Something You Should Know - Discover How Suggestible You Really Are & 4 Questions You Must Ask Your Doctor

Episode Date: November 25, 2019

Lots of people listen to music when they are working because they believe it helps them concentrate and be more productive? Does it? This episode begins by exploring which, if any kind of music really helps your concentration and productivity. https://www.businessinsider.com/10-minute-trick-to-boost-your-productivity-2016-1 How suggestible are you? Could you be hypnotized into believing something that isn’t true? What about placebos? If I tell you a sugar pill will cure your headache, will your headache go away? It’s fascinating to think that the human brain can be fooled into thinking and doing things. Science writer Erik Vance is a science writer who has explored why it seems your brain is so suggestible - even if you think it isn't. He is the author of the National Geographic book, Suggestible You: The Curious Science of Your Brain's Ability to Deceive, Transform, and Heal (https://amzn.to/2L5ptqn) and he joins me to shed light on this interesting quirk of the human brain and what it means.  You know when you go to drug store and right next to the name brand lotion or shampoo or pain reliever is the store brand in a bottle that looks kind of like the name brand but a lot cheaper? So is it the same as the name brand? Listen to discover the answer. (Shopsmart magazine Dec 2014 issue) When you are sick and go to the doctor, you expect the doctor will treat you. And the doctor knows you expect him or her to do something – and so you walk out with a prescription. But there is often a flaw in that process that is leading to a lot of patient overtreatment. Norway neurosurgeon Christer Mjåset has explored this problem and has come up with 4 questions you should ask your doctor went he prescribes a medication or medical test. Hear what they are and discover why this is such an important subject. Dr. Mjåset did a TED talk on this which you can see here: https://www.ted.com/talks/christer_mjaset_4_questions_you_should_always_ask_your_doctor?language=en This Week’s Sponsors -Fetch Rewards. Download the Fetch Rewards app and use promo code SYSK to receive 4000 points when you scan your first receipt.  Learn more about your ad choices. Visit megaphone.fm/adchoices

As a listener to Something You Should Know, I can only assume that you are someone who likes to learn about new and interesting things and bring more knowledge to work for you in your everyday life. I mean, that's kind of what Something You Should Know was all about. And so I want to invite you to listen to another podcast called TED Talks Daily. Now, you know about TED Talks, right? Many of the guests on Something You Should Know have done TED Talks. Well, you see, TED Talks Daily is a podcast that brings you a new TED Talk every weekday in less than 15 minutes. Join host Elise Hu.

She goes beyond the headlines so you can hear about the big ideas shaping our future. Learn about things like sustainable fashion, embracing your entrepreneurial spirit, the future of robotics, and so much more. Like I said, if you like this podcast, Something You Should Know, I'm pretty sure you're going to like TED Talks Daily. And you get TED Talks Daily wherever you get your podcasts. Today on Something You Should Know, what's the best music to listen to when you're trying to concentrate? I'll have the surprising answer. Then, how gullible and suggestible are you to things like placebos and hypnosis?

So if someone has, let's say, a fear of the dentist chair, this is where this has been used a fair bit, you can change that, but you get someone into that state and you can change their expectation when they see a dentist chair. You can have them visualize such a chair. Now, I should say throughout this whole process, you're not asleep. Also, are those generic lookalike products at the drugstore, like shampoos and lotions, are they really the same as the name brands? And why your doctor may be over-treating you?

If you come to the doctor and you're having a cold, you expect a treatment, and the doctor is also trained to treat patients. And what we find is that in 30% of cases, unnecessary treatments are prescribed. All this today on Something You Should Know. People who listen to Something You Should Know are curious about the world, looking to hear new ideas and perspectives.

So I want to tell you about a podcast that is full of new ideas and perspectives and one I've started listening to called Intelligence Squared. It's the podcast where great minds meet. Listen in for some great talks on science, tech, politics, creativity, wellness, and a lot more. A couple of recent examples, Mustafa Suleiman, the CEO of Microsoft AI, discussing the future of technology. That's pretty cool.

