Science Friday - Improving Care For Disabled Patients, Transistor Anniversary, Whale Strikes. December 16, 2022, Part 2

Episode Date: December 16, 2022

Medicine Is Failing Disabled Patients. Meet The Doctors Pushing For Change “More than sixty-one million Americans have disabilities, and increasing evidence documents that they experience health care disparities.” That’s the conclusion of a series of studies, in which researchers pulled back the curtain on how doctors perceive disabled patients. A study from last year found that more than half of surveyed physicians do not feel fully confident that they can provide disabled and non-disabled patients the same level of care. And in another paper, some doctors went as far to say that if you have a disability then “I am not the doctor for you.” So how do we change that? Ira talks with two researchers, who are disabled themselves, about how the medical field needs to better serve the disabled community. He hears from Dr. Lisa Iezzoni, an author on those studies and a professor of medicine at Harvard Medical School, who is based at the Health Policy Research Center at Massachusetts General Hospital in Boston. Also joining Science Friday is Dr. Feranmi Okanlami, a physician and assistant professor at the University of Michigan Medical School, based in Ann Arbor, Michigan. To Stop Whale Strikes, Ships Were Asked to Slow Down. It Worked. The Santa Barbara Channel is like an underwater national park with marine mammals, seabirds, fish and even shipwrecks. Ocean currents from the north and south meet and mix here to create an ideal feeding grounds for marine life. “Just the other day I was flying over the channel and we counted over 40 humpback whales in a rather small region feeding on fish,” said Sean Hastings, the Policy Management and Information Officer for the Channel Islands Marine Sanctuary—part of the National Oceanic and Atmospheric Administration or NOAA. We met at the Santa Barbara Maritime Museum, close to his office, and sat in the museum’s library which is filled with books that are different shades of blues and greens—the colors you’d expect books about the ocean to be. Hastings continues his story about a recent flight over the channel spotting all those whales. To read the rest, visit sciencefriday.com.   How The Transistor Transformed The World 75 years ago this month, research scientists working at Bell Labs first created, then unveiled to the world a new device—the point contact transistor. Some call it the greatest invention of the 20th century. That first transistor was a clunky looking thing, with two gold contacts on a plastic wedge pressed against a crystal of germanium. But that early device had a magical property: A voltage in one part of the device could control the flow of electrons in another part of the transistor. It could be a switch, or an amplifier. That device and the ones that followed and improved on it would become an essential part of modern life. From the first transistor radios to modern computers, hearing aids, and more, transistors are everywhere, in great numbers. An ordinary cell phone today likely has billions of transistors in it. In fact, the transistor has become so ubiquitous that one estimate puts the number of transistors on the planet as about three million per square foot. The three researchers credited with the invention of the transistor, William Shockley, John Bardeen, and Walter Brattain, went on to share the Nobel Prize in Physics—but they saw limited financial gain from their creation, and had a rocky personal relationship. Michael Riordan, a physicist, science historian, and coauthor of “Crystal Fire: The Invention of the Transistor and the Birth of the Information Age,” joins Ira to look back on the invention, the scientists who got credit for the device, and where transistor technology has gone since 1947. Transcripts for each segment will be available the week after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm Ira Flito. And now it's time to check in on the state of science. This is KERNO. St. Louis Public Radio News. Iowa Public Radio News. Local science stories of national significance. Off the coast of California, there's an incredibly vibrant and diverse ocean ecosystem. Wales call this area home, but the real estate does have some downside. Other big things that frequent this area, ships, transporting supplies, to large coastal. ports. And sometimes these whales and ships meet with deadly consequences for the whales. So how can these ocean-dwelling mammals be protected while still making sure ships can deliver their goods?

It turns out the answer may be as simple as just slowing down. Mm. Joining me to talk about this is Michelle Loxton, podcast host and producer for KCLU. She's based in Thousand Oaks. She reports this story for KCLU's podcast, The 101. Welcome back to Science Friday. Thanks, Ira. What does the ocean look like around that area? Okay, so the Santa Barbara Channel is a piece of water that divides the California coast from the Channel Islands. And the main word I would use to describe this area is strategic. And that's because, as you mentioned already, the channel is one of the most vibrant ocean environments in terms of marine life diversity. The Santa Barbara Channel is also a corridor that leads to three very important southern California ports, Long Beach, Los Angeles, and

Wynimi. These ports account for over 40% of all imports to the United States. So the ships are maybe banging into the whales. Which whales call this area home? So there's a lot of different whales that you'll find that they'll be migrating through or coming to feed or breed. There's fin whales. There's also humpback whales that gather to feed on the swarms of krill. For this story, I went up on a survey plane on a whale counting mission, and we spotted two gray whales that were migrating side by side. They looked like two speedboats racing along with the straight line of white water behind them. But you'll also find the world's largest animal, the blue whale. Scientists who study these whales along the west coast have described the blue whale population here as one of the largest and most thriving anywhere in the world.

