bunch of reasons, one is relevance to my current life because I’ve been working with a doctor for about 10 weeks doing heart rate variability training. There are some researchers with claims, I want to say out of Rutgers and elsewhere, that certain types of HRV training affect vagal tone and via affecting that vagal tone, have a host of cascading therapeutic benefits. Whether or not that holds up to scrutiny or not, I don’t know.

The second, and I’m embarrassed to even give voice to this, so hopefully, this won’t just destroy any tiny shred of credibility that I might have as I mention it, but while — I lived in China for a period of time in college, went to two universities there in Beijing as effectively an exchange student, but it was a one-way exchange. I don’t think we had any students in return from China. The years are very much utilized in the world of acupuncture. I’m curious to know if you think that, whether by trial and error or otherwise, it’s possible that acupuncture stumbled upon the effects without knowing the mechanism of stimulating or affecting the ears to then in turn affect the vagus nerve.

I know it’s quite a stretch, but when I first read about this access via the ears, that is one thing that jumped to mind because I always kind of poo-pooed, and if I’m being honest, ridiculed the idea of using the ears to access these deep inner points but here we are. So, I don’t know if you have any thoughts.

Martine Rothblatt: Tim, first, your credibility is immense so don’t — you would have to actually say something crazy to dent it. What you said is the opposite of crazy. What you said is extremely insightful and prescient. So, as convinced as I was that putting a satellite in geostationary orbit would enable people across the planet to receive radio signals, as convinced as I was that we could have a molecule that would help the progression of my daughter and other people’s disease, that’s exactly how convinced I am that the acupuncturists of traditional Chinese medicine did, in fact, come upon the nerve patterns that are accessible from the earlobe.

One of the first things that Dr. Tracey showed to me was a very medically accurate, from Chinese traditional medicine practitioner, map of the earlobe in terms of exactly where you put — I’m sorry. I don’t know what the official name is of the pins or needles that they put in your earlobe, and how they map to different parts of the body. Then, he showed me on an anatomy map how that traces the lines of the vagus nerve so — 

Tim Ferriss: That’s wild. Wow.

Martine Rothblatt: Yeah. It is totally true, and why really would it not be true? I mean, thousands of years of Chinese civilization, they have had a chance to do so much trial and error, and they were a literate civilization for so long, so the results of that trial and error could be passed on and passed on. So, I do think it’s entirely rational that they would have figured this out, and what I’m hoping for now and what I’m trying to support is there is an opportunity to what I call in my own words, crack the human neurome. So, what that means, that there are a unique pattern of amplitudes and signal lanes and signal voltages that will activate some different part of the vagus nerve than others. Each of these different voltages and wavelengths will correlate to a different part of the human body. We don’t know what those are.

Right now, we are just kind of, in a way, I would say we’re dumber than the acupuncturists because almost all of the work that the FDA has allowed to go forward on vagal nerve stimulation, they all use the same pulse width, the same pulse power, and it works, so that’s great, but I think it can work even better if we decoded the human neurome. I believe in the future, people will be able to put on a pair of like Beats headsets, and those Beats headsets will have a gel-less, meaning like you don’t need the X or the EKG kind of gel, gel-less electrodes will rest across your cymba conchae and your tragu and the different parts of your earlobe and will provide you a stimulation that matches the particular ailment that you have, eliminate the ailment without taking any pills, without paying any money to anybody.

Tim Ferriss: This is an area I want to keep digging in because it’s rare. Well, it’s pretty much nonexistent that I have the opportunity to speak with someone with so much electrical engineering background about the possible applications or implications of technology like this. I’d love to just throw out another group of devices to see if you have any opinions on them one way or the other, but potential applications of, let’s just say tDCS or TMS, transcranial direct-current stimulation, or other means of stimulating the brain, typically using some type of conducive gel but not always in the case of a TMS paddle. Have you looked at these technologies or done any reading in the literature related to them?