And writer, podcaster, and filmmaker John Ronson discussing the rise of conspiracies and culture wars. Intelligence Squared is the kind of podcast that gets you thinking a little more openly about the important conversations going on today. Being curious, you're probably just the type of person Intelligence Squared is meant for. Check out Intelligence Squared wherever you get your podcasts. Something you should know. Fascinating intel. The world's top experts. And practical advice you can use in your life. Today, Something You Should Know with Mike Carruthers. Hello. Welcome to Something You Should Know. You probably like music.

I like music. Everybody likes music. We don't all like the same music, but pretty much everyone likes music. So it's pretty common when people are doing intellectual work, schoolwork, working at your desk at your job, to listen to music while you're working. So what kind of music is the best kind of music to listen to while you're working or studying? None. Listening to music kills your productivity. There are thousands of studies that have proven this,

and while listening to music may make work more enjoyable, it will always make you less productive. Always. What does work is to take breaks during your work day and listen to music for 15 minutes or so and totally immerse yourself in that experience. Then you'll come back to work feeling refreshed and more productive. And the type of music doesn't matter when you listen to it during that break. It's whatever you enjoy. And that is

something you should know. It seems we are all gullible to some extent, or maybe a better word is suggestible. It helps explain why people respond so well to placebos, or why some people can be hypnotized, or some people can have false memories that they are certain are true. It does seem that if the brain actually believes something, not everything, but some things, it can actually make those things happen. To the untrained observer, it almost seems like magic. It's really fascinating.

So what is really going on here? Eric Vance is a science writer who has explored this whole idea of human suggestibility. He has written for National Geographic and he is author of the National Geographic book, Suggestible You, the curious science of your brain's ability to deceive, transform, and heal. Hi Eric, welcome. Hi, thanks for having me. So this idea of suggestibility implies to me that if you can convince me, my brain, that something is true, then my brain kind of makes it a reality, right? So when the hypnotist in his show gets people to believe that they should cluck like a chicken

or a sugar pill actually relieve someone's headache. It's because the brain somehow makes it so. And the question is, how? How does the brain make it so? Well, you know, it's a great question. Really, the brain at its heart does one job, and that is it's a prediction machine. So let's say you take a pill and how many pills have you taken for pain in your life? And your brain has a certain expectation that it's going to remove pain. And you take that pill, but it's a placebo pill and you don't know it. Your brain will actually step in and self-medicate itself to make that pain go away rather than change the expectation because your

brain actually has access to a lot of different drugs on hand, like endogenous opioids. These are just like the opioids we inject or we take in pill form, except they're already in our brain. And so your brain can release those when it has the correct expectation and make that pain go away. We also have endogenous cannabinoids, which is like what you find in marijuana. We have serotonin and dopamine and all these other different drugs. It's often referred to as an internal pharmacy that your brain has access to and just needs to be coaxed into using. And so when you take a placebo pill, for example, you're sort of tricking your brain into releasing its own drugs. Clearly, though, there are limits because the placebo effect might work on a headache or back pain or something like that.

But you can't think a pill will cure your cancer and your brain somehow cures your cancer. That is a great point. Yes. And this is actually what I think is most interesting is there are some things that the brain has a lot of power over. For instance, pain, chronic pain, depression, anxiety, stomach issues like irritable bowel syndrome. Parkinson's is a great example of something where your brain has a tool, dopamine, to change how your body experiences Parkinson's. But you're right. A tumor does not respond well to any of your internal pharmacies.

And placebos don't last that long. Historically, placebos have't last that long. Historically, placebos have been thought to be very short term. I think we all know that. One of the big questions is, can they be used to make lasting changes in, say, chronic pain? Which I think I've heard is an area where some advances have been made. And it's just so interesting to me. If something hurts, it hurts. And so how do you suggest that it doesn't hurt and somehow people believe it and the brain makes it so? A lot of people who work in chronic pain have been trying for years to find more effective solutions to what is a pain epidemic in our country. And if I give you a placebo pill and I say, look, this will make your pain go away, it'll work for maybe a couple hours.