So basically you've got a lot of blubber out there. I'm glad you said. What is the history of the whale strikes in the area? So it was really with the creation of faster and larger ships about 20 years ago that scientists started seeing these fatal ship strikes. What they started seeing was sometimes a whale would wash ashore after a strike or ships would find a dead whale wrapped around the bow. The National Oceanic and Atmospheric Administration, or NOAA, who was tracking the amount of whales killed by ships along the California coast, they recorded between one and three fatal strikes a year.

But they believe that that was really just the tip of the iceberg. They estimated the true number to be 10 times higher. Why? Well, whales are negatively buoyant, meaning when they die, they float to the bottom of the ocean out of sight. But it's important to add here that the ships aren't trying to hit these whales. They have to stick to these shipping lanes in the channel like highways. And this is often where the whales are. Boy, that is really tragic.

Your podcast dives deeply into an incentive program to help stop the whale strikes. And it sounds like they came up with a very simple solution. Yes, it's called the Protecting Blue Whales and Blue Sky's incentive program. And basically Noah and their partners came up with this idea to incentivize ships to do one single thing, slow down. They said, okay, if you slow down to 10 knots in the Santa Barbara Channel, it's about 12 miles an hour, between the months of May and November, when the whales are most present, we'll reward you with some nice positive PR in the press and we'll give you money, depending on how much you slow down. 18 global shipping lines signed up representing 90% of the container traffic coming over from Asia, and the program has been running for almost a decade. Successful, has it been?

Well, this is the crux of the whole program. When you slow down a ship, what that means is that when a ship comes into a contact with whale, it's a bump and not a kill. It's not necessarily fatal. The program puts together reports, and for 2021, it said all that slowing down, meant a 50% reduction in fatal whale strikes. And I understand there's been another positive benefit, and that's on pollution. Yes.

So marine shipping causes a lot of air pollution in our region. In Ventura County, for example, where I live, ocean-going vessels contribute about 40% of the total NOx emissions in the county. That's nitrogen oxides, a principal component of smog. So what happens is when you slow down ships, they burn less fuel, That means less air pollution. The program estimates since the inception thousands of tons of smog causing emissions and tens of thousands of greenhouse gas emissions have been avoided. To paint a picture of what this means for communities, I'm bringing in Giles Petafore now.

He's the environmental manager at the Port of Wainimi. The port is one of the partners in the incentive program, along with local air pollution control districts. And besides getting ships to burn less fuel on their way to the port, ports. They're also working on getting them to plug into shore power rather than burning their engines the whole time they're sitting there in the port. Here's what those improvements have meant for local residents. We've talked to folks in the community here that have lived next to the port for decades. And they would talk about back in the day before our shore power system, which allowed those ships to plug in and shut off those diesel engines, they would

say come out of their apartment in the morning and they would have to hose off their patio furniture or they would have to wipe off the windshield of their car in the mornings because of that accumulation of soot particles from the ambient air around the port. And how now that no longer is the case. Yeah, that's terrific. What have the shipping companies been saying? I spoke to two of the biggest global shipping companies for the podcast episode, Mursk and Hapagloid.

In 2021, those two companies slowed down in the Santa Barbara Channel about 85% of the time. They say slowing down is now part of their ship's GPS and they do it when it's safe and feasible. Remember, they have these tight schedules and time slots at the ports to keep on top of. And depending on how much they slowed down, shipping companies were rewarded between $5,000 and $50,000 per company. But here's the interesting part. A lot of the shipping companies will donate the money back into the program. Mersk has done this for the last two years. For hapegloid, they gave their incentive money to the seafarers mission, who they said were instrumental in helping their seafarers with amenities during the pandemic.

So they're happy to be part of the program. But it really is part of their larger environmental goals. Both these companies have zero emissions goals, and they're also hearing it from their customers as well who want to make their supply chains even greener. Here's Lee Kenberg, the head of environment and sustainability at Merck, North America. About two-thirds of our top 200 customers have set zero-carbon goals. So delivering to them an environmentally safe product where they have actually the data to show that they're doing the right thing is very important to companies like the

Amazon's, the Nike's. Yeah. And if the companies like this incentive program, why not just make it a requirement? Ah, regulations. If this program is helping whales, it's improving air quality, and most of the shipping companies are literally on board, it makes sense to ask, why not just make it mandatory?

