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0:37

Can you have too much of a good

0:39

thing? Medical care is a

0:41

good thing, but... My guest today,

0:44

Suzanne O'Sullivan, says that our medical

0:46

system is over testing, over-diagnosing, and

0:48

over-treating patients. That's the case she

0:50

makes in her newest book, The

0:52

Age of Diagnosis, how our procession

0:54

with medical labels is making a

0:57

sicker. Suzanne is a neurologist who

0:59

focuses on the treatment of epilepsy,

1:01

and she's written four books about

1:03

her experiences as a physician. Many

1:05

of my patients are in their 20s

1:08

or 30s. I see people with long

1:10

lists of medical labels at that age

1:12

and it shocks me because I didn't

1:14

see it 30 years ago. And I

1:16

can't believe that we've got sicker, you

1:18

know, to that degree. Something is going

1:20

wrong and I appreciate that some of

1:23

the subjects in this book will be

1:25

difficult for people but I also think

1:27

that something needs to be said about

1:29

these issues. Welcome

1:36

to People I Mostly Admire with

1:38

Steve Levitt. Suzanne not only thinks

1:41

that the medical system is

1:43

working on overdrive, she

1:45

believes that many patients

1:47

are misdiagnosed. Her first

1:49

book tackles the complexities

1:51

of psychosomatic disorders. As

1:53

a neurologist, she commonly

1:55

sees patients who experience

1:57

paralysis, headaches, dizziness, and

1:59

seizures. However, she estimates

2:02

that for 20%

2:04

of her patients,

2:06

the cause of

2:08

their sometimes debilitating

2:10

symptoms is not

2:12

neurological, it's psychosomatic.

2:14

We start our

2:16

conversation with Matthew,

2:19

one of the patients she

2:21

describes in her first

2:23

book, it's all in your head,

2:25

true stories of imaginary illness. at

2:27

the beginning were not terribly disabling,

2:29

but over the course of a

2:31

few months he got to a

2:34

point where he came to my

2:36

clinic in a wheelchair, essentially unable

2:38

to walk or unable to move

2:40

or to feel his legs. As

2:42

a neurologist you can generally tell

2:44

if somebody has a weakness in

2:46

a limb, whether it's coming from

2:48

their brain or whether it's coming

2:50

from a nerve or whether it's

2:52

coming from a muscle, because

2:54

these types of weaknesses have

2:57

a very precise pattern. that

2:59

fit with our neuroanatomy, essentially.

3:01

So examining Matthew, his clinical

3:04

signs were very contradictory, meaning

3:06

they didn't fit with neuroanatomy.

3:09

Certain reflexes were normal in

3:11

a situation in which his

3:13

muscles were entirely paralyzed. So

3:15

you banged him on the knee

3:17

with the hammer, his leg would

3:19

kick, but he absolutely was unable

3:21

himself to force his leg to move. Yeah,

3:23

and that's acceptable neurologically in some diseases,

3:25

but in the situation in which he

3:27

had this kind of very profound amount

3:30

of paralysis, you would expect the reflexes

3:32

if it's a nerve problem to be

3:34

gone, or the reflexes to be very

3:36

brisk if it's something in the brain.

3:38

But neither was present. His unconscious reflexes

3:40

were all entirely normal. What we're trying

3:42

to do as neurologists always is to

3:44

try and hone down to a point

3:46

in the nervous system. Someone's weak in

3:49

their legs. Is it a back problem?

3:51

Is it a brain problem? Is it

3:53

a muscle problem? And that simply wasn't

3:55

possible with Matthew because the signs

3:57

were not consistent with any single

3:59

neural. anatomical place. And that happens

4:01

in a very specific condition which

4:03

neurologists see very regularly, maybe

4:05

about a fifth of their clinical

4:07

encounters. And that's a condition

4:09

called functional neurological disorder. It would

4:12

previously have been referred to

4:14

as psychosomatic. So this was weakness

4:16

which had a psychological origin

4:18

rather than being due to a

4:20

neurological disease. So psychosomatic is

4:22

a term we've all heard. Can

4:24

I make sure that the

4:26

definition that we use in popular

4:28

culture matches with the definition

4:30

you're using as a doctor? I

4:32

think that's a good idea.

4:34

Psychosomatic disorder is a set of

4:36

physical symptoms that are real,

4:38

that are usually causing significant disability,

4:40

but that cannot be explained

4:42

by a disease and are likely

4:44

to have a psychological origin.

4:46

So Matthew is a little bit

4:48

like me when he feels

4:50

something wrong. He sounds like he

4:52

was the kind of person

4:54

who went on the internet. He

4:56

came into your office completely

4:59

and utterly convinced that he

5:01

had multiple sclerosis, although he in

5:03

your view didn't. What do

5:05

you do when you face a

5:07

patient who is certain of

5:09

their own diagnosis and you're certain

5:12

they have a different diagnosis?

5:14

How does that conversation go? Well,

5:16

I mean, that's a phenomenally

5:18

difficult conversation. Most people are not

5:20

aware that something as dramatic

5:22

as complete paralysis can occur as

5:24

a result of a purely

5:26

psychological cause when the brain and

5:29

nerves are otherwise healthy. So

5:31

that diagnosis usually comes as an

5:33

absolutely immense shock. And if

5:35

you deliver the diagnosis clumsily, people's

5:37

initial reaction is you're telling

5:39

me I'm doing it on purpose,

5:41

you think I'm imagining it.

5:43

And so the first thing I

5:46

really need to do with

5:48

patients in that situation is reassure

5:50

them that this is a

5:52

real condition. I do not believe

5:54

it's within their control, but

5:56

I believe it is controllable. I

5:58

usually start by really describing

6:00

to people all of the really

6:03

common psychosomatic symptoms that are not enough to be

6:05

a disorder that we all experience. So I'll often say to

6:07

patients, well, you know, sometimes if you're nervous, your heart beats

6:09

incredibly quickly. You can't control that. You're not

6:11

doing it on purpose, but you know it's

6:13

not due to a heart disease. If I

6:15

told you to stop it, you couldn't simply

6:17

stop it. And it's the same with motor

6:19

symptoms or sensory symptoms. Movement is

6:22

supposed to be automatic. If you're paying

6:24

an excessive amount of attention to movement,

6:26

it stops being automatic. We've all experienced

6:28

that if we've walked on a side

6:30

of a cliff or somewhere that feels

6:32

precarious to us, it makes us less

6:35

efficient in our movement. And that's the

6:37

way that we all experience this kind

6:39

of mind-body connection that makes our bodies

6:42

less efficient. But for some people, it

6:44

can... become much more extreme and lead

6:46

to disability. Similarly to sensation, our bodies

6:48

are awash with sensations that are available

6:51

for us to notice, but we don't

6:53

notice them because they're not important and

6:55

we dismiss them because we couldn't possibly

6:57

deal with all of the information we're

7:00

being bombarded with all the time. But

7:02

if I say to somebody, we'll pay

7:04

attention now to how the chair

7:06

feels underneath your bottom or

7:08

pay attention to your hand. suddenly

7:11

your hand feels different. And

7:13

through examples like that I try

7:15

to let patients know that

7:17

these are common experiences and

7:19

like anything in the body

7:21

they go wrong and when

7:23

they go wrong they can lead to illness.

