[MUSIC] >> Hello everyone and welcome to Amanpour and Company.

Here's what's coming up.

>> Then I heard a lot of shooting and bodies fell on top of me.

They were the people standing behind me.

I fell too.

>> Remembering Srebrenica, we mark 30 years since the genocide in Bosnia with the report from my archive and- >> The presumption in the 90s was impunity first, accountability as kind of an exception.

Now 30 years later, actually accountability is the norm.

But impunity, there are huge exceptions to it in current society.

>> I speak with David Sheffer, former US Ambassador at Large for War Crimes.

Then and now, how international law should prevent atrocities today.

Plus- >> It felt like kidnapping, having plainclothes agents follow me into the lobby of my building, a private space, threatening my wife with arrest if she wouldn't separate from me.

>> The activist and Columbia graduate, the first to be jailed under Trump's crackdown on free speech, immigration, and elite universities.

My conversation with Mahmoud Khalil, also ahead.

>> The real goal is just to get as many fully healthy years as possible.

>> Super Agers, Dr. Eric Topol tells Walter Isaacson about his new book, laying out the route to a longer, healthier life.

[MUSIC] >> Amanpour & Company is made possible by the >> Welcome to the program everyone, I'm Christiane Amanpour in London.

30 years since one of the darkest days in the history of modern Europe.

In Bosnia on July 11th, 1995, General Ratko Mladic and his foot soldiers stormed the tiny, mostly Muslim town of Srebrenica.

His forces separated the women from their male relatives and systematically killed more than 7,000 men and boys, Muslims.

Despite being declared a safe area under UN protection, Mladic's troops weren't stopped, committing the largest massacre in Europe since the Holocaust.

This genocide marked a violent turning point, forcing America and the world to act to finally end the bloodshed.

I was a young correspondent in Bosnia during that horrific war, and I saw for myself the crimes of Mladic and how he finally did face justice.

>> We'd be poor without the Muslims.

It's good to have them around, but in a smaller concentration.

>> Chilling words from the man they called the butcher of Bosnia, General Ratko Mladic.

The snide humor masked his killer instinct.

It defined Mladic, and it made him an uncomfortable man to confront.

And we'd see this preening smile again and again as the war unfolded.

Indeed, the Muslims, the Bosnian government says, I'd been covering the Bosnian war for more than a year by the time I met him, living in this shelled, sniped, and besieged city of Sarajevo.

A year of witnessing the ferocious war machine that the Bosnian Serb commander had unleashed, and he did not like my reporting.

>> What's the lady's name?

>> Kristiana.

>> Kristiana, I like Kennedy's Kristina.

>> [LAUGH] >> I like Kennedy's Kristina.

>> It won't be difficult for her to understand, because when I saw her first reports from Sarajevo, I was very angry.

>> Mladic was commanding the Bosnian Serb military mission to carve out their own ethnically pure republic and join it into a greater Serbia.

[SOUND] This was a daily occurrence, dodging bullets as we covered the unfolding tragedy.

[SOUND] For the Bosnian Muslims, the villain was clear.

They're your own people and your soldiers.

To them, you're a great man, you're a hero.

To your enemies, you're somebody to be feared and somebody to be hated.

How do you feel about that?

>> [FOREIGN] >> Very interesting question.

>> [FOREIGN] >> Both things you say are correct.

>> Prosecutors say what Mladic believed to be his greatness was, in fact, ethnic cleansing and genocide.

It would reach its climax with the massacre at Srebrenica, July 11th, 1995, more than three years into this brutal war.

It was meant to be a UN protected zone for Muslims.

When Mladic's forces overran UN positions and invaded the tiny enclave, they handed out candy, and General Mladic promised the townspeople they would be safe.

>> [FOREIGN] >> Of course, they were not.

His soldiers slaughtered more than 7,000 Muslim men and boys who tried to flee.

Hurem Suljic was one who miraculously survived the massacre.

I tracked him down in the Bosnian held town of Tuzla four months later.

>> The Serbs said, don't look around.

Then I heard a lot of shooting and bodies fell on top of me.

They were the people standing behind me.

I fell too.

>> Here, he says, he saw Mladic one last time.

>> He stood there and waited until they killed them.

When they killed them, he got back in his car and left.

>> After that massacre, the US led a bombing campaign against Bosnian-Serb military positions and peace negotiations that eventually ended the fighting.

Mladic became a wanted man and soon went into hiding.

>> CNN.

>> I never knew if I would see him again, the man with whom I'd stood on a Bosnian hilltop at the height of the war.

