Strategies for Stress Reduction and Wellness – David Kopp, Former CEO of Healthline Media

Dr. Rishi Desai: Hi, I'm Dr. Rishi Desai. Today on Raise the Line, I'm happy to be joined by David Kopp, former CEO of Healthline Media. Prior to his time at Healthline, David led North American ad product marketing for Yahoo as well as marketing for a division at Disney, and held leadership roles in several internet advertising and technology startups. Thanks so much for being with us today.

David Kopp: Thank you for having me, Dr. Desai.

Dr. Rishi Desai: You can definitely call me Rishi. David, before we got started you were talking about your own avid love of Peloton and of training, I'd love to understand both that as well as how it ties into your love of health and healthcare more broadly.

David Kopp: Sure. Well, I think there are probably a few different connections there. Biking in general is super therapeutic for me on two levels. One is sort of the obvious, it's a good workout. It's kind of a lifetime workout sport, right? Low impact but really great for cardio and I am at an age where I can either sort of watch my diet and exercise aggressively or completely watch my diet and exercise not so aggressively. I prefer to have a broad diet and be able to eat a little more aggressively so that means I spent a lot of time on the bike. The other thing that I really realized about biking, there's actually good neuroscience behind this, is that I do my best thinking on the bike. The neuroscience behind it is that when your brain is slightly distracted by somewhat routine activity, it is able to process much more deeply. I know that when I'm in a new lane on a particularly thorny complex problem, getting on the bike for an hour or an hour and a half and heading off alone is generally the most productive thing I could do. It's much better than thinking in the shower, plus it's better for the environment than letting an hour and a half of water go down the drain.

Dr. Rishi Desai: I totally agree and it's kind of interesting whenever we do these kinds of things, I think it also helps to recalibrate...kind of refocus and bring us back to the core of who we are and our health on an individual basis. Tying that in more broadly, your profession has led through a very interesting route through health and healthcare. Do you mind just talk a little bit about your role as the former CEO of Healthline Media and your interest both in physical health but also more broadly diet and nutrition?

David Kopp: Yeah, definitely. It's interesting too. I did not join Healthline because I was super passionate about health. I joined it because I thought it was going to be a good business. It turned out that we had a lot of work to do to turn it into a good business, but one of the things that happened after it became a good business is we started to then turn it into a much better business and have a lot of success. I remember when there were 10 million people who visited us in a month and we started having conversations about how critical what we were doing was because we really believed that the content that we were producing was better content and our whole strategy was around like let's create the best possible content out there. The best content ultimately is going to win and that's how we'll build a great business. 

We came to the conclusion that what we were doing actually was really good for the world which seems in retrospect a little obvious, but I had come out of digital media -- I'd worked in digital media for 25 years and I'd spent 15 of it doing things that weren't bad for the world, but I just didn't have that dimension to my experience and I think at that point, which was maybe three or four years into the Healthline experience, I started to really focus on it. We became actually very focused on the mission and the vision of building a stronger healthier world. Ultimately by the time I left, we were reaching, 300 to 350 million people globally and really having quite an impact. As you get deeper and deeper in healthcare you realize most of what people think of as healthcare is actually sticks and carrots. It's actually treating chronic conditions and things that are probably-- not all of them are avoidable but a lot of them are avoidable --by good, healthy habits and diet is probably the biggest of those. I was constantly in the world that became much more focused on diet, nutrition, and things like functional medicine and how you kind of integrate diet into your life in a way that preserves health.

Dr. Rishi Desai: One of the things that I've always struggled with and have been frustrated by is that as a pediatrician one would think that I would be equipped to give advice on things like nutrition and exercise and mindfulness and all those kinds of things that parents and kids might be interested in, probably should be interested in, and yet I'm not. I'm not at all able to do that. I'm just curious, at Healthline, did you come across healthcare professionals feeling ill-equipped to council on these topics, and what did you guys do about it?

David Kopp: Yeah. Well, it's interesting because I think that there are three buckets. There are doctors who, like you, realize, "People are asking me a lot about nutrition and I'm ill-equipped to answer." Then there are people who answer anyway and think of themselves as experts; and then I think there's a group that actually recognizes that, "Hey look, this is something I either need to get educated on or I need to build a referral relationship with nutritionists or dietitians who can help with this." 