But the question that a lot of people have is, is there a way that I can take that temporary placebo treatment and make it permanent? Let me give you an example of this. There's a scientist who works with soldiers coming back from the war, a lot of people who've lost limbs. And one of the first things he does, this is when you lose a limb, you have a lot of chronic pain afterwards, generally. And what the first thing he does is sits down with these soldiers and he says, okay, tell me about your childhood. Tell me about the sensory experiences of your childhood. And say it's the taste of caramels that comes to your mind when you went to your grandmother's house or the smell taste of caramels that comes to your mind when you went to your grandmother's house or the smell of eucalyptus trees outside your bedroom window or

the sound of jazz as your mom played jazz in the morning. And every time you take your medicine, your opioids, you also take that sensory experience. So you taste a caramel or you listen to jazz. And you do this every day for a month or however long you need to. And then over time you take away the drug, but you keep having the sensory experience. So you keep smelling eucalyptus every day. And what you're doing is he's, he's able to sort of train the brain to self-medicate. It's, it's a placebo effect, but it's sort of a trained placebo effect. And he's had tremendous success with getting people off of these really addictive drugs. And then you tell me, by the way, this was just a placebo pill, and then you give it to me the next time I have a headache.

Is it now not going to work? Well, that's a great question. It depends on the person. That might work this week and not next week. Placebos are really hard to pin down. This is one of the reasons why we've had so much trouble understanding them. If you think about it, placebos are actually the cornerstone of modern medicine. Basically, any drug that you take has to outperform a placebo. And it can be very difficult when you do a trial and you get a bunch of placebo responders, and then you remove them from the trial. New ones pop up the next week or the next month. It's very hard to figure out when and how people have placebo responses. So there are some studies where you can actually take people and tell them, this is a placebo. There is nothing in this. And you have them repeat to you, what is

this? It's a placebo. Okay, you understand. and they take it and it still works. Not for as many people, but it still works for a pretty big chunk of society. So that's just something that our brain, that's an unconscious placebo, something you can't really stop from happening. Your brain just has a placebo response. Well, it would seem that in this discussion you have to bring in alternative medicine, because one of the criticisms of alternative medicine is that it doesn't work, and yet there are people who swear it does work, and perhaps in many cases the reason people swear it does work is because they believe it works, and so it works. And so if you sell somebody something that doesn't work, but they believe it works, and because they believe it works and so it works and so if you sell somebody something that doesn't work but they

believe it works and because they believe it works it works is it wrong to sell them something that doesn't work that's a great question i think that's the the two million dollar question or maybe 10 billion dollar question it's a very large the alternative um medicine industry is a very large one. It does work. And it is placebo. These things can both be true in a lot of cases. And I don't mean all alternative medicine. There's a lot of alternative medicine that really hasn't been investigated fully yet. But a lot of the medicines that you see that sort of the old standbys, they haven't outperformed the placebo response. And if they haven't outperformed a placebo response. And if they haven't outperformed a placebo, then they are kind of by definition placebos. But they still work. I mean,

you see these placebo rates, especially with something like pain of, you know, 50%, 40, 50, even 60% of the people in the trial get better on the placebo. It's very hard for a drug to outperform something that is making 50 or 60% of the people feel better. You have to have a powerful drug to do that. So it does work, but it's just the placebo effect is a lot higher, I think, than a lot of people realize. That's why you don't see a lot of new pain drugs on the market. Depression is another one. You don't see a lot of new drugs. Parkinson's is very, very hard to treat. It's very hard to come up with new treatments for it because of the high placebo response. If you're fighting against a disease where 60% of your patients are getting better

through trickery, how do you know if what you're testing is working? So a lot of these alternative medicines do rely on placebo effects, and they do make people feel better. And it's a big question whether or not we have a problem with that, because there's some deception in there. And, you know, we're telling ourselves stories, but if they make you feel better, and they're not too expensive, and they're not hurting the world, well, I don't know where the harm is, especially if they're bringing relief, which they clearly are. Well, that brings up a question. Are we so susceptible, if we drill down a little deeper here,

are we so susceptible that if I tell you I've got these placebo pills here and you don't know they're placebos, and I tell you this pill's going to make you feel better and this one's a dollar, but this $10 pill's going to make you feel even better. Does the $10 pill work even better because you paid $10 for it and you believe it works better? That's a great question. Yes. That's one of the problems with this is that the more a placebo costs, the better it tends to work. There's a lot of ways to make placebos more effective. You can change the color. Bigger placebos tend to work, pills tend to work better than smaller ones. Injections, placebo injections tend to work better than placebo pills