But it was with deep satisfaction that I watched Mladic stand in the dark at the Hague to finally face the justice he so brutally denied others.

>> [FOREIGN] >> America has called him a war criminal.

And under any kind of UN tribunal, he may have to be prosecuted.

What does he think about that?

>> [FOREIGN] >> And it's a tough question, but he's a tough man and he can answer it.

>> Yes, I can take it.

I've taken more rough ones.

I can take hers too.

>> [LAUGH] >> He'd be in hell.

>> [LAUGH] >> I defended my people, and only my people can judge me.

And there's no greater honor than defending your people.

>> Some twisted definition of honor.

Mladic and the other architects of those crimes against Bosnia remain in jail for life.

And 30 years later, the people of Bosnia still remember.

Thousands of them have been walking this week through the forest of eastern Bosnia near Srebrenica, the site of the massacres.

Since the war, over 160 individuals have been indicted by the International Criminal Tribunal for Yugoslavia at the Hague, including former President Slobodan Milosevic, who was charged with genocide, crimes against humanity, and war crimes back in 2001, but died in his cell before the verdict.

Today, war crimes tribunals are still working to prosecute, with leaders from Israel, Gaza, and Sudan facing some of the gravest accusations.

So, what will it take to stop these horrors for good?

David Sheffer, former US Ambassador at Large for War Crimes Issues, was instrumental in establishing the tribunal that sought justice for Bosnia.

He joined me to reflect on what we've learned and the power of international law today.

Ambassador Sheffer, welcome back to our program.

It's really important to have you on.

And I just wonder, that report about Mladic and Srebrenica 30 years ago still gives me chills.

And I wonder how you feel reflecting on what happened at Srebrenica all these years later.

>> Yeah, it gives chills to me too.

And frankly, if one were to sit through the entire video of days and days and days of the trial of Ratko Mladic at the trial chamber level, you would witness victims who would say so many things about Ratko Mladic that reflect exactly what you showed in that clip.

He had a dichotomous personality of graciousness and of politeness.

But then suddenly he would switch to kind of horrid, brutal directions that you either live or you die, as he was talking to the Amprofor people, the refugees at Potokeri.

So he was a dichotomous character, but I think it's the evil part of him that will be his legacy.

>> For sure, I interviewed him many times and he was pure evil.

Let me get back to about Bosnia itself and about the Clinton administration that you were serving at the time.

So in your book, you talk about having been in the room where deliberations were going on for, I mean, it was years, let's face it, throughout the entire Clinton administration until decisions were made after the massacre at Srebrenica.

And you reflect quite poignantly on that and with, in my opinion, fingers pointed, all these sophisticated talks that, what were they for really?

Tell me about that process.

>> Exactly, what we had in front of us is we were debating endlessly for months between two plans.

One was to literally withdraw Amprofor and have a NATO force protect it while it was withdrawing.

And then just letting the Bosnian Muslims, the Bosniaks, fight on without any constraint.

That was an endless debate at the table.

And it had not been finally resolved prior to Srebrenica, although the rapid reaction force option was gaining steam.

The problem is we couldn't figure out the funding for it yet.

And of course, by the time Srebrenica occurred in early July, the anticipated NATO soldiers and helicopters, etc., had not yet been deployed in theater that would have been available to just swoop in to Srebrenica and deal with that situation as it should have been.

>> So let's go all the way forward.

We mentioned that more than 7,000 Muslim men and boys were killed in the space of about two days after Mladic's forces stormed in there.

He run roughshod over the minimal UN presence there.

But all these years later, you had said, for instance, 10 years ago on the 20th anniversary in a column, "My hope is that one day a vibrant outdoor cafe will sit beside a renovated Muslim-owned building in Srebrenica, where people of diverse heritage speak knowingly of the past and optimistically of their common future.

But before that happens, attempts to deny the genocide that happened there must be buried."

So let's just take that, because the Serbian leaders, whether it's Milorad Dodic in the Bosnian Serb Republic or whether it's Aleksandar Vucic, the president of Serbia, they really shy away from that word, and they block it at the UN and all sorts of things.

And this vision that you had has not come to pass.

>> Exactly.

It has not come to pass.

And by the way, the president of Croatia is also a genocide denialist of what happened at Srebrenica.

So you have the very top leaders in that region that are sowing this untruth.

It's literally an untruth.

And I think the point to make between what I wrote 10 years ago and today is that, in the interim, seven convictions through the appeals process have been rendered against senior Bosnian Serb leaders for the Srebrenica genocide.

