Something You Should Know - SYSK Choice: Stories Behind Our Favorite Tech & Health vs Healthcare

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Starting point is 00:00:44 from YouTube to the iPhone and the movie Toy Story. Toy Story was actually quite a groundbreaking film because it was the first fully feature length film that was completely computer animated. Despite how popular it is, a lot of people actually don't know just how much was riding on its success. Also, pictures you should never post on social media. And what really determines how long you live. And it's not about going to the doctor.

Starting point is 00:01:15 If you look at the maps of life expectancy by zip code in a city like Philadelphia, people living in the Liberty Bell area have life expectancies that are about 20 years longer than people in the adjacent zip code in East Philadelphia. 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.

Starting point is 00:01:50 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.

Starting point is 00:02:22 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. Hi, welcome. If you drive a car, you've probably had that experience with a motorcycle or a bicycle where it seems to have come out of nowhere. You didn't see it and then all of a sudden it was right there. That turns out to be a very common experience, and it has to do with the limitations of your vision and brain.

Starting point is 00:03:09 You see, a motorcycle approaching head-on from a distance occupies a very small part of a driver's vision, and if it's going quickly, it's possible that the eye simply doesn't get around to looking at it enough to make it stick in the brain before that motorcycle arrives in the driver's immediate vicinity. Let's take a typical case. You're preparing to make a left turn from a side road onto a main road. There's a motorcycle flying down that main road towards you. So you, the driver, you look left, and you don't see anything

Starting point is 00:03:44 because it's pretty far away, and then you look right, and now you look left again. Now, the motorcycle is much closer, almost on top of you, but because you didn't see it the first time you looked, and this is important, your brain simply discards it as a result of your brain not expecting to see it. So, you pull out in front of the motorcycle. So, what can you do about this? Well, you just have to be more conscious and deliberate when you look around as you drive. It will lead to a much higher quality mental picture.

Starting point is 00:04:22 In short, you'll actually learn how to see things that are otherwise invisible. And that is something you should know. Over the last 30 years or so, our lives have been transformed by technology. The PC, the smartphone, software, the World Wide Web. We use and have come to rely on so much technology. And how some of that technology evolved and arrived in your life is really interesting. Dagogo Altrade is the creator of a YouTube channel called Cold Fusion, which offers a series of really interesting videos on technology,

Starting point is 00:05:02 and he's got over 1.6 million subscribers. Dagogo is also the author of a book called New Thinking, From Einstein to Artificial Intelligence, The Science and Technology That Transformed Our World. Hi, DeGogo, welcome. Hi, Michael. Thanks for having me on. So you have really studied technology going pretty far back and then right up to modern day. And what I like about your videos is that they're

Starting point is 00:05:25 really interesting and easy to digest. And when you watch them, you see that there are some really fascinating backstories to much of the technology we use today. Yeah, that's very true. There's definitely an interesting story behind most of the fundamental technologies that we see around us each and every day. So let's talk about some of them and maybe YouTube would be a good place to start because you have this big YouTube channel and I think everybody's been to YouTube, maybe posted videos on YouTube, certainly watched videos on YouTube. So how did all that begin? Sure. So first of all, just to give you a scale of how big YouTube is, every single minute, there's over 300 hours of video actually uploaded. So first of all, just to give you a scale of how big YouTube is, every single minute,

Starting point is 00:06:05 there's over 300 hours of video actually uploaded. So it's absolutely massive. But when you look at its origins, it's actually quite a funny story. So there were three ex-PayPal employees that tried making actually a video dating website in 2004. And they pretty much tried to get people to sign up. They even paid some girls to sign up to the dating website, but it ultimately failed. No one wanted to do it. So they kind of abandoned that idea. And then later on in 2004, there were two events that happened, two major events that lit a spark in their brain. So the first one was the boxing date tsunami that was quite devastating. But then the other one was actually Janet Jackson's wardrobe malfunction that famously happened.