and placebo surgeries called sham surgeries tend to work better than injections. So yeah, an expensive placebo tends to be more effective than a cheaper one. And yet, you know, asking someone to pay $2,000 for a placebo, which certainly this is out there. Uh, it's a, you know, I have talked to a number of people who spent their fortunes or their, or their, you know, their, their savings or their retirement money chasing after these placebos that, that in the end never really, never gave them what they were searching for. And so it's a tough moral question, right? again using a placebo, if you're in a room full of people and we're all taking this placebo pill and everyone's raving about how good it is, are you then more likely to rave about how good it is too and really feel a lot better because all these other people claimed it felt a lot better?

This is actually kind of new. And I think we all kind of know this when, you know, when you talk to your aunt and she says, oh, you know, you've got to try this new thing that I've, you know, you if you rub salt on your nose, it'll make this thing go away or have a have a clove of raw garlic. And I've done it for years, and everyone around the room agrees. What we found is that peer pressure is a very powerful part of placebo. and you can actually test it in a laboratory where you actually uh i did this a lot a few times where you sort of the scientists will trick you into thinking that a certain amount of pain comes from a certain color or a certain thing that you see you're hooked up to a machine and it gives you pain and then you see a color and then they start

changing the colors and they they trick you into thinking having less pain than you than you expect well if you do the same experiment but then you say oh by the way um 50 other people did the same thing and they said it wasn't very painful you know be honest tell us how much it hurts but just know that 50 other people said it didn't hurt very much well that has an effect on you and suddenly you start not only rating the pain lower, but through other measurements you can see that you're actually feeling less pain. So by assuming that these other people have had less pain, you have significantly less pain just through their peer pressure, people who don't even exist.

They're not even real people. And you can actually simulate this again by giving people shots of vasopressin or oxytocin, which are hormones that are released when we get in contact with other people or we're around family. If you give someone those kinds of injections while they're having a placebo response, the placebo response goes through the roof. So there's something inherently powerful about other people.

It's so interesting that we're just more suggestible than I think anybody really realizes. I'm speaking with Eric Vance. He is a science writer. His book is Suggestible You, the Curious Science of Your Brain's Ability to Deceive, Transform, and Heal. Since I host a podcast, it's pretty common for me to be asked to recommend a podcast. And I tell people, if you like something you should know, you're going to like The Jordan Harbinger Show. Every episode is a conversation with a fascinating guest. Of course, a lot of podcasts are conversations with guests, but Jordan does it better than most.

Recently, he had a fascinating conversation with a British woman who was recruited and radicalized by ISIS and went to prison for three years. She now works to raise awareness on this issue. It's a great conversation. And he spoke with Dr. Sarah Hill about how taking birth control not only prevents pregnancy, it can influence a woman's partner preferences, career choices, and overall behavior due to the hormonal changes it causes. Apple named The Jordan Harbinger Show one of the

best podcasts a few years back, and in a nutshell, the show is aimed at making you a better, more informed critical thinker. Check out The Jordan Harbinger Show. There's so much for you in this podcast. The Jordan Harbinger Show on Apple Podcasts, Spotify, or wherever you get your podcasts. Do you love Disney? Then you are going to love our hit podcast, Disney Countdown. I'm Megan, the Magical Millennial. And I'm the Dapper Danielle. On every episode of our fun and family-friendly show, we count down our top 10 lists of all things Disney. There is nothing we don't cover.

We are famous for rabbit holes, Disney-themed games, and fun facts you didn't know you needed, but you definitely need in your life. So if you're looking for a healthy dose of Disney magic, check out Disney Countdown wherever you get your podcasts. So Eric, I'm wondering

how much more or less suggestible are you depending on who's telling you? In other words, is a guy in a lab coat telling you that this medicine is going to work, going to make it work a lot better than if it's just some guy on the street who says, hey, try this? It's something that scientists call the theater of medicine, which is very important for creating placebo. It's the story around the medicine. We call it bedside manner. This plays a huge role. Actually, there's some scientists at Stanford who are playing with changing the demeanor of a doctor or changing what's on the walls and seeing how it affects people's placebo responses. Specifically, you can create rashes and then create your placebo treatments for rashes. And they're seeing some strong effects by simply changing the theater in which people are experiencing medicine. I mean, a lot of people feel better as soon as they walk into a hospital, even before they get anything from the doctor.

