Radiolab - Diagnosis

Episode Date: December 29, 2008

Humans love to solve problems. In this hour of Radiolab, diagnosis--our attempt to find out what's wrong, and give it a label.

You're listening to Radio Lab from Public Radio, WNYC and NPR. What we have over the criminal is the criminal actually thinks he's destroyed all the evidence. It's never all destroyed. Ever, ever, ever, ever, never. This is Lou Garcia. I recently retired from the New York City Fire Department as the chief fire marshal. So I've spent 25 years of my life looking at fires and investigating the causes of fire. How many fires do you think you've seen?

Oh, tens of thousands of fires. You've seen tens of thousands? You, you, you yourself? Yeah. When he tells me his story. There was, this is a true story. I'm not going to get too many details about it, but there was a fire in an area of New York City.

It was in an apartment building in the South Bronx. As I pulled up to this building. The fire was already over when Lou got to him. There were people in the street and were questioning people. People are saying, well, in the apartment where the fire was, There was this brave guy. Somehow he'd gotten in there and he was pouring water

trying to get the fire out. This guy was really something. You know, and he's a hero right now. Everybody's telling me what a hero he is. Everything they were saying in the street about this man was wrong. So he walks into the apartment, and he looks around and he knows right away.

Where the fire started. Now... How? Well, you just look at the fire pattern. And he could tell that the fire started, first of all, in the bed. room with a mattress. Mattress, the mattress.

Now, mattresses go up if you put a match to it. Really? Don't you have to put gasoline on the mattress? No, no, no. You can just put a match onto a mattress and it will catch a fire, yes. If you leave a whole day long enough, yeah. And he also knew that the mattress

had been placed upright against the wall. You could tell by the fire pattern that was standing on it. Wow, he can even know what position the mattress was in? Yes, absolutely. Believe me. So he meets the woman whose apartment this is. She shows up. And he says to her, so do you know this fellow

who was putting out the fire. She says, yes, as a matter of fact, I do. It just so happens that... He used to live with me, but I kicked him out. And he still had a key, by the way. And... She now says, I have a new boyfriend. So, Garcia naturally goes and finds the hero.

All right, so now, I'm questioning this fellow. I said, by the way, did you buy that mattress? And he says, yes, I did. And you weren't sleeping anymore. Was someone else sleeping in the mattress in your place? And he says, yeah, she's her the boyfriend. I said, boy, I'd be pissed. How much did it cost you?

Like $4,500? He said, no, more than that. It was like $800. I said, so now she is screwing somebody else. On the mattress, you bought? I would be pissed. I said, you know, if it was me, if I were in your place, I would want that mattress to burn.

I would probably stand it on end. I would take matches, matches, and I would put it to the mattress. That's what I would do. And in fact, I'm an expert on Fires, and I know that's what you did. You really did do that, didn't you? You can talk about it. I don't blame you.

I mean, at least you try to put it out. They'll work in your favor in court. And he looks at me. He says, well, you're not so smart. I said, wine. He goes, I used a lighter. I said, oh, you're right. I'm not that smart.

Now you put the coach on. Okay, so that was an easy one. We're going to have some harder ones coming up. Yep. Point is, the whole hour we're going to be addressing the same problem. We'll walk into one situation after another and discover that something is not right here. That's right. Something's not right with my son.

What do I do? Something's not right with my pancreas. What do I do? Something's not right with the very phrase something is not right because it presumes that I know what's right. Maybe I don't. Have we confused you enough? Well, there's a whole lot of abnormal things coming your way. This is Radio Lab.

I'm Chadabumra. And I'm Robert Colman. Stay with us. Okay, so this first story is about delivering a diagnosis. It comes to us from producer Lou O'Kowski. It's about two doctors. We start with that phrase, something's not right here, and end up going on a crazy adventure after a cure for a deadly disease.

Which is that? Pancreatic cancer. Oh, that's not good. It is like the most deadly cancer. This is the one that people have nightmares about. Why? You mean it's deadly how? Well, it's really.

rare, but it's deadly. It's the one where, you know, you something's wrong. You go to the doctor and they say you have six months to live. Wow. Is it that fast? It usually is that fast. And how did you find this out? I found this out because my friend Amy said, I've got a friend named Dr. Terry Brentall. She made a big scientific discovery and you should go to her press conference. This will be amazing. I go. And I go to the press conference. It's just a tremendous pleasure to be here today. It's unlike press conferences are kind of never amazing. I hope to unfold a story for you. I hope it will capture your attention. It's a

fascinating story. And I heard this incredible story. About 10 years ago one morning a 40-year-old guy came into my clinic. Mr. X. Very healthy looking. And he comes into my clinic and he says, I'm worried I'm going to get pancreatic

cancer. That I'm going to get the curse in my family. It was like, good Gooby. What are you talking? about. And he said, well, in my family, my father got pancreatic cancer, my grandfather, and my four uncles and my three cousins. Wow, four uncles, three cousins, father, grandfather all die of pancreatic cancer? And this guy was sure he was next in line. His uncles and his father look like the healthiest people in the world. Six months later, they're dead. He was terrified. He came to me as a

act of desperation. I mean, it's not a feeling, I guess, that maybe I know or you know. But what happened when he walked in is like, Terry, she knew exactly how he felt. You can't even process anything. You're just like almost in a trance. She'd gone through that before. Completely and utterly alone.

