Quadruple board-certified physician Dr. Gerald Cox joins Dr. Ned Palmer for a thoughtful conversation on personalized medicine, obesity care, and the future of longevity. Dr. Cox reflects on his own childhood struggle with obesity and how it shaped his path from personal trainer to physician, ultimately leading him into concierge medicine where deeper relationships and individualized care take center stage.

Together, they explore how AI is reshaping clinical practice, why prevention will define the next era of healthcare, and what we can learn from the world’s Blue Zones about living longer, healthier lives. Dr. Cox explains his approach to personalized health plans, the power of motivational interviewing, and the role of precision genomics in cardiometabolic and longevity medicine.

What does truly personalized care look like in a system built for volume? And how can technology, motivation, and lifestyle-based medicine converge to meaningfully improve long-term health outcomes?

Dr. Cox closes the episode with reflections on passion, purpose, and his mission to combat medical misinformation through digital education, reminding us why the future of medicine depends on both innovation and empathy.

Here are four takeaways from the conversation with Dr. Gerald Cox:

1. Impact of AI in Medicine

The episode discusses the transformative role of artificial intelligence in healthcare. Dr. Cox emphasizes how AI can reduce administrative burdens, allowing physicians to focus more on patient care and interaction, marking a significant shift in medical practice.

2. Transition to Concierge Medicine

Dr. Cox’s move from managed care to concierge medicine was driven by a desire to provide personalized care. This transition underscores the value of patient-centered approaches in healthcare, where individualized attention can lead to better patient outcomes and satisfaction.

3. Importance of Blue Zones and Longevity

The concept of Blue Zones, areas with high longevity rates, is explored in the episode. Dr. Cox highlights how lifestyle and environmental factors contribute to longevity, advocating for personalized care to achieve long, healthy lives.

4. Future of Personalized Medicine

Dr. Cox envisions a future where prevention and technology play key roles in healthcare. He discusses the integration of cardiometabolic care and longevity medicine, emphasizing the potential of precision medicine and genomics to enhance patient outcomes.

Transcript

Gerald Cox:
What is something I recently changed up? Hoo hoo hoo. You’re gonna love this, Dr. Palmer. I want to say—it’s tough. And it’s not going to fit everyone, but you’re asking me personally, so I’m going to share my experience. It’s not all about the money.

Ned Palmer:
Hello everyone, and welcome back to The Podcast for Doctors (By Doctors). My name is Dr. Ned Palmer. I’ll be recording solo today—unfortunately, Dr. Jerkins cannot be with us. However, I have brought an excellent physician replacement in the form of Dr. Gerald Cox, who is an entrepreneur, a lifestyle medicine doctor, and overall just a good hang. I’m really excited to have this conversation with him.

I hope you all get a chance to learn something about the opportunities we have as physicians to support people throughout their entire lives—not just in the hospital, not just in the clinic—to help them become healthier, better, and more functional individuals. It’s a fascinating conversation with a quadruple-boarded physician. He may have the most boards per doctor that we’ve interviewed yet. So please join me in welcoming Dr. Gerald Cox.

We have the one and only Dr. Gerald Cox, a unique leader in modern precision medicine. Dr. Cox is a quadruple board–certified physician whose work sits at the crossroads of internal medicine, obesity medicine, preventative medicine, lifestyle medicine, and digital health innovation. He’s the founder and medical director of M.E.A.R. Health Specialists and CEO of M.E.A.R. Health and Wellness, where he integrates precision medicine, metabolic health, and patient-centered technology to achieve sustainable, real-world wellness.

Dr. Cox also serves as an associate professor at Loma Linda University—one of the Blue Zones, which we’re going to talk about, with the most centenarians in the world—where he has trained and mentored the next generation of physicians.

Prior to launching his own organization, he served as a clinical site director at Kaiser Permanente, where he expanded clinical training programs and helped integrate AI-enhanced documentation tools to improve workflows and the provider experience. His research spans these fields, and his work consistently focuses on improving patient outcomes, sustaining longevity, and building scalable, community-centered models of care.

What truly stands out about Dr. Cox is his ability to blend scientific evidence with behavioral insights and compassionate care, empowering both patients and clinicians with practical strategies to tackle chronic disease and elevate metabolic health. Dr. Gerald A. Cox, welcome to The Podcast for Doctors (By Doctors). I’m really thrilled to have you here.