When the doctor starts, you know, feeling their heartbeat and talking to them, a lot of symptoms disappear. And we have for many years considered this to be sort of self-delusion. But in fact, I think what science is showing us is that these are real effects, that people are feeling better and that the body has a lot of power to make people feel better as soon as it gets that that expectation that that trigger that okay now it's time to feel better it has a lot of tools at its disposal well but what does it mean to feel better is it just that general sense of well-being that now i'm the doctor's here so everything's fine like when you hear the ambulance coming after you've been in a car wreck and now you know help is on the way or is it really objectively symptoms begin to go away it's well the easiest thing to test in all of this is pain with a lot of these studies where you're looking at is pain i mean

obviously things like nausea and depression and um irritable bowel syndrome a lot of these other conditions would be probably in that group, but we don't, it's harder to have, you know, you can't give someone depression in the laboratory. You can't, yeah, it's very, it's hard to study this. You can give them pain. And so from what we're understanding about pain, yes, these symptoms are going away. And it's, you know, it's been proposed that maybe chronic pain itself is simply just your brain not dialing up itself medication enough. That that's all the chronic pain really is. It's not actually the injury. It's actually the brain not twiddling the dials quite right to make the pain disappear. So you've talked about the suggestibility for people with pain or perhaps with depression or a few other things. What does that list look

like beyond those two? And where does it stop? Where is it like, I'm sorry, placebos don't help this? That's a great question. I think this is really one of the most important issues that when you are talking about your body's ability to heal, that it's not limitless. I mean, one scientist told me it's not that the brain has an unlimited ability to heal your body. It's just that we don't know what those limits are. So, yes, you named a bunch of me. I mentioned pain, depression, anxiety, irritable bowels, Parkinson's, a very classic one. Then also you have certain types of addiction, which are also related to opioids, and it's been a little harder to study.

A lot of autoimmune diseases fall into this. Asthma falls into this category. A lot of chronic diseases tend to fall into these categories. Something like Alzheimer's disease does not, while depression or anxiety does, obsessive compulsive disorder does not. We started by talking about hypnosis. I want to go back to that just briefly. When you have this view in your head of somebody being hypnotized. It's this guy and he's holding a watch and you see, you know, going back and forth and you're getting very sleepy. And do people actually get sleepy? Is the watch doing anything?

Is this just showmanship? Is this all? What is that? Hypnotists haven't used watches for a long time. They did used to use watches and there's a lot of conversation in the very small sort of community of hypnotists or hypnosis scientists as to what exactly is going on with the watches and the brain. But I think today almost everyone, they have you close your eyes and they have you imagine something. Usually it's a guided sort of guided visual visualization

where, you know, I say, okay, imagine you're standing at the foot of a bunch of stairs and you go up one step and and you are getting you're not getting sleepy you're getting more relaxed and what you're trying to do is you're trying to shut down some of the parts of your brain that are moving really really quickly these sort of alpha waves where your brain is sort of firing really really really fast and and encourage the parts of your brain is sort of firing really, really, really fast and, and encourage the parts of your brain that move slower. It looks in the brain like meditation and hypnosis are not the same thing, but they're, they're both very sort of slow states. And you get into this specific slow state that we don't fully understand. But, uh, if you get, and what's interesting about hypnosis is not everyone can reach it in the same way.

So I am actually low on the hypnotizability scale, so I can't get really, really powerfully hypnotized. You can't, for instance, take away my memory. Some people, you can make them forget things if they're very hypnotizable. I can't get that hypnotized. But I can feel some of the lighter effects. And if you can get to this stage where your brain is moving slowly, you're more available for suggestions, for changing your expectations, the deep expectations in your mind. This is at least the theory.