7:26

It's really interesting and

7:28

surprising to me that the

7:30

brain has the power to pull these

7:32

things off. It must be working through

7:35

some kind of a feedback loop

7:37

in which little actions... trigger things

7:39

far beyond the control of what

7:41

Matthew or someone else is trying

7:44

to accomplish. I mean we think about these

7:46

things as part of what they

7:48

call predictive coding. So our brains

7:50

are like prediction machines. They're not

7:52

assessing the world as it's presented

7:54

to us exactly. They are assessing

7:56

the world according to its experience

7:58

and its expectation. And those sort

8:01

of perceptions, unfortunately, can lead us

8:03

into illness. So if I give

8:05

an example of, say, someone having

8:07

a blood test, if you are

8:09

really phobic about having a blood

8:11

test and a needle is approaching

8:14

your arm, people can feel pain

8:16

before the needle even touches their

8:18

arm because their expectation of pain

8:20

is so strong that it creates

8:22

pain even in absence of the

8:24

painful stimulus. And in the case

8:27

of Matthew... The first thing he noticed

8:29

was the tingling in his legs and

8:31

that directed all of the attention towards

8:33

his legs. And then as we all

8:35

do, he developed a very rich kind

8:37

of inner picture of what he thought

8:39

was happening in his body and he

8:42

had an expectation of how his symptoms

8:44

would progress. Well, is my walking okay?

8:46

So now he's paying lots of attention

8:48

to his walking and something that we

8:50

do automatically and never think about is

8:52

suddenly within his frame of attention. and

8:54

that makes his walking unnatural. So it's

8:57

sort of an escalating problem that the

8:59

more you notice the more you pay

9:01

attention and then it escalates in that

9:03

way. Now you've also told the story

9:05

of a woman named Sharon and she'd

9:08

been having seizures for five years before

9:10

she found her way to you and

9:12

twice because of her seizures lasting so

9:14

long doctors had put her into an

9:17

induced coma out of fear that the

9:19

prolonged seizure would lead the brain damage.

9:21

or death. So to any observer like

9:23

me, Sharon obviously has

9:25

epilepsy, but when you

9:27

see people like Sharon,

9:29

oftentimes you find the answer

9:32

lies somewhere very different. We

9:34

all kind of dissociate, which is

9:36

the basis for these seizures.

9:38

We all dissociate from time

9:40

to time. I am constantly having

9:42

to replay news broadcasts or podcasts for

9:45

the fact that I missed. Sometimes I

9:47

have to do it ten times in

9:49

a row because I zone out regularly

9:51

when I'm listening to things because my

9:53

brain is distracted or my brain can't

9:55

handle everything I have on my plate

9:57

at the moment. But for some people

9:59

it goes... so wrong that it

10:01

produces dramatic symptoms that are disabling

10:03

and that's when it becomes a

10:05

disorder. How do you distinguish

10:08

between someone who has epilepsy

10:10

and someone who's having seizures

10:12

that are coming from a totally

10:14

different source, a psychological source?

10:16

Yeah, so I'm a seizure specialist, so

10:18

I would say that it's phenomenally easy,

10:20

but it's not phenomenal easy for people

10:23

who don't see seizures all the time.

10:25

When an epileptic seizure, there's kind of

10:27

a wave of... electrical discharge that shouldn't

10:29

be there passing through the brain and

10:31

as it passes through the brain it

10:34

does that in an anatomical way so

10:36

it starts in one bit of area

10:38

of the brain then it spreads to

10:40

the motor region on the same side

10:42

of the brain and then forward or

10:45

backward and that makes intelligible kind of

10:47

sense in how the symptoms evolve

10:49

but in a non-epileptic seizure or

10:51

dissociative seizure as we now call

10:53

them what happens is that the...

10:55

Seizures don't make anatomical sense, so

10:57

the shaking stops and starts, for

10:59

example. If you want to tell

11:02

the difference between these different seizures,

11:04

if you're not a seizure specialist,

11:06

you do an EEG or a

11:08

brainwave test, and in an epileptic

11:10

seizure in which someone is convulsing,

11:12

you will see lots of these

11:14

kind of spike discharges representing unwanted

11:16

electrical activity in the brain in

11:18

someone with epilepsy, but if you

11:21

look at someone with dissociative

11:23

or non-epleptic seizures, The brainwave

11:25

pattern looks like a normal

11:27

waking pattern. In a modern

11:29

Western society, there is a

11:31

strong tendency to be dismissive

11:33

of psychosomatic disorders. The word

11:35

hysteria, which preceded it, is

11:37

loaded with negative connotations. We

11:40

just want to be really

11:42

clear. In no way, shape

11:44

or form are these patients

11:46

faking anything. These are real

11:48

seizures that are happening. They're

11:50

just not being triggered. by

11:52

the mechanisms that we associate

11:54

with epilepsy. But in general,

11:56

society is not very sympathetic

11:59

to these. kinds of illnesses, but you

12:01

are sympathetic to them. Can you

12:04

talk about your own transformation from

12:06

I think being less sympathetic to

12:08

being much more sympathetic? Yeah, I've gone

12:10

through the same kind of trajectory as

12:12

most people which is struggling to believe

12:14

these are possible to struggling to believe

12:16

that my patients genuinely have no insight

12:19

into what is happening to them and

12:21

I'm 100% sure they have no insight.

12:23

As a medical student I didn't always

12:25

find that idea easy to hang on

12:27

to because these Conditions can often show

12:29

signs that make you suspicious of your

12:32

patients. For example, in people like Matthew,

12:34

what can happen is they've got this

12:36

profound weakness in their legs when they're

12:38

lying on the examination couch and you

12:40

say, move your toes, move your foot,

12:42

they can't move it at all. And

12:44

then you go back to your desk

12:47

and you're writing your notes, you'll see

12:49

little flickers of movement as they're putting

12:51

on their shoes. or people like Sharon,

12:53

when they're having seizures, sometimes they wake

12:55

up in the middle of the seizure

12:57

and then go back into it again.

13:00

And you think, are they doing it

13:02

on purpose? Are they trying to trick

13:04

me? So I had those experiences as

13:06

a medical student. I understand the disorders

13:08

better now. I realize that the reason

13:10

someone like Matthew can momentarily move

13:13

his feet when he's putting on

13:15

his shoes is because these disorders

13:17

are maintained by the attention you're

13:19

paying to your symptoms. symptoms are

13:21

not so severe. The reason I became

13:24

interested was because I wasn't taught about

13:26

these as a medical student. I'm not

13:28

saying I wasn't aware of them, but

13:30

it wasn't really considered to be my

13:32

job as a neurologist to deal with

13:34

these issues because they were considered to

13:36

fall more within the remit of a

13:38

psychologist or a psychiatrist. So when I

13:40

became a consultant and patients were my

13:42

own patients, I found that I was

13:44

seeing a very large number of these

13:46

people because I was working for an

13:48

epilepsy service and I was expected to...

13:50

see somebody was having a hundred seizures a

13:53

day and say, well, it's not epilepsy, so

13:55

you no longer can see me, go home

13:57

and find somebody else to see. These people

13:59

have physics. symptoms, but doctors who look

14:02

after people with physical symptoms are

14:04

not taking responsibility for them. And

14:06

then I just found that it

14:08

was just too difficult to be

14:11

constantly discharging people who are some

14:13

of the sickest people I was seeing.