She was diagnosed with breast cancer when she was 34. It's a sense of falling. It's truly a sense of falling. The world slides away from you. You literally, it's almost like it disappears from underneath you. When she got the news, the first thing her doctor did, he was a friend of hers. It pulled out the whiskey. Put it on the table.

We each had a shot, which I was like, thank God he did that. Then he said, I'm not going to quit on you. We're going to fight this thing. You are not alone. That's all I needed to hear. And so when she was sitting there with patient X, she knew exactly what to say. You have to step forward. You can't step back.

You have to step forward. I was young then, and so I felt, look, I can fix this thing. I'll take that on. I can help you. I don't care how horrible it sounds. What happens next? So Terry runs back to her office,

an office she shares with another doctor, Mary Bronner. I'm Mary Bronner. I'm a pathologist. So I was like, Mary, Mary. He says, you won't believe this. This guy, Mr. X, walked into my office. And he has this outrageous, this crazy family history. This horrible problem.

It was floored. Terry had never heard that pancreatic cancer could be inherited in families. I'd never heard of anything like that. Terry comes in and she's like, I've got to help this guy. I have to figure out what's making these people sick. And Mary, I need your help. And Mary, what did she say? Well, she's a pathologist.

And what does it mean to be a pathologist? Well, she's the person who physically does the diagnosis. When your surgeon does an operation on you or your internist takes a biopsy of you, they send that tissue to me, and I make it into glass slides to look at under the microscope. So she spends her time looking at tiny pieces of Terry's patients smeared on little slides. I love the emotional distance that you have in pathology. You're, you know, a step removed from the misery, and it makes it so much easier for me to handle it. And does she interact with patients?

Almost never. Terry was right up against the misery, and she was just relaying the story to me. But I can sit very comfortably at my microscope and be very objective and just look at the tissue and decide where the cancer is. Because I don't know these patients. So you're like, I've got to go do this. Come with me. As she usually does. How did you decide that Mary should join you?

She's my science partner. That's it. And I have to in the car. So they decided. In order to help this guy, they need to go to where his family is. We drove across the mountains of Washington State. It was a long drive. They want to get the family together.

Look at these trees, aren't they make those? Draw their blood. Look at their blood to see if there's something in there that's making all these people sick. And we arrive at the little tiny town in eastern Washington. This little town called Elma. And they didn't even have, they're so small, they don't have a single medical facility. So in order to do the blood draw, we basically had to use the Subway Sandwich Shop in town. Why Subway?

Well, I have great sandwiches. One of the family members worked there and asked the boss if the family could all come and these doctors could come and draw their blood, and could we use the shop as the meeting place. All I remember was walking in and thinking, this is small. So we've set up a little corner booth with our box of... blood-drawing supplies, and they sort of came in waves. Uncles, cousins, nieces, nephews. And they brought their kids?

You filled that subway sandwich, huh? How many in all? About 30. It was funny because they hadn't seen each other in long times. They're like, oh my God, I've seen you in 10 years. It's like, wow, you guys only live like five miles apart. We'd bring them over to our little tiny booth, and we'd introduce ourselves. I'm Terry Brentall. I'm Mary Brunner.

I'm a GI doctor. I'm a surgical pathologist. The purpose of our work today is that we are trying to find the cancer gene that causes the disease in your family. With your permission today, we'd like to take a small blood sample. It's about the size of two tablespoons. You will not get any results back from this blood test. I want to be really clear about that.

It's all for us to try and find the gene. I can't even promise that we'll definitely find the gene. Here's your sandwich and now may have some blood. we were waiting for most of the family to show up. Terry and I were sitting in this one booth with one of the family members who we had already identified as having the disease. He was young. He was in his 30s. And all I could think was, you have a time bomb inside your body. And then this little boy comes running into the Subway Sandwich Shop, just like runs up to this guy that we're talking to, this patient. to family ex.

Rows his arms around his daddy's neck and kisses him. And all I could think was, oh, my God, this beautiful little child, he has 50% chance of having this hideous disease. And I was so upset about that. I was just so torn apart inside. But I couldn't really start bawling right there in their restaurant. That wouldn't have been professional. I held it together until we were driving home, and I was telling Terry how sad I was about that little boy and how it just really hit me.

And she said, oh, him? Don't worry about him. He's adopted. You have to remember, Mary doesn't come face to face with patients very often. It's not something a pathologist does very frequently. Pathologists have a, I don't even know if I want to tell you this, this is sort of like the black side of pathology. Black humor to get you through, or what do you mean? Yeah, really black humor. You know, we'll say things like,

somebody better tell this patient not to buy the big tube of toothpaste. Terry's laughing, but that's why we do it, because it's so horrible. I spent an afternoon with Mary going through slides, looking at pancreatic tissue, trying to figure out, like, you know, if this person has cancer or not, dozens of patients. Now this is another case with a terrible, terrible case. And that's when I really kind of got it, like why she'd want to keep herself distant.