Well, it's not like this is a foreign idea in the U.S. Regulations already exist on the East Coast. Well, despite being considered at the federal and state levels before, the answers I got for those who make regulations for protecting whales is that because overall whale populations are recovering individual whale strikes seem to be less concerning to regulators now. It just seems that incentives rather than regulations continue to be the preference. And I put this idea of regulations to the shipping companies. And for them, it's all about fairness.

Basically, they said if mandatory slowdowns are implemented, they want all stakeholders involved, but here's the key thing, they want it to be enforced. They don't want to be disadvantaged because they're following the rules and others aren't. And this is a good reminder because this is a voluntary program and not everyone is taking part. When I flew over the channel, I saw this ship that was going very, very fast, almost like it was trying to overtake the ship ahead of it. The current compliance for slowing down among ships traveling through the channel is 60%. Well, yeah, that's not everybody, and people are not living up to the voluntary part of it.

Is the voluntary part going to end soon? And can we see the return to speeding through the channel again? Well, here's the interesting part is, sadly, after almost a decade of the Blue Whales and Blue Skies program, they don't have funding for the incentive part of the program for next year. But they are remaining optimistic, and they told me that they're planning on running the program again next year and hoping that the shipping companies who do get incentive awards will decline the money. They say at some future point they may have to or want to move away from financial incentives, but they're always going to need money for the running of this type of program, you know, for data and PR and things like that.

Yeah. You know, it strikes me that we all depend on the shipping to get our stuff delivered, right? So shipping happens because consumers need an item, whether that's individuals or companies. So I'm thinking, is there a way to know if your package comes from a ship that's slowing down or speeding up? And could you let them know that that's what you want? There actually is, Ira. Earlier this year, the people behind the incentive program launched a brand ambassador initiative where brands who are interested in making their supply chain greeno receive data on if their shipping companies are actually, slowing down. The whole idea of this program is this information can be passed onto consumers.

And they can add it to, you know, their sustainability pages and things that we often see on websites. And you're seeing a few companies start to join up. But overall, it's this idea of the power of personal responsibility. A lot of people listening to Science Friday today care enough to say, how can I make a difference? And the idea is if we insist on having whale, and air-safe products next time we shop online, then companies along the entire supply chain will be pressured into delivering. And that means finding a solution to a massive air polluter in my region and really what some believe is the last threat to endangered whale species.

Well, we're all rooting for the whales. We're rooting for less pollution in your area, Michelle. Thank you for taking time to be with us today. Thank you, Ira. Michelle Lockstone, podcast host and producer for KCLL. NPR for the California coast based in Thousand Oaks, California. She reports the story for KCLU's podcast, The 101. We're going to take a break and when we come back,

how ableism affects the kind of medical care disabled patients receive and what two doctors are doing about it. Hey, IRA here with an exciting message. Science Friday currently has a dollar-for-dollar donation match and effect, which means that any donation you make through disqualification, December 31st will be doubled. Yes. Now is the time to head over to ScienceFriday.com slash support and make a gift. Our 2023 programming depends on the generosity of our fans and our listeners. Again, that's Science Friday.com slash support. And thanks. This is Science Friday.

I'm Ira Flato. More than 61 million Americans have disabilities. And increasing evidence documents that they experience health care disparities. That's the conclusion of a series of studies in which researchers pulled back the curtain on how doctors perceived disabled patients. Now, one study reported that more than half of surveyed doctors do not feel fully confident

that they can provide disabled and non-disabled patients the same level of care. And in another study, some doctors went as far as to say that if you've got a disability, quote, I'm not the doctor for, for you. But my next two guests are committed to changing that. Dr. Lisa Iazone is an author on

those studies and a professor of medicine at Harvard Med School based at the Health Policy Research Center at Mass General in Boston, as well as Dr. Faramio Kinlami, who also goes by Dr. O, physician and assistant professor at the University of Michigan Medical School based in Ann Arbor. Both of you, welcome to Science Friday. Thank you for having us. Indeed. Thank you, Dr. Iazone, let's start with you. Why did you start studying physicians? I had been doing work on health care disparities for people with disabilities for about 25 years. I have interviewed over that time probably about 300 people with different disabilities, and I'd heard for them repeatedly, you know, my doctor doesn't really know much about my disability,

or my doctor makes erroneous assumptions about me, or my doctor doesn't. accommodate me when I come to visit them. So I finally decided it was time to talk to doctors. And so back in 2018, I was privileged to moderate three focus groups of 22 physicians from around the country that we did specifically to inform development of the survey that we administered a couple of years later. And so tell us, what did the participants tell you? Well, I have learned over time, to keep my facial expression extremely neutral. They said things like they thought people with disabilities were too entitled, that they had bad attitudes, that they asked for too much.