GC:
Dr. Palmer, I really appreciate you. Thank you for having me on. Honestly, I think it’s just wild how it was a Medscape post of yours that really led to this. I was like, “Man, whoever wrote this is really good—let me send an email to this person real quick.” And then three years later, here we are.

NP:
I appreciate that. You’re too kind. I had a lot of help writing those Medscape posts, up to and including one of our other podcast producers. So, same team—and I’m glad we came together through this serendipitous, medicine-is-a-small-world moment.

GC:
That’s how it should be. That’s how it should be.

NP:
Let’s dive right in. You are the most board-certified doctor we’ve ever had on this podcast. Boards per doctor, you stand apart. I thought Dr. Jerkins and I were nerdy with two boards, but you jumped over us quickly with four. You’re now running MEAR Health and Wellness. But let’s talk about you a little. I want to learn from you. What early habits or mindset helped you thrive across this diverse clinical practice and digital health innovation sphere you operate in?

GC:
You’re going way back, huh, Dr. Palmer? All right. If we’re going to do that, I would probably say it started with childhood obesity, honestly.

Yeah, I was an overweight child growing up. Junior high was a challenging experience—your body is changing, your mind is changing, your mindset about the world is changing. And then there’s the personal aspect of: “Wow, am I happy with myself?” I really wasn’t. I was 132 pounds in seventh grade, and I was struggling with that.

My mom recognized it early. She was a motivating force to help me see things from a different lens. We did a weight-loss program together, and when we went through it, I lost a lot of weight. I recognized that I could make different choices that would lead to different results. That was a reflection point for me.

Fast forward a few years—I got into personal training. I became a personal trainer at LA Fitness, and I loved it. I wanted to bring that passion into medicine, which led to this path.

But that doesn’t answer the digital innovation part. That actually started in high school, when I was in a tech program learning programming and a bit of electrical engineering. That slowly became, “Okay, I might dabble in computers here and there.” And then once AI came around, I was like, “No, now we’re more than dabbling. Now we’re getting in.”

NP:
Absolutely. We’re going to dive into what AI has done to medicine and what you’ve seen it do in your life. But first: what’s the quickest way to explain what AI is doing to digital health innovation right now? What’s your feeling on it?

GC:
We always talk about segments in history where there’s an exponential period—these different phases of the Industrial Revolution. Artificial intelligence is without question one of them.

When you and I were kids, we saw the first iPod. Remember that brick? It was totally different from the Walkman. I feel like that’s exactly what we’re experiencing in medicine today.

We’ve been blessed to learn from our forefathers in medicine who, before UpToDate, had to go to the medical library, pull out a textbook, and sit down with it. Galen’s anatomy textbook from the 1500s is still there.

NP:
Bright yellow nerves in Netter—makes it easy for med students.

GC:
Then you get into lab and you’re like, “Wait, I thought it was yellow. What is this white string?” Everything is tan and smells like formaldehyde.

NP:
Terrible.

GC:
Exactly. But now we’re experiencing a complete shift. Once we got into large language models—AI that can read physician notes, radiology reports, specialty documentation—the computers can actually digest that information.

That allows us to leverage technology for mundane administrative tasks that were taking away opportunities to truly connect with our patients.

NP:
I love that. Because we’ve seen both sides—some training with paper charts, then the early days of computer-generated note taking, which was horrible and still is in some places. Now the pendulum is swinging back toward using AI to make administrative work better so we can double down on actual care.

GC:
Exactly.

NP:
I love that, and I’m excited to dive deeper into it later. But first, I want to ask a few more questions so our audience gets a sense of what you’ve experienced in medicine. I think it’s helpful for younger listeners to know how variable a career can be. It often looks like one path, but it isn’t.

So—you’ve transitioned from supporting congressional health initiatives to running a concierge medicine practice. What was the most surprising lesson in that?

GC:
My concept of time.

I would say that was the biggest shock. Time management as a physician—you kind of pick it up. You’re seeing patients, and there’s that mental timer: “Okay, I need to move on to the next patient.” Those are the constraints we work within.

But once I transitioned into entrepreneurship, I thought I had time figured out. I thought: “I can send these emails, see patients, build the clinic, contract with insurance—I’ll do all that this week.”

But what I came to realize was: no. One aspect might take several months. Another aspect might take several more. Writing a business plan? Five months. A P&L statement? I don’t have a finance degree—I had to figure it out.

So my concept of time completely changed. I needed to be more realistic with my goals and create a six-month plan, a 12-month plan, a two-year plan. That helped me be kinder to myself as I worked toward them.