Oh, this cancer is even worse than the last one. This person, if they can, should go to a beautiful place on place. planet earth and just stay there until it's over. What happened after Subway, though? I mean, were they able to, you know, figure out what's causing this thing? Well, once they got the blood, they worked on it for about five years. Five years. You know, they went chromosome by chromosome, collaborated with all these other researchers.

And at the end of the day, they discovered that the thing that causes familial pancreatic cancer comes down to a mistake, one little mistake, on one little mistake on one. One molecule. Molecule. That's all it comes down to. One tiny molecule, yes. So our discovery is, we're titling it, Paladin mutation causes familial pancreatic cancer,

and suggests a new cancer mechanism. So they write a paper, I have a press conference. First of all, I want to acknowledge it. And they celebrate it. A little, Bobby. Congratulations. Thank you. So in the end, do they find a cure?

Well, no, not yet. Not yet. They're working on it. Can they at least test for it? now? Well, they can test, but... What? You know, most pancreatic cancer isn't hereditary like this. This is actually a small subset. So where does that leave Mary and Terry? I mean, where are they now? Mary's really glad that the research phase is over and that she doesn't have to be with patients anymore.

Terry knows they have more work to do and they can't really give up but she's really tired and thinks about it a lot You know the stakes are so high in this Sometimes it's almost unbearable sometimes I think I should quit Really? Yeah totally I've talked to Mary about it But you know what I know she'll never stop doing it Right Terry? Sometimes it's just too much Mary and I love to garden

So sometimes you know we think about being landscape architects. Yeah. And then the worst thing that does is, oh, I killed the bush. And we're like, you lose her, you killed the bush. Thanks to Lou Elkowski for reporting that story. The next story concerns a dad and his little boy. There's something about this little boy that is not quite right,

but there's something about the dad that doesn't want to say so. That's coming up in about a minute. I'm Chad Abumrod. And I'm Robert Crowich. Radio Lab will continue. Radio Lab is funded in part. by the Alfred P. Sloan Foundation, the Corporation for Public Broadcasting

and the National Science Foundation. Hey, I'm Chadabumra. And I'm Robert Crowich. This is Radio Lab. This hour, our topic is diagnosis. This next story begins with a dad, two sons, and a question. What do you do when you notice somebody's different? I heard it from reporter Gregory Warner.

Hello. Hi. Gregory. I'm proud of Gregory Warner. Nice to meet. Nice to meet you. Okay, just so you know, it took me over a year. All right, you can sit down at me. to finally get an interview byron frowner yeah i can turn he's the dad in this story and i'm up in his

apartment in south bronc you'll have to excuse all this loose paperwork are you just are you moving out or are you moving it looks might look like that it was that messy i don't want to put this too around boxes everywhere craves piles of stuff okay let that go don't worry about are you sure yeah it's in it's in disarray there so who is this guy i uh i'm a retired alexi i'm a retired a electrical engineer. He worked for the subway most of his life. Now I consider myself a science researcher. And it's 71 years old. He's basically teaching himself... Phantom physics. That's where all the books and stuff you see around. I love that stuff. And he's written this book called Einstein's Era. Criticizing special relativity, Einstein. I sent it to the New York Academy of Sciences. Caltech, MIT, Harvard. Stephen Hawkins. Still waiting for him to get back.

Most people just ignore him. These are the ravings of a maniac. But then he points to this letter on the wall. Neil de Grastheson. I know that name. This major scientist. The head of the Hayden Planetarium in Manhattan. Exactly.

Yeah. And it says, How dare you? You're just an engineer. And he's beating. Why? Why do you smile when you talk about that letter from Neil de Gras Tyson?

Because I know how foolish it is. Einstein. They didn't even want to read his paper. He said, who is this guy upstart? He's just a patent examination clerk in Byron. Byron Furner is a man who's proud to go against the grain. What other people do, I don't really do. And that's especially true with how he raised his son.

So now, Gregory, you're going to do some kind of a story on Emmanuel? His youngest son, Emmanuel. And that's why I'm here to question him about how he raised his son. All right, I'd be glad to. Okay, great. So here's Emmanuel. Hi, I'm Emmanuel Frana. Amanda, could you take a drink of water for me?

Okay. Thank you. No, don't think me. Take as many drinks and water if you want. He's 28. So what things are you good at, Manuel? Writing essays and making sure they are grammatically correct, bowling. And as you can hear...

Analyzing stuff. There is something going on with him. Um, and, and, and not talking that much, I guess. Now, if you ask Dad, he'll say, Emmanuel's an excellent student, a future Nobelist. He's going to win a Nobel Prize. We never know. But, if you ask Blair.

I'm Blair frowner. Who's that? Emmanuel's half-brother. I'm about 20 years older than Emmanuel. He'll tell you that even as a little kid, like five years old. There was something odd, and I just didn't know what it was. It was. It was a bunch of little things.

Yeah. Like he'd look at you really weird. Kind of like a doll face expression. He could stare at me without blinking for 15 minutes at a time. And I would notice, because you didn't blink once. Then there was a speech. I did not talk as much as other people. There was something going on with the manual, but I did not have a word for it.

And so I pushed several times to get speech therapy. But every time he did, Dad would just say, Are you kidding? He may have trouble stumbling and stammering, but... He'll grow out of it. I stuttered to. Blair, you also stuttered. Einstein, he didn't speak a word till he was six. He was considered retarded in school. He would say that this was some temporary problem that would pass. I didn't see anything that was screaming out for attention. He was doing his work. He was interested in the Knicks. We would go out endlessly in cold weather to the park.