14:15

So even though you're in an epilepsy

14:17

clinic and these folks don't have

14:19

epilepsy, you keep seeing them and

14:21

keep treating them because they're sick.

14:23

Yeah, I mean, there's a limit to what

14:26

I can do in terms of treatment.

14:28

So I refer them to my psychiatry

14:30

and psychology colleagues. It depends on the

14:32

problem. If it's a problem like Matthews

14:34

with walking, well, if you couldn't walk,

14:37

how would you feel about just being

14:39

referred to a psychiatrist? You think, well,

14:41

I can't walk. I need to be

14:43

rehabilitated. So if it's a physical problem,

14:45

I'll make sure they get physical rehabilitation

14:47

with psychological support. But I will also

14:50

very often keep them under my care

14:52

because... What happens is that they feel

14:54

dismissed, like their problem isn't a real

14:56

problem, and when they're having lots and

14:58

lots of seizures, there's not much value

15:00

in me saying, I believe you have

15:02

a real problem, but I'm not going

15:04

to see you anymore for it. So

15:07

I think that ongoing care to support

15:09

them in the belief of the diagnosis

15:11

is very important. What can also happen

15:13

is people with seizures, they end up

15:15

in emergency departments. and they see a

15:17

new doctor who's never seen a seizure

15:19

in their life before and that doctor

15:21

says no this is epilepsy. So a

15:23

very big part of my role is

15:26

just helping them to keep trust in

15:28

the diagnosis and to do that I

15:30

need to keep them under my care. Because

15:32

recovery is not quick, one

15:34

might naively expect that well if

15:37

it's psychosomatic and once I come

15:39

to understand it's psychosomatic maybe the

15:41

symptoms would go away but it's

15:43

not nearly that simple is it. No,

15:45

I mean that's the difficulty for these patients

15:48

very often. You can imagine you've got

15:50

a colleague or a next-door neighbor who

15:52

you thought had epilepsy and now they're

15:54

telling you they have these sort of

15:56

dissociative seizures that were once called hysteria

15:59

in many people's minds. immediately downgrades the

16:01

level of suffering or disability that

16:03

they have. But the reality is that

16:05

patients with epilepsy, 70% of them

16:07

will go into remission and they will

16:10

live completely normal lives and epileptic seizures

16:12

are often very brief lasting less

16:14

than a minute or a couple of

16:16

minutes. Whereas these dissociative seizures, only

16:18

30% go into remission, and often those

16:21

seizures are much more frequent, dozens in

16:23

a week or even in a

16:25

day. Often those seizures are much longer

16:27

and they're much more likely to

16:29

lead to intensive care admissions. It's

16:31

ironic that people respect this type

16:34

of suffering so much less, and

16:36

in many ways it's extremely disabling

16:38

and it's very hard to recover

16:40

from. But if you can see a patient

16:42

who has these sort of problems very quickly,

16:44

you know, if I met Matthew... In the

16:47

first couple of weeks of his

16:49

journey, before the paralysis had set

16:51

in and was able to allay

16:53

his fears, it would not have

16:55

progressed. Or if I met Charon

16:57

three months after her seizure started,

16:59

was able to direct her attention

17:02

away from the seizures, you can

17:04

stop them in their tracks that

17:06

way. But unfortunately, many people spend

17:08

years looking for that. physical disease,

17:10

that cancer, that multiple sclerosis, before

17:12

they get to the point of

17:15

having someone tell them it's psychosomatic.

17:17

It's the delayed diagnosis that I suspect

17:19

is the reason why so many people

17:21

don't get better. I'm sure you're

17:23

familiar with the book The Body

17:26

Keeps a Score by Vessel Venderkolk.

17:28

I'm probably misinterpreting this argument for

17:31

certain I'm radically simplifying it, but

17:33

I remember him arguing that the

17:35

body, not just the brain, retains...

17:38

powerful memories of childhood trauma. And

17:40

it seems superficially at least to

17:42

line with the existence of these

17:44

psychosomatic illnesses. Do you see things

17:47

in the same way as

17:49

Vanderbilt does? I don't disagree

17:51

with that statement, but I also

17:53

think that these disorders have a

17:55

much wider range than that. So

17:57

I think that sometimes these disorders

17:59

are... conceptualized as all due to

18:01

stress and all due to childhood

18:03

trauma and therefore for many years

18:05

people have gone to patients with

18:08

these sort of conditions and said

18:10

something must have happened to you

18:12

and they're desperately trying to talk

18:14

the patient into admitting that there's

18:16

some major psychological trauma either in

18:18

their background or in their current

18:20

lives and the truth is that

18:22

for a large percentage of patients

18:25

that's not the case. It's actually

18:27

just a maladaptive response to some

18:29

physical illness that's happened to them.

18:31

So I see these kind of problems

18:33

often in people who, for example, had

18:35

an injury that changes their relationship with

18:38

their body and changes the attention they

18:40

had with their body or someone who

18:42

faints. A faint can often lead to

18:44

these dissociative non-epleptic seizures. I think it's

18:47

just that there are a great deal

18:49

more causes. And when we focus too

18:51

much on trauma, psychological trauma, and childhood

18:53

trauma, patients often feel that they have

18:56

to dig into this position of having

18:58

a real illness that is nothing to

19:00

do with psychology. Naively, one

19:02

might think that a good way

19:05

to treat psychosomatic disorders would be

19:07

with placebo. If the brain can,

19:09

quote, trick the body into illness,

19:11

perhaps the brain can be... tricked out

19:13

of it. I think placebos could have

19:16

a really useful place in treating these

19:18

disorders for exactly the kind of reasons

19:20

you describe. Some patients who have non-epleptic

19:22

dissociative seizures are given epilepsy drugs which

19:25

obviously shouldn't have an effect on them

19:27

but actually do get rid of the

19:29

seizures. So placebo would certainly help patients.

19:31

I think that these treatments have just

19:34

fallen out of favor and people are

19:36

a bit nervous about using them because

19:38

they are perceived as a bit of

19:40

a bit of a trick. I don't

19:43

think that they are a trick because

19:45

actually as I'm sure you know placebo's work

19:47

even if you know it's a placebo. I

19:49

think it depends on the patient of course.

19:51

My dad is a doctor and I still

19:53

remember vividly a story he told me when

19:56

I was a child. He was in the

19:58

US Air Force stationed in the... in the

20:00

early 1960s, and he had to

20:02

deal with a really wide range

20:04

of illnesses with the soldiers who

20:07

would come and see him. And

20:09

my father is very physical as

20:11

a doctor. He tries to really

20:13

put his hands on people and

20:15

make them feel like he's giving

20:18

them attention. And when he was

20:20

convinced that one of the soldiers' symptoms

20:22

were psychosomatic, He'd listened very carefully to

20:24

the story, and then he would send

20:26

them home with sugar pills, placebo, and

20:29

tell them to come back in two

20:31

weeks if they weren't feeling better. Now

20:33

he wouldn't tell them they were placebo,

20:35

he would just say, hear your pills.

20:37

Now if the patient came back in

20:39

two weeks... he would give them another

20:42

thorough examination, and then he would send

20:44

them home with another set of sugar

20:46

pills, but these pills looked different. They

20:48

were huge pills, like horse pills, with

20:50

the idea of being that a pill

20:52

that is this hard to swallow it,

20:54

it must be powerful if the doctor

20:57

is giving me such a crazy pill.