Martine Rothblatt: A little bit. I’m aware of — a friend of mine has a company that obtained an FDA approval for treating a particular form of brain cancer with this type of technology, so there’s this very solid, scientific benefit that’s been documented. After many years of working through the FDA, I have a world of respect for the rigor that they put into any decision to approve something, so when they approved it, it meant that it was scientifically proven to work. Something that is quite different from that but at the same time, related to it, Tim, is on the last day of 2019, which was like the last day of the decade, it turned out to be a weekday. I forget if it was a Tuesday or whatever, but the US Patent Office only issues patents on one day of a week. It was like the one day of a week that they issue them on Tuesday or whatever. It was a patent that I received for a device that I call an Alzheimer’s cognitive enabler.

This device is worn over the cranium, as you mentioned, and it senses nerve impulses inside the brain. It is connected to a computer with a visual recognition and a speech comprehension system so that if a patient with Alzheimer’s is not able to adequately communicate and appear to recognize the people who are coming into their room, the computer vision recognition system and sound recognition system will talk on behalf of the Alzheimer’s patients, say, “Hello, son. Thank you for coming to see me.” It is actually being triggered by recognitions that are deep in the Alzheimer’s patient’s mind so that more people will come to visit the patient, the patient’s stress levels may be lower. So, I believe this kind of bridging of electronics and the mind is really right around the corner.

Tim Ferriss: What inspired putting the work into that research and filing that patent?

Martine Rothblatt: I think part of it was seeing my mother-in-law suffer pretty badly from somewhere on the spectrum between dementia and Alzheimer’s. It was never really completely clear where she was at that. She would recognize us coming in, but she couldn’t communicate. It would’ve meant a lot to everybody if she would be able to communicate. My own mother is more or less at that point right now as well.

Secondly, the work on the BINA48 computer showed me that it was really possible for people to strike up meaningful relationships with the digital version of Bina, the BINA48 robot. So it was just like a very short step from, instead of putting all of Bina’s or even a good portion of her memories and her personality into this computer, why not actually have the computer’s interaction capability, input-output capability triggered by something like a NeuroSky type of EEG brain interface? The last piece of it was, I was given a Christmas present by a friend of mine, which was one of these NeuroSky headsets that lets you kind of like play a game just with your thoughts by controlling your EEG signals, so that’s a consumer product anybody can buy, and it really works.

Tim Ferriss: Wow. This conversation brings back a lot of memories for me because I have Alzheimer’s disease — it’s very prevalent on both sides of my family and observed both sets of my grandparents deteriorate to the point where at least some of them couldn’t recognize immediate family members, and was recently rewatching segments of a documentary I saw called Alive Inside. The subtitle is A Story of Music and Memory. What struck me most about this documentary is that they could play music from someone’s youth to them through headsets and watch them come alive in some really spectacular ways, both physically in terms of kinesiology moving around but also psychologically.

The most impressive part to me is that they would play music for, say a handful minutes, five to 10 minutes from someone’s youth, and then turn off the music, and that person could have a perfectly coherent, reasonably fast speed conversation, whereas prior to the administration of the music, they were, from the outside, catatonic basically. It makes me wonder what music is doing, I’m sure there are people who study this and probably have a better mechanistic explanation, and how it could be incorporated into therapies intended to counter dementia or advanced Alzheimer’s disease, things of this type.

Martine Rothblatt: Tim, you see, like just in this conversation, we are in covering like so many vast new oceans of opportunity for people to learn and study about music. To me, music is the foundational human technology because the first thing that we ever could become aware of would be the beat of our mother’s hearts while we were still in utero. That beat, that’s a rhythm, okay? After we’re born, people may have better or worse rhythm, but there’s nobody that cannot detect the sound of a beat and move to it. Then, all the different types of melodies and chords that build upon rhythm, it’s just fancier and fancier forms of music. So I believe that there’s tremendous therapeutic properties to music, and it’s just been scratched. Not even scratched. It’s been kind of like blown on like — you know? It’s there for like all the thousands of young people today who have come up growing up with more music than ever before to begin to apply this great human cultural technology of music to the biggest mystery in the entire universe, which is the human mind.