Starting point is 00:06:52 So it actually gave them an idea. They realized that they couldn't actually find videos of any of these topics online easily. So they thought about it and then they said, well, instead of making a website where people can upload videos of their dating profile, how about we make a website where people can upload absolutely anything that they want? So they went about building that with the infrastructure they already had. And then they went live with what their new website was to be called YouTube in 2005. Not long after that, I think it was a couple of years after they went live, Google kind of looked in and saw that what they were doing had a lot of potential,

Starting point is 00:07:31 so that they bought them for a multi-billion dollar deal. I think it was $9 billion. And yeah, it came under the umbrella of Google, and they put advertising on there and made revenue out of the website. And it grew to be obviously the largest video sharing website in the world. I think for a lot of people, one of the first uses of technology the way we think of technology today was Nintendo, playing games on Nintendo. So talk about that. In the early days when they were coming up in the 1980s, there was quite a couple of interesting stories about some of their biggest hits. So you might know the video game Donkey Kong, the platformer jumping game. That was originally based off a popular TV show, Popeye, in the 1980s. But Nintendo actually couldn't get the rights to actually base their characters off the Popeye

Starting point is 00:08:22 characters. They had to kind of just change it a bit. So the antagonist, who was Bluto in the Popeye series, just became a bumbling gorilla. And Popeye actually became the character of Jumpman, which is the... Jumpman was actually the character that the player uses to jump between different platforms. And so Mario, like everyone knows who Mario is from the Nintendo universe, but the origins of the character was actually quite interesting. So back in the day, Nintendo America was actually leasing an office and the landlord, who was quite a fiery, angry Italian man called Mario Siegel, and he would often barge in during meetings and demand late rent while the Nintendo staff were having meetings. So they decided to kind of play a little trick and tongue-in-cheek named Mario after this angry landlord. And interestingly enough, the reason Mario has a hat and moustache

Starting point is 00:09:18 isn't because he was an Italian plumber. It was actually because it was quite hard to draw his features using the limited technology, the pixelated graphics that were available at the time. It was just easier to draw those than the actual hair and mouth. So it's actually quite interesting when you look into it. And Pac-Man, this is not Nintendo, it's actually another video game company called Namco,

Starting point is 00:09:42 but Pac-Man was actually originally going to be called Puck-Man, which was spelled P-U-C-K. But obviously, the Japanese executives were quite worried that young American kids would scratch out the end of the P and make it an F. And I guess that sounds too much like something else. So they decided to change the name just to Pac-Man. So yeah, some very interesting stories in the 80s when gaming was coming up. Let's talk about memes, because you can't go on Facebook or Instagram or you can't go anywhere and not see memes about somebody or something. Where did that start? I guess we could start from the definition of a meme, because most people think a meme is just something that,

Starting point is 00:10:24 you know, a funny picture online that has a few pieces of text under it. But the actual original idea of the meme was actually coined by Richard Dawkins. And what it really means is actually just simply a spread of a cultural idea through society. So the first meme on the internet could actually be recognized as the smiley face. So it's an interesting story. In 1982, there was a university student at Carnegie Mellon University. His name was Scott Falman. And he noticed something. Like back in the day, they did have internet, not the World Wide Web as we know it, but

Starting point is 00:11:02 still computers could communicate between each other. So students would often talk on forums and talk about different things. But he did notice that there was no way of actually conveying human emotions during these text-based conversations. So someone would make a joke on one end of the computer, and on the other end, at another university, someone would take this the wrong way and start getting angry. And then it would start a big flame war, and people would start shouting at each other just because the joke was taken the wrong way. So Scott noticed this, and he came up with the solution of colon and then parentheses to make, I guess, a pictorial smiley face over text.

Starting point is 00:11:41 So when he did it, he first just put it at the end of a sentence, and then he soon noticed that it was catching on at other universities all around the country. And then within a matter of weeks, the whole of America was using it throughout the university networks. So it's quite interesting when you look at it that way, that one idea spread and people just intuitively knew that it meant that the joke wasn't to be taken seriously. Okay, so the smiley face may have been the first meme, but that's not what we think of when we think of a meme today. We think more of a picture or a video with some kind of text. I guess the first proper meme in the modern sense, as we can look at it today, would have been

Starting point is 00:12:20 the dancing baby. I'm not sure if you remember that. It was like a little computer-generated baby that was just doing some dancing, basically. It first came online in 1996, and it was actually part of a package 3D editing software. Someone just found it off there and uploaded it online, and it became an internet phenomenon and was even featured in some uh TV shows like Ally McBeal and third Rock from the Sun back in the day and it really spread beyond