NP:
When I hear you describe your perception of time, I think there’s also an element of locus of control in there, right? Some areas are just you, grinding away—you can’t do everything in a week. But then there are things you don’t control: pay, credentialing, integrating a bank account into your accounting system, whether your EHR is up or down. All of these other factors play into it. As an entrepreneur, you realize you’re dealing with dependencies you’re not used to. As a clinician, you know exactly how a 20-minute visit goes—you can do that consistently. But to build all the systems and interdependencies? That’s huge.

GC:
I love the way you put that. Basically, there are more variables in the equation. We’re doctors—we like to minimize variability. We’re risk-averse; we don’t like unexpected variables coming in. That’s risk, and it’s horrible. Locus of control is gone, and that’s hard for many people. I’m sure building Panacea was a similar experience for you.

It never goes away. There are constantly new factors. You develop a different heuristic to manage and mitigate risk. That brings me back to your earlier comments about AI and this new industrial revolution—or whatever we’re calling it. If you could spend a day shadowing any physician or innovator in AI-enabled medicine, who would it be, and why? My name’s not good enough.

NP:
Go ahead.

GC:
Probably Dr. Anthony Chang. He’s one of the leaders in the field. He created the American Board of Artificial Intelligence in Medicine, has a master’s in data science, and works at CHLA in Orange. He’s a pioneer in AI and medicine. He has a lot of insight—he’s talked about convolutional neural networks that allow computers to digest radiology imaging. Next thing you know, they can determine race from a chest x-ray with 90% accuracy. That’s wild. Are we having ethics conversations about that yet?

NP:
That’s another discussion down the road. We’ll need to.

GC:
Absolutely, there has to be an ethics conversation right behind it. The capabilities of AI are just leveling up so fast. I’d love to hear more. That’s who I’d spend the day with. Have you had a chance to meet him or work with him before?

NP:
I’m just a fan from afar.

GC:
Same here. I’ve attended a couple of his lectures when I was taking that board exam, but I never got a chance to meet him and pick his brain—or shadow him, to answer your question. If that’s where his work has been over the last few years, I imagine he’s incredibly busy.

NP:
God willing, we’ll make it happen. Hey, maybe he’s a listener—then we’ll connect you.

GC:
You’ll have to connect me with Mark Cuban too, since he was on the show.

NP:
All right, we’ll work on that.

So, coming from our era of a very traditional healthcare system, we both experienced that the system often doesn’t meet patient needs. It’s hammered into us during training: “The patient, the patient, the patient.” But then you see what the system actually does. When did you realize the traditional healthcare system wasn’t serving your patients, and that transitioning to concierge care was the solution?

GC:
I’m glad you asked. It was when I was working at one of the largest managed care systems in the U.S. Managed care does what it intends—to mitigate costs. But I found that cost mitigation was not the care many patients were asking for. It put doctors in difficult positions. We know what’s best for the patient ethically, but bureaucratic roadblocks prevented us from providing that care.

A clear example: those commercials that say, “Ask your doctor about this medication.” I get frustrated—I think, “No, ask your insurance. Call them.” Prior authorizations and barriers make providing care arduous. That led me to switch.

NP:
It’s the lack of autonomy, right? Physicians constantly report this as a cause of burnout. You’ve spent a lifetime training to make decisions, yet you’re forced to operate within a box defined by non-physicians. Decisions aren’t always in the patient’s best interest—they’re in the interest of who’s paying for it today.

GC:
Exactly. Our forefathers in medicine had a term I recently came across: “a doc in the box.” I never heard it before, but it makes sense—you’re confined, trying to work around walls of rules.

NP:
Yeah, feeling around for boundaries—over here is UnitedHealthcare, over here is Aetna. Prior authorization—don’t touch that.

GC:
That’s right. It’s horrible. It leads to moral conflict. For me, I realized my patients were asking for something I wasn’t able to provide. I had an internal conflict: continue in a system causing moral strain and burnout, or take a risk—go out on my own. I hadn’t credentialed with insurances, the hospital owned my MPI—I had to figure it out.

At the end of the day, my wife and I discussed it. We decided it was time to take the leap. Once I opened my doors, patients said, “This is the care I’ve been looking for. You’re the future of medicine.” People want personalized care—not a check-the-box approach. Patients want to be seen as individuals: their childhood, adolescence, environment—not one-size-fits-all.