And it seemed like things were okay. What about Emmanuel? Well, I knew that I was a nicer person. A nicer person? Yeah. And that I was sensitive, and I don't automatically look at people in the eyes and face and stuff, you know? So as long as Emmanuel was a little kid, this wasn't such a big deal. But then he got older.

He was around 10 years old. And it was, I think, at the point where other people would point it out. What did they say? Well, I have been called retarded and idiot savant the N-word and stuff. They lost the innocence of the elementary school. Emmanuel would come home with bruises on his arms. Yeah. Yeah.

It was something that I constantly thought about and worried about. And I said, yeah, well, it would be really good for him to get professional help with that. If you ask Dad, he said the problem wasn't Emmanuel. No. It was all the other people. The bullies. The group. In this neighborhood, it was hard.

There was fighting, constant fighting, right down the street over here. People involved with crack. These are big guys, you know. I felt that it could have been a dangerous situation. So his solution... I decided that I wanted to teach Emmanuel homeschool. Was just to pull his side. out of school. Yeah. And how do you feel about this at the time? Well, I really didn't know.

Up here. So we're looking in the closet here. I thought that whatever way he has kind of turned in, this is a binder from one of his classes, that if he got bullied and tormented in going to school, that it would turn him further in. Let's see what this is. But that if he were here, he could develop along his own line until he became old enough that they wouldn't want to pick on him. Oh, look what we turned to. Nature, nurture. It was a big deal for Dad. You hadn't homeschooled anybody else before, right?

No, I had to get books. I had to go meet the principal. He left his job, submitted a curriculum to the school. And I had to register with the state of New York. Created this syllabus for his son. Grade 10, integrated math, course of life. And they would wake up each morning. Rational numbers, geometry.

Do their lessons. Aseously's triangle, equilateral, triangle. have some lunch. This is the work that he did at home. And in the afternoon, they'd go bowling. Bowling? Emanuel was an awesome bowling. His dad would videotape him. Today is Tuesday, December 28th.

28, 1993. Is it taping? It's weird footage, it's weird to watch because Emmanuel is such an incredibly good bowler. He took it out. But he's always by himself. tape after tape of nothing but Emmanuel. Nobody else in the picture. I would fan to size about

throwing on a tour and winning some titles and stuff. Did you think about joining any youth league or something like that? Well, I kind of, well, I vaguely thought about it, but for some reason my dad didn't I want me to I think you swung out I think so

meanwhile his brother is just Blair's in Canada At a distance Yeah he followed a girl there And one day he picks a book off the shelf The DSM And the DSM is The diagnosis statistical manual

Of mental disorders Okay And I started just to do I guess what a lot of people would do Who get a hold of this thing is to start diagnosing all of their friends. I diagnosed my girlfriend, I diagnosed my dad, and then I saw...

Right there on the page. Mark's impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze. Repetitive behavior patterns. Problems. Seeking new friends. Problems. Being able to understand what someone must be thinking.

Problems. I went down this whole list, and everything seemed to fit. Marked impairments in eye-to-eye gaze. Problem is, every time he tried to call his dad. Dad, what do you think? His dad would say, Just stop whiting.

Go away. He'll just go through this. And he shut him out. He basically cut communication. I know my son. He would always tell me that whenever I had would go away when I was an adult. What does an adult mean? Does that mean 18?

Um, 20, maybe 20, let's say. Okay. So you thought, as soon as I reached the age of 20, And I won't have these problems. Yeah. So did you wake up on your 20th birthday and think? I thought that maybe things would change right away. But they didn't.

After that, Emmanuel says he got really depressed. And that's how things might have stayed. Until Dad had a heart attack. Blair comes to the hospital, finds dad unconscious on the bed, and he realizes this is my big chance. Because he was not in a position to intervene. And you're thinking... I'm thinking the first thing that's going to happen

is that we're going to get a diagnosis because we've been waiting for it for so many years. 26 or older or whatever. I think I was like 25 maybe? He's going to get help. You know, he has to get help. New Year's Eve, 2005. So where are we coming into now?

We're at 42nd Street. Times Square. Time Square is one of Emmanuel's favorite areas to hang out, And I figured I wanted to be on his surf. So they're outside. The crowd is just beginning to arrive. They were starting to snow a little bit. And rain sometime.

Yeah. And Blair turns to a manual. And he says, Have you ever heard of autism? I said, I highly suspect that you have some form of autism. And I want us to find some way for you to get a diagnosis. Oh, and I said, Don't breathe the word of this to dad.

Four, three, two, one. Doctor, how do I pronounce your name? Avdokia, anagnost. And pretty soon after New Year's, and where are you from? I'm Greek. Emmanuel gets his diagnosis. He was right here on this couch.

I did get a feeling from the beginning of the interaction that he was going to meet criteria for autism. And a month later, She told me that I was on the autistic spectrum. It was official. Okay. Halfable. Even more, yeah.

Halfable. Great, good. And so at the age of 26, assemble. Finally. His life completely changed. So I gave him a tape recorder to record his life. Hello, with me, Emanuel.