Starting point is 00:12:52 the internet at that point so I think that could be considered well that is considered the first modern classic meme as we know it let's talk about uh blockbuster Netflix, because that's like the big fight between two giants, and nobody expected Netflix to win. So how did that all play out? Blockbuster, I guess we all know and love that. That was quite big in the late, well, in the 1980s and 1990s. And there's been countless nights of people sitting around and having rental movie sessions, but there's no way to be found today and that's mainly because of netflix so in the year 2000 netflix was just starting up and there were a dvd mailing company and um pretty much they they offered to um sell themselves to

Starting point is 00:13:37 to blockbuster for about 50 million dollars but the blockbuster ceos didn't really see uh anything in that so they actually literally laughed Netflix out of the office. They just didn't see it as a viable business. But Netflix didn't give up. They went on to, in a few years, in about 2007, they pretty much went into the online streaming services sector and decided that this was going to be the next big thing. Because they were seeing that broadband internet was becoming a thing most people had it um computers were becoming in every home so like it kind of was like a a good platform to to get into so they started doing that and to be honest blockbuster saw this this. They saw Netflix going into the online business.

Starting point is 00:14:25 And they said, you know, the CEO of Blockbuster at the time famously said that Netflix isn't even on our radar. So they didn't see it at all. So for Blockbuster, you can kind of see it from their perspective. Their CEO said that Blockbuster was really a retail company and not a technology company. They saw online streaming as something completely different to what they were doing. So they didn't want to mess up the customer base that they already had by changing. So Blockbuster decided to stay with the same thing. But as we know, video streaming was the future and Netflix did go on to thrive.

Starting point is 00:14:59 And then Blockbuster pretty much is out of business now and just a relic of history. Not pretty much. They're all gone, right? There's nothing left. But didn't Blockbuster make some attempt to catch up and to get into the streaming business, or am I mistaken? Well, they did. It was a very fleeting attempt, and it was pretty much too little too late. Netflix had a better service. They had the market share. Blockbuster was just coming in at the wrong time, and it just didn't work out for them.

Starting point is 00:15:32 If they had gone in a few years earlier, maybe, but they were too late. We're talking about big moments in the history of technology, and my guest is Degogo Altrade. He's the creator of the YouTube channel Cold Fusion and author of the book New Thinking, From Einstein to Artificial Intelligence, the Science and Technology that Transformed Our World. Contained herein are the heresies of Rudolf Pantwine, erstwhile monk turned traveling medical investigator. Join me as I study the secrets of the divine plagues and uncover the blasphemous truth that ours is not a loving God and we are not its favored children. The Heresies of Adolf Buntwine, wherever podcasts are available. Since I host a podcast, it's pretty common for me to be asked

Starting point is 00:16:28 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

Starting point is 00:16:44 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.

Starting point is 00:17:23 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. So, DeGogo, talk about the origins of the telephone, the original telephone, because it is from the original telephone that the smartphone has evolved to. And it's a pretty interesting story of trying to get that technology out and into the world.

Starting point is 00:17:51 At the time, so this was in the late 1870s, like telegraph was pretty much the best form of communication that humans had. So you can think about it previously to this time, if you wanted to send a message to someone, it would usually be on horseback or through a pony. And of course, that's quite slow and unreliable. But Telegraph, that was almost, for the time, instant communication. So Western Union at the time was one of the biggest companies in the Telegraph business. They pretty much had a monopoly. And their CEO, William Orton, was approached by a young man called Alexander Graham Bell, which might ring a bell. He was the

Starting point is 00:18:30 inventor of the telephone. So he had this new invention and he went to William and said, you know, I have this invention, would you like to buy and integrate it into your company? But surprisingly, William didn't really think it was much. He actually famously said that it was an interesting invention, but what use could this company make for an electrical toy? That's literally all William saw it as. Two years later, after William made that statement, the telephone actually took off and he realized the mistake that he made. And for years, he tried to challenge Alexander Graham Bell's patents, but lost and was actually forced to leave the telephone business just a few

Starting point is 00:19:11 years later. It's interesting. You would think that voice communication would be obvious, but at the time it just wasn't. Most people probably wouldn't think that a cartoon has much of a place in the history of technology, but Toy Story, the movie Toy Story really did. So, explain how. Sure. Toy Story, yeah, it wasn't just a movie. It was actually quite a groundbreaking film because it was the first fully feature-length film that was completely computer animated. And that was definitely not an easy task when it was made in 1995. But despite how popular it is, a lot of people actually don't know just how much was riding on its success because the movie was almost