20:59

And I think he would say just

21:01

for emphasis, I need to take two

21:03

of these pills. And then if the

21:05

patient came back two weeks later, Then

21:07

my dad went to his secret weapon.

21:09

Now very few patients did come back,

21:11

but this third set of placebos were

21:14

incredibly tiny pills. And he would

21:16

say, these are so powerful, they're very tiny,

21:18

you only need one. And he said

21:20

he never had a patient come back

21:22

again after those bills. Now, I find

21:24

the psychology of what he was doing

21:26

fascinating, but also the notion that. He

21:29

was fine to practice medicine that way

21:31

in the 1960s. I think he would

21:33

get you a lot of trouble if

21:35

you were doing that today. Yes, certainly

21:37

I wouldn't suggest doing that today, but

21:39

I mean in treating these disorders, the

21:41

relationship between the patient and the doctor

21:44

and the trust that the patient has

21:46

in the doctor, it may not even

21:48

have been the pills. Your father put

21:50

his hands on these patients, which is

21:52

something that doesn't necessarily always happen these

21:55

days. And treating people with these sort

21:57

of disorders is a very important clinical

21:59

skill. time spent with a patient,

22:01

I often find one conversation with

22:03

a patient can actually make seizures

22:06

better almost immediately. I am fascinated

22:08

what he got away with, but

22:10

not surprised to hear it was

22:12

helpful. We'll be right back with

22:14

more of my conversation with neurologist

22:16

Suzanne O'Sullivan after this short break.

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30:10

improve their bargaining power. And

30:12

now that's a very economic

30:14

language, but in the language

30:16

you use, it maybe has

30:18

some parallels to this resignation

30:20

syndrome in that. These teens

30:22

are trying to express their

30:24

pain in a way that

30:26

people will listen and in

30:28

the US that's a suicide

30:30

attempt and for Swedish refugees

30:33

that's complete disappearance

30:35

into solitude. I think we

30:37

express our distress in a way that

30:39

is intelligible to the community in which

30:41

we live and in a way that

30:44

is most likely to elicit the help

30:46

that we are asking for. And very

30:48

often in the case of young people,

30:50

and I would say young women in

30:53

particular, just expressing your distress in a

30:55

verbal way, doesn't necessarily get a lot

30:57

of attention or doesn't get results, there

30:59

was another example of a culture band

31:02

syndrome that I wrote about which is

31:04

called greasy sickness. which affects the mosquito

31:06

people of Nicaragua. This greasy

31:08

sickness literally translates to crazy

31:10

sickness. It affects young women

31:13

in particular. Young women in

31:15

their teen years are faced with

31:17

unwanted male attention and they're in

31:19

a society that asked them to

31:21

be modest, but they're also being

31:23

sexualized by men and it's a

31:25

very difficult situation for them and

31:28

they don't know how to express

31:30

the need for help or to

31:32

express how it distresses them. and

31:34

in greasy sickness it's like a

31:36

cultural way of expressing that distress

31:38

to get the help you want

31:40

and greasy sickness manifests as seizures

31:42

along with hallucinations and other symptoms

31:44

and it's understood by the community when

31:47

greasy sickness occurs you need to band

31:49

around this young woman as a community

31:51

and help her and these a lot

31:53

of traditional treatments but I would suggest

31:56

the support of the community is probably

31:58

the thing that really helped. them. That

32:00

speaks to how you ask for

32:02

help in a way that works

32:04

and you know the way that

32:07

works from the society in which

32:09

you live. And I think that

32:11

for these young people with resignation

32:13

syndrome, this was a very powerful

32:15

expression of distress and without it

32:17

they could have complained and no

32:19

one would have listened. It's interesting

32:21

that in Nicaragua the response to

32:24

the psychosomatic... hallucinations and whatnot is

32:26

for the community to band together

32:28

and support the young girls, whereas

32:30

in Western culture our response to

32:32

psychosomatic illness is typically the opposite,

32:34

right? I was so impressed by

32:36

that because basically if you get

32:39

greasy sickness and you get these

32:41

seizures you have an expectation of

32:43

full recovery actually. People do band

32:45

together and support them and there's

32:47

nothing stigmatized about greasy sickness. People

32:49

just have a different understanding of

32:51

illness than we do. It's not

32:53

divided into psychological, which is slightly

32:56

less important than physical. They don't

32:58

consider greasy sickness to be a

33:00

psychological problem. They understand what they

33:02

have to do to help it

33:04

and therefore it gets better. Whereas

33:06

we block people away and make

33:08

them feel ashamed of what's happening

33:11

to them and they don't get

33:13

better. Your

33:22

books have been extremely well received,

33:24

both liked by readers and by

33:26

book critics, and you've got a

33:28

new book called The Age of

33:30

Diagnosis, which I think people will

33:32

like as well, but I think

33:34

your book is also going to

33:37

make a lot of people angry.

33:39

Are you prepared for the firestorm

33:41

of controversy that might come with

33:43

your new book? I cannot tell

33:45

you how much I don't like

33:47

controversy. I could be a lot

33:49

more provocative with some of the

33:51

subjects that I write about, but

33:53

I go out of my way

33:55

not to be provocative. But I

33:58

appreciate that the age of diagnosis...

34:00

going to be a difficult read

34:02

for some people, but I also

34:04

think that there are things that

34:06

occur within medicine that are controversial

34:08

within medicine between professionals, between scientists.

34:10

We're aware of all of these

34:12

controversies, but we don't always share

34:14

them openly enough with the general

34:16

public, and I think they're also

34:19

conversations about the issues in this

34:21

book that deal with over-diagnosis that

34:23

lots of us are having in

34:25

our living rooms, but nobody is

34:27

having loudly enough in public forums,

34:29

and I think that something needs

34:31

to be said about these issues.

34:33

Yes, so the main thesis of

34:35

your book is that we are

34:37

living in a world of over-diagnosis.

34:40

So what do you mean by

34:42

over-diagnosis? is occurring within the field

34:44

of mental health. And that's the

34:46

first thing people think about when

34:48

you talk about over-diagnosis. So that's

34:50

what I would refer to as

34:52

kind of over-medicalization, where you are

34:54

referring to difficulties or struggles that

34:56

we would once not have considered

34:59

to be as medical and directing

35:01

them towards medical attention. So I'm

35:03

talking about the number of people

35:05

who've been diagnosed with autism, ADHD,

35:07

depression, and so forth. that 20,

35:09

30 years ago perhaps would not

35:11

have attracted those diagnosis. But I'm

35:13

not only talking about those mental

35:15

health conditions, I'm talking about the

35:17

over-diagnosis and over-medicalization of physical parameters

35:20

too. We have gradually changed the

35:22

concept of how depressed you have

35:24

to be called medically depressed, but

35:26

we've also gradually changed the concept

35:28

of what it means to have

35:30

high blood pressure or diabetes and

35:32

numerous other diseases like that. Scientists

35:34

and doctors have been gradually changing

35:36

the parameters of what counts as

35:38

disease and they do this for

35:41

a really good reason. They do

35:43

it because they want to miss

35:45

as few patients that could benefit

35:47

from help as possible. So it's

35:49

all done in a... well-intentioned way,

35:51

but unfortunately that trend of gradually

35:53

loosening diagnostic criteria for both physical

35:55

health conditions and mental health conditions

35:57

has led to a sort of

35:59

diagnosed explosion in numerous sectors of

36:02

medicine. I was surprised that in

36:04

the statistics you report that asthma

36:06

of all things has increased by

36:08

almost 50% when you might have

36:10

thought it should be the opposite

36:12

because many of the air quality

36:14

problems that would have triggered it

36:16

have been improved by public policy.