Tim Ferriss: I want to come back to the mind or more accurately, consciousness in a moment, but first, this will seem like a left turn, and it is, I was reading a piece in The Washington Post that covered quite a lot of your life. There was a segment on love night. I don’t know if that’s enough of a prompt, but can you tell us what love night is?

Martine Rothblatt: So when Bina, my partner, and I got married, we each had one child from a previous marriage that each of us had custody of. Then, we had two children together, and we were kind of trying to build a blended family that would feel like nobody was a stepmom or a stepdad, that everybody was just like in one family. In fact, we cross-adopted each other’s kids from our previous marriages. So I was taking the kids to music classes. All of the kids were in the Yamaha music program where they learn piano and violin, instruments like that, and we would practice songs.

I was brought up Jewish where every Friday night was something that was special. It was the Sabbath, and the family sat down together and had dinner and said a couple of prayers. So, Bina and I tried to think, how can we like merge all these things together? The Jewish tradition, the need to create a blended family, the music that we were all enjoying from watching the kids learn to play piano and violin. We decided to, every Friday night, have a special family ceremony, which we would call love night. We sang a song, which the melody was actually based on one of the kids’ songs that they had learned in the Yamaha music program. The words were very simple and affirming. At love night, the core of love night was that each person around the table would have an opportunity to say what love meant to them during the past week. During the week from the previous Friday to this Friday, what does love mean to you?

Bina and I, as the adults, we would say something either sophisticated or simple like, “I love Bina. I love Martine. I love the kids.” The kids started off just saying like, “What love means to me is like our dogs, our cat.” Very basic things, but as they grew older, they came into more and more sophisticated definitions and expressions of love until after a couple of decades of this, I have heard all of them, all of us have heard thousands of different things that love can mean to a person.

Now, I’d like to fast forward, and sorry to be in a little riff here, but I want to fast forward to the current COVID pandemic. Our kids are all adults now. They’ve flown the coop. They have their own kids, and suddenly, we are in a situation where we can’t all gather together in any one house for love night. You don’t want to travel. You don’t want to like endanger people, so on and so forth. So, we decided to continue the love night tradition but on Zoom or to be fair, Google Meet, not — yeah. Google Meet. Got to get them all straight.

So every Friday night, from my son who’s a captain in the army in Iraq to his wife who’s on a base in El Paso to my other son with four grandchildren in Florida, to my daughter in Brooklyn and her kid and her husband and Bina and I, we all get together on Zoom, plus friends of all of ours. The kids were not embarrassed by love night. In fact, they wanted to share it with their friends, and their friends were saying like, “Whoa, this is crazy. This is beautiful.” So we get together every Friday night. We sing our love nights song. Now there’s about 20 of us. We go around virtually what love meant to us during that previous week. I would say love night is one of the most beautiful parts of my life.

Tim Ferriss: I’m so glad that I asked that question. And love night, could you give a few more examples of possible answers just to give people a flavor for how people might answer this question? Because I, for instance, would love to try this with my girlfriend, with some of our friends, family, et cetera, but I would be nervous as the orchestrator that I might get that question and not have the ability to kick things off effectively.

Martine Rothblatt: Sure. So every morning, Bina, my partner, goes out for — takes our two dogs out for a walk with one of her best friends who lives a few houses away. That best friend now joins our love nights. Last Friday, she said, “What love means to me is every morning, going out for a walk with Bina and the dogs.” Last week, our youngest grandson, Saturn, he was born in 2010 so he’s 10 years old, he said, “What love means to me is this.” He pulled a piece of paper. He said, “I got a 95 on my math test,” and he was just so proud of himself and shared it with us. So those are typical examples of — I think I, last time, said “What love means to me is sitting down at the piano and playing different songs from memory.”

Tim Ferriss: Do you use this as a skipping — I was going to say a skipping stone, but I think I’m getting my metaphors mixed up. I’d say a launch pad, a lily pad, pick your choice, to consciousness? Do you think that we will be able to, as I’ve heard you put it once, recapitulate or recreate consciousness synthetically? Does that mean we’ll have machines that can love, for instance, in the not too distant future? What would it mean to have created consciousness?