Starting point is 00:19:57 never finished because there was just so much fighting and bickering within the production process. And the thing is, if Toy Story had failed, then Pixar itself would have failed. That's how much was riding on the success of this film. So we have to go back to the late 1980s to really understand what was going on. So at this time, Pixar was actually producing computers, which a lot of people don't know. And this was computers for graphical applications. So anything from animation to geology surveys or engineering, and they're just really seeing how to demonstrate the power of their computers to potential clients. So one of

Starting point is 00:20:37 the Pixar staff, John Lesiter, he actually came up with the idea of creating little short animated films on these computers that featured toys or inanimate objects that kind of had human-like behaviors. And then during one of these demos, one of the Disney executives saw this, and they loved the idea. They loved the concept. And they were like, hey, Pixar, why don't you make a feature animated film with us? So the two paired together, and you'd think that this was the start of a great relationship, but it really wasn't. What happened was during production, Pixar would

Starting point is 00:21:12 put some ideas forward and Disney hated everything that Pixar pitched at them. Basically, Disney wanted the film to be quite dark and serious and they actually wanted Woody, the main character, the main toy, to be quite an unlikable jerk, just a terrible person. So it's very different to the toy story that we know today, but that's how it was supposed to be pitched. And it was so bad that in 1993, during an early production screening halfway through the film's completion, there was a screening and both Disney and Pixar just hated it. They hated everything that they saw. And it was so bad that the entire film was scrapped, which is, it's hard to believe now, but John Lasseter, the guy who first created those animated pieces on the demo computers, he just pleaded with the Disney

Starting point is 00:22:03 executives and said, Hey, look, I really want to do this, and I think we can make something here. And he actually offered to revise the entire script in just two weeks, which is absolutely incredible. And he did it, and he managed to pull it off. From that moment, Disney actually liked what they saw, and so did the rest of the Pixar staff, and they went on to create one of the most groundbreaking films of all time,

Starting point is 00:22:26 ushering in the computer-generated age of movies, which, yeah, it was almost not going to happen. Certainly the one piece of technology that impacts so many of our lives all the time, all day long, every day, is the smartphone. And for many of us, that means the iPhone. And how the iPhone came to be, that's a pretty remarkable story. In the mid-2000s, Steve Jobs actually pitted two teams against each other within Apple. One team was headed by Tony Fadell,

Starting point is 00:22:56 and this team was to turn the iPod into a phone. And the other team, headed by Scott Falstall was to shrink the entire Macintosh down into a phone. So one team was going from the bottom up and the other team was coming from the top down. When Steve Jobs actually went on stage to unveil the iPhone to the world, he actually did something quite cruel. So in the presentation, Steve Jobs took, you know, he took out the phone and was demonstrating how to type and call and do all these things. But then he came up to the contacts section and was like, OK, so how do you delete a contact? And then what he did was he swiped Tony Fidel, the leader of the losing team, off the screen. And according to insiders at the time and Apple employees, he never did this during the practice runs of the presentation. So to them, this meant that Tony was in trouble and he was

Starting point is 00:23:51 fired. And it was actually quite a brutal time because both teams worked extremely hard under jobs for two straight years. Some sacrificed their health, some, you you know they didn't get much time to take off when they had newborn babies some marriages were broken they just worked without breaks and yes I guess really it's just important to see the hard work that was behind the scenes so like next time you see a shiny new iPhone just kind of think about the sacrifice and what people put in to make this technology possible in the first place. One of the exciting things going on right now that you talk about is in the world of batteries. And I think a lot of us have felt over the years that not much has happened with batteries

Starting point is 00:24:37 and that they're problematic in the sense that they take a long time to charge, they don't hold a charge long enough, and things are about to change. A lot of people still think that batteries are quite a bottleneck and haven't been improving for years, but right now there's actually kind of a little battery revolution going on. So we've kind of had the same technology of lithium-ion, which is the dominant batteries in your laptops and your phones, for decades now, since the early 1990s.

Starting point is 00:25:07 But a lot of people might not know that, for example, like everyone knows the Tesla cars, but since 2008, the capacity of these batteries have actually gone up by 60%. And these improvements are actually making new things possible, like the drone revolution of like the early 2010s. This wouldn't have been possible with less powerful batteries or batteries as light as they are now. So there's a lot of research going on with battery technologies at the moment. For example, we're getting solid state batteries, which are safer, liquid batteries, which theoretically could power entire neighborhoods. Even recently, there's been the first real production electric planes coming out.