They also indicated that their practices were often not equipped to care for people with disabilities, that it took too much time to care for people with disabilities. Oftentimes they found it just easier to talk to the quote-unquote companion of the person with a disability rather than talk directly to the person with a disability. And then finally, some of the physicians actually said that they figured out ways to disenroll people with disabilities from their practice or not to enroll them at all to begin with. Wow. Do you think they would not have been as frank about telling you these things if they realize that you are also a wheelchair user? That fact was hidden from them. Not so much intentionally.

It's just that that is the case when you sit in front of a video screen. And I did not reveal to the participants that I myself have a disability. And Dr. O, what was your reaction to these studies? Unfortunately, I have not surprised because as a wheelchair user as well, I actually have been in a position where people have told me to my face that with all due respect, Dr. O, you know, I know you have a son and I'm sure you'd want a physician that was the best physician possible. And the phrase that someone used was, I have a hard time seeing how someone who can barely take care of themselves will be able to take care of my patient or my son.

And that's why I'm so happy and fortunate for the work that Dr. Iazone and colleagues have done because it's now demonstrating what many of us have been experiencing sort of in real life and bringing it to sort of the academic world to then show that this is a real thing that we're not making up. How do you react to that when somebody says something like that? I think it all depends on the mood I'm in that day. Some days I have a little bit more grace and I recognize that it's likely coming from a position of fear that the individual is in concern in that way. But other times, I take it a bit more personally and an attempt to demonstrate to this person that disability does not mean inability. And the assumptions that they make that just because someone cannot do something

like walk or see or hear does not mean that they're not going to be able to be the most excellent physician that takes care of them. And that's part of the stigma that exists. And that's part of the stigma that that we're trying to dismantle is that people believe that disability by definition means that someone cannot do one or many or any things, and that's quite unfortunate. Dr. Izzani, part of the problem is physical accessibility, right? Like having ramps and scales big enough for wheelchairs. What did the doctor say to you about that? Our survey was a nationwide survey.

And we found that only 22% of physicians usually are always used wheelchair accessible weight scale. for their patients who are wheelchair users. Instead, they typically ask the wheelchair user their weight. There actually is research that shows that people who are wheelchair users tend to underestimate their weight, and especially if weight is necessary for monitoring chronic conditions or doing something like setting a chemotherapy amount. This is really critical information to have accurately assessed. And only about 40% of doctors used a,

adjustable exam tables, that is exam tables that automatically lower to be able to facilitate a transfer for somebody with a disability. In fact, only about a third of primary care doctors have height adjustable exam tables. And oftentimes, if they have somebody who they do not feel that they're going to transfer them onto an exam table, they simply examine them in the wheelchair. And obviously, let me just suggest to you that doing a PAP test in a wheelchair isn't actually possible. So one of the things that I've found for many, many years, again, of interviewing patients was that especially as your mobility, disability increases, your likelihood of getting the PAP test, for example, decreases. You know, I can imagine if someone tries to visit an office and they can't get the services that they expect, it's got a bit of. be pretty discouraging. Yes. Well, it's not just discouraging. It's bad quality of care, and it leads to

risk of disease not being diagnosed until later stages, which could put people's lives at risk. Dr. O, so the physical barriers, they can be changed pretty easily, I imagine, but something is much more deeply rooted in how physicians see disability as something to be cured, right? Right. Right. And this is that it's a difficult balance to then achieve, actually, because as any budding medical student thinks, you know, disability is pathology, is the way that the medical model of disability describes this. And so most people would think that I'm supposed to go into medicine to cure the world of illness, to then make sure that we eradicate these things that we see as sort of a scourge on society. But the social model of disability is one that then acknowledges that this is disability

as an identity or as culture. And that needs to acknowledge that it's oftentimes the environment in which we are in that creates the disabling environment. And the individual should not be seen as broken or wrong or bad in needing to be fixed, but looking at what is it that puts a barrier in their way that makes it such that they lack access to be able to demonstrate their ability to achieve success. Dr. Aizoni, that surely affects how a person is treated. Absolutely.