That means that is fact.

It's not something that can be denied anymore.

It has been judicially determined with enormous evidence of witnesses, of documents, et cetera, that the court has been persuaded, the Yugoslav tribunal and then its successor, the residual mechanism, have both made these determinations.

So if you pursue genocide denial today, you truly are revealing either an enormous amount of ignorance or you're revealing what you're using it for as leverage for your own power among your people.

>> Exactly.

Here's what a former mayor of Srebrenica said.

"Now it's 30 years and I don't see progress.

In fact, I see us going backwards.

This government is reversing anything good that was done since the war ended.

Facing the past is still our biggest problem."

Talking about that government, the Bosnian Serb government, which is nominally in charge of Srebrenica.

Where do you see the dangers there?

I mean, in other words, have lessons been learned?

>> Yeah.

That is the question.

And if you don't have memory established in your society of the genocide or, frankly, other atrocity crimes like crimes against humanity, ethnic cleansing, and massive war crimes, if that memory is not established in society and confirmed and embraced by the leadership of that society, then you are destined to see a repetition of those kinds of crimes in the future.

You know, what we were attempting to do in the 1990s in building many war crimes tribunals during that period was to establish both a means of achieving that memory and also deterring future atrocities.

Unfortunately, I have to admit that those lessons are not generally widespread 30 years later.

We have achieved accountability, which we didn't have back in the 1990s.

In fact, the presumption in the '90s was impunity first, accountability as kind of an exception.

Now, 30 years later, actually, accountability is the norm, but impunity, there are huge exceptions to it in current society.

And so we flipped kind of the normative reality in 30 years, but we haven't achieved enough practically to say that the lessons have been firmly embedded in societies.

>> Mm.

And you know what?

Obviously, that brings me to Gaza, because there are increasing number of Israeli officials and former officials through politics, the defense, and other establishments there who are saying that, you know, their soldiers are being ordered to commit war crimes in Gaza after the war crimes that Hamas committed in Israel on October 7th.

So this is Jeffrey Neiss, Sir Jeffrey Neiss, who is one of the lead prosecutors at the Ikti Tribunal in The Hague that you helped set up.

This is what I asked him not so long ago about that particular issue of impunity, accountability, and war crimes when it comes to the current war against Gaza.

Here we go.

>> It has seemed to me from an early stage, it was clear that war crimes were being committed.

Or to be fairer, there was plenty of evidence to show that war crimes were being committed.

And the responsibility is not on commentators like me.

It's on governments.

And governments should have been saying, if the evidence was sufficient far earlier, these are war crimes.

They don't do it for a whole range of very unhappy and unsatisfactory reasons.

But that's the people who should be saying it.

>> So do you agree with that?

Governments should be standing up and saying that?

I mean, look, Bosnia was the first time since World War II that genocide was committed in Europe.

And we reported it as students of the "never again" generation.

And, you know, as you say, impunity continues.

>> You know, recently, in recent years, we've actually achieved at the governmental level what Jeffrey was speaking about, which is condemning war crimes in the Russia-Ukraine war.

But in the case of Israel and the Gaza situation, the point that I've been making for, you know, a couple of years now is that every single day, with every single hour of the operations of the Israeli defense forces in Gaza, there will be a calculation made in history, because it will be done, as to whether or not the IDF was operating in accordance with the law of armed conflict, in accordance with international humanitarian law, in how it waged its war against Hamas, as well, historians will put that calculus on Hamas.

I think the point I would like to make is that so much emphasis has been put on the allegation of genocide that we sometimes lose sight that the real issue to focus on is, how has this war -- Israel had the right of self-defense.

How has this war been engaged day after day after day in terms of how military forces operate on the ground, where there is a huge civilian population, but also the enemy?

And we don't have access to the rules of engagement for the IDF, so we don't know what their rules of engagement are.

But, at some point, all of that has to be known.

It has to be revealed, so that we understand, if Israel wants to defend its actions in Gaza, defend them.

Don't just say that we act in compliance with international law.

It's a much more granular explanation that we need.

And so that has to come forth.

>> And, of course, international law, as documented in the Geneva Conventions, and it's on the wall of the ICRC in Geneva, even war has rules, because you've written, "The American Republic is pummeled with foreign policy by tweets and bombastic rhetoric from a president who may precipitate unnecessary conflict and divisiveness in the world, rather than act to prevent such outcomes."

>> It's being continued in that way, in the sense that there are decisions that have been made within the early months of this second term.

Some of them have legal rationale to them.