Starting point is 00:25:52 So it's really, really interesting to see the place that we're at now. But there has to be one question asked, and that's, why did it take so long? And the reason for this recent revolution was pretty much because of Tesla. So now that Tesla is starting to succeed and all the other car manufacturers are saying, okay, electric cars are going to be a thing. Now there's really a potential for a huge market with batteries. So with this possibility of such a large profit, it means that there's now a monetary incentive for a lot of research agencies and even car manufacturers to put in all this money into making batteries better for next generation batteries. So it really kind of is a battery revolution under our nose going on right now. Well, I appreciate you sharing the stories because it's always interesting to hear what happened and how things came to be, especially regarding the things that we use every day in our lives. DeGogo Altrade has been my guest. He's the creator of the YouTube channel called Cold Fusion, and he's author of the book, New Thinking, From Einstein to Artificial

Starting point is 00:27:02 Intelligence, The Science and Technology That Transformed Our World. There's a link to his YouTube channel and a link to his book at Amazon in the show notes. Thanks to Gogo. No worries. Thanks for having me, Mike. Hey, everyone. Join me, Megan Rinks. And me, Melissa Demonts, for Don't Blame Me, But Am I Wrong?

Starting point is 00:27:21 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 listener 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.

Starting point is 00:27:57 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. When you get sick, you go to the doctor because the common belief is that whatever's wrong with you, modern medicine can do something about it and maybe just be able to cure it.

Starting point is 00:28:41 There's a real problem if you believe that because it's not as true as people like to believe. The fact is that modern medicine is really good at some things but not so good at others. And one of the things it's not so good at is making you healthy and increasing your lifespan. And you might think, well, wait a minute, that's exactly what health care is all about. But you're about to hear a very different story with some very compelling evidence behind it. Robert Kaplan is a behavioral scientist at Stanford, and he's been studying health care for several years, trying to figure out what works, what doesn't, and why. Robert is the author of a book called More Than Medicine, The Broken Promise of American Health. Hi, Robert. Thanks for being here. Hi, Michael. It's great to be with you.

Starting point is 00:29:31 So what's the core problem here? What is it that you study and what is it you're mostly concerned about? Over the last series of decades, we've been studying what makes people better, what makes people live longer, healthier lives. And we encountered this terrible dilemma, and that is that we're spending more and more on health care in relation to other rich countries. So now U.S. health care is the biggest sector in the biggest economy in the history of the entire world. So as these health care costs have grown, we have this other troubling phenomena, and that is that in relation to other rich countries, our life expectancies are actually

Starting point is 00:30:10 going down. Now, overall, life expectancies are increasing, but they're declining in relation to other rich countries. So we think that's a big problem. We're spending more, but we're getting less in return. And why is that? Why is health care so expensive, and why are we not getting more bang for our buck? We have a system that's, you might call a reactive sick care system. So a system that tries to find and fix health problems and identifying cures, but we're not attending enough to the real underlying determinants of long and healthy lives. There is a belief, I think, whether it's true or not, that the United States has the best health care system in the world, and if you're sick, going to the doctor is a good idea because there's probably something they can do to help you, right?

Starting point is 00:31:02 Well, I think one of the big issues is that there is a narrative, and the narrative goes something like this, that if you're not feeling well, we can find the problem and fix it. So diagnose it and treat it. And part of what I've been working on for a fair number of years now is, is that narrative really right? So, for example, how well are we really doing at identifying the basic, you know, the basic problem, and then fixing it in relation to having a broader approach that tries to think through, what is it that's making lives shorter and less desirable? But are we there? Are our lives shorter and less desirable than they used to be? That's really a good question, Michael. So you've probably been reading a little bit lately about

Starting point is 00:31:53 how life expectancy in the United States declined over the last couple years. That is actually quite an unusual phenomenon. So if we go back a century or so, life expectancy in the United States has been increasing, and increasing at an impressive rate. But it's not increasing as rapidly as it has been in other countries. So, for example, if you go back to the 1950s, the life expectancies in Japan and South Korea were significantly lower than they are in the United States. And then we've now been bypassed. So South Korea is just a great example, particularly for women.