Martine Rothblatt: Sure. I do believe it’s possible. A great book that I would recommend that goes into this subject in beautiful detail is called The Emotion Machine by Marvin Minsky. Marvin Minsky is often thought of as the father of artificial intelligence. He was a professor at MIT for a great many years. So in The Emotion Machine book, he really describes exactly how you would go about creating a computer and the type of software that it would take in order for the machine to feel what we feel when we say that we love somebody. I think it’s likely to occur, Tim, because it’s hard for me to think of any aspect of life that cannot be replicated if one had sufficiently advanced technology.

One of my favorite sayings from another role model, Arthur C. Clarke, is that magic is indistinguishable from sufficiently advanced technology. So I think just like we have been able to create an artificial hip, artificial knees, artificial hearts, in my own company, we are building lungs and kidneys, people are creating artificial nerves, people like Elon Musk has formed a whole company, Neuralink, where he’s working on downloading a whole human brain, I have little doubt that humans will end up being able to replicate a human mind.

Now, whether or not the rest of society accepts it as a human mind or not, I think, is going to be a long pitch battle. That’s what is the subject of my book, Virtually Human. That whole book talks about how and when will society accept digital consciousness as being as conscious as a human, but even if that digital consciousness is not yet at human level, what happens when it’s at, say, primate level or at canine level, or even now at rodent level, if you can get to any of these levels, you could kind of see how it’s the same old human effort of keep making incremental improvements that would eventually get you to the human level.

Where I think that the individual alive today that has the best understanding of this topic, Tim, is a guy at Google named Ray Kurzweil. He’s a director of engineering at Google. What I love about Ray is he never tires of pointing out that this digital human consciousness, it’s human. Human consciousness is a human phenomenon, so when we create a digital-analog or a doppelganger or simulacra, whatever you want to call it, when we create a Her, that Her is human. It’s not us versus them. It’s one. It’s we will have been able to move our mind into a digital substrate just like if our knees give out, you move it to a mechanical substrate, or if an organ gives out, you transplant it with another organ.

Tim Ferriss: Where would you, if you had to, kind of Price is Right style, put a timeline on this, when do you think we’ll have rodent or canine level in — I was going to say intelligence, but let’s call it consciousness plus intelligence?

Martine Rothblatt: Yeah. It’s pretty hard to say, Tim, because one thing I am not is I’m not a soothsayer, I’m not a prophet, I’m not a visionary, any of those things. I’m just a humble technologist and all the projects I work on, they have five-year time horizons because I have difficulty really seeing beyond five years. So, every technology I’m working on, it’s like, I want to get this thing done and out to the public within five years. Also, I am totally a believer in this adage that futurists usually over-promise in the near-term and under-promise in the long-term. So what that would mean in this context is you will hear a lot of futurists saying, “Oh, we’ll have digital rats or digital dogs or digital people in 10, 20, or 30 years.” They have probably over-promised in the near term. What they have under-promised in the long-term is, in not 10, 20, 30 years, but in say 80, 90, or 100 years there won’t be just digital rats, digital dogs, and digital people, but most people will be digital.

Tim Ferriss: Exciting, and I suppose for some people very terrifying at the same time. What are some of the most important ethical questions or considerations related to technology as we move into future decades in your mind?

Martine Rothblatt: Yes. In my mind, the biggest problem with technology is that people only think about the rights to implement a technology and they don’t think about the obligations they have as somebody creating a technology. And what I mean by that, Tim, is there was this great philosopher of the 20th century, [Isaiah] Berlin, I believe he was German, and he had a real simple message. His message was that for every right, there is an obligation. Again, it’s a very Alan Watts-ian, sorry to keep coming back to Alan Watts, but it’s a very Alan Watts-ian point of view that a right only means something in the context of its obligation. So for example, if I have a right to be a parent, which we think everybody has a right to be a parent, you only have that right to be a parent so long as you comply with your obligation to be at least not a horrible parent. If you’re a horrible parent, you will have your children taken away from you and you’ll no longer, in that sense, be a parent.