Others of them could be questioned, particularly the bombing of Iran.

The question there is, does that really meet the requirements of anticipatory self-defense under international law?

That's a scrutiny that will be undertaken, if not by courts, by historians and legal scholars, et cetera, as to whether or not that particular criteria was met with respect to Iran.

>> And so many civilians killed there, and none of them were in the nuclear sites.

Let's just say that, because none of the women and children who were killed were in the nuclear sites.

>> I think what we've lost sight of in warfare generally is there is a new and emerging predominant requirement that civilian populations be protected, particularly from the fierce force of modern weaponry, which is supposed to be very precise, but in the end is so precise that it actually kills a lot of civilians, ironically.

So, we need that as a priority.

>> Well, on that note, I thank you, Ambassador David Schaeffer, for all that you've done, for justice and accountability and impunity, and for talking to us on this 30th anniversary of Srebrenica.

Thank you.

>> Thank you, Christiane.

I appreciate it.

>> As we've discussed, the worst crimes under international law are being committed all over the world.

Right now, focus continues on the war in Gaza, with the International Criminal Court still seeking the arrest of the Israeli prime minister and his former defense minister.

The Hamas leaders who were indicted by the ICC have now all been killed by Israel.

This war has divided communities and raised fury all over the world, particularly fraught in the United States, where you can even end up behind bars for your views.

One example, Palestinian activist and Columbia graduate Mahmoud Khalil.

He played an integral role in the anti-war campus protests last year, and it made him a target in Trump's battle with universities, free speech, immigration, all in the name of combating anti-Semitism.

In March of this year, ICE officials seized him from his apartment and threatened to revoke his green card.

After three months in detention without charge, Khalil was finally released on bail.

His story has outraged many, and I spoke to him, asking how it felt to be in the middle of Trump's crackdown.

Mahmoud Khalil, welcome to the program.

>> Thank you.

Thank you for having me.

>> Take me back to that day, which was awful for you and your family and all your friends and relatives and people watching, when they came to your house -- I think it was nighttime, and we have some video -- and seized you.

>> You guys really don't need to be doing all of that.

>> Yeah.

Christian, it felt like kidnapping, having plain-clothes agents follow me into the lobby of my building, a private space, threatening my wife with arrest if she wouldn't separate from me, refusing to answer any questions I have, refusing to produce a warrant arrest, and basically, like, saying all the wrong things, like that I have a student visa.

They did not believe that I am a green-card holder.

So, it literally felt like kidnapping, extrajudicial targeting.

And for the next 24 or 30 hours, I was literally moved from one place to another, like an object.

So, they took me to an office in New York, then New Jersey, to Texas, then to Louisiana, which is literally 1,400 miles away from New York.

So, it would have been easier to fly from New York to London than actually take me to Louisiana.

>> And probably more comfortable.

Let me just ask you... >> Absolutely.

>> ...were you harmed at all at any time?

Were you beaten?

Were you roughhanded?

Were you harmed?

>> I was shackled all the time, shackled like this and my ankles, as well.

It felt like I was criminal.

I did not know what charges they have against me.

And by the time I arrived in Louisiana, my leg was fully swallowed.

I couldn't walk to enter the detention center.

So, it was a very, very dehumanizing experience for someone who was not accused of any crime whatsoever.

>> You say that because there's no charges, no formal charges against you.

And you mentioned you're a green-card holder, and that is a lawful permanent resident of the United States.

Have you still got your green card?

Have they taken it away, revoked it?

>> They are in the process of revoking my green card.

I still have it as, like, a lawful residency.

And as you said, the charges against me are immigration-related.

They are not criminal or civil, actually.

It's just like I am a foreign policy threat to the United States, the irony.

Or they later added retaliatory charges that I misrepresented my green-card application.

Given that, I submitted my green-card application a year before my arrest, and it was approved by the same Department of Homeland Security.

>> So, let's talk about the accusations.

You say it was, you know, foreign policy-related.

Let's get it absolutely straight.

President Trump, on Truth Social, called you, quote, "a radical, foreign, pro-Hamas student."

His spokeswoman, Carolyn LeVitt, said that you were, quote, "siding with terrorists."

Why do you think they said that about you?

And as we, you know, as we described when we introduced you, you were one of the student protest leaders in this very fraught situation of the war between Israel and Gaza on Columbia University campus.

What did you think when they said that about you?

>> It's absurd.

It's basically to intimidate me.

They want to conflate any speech for the right of Palestinians with a speech that's supporting terrorism, which is totally wrong.

The protests were peaceful.