And one of the kind of most troubling findings from our survey for me was that 82% of physicians feel that people with significant disability have worse quality of life than other people. And we were getting these findings back from our survey scientists just as the COVID pandemic was really hitting a peak. back when there was concern about ventilator scarcity, back when there was concern about ICU bed scarcity. And frankly, the disability community was terrified that they were going to be denied services if they got COVID because doctors felt that they had worse quality of life than other people do. And in fact, there were crisis standards of care around the country that indicated specifically that people with certain types of disabilities. should go to the back of the line if there was a shortage of medical facilities. I imagine that those same issues that keep patients from getting care also keep disabled physicians from doing their job. Oh, absolutely. So as a wheelchair user myself, if I'm going to be

seeing patients with or without disabilities, I also need physical access myself. Not only do we pathologize disability, but because we pathologize disability, but because we pathologize disabilities, we create this notion that physicians cannot be disabled themselves, and therefore we lack accessibility from the clinician side even more. So I think it just goes back to the way that our society views disability such that we don't expect much of individuals with disabilities, and therefore we have not created spaces with or for disabled people in mind, and medicine is probably one of the most guilty sort of professions in that way. And having a high adjustable exam tables, some doctors are taller than other doctors.

And it allows the doctor to set the table at an ergonomically comfortable level for them to do the best physical exam. But it also reduces the risk of practice assistance from injuries while helping to transfer patients. We know from the Occupational Safety and Health Administration that practice assistants have one of the highest rate of workplace injuries. And not having accessible equipment really makes the likelihood of getting those kind of injuries. even higher. You know, Dr. Iazani, I read in your studies that some physicians will go as far as trying to get disabled patients to leave their practice. Oh, yes. Well, that's from the focus groups. Yeah. They figured out little interesting ways of doing that, such as saying, you know, I think you really need a specialist, or I think that it would be better if you got seen at a bigger facility. So,

physicians have figured out ways to try to winkle out of caring for patients with disabilities. There's some pretty blatant discrimination by telling a patient goes someplace else. I mean, should the Americans with Disability Act protect against that? Well, you know, while this is 32 years since the institution of the ADA, unfortunately, it's one of these things that is not always implemented in the ways that you'd want. And one of the reasons I feel that we see these things is these physicians weren't trained to actually take care of patients with disabilities. As surprising as that may sound, the reason that they probably are discouraging patients from coming to their practice or encouraging them to go see specialists

when it's not necessary is because they themselves are not comfortable taking care of patients with disabilities. So even much further downstream, we need to do a much better job of making sure that disability education is embedded in the curriculum from pre-medical to medical curriculum. Dr. Ayazone, I know you have research into how physicians feel about the ADA. What did they say? Some physicians in the focus group actually said that the ADA harms patients with disabilities because it makes doctors unwilling to care for them. And in fact, our survey found that 68% of physicians fear that they are at risk of an Americans with Disabilities Act lawsuit. And so they're afraid that a patient with a disability is a lawsuit,

coming towards them. However, that should not be the case if, in fact, they make appropriate accommodations for people with disabilities. You know, it's doctors and patients talking together, the doctor saying, what would work best for you, and then the patient kind of hearing from the doctor what they can offer, and it's kind of a collaborative decision. You're listening to Science Friday from WNIC Studios. Dr. Okolam, okay, we've talked about the problems here. I wonder if we might get into some of the solutions. What does an inclusive medical system look like to you? And how do we get there?

Well, you know, piggybacking off of what Dr. Ayazone just said, I think people fear disability conversations because they just don't know how to accommodate. But she just clearly stated that the way that you figure out what access someone needs is just by asking them. And so an accessible and inclusive healthcare system is one that recognizes that everyone will have different needs for access. and there's certain things that we can institute and implement ahead of time to then create

broader need. It's sort of the curb cut effect as we talk about, that's something that benefits one small group actually benefits more people, right? The curb cut to then make access for someone to then get onto the sidewalk that's a wheelchair user also benefits someone pushing a stroller, also benefits a male delivery person. And so some of the ways that we can create access within the healthcare system will benefit more people, but will also directly create access for individuals of disabilities. But I think it starts with cultural humility to recognize that we may not know everything and that there is something that we can learn from the disability community as to how to then make things more accessible. And we should make sure that at the very least,

our health care system is recognizing that importance in doing so. Are med students, though, new doctors being steeped in this new idea, this new kind of culture you're talking about? I would say that the new students are much more aware of the need for access and inclusion, but they are entering medical schools that are not yet prepared to be able to then equip them with the things that they are yearning for. Abelism is the fact that the world, as I said earlier, was not built and created for people with disabilities in mind. And that is something that the generation coming up right now recognizes is not the case. And I think that COVID is also sort of bringing this to the forefront more with individuals, identifying as having disabilities after COVID.