NP:
Totally agreed. I love your approach to personalization and individualization. So much of medicine—and both of us have a public health background—is about drawing lines around groups of people to study them better. It’s about depersonalization and deindividualization. But then you have to flip it. At the end of the day, there’s one person sitting on the bed or examination table. You don’t have a “19–24-year-old, this race, this ethnic group, this geographic distribution.” How do you integrate clinical care, labs, lifestyle interventions? Help me understand how you create an individualized health plan—what’s your mental model?

GC:
That mental model really got shaped while I was in the Blue Zone, training in Loma Linda. When I got my lifestyle medicine board certification, I realized that background—my childhood, adolescence, working as a personal trainer—helped me understand the small micro aspects that add up to the patient on the examination table.

My thought process is to get to those different points. I did a psychology degree for my bachelor’s, and I didn’t know exactly how it would help, but it did. I start with open-ended questions: “How can I help you today?” or “Tell me about what you’re experiencing.” I follow those breadcrumbs because ultimately, the patient wants help. Some patients come in with everything pan-positive, just going through the weeds, but I really try to understand where the patient is coming from.

I look at their daily routines, their experiences, and try to put it all together to see what’s leading to their presentation. Open-ended questions, an open mindset, and eliminating bias are key. That’s my approach from the very beginning of every encounter.

NP:
I love that. Before we go deeper, let’s talk a little about Blue Zones. This research was super popular 15–20 years ago. For listeners who may not have come across it, can you explain Blue Zones and why they’re significant?

GC:
Absolutely. There’s this innate human desire to live a long life, but not a decrepit one—active, enjoying life. In certain areas of the world, people—called centenarians—live past 100 and remain active: mowing lawns, gardening, spending time with family and friends. These areas became known as Blue Zones, popularized by a National Geographic publication.

Investigators were curious: why are people in these areas living so long, while in other regions, people only live to 60, 70, or 80? How can life be expanded by 30–40 years? That’s what led to the popularity of Blue Zones. The original five included Loma Linda in California (the only one in the U.S.), Okinawa, Japan, Greece, and two more, including Dominica in the Caribbean. Dominica is a small island nation that counts as a second-level Blue Zone. There’s also one in Costa Rica, Nikoya, which is another well-known example.

NP:
I’ve been to Nikoya. It’s fascinating research—Blue Zones were all the talk of longevity medicine. Not just a hundred years old, but living your life while reaching that age.

GC:
Yeah, I could nerd out on this all day.

NP:
Going back to individualized health plans, a huge part of what you’re tackling is chronic disease—or non-communicable diseases. Motivation and coaching are key. How do you keep patients motivated while tackling challenging conditions like obesity and type 2 diabetes? These diseases rob joy, and treatment doesn’t always restore it immediately.

GC:
Motivational interviewing techniques are very helpful here. The American College of Physicians has resources on this, especially for obesity. Listening to the patient with open-ended questions helps uncover what truly motivates them. Sometimes it’s a spouse, children, or a colleague who models healthy behaviors. It’s different for everyone, but understanding those motivators is key.

Another critical piece is identifying barriers. If we can recognize obstacles—like fallen trees blocking a street—we can help clear the path. Encouragement along the way is important too, like a helpful friend pushing your car when you’re stuck. Patients face debris from misinformation, conflicting advice, and media. Part of our role as physicians is to meet patients where they are, guide them, and provide truthful, reliable information. Awareness and support go a long way.

NP:
Absolutely.

GC:
And yes, living in the Caribbean, we’ve cleared streets after hurricanes—studying by headlamp while helping communities. Patients face similar chaos today: misinformation, conflicting advice, social media myths. Our role is to provide guidance, clarity, and support, helping them navigate toward their health goals.

GC:
When we’re in a patient encounter, many patients—and people around the world—don’t know what they don’t know. In the clinical setting, we can dial in, ask open-ended questions, and get to know the patient personally. We assess how receptive they are to information they may not have been aware of, and we can have difficult conversations. Sometimes I pose it as a question: “I think I have an idea of what’s going on—how would you like me to share this with you? Do you feel comfortable if I explain?” It helps break down barriers.

NP:
I love that approach. It’s hard work—countering loud, well-funded voices of misinformation. It’s Sisyphean at times, but the value is in the patient care. In your concierge practice, you see that value of being a trusted partner. That brings me to my next question: how do you measure success in a concierge medical practice? You come from a managed care world with population-based metrics, and now you have a smaller patient panel. What does success look like here?

GC:
It’s different for each patient, but there are tools available. The CDC has assessments for barriers to exercise, SF-36 scores, and MD-Calc metrics. The SF-36 measures quality of life. You can assess a patient’s baseline, then reassess in three, six, or twelve months to see improvement.