We're asking a simple ask to stop Columbia University and the U.S. complicity in the genocide that's happening in Gaza.

And that's why I see these accusations as intimidation.

And that's why it did not-they did not succeed in court, I mean, as of yet.

And it's just like to distract from what's really happening.

They want to distract us from the U.S. support, unconditional support to Israel and its genocidal war in Gaza.

This is what's happening, or what happened to me and to others.

And it's a message that they want to make an example out of me, even if you are a legal resident, even if you are a citizen, actually, that we will find a way to come after you, to punish you if you speak against what we want.

>> Can I just ask you, because you're right in the middle of it, and you were a student leader, and as you say, the events that you were involved in were peaceful.

You never masked yourself, I don't think.

You never claimed to be Hamas or pro-Hamas.

But I want you just to try to understand that in some other universities, there were people in the immediate aftermath, pro-Palestinians, in the immediate aftermath of October 7th, who essentially blamed Israel and, you know, even exacerbated even support for Hamas.

And I wonder whether you think, in retrospect, these protests were the early ones, maybe even some on Columbia campus, were self-defeating and got you all in the kind of trouble that you're in now.

>> What's self-defeating and what's dangerous is actually continuing the killing in Palestine.

This is what these students speak or spoke against.

And from the moment that these students spoke out against Israel, they were labeled anti-Semite, that they're creating hostile environment to Jewish students.

Again, this is just like deliberate distortion from reality.

These students did not actually, like-or the protests themselves did not create a hostile environment for Jewish students.

The Jewish students were an integral part of this movement, because their Jewish values and teachings tell them that they should stand up against injustices, especially when these injustices are being committed by a state or by a state that claiming to represent them.

So I refuse this sort of connotation that these protests were in any way violent, in any way anti-Semite.

What's violent is universities and governments penalizing and criminalizing freedom of speech.

This is what we really should look at right now.

We should focus on actually why these students are protesting right now.

It is because their universities and the U.S. government is fully invested in the killing of the Palestinian people.

It's as plain as that.

And they take safety and anti-Semitism concerns very, very, very seriously.

But we have to distinguish between discomfort and safety.

>> When you came out-and I'm asking you this because people will ask you-you did actually walk around with a bunch of people, protesters, who were chanting "from the river to the sea," that whole thing that seems to just drive people mad, even though the Israeli government says it as well.

People just seem to think that that is a connotation for destroying a people, for all the issues of anti-Semitism that those concerned have raised.

Why do you keep using it?

What's the point and the value of that slogan anymore, since both sides use it?

>> Yeah, that's a fair question.

And protesters keep using it because language matters, history matters.

And "from the river to the sea" is a call for justice, for freedom for all people between the Jordan River and the Mediterranean Sea.

Unfortunately, the pro-Israel camp in this country and around the world, they would rather deliberately misrepresent this slogan, because for them to cancel speech is easier than actually engaging and reflecting on this speech.

And I even would go like further with the globalized intifada that now the whole country is mad about.

Globalized intifada, we have to take it within its context, because globalized intifada is a call to globalize solidarity in the world.

The intifada is simply a word for uprising.

And I don't want to give a history lesson now about what intifada, like first intifada and second intifada, were, but were largely a mass civil resistance against Israel apartheid and Israeli occupation, whether in the '90s or early 2000.

So, this is, again, goes with the fact that what we should be worried about is the bombs that are killing people, rather than the chance that are making some people uncomfortable.

- You know, there are people who are going to ask you, do you condemn, and I'm going to ask you, what Hamas did on October 7th?

- I condemn targeting and violence against all civilians.

And international law is clear about that.

I also condemn the selective outrage on such circumstances, because I also condemn the 75-year of dispossession of ethnic cleansing, of killing of Palestinians.

And this is not just justification, it's really dealing with the root causes of the war against Palestinians.

- Mahmoud Khalil, you have come out as determined as ever to speak up for your cause and for the justice of your people.

They didn't beat that out of you in jail or, you know, push you to take a different track.

Tell me again what it was like in jail, in terms of, I don't know, the food, the sleeping, the people who you were in there with.

What was it like, and did you ever risk your spirit being broken?

- From the moment that I was detained, I knew that I would eventually prevail, that what I simply did is protesting a genocide.

In terms of conditions, and this is what I keep saying, the moment you enter such facilities, such ICE facilities, your rights literally stay outside.

On the inside, as you would expect, the food was as close as could be to inedible.

I had to switch to vegetarian because the meat was, I threw up, like, after I ate the meat there.