He's meeting with a speech pathologist a couple of hours a week. Also, he's joined this program. Adaptations. And started making friends. What do I say? Oh, well, anything. Hello. Hey, Jason.

Peace out. He got a girlfriend. Hey, it's me, Emmanuel, once again. And there's one lady that I haven't talked about it, named Norma. And we went to Central Park, and we took pictures, and it was great. But wait a second. I thought the people who diagnosed with autism don't, The definition is they don't want to socialize.

Well, it's not because I don't want to, but it's just hard to do, you know? But here's the thing about Emmanuel. He's had this whole new life. He hasn't told Dad about any of it. But anything? Not the girl, the friends, the diagnosis. His dad doesn't know anything's different. So how long have you been keeping it a secret?

It's been since 2005, right? Yeah. So basically for the last two years, Emmanuel's been leading this double life. Outside, he's a person with autism. Then he comes home, nothing's wrong. Why? Well, I'm just afraid that any won't really believe it.

But he knows he's got to tell his dad who he really is. Yes, I do. And he keeps saying he will. I'm going to say within a month soon. I'm not quite sure. I am a little bit nervous about telling him about my assports. Maybe within a few minutes or so. Let me tell him in like two weeks or so.

Another day or so. I mind to tell him after I meet Blair. I'm going to probably tell him tomorrow. Maybe. I don't know yet. Maybe I'm just thinking about it a little bit too much. I don't know. And then finally.

One night. Hi, it's me. I just want to say that I told my dad. and about my diagnosis. I said, I really have something important to say and don't get angry. And then I told him that I was diagnosed with Asperger's syndrome. And he asked me what it was.

And then I told him it is high-functioning autism. I was shocked. That would be a good way to put it. So do you think he has Asperger's? Yes. Yes. I do. When I look at this syndrome, for a lot of good parts of it, it's Emmanuel.

But I never, in any point, felt that Emmanuel was in need of any deep psychological or psychiatric help. But, I mean, what makes you qualified to say that? Just being a loving parent. As I'm talking to him, we're sitting there on the couch in front of us on the coffee table, is all of Emmanuel's notebooks from H5 onward. And they're really good stuff. I mean, it's stuff that you and I would write. He saved it all.

But the question that I feel like I've got to ask. Baron, I just have one more question on my list, if I can ask you that one. Is now that you know that there is something wrong with your son, that there always was this disorder, that it's incurable, do you think you did the right thing? So do you wish that he had gotten the diagnosis earlier? No. Because I think that he's better off at this point in time.

Why wouldn't it make a difference to know earlier what's why you're acting so strangely? I didn't want Emmanuel to get a diagnosis that would put him in a box, like a label. And then Dad says to me, look, I mean, if I had let the school give him some kind of diagnosis, they would have thrown him in special ed. And say, oh, he's a retort. Look, he can't even talk. I mean, that would have destroyed him. irreparable damage. I asked the doctor, was there any truth to them? If Emanuel was put into special ed, hypothetically...

If he was in a district 75 class... The technical word for special ed? He would not have raised his academic potential. He is a graduate from St. John's with a degree in psychology. Kids who graduate district 75, don't do that. Just to put that in perspective, Emmanuel comes from a neighborhood where about 10% of the kids ever graduate college.

And my GPA was like 3.4 in change. Wow. And he's got Asperger's. So now we're kind of in the opposite. We're kind of vindicating really what his father did, right? Well, in terms of his academic achievement, his father did the right thing. The problem with his dad's choice, and he had no way of knowing at the time, was the lack of peer groups.

What he missed out on. It seems like a cruel choice, but... It's a cruel choice. So if you were your father... and you were raising your kid at that time, would you have made the same choice he did? Well, could... Well, if I had known what I known now,

then maybe I would have maybe begged him a little more. For me, to interact with others who were like I am, who are like I am. That story from our correspondent, Gregory Warner, Cricks reporting was made possible in part by the Rosalind Carter Fellowship for Mental Health Journalism, thanks to them. And thank you to Lulu Miller for producing that piece. We will continue in a moment. This is Bonnie calling from Boston, Massachusetts.

Radio Lab is supported in part by the National Science Foundation and by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at www.sloan.org. Hello, I'm Chad I boomrod. And I'm Robert Krollwitch. This is Radio Lab. This hour we're talking about diagnosis. Diagnosis, the easy kind, we're not going to talk about it.

Easy would be you come into my office and I'm a doctor. You have a broken arm. I take a picture. I say, hey, you've got a broken arm. The picture says so. Yeah, because you can see the break right there. But let's suppose you came into my office and you were sad. You tell me that your sex drive is down.

Hey. I'm the doctor, so it's just between you and me. All right. Well, right away, my learning tells me that, you may be a candidate for depression, but how do I know that you're depressed? What do you mean, how do we know? We talk about it. You just said. Well, you can't measure sadness or depression. You can't go to a test tube and count anything. Right. It's not hard science. Yeah, because... Until now. What if I put you in one of those FMRI machines that we've talked about so

often? Yes. I snap a picture of your brain in action and I look at it. And, From your picture, I say, you are depressed. You're going to tell me I'm depressed just from looking at a picture of my brain? Yes. What? No way. Look, it's now here. Photographic diagnosis of mental illness.