36:18

I think that when people think

36:20

about diagnosis, they think about it

36:23

as a more definite thing than

36:25

it actually is. I'm not an

36:27

expert in asthma, so I don't

36:29

necessarily want to speak to that

36:31

in great detail, but people think,

36:33

well, if someone says that you

36:35

have high blood pressure, someone says

36:37

you have asthma, someone says you

36:39

have diabetes or autism, that's a

36:41

definite fact based on clear scientific

36:44

evidence. But first of all, diagnostic

36:46

criteria are always changing for how

36:48

much of something you need to

36:50

have the disease. And then we

36:52

also have the difficulty of medical

36:54

tests and how we diagnose things

36:56

as being highly subjective things. To

36:58

a certain degree you can bend

37:00

tests and you can bend medical

37:03

criteria to diagnose as many people

37:05

as you... want to, and we

37:07

are encouraged to do so because

37:09

under-diagnosing terrifies doctors, they don't want

37:11

to miss things, terrifies patients because

37:13

they don't want to be under-diagnosed,

37:15

but there's always a gray area

37:17

in every diagnosis. There's always a

37:19

gray area where you're not completely

37:21

sure, and it's very easy to

37:24

draw a lot of people in

37:26

the gray area into the diagnostic

37:28

category. The most interesting chapter to

37:30

me was focused on Lyme disease.

37:32

Could you talk about how Lyme

37:34

disease is diagnosed? This is a

37:36

really good example because you would

37:38

think that Lyme diseases are fairly

37:40

straightforward diagnosis so obviously people will

37:42

be aware that Lyme disease is

37:45

caused by a bacteria. and that

37:47

you catch Lyme disease by a

37:49

tick bite. And one might assume,

37:51

therefore, that if you have the

37:53

bacteria, you must have Lyme disease,

37:55

and if you don't have the

37:57

bacteria, you don't have Lyme disease.

37:59

But Lyme disease is a beautiful

38:01

example of how subjective diagnosis is

38:03

both in the clinical symptoms and

38:06

in the tests. that bacteria that

38:08

cause Lyme disease are very hard

38:10

to detect in the blood, because

38:12

there's not loads of them. You

38:14

might take a blood test and

38:16

you're not necessarily going to see

38:18

a bacteria. So instead what you

38:20

look for is the immune reaction

38:22

to the bacteria. So you're immediately

38:24

got a problem, because now you're

38:27

looking at something that is indirect

38:29

evidence for the disease. And there's

38:31

lots of things that will affect

38:33

that indirect evidence. It could be

38:35

that you have an immune reaction,

38:37

but it's a really old reaction.

38:39

You've been living in a Lyme

38:41

disease area your whole life. You've

38:43

been exposed to this bacteria lots

38:45

of times. Or it could be

38:48

that you're very sick for some

38:50

other reason. You're producing lots of

38:52

antibodies, and those antibodies calls false

38:54

positives. So the blood tests that

38:56

you do for Lyme disease are

38:58

confounded. by multiple different variables. Did

39:00

you test for the right strain

39:02

of the bacteria? All of these

39:04

things can be changed according to

39:07

how labs can figure their tests

39:09

and how doctors interpret the results

39:11

of the tests. So the CDC

39:13

sets out standards for a Lyme

39:15

disease diagnosis. And I think it

39:17

was in about 2023, it recognized

39:19

about 63,000 people had Lyme disease

39:21

according to the CDC standards. but

39:23

nearly half a million people were

39:25

being treated for Lyme disease according

39:28

to their health records. So it's

39:30

likely that all of those extra

39:32

people had a diagnosis that would

39:34

not be necessarily considered correct according

39:36

to CDC standards. And that's because

39:38

medicine is an art. Clinically, medicine

39:40

is an art, but also when

39:42

you look at lab tests, they

39:44

are subjective and they are open

39:46

to interpretation. probably about incentives, right?

39:49

The doctors have a patient, they're

39:51

sick, they worry about what will

39:53

happen if they don't treat them

39:55

for Lyme disease, so they have

39:57

no idea if they have Lyme

39:59

disease, but they treat them anyway

40:01

and hope for the best. In

40:03

Lyme disease, that's probably why there

40:05

are so many more people who

40:07

are told they have Lyme disease

40:10

than the CDC thinks are true.

40:12

I think it's probably a bit

40:14

more than that. A difficulty with

40:16

Lyme disease is that some of

40:18

the symptoms it produces can be

40:20

quite vague and there can be

40:22

symptoms of almost anything tiredness or

40:24

a skin rash, for example. So

40:26

you can imagine how common those

40:28

symptoms are if you're a family

40:31

doctor. You're seeing them all the

40:33

time. And then also there are

40:35

lots of areas in the US

40:37

where Lyme disease is quite prevalent.

40:39

It's perfectly reasonable, therefore, if someone

40:41

sees a patient in the first

40:43

instance, they've got vague symptoms or

40:45

in a Lyme disease area to

40:47

treat them for Lyme disease, even

40:50

though you're not sure. That's the

40:52

way doctors practice all the time.

40:54

However, usually what we'll do as

40:56

doctors in that circumstances will try

40:58

the treatment, if it's not working,

41:00

then we'll stop the treatment. That's

41:02

not what happens with Lyme disease.

41:04

Unfortunately... A condition called chronic Lyme

41:06

disease has taken hold of the

41:08

Lyme disease community and is being,

41:11

I would say, exploited. There is

41:13

a very standard treatment for Lyme

41:15

disease as laid out by the

41:17

CDC, but there are a lot

41:19

of people who are attending private

41:21

doctors who get antibiotics for many

41:23

years, even though the signs are

41:25

not felt to fit very well

41:27

with Lyme disease. And one of

41:29

the reasons why overdiagnosis would be...

41:32

If there's a psychosomatic component that

41:34

kicks in when you're led to

41:36

believe that you have Lyme disease,

41:38

do you think there is a

41:40

big psychosomatic component of chronic Lyme

41:42

disease? I would be quite sure

41:44

that a percentage of people, I

41:46

spoke to this very nice lady

41:48

from Wales in the UK who

41:50

suffered a kind of flu-like illness

41:53

while she was on... holiday, she

41:55

did not live in a Lyme

41:57

disease area and she was on

41:59

holiday in a city, there was

42:01

no reason for her to contract

42:03

Lyme disease and she developed flu-like

42:05

symptoms that didn't go away and

42:07

then within a couple of weeks

42:09

she had 90 to 100 different

42:11

symptoms. and this progressed to the

42:14

point that she was too tired

42:16

to leave her house. Now, if

42:18

you've got 90 to 100 symptoms,

42:20

you're bound to have a couple

42:22

of symptoms in there, the fit

42:24

with Lyme disease. And after she

42:26

saw a television program about Lyme

42:28

disease, she developed the conviction that

42:30

this was her diagnosis. I would

42:33

say that people in her situation,

42:35

I would certainly say this is

42:37

a large psychosomatic element. The belief

42:39

in the diagnosis of chronic Lyme

42:41

disease is very problematic because people

42:43

get... dependent on long-term antibiotics and

42:46

the belief that they won't get

42:48

better. And if you believe you

42:50

won't get better, then it's very

42:52

difficult to get better. So I started

42:54

this conversation by suggesting that I

42:56

thought that this book would make

42:59

people mad. Now I'm going to

43:01

ask you about long-covid and see

43:03

how many people with long-covid you

43:05

can offend, because you are a

43:08

real skeptic with respect to long-covid.