It was so cold, we had to ask for more blankets, but no one would answer our requests.

A lot of people inside, like, they don't know their rights.

They are not allowed to question, like, ICE about, like, "Why you brought me here?"

Because a lot of them were brought from the court.

Literally, someone was in his court, defending his case, asylum case, and was taken into custody from court.

So, there's a lot of dehumanization.

The Trump administration is trying to paint all these, like, undocumented people as criminals.

However, it's the opposite.

It's totally the opposite.

A lot of them have been in the United States for a long number, for a large number of years.

They have U.S. citizens, like, family members, yet they feel that they are defeated.

- You missed the birth of your first child, a boy.

Everybody was very concerned about your wife, who is an American citizen, there without you.

What was that like?

And then what was it like when you were first able to hold your child for the first time?

- Missing the birth of my child, I think that was the most difficult moment in my life, especially because, like, this could have been avoided.

We put so many requests to be able to attend that moment.

And I don't think I would be able to forgive them for taking that moment away from me.

The first time I saw my child was literally through thick glass.

He was literally in front of me, like, five centimeters away from me, yet I couldn't hold him.

And when the moment came to hold him, it was by court order to have one hour with him.

So, to be honest, my...

I just can't describe that moment.

And it's a combination of anger and happiness.

I was happy that I'm finally holding him in my hands, but at the same time, angry at this system that deprives people from such important moments in their lives.

- Mahmoud Khalil, thank you so much for being with us.

- Thank you.

- Now, often we're warned about the risks of an aging population, the so-called demographic gray zone, the drain on the economy, medical services, and so much more.

But author and Dr. Eric Topol suggests that's no longer the case.

He argues that, in fact, new technology and medicine will provide us with vibrant, healthy lives much later on.

He joins Walter Isaacson to discuss what he calls a breakthrough moment in the history of human healthcare.

Thank you.

And Dr. Eric Topol, welcome back to the show.

- Great to be with you again, Walter.

- You know, this book, "Super Agers," it's a lot different than the books about how to age well and stuff because it's so evidence-based.

Were you showing this sort of as a counterpart to all these bestsellers that have all sorts of new theories but aren't evidence-based?

- That certainly was part of it.

I think, you know, the idea that we'd already been active trying to hunt down the source of healthy aging, of super-agers, of welderly, whatever you want to call these remarkable folks, was very different than what's out there.

And so, you know, trying to set the record straight, putting in some around 1,800 citations, but really, as you said, Walter, going over the real exciting advances in the science, too.

- We always talk about lifespan.

We want to increase lifespan.

And you talk about healthspan.

Why do you focus that way?

- Yeah, I don't see the reason to promote longevity if you're not also getting as much healthspan out of it as possible.

Because if you have someone of advanced age and they're so frail or demented or something that's really compromised terribly their quality of life, that isn't what we're aspiring to do.

The real goal is just to get as many fully healthy years as possible.

And we're not doing that now.

Most of the American population are the elderly, not the welderly or the super-agers.

But I think we have the capacity now to flip this.

And over the years ahead, we'd have a lot more welderly and super-agers than people with chronic age-related diseases.

- You both begin the book and you end the book with a couple of patients.

I think it's Mrs. L.R.

and Mr. R.P.

Tell me why you use them.

- Yeah, so Lee Rusall, who's happy to be identified, but was referred in the book, as you said, Walter, to Mrs.

L.R., she was a patient recently in my clinic, 98, and incredibly intact.

And also with a great sense of humor and just having a very rich life.

And she made me think about our welderly study of the 1,400 people like her, the average age was in their late 80s, never been sick, no medications.

These are a rarefied group of people.

It took us seven years, Walter, to find 1,400 of these folks.

Well, because she's so emblematic of healthy aging and the striking features were her relatives, her parents and her two brothers died 30 or 40 years of age younger than her.

She's the last one standing.

- So it wasn't just purely genetic?

- Not at all.

And in fact, that's what we found in our welderly study is that when we, not only was the familial pattern a lot like Lee Rusall, but we did whole genome sequencing, and we found very little that could account for this remarkable super aging status.

- So let's start looking at the factors for super ages and start with lifestyle, if you would, what you call lifestyle plus.

- Yeah, because while we've concentrated largely on diet and exercise, sleep is equally important.

And then there's these other factors like social engagement, avoiding isolation, being out in nature.

These have really strong support, as do the environmental toxins of air pollution, of forever chemicals and the microplastics, nanoplastics story.