Again, it's really hard to study, but you have access to, so if someone has, let's say, a fear of the dentist chair, this is where this has been used a fair bit, you can change that. You get someone into that state, and you can change their expectation when they see a dentist chair. You can have them visualize the dentist chair. Now, I should say, throughout this whole process, you're not asleep, and you're working with the hypnotist. One of my favorite examples quickly was a guy who got he had full body burns. Forty percent of his body was burned. Really, really terrible pain. And he wasn't responding well to painkillers. And so a hypnotist came in and said, you know, do you mind if I try and hypnotize you?

And he said, oh, you can't hypnotize me. I'm not hypnotizing. So, OK, well, let me try. And he tries. It turns out this guy is very hypnotizable. He slips right under and they got him to the point where they actually could take off all of his bandages and scrub out all of his wounds, which would be incredibly painful, no painkillers. And he was awake. He was looking around. He was completely conscious, but he didn't feel any pain because the hypnotist had sort of given him this expectation that there wouldn't be any pain. Now, I don't know what that was, but whatever it is, we should be studying that a lot because it's absolutely phenomenal. And the next day he went to someone else and it didn't work at all. And that's the frustrating thing with hypnosis is it doesn't, it's not steady. It's not constant

from person to person. Which is one of the reasons this is so interesting and like magic. Because, you know, it is hard to explain. And it isn't clear how it works. And yet it does work in so many cases. But then again, it doesn't work in other cases. Eric Vance has been my guest. He is a science writer. And the name of his book is Suggestible You,

The Curious Science of Your Brain's Ability to Deceive, Transform, and Heal. And you'll find a link to his book in the show notes. Thanks, Eric. Thanks, Mike. This has been a real pleasure. Hey, everyone. Join me, Megan Rinks. And me, Melissa Demonts, for Don't Blame Me, But Am I Wrong? Each week, we deliver four fun-filled shows. In Don't Blame Me, we tackle our listeners' dilemmas with hilariously honest advice. Then we have But Am I Wrong?, which is for the listeners that didn't take our advice.

Plus, we share our hot takes on current events. Then tune in to see you next Tuesday for our Lister poll results from But Am I Wrong. And finally, wrap up your week with Fisting Friday, where we catch up and talk all things pop culture. Listen to Don't Blame Me, But Am I Wrong on Apple Podcasts, Spotify, or wherever you get your podcasts. New episodes every Monday, Tuesday, Thursday, and Friday. People often look at me with confusion when I ask them what their only one in the room story is. They think it has to be like mine, where I went to a 600-person event and discovered that I was the only black person there. I know, horrifying, right? Hi, I'm Laura Cathcart-Robbins, and I am the host and creator of the podcast, Only One in the Room. Every week, my co-host Scott Slaughter and I invite

you to join us for an hour and lose yourself in someone's only one story. This podcast is for anyone who's ever felt alone in a room full of people, which is to say that this podcast is for everyone. When you're sick, sick enough to go to the doctor, there's an expectation that the doctor will do something to make you better, or at least make you feel better. If you went to the doctor and told him you were sick and he said, well, beats me, nothing I can do except tell you to go home and rest, you would be unimpressed. And doctors know that. They know that to keep you as a patient, they typically need to do something when you say you're sick. And this is just part of a bigger problem that has led to patients being over-treated and over-medicated.

Dr. Christer Mjorset is a neurosurgeon in Norway who's currently doing research at Harvard, and he's looked into this problem and has come up with four questions you need to ask your doctor. He gave a very interesting TED Talk on this, which you can see online. Hi, doctor. Welcome to Something You Should Know. Hi and thanks for having me. Of course. So explain the problem in a little more detail than I just did that you're addressing here with these four questions that you've come up with that everyone should ask their doctor. Well for many years in healthcare we've been believing that more care is the same as better care. But we've been

more and more aware of that more care can actually mean that you can be harmed. You can have side effects, you can risk complications. By being a more engaged and active consumer, you can actually prevent a lot of unnecessary treatment. Well, we do live in a culture where more is better, at least that's the way it often seems, so it makes sense that it would apply to health care as well. But, you know, I'm one of those people that I would rather never see the doctor. I would rather not go to the doctor. But when I do have to go, if I am really sick, I understand that idea that idea of well i want the doctor to do something yeah and i think that goes for the patients uh when they see a doctor they expect something if

you come to the doctor and you're having a cold you expect a treatment and the treat and the doctor is also he's trained to treat patient not to say no to the patient. You don't need any treatment. And so you have this symbiosis that is creating overtreatment. And what we find is that in 30% of cases, unnecessary treatment or tests are prescribed. 30% of what cases? Of any, actually, consultation. There's been several studies performed on this. Let me just take an example from my reality.