43:10

Is that true? First thing I

43:12

want to say is that there should

43:14

be nothing offensive in my view at

43:16

all here because my position always with

43:18

these disorders is that people are suffering.

43:20

Symptoms are real but it's how people

43:23

conceptualize what's causing those symptoms that I

43:25

think is a problem and it's also

43:27

the perception so if I'm about to

43:29

say that I believe long COVID for

43:31

a lot of people is psychosomatic that

43:33

should not be seen as in any

43:35

way lessening their suffering or saying that

43:38

they are not suffering or saying that

43:40

they do not need help. I'm merely

43:42

saying that the mechanism of illness,

43:44

according to the evidence and according

43:46

to my view, fits better with

43:48

psychosomatic illness. But with regard to

43:50

long COVID, I mean, it came

43:52

about in a very unconventional

43:55

way. The term arose on the 20th

43:57

of May 2020 when it was tweeted

43:59

by an Italian... person who was suffering

44:01

with long-term symptoms after contracting COVID,

44:03

it very quickly took off in

44:05

social media. There were people who

44:07

were not hospitalized, who had a

44:10

more mild form of COVID, who

44:12

didn't seem to be getting better

44:14

quickly enough. And they banded together

44:16

on social media under the hashtag

44:18

long COVID and found support in

44:20

each other that way. The difficulty

44:22

was that long COVID then spread

44:24

very quickly to the mainstream media

44:27

into the mouths of government officials

44:29

who were telling us every day,

44:31

not only could we. die and

44:33

we might end up in hospital

44:35

but even if we got a

44:37

minor illness we could get this

44:39

thing called long COVID. But there

44:41

was no definition for long COVID.

44:43

There was no specific symptoms that

44:46

told you what it was. There

44:48

was no test that proved what

44:50

it was. So it was a

44:52

name that could explain any type

44:54

of suffering during the pandemic in

44:56

those early stages. It quickly spread

44:58

to medical journals and that science

45:00

just moved. too quickly to be

45:03

really accurate or meaningful. And for

45:05

some people it was being referred

45:07

to as long COVID and for

45:09

others, it was probably given different

45:11

names. There's a few pieces of

45:13

evidence that really support the psychosomatic

45:15

theory. More than one study has

45:17

shown that loneliness was a predictor

45:20

for long COVID. There was a

45:22

study in Germany where they followed

45:24

health care workers and people who

45:26

had an expectation of symptom severity.

45:28

were more likely to get lung

45:30

COVID so people expected to get

45:32

it got it was another study

45:34

in which they showed that self-diagnosis

45:36

was more likely to lead to

45:39

long COVID and official diagnosis of

45:41

COVID infection. Obviously people were suffering

45:43

in the pandemic, they were suffering

45:45

psychologically, their diets changed, they stopped

45:47

exercising, everything about their body changed

45:49

and here was a diagnostic explanation

45:51

for it. So I really feel

45:53

that long COVID drew in. Lots

45:56

of people who are suffering in

45:58

lots. of different ways under this

46:00

umbrella, but I really don't think

46:02

people should feel that means the

46:04

suffering isn't real. Again, it's an

46:06

intelligible way of asking for help

46:08

at a time that you need

46:10

help. And perhaps what we should

46:12

learn from it is that we

46:15

need better support systems for people

46:17

that don't rely upon a medical

46:19

diagnosis. Yeah, it's really true, right?

46:21

In my society, if you want

46:23

to get help, you need a

46:25

medical diagnosis. can't get access to

46:27

a lot of the support you

46:29

might want if a doctor hasn't

46:32

signed off and says you need

46:34

it. It seems like that's just

46:36

a fundamental problem with the way

46:38

we've organized society. Would you agree?

46:40

A hundred percent, particularly for some

46:42

of the mental health disorders or

46:44

learning disorders, problems like autism, ADHD,

46:46

depression, etc. First of all in

46:49

schools, your child is struggling in

46:51

school, you want to... pay attention

46:53

to that struggling and try and

46:55

get them extra support. The only

46:57

way to get that very often

46:59

is through a diagnosis or the

47:01

only way for the school to

47:03

justify extra staff is through a

47:05

diagnosis. And similarly, outside of schools

47:08

for older people illness gives you

47:10

a pathway to ask for help

47:12

and it also makes you part

47:14

of a community of other people

47:16

who are suffering. It makes a

47:18

lot of sense for distress to

47:20

be conceptualized under a medical label,

47:22

but my concern really is... What

47:25

happens after that? When you label

47:27

people, you change how they see

47:29

themselves and you change how they

47:31

are seen by others and that

47:33

can affect their future, either as

47:35

a child or as an adult.

47:37

And that's the thing I want

47:39

people to realize when they're thinking,

47:41

well, you know, my child, I

47:44

don't know, they're on the borderline,

47:46

perhaps I notice social difficulties, perhaps

47:48

a diagnosis of autism, will get

47:50

them extra help in school, that

47:52

will propel them forward. But what

47:54

else comes with that? Will that

47:56

child feel that they have a

47:58

brain abnormality they cannot overcome and

48:01

change their future in that way?

48:03

Will other people think that there's

48:05

something wrong with them? So I

48:07

think we need to talk more

48:09

about diagnosis is not inert. We

48:11

don't talk enough about the negative

48:13

implications of a diagnosis. You're listening

48:15

to people I mostly admire. I'm

48:18

Steve Levitt and after this short

48:20

break, neurologist Suzanne O'Sullivan and I

48:22

will continue our conversation about overdiagnosis

48:24

in modern medicine. We need to

48:26

give doctors the time to practice

48:28

their art in a way. that

48:30

will also be significantly more satisfying

48:32

for a patient. Tax

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Act can think of a million

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Tax Act is going to

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traffic. Folding a fitted bed

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Digging a hole. Digging an even

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a quote today. Restrictions apply. world.

54:25

What's your vision? How should society

54:28

and medicine and medicine interact? So I

54:30

really think we need to place

54:32

more value and more investment in

54:34

the clinical side of medicine. You

54:36

get the most accurate diagnosis if

54:38

you have a few different quality

54:40

consultations with your doctor who lays

54:42

hands on you and therefore can

54:44

really understand the problem that you're

54:46

bringing to them. and then interpret

54:48

the tests in light of that

54:50

understanding. So I think at the

54:52

moment we're really heading more in

54:54

the direction of saying maybe this

54:56

AI tool will diagnose millions of

54:58

cancers much faster than a radiologist,

55:01

but actually there'll be nothing without

55:03

that consultation that makes sense of

55:05

what that scan is finding for

55:08

the clinical context of the patient.