It is really interesting. There are huge structural impediments to actually working properly, right? You highlighted the first which is that med schools, in general, do not require much knowledge of nutrition or diet as part of your fundamental training. But then you have the whole financial impediment that the whole insurance system in the US -- and in general fee-for-service approach -- diet and nutrition tend to be things that you really have to spend a lot of time to understand the patient's specific situation and their likes and dislikes. Our whole system is you've got 11 minutes to spend with patients. It's not enough to actually get into those kinds of issues.

Then there's a third kind of structural impediment -- it's part of what you're highlighting, too -- which is we have such specialization but we have no medical specialization in diet and nutrition. You have nutritionists who are seen as affiliated but not really part of the professional organization. So, when you go and you look at a hospital system, the leading ones are now starting to employ dietitians and nutritionists certainly on staff, but there is a lot that is actually just considered outside the realm of medicine and that again probably has something to do with the other structural impediments. We encountered a lot of that and we realized consumers are actually having to solve that problem on their own, which is why a quarter of our total traffic at Healthline was to diet and nutrition.

Dr. Rishi Desai: You said earlier like this dichotomy between sick-care and well-care, at least as a clinician my interaction with a nutritionist or dietitian, it was almost always in the context of someone in the ICU or someone that was getting parenteral nutrition. It was in that sort of intensive care setting, or someone with cystic fibrosis that might have a need for supplements. It was almost never in the realm of like, let's say a child who is trying to eat healthier or anything that feels vaguely mainstream. It was always in that very corner case scenario that that interaction happened. So, I didn't learn any of the general nutrition principles. I learned only how to set up a parenteral nutrition bag so that someone can get fed through an IV line. That was the kind of nutrition I was learning.

David Kopp: This is another kind of structural impediment, that most of medicine today addresses problems after they've happened as opposed to before, right? You're giving me all these examples of a patient being in this acute situation where yes, nutrition is important, but it's not going to help that patient avoid being back in that situation. If their insurance plan would only cover your prescription putting them on a plant-based diet, that would be great but that also doesn't exist structurally. Although, some leading health systems are starting to do that with food pantries and things like that where they're finding just phenomenal results. Even replacing only half of the food intake with something that is just healthier, organic, plant-based...addressing some of these fundamental sources of information in people's diet.

Dr. Rishi Desai: That phrase plant-based is interesting as well because it truly wasn't in the general lexicon a decade ago. A decade ago, the words that we used were vegetarian or vegan and other words like that, and each word has a feeling around it. I think plant-based has changed the feeling quite dramatically to feel much more mainstream or okay, or normal. I'm curious, did you see that with queries at Healthline or other junctures in your professional career?

David Kopp: Well, it's interesting because I have two vegan daughters and so our house is largely plant-based at this point. There's been a lot of conversation, but one of the things that I've really looked at after leaving Healthline is the whole plant-based market because I really do believe that the science is very clear that-- whether you are strict plant-based or strict vegan, strict vegetarian, or you just become more plant-based -- there's no question that more plants in your life is better for your health. I don't think that's going to change. I think it's going to accelerate. I think part of the stigma around veganism is that a lot of the motivation for veganism actually is not health-related. It's actually kind of a climate-ecological thing and it's seen as being very radical. 

But from my perspective -- and I think you totally nailed it -- plant-based is a much more mainstream way to think about this and I'm a huge fan of ‘progress, not perfection.’ I suppose I could do a perfect vegan diet if my life depended on it, but I like eggs and I like cheese. Every once in a while, I also like meat although I'm starting to realize there are really good alternatives to most of those things and if I just skew my diet toward a stronger plant basis, I feel better. Things seem to work better and just in general, I think it will lead to better health. I think people are starting to see that the term "plant-based" is in that ‘progress, not perfection’ sense.

Dr. Rishi Desai: I love that phrase, progress not perfection. I think maybe again one cycle ago, there was a whole thought around harm reduction around cigarettes and I was always of the mindset that if I can get my patient to go from 20 cigarettes to 19, that was as big of a win as going from one to zero. You've reduced it by a cigarette, right? But going from one to zero is dichotomous. I'm a smoker or non-smoker. Whereas going from 20 to 19 doesn't get celebrated with a different label, right? You're still a smoker but 19 versus 20. But it's just as big a win, right? It's just as important. I feel the same way around what you said. There are a lot of folks out there who are committed to trying to eat less meat products and other things that we know are not as healthy. That to me is just as exciting.