Starting point is 00:32:32 Women in South Korea have a life expectancy now that's near 90 years. Way back in the mid-50s, by the way, it was only about 55 or 60 years in South Korea. So something's happening in other countries that's allowing them to increase their life expectancy at a much more dramatic rate than in the United States. And again, there are a lot of determinants of life expectancy, and medicine definitely is one of them. We don't want to abandon that. But I'm worried that we're neglecting the real most important determinants of how long people live. Well, wait a second, though. What you just said, that women in South Korea in the 1950s

Starting point is 00:33:09 had a life expectancy somewhere in their 60s, and now it's near 90, that's huge. What's going on in South Korea that life expectancy in basically 60 years or so jumped by 50%. So I'm going to go on a little tangent, if that's okay, and just point out that here in the United States, if you look at something like getting regular mammograms, for example, you know, a find-it-fix-it solution, for women, it may increase life expectancy, but most of the analyses suggest that, on average, that increase increase life expectancy, but most of the analyses suggest that on average that increase in life expectancy is relatively small.

Starting point is 00:33:50 So if you take all of the big randomized clinical trials that have been done and aggregate them in a meta-analysis, it turns out that the increase in life expectancy from mammography is only about a month or so on average. But if you look at something like educational attainment, the highest year of education you've achieved, that turns out to be one of the strongest correlates of life expectancy. The difference in life expectancy between someone with a graduate degree versus someone with less than a high school education is about 12 years. So just the order of magnitude is enormous.

Starting point is 00:34:26 And there have been a lot of these studies geographically in the U.S. One of the most interesting ones is if you look at the maps of life expectancy by zip code in a city like Philadelphia, people living in the Liberty Bell area have life expectancies that are about 20 years longer than people in the adjacent zip code in East Philadelphia. So there are huge differentials in life expectancy associated with some of these social factors. And actually, the things that we really believe in, and by the way, I believe in as well, the things that we should keep doing, but a lot of these interventions in

Starting point is 00:35:03 the medical system have relatively small effects on life expectancy and quality of life. But what is it that happens? You don't inherently live longer because you sit in a classroom through a graduate degree or live near the Liberty Bell, so what's going on? I wish I could tell you exactly. So there is a lot of work trying to figure that out. But we do know that the socioeconomic variables, what we can now call the social determinants of health, are highly correlated with health habits. And so we know, for example, that prudent diet, regular physical activity, and avoidance of cigarettes are key factors in longer, healthier lives.

Starting point is 00:35:46 And again, if you just take cigarettes, which is something that I just had a profound interest in for a long time, we have seen these very systematic declines in deaths from heart disease and cancers, and all cancers actually, over the course of the last couple decades. And people scramble to explain those in terms of medicines that people are taking and cancer screening tests. And clearly those have contributed, medicines and screening tests. But the strongest correlate of those declines in cancers and heart disease

Starting point is 00:36:17 is the decline in cigarette smoking. Yet we know from some other work that we've done that cigarette smokers in the United States are actually not advised by their doctors as often as you would think to stop smoking. So, for example, in the Medical Expenditure Panel Survey, a big national survey that's done by the federal government, people self-identify as to whether or not they're smokers. So they will respond to a question in the survey that says, do you smoke cigarettes? And among those people who smoke cigarettes, only half of them report that their health care provider advised them to quit. So there's this enormous opportunity. We know that cigarette smoking is one of the very worst things people can do.

Starting point is 00:37:03 But in fact, it doesn't fit into this narrative, sort of the find-it-fix-it narrative of what makes people better, and it gets neglected. What would be interesting to know is, of the smokers who said that their health care provider did recommend that they quit smoking, how many of them actually quit smoking? I mean, it wouldn't seem to me that having your doctor suggest you stop smoking is a very effective way to quit smoking. Yes, you're absolutely right

Starting point is 00:37:34 that just advising people to quit doesn't do the trick. And so that we actually have been studying that to what extent does the primary health care provider go to that next step? That is, refer to some other provider that's a specialist in smoking cessation or prescribe a nicotine patch or some other medication that might be helpful in getting people to smoke. As far as we can tell from the survey data, those are very underutilized. And again, it doesn't fit into the ordinary pattern of how we think of cures and how health care is delivered. Yeah. Well, you're right. I mean, certainly when you think about it, people don't go to the doctor for lifestyle advice. They go to the doctor because something hurts. And so the expectation is that

Starting point is 00:38:25 you'll give me something for what hurts. And in fairness, by the way, that I think that the primary care communities, general internists and family physicians have been much more active and they are making this a much bigger part of their practice, but we just have an enormous way to go. It would seem though that if the goal is to get people to lead a healthier life, because that has more impact in terms of them living longer and being healthier than the find-it-and-cure-it mentality that we have now, that that has to start with the patient. That has to be up to people to decide that that's a priority, that you can't dictate it or legislate it, and health care can't make people be healthy.