And so I think it's opening up the conversation for people being more comfortable disclosing disability and speaking up and asking for the reasonable and appropriate accommodations that they deserve. Are you saying that sort of the COVID is sort of taken the Band-Aid off of this wound? Yes, I would say that COVID has just exacerbated already problematic structures that existed prior to the pandemic. What we were doing during that COVID era was we drastically shifted the way we did things and it unintentionally created more access for the disability community

in a way that it didn't have before. And so certain things like virtual care or even just virtual meetings, things that a lot of disabled individuals were asking for before to then provide them with access, we quickly pivoted and provided it for everyone by necessity. We need to hold on to some of the things, some of the innovations and creativity and access that we provided during COVID, to then demonstrate how that's going to provide

with more people with the ability to demonstrate what it is they can do instead of being limited by what people think they cannot. It's unfortunate that it was not done when the disability community was sort of speaking forward and asking for it, but for whatever reason, now that people see the need to provide access in different ways, I think we will see more and more people that are recognizing the importance of creating access for the disability community, and you're certainly seeing more people within the disability community, being able to be recognized for the work that they had been doing like Dr. Iazone and off her work for years, finally now people are starting to reference those things and putting things in place to hopefully make this sustainable.

Dr. Ayazone, I would imagine that there's an irony here about accepting people with disabilities because so many baby boomers, so many people are getting older and we're all going to be disabled in some way, right? Well, one of the things that I like to do is quote the World Health Organization, which says that disability is just part of the normal human experience. At some point, everybody, with some modest exceptions, will experience some type of disability, whether it be aging-related hearing loss or mobility difficulties. This just needs to be recognized as not something that's abnormal or something to kind of stigmatize,

but just something to accept and understand and accommodate. Well, those are great words to end our conversation because we have run out of time. I want to thank both of you for taking time to join me today. Dr. Lisa Ayazone, Professor of Medicine at Harvard Med School, based at the Health Policy Research Center at Mass General in Boston, and Dr. Farah, Mokanlami, a physician and assistant professor at the University of Michigan Medical School. Of course, that is in Ann Arbor.

Again, thank you both for taking time to be with us today. Thank you for having us. Thank you so much, Ira. Up next, we'll take a look back at 75 years of the transistor device that revolutionized modern society. Stay with us. This is Science Friday. I'm Iroflato. 75 years ago, this month, December 23rd, saw the creation and unveiling of what some call the greatest invention of the 20th century, the transistor unveiled at Bell Labs,

the research arm of Mar Bell. It was a clunky-looking thing with two gold contacts on a plastic wedge pressed against the crystal of germanium. But that early transistor had a magical property. A voltage in one part of the device could control the electrons in another part of the transistor. It could be a switch or an amplifier. It was the first semiconductor. And that device and the ones that followed and improved on, it would become an essential part of modern life. Your cell phone today likely has billions, whether it be billions of transistors in it, and soon, soon to have trillions inside. Here to help put that anniversary in contact is Michael Reardon.

He's a physicist, science historian, author of several books, including Crystal Fire, The Invention of the Transistor and the Birth of the Information Age, co-authored with Lillian Hottison. Welcome back to Science Friday, Michael. It's been a few years. Yeah, it's been about 25 years, if I remember correctly. Yeah, we celebrated the 50th anniversary. Now we're back with 75. Well, take us back 75 years.

You know, they used to say necessity is the mother of invention. Why was Bell Labs, the phone company, interested in creating a transistor at this time? Well, led by Mervyn Kelly, who was then the vice president of Bell Labs, they could see that after World War II, there would be an enormous need for telephones. In fact, I think he projected that if they did nothing. else using their old electromanchanical switches that they would need to hire all the women in the United States to serve as operators. No kidding. They were looking for something to get beyond these switches and vacuum tubes and thought that the solution would occur in solid state physics. So he set up a solid state physics group at Bell Labs just after World War II headed by the theoretical physicist

William Shockley. And Shockley gathered not just physicists, but chemists and engineers, electrical engineers in particular, into a multidisciplinary group to study solid-state physics and how it might improve communications. And out of that group, two of them, physicists John Bardeen and Walter Bratton came up with the first transistor, the point contact transistor on December 23rd, 1947. Now, the interesting part of that story, if I recall, is that Bratton and Bardeen created a transistor that Shockley was not looking for, right?