So with regard to technology, I think there is a point of view that anybody who can create a technology has a right to make that technology. But I dispute the ethics of that perspective. I think that every right to make a technology is coupled to an obligation to have the consent of anybody who would be adversely affected by that technology. So for example, my right to build an atomic power plant or a nuclear power plant someplace, I don’t just have that right. That right is coupled to an obligation that I have to have the consent of all the surrounding communities of people who could be adversely affected by the implementation of that technology. And it comes into this domain of, in my own field, say the transplantation of genetically modified pig organs into people. For me to have a right to do that technology, I have to have the consent of the larger community that that’s a safe thing to do.

In a democratic country, that consent is issued on behalf of the country by the government, and in the field of health it’s issued by the FDA. So, before the FDA permits us to transplant these genetically modified pig organs into people, they want us to demonstrate to them that there is no risk, not a small risk, but no risk of any kind of animal virus seeping into the human population as result of these animal transplants. So in summary, I believe in like an amazing field for the future. A field that will, probably in the future, have almost as many people with this career as our web designers today, is the field of technoethics. Everybody who wants to create a technology will need to wrap that technology in an ethical envelope of consent.

Tim Ferriss: If we look at science over, well, we could look at it over the last few thousand years, but let’s just say the last few hundred years, you mentioned earlier that, I think you were discussing the structure of scientific revolutions, how these breakthroughs, these massive scientific leaps forward, seem like complete madness at the time to the vast majority. And we don’t have to go that far back to find say surgery without or with minimal use of anesthetics on newborns and infants. This is not the dark ages, this is less than a hundred years ago. You see some really appalling things that were taken as best practices or common practice.

And one of my friends, who’s an outstanding doctor, likes to repeat this, I suppose adage, that you hear among good doctors, which is 50 percent of what we know is wrong, we just don’t know which 50 percent. And that seems to always be true. So if we flash forward 10 or 20 years, and I know you’re not a prophet or a soothsayer, but I’m curious, or it could be five years, as a technologist, what do you think are any of the things we’re doing now or believe now that will be shown to be patently absurd or viewed as barbaric or crazy or naive in the near future?

Martine Rothblatt: Well, probably a lot of things. Since there are a lot of what we look back in the past at seems to be barbaric. For building on top of your example of the torturous procedures put onto neonates, people forget that the founder of the American Medical Association, the first doctor who created the American Medical Association, his name was Dr. Gross and he lived in Philadelphia. And he did not believe in asepsis at all, and so he would do all of his procedures right in his street clothes infecting everybody and countless women lost their lives because of having those types of quote unquote doctors helping with the delivery of the children and ending up creating a septic condition in the mothers. One of the most famous painters in American history, Thomas Eakins, painted this picture of the Gross Clinic, where Dr. Gross was teaching all the young doctors how to do a procedure, and you see dirt in his shoes and scruffy hands.

Then he was followed, the second president of the American Medical Association was a Dr. Agnew, who was the student of Gross. And he had read about the research of Lister in England and became a believer that even though we can’t see these things, germs, they’re real and we need to practice strict septic procedures before we do an operation. A few years later, Thomas Eakins painted the Agnew Clinic and you see that the doctors are in white smocks and everybody is looking super sterile and clean. So these type of revolutions can occur just like one generation to the next. It’s not something that takes a long time. I think that looking at what’s going on today in our world, I think the fact that we burn our own house will look to be absolutely bonkers.

People will say, “Well, let me get this right. You’ve got a super-thin atmosphere. I mean, you guys saw that from space since the ’60s at least, this atmosphere around your planet is super thin. You have an undeniable record of measurements of carbon dioxide into the atmosphere going up year after year after year. And you continue to just spew without limit greenhouse gases into this atmosphere despite the fact that people are dying on the shorelines, dying of diseases,” et cetera, et cetera. I think they will think we are as stupid as somebody who would light a fire in the middle of their house to try to keep warm and not bother with the smoke that they were choking on.