David Kopp: Yeah. I think that the insight you have here is one of the biggest things I took away from my time at Healthline. We were in the thick of it with consumers. When I would spend time with people who are more traditionally healthcare people, it was like we were speaking a different language. What I started to realize is that human beings are messy. We're just messy. We have a lot going on in our lives. Most of healthcare comes from a position of science. There is this dichotomy that kind of leads to people saying, 'this is the right answer' as opposed to 'this is progress, so this is a better answer.' We have millions of users and not everything works for everyone. You start to realize that if I can get people from 20 to 19 on whatever that bad habit is, that's great. 

I think the other thing that we learn is when you look at the science of behavior change, in general, small steps lead to transformation as opposed to large steps. Very few people are able to do anything cold turkey and there's a whole science behind when you take a small step, the body's reaction to that small successful step is to give you a reward, right? It gives you a psychological feeling that is powered by your endorphins or some other neurotransmitter that makes you feel great. So you are more likely to then take the next small step. I think it just reinforces that if you really want to change things, taking more of that steady progress, small changes, progress not perfection approach will likely have a bigger impact.

Dr. Rishi Desai: Yeah, I could not agree with you more. I think in many ways, we're preaching to one another's choirs right now.

David Kopp: Yes, exactly.

Dr. Rishi Desai: Do you mind talking a little bit about the COVID pandemic and what you've noticed about it with regards to remote work and social distancing...specifically around what we've been touching on and the sedentary lifestyle a lot of people have been leading, both adults and children. How we can start to reverse this and maybe find a new normal through these baby steps you're describing?

David Kopp: I think actually it has really reinforced my experience of small changes versus big changes. In many ways, the pandemic was just this massive change where everything changes. I'll tell a little bit of my pandemic story, which is not a hard story, but I think it's probably shared by a lot of people. I'm an introvert, so I found myself a couple of weeks into it saying, "Hey, this is great. I don't have to commute but I still have all the one-on-one engagement that I want." Albeit through video. It seemed great and then, three or four weeks in, I started to just feel this malaise and sense of exhaustion. I read something from Deepak Chopra about nature. It's all part of a larger construct of what I like to think of as MENDS: mindfulness, exercise, nature, diet, and sleep. 

I paid a lot of attention to mindfulness because I have learned that I function better if I do my daily meditation. I kept that up during the pandemic realizing this is going to be stressful. On exercise, I took advantage of the fact that I didn't have to commute. I knew that I needed that. I already talked about the ability to process through difficult things and just feel better by exercising. I've been doing those things. The diet I've been fairly careful on. Sleep...I probably hadn't been as careful as I should be, but the nature thing was missing for me. That was a really interesting one to say, "Okay, I'm going to try to do my mindfulness or meditation outside," or "I'm going to take one or two of my phone calls and instead of doing a video call I'm going to do a walk around the neighborhood." It was transformative. That malaise disappeared week-to-week for sure, but almost overnight. 

I think that balance of looking at all five of those dimensions is really important. And I would guess coming back into whatever the new normal is -- I don't think the commutes will be the same and work will be the same and all those things will be exactly the same -- it will be a radical change and we will have to adjust to it. I think going back to those five dimensions and saying, "Okay, how do I create new routines around mindfulness, exercise, nature, diet, and sleep" will really help people. It's great because you can make a small change in any one of those dimensions and it starts to build as you look at that portfolio.

Dr. Rishi Desai: I'm listening to you and I'm getting different ideas in my head. I remember hearing someone talking about a group of chickens that were released from being in their chicken coop out into free space. They were imagining that the chickens were excited and were kind of feeling the ground beneath their toes and whatnot, and I was thinking to myself, 'how am I that different from that chicken' in the sense that I'm always in my apartment. Then when I go outside, I'm like, "Oh my God, there's a wind on my face, sunlight, I feel the grass." I sit on the grass and have a picnic and I feel kind of normal again. I think sometimes it's easy to forget that at our core we're animals, and animals need certain things beyond just food and water. We need to feel nature and that's just as important as I think anything else. I think being deprived in a way by always being on a futon or a bed and a hardwood floor...I mean that's not nature. I think there's something about being outside, like you said, that is very replenishing and very nourishing the way that a good night's sleep is very nourishing.