A different transistor than he had in mind. Yeah, Shockley was trying to come up with what is called a field effect transistor. And in fact, in modern life, all the billions of transistors on at least my microchips in this computer, are field effect transistors. But there was a problem with field effect transistors.

There would be a layer of electrons on the surface that would prevent the field from getting inside and influencing what was happening with the electrons and holes. Holes are like the absence of electrons in a crystal. And Bardeen and Raton came up with a way to get beyond that by putting two sharp points close together on a germanium surface, not silicon, They were working with germanium, which was a lot easier to work with, and injected holes into the innards of that slab, thereby influencing what was going on, the currents that were flowing beneath.

Was there a breakthrough an aha moment that made this all possible? Well, I think it was a series of small breakthroughs happening all through the month of December, one after another. I can't really point to one great breakthrough there. It was just the combination of Bardeen's theoretical insight and Ratten's experimental dexterity that made it possible. Bardeen realized that there were these objects called holes. There was not by no means common knowledge in those days in 1947. But he was the one who thought of minority carrier injection

that holes were being injected into the in the inerance that made it all possible. Now, if you look at patents, there are claims around transistor-like devices even before then. So what's the catch? Well, there was a patent by Julius Lillianfeld going back, I think, to 1930. He was not a Bell Labs person. He was a physicist. He never, as far as I can tell, or historians can tell, he never made one of these devices. but it really was the field effect transistor.

So Shockley could not have claimed a patent on the field effect transistor. And let me add that he felt he was being scooped by his own employees, or members of his group, I should say. And so starting on about New Year's Eve at that party that same year, he went away and started working in his hotel room to try to come up with an alternative device that he could patent and claim as his own. And that led to the junction transistor, which was a lot more easily manufactured device. Right. And in fact, Shackley would go on to fame on his

own, would he not? Oh, yeah. His co-workers said that Shockey could virtually see what was going on with electrons inside matter. You know, he really deserved his part of the credit. He just had difficulty sharing it with others. Yeah. In fact, there's a very famous picture on the anniversary, a very famous picture of the three of them gathered around a transistor and a microscope, if I remember it correctly. And it's Shockley who's sitting there as if he's working on the transistor, but he never really did any of that, did he? No, it was terrible at the lab bench. And in that picture, I can recall Bratton has a grimace on his face. And he was a face, as if to say, what is this guy with this theorist, William Shockley doing, looking

in my microscope. Yeah. And before there were transistors, we all back in the day knew there were vacuum tubes, right? How was this different? What could it do that a vacuum tube could not? Well, it was a lot smaller and it didn't generate heat. I mean, vacuum tubes are pretty sophisticated devices by the end of the 1940s. I remember that it took a while before transistors were able to surpass them in high fidelity recording, for example.

But the fact that they generated heat, that they burned out, that they took up so much space, that they were difficult to manufacture, I think ruled them out. as miniaturization became important, both, you know, commercially and to the U.S. military. And of course, then that led to the famous transistor radio of the 50s, right? Yeah. And the Japanese were very much involved in the early transistor radios. That was because they were prohibited from producing, after World War II, from producing any defense capabilities. And so they sunk it into commercial stuff like transistors.

transistor radios. Yeah, the beginnings of Sony have to do with the first Japanese transistor radio, which came in in the mid, I think about 1956, just after the first, the very first transistor radio produced by Texas instruments, the TR1. And what's also interesting about that and what Bell Labs did is Bell Labs invented it, but they did not keep the intellectual property secret? They realized how big an invention this was and were willing to let other people, other countries share in that knowledge, right? Yeah, they realized that even with all the intellectual capital that they had at Bell Labs, that important discoveries were going to occur elsewhere. And so they licensed it pretty liberally up until 1956 when there was a consent decree

that said they had to make the original transistor patents available free of charge. Okay, but they were on that road anyway. I didn't think that made much difference. They were interested in using the transistor to improve communications. And there are many other applications that they were not interested in. For example, hearing aids. Before the transistor, people had to carry a big package on their belt with a mechanization. tubes and batteries, and then lines going up into their ears to have hearing aids. I've actually

got hearing aids right now. They're totally self-contained. They've got a microchip in them that I don't know how many billions of transistors are on them. You mentioned that that first transistor was made out of germanium. Why was then a switch made to silicon? The driving force for silicon was mainly the military. Germanium, although it was really easy to work with, suffered from the fact that its performance varied with temperature. You got up to about 75 degrees centigrade. They stopped working all together. And the military could not tolerate that. So they were pushing hard in the mid-50s for silicon transistors. I mean, they were willing to pay $100 per transistor. We're also talking about the age of Sputnik and rocket launches and the military wanted to shrink things down,

needed tiny little devices. Yeah, no, definitely. I mean, you know, the Russians, I think, used vacuum tubes in the first few Sputniks. But they had the enormous thrust capacity of their rockets. You know, the United States, and I remember the first, you know, the Vanguard collapsing on the launch pad. The United States was way behind in thrust capacity in the mid-50s. So it really needed to lighten the load. and transistors allow them to do that.