55:10

It's all about the patient and

55:12

doctor's interaction. and I think we

55:15

need to start prioritizing that over

55:17

technology. So in the US, at least,

55:19

I think every trend goes in the

55:22

opposite direction, right? Doctors spend so

55:24

little time with patients, they have

55:26

such high caseloads that they don't

55:28

have time to sit down and

55:30

to hear the patient because there's

55:32

seven other patients waiting in line.

55:34

Yeah, and it's a huge problem

55:37

in the UK, and very often general

55:39

practitioners only have... five minutes with their

55:41

patients, how can you really get to

55:43

the kind of nub of the problem?

55:45

And that's why doing tests and putting

55:47

a medical label on something is often

55:49

the easiest consultation for a doctor. Someone

55:51

comes to me with a headache and

55:54

they're worried they have a brain tumor,

55:56

doing a scan to assure them they

55:58

don't have a brain tumor. is the

56:00

easiest thing I can do. It

56:02

takes a few minutes explaining why

56:04

doing the scan, A, it isn't

56:07

necessary, B, it could be harmful

56:09

because it'll pick up all sorts

56:11

of incidental findings that will just

56:13

add to the anxiety. That's a

56:15

20-minute consultation, you know. If we

56:17

go back to the example of

56:20

chronic Lyme disease, and I was

56:22

talking about a lady called Shannon,

56:24

who had chronic Lyme disease, she

56:26

saw lots of private doctors. And

56:28

I would say that there were

56:30

some real charlatans amongst that group

56:32

who charged her large amounts of

56:35

money for very unconventional treatment that

56:37

most doctors wouldn't agree with. She

56:39

loved those doctors. And I would

56:41

say what was at the heart

56:43

of that was. that what she

56:45

was really paying for was to

56:48

be heard. These doctors spent time

56:50

with her, they examined her, they

56:52

listened to her and they wanted

56:54

to meet her again. That's what

56:56

was sustaining her. And I think

56:58

we, in the more conventional side

57:01

of medicine, do need to learn

57:03

from that. We need to understand

57:05

that you make more people better

57:07

with slow medicine, given the doctor

57:09

time. I'm wondering about... the many

57:11

people who have friends or loved

57:14

ones who are suffering from psychosomatic

57:16

illness? And what advice you have

57:18

for those bystanders? How can we

57:20

interact in ways that will be

57:22

most helpful to those patients? I

57:24

think it's extremely difficult for an

57:27

individual to express this kind of

57:29

concern about psychosomatic symptoms to their

57:31

own loved one because it's such

57:33

a stigmatized disorder still, which is...

57:35

terrible given how common it is.

57:37

I usually caution people to be

57:40

reasonably careful about diagnosing friends and

57:42

loved ones because it often isn't

57:44

taken terribly well. There are doctors

57:46

who specialize in this now, so

57:48

there are people who will be

57:50

able to give a sound diagnosis.

57:53

So it's very important that people

57:55

recognize that psychosomatic symptoms are real

57:57

and that they are... completely unconsciously

57:59

generated, and that we start having

58:01

the same attitude to them that

58:03

we would have to any illness.

58:05

If your loved one was in

58:08

a wheelchair because they'd had a

58:10

terrible accident and they'd injured their

58:12

spine, you'd have an immense amount

58:14

of understanding for that situation. A

58:16

psychosomatic disorder is equally disabling. So

58:18

we need to start giving parody

58:21

to these illnesses. so that we

58:23

respect the suffering of the person

58:25

and their experience and that we

58:27

understand that what's happening to them

58:29

is outside of their control. But

58:31

there's also a balance there with

58:34

also understanding that if you support

58:36

them correctly they can get better

58:38

and that is the difference basically.

58:40

We want to validate what they're

58:42

going through is real but also

58:44

support them to get better. People

58:47

have to believe in recovery to

58:49

get better. I

58:52

have to say, I found myself

58:54

a little bit shocked by what

58:56

Suzanne O'Sullivan had to say today.

58:59

Of course, I've heard of psychosomatic

59:01

illness, but I always imagined it

59:03

was both extremely rare and that

59:05

there were real limits on the

59:07

types of symptoms the brain could

59:09

induce in the body. Hearing Suzanne's

59:11

stories, I feel like I need

59:13

to dramatically update my worldview. The

59:15

human brain is even more powerful

59:17

than I imagined. I do think,

59:20

though, that there is a really

59:22

important... practical lesson to be gleaned

59:24

from Suzanne's work. Psychosomatic illnesses start

59:26

small and it's only through a

59:28

destructive feedback loop that they can

59:30

eventually become debilitating. If one is

59:32

aware of the sneaky way in

59:34

which psychosomatic illnesses operate, one should

59:36

be able to recognize the initial

59:38

signs, the tricks the brain is

59:41

playing, and short circuit the whole

59:43

process. I'm going to keep a

59:45

watchful eye out for this sort

59:47

of feedback loop, and I'd suggest

59:49

you do the same. If you'd

59:51

like to dive deeper into Suzanne

59:53

O'Sullivan's ideas, I hardly recommend all

59:55

four of her books, especially... The

59:57

most recent book entitled The Age

59:59

of Diagnosis, How Our Obsession with

1:00:02

Medical Labels, is making us sicker.

1:00:04

It is a scathing indictment of

1:00:06

many aspects of modern medicine. Now

1:00:08

it's a point in the show

1:00:10

where I welcome on my producer

1:00:12

Morgan to tackle a listener question.

1:00:14

Hi Steve, so I actually don't

1:00:16

have a listener question for you

1:00:18

today. Instead, I want to talk

1:00:20

about a documentary I just saw.

1:00:23

It was released in 2024. And

1:00:25

it's called Counted Out. And you

1:00:27

make an appearance. The films about

1:00:29

the state of math education in

1:00:31

the United States, and it focuses

1:00:33

on some innovative math programs that

1:00:35

are happening in schools right now.

1:00:37

Do you remember being interviewed for

1:00:39

this film? I do. It was

1:00:41

a long time ago. It was

1:00:44

right when I was first starting

1:00:46

my center. and I remember that

1:00:48

a documentary filmmaker reached out to

1:00:50

be and she said, do you

1:00:52

want to be in a documentary

1:00:54

about math? My knee-jick reaction is

1:00:56

I never want to be in

1:00:58

any documentary about anything, and I

1:01:00

probably turned down a hundred of

1:01:02

them, but I just started my

1:01:05

new center at the U of

1:01:07

C, and I think we were

1:01:09

just talking with Stephen Dubner about

1:01:11

how we would do a free

1:01:13

economics episode on math and data,

1:01:15

and so against all of my

1:01:17

better instincts, I said yes, and

1:01:19

I agreed to do that interview

1:01:21

that interview. Right, so you guess

1:01:23

hosted an episode of Free Economics

1:01:26

Radio in 2019 called America's Math

1:01:28

Curriculum Doesn't Add Up. But before

1:01:30

that, earlier that year, you were

1:01:32

interviewed by Vicky Abelis, who's this

1:01:34

film's director and producer. Were you

1:01:36

familiar with any of Vicky's previous

1:01:38

documentaries? I hadn't seen her movies,

1:01:40

but when she reached out to

1:01:42

me before I agreed to say

1:01:44

yes, I just looked and tried

1:01:47

to see what she had done.

