Something You Should Know - SYSK Choice: Your Suggestible Brain & Must-Ask Doctor Questions

Episode Date: December 4, 2021

People often listen to music while they are working because they believe it helps concentrate and possibly makes them more productive. Does it? This episode begins by exploring which, if any kind of music can help your concentration and productivity. https://www.businessinsider.com/10-minute-trick-to-boost-your-productivity-2016-1 Are you suggestible? Could you be hypnotized into believing something that isn’t really 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. Erik Vance is a science writer who has explored why it seems your brain is so suggestible – even if you believe 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 phenomenon 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 12/2014 issue) If you are sick and you go to the doctor, you expect the doctor will treat you somehow. He’ll give you medicine or something. And the doctor knows you expect him or her to do something – so you walk out with a prescription. But there is 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 to ask your doctor went he prescribes a medication or medical test. Hear what they are and discover why this is so important. 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 PLEASE SUPPORT OUR SPONSORS! Grab NordVPN’s Cyber Month Deal! Go to https://nordvpn.com/SOMETHING or use code SOMETHING to get up to 73% off your NordVPN Plan + a bonus gift! We really like The Jordan Harbinger Show! Check out https://jordanharbinger.com/start OR search for it on Apple Podcasts, Spotify or wherever you listen!  Design like a pro with Canva Pro! Get a FREE 45-day extended trial. Visit https://canva.me/something Go to https://FarewayMeatMarket.com promo code: SYSK to get $100 off The Butcher's Holiday Collection and site wide free shipping! Go to https://backcountry.com/sysk to get 15% OFF your first full-priced purchase! Discover matches all the cash back you’ve earned at the end of your first year! Learn more at https://discover.com/match Visit https://ferguson.com for the best in all of your plumping supply needs! https://www.geico.com Bundle your policies and save! It's Geico easy! Learn more about your ad choices. Visit megaphone.fm/adchoices

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You can now make the first move or not. With opening moves, you simply choose a question to be automatically sent to your matches. Then sit back and let your matches start the chat. Download Bumble and try it for yourself. 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. 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 look-alike 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 in 30% of cases, unnecessary treatment are prescribed.

All this today on Something You Should Know. This is an ad for BetterHelp. Welcome to the world. Please, read your personal owner's manual thoroughly. In it, you'll find simple instructions for how to interact with your fellow human beings and how to find happiness and peace of mind. Thank you, and have a nice life. Unfortunately, life doesn't come with an owner's manual.

That's why there's BetterHelp Online Therapy. Connect with a credentialed therapist by phone, video, or online chat. Visit betterhelp.com to learn more. That's betterhelp.com. 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 relieves 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 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. Um, your brain will actually step in and self-medicate itself to make that pain go away rather than change the expectation. Uh, because your brain actually has access to a lot of different drugs on hand, like, 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 the 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 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 on 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 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 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 uh the 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 the 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, um, getting people off of these really addictive drugs. And this is really new stuff.

This is stuff that we're still coming to understand right now. So what do we know about if, let's say you give me a placebo pill for my headache and my headache goes away. 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, it works. Is it wrong to sell them something that doesn't work? That's a great question. I think that's the $2 million question or maybe $10 billion question. It's a very large, the alternative medicine industry is a very large one. It does work. And it is a 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, 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 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 uh 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 is going to make you feel better and this one's a dollar, but this $10 pill is 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, um,

surgeries called sham surgeries tend to work better than injections. So yeah, they're 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. 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, it's a so it's a tough moral question, right? What about the idea that suggestibility is stronger in the presence of others,

meaning, 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 talk to your aunt

and she says, oh, you've got to try this new thing. If you rub salt on your nose, it'll make this thing go away or 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, I did this 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 trick you into thinking – having less pain than you expect.

Well, if you do the same experiment but then you say, oh, by the way, 50 other people did the same thing, and they said it wasn't very painful. 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. This winter, take a trip to Tampa on Porter Airlines. Enjoy the warm Tampa Bay temperatures and warm Porter hospitality on your way there.

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Be careful along our tracks and only make left turns where it's safe to do so. Be alert, be aware, and stay safe. 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, you know, bedside manner. This plays a huge role. And 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 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 expectation, 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 uh in the laboratory uh 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 its self-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 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 where those limits are. So yes, you named a bunch of me of, you know, 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, 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 community of hypnotists or hypnosis scientists as to what exactly is going on with the watches in 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 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 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. And it, so if I am actually low on the hypnotizability scale, so I can't get really, really powerfully hypnotized. Um, you can't, for instance, take, take away my memory. Some people, you can make them forget things if they're very hypnotizable. I can't get that hypnotized, but, um, I can feel some of the lighter effects. And, uh, and if you can get to this stage where your brain is sort of moving slowly, you're, you're, uh'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. 40% of his body was burned. Really, really terrible pain.

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. I said, okay, 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. At Wealthsimple, we're built for whatever you're building. Built for Jane, who wants to break into the housing market. We're built for Ted, who's obsessed with what's happening in the global markets. And built for Celine, who just wants to retire and explore the world's flea markets. So take a moment and think about what you're building for. We've got the financial tools to help make it happen. Wealthsimple. Built for possibilities. Visit wealthsimple.com slash possibilities.

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.

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 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 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 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, 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 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 the fifth question being, and how much does it cost?

Do you think this is a new, relatively new phenomenon 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 dollars every year and at the same time we see that health care costs are rising uh the gdp amount in the us is about to

turn it's about to be around 20 percent of the gdp uh 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 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 that it's up to them they're the doctor but also it seems that there's a problem with, 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 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 silos. 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. And actually, that's what I'm looking at here at Harvard 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 as 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, you know, 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 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 then again I would say like you're maybe not the 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 always said to me like remember every time you operate the patient tell the patient about the risks every risk because you that's one of your duties as a physician to make the patient aware of what he's going to go through right and nobody when i do that to patients like they've never heard about

the complication rates like some of them actually and i have experienced that patient 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 there's no

treatment for that, that you're just going to have to live with it. We can do the tests, but that's probably what's going to happen. But people don't have that expectation. They expect if it hurts, you will fix 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 healthcare needs to also help the patient, you know. Just don't send them on the door and say 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 other options that make this unnecessary. So you got to really, there's so much to, there's so many moving parts. It's up to the patient to keep their eye on it. It is, and it's the responsibility for the physicians also 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. Krister 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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