Starting point is 00:39:11 And maybe that's not the role of health care. Again, I think that an awful lot of this is there is this cures narrative, and the narrative is that medicine does a really good job of identifying what's wrong with you and fixing it. And so the idea that a lot of people may be thinking when they go to their doctors is, well, I don't have to worry about this because if I get diabetes or, God forbid, some sort of cancer, the medical care system will fix it. And the problem is that, in fact, the system doesn't do very well at fixing those things. And I can give you a couple examples if you'd like. Yeah, sure, sure. So if you take something like the very best drugs that we have

Starting point is 00:39:57 in preventive medicine, one example might be the statin drugs that lower cholesterol. And the assumption that people have is that if they take these medications, then that will fix the problem and they don't have to worry about death from heart disease. But in fact, that's not right. That if you look at the large randomized trials, what they show is that the medications reduce your probability of death from heart disease, but not by very much. They reduce them some. And if you look at death from any cause, that is, you're not just considering death from heart disease,

Starting point is 00:40:34 but you consider are you likely to be alive over the next decade, for example, the numbers are surprisingly low, but the public expects this enormous benefit, where in fact the benefit is relatively small. So we can go back to that example of, well, how much life expectancy do you gain by having high cholesterol diagnosed and treated? And there are various ways to analyze this, but it's probably about six months. And blood pressure is probably a year and a half. But again, the difference in

Starting point is 00:41:05 having a graduate degree versus a high school degree or less than a high school degree is about 12 years. So there are very big effects for things that we're not attending to. And there are significant but very small effects for a lot of the things that we consider the cornerstone of preventive medicine. This is really, well, it's interesting, but it's really significant because I agree with you. There is this belief, this assumption with people in the United States that whatever's wrong with you, the doctor has something for it and can fix it. And in many cases, they may have something for it, like high blood pressure medication and diabetes medications and all that. But it doesn't do what people think it does. It doesn't solve the problem.

Starting point is 00:41:55 So we're really operating under a false assumption. side of what you're saying, which I just, I still can't understand, is that there's a 12-year difference in life expectancy between somebody who has less than a high school degree and somebody who has a postgraduate degree, and nobody can explain why that is other than maybe it's the logical, well, you're more educated, so you're more up-to-date on health information and whatever, but 12 years? So it seems like the word needs to get out that if you think your doctor is going to save you, you have another thing coming. There are a variety of things that I think we should be doing.

Starting point is 00:42:43 So first of all, we should be thinking about producing health rather than producing health care. So we have a system that really is focused on being reactive and taking care of people who are sick. We have to get it out of the acute disease model, that is, the find-it-fix-it model, and coming to the realization that most of what we're spending money on and most of what people are concerned about has to do with chronic diseases that don't have any simple cure. We probably have to think a little bit about how we finance

Starting point is 00:43:10 or how we use our resources to make people healthy. And again, so much of the discussion about making people healthy has to do with investing in medical care and hospitals and clinics. And again, to be fair, hospitals and clinics are a cornerstone of what we need, but we have to come to the recognition that we have to integrate healthcare with a whole lot of services and activities outside of the healthcare system. Can you make people healthy if they don't want to be healthy? Probably not, although we might be able to create environments where people are healthier. And, you know, your question is a really good one. The best example of this is what's happened with cigarette smoking. So some of the cigarette smoking achievement has to do with people making individual choices, but an awful lot of it

Starting point is 00:44:06 has to do with early changes in labeling, smoking policies that didn't allow people to smoke at workplaces or on airplanes and restaurants and so forth. Don't you think that the healthcare system has done a pretty good job getting the word out about certain preventative measures like cancer screenings and physicals and mammograms and things like that that are designed to help people stay healthier because you're screening for disease early on. It's interesting that there are issues like, should a woman get a pap smear every year or every third year, well, there's an enormous debate, and people will fight to the death over the different positions and look at the data and so forth. But at the end of the day, getting a pap smear every year versus every third year

Starting point is 00:44:55 might only mean a differential life expectancy of a couple days at best. Where cigarette smoking, if you choose to smoke cigarettes, you might be sacrificing somewhere between 7 and 10 full years of life expectancy. So cigarette smoking is a very big impact. Frequency of screening for cervical and uterine cancer is important, but just not of the same magnitude. As you said in the very beginning of this discussion, the healthcare system in the United States is so huge, and it is difficult enough for individuals to navigate when they do need services.