And then, if I could add an addendum to that, did you guys know that the Earth receives 10,000 times the amount of solar energy, falls right on the Earth each day, than it uses? 10,000 times the amount of energy, it flows, and that’s not to talk about the wind and that’s not to talk about the waves, and that’s not to talk about the nuclear energy. I mean, I think the people in the future may think we were pretty stupid to be so scared of nuclear energy, which has killed a few dozens of people, that we went ahead and just stopped all the nuclear plants and began pouring ungodly amounts of greenhouse gases into the atmosphere that will kill millions of people. That will seem ludicrous to them.

Tim Ferriss: I won’t keep you too much longer, but I think I would be remiss if I didn’t ask you to comment on or describe your own engineering projects with carbon neutrality or zero-emissions as an objective, because this is not just kind of idle hand-waving for you. This is something that you’ve taken a keen engineering mind to. And I think that was not mentioned in your bio, even though it’s yet another one of these examples of your sort of extreme curiosity and capability. Could you just describe what you’ve done in that arena, please?

Martine Rothblatt: So, this is another area that gives me immense enjoyment. Again, another kind of lightning bolt to my soul is to try to create infrastructure, buildings and cars and planes, and things that have a zero-carbon footprint. I look at it as an intellectual challenge. When I read that people said, “Well, we cannot have a zero-carbon-footprint society until 2050,” that’s what the authorities say. You know already, Tim, I’m going to say, “Why? Why not? Why not? Why not?” I’m going to question that authority. So about three years ago we undertook to build a new headquarters for our company in Silver Spring, Maryland, that would have a zero carbon footprint. Not in the best climate, Maryland, it’s got its good seasons and its bad seasons.

Right in the middle of a city, Silver Spring, Maryland, is a built-up suburb of Washington DC and for the manufacturer of medicines and stuff, which is a somewhat of an energy-intensive activity. So we built a 150,000 square foot, zero-carbon-footprint building, which turned out to be the largest zero-carbon-footprint building in the entire world and we inaugurated it a couple years ago. It turns out we produce more energy than we use each year, now two years running. We did this by just thinking carefully about energy and how to manage it. So for example, we have underneath the building 50 Wells, each of which go down 500 feet and they exchange heat from the building with the coolness of the earth in the summer, bring the coolness back up. And in the winter they exchange coolness of the building with the steady temperature of the earth in the winter to keep the building warm.

The sides of the building are clouded with the solar panels. The entire building has a brain that automatically opens the windows and closes the windows to allow natural ventilation. And it’s a role model for many other buildings and lots of designers and engineers have come over there. Another example is in the delivery of our organs. Right now, we refurbish organs, lungs in particular, that the decedent has donated, or decedent’s family has agreed to the donation, but when the transplant surgeons look at that lung, they say, “It’s too full of fluid and mucus; we can’t use it. Throw it away.” So what United Therapeutics says is “Give us your lonely, unwanted, unloved lungs, fly them to Silver Spring, Maryland, we will refurbish them.” We’ll show, through a high-speed digital network to the transplant surgeons all across the country, that the organ is good as new through this digital network and bronchoscope and x-ray and all that stuff. And then we fly the lungs back out to them. We’ve saved over 150 lives this way, Tim.

Tim Ferriss: How do you refurbish a lung?

Martine Rothblatt: First you have to remove it from the dying body. A dying body is a terrible place to be. So, we remove it from the decedent. We cool it down. We kind of give it a, I won’t say we freeze it, but we cool it down to a very low temperature. We fly it to Maryland and we put it in a glass dome. And in this glass dome, we have tubes, we have a kind of artificial blood and the air pumping. So, we’ve made a kind of isolated artificial body just for that lung. We have expert technicians who work these, sorry, I don’t know the exact name of the equipment, but it sucks out the mucus and they operate on the lungs like it was a person, but it’s just an isolated pair of lungs. And the transplant doctors who could be in Texas or Florida, wherever, they tell us through the digital screen and the voice, “Put the bronchoscope down the left side or down the right side,” or “Go further.”

