Robert Gatenby, M.D.: Viewing cancer through an evolutionary lens and why this offers a radically different approach to treatment

**Peter Attia** (0:11)
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Now, without further delay, here's today's episode.
Everyone, my guest this week is Dr. Bob Gatenby. Bob is a radiologist whose specialty is treating oncology through an evolutionary lens. Now, I stumbled across his work when doing research for another podcast and got completely transfixed down the rabbit hole of what he does. This is a simply fascinating podcast, and we get into what I believe is a very important way that we need to consider treating cancer. And I hope that this podcast will provide both some hope to people who themselves have cancer, but of equal importance inspire some people who are on the front lines of cancer research in exploring another way to think about treating a disease for which frankly we haven't had a lot of great success over the past 50 years. Hey Bob, thanks so much for making time to chat today. I've been looking forward to this one for quite some time.

**Robert Gatenby** (1:45)
Thanks for having me.

**Peter Attia** (1:47)
I'll tell you, I kind of stumbled across your work in preparing actually for another podcast. I was doing another podcast some time ago and in the process of it, I actually came across an article in Wired about you, which we'll obviously link to in the show notes. And that whole concept just quickly captivated me such that I kind of made a note to my team and said, hey, at some point, this is someone I'm going to want to interview and I'm going to want to talk about this entire approach to cancer. And lo and behold, that led us to reach out to you and that's how it came about. But it's interesting that it really started with this sort of rabbit hole you can easily find yourself on in Google where you're trying to find out about this treatment for this type of cancer and this treatment and then all of a sudden you see something and I don't know what led me to read that whole article, but I was very captivated by it.
And I guess part of it is my own bias, which is my background is very similar to yours. So tell folks a little bit about your background because your path to medicine was not, I guess, the standard path.

**Robert Gatenby** (2:51)
No, I guess when I went to college, I wanted to be a physicist and spent most of that time really thinking that I should do that.
And then I had some great physicists as mentors and kind of came to the conclusion, I'm not smart enough to do this. And I got to find something else to do. And of course, that was a great humanist, the Vietnam War era. And going to medical school was considered something that was really, you know, for humanity and something that I decided I would do. To my regret, by the way, but I did end up doing it.

**Peter Attia** (3:30)
So you were at Princeton as an undergrad in the late 60s?

**Robert Gatenby** (3:34)
Late 60s, early 70s, yes.

**Peter Attia** (3:36)
And, you know, Richard Feynman, of course, also did his undergrad at... Actually, no, no. Did he do his Ph.D. at Princeton and his undergrad at MIT, right?

**Robert Gatenby** (3:44)
Yes.

**Peter Attia** (3:44)
So was there still the shadow of Feynman there in the late 60s? Because he had just won his Nobel Prize in about 66, right?

**Robert Gatenby** (3:52)
Absolutely. And Wheeler was still the department chair, and he was, you know, one of the great physicists of his generation.
Actually, my TA won a field medal. Subsequently. You know, I was surrounded by really smart people, and it was a very enriching time. I mean, it was just very stimulating and intellectually exciting to be there at the time.

**Peter Attia** (4:14)
And for people who don't know, the Fields Medal is like the Nobel Prize for mathematics. Mathematics does not have a Nobel Prize and the Fields Medal is a substitute, although it comes with two caveats. One, the recipient has to be, I believe, under 40, correct?