This is happening. There is no question. And that, by the way, is Eric Candell, a professor of a Columbia University, who just happens to have won the Nobel Prize for Medicine. Let me give you a little historical background. Did you get a Nobel? I don't think you did. I still don't believe you. What, just because he's got a Nobel Prize, I'm going to suddenly turn around.

No, no, no, you're not. So let's do this step by step, okay? Step one. Imagine you're slipping into an fMRI machine, okay? Now, I want you to just look at my face. Why? Is that so difficult? Yeah, I just want to know where this is going.

Anyway, okay, I'm looking at your face. So now that you're looking at my face, different regions of the brain, they become active. There are cells in your brain that are saying, I know him. The cells are more active. They need energy, just like when you run, you have to breathe fast. And to get the energy? Your heart pumps, more blood.

The body sends a rush of fresh blood to that particular group of cells. And because the blood has iron in it, the magnet in the brain scanner can see the iron and therefore see the blood flow and take pictures of it, many, many pictures in real time. I'll show you a very nice example of this. Eric's now heading off across his ample. office with an extraordinary view of the Hudson Valley. And he brought over a picture of a human brain with different colors in different areas.

And he told me, when you look at a face. When you image the face, this area lights up. You're pointing an area of the brain. An area of the brain. Up on your forehead, kind of a hot area. That's right. That's right. If you look at a house, some other area lights up. But this area does not light up.

You look at another face, this area lights up again. Every time you see a face, the same area? Yep. Hmm. But you haven't told me anything about emotions yet. That's true. So let's move on to step two. Because we use faces to tell what someone else is thinking or someone else's feeling, looking at faces also triggers an area deep in the brain that is concerned with emotion.

Called the amygdala. Now, very recently... A number of people have looked at the amygdala looking at faces, and it's extremely interesting. Step three. Okay. I'm going to take you now to London. Hello? Hi.

Yeah, hi. Yeah, that's good. Hey, who's this? Oh, very sorry. Who are you? I'm Cynthia Fu. I'm a psychiatrist at the Institute of Psychiatry, King's College, London.

And are you like in your 30s or your 40s or your 50s? Is this part of the interview? Rood. No, I wanted to establish that she came into psychiatry. I'm trying to think. When did I graduate medical school? At a very critical time. I finished my training in 97, my training in psychiatry in 97.

That's 1997 when the fMRI machines were first becoming available. and so Cynthia was able to do a rather amazing study. What? In this study, she got together a group of people who were clinically depressed. Depressed people. And then another group of people who were normal. Healthy people. And she put them in the brain scan machine and showed them.

Facial expressions. Faces. Ranging from more neutral expressions to more sad expressions. So they saw a sad face and then a neutral face and then a sad face. That's right. And what the person in the machine was supposed to do is... To look at these faces and decide whether it was a man or a woman's face. What does that have to do anything?

Because while they were doing that... While they're making this decision, the emotion of the face is being processed automatically. The amygdala sees the emotion on the faces at that moment. And the machine... It's like, tick, tick, tick, tick. And there were hundreds of pictures. 10th of a second to 10th of a second to 10th of a second. That's right. Did you see a difference between the people who were depressed and the people who were...

Normal? Yes. Was it a significant difference or a just barely difference? As a group, it was a significant difference. And now she takes the big step. Step four. From the pattern she sees in bunches of people, she feeds all those patterns into a computer. It's called machine learning. She told the program, this is a pattern of brain activity in depressed people.

This is a pattern of brain activity in healthy people. And then... She shows the computer a brain scan of a new person. So this is someone the computers never met before? Exactly. And she did this a bunch of time. Right, a whole bunch of people. And each time the computer tries to guess, is this new person?

Depressed or not. Oh, and what happened? More than 85% of the time, 86% of the time, the algorithm correctly diagnosed whether that person was depressed or healthy. With just a brain scan, a computer, and a patient, no doctor needed. Cynthia's computer got the diagnosis right 86% of the time, a computer. When we saw the results, it was like, wow, this is amazing. Wait a second.

Has she repeated this? Well, this is actually the very first time that this has been done with depression, and so it's just a pilot study, and like you say, someone else will have to do it again and then again and again. But according to Cynthia... The potential is fantastic. Psychiatry is going to be absolutely revolutionized by this. I think this method can be applied to any psychiatric disorder. Any?

Autism, schizophrenia. Obsessive-compulsive disorder. No way. Come on. Why not? Every one of these illnesses ultimately must have an anatomical basis. Every one of these illnesses. So this means that it will soon or one day be possible for a patient to come in and you take a picture of him in real time or of her and you will have a diagnostic tool.

That's what you're saying. Absolutely. Absolutely. You mean to tell me a... to tell me that they're going to put people in machines and just go boop. No, no, wait, wait, wait, to make things clear. This is not a casual thing. You go to the doctor.