I'm a neurosurgeon, so I see a lot of patients with a mild head trauma. Now, the evidence-based care of such a patient would be to observe the patient in 24 hours or maybe even less to see if he recovers. And then if he doesn't recover, you might take a CT to rule out a hemorrhage. What we see is that in 30% of cases, doctors take a CT scan right away instead of observing. And the reasons might be that the doctor, you know, are in a hurry. Maybe the patient's mother wants the CT to be performed. But what you're doing when you're taking the CT scan is you're actually exposing the patient to radiation

that might be associated with cancer. And so it's an unnecessary procedure that can actually be harmful. And if the doctor is in a hurry, or if the patient's mother really wants that CT scan for her peace of mind, are those not legitimate reasons to do it? In most cases in medicine, we have guidelines. And the guideline says that we should observe. It costs less. And it's the evidence-based guideline that, you know, it's the best treatment. Isn't that interesting, though, that the whole idea of telling a patient,

of telling somebody who has head trauma, we're just going to keep our eye on you for a while. It just sounds like you're not doing your job. Yeah, and it's really, really difficult. And especially if maybe I was mentioning the mother of a young kid is questioning you. Are you sure? Well, then you should point out as a physician that the guidelines show that this is the best care or treatment.

And that's what I want with my questions. I want the patient to engage. And instead of demanding that a CT is being performed, ask, is a CT scan really necessary? What are the risks? Are there other options? And so let's run through the four questions. What are the four questions? The main question is, and I think if you come out of this interview with anything,

I think you should tell your doctor whenever you see him and he suggests the tests or a procedure doctor is this really necessary sometimes he might say yes and sometimes he might say no but even so you should ask what are the risks involved doing this taking this test or doing this procedure and you should also ask are there other options and you could go as far to say what happens if I don't do anything and may I suggest the fifth question in the fee-for-service environment that the US is you could also ask what are the costs okay so the four questions are is this really necessary what are the risks are there other options and what if i do nothing and and the fifth question being and how much does it cost do you think this is a new relatively new phenomenon that that 10 20

30 years ago we wouldn't have had to have asked these questions. People were more willing to accept the doctor saying, you know, there's nothing to do or wait a week or this idea of I have an expectation that you'll do something for me now, doctor. Is this a recent thing or not? Around like 20 years ago, something happened in research and the focus sort of changed. And 10 years ago, Donald Berwick, among others, looked at the healthcare costs in the US, how much of the healthcare is wasteful. And he turned out with an estimate around $200 billion every year. And at the same time we see that health care costs are rising

the gdp amount in the u.s is about to turn it's about to be around 20 percent of the gdp way above other countries and it's not sustainable so we have to do something about it so the focus of this is actually affecting the whole medical community at this moment, I would say. I'm in the US to research health policy, and we need to do something. And these four questions is part of a bigger package to shift the focus to be more evidence-based in medicine. Well, it would also seem that doctors play a role in this problem, because if they're recommending procedures and pills and things that aren't really necessary, well, that's on them.

I mean, it's up to them. They're the doctor. But also, it seems that there's a problem with, and, you know, there's a saying in English, you know, to a hammer, everything's a nail. And meaning that, you know, if you have back pain, and you go to a hammer everything's a nail and meaning that you know if you have back pain and you go to a back surgeon well guess what he's going to recommend if you go to a physical therapist well guess what he's going to recommend so there isn't this objective view of these conditions in medicine we have all these academic. We don't have that much integrated care. So I think the solution to such a problem is to make physicians more accountable for the whole episode or the patient's cycle. at this moment i'm researching different financial models that could affect waste could affect the treatment decisions like you are saying uh because i know as a physician you know being a spine

surgeon and all uh it's really hard to say no to a patient also it's not that uh you know i see a nail when the patient comes in that's a hammer myself but it's uh if a patient comes in and wants an operation it's really hard to say no and this is what you've been trained to do. This lies in you, like you say. You're a hammer, right? So making people more accountable for whole patient cycles, I think that's one of the solutions to beat this problem. Well, it's quite a dilemma because it would be one thing if prescribing these treatments or medications or whatever was benign, it made the patient feel better, but it didn't cause any harm.