They see this and they know what they want. So our technicians know how to do this. And within four hours, in almost two-thirds of the time, we are able to take what was a non-compliant, dead piece of tissue and turn it into a nicely breathing lung. It’s so beautiful to watch, Tim. The lungs go in and out like a butterfly’s wings going up and down. In fact, you could see a video of it on that Washington Post article you were mentioning. And then, we cool the lungs back down and we fly it to the transplant surgeon, and 100 percent of the time that they have accepted these lungs, they have had successful lung transplants with, like I mentioned, over 150 people walking out of the hospital.

But I mentioned this because this has a lot of flying around; flying here, flying there, helicopters going back and forth, planes. And if I’m going to make an unlimited supply of organs, and you remember all those numbers we talked about at the beginning of the call, the hundreds of thousands of people who need these organs, that is going to be a humongous carbon footprint. We could have said to ourselves, “Well, we’re doing such a good thing. We’re saving all these lives. We could be permitted to foul our atmosphere because it’s balanced by the good things we’re doing.” But instead, we like to ask ourselves the challenging question, “How can we do the good thing and the right thing at the same time? How can we manufacture all these lungs and deliver them with a zero-carbon footprint?”

And the solution came from the technology of electric helicopters, which are powered by renewable energy that can fly these organs from one place to the other without adding any carbon footprint at all. And I will be a little bit of a soothsayer here, I am absolutely convinced that in this decade, the 2020s, we will be delivering manufactured organs by electric helicopter.

Tim Ferriss: I love it. I have, I will say one, I may cheat and sneak in one or two more, a question.

Martine Rothblatt: I love talking to you, Tim.

Tim Ferriss: Well, likewise. This is just endlessly interesting. So many different pathways into the labyrinth. But I need to make sure, I suppose, since my job as supposed interviewer that I can find my way back out.

Martine Rothblatt: Alan Watts will show you the way.

Tim Ferriss: Alan Watts will show me the way. He does have a most seductive and hypnotic voice for those who haven’t heard, I recommend. I’ve read that a favorite saying of yours is, quote, “Identify the corridors of indifference and run like hell down them.” End quote. Can you please speak to that and explain what that means for you?

Martine Rothblatt: So, identify the corridors of indifference and run like hell down them means to try to find a — I’ll put it in business terms — a market area that is ignored, an unmet need. But that doesn’t really have to just apply to medicine, it can apply to any area of life. And the way I would phrase it, Tim, in just like a very natural almost folklorish way is that it’s better to be a big fish in a small pond than a small fish in a big pond. In business school back at UCLA, one person we studied a lot was the experience of General Electric under Jack Welch. And he had an adage, which from a business sense was, I think, very, very smart.

He said, “If you can’t be number one or number two in the market, don’t even try, because you will have to spend an amount of money equal to the revenues of the number one or number two in that market to become the number one or number two in the market.” If you’re not the number one or number two, you will always struggle to be profitable. But if you are the number one or number two, your profitability is assured.” So what that means, translated to all of our activities, is if there’s an area like for example, a number of people have said we should get involved — when I say we, my company United Therapeutics — should get involved in creating a vaccine for COVID.

And to me, well, it’s not a corridor of indifference. There are dozens of companies working on a vaccine for COVID. So that’s not what we would want to do. It’s very unlikely we’d ever be successful on that. Somebody else said, “Well, how about these people, the COVID long-haulers? The people who have survived from a very difficult course of COVID and they’ve got chronic lung problems that are bothering them months and likely years after the effect.” I said, “Yes, that’s a corridor of indifference. Nobody is thinking about the long-haulers, the people who now have chronic lung problems because of the havoc that COVID racked in their lungs. Let’s develop some medicines for these chronic long-haulers.”

Tim Ferriss: That makes a lot of sense. That makes a lot of sense. And on a related, maybe a related note in some respects, and this is a question that doesn’t always work so I’ll take the blame if it doesn’t, but if you had a billboard, metaphorically speaking, to get a message, a quote, a word, an image, a question, anything, out to billions of people — let’s just assume they all speak English for the sake of argument — what might you put on that billboard?

Martine Rothblatt: I think Apple Computer and Steve Jobs got there before me. Think different, think different.

Tim Ferriss: Why is that important?