You tell the doctor that you're feeling a certain way. The doctor will talk to you. And then he would come to and say, well, my learning and the test tells me that you're ill. So that's all that's happening here is now the mental doctor will say, I have a test. There's nothing in this that feels invasive to you. Well, obviously. It's tunneling into the deep depths of your problem. personhood. No, this is, if you believe that mental illness is a mental illness, it is a structural

condition which can be fixed. So it's not the deep inner you, it's the broken you. So it's like the broken arm thing you started off with. So you would put the two side by side? I think I would. And then, of course, you get to the next. No, come on, Robert. I mean, human beings are way too messy for that. You're too messy for it to be that easy. No, no way. So you think this is out of science's reach, really? It's just too... There's a part of me that does think it is out of science. I think it's because you think that they're looking deep inside you. That's what you don't like.

I do. I mean, don't get me wrong. I find brain scans fascinating when it comes to questions like, where is the soul? What is consciousness? That kind of stuff. But don't kind of get in my head and tell me what's right and what's wrong? What if you're feeling sad and sick? Don't you want to get better?

Yes. But I enjoy the comfortable ambiguity that would come from a situation like sitting in a therapist I was obviously saying, well, how am I feeling? I'm feeling this way or that way. And in the messiness of trying to describe how you're feeling, there's a vast landscape of things that can happen, choices you can make, therapies you can pursue. Let me just do it this way. Let's say you are sick and you know that you're sick, machine or no, okay?

If you are feeling badly, wouldn't it be nice if a machine could help you find the right kind of help? What do you mean? Well, Eric took me through a little thought experiment. A mind experiment. You've developed a psychotherapy, and I've developed a psychotherapy. We each claim it's the best in the world. Now we have an objective way of seeing. The machine allows you to independently of any evaluation see the outcome of treatment.

So you can audit the doctor. Audit the doctor and give you evidence that it's working or no. Okay. I think I'm a little bit on board. I can give you 10% buy-in now. Okay. So how far off is this stuff? Is it going to come soon?

This is very early in the game, obviously. I get asking, like, how far into the future are we talking about here? Soon or long after you're dead? I'm going to be around a long time. But the question stands. Will you make it to see that people actually have a... You know, one can't, in medicine, in all honesty, give a timeline for many of these things.

Imaging methodology right now is quite sophisticated, but it's still primitive compared where it needs to be. You're picking this up in status and ascendee. You've become excited as the thing is beginning to emerge. We see it for the first time on the horizon. You're saying we got to the story too early. That's what you're saying. Just right.

It's not going to be interesting 20 years from that. It'll be obvious. Or in 20 years, it'll be obvious that we were wrong. Okay? That's a real possibility because what we don't know is vast. And I want to tell you a story now about just how wrong people can be. It begins with a mystery. Sudden infant death syndrome.

Perfectly healthy child goes to sleep and dies during the night. It's about the worst thing that can happen to a parent. And each year, it does happen about 7,000 times. Still no one knows why. Oh, and by the way, that was Robert Spolski. He's a professor of neuroscience at Stanford University. And Spolsky tells this story of the moment SIDS was diagnosed for the first time, or at least classified. And a terrible mistake that was made.

Around 1900 or so, people were beginning to recognize this as a disease entity, and nobody knew what was up, so people decided, let's go dissect SIDS kids. Meaning when a baby would die, they would perform an autopsy. Exactly. You know, check the baby's insides. See if there's anything different in them from normal kids. That seems logical. Absolutely.

They'd measure the size of the baby's lungs. Yep. Not like normal. They'd measure the size of the heart. Nothing strange there. Stomach, kidney, liver. Yep. Those are all fine.

Then they would look in the throat. They look in there and they say, oh my God, these SIDS kids, they have enormous thymus glands. The thymus. The thymus. What is the thymus? Yeah, what is the thymus? You may wonder. Well, it is a little tiny pink gland that is right here behind your collarbone at the base of your throat.

And its job is to help you fight disease. It makes one type of cell critical to your immune system. Especially in times of stress. Hmm. Any case, normally this little organ is about the size of a tiny tube of toothpaste, like the tribal kind. But in these sit-skids, it was huge, enormous. Twice the size. Exactly.

And since the thymus is dangerously close to the windpipe, doctors came up with a hypothesis. A perfectly reasonable hypothesis. Which was that maybe if you're one of these babies with an enlarged thymus and you're asleep and somehow you roll over wrong? Uh-huh. Well, that gland might press down on your trachea and suffocate you during the night. Oh. So, ding-ding-ding. Medical mystery solved.

Really? No. They even came up with a name for it. It was called Stathymical lymphaticus. Stats pharmacolomachycin. It was in all the pediatric textbooks by the 1920s, and you would love. look in there and there'd be pictures, there would be pictures of the dissected thymuses. Normal size and here on the right.

Enlarged. Abnormally large status thymical lymphatics. And in no time at all, doctors came up with a treatment. A perfectly logical therapy. Which is that if we're going to help these babies, we've got to shrink their thymus glands. And to do that, the best solution, obviously, is to irradiate their throats. Irradiate their throats to shrink their thymus. Clasped the child's throat with trillions of radioactive particles.

Really? You, literally? You betcha. And this was considered like something every good loving parent should do? Absolutely. If you worry about your child being at risk for SIDS, go and get their throats irradiated to shrink the thymus glands. And did it work? Yes, it shrank the thymus glands. But he says it did have another effect.

Decades later, you've killed 20 to 30,000 people. with thyroid cancer. 20, 30,000 death. That's a real number. Yeah, that's a fairly big one. So here's my question. How could these doctors have gotten it so, so, so, so, so wrong?