David Kopp: I read an article in Healthline that talked about the neuroscience behind the malaise that people feel. It was interesting because it said you need equilibrium in stimulation, and two things happened at the outset of the pandemic and for many people, I think are still happening. One is this overwhelming stimulation around the news cycle and it's not healthy to have so much of your stimulation be on topics that I think at the end of the day, you don't have much of a sense of control over. You just feel like there's all this new information and stimulation that is just depressing. So that's one thing and the advice is you've got to limit that. You go to like X number of minutes a day. Create a routine around limiting that stimulation. 

The other was far more interesting, which is that your brain needs a certain amount of environmental stimulation. What happens when you sit in the same spot in front of a screen is you get very little environmental stimulation and that is the neuroscience behind why getting out into nature is just radical stimulation, right? It's probably a hundred times more stimulation from the sounds you hear, the colors you see, the people walking their dogs. It's just transformative. That's why when you get out even for that half an hour or 10 minutes to just sit and feel the grass, it's a relief for many people. I think you know that's the neuroscience behind it, which is just fascinating to me.

Dr. Rishi Desai: I would imagine nature stimulation is even more important in kids as their brain is kind of developing and growing. I have a four-year-old and he often reminds me to go outside.

David Kopp: Yeah.

Dr. Rishi Desai: It's an interesting issue...what's happening in these kids' brains in the neurochemistry if they're not getting as much stimulation outdoors as they maybe had in years past.

David Kopp: I have several teenagers so there's no real influencing on some of those things, but you see the effects. I have one child who went through a whole period where there was very little of that, and then as she started to actually figure out for herself that she needed that and it was valuable. You could just see how much it positively affected her mood. It is really interesting to see it played out especially in my little clinical trial of four children.

Dr. Rishi Desai: Right, exactly. You've got a little lab there. We've talked about a lot of different things and a lot of our audience is represented by kind of young, early-career health professionals. Do you mind offering some parting words of advice? What would you say to them now that you've had this experience of COVID, this longer-term experience at Healthline and all these different data points we're grabbing from what you've read and what you've heard? What would you say to folks that are in training in terms of how to approach either themselves or their careers?

David Kopp: I think that is a great question and at the risk of kind of a cliched answer -- people say this all the time to people early in their career -- you should follow your passion. I don't think I understood what that meant. I was always passionate about business and really interested in the way that when you're playing a game, you're just really engaged in the game But I was lucky that at Healthline, as we started to really have this positive impact on our audience and on our users, I realized I felt purpose in that and I felt a passion around that purpose. What that gave me was this deep reservoir of resilience. I could do the hard work. 

I think most things you're going to be proud of require a lot of hard work, a lot of discipline, a lot of focus, a lot of just stick-to-itiveness. If you don't have that resilience -- which I think almost always comes from some combination of passion and purpose -- it's hard to do that. But for me, finding that passion and purpose led to a willingness to do that and then the reward of just really feeling great when you actually accomplish something that took years to accomplish and was hard and you did it in the trenches with a team of people who you've built great relationships with because they also share the passion. 

There's a couple things in there, but it's about making sure that you really have passion and purpose in what you do, and enough resilience coming from that to commit to that hard path…doing the quality work as opposed to just looking for a shortcut. I think those are two super important things. I think in the pandemic, we all have started to understand how important self-care is and I think the older you get, the more you need that kind of balance around self-care because of kids and aging...just all your challenges become more complex. You need a kind of well-rested, well-tuned mind and body to take those things on. Those would be my three points; passion, commitment, and self-care.

Dr. Rishi Desai: Awesome. And in your background with that bike is a good healthy reminder that you're practicing what you preach. I appreciate that.

David Kopp: I'm trying.

Dr. Rishi Desai: Well, listen, thank you so much David for being with us today. That was fantastic.

David Kopp: Thank you, Rishi. It was great to meet you. I loved the dialogue and I feel like we're very simpatico in the way we think about these things. Progress, not perfection. Let's keep making it better.

Dr. Rishi Desai: That's exactly right. That's definitely my mantra. Listen, I'm Dr. Rishi Desai. Thank you for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.