So it all fits into a simple model that the things that promote inflammation, like a poor diet, ultra processed food, overdose of proteins, lack of deep sleep, the lack of exercise and physical activity, the toxins from our environment.

They all fit in the model that if you promote inflammation that occurs more as we age or immunosynthesis, the deterioration of our immune system as we age, which are intertwined, that's where you get age related diseases.

- You talk about sleep though.

Can we go back to that?

Because one of the surprising things in your book was you said you should get about seven to eight hours of sleep.

If you get less, it's a problem.

But you also said if you get more, it's a problem.

- That's right.

And the question is, even start to see over seven hours, do you see this adverse linkage?

The question there is, is it because people have depression or is it really something about too much sleep that is not helpful?

We don't really know, but the population studies where of course, everyone's different.

And we emphasize that if you look at it from a big population level, seven hours, not often what's referred to as eight plus is the optimal level.

But obviously that'll vary from one individual to another.

- What does sleep do for us?

- Yeah.

That's the big thing that we've learned in recent years.

So the one component of sleep known as deep sleep, the slow wave of sleep typically occurs in the early hours of sleep.

That is the critical time when we use our glymphatics, not lymphatics, but glymphatics in our brain.

These are the channels that get the waste products, these toxins that we accumulate through our brain metabolism each day.

And at night or whenever you sleep, that's when these glymphatics go to work and get these toxins out of our brain, which are very pro-inflammatory.

If you don't get enough deep sleep, which as we get older, we lose our propensity for deep sleep.

If you don't get enough, you don't get these waste products out.

And not only that, but if you take medications like Ambien, everything points to that you get basically a backup of these toxins.

You may get some more sleep, but you're not doing anything regarding deep sleep and clearance of these waste products.

- With alcohol, every year we seem to have some new studies saying one drink is horrible, one drink is great or whatever.

There's a new study out from the American Heart Association.

I saw that you even have written about some.

Tell me what you feel now about alcohol consumption.

- Yeah, the point you're making, Walter, it's really the problem.

Depending on which report, looking often at the same data, the conclusions are quite different.

Overall, it does look like if you are at risk for cancer, particularly certain types of cancer like colon or esophageal and even breast cancer, if you're more than one to two drinks a day, you're getting into a risk zone.

There is a convergence of that.

There's also the National Academies of Medicine and the Circulation American Heart reports that say, "Hey, there really is some benefit of alcohol for men up to one drink per day or seven per week and for women, perhaps four or five per week."

So we have mixed data.

The problem, again, is we're trying to come up with these reports and recommendations for all people.

- By the way, let me push back on the all people.

Why can't I sequence my genome, put it in a computer and have it tell me, "You're okay with salt.

Your cholesterol is not going to be affected by meat or it will be.

And by the way, you can do alcohol or you can't do alcohol."

- We should be doing that because we can do that right now, Walter.

Like for example, you can get a polygenic risk score, which isn't even require a full genome sequence.

It will tell you every different cancer risk.

If your cancer risk is really low across the board, your concern about drinking alcohol would be less, not to go excessive.

But we don't do that.

We treat everybody the same and this is really part of the problem.

And that is the ticket to prevention as well.

- Wait, well, why don't we do that?

- Yeah, it's because the medical community is slow, slow, slow, so slow to adopt the body of knowledge.

Everything sits in this research compartment, like a different orbit, Earth one, and the medical practices like Earth two.

And it's just really frustrating.

It takes so long to take validated, compelling data and put it into daily medical practice.

- One of the biggest differences between having a long lifespan and a healthy long lifespan or a health span is dementia and specifically Alzheimer's.

What causes Alzheimer's?

- Well, there's been the amyloid hypothesis and the tau hypothesis.

Basically the story is there's misfolded proteins that get in the brain, develop in the brain, and we develop a very severe inflammation response.

If we do that, we're gonna more likely go on to Alzheimer's disease.

Now, turns out a lot of healthy people may have these misfolded proteins, but they don't have the inflammatory response to them.

So you don't have to worry about the amyloid hypothesis or the tau hypothesis.

Basically, what you want is to not have this misfolded protein and its inflammatory reaction occur in your brain.

We have a way to do that now.

We have a marker called P-tau-217 that a lot of people and doctors don't know about.

And it can tell us more than 20 years in advance that you are a high vulnerability.

- So what happens if I learn 20 years in advance?

- Yeah, that's what's great.

It's kind of like if you've been following, I suspect you have, because you follow a lot of stuff, the LDL and the cholesterol story.

You lower the LDL and you have less heart disease.