Starting point is 00:45:37 But knowing what you know, and having looked at all this data, what is it that does make a difference for people who are interested in doing the right thing and leading a healthy lifestyle? What are the big things that people can do that the research says will improve your health and help you live longer? If you look at some of what's been coming out of the literature over the last decade or so. Just a couple habits. Regular physical activity, a prudent diet, and avoidance of cigarette smoking. Those have a big impact on the big diseases. Diabetes, heart disease, and cancers.

Starting point is 00:46:18 And together, those account for about 50% of the premature deaths in the United States and other developed countries. So that at the individual level, taking good care of yourself, developing healthy habits, and prudent use of medical services as well can have a big impact. And the idea that you don't have to worry about things because if you get sick, the medical care system will fix you. I think that making that switch could be very important for people. Which interestingly is pretty standard conventional advice, but oftentimes the standard conventional advice works. Robert Kaplan has been my guest.

Starting point is 00:47:01 He's a behavioral scientist at Stanford University, and he's author of the book More Than Medicine, The Broken Promise of American Health. There's a link to his book at Amazon in the show notes. Thanks, Robert. Thanks for coming on. Thanks, Mike. It's really been a pleasure talking with you. People post a lot of things on social media, and the editors of PureWow.com came up with some suggestions regarding what not to post on social media. And here are their suggestions, and they ring right to me. Stop the endless stream of pet and kid photos. A few are fine, but if that's all you post, everyone is really getting tired of it. Don't post anything after two glasses of wine or more. Only post when you're sober and you will not regret it.

Starting point is 00:47:54 They recommend if you're going to post selfies, only post them if they are spectacular photos of you. Keep those photos out of the airplane window to yourself, because those of us looking on social media, we really can't see anything. You really had to be there. And the leg perspective photos of you on the beach, it's just not as cool as it once was. And that is something you should know. You know, I'm sometimes asked, I love your podcast. Is there anything I can do to support it? Well, the answer is yes. Yes, you can leave a rating and review on Apple Podcasts, and you can also buy products from our advertisers. That's what really supports this podcast and makes it possible, is advertisers who advertise hope that you will buy their products,

Starting point is 00:48:44 and then they come back and advertise more, and it keeps the whole thing going. I'm Micah Ruthers. Thanks for listening today to Something You Should Know. Welcome to the small town of Chinook, where faith runs deep and secrets run deeper. In this new thriller, religion and crime collide when a gruesome murder rocks the isolated Montana community. Everyone is quick to point their fingers at a drug-addicted teenager, but local deputy Ruth Vogel isn't convinced. She suspects connections to a powerful religious group.

Starting point is 00:49:15 Enter federal agent V.B. Loro, who has been investigating a local church for possible criminal activity. The pair form an unlikely partnership to catch the killer, unearthing secrets that leave Ruth torn between her duty to the law, her religious convictions, and her very own family. But something more sinister than murder is afoot, and someone is watching Ruth. Chinook.

Starting point is 00:49:38 Starring Kelly Marie Tran and Sanaa Lathan. Listen to Chinook wherever you get your podcasts. Hi, I'm Jennifer, a co-founder of the Go Kid Go Network. At Go Kid Go, putting kids first is at the heart of every show that we produce. That's why we're so excited to introduce a brand new show to our network called The Search for the Silver Lightning, a fantasy adventure series about a spirited young girl named Isla who time travels to the mythical land of Camelot. During her journey, Isla meets new friends, including King Arthur and his Knights of the Round Table, and learns valuable life lessons with every quest, sword fight, and dragon ride. Positive and uplifting stories remind us all about the importance of kindness, friendship, honesty, and positivity. Join me and an all-star cast of actors,

Starting point is 00:50:25 including Liam Neeson, Emily Blunt, Kristen Bell, Chris Hemsworth, among many others, in welcoming the Search for the Silver Lining podcast to the Go Kid Go Network by listening today. Look for the Search for the Silver Lining on Spotify, Apple, or wherever you get your podcasts.

Something You Should Know - SYSK Choice: Stories Behind Our Favorite Tech & Health vs Healthcare

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