Martine Rothblatt: Because the solutions — Albert Einstein said you can’t solve a problem on the same level that it was created. You have to solve it on a different level. If we all think the exact same way, we will never get out of the ruts that we’re in. The only way to get out of the problems that we face is to think differently, to go down the corridor of indifference, to question authority, to be diverse. Thinking different is the pathway to solving problems that exist today.

Tim Ferriss: Looking back at everything we’ve talked about and looking at all of the copious pages of notes for prep in front of me, it strikes me that you’ve forged many paths for yourself and helped others do the same, by thinking different, but also thinking brightly, coming back to Alan Watts yet again. Right? The yin and the yang and seeing the positive, looking for the positive in different circumstances, different situations. Do you have any advice or recommendations for people who struggle to do that? Who are maybe mired in a sense of — hopelessness might be too strong a word — but those who tend to see the glass is half full and perhaps as a result of that tend to see half the spectrum of options or solutions?

Martine Rothblatt: So it’s a really difficult question to answer, Tim, because everybody’s situation is so unique and so different. I do not doubt that for many, many people, it is just a bad life and whether it started that way or ended up that way, and it’s almost impossible to see a way out. The perspective that I take is that I try to stay in touch with my ancestors. I think about the great-grandmothers who had to bear children in the worst of possible circumstances. I think about all of the — like my partner Bina’s great-grandmothers — who were picking cotton as slaves and had to work all day, being bitten up by bugs, burning in the sun, feet deep in mud, and then bear a child at the last moment. So whether it’s like my great-grandparents from Eastern Europe or hers from the African diaspora, they had nothing to look forward to other than just the hope that they were going to have some children and that maybe those children might have a little bit of a better life than they did.

And if not their children, their children’s children. So their only purpose in life, their only hope in life, their only joy in life was to make a generation and that maybe that generation would be better. Now, here we are in America, or really most any other country in the world, we’re at a point now where like eight out of 10 people have a smartphone with access to all the world’s knowledge and information, with access to countless amounts of music and training through YouTube. There are many people in the world still in dire circumstances, but the vast majority of people are doing better than people have ever done before in history.

So I say to myself, and I would ask somebody else looking through the world darkly right now, looking at the glass half full, I would say, “How much worse it must’ve been in the past? What do I owe to my grandparents and great-grandparents, and great-great-grandparents who suffered and toiled, who barely managed to survive to produce another generation? What do I owe to them? I owe it to them to make the absolute most possible out of my life and that’s what I’m going to do.”

Tim Ferriss: Hot damn, Martine. I’m ready to get out there and get amongst it. I have so enjoyed this conversation. There are 79 more hours we could do just in round one. I won’t subject you to that. I’m so grateful that you were willing to make the time to have this conversation. Thank you so much.

Martine Rothblatt: My pleasure being with you, Tim.

Tim Ferriss: And is there anything else you would like to say, to suggest or ask of those listening before we bring this to a close?

Martine Rothblatt: Two of my best friends and people who I think are the smartest, most creative, most happy, loving people I know, Paul Mahon and D.A. Wallach, both said to me that your podcast is the best, and Martine, if Tim Ferriss invites you on his podcast you have to go on it. So, thank you, D.A., and thank you, Paul.

Tim Ferriss: Well, thanks to them also for me. I have for many months, my whole team knows this, been hoping to have you on. I had high hopes coming into it. You exceeded all of those high hopes, which seems to be a pattern for you. And I’m just very grateful and happy that we had a chance to connect. So, thank you again. And for everyone listening, you can find Martine on Instagram @transbinary, Twitter @skybiome. We will link to everything in the show notes that have mentioned in this conversation, the books and everything you can imagine that we discussed, will be available in the show notes at tim.blog/podcast. And until next time, be kind, practice love night, think different, think brightly, and thanks for tuning in.

The Tim Ferriss Show is one of the most popular podcasts in the world with more than 600 million downloads. It has been selected for "Best of Apple Podcasts" three times, it is often the #1 interview podcast across all of Apple Podcasts, and it's been ranked #1 out of 400,000+ podcasts on many occasions. To listen to any of the past episodes for free, check out this page.

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