We also use devices for more personalized assessments. For example, a bioimpedance machine measures body fat, skeletal muscle, and water distribution. For weight loss programs, this helps track whether patients are losing fat versus muscle and adjust plans accordingly. These tools help personalize medicine and bring objective data to the bedside, which is important because traditional metrics like BMI are often inadequate.

NP:
I love that. Bringing objective data to the bedside gives a yardstick for quality. So, looking ahead, how do you see the future of concierge medicine? How will personalized care reshape the broader healthcare landscape?

GC:
We’re moving toward prevention—finally, after 2000 years of medicine focused on treatment. Treatment took us far, but the capitalization of treatment systems has led to mistrust. People are becoming aware of risks early: abnormal labs, early signs of osteoarthritis, or lifestyle-related concerns. They want to prevent issues before they escalate.

NP:
Exactly. That aligns with cardiometabolic and longevity medicine. People want long, rich lives of quality. Where do you see individualized cardiometabolic care and longevity medicine merging in the next five to ten years?

GC:
Longevity medicine is an underutilized term but a growing specialty. Patients increasingly demand individualized care. I envision using technology and digital systems to track cardiometabolic health and longevity biomarkers. We’ll be able to assess environmental factors like diet, precision medicine, and genomics. For example, based on genetic information, we could recommend diets that lower risk for specific conditions, like prostate cancer, and optimize protective factors.

We’ll get more actionable data from everyday life and adjust environments to support quality of life, aiming for Centurion-level longevity and beyond.

NP:
That’s an incredibly valuable goal. It’s ambitious, but with technology, wearables, data analytics, and proper coaching, we can create a real tailwind for longevity medicine.

Okay, we’re moving into rapid-fire mode. True or false: personalized care beats traditional clinic visits for long-term patient adherence.

GC:
Okay, all right. True. Seems obvious after the last hour of talking together. When it comes to adherence, it needs to be tailored to fit people’s lifestyles. In a typical clinic visit, it’s hard to go beyond “you need to diet and exercise” when labs are abnormal. But in a precision-based longevity medicine clinic, you can break things down for each individual—for example, a mechanic eating fast food after work—and discuss practical alternatives. This individualized approach leads to adherence because patients feel heard and understood.

Next question: lifestyle interventions are more powerful than most medications for cardiometabolic health.

GC:
True. Both lifestyle and medications face challenges with long-term compliance. People don’t want to take medications forever, and it’s hard to maintain strict diets or exercise regimens indefinitely. Some indulgences are fine, but lifestyle changes have greater long-term impact than medications when balanced properly.

Next: technology will revolutionize patient monitoring more than new drugs in the next decade.

GC:
True. Wearables and digital systems can capture lifestyle and health data to propose more tailored interventions. Ethical considerations about data ownership and bias remain, but the potential is transformative.

Next: everybody should be taking Metformin as a form of longevity medicine.

GC:
False. Nothing, aside from basic nutrition, water, and lifestyle, should be universally prescribed for longevity. Longevity starts from within—your body can heal and regenerate when given the right environment. Medications like Metformin are not necessary for all individuals.

Next: processed food is more dangerous to health than most people realize.

GC:
True. Ultra-processed foods are a serious public health threat. Global corporations use sophisticated tactics to maximize profits, and relying solely on behavioral change is insufficient. Improving access to fresh foods and increasing awareness are key steps to combat this.

Ned Palmer:
As we wrap up, Dr. Cox, what’s something you’ve recently changed your mind about?

GC:
It’s not all about the money. Medicine has financial pressures, long hours, and student debt. But passion—doing what you love and creatively sharing it—is more fulfilling than income. Helping patients overcome challenges, like childhood obesity, and seeing them leave motivated and encouraged, is worth far more than money.

NP:
Thank you for ending on that note. Where can listeners follow you and learn more about Mirror Health and Wellness?

GC:
Instagram is a great starting point. We’ll also expand to YouTube and TikTok to tackle misinformation. Website: https://www.mirrorhealthandwellness.com/

NP:
How can physicians or patients connect with your concierge practice?

GC:
The website has a phone number and email for contact. Listeners can reach out directly to connect with the practice.

GC:
I appreciate this conversation, Dr. Palmer. Finding individuals with similar mindsets is rare, and these discussions make medicine and patient care even more rewarding.

NP:
Thank you, Dr. Cox. We look forward to having you back.

NP:

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