1:01:49

She seemed like a really high

1:01:51

quality thoughtful documentary filmmaker. And I

1:01:53

loved the spirit of what she

1:01:55

had done in the past. She

1:01:57

had a film called Race to

1:01:59

Nowhere, which is about the cycle

1:02:01

of anxiety that kids have because

1:02:03

of the tremendous... pressure to achieve

1:02:05

within the current high school system.

1:02:08

So you have not seen Counted

1:02:10

Out, I take it. I have

1:02:12

not seen the movie and I'm

1:02:14

actually a little bit afraid because

1:02:16

at the time that I talked

1:02:18

to her I hadn't thought it

1:02:20

all about math and how we

1:02:22

should change it. I bet I

1:02:24

was not a very good interview.

1:02:26

I'll say that for something. They

1:02:29

use one line from you. Awesome.

1:02:31

What was my one line? This

1:02:33

is what you say. parts of

1:02:35

life that used to be driven

1:02:37

by words in rhetoric, journalism, politics,

1:02:39

law, almost every occupation is now

1:02:41

embedded in data, and it is

1:02:43

transforming our ability to understand the

1:02:45

world around us. Oh, good. Feel

1:02:47

good about that line? Yes. Hey,

1:02:50

how do I look? Do I

1:02:52

look younger? Steve, you have to

1:02:54

remember that I've never met you

1:02:56

in person. A. B. The headshot

1:02:58

that Free Economics Radio Network has

1:03:00

of you is from so long

1:03:02

ago. C. You never let us

1:03:04

record these listener questions with our

1:03:06

cameras on. So to be honest,

1:03:08

I have no idea. But you

1:03:11

look good. I think they put

1:03:13

a lot of makeup on me

1:03:15

to cover up my imperfections. I

1:03:17

probably got a haircut just for

1:03:19

it too. But I really enjoyed

1:03:21

the film. You know, it covered

1:03:23

a lot of the ways that

1:03:25

data science is the underpinning of

1:03:27

so many areas of society. It

1:03:29

covered things like gerrymandering, which has

1:03:32

political implications. It covered things like

1:03:34

recidivism. It covered things like COVID

1:03:36

and... the public's understanding of how

1:03:38

disease can spread so quickly through

1:03:40

a community. And then a big

1:03:42

part of the film was about

1:03:44

math education. You know, the beginning

1:03:46

does paint a pretty bleak picture.

1:03:48

There is a large number of

1:03:50

adult Americans who just do not

1:03:53

have a basic. grasp on computation

1:03:55

and that's a problem because there's

1:03:57

a lot of profession today that

1:03:59

require an understanding of data science

1:04:01

and basic math. But the documentary

1:04:03

also highlighted these select math programs

1:04:05

in different schools and these select

1:04:07

teachers who are providing additional support

1:04:09

to students. It did end on

1:04:11

this uplifting note. There's a lot

1:04:13

of interesting and smart people that

1:04:16

are thinking about math education in

1:04:18

this country. Yeah, there sure are,

1:04:20

and they're needed. So within a

1:04:22

year of doing this interview, we

1:04:24

had launched Data Science for everyone,

1:04:26

this consortium that's brought together, a

1:04:28

really wide variety of people who

1:04:30

all care about how we teach

1:04:32

math and think we should have

1:04:34

more data in it. And that

1:04:37

organization continues to be really effective,

1:04:39

and honestly, we're making bits of

1:04:41

progress. I feel pretty good about

1:04:43

that. Do any of the guests

1:04:45

we've had in the show make

1:04:47

an appearance? One does. Tillethea Williams,

1:04:49

who is a professor of mathematics

1:04:51

at Harvey Mud. And then Joe

1:04:53

Bowler is in there as well,

1:04:55

I heard, right? Joe Bowler is

1:04:58

in there, she is in your

1:05:00

episode with Free Economics Radio. Correct,

1:05:02

she's an educator at Stanford University.

1:05:04

You shouldn't feel too bad because

1:05:06

you are not the only academic

1:05:08

that makes a very brief appearance.

1:05:10

There are a lot of people

1:05:12

in this film. What makes you

1:05:14

think I feel bad? A normal

1:05:16

person might feel bad, but I

1:05:19

really had nothing to say. Then

1:05:21

I think if she came and

1:05:23

talked to me now, I would

1:05:25

have something to say. But back

1:05:27

then I didn't really have anything

1:05:29

to say. In fact, I think

1:05:31

talking to her helped me really

1:05:33

get on the path of starting

1:05:35

to have something to say. In

1:05:37

that sense, even though I have

1:05:40

a very small role, it was

1:05:42

helpful to me and started me

1:05:44

launching the school. That's great. You'll

1:05:46

have to watch the film and

1:05:48

see your 10 seconds of fame.

1:05:50

Listeners, if you have a question

1:05:52

for Steve Levitt, please send it

1:05:54

to our email, Pima at Fre

1:05:56

economics.com. That's P-I-M-A at Fre economics.com.

1:05:58

If you have thought. or questions

1:06:01

about the show, send us an email.

1:06:03

We do read every email that's

1:06:05

sent and we look forward to

1:06:07

reading yours. And in two weeks we've

1:06:09

got a brand new episode

1:06:11

featuring UC Berkeley roboticist Ken

1:06:14

Goldberg. There is a huge wave,

1:06:16

the biggest wave I've ever seen

1:06:18

in my whole life, of interest

1:06:20

in robots and it's specifically around

1:06:23

the humanoids and the big proponents

1:06:25

of that, namely Elon Musk and

1:06:27

Jensen Wang from invidia. are saying

1:06:29

that we're on the verge of

1:06:32

achieving this dream finally, like Rosie

1:06:34

from the Jetsons come in and

1:06:36

clean up our house. But she

1:06:38

didn't even look that much like

1:06:40

a human. Well that's true. In

1:06:42

fact, she was always kind of

1:06:45

breaking down and was always malfunctioning,

1:06:47

which is actually the way real

1:06:49

robots are. As always, thanks

1:06:51

for listening, and we'll see you

1:06:53

back soon. People

1:07:00

I mostly admire is part

1:07:02

of the Freakonomics Radio Network,

1:07:04

which also includes Freakonomics Radio

1:07:06

and The Economics of Everyday

1:07:08

Things. All our shows are

1:07:10

produced by Stitcher and Renbud

1:07:13

Radio. This episode was produced

1:07:15

by Morgan Levy and mixed

1:07:17

by Greg Rippin. We had

1:07:19

research assistants from Daniel Moritz

1:07:21

Rabsin. Our theme music was

1:07:23

composed by Luis Guerra. We

1:07:25

can be reached at Pima

1:07:28

at freakonomics.com. That's P-I-M-A at

1:07:30

freakonomics.com. Thanks for listening. That's

1:07:32

a conversation my wife and I

1:07:34

have all the time. She thinks

1:07:37

because I'm such an incomplete

1:07:39

person, something terrible must have

1:07:41

happened to be as a

1:07:43

kid, but I keep on

1:07:45

fighting back and saying, no,

1:07:47

I'm just a really incomplete

1:07:50

person, absent that kind of

1:07:52

trauma. Well the difficulty she has

1:07:54

with doing that is you might

1:07:56

just become more incomplete to prove

1:07:58

your point. Preconomics

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