Do you know what I mean? I do. Don't you know what you mean? You just answered your own question a minute ago. No, no, I didn't. I'm about to answer it right now. They're playing with radiation, you just said that. But what they didn't know that radiation

would hurt you. They had no, it was a brand new technology. Yeah, but that's not what I was going to do. Oh. This was, you know, a couple of decades into radiation having been discovered. Isotopes are performing near miracles of diagnosis and discovery. People were just tossing around radiation all over the place. Iodine 131. Radioactive sodium. Radar. Gamma rays neutrons. And this was a period with Madam Curie, like dipping her arm into vats of uranium. Radioactivity is harmless.

and dying soon afterward from cancer, people would go into shoe stores and they would have their feet x-ray. Yes, X-ray is a wonderful invention. I had that. You had that. I did, yeah. Take off your shoes and then you can look at your bones.

That's exactly what they would do. Why would you do that? That was the thing you could do at the shoe store. It was very cool. Yeah, showing how cutting edge of a shoe store they are. So that's your explanation. No, that may look like the explanation. I mean, sure, radiation played a role, but if you would have let me say what I was going to say, I would have told you the real explanation.

Yes. Preceded the radiation by like a couple hundred years. Whoa, I have no idea what you're talking. I'm going to tell you. Back in the 1700s, okay? Oh, that far back. That far back. Before radiation, before your grandpa.

Well, before the Civil War or the Eiffel Tower or Napoleon. I'm talking when the red coats. We're still wearing red. Yeah. Yeah. This was shortly after the Revolutionary War. Right about this time, says Sibolsky, the first med schools started to pop up in America, and a supply and demand issue came into effect, because with these med schools came med students.

Medical students. Who needed to learn about anatomy, and of course, in order to do that, they needed bodies. You know, to dissect. This produced this whole occupation. You could be a resurrectionist. A resurrectionist. Yep. And they would go out and dig up bodies.

at night. And sell them to the anatomist as the medical school. I'll need two more by Thursday. Dig. Dig. Now here's the key point. Since demand was so high, the resurrectionists had to go

where the bodies were easiest to get. Which meant, you know, avoiding the fancy graveyards. If you were wealthy, you could have yourself very, in what was called a patent coffin, which was a triple-layer coffin, which was meant to be Resurrectionist proof.

But if you were not wealthy, no fancy coffin for you, you'd probably just be buried in a sack in some Popper's field, just a few inches under the soil, very accessible for these resurrectionists. Not surprisingly, that's where they went. Are we still on the same topic?

Are you explaining why children died? Yes, yes, bear with me. All right. What I'm trying to make is that the grave robbers targeted the poor. So much so. It's sometimes when people would catch these resurrectionists in the act and see like, oh my God, that's my dad you're digging up. There'd be riots.

Get them! Stop stealing our bodies! Troops were called out and rioters were shot. Are we talking like hundreds of people, torch-bearing? Yeah, it was townies versus the people who were trying to dissecting. their dead relatives. Okay, okay, okay. This is a lot of history, and I'm very fascinated, in quotes.

What does this have to do with kids dying of thought? All right, let me bring it home. Not that it hasn't been interesting, but bring it home. Okay, as a result of all of this hubbub over grave robbing, country after country throughout Europe decided, well, it's standardized how science gets its cadavers. Forget all this grave robbing. So they passed laws.

Which formalized anyone who died in a poor house, their body would be turned over to the anatomists. This was like the cadaver version of direct deposit. Okay, so grave robbing was gone, but now all the bodies used by medicine, not just some, but nearly all, now came from the poor. Estimates were by the end of that century, 99% of the bodies used for anatomy lessons had been derived from poor houses. And that seemed okay until.

1936, a guy named Hans Selier showed that being poor actually warps your body. And now, Robert, now we come back to the case of the mysteriously enlarged thymus. Because if you're poor, you're worried about your job. You're worried about feeding your family.

You're worried about the bills. In other words, you are stressed out. And during chronic stress, your immune system goes down the tubes. And since the thymus is part of the immune system, if you are chronically stressed, the thymus gland shrinks.

Wow. For 150 years. Doctors had been dissecting cadavers, pointing at organs, which they thought were normal, but which were in fact shrunken from a life of poverty and stress, and saying, that's normal. So that when these SIDS babies show up with these gigantic thymuses, oh my God! In fact, that was the first time they'd ever seen a normal one. People had no idea what was normal and what was abnormal, and they got it backwards.

Killing about 30,000 people in the process. Now, the scary thing, says Sipolsky, is that these doctors were not dumb. No, these were the best, most careful researchers at the time, and this were the only logical conclusions that could have been made. And nonetheless, it produced an utter disaster. There's, you know, not the slightest reason to think. We're not doing the same thing right now.

Robert Spolski is a professor of neuroscience at Stanford University. He's the author of many great books, including Monkey Love, The Trouble with Testosterone. For more information on him or anything that you heard in the story, hour. Visit our website RadioLab.org. And you can send us an email while you're there.

RadioLab at WNYC.org is actually. That is the address. Remember that. Yep. I'm Chad Abumrod. I'm Robert Quilwitch. Thanks for listening. Message 10 new from an external number.

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