The same thing, if you have a high P-tau-217, and the only reason to get it is because you have a familial pattern of Alzheimer's, you have an APOE4 or a polygenic risk that's increased.

Anyway, you're at higher risk, you get the P-tau-217.

And if you're relatively young, you're in the 40s or 50s, you've got a 20 year lead time.

Now, when you start to lose weight, exercise, have a better diet, that's not pro-inflammatory, sleep better with high quality deep sleep, those markers come down.

It's remarkable.

It's modifiable.

And so we should be able to prevent Alzheimer's because we have brain clocks, we have these markers, we have even healthspan clocks from these proteins in our blood now.

So you can not just use these clocks to tell about risk and markers, but then you can use them to see if the interventions are working.

And one of the exciting things, I know you're aware of this, but these GLP-1 drugs like Ozempic and Mungero, Zep-Bound, they are being tested for Alzheimer's in people who are not overweight in large trials, which we'll have in the beginning of next year.

That may work because these agents, these drugs markedly reduce inflammation in the brain and in the body.

And we haven't had any drugs like that previously.

So if we can control the inflammation process and these drugs, as well as other gut hormones are going to do that for us, we're going to have a way, not just lifestyle factors, but in the high-risk people to bring down the markers, the metrics of the aging brain, the sick brain that's emerging towards Alzheimer's years before people ever get mild cognitive impairment.

- Wow.

You talk about Ozempic and the similar GLPs.

How much of a miracle drug is that?

- Well, we've never had a family of drugs like this.

And I want to just submit to you that we're still in the early phase of this.

What we've learned, now there's like 15 different gut hormones.

We only are into two or three of these that talk to the brain and talk to the immune system.

This gut-brain axis is one of the most important discoveries for our health in history.

And this drug class reflects that.

As you know, these GLP-1 drugs are not just influencing diabetes, you know, favorable effects, improving people's obesity status, but they're also improving the heart, the kidney, the liver, I mean, virtually every organ.

And the last one to be tested of major organs, which is in progress in large trials now is the brain.

But even if these, even if Ozempic, which is the lead one as far as these trials, even if that doesn't hit, there's many other of these gut hormones that are going to be in pill form, various combinations, some of which get in the brain far better.

They don't rely just on the gut to brain signaling.

That's what's going to take us to ability and these other anti-inflammatories to prevent these three diseases, cancer, neurodegenerative, and cardiovascular, because they all have common threads and they all take 20 years to take hold in our body.

- The things you've talked about, the immunotherapies, the GLP and the Ozempics, all were part of basic science research that led to discoveries that may not have even been expected.

And we move it from the lab bench to the bedside, but now we're cutting basic science funding and the National Institutes of Health.

How harmful is that going to be to the breakthroughs we're just beginning to see?

- Well, you've nailed it there because this is the most extraordinary time in my four decades in medicine where these discoveries, and of course, the multimodal AI to analyze all the person data is here and now.

So we are at the extraordinary moment of a series of breakthroughs, some of which we've reviewed in our conversation.

And at the same time, we're taking down the chance for building on this by seeing near $20 billion gutted out of the NIH.

And then all the other public health and science agencies of our government are similarly being dismantled.

So our ability to follow through and build on this progress is going to be profoundly compromised.

It will go forward, but at a different pace.

- Wait, wait, let me put a fine point on it.

You're saying these cuts will cause more people to die of cancer?

- Well, to put it another way, the advances that we could make in cancer to save lives and prevent cancer will be put many years forward.

So the corollary of what you just said, I believe is true.

We're missing the chance to have better treatments and preventions by not supporting our biomedical research engine, the crown jewel of the world, by just taking in a reckless way, taking away its support.

It's no doubt going to hurt the health of a large number of people in the United States.

- Tell me about health inequities in the United States and whether that's a problem for overall health.

- It's a big issue.

And it's one of the biggest concerns is the things that we've been talking about, the prevention of age-related disease.

The people who are the most indigent, the lowest socioeconomic status have the most to gain, the most need, and they may be the least to be able to be advantaged here.

So you have to go after this.

You can't just assume when you have some new thing that the people who need it the most are going to get it.

And we could make inequities worse.

And they're already at a serious level in this country.

So it's certainly one of the concerns that I have.

- Dr. Eric Tobel, thank you so much for joining us.

- Thanks, Walter.

I really enjoyed the conversation with you.

- And that's it for our program tonight.

If you want to find out what's coming up every night, sign up for our newsletter at pbs.org/amanpour.

Thanks for watching and goodbye from London.

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