Peter Attia and Andrew Huberman establish that smoking is causally related to lung cancer and not just an association.

• Attia asks Huberman if smoking is causally related to lung cancer, to which Huberman confirms.
• Attia clarifies that Huberman does not believe the relationship between smoking and lung cancer is merely an association.
• Huberman acknowledges that there are mechanistic steps between smoking and cancer, implying a direct causal link.

Peter Attia discusses the importance of causality in medicine and how it's often overlooked in medical studies and practice.

• Attia expresses his obsession with causality and its significance in the field of medicine.
• He highlights the challenge of inferring causality in human medicine and the need for more attention to this aspect.

Attia criticizes the flawed approach of waiting for a high risk of lung cancer before recommending smoking cessation.

• Attia presents a hypothetical scenario where smoking cessation is recommended only after a person's 10-year risk of lung cancer crosses a certain threshold.
• He questions this approach and suggests that immediate action should be taken upon the first instance of smoking, given the causal relationship with lung cancer.

Attia discusses the causal relationship between ApoB and atherosclerosis, supported by clinical trials, epidemiologic literature, and genetic studies.

• Attia and Huberman discuss how clinical trials, epidemiologic literature, and Mendelian randomizations support the causal link between ApoB and atherosclerosis.
• They touch on genetic mutations that lead to variations in ApoB production and how these affect the risk of dying from heart-related illnesses.

Peter Attia argues that current medical practices concerning LDL or ApoB treatment based on risk assessment are backwards.

• Attia argues that the current medical approach of treating LDL or ApoB based on calculated 10-year event risk is flawed.
• He advocates for modifying causal and modifiable risks regardless of the individual's current risk level.

Attia and Huberman discuss risk assessment tools for cardiovascular events and the necessity of addressing causal factors early.

• Attia criticizes the use of risk calculators that predict 10-year risk for major adverse cardiac events, as they can be misleading.
• He stresses that early intervention is key, and treatment levels should be adjusted based on various factors such as age, existing disease, and family history.