Let's talk about what's actually going on in the device itself. You mentioned it briefly, but let's talk about there being different kinds of transistors. The first device was called, as you mentioned, a point contact transistor, but the ones that are so present today are largely field effect transistors. What's the difference? Well, in the field effect transistor, which was the original conception of Lillianfeld and Shockley, you have a metal contact on the surface, and below that you have silicon dioxide. That's the oxide layer on silicon, and below that you have silicon.

And the actual electrical activity takes place inside the silicon. But you need to bring, if you're going to change the behavior underneath that silicon dioxide insulating layer, you've got to bring in a field, you know, on that metal lead on top. And that very, very fundamentally, very simply, I should say, is how the field effect transistor works. You know, there's charge coming from one side and flowing to the other side. It can be electrons. It can be holes. And you'll influence that left to right flow by changing the field on the middle,

above the silicon dioxide layer. And that first device was called a point contact transistor because instead of bringing a wire, let's say, a contact with an electrical field close to it and having the field effect, the surface, you actually had to touch it, right, with the wire. Yeah, the wire sticking into a germanium surface. I don't think there was ever any point contact silicon transistors.

This is Science Friday from WNYC's two. videos. Talking with Michael Reardon, physicist and science historian, about the invention of the transistor 75 years ago. And so the three of them shared a Nobel Prize, but their relationship was never repaired, I don't think, over the years because of shockly trying not to give anybody else credit. Well, there was a lot of grief in that group, and I think Bardeen eventually left and took up a professorship at the University of Illinois because he just couldn't continue to work for Shockley. That must have been, but I think by the time they all shared the Nobel Prize, they began coming together again. You know, when you're leading up to the Nobel Prize, there was a lot of

grief or, say, anxiety that, gee, maybe I'm not going to win it. Right. And that creates barriers. But after they were, and I think justifiably, where they all shared the 1996 Nobel Prize in Physics, I think that rivalry at least dissipated. Do you think anyone really understood at that time how significant that invention would be, how ubiquitous it would be, how important it would be to creating the world we have today? I don't think anybody did. Let me just give you some numbers, if I may, you know. You know, in December 1947, there was exactly one transistor in the entire world. There are now something like 20 sextillion.

Now, what's that? Well, that's 20 billion trillion transistors in the world. And that's about 3 million transistors per square foot of land surface, you know, all over the entire world. Three million transistors per square foot. Now, there are 114 billion transistors. in the M1 chip in my computer that allows me to talk to you right now. And they're shrinking all the time, aren't they? They're putting more and more transistors on chips all the time.

And that's the good point because, you know, how small you can make your transistor determines how many transistors you can put on a single chip and how powerful it is. I think the leader in that field is Taiwan Semiconductor. They're trying to get down to three nanometers per the size of each transistor. And I just read that they're planning to spend $14 billion to try to do so in Arizona. Yeah, they're moving some production. Yeah.

As opposed to the mainland Chinese can get down to 14 nanometers. The Russians can get down to about 28 nanometers. So that tells you the sophistication of the electronics that they can produce. And even though the three shared a Nobel Prize, they didn't make much money off of it, did they? No. I think they got paid $1 by Bell Labs for their rights to the transistor. Wow. That's a good place to wrap up to see how much it was worth to them compared to how much it is worth to the world. Thank you, Michael, for your work and for taking time to be with us today. Thank you very much. And I hope everybody will read about this in Crystal Fire, which is still in print after 25 years.

Michael Reardon is a physicist, science historian, and author of several books, including the aforementioned Crystal Fire, the invention of the transistor and the birth of the information age, co-authored with Lillian Hattison. And that's about it for this week. If you missed any part of the program or you would like to hear again, subscribe to our podcasts or ask your smart speaker to play Science Friday. And you can say hi to us all week on social media, Facebook, Twitter, Instagram, or you can email us the old fashion classic way, sciFri at ScienceFriday.com. And send us feedback. Tell us what you'd like us to cover. Have a great weekend. We'll see you next week. I'm Ira Flato.