But what you're saying is that this over-treatment, this over-medicating, this over-operating on people, you know, it has the potential to cause real harm. And yet people want something done. They go to the doctor, they want something done. And I think that's human, you know, it's cause and effect and everything. We like to tell the story where things happen and you get better. But it turns out that more care is not always better care. And we're getting increasingly aware of that. And more care can actually be harmful. And that's why you need to, again and again, bring those four questions or even the fifth question with the costs to the doctor and keep on asking them. Don't be shy. I guess maybe I'm just not in the majority, but I would be looking to avoid

more medication, going to the hospital. Because it's not just the risk of the procedure. There's a risk just walking into a hospital. I mean, there's a lot of sick people there. There's a lot of infection. People get sick from going to the hospital. So, you know, if my doctor says, well, you need an operation, I'd be looking at talking to other people about finding ways not to have an operation, not to walk into a hospital if I didn't have to. Yes, but then again, I would say, like, you're maybe not a typical patient, but most patients that I have have not considered the risks of getting through an operation.

I've been trained by some physicians in Oslo. And one of them said to me, like, remember, every time you operate a patient, tell the patient about the risks, every risk, because that's one of your duties as a physician, to make the patient aware of what he's going to go through. And when I do that to patients, they've never heard about the complication rates. Some of them actually, and I have experienced that, patients have said, actually, I want to think about this. And I think I'm happy when that happens because then I basically made people aware of what they are going through. But a lot of people just listen me out and then they say, when are we going to start? Me as a patient, I'm much more concerned about side effects and complication rates.

And the reason is that I'm actually experienced and I've seen everything that has gone wrong and so I'm more aware of it and afraid of it and afraid of it yeah well as I listen to you you know it is funny that there is this expectation that medicine can do something for everything that ails you. And I know from personal experience, as well as other people I know, that sometimes you go to the doctor, and I went to the doctor once for a pain, kind of a chronic recurring pain thing, and the doctor said, well, look,

we could run you through a whole battery of tests, and most likely what's going to happen is there's nothing we can do that that there's no treatment for that that you're that you're just going to have to live with it and we can do the tests but that's probably what's going to happen and and but people don't have that expectation they expect if it hurts you will it. And sometimes you can't fix it. Definitely not. And that's tough for people to hear. Basically, when you get such an information, you have to go through the five stages of grief.

You know, really? I'm not going to be like I was before? Do I really have to, you know, have this pain the rest of my life? And then sort of you come out to the other end and like you you say you're okay with it that's life but a lot of people struggle in that phase and that's where health care need to also help the patient you know just don't send them on on the door and say bye bye okay you'll be okay well it's really interesting and i think it's it's uh smart of you to to get out in front and say look you know you as the patient have have to pay attention here and ask some

questions and and not just do whatever you're told because like you say there's consequences there's risks there's there's other options that aren't that make this unnecessary so you got to really there's so much to there's so many moving parts it's it's it's up to the patient to keep their eye on it it is and then that and it's the responsibility for the physicians also to to be aware of this and be focused on this so we have to work on different levels like i say to bring the best possible care avoid the unnecessary treatments and tests. Well, what I like about this discussion is most people never think about it.

They think that if they go to the doctor, they should get some sort of treatment and that there's nothing wrong with that. In fact, that's the right thing to do. But in some cases, and clearly in many cases, it's contributing to a bigger problem of all of us being over-medicated. Dr. Christer Mjorset has been my guest.

He is a neurosurgeon in Norway who is currently at Harvard doing research, and he has a TED Talk about what we've just been talking about, and there's a link to that TED Talk in the show notes. Thanks for being here, doctor. Thank you for having me. You know those look-alike store brand products? They're usually drug or personal care items, and they usually say on it, Compare To, and then they list the name of a product that's usually sitting right next to it on the shelf.

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