Something You Should Know - Think You’re Too Smart to Be Scammed? & The Invention That Changed Medicine

Episode Date: October 27, 2025

People who live the longest aren’t always the ones with the “perfect” body weight. In fact, research suggests that being slightly overweight can actually increase your life expectancy. It sounds counterintuitive, but the science may surprise you. Listen as I explain what’s really going on. https://healthland.time.com/2013/01/02/being-overweight-is-linked-to-lower-risk-of-mortality/ Ever since the dawn of the Internet, we’ve been told to guard against hackers — but today’s biggest threat isn’t hacking, it’s scamming. Cybercriminals are more cunning than ever, tricking millions into giving up money and information every day. If you think you are too clever to be taken by cyber-scammers, think again. Eric O’Neill — former FBI undercover operative, national security attorney, and cybersecurity strategist — reveals how modern scams work and how to stop them before they get to you. He’s the author of Spies, Lies, and Cybercrime: Cybersecurity Tactics to Outsmart Hackers and Disarm Scammers (https://amzn.to/4nRvvv1). Imagine medicine without X-rays, CT scans, or MRIs. It’s impossible — these imaging breakthroughs revolutionized how doctors diagnose and treat disease. Yet not long ago, the idea of seeing inside the body without a single incision was pure fantasy. Dr. Daniel K. Sodickson, chief of innovation in radiology at NYU Grossman School of Medicine and author of The Future of Seeing: How Imaging Is Changing Our World (https://amzn.to/3KNz3zS), shares the fascinating story of how imaging transformed modern medicine — and what’s coming next. Sarcasm might seem like just a clever way to joke around but it’s actually good exercise for your brain. Using and understanding sarcasm requires multiple parts of your mind to work together. Listen as I explain why being sarcastic might make you sharper. https://www.hbs.edu/faculty/Pages/item.aspx?num=49283&utm Learn more about your ad choices. Visit megaphone.fm/adchoices

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It's up to you. We'll take the laundry. Rinse, it's time to be great. Today on Something You Should Know, the science behind why many overweight people live longer than thin people. Then the latest cyber scams that victimize millions. Some will amaze you. One of the number one celebrity issues gets impersonated is Brad Pitt. Thousands of people online fall in love with Brad Pitt thinking they're actually talking to the actor

and they're just being scammed by a clever cyber criminal. And of course, they are always asking for money. Also, the benefits of sarcasm and the evolution of imaging, MRIs, CAT scans, and when X-rays took the world by storm. There used to be X-ray machines in shoe stores, and people were invited to come in and look at the bones of their feet, because how cool is that? It took a while for people to put together that extended exposure could be dangerous.

All this today on something you should know. I want to tell you about a podcast I listen to. There's a new episode every weekday, and I believe it can help you uncomplicate the news and better understand what's really going on in the world. It's called On Point. On Point is a rare public space where you hear nuanced explorations of complex topics, live and in real time.

Host Magna Chakrabarty leads provocative conversations that will help make sense of the world with urgency, timeliness, and depth. Each episode is a deeply researched, beautifully produced hour. Listeners will learn, be challenged, and have some fun, too. You can hear episodes of On Point every weekday, wherever you get your podcast. Something You Should Know. Fascinating Intel, the world's top experts, and practical advice you can use in your life. Something You Should Know with Mike Carruthers.

Could it be that overweight people statistically live longer than thin people? Well, that's what we're going to start with today on this episode of Something You Should Know. Hi, welcome, I'm Mike Carruthers, and it's called the obesity paradox, the idea that overweight people live longer than thin people. And this somewhat surprising conclusion comes from a review of over 100,000, previously published research papers connecting body weight and mortality risk among 2.88 million people. Now, this is not a reason to let yourself go. The researchers concluded that it's possible overweight and obese people get better medical care, either because they show symptoms of disease earlier, or because they're screened more regularly because they're at higher risk. There's also some

evidence that heavier people may have better survival during a medical emergency, such as an infection or surgery. If you get pneumonia and lose 15 pounds, it helps to have 15 pounds to spare. And that is something you should know. From the moment we first went online, we've all been warned, protect yourself from hackers, use antivirus software, set up firewalls, be careful what you click. For years, that was solid advice. But the truth is, today's cybercriminals don't just break into your computer. They break into you.

The game has changed, and the old defenses aren't enough. My guest, Eric O'Neill, knows exactly how that works. He's a former FBI undercover operative, turned national security attorney, and cybersecurity strategist. And he is author of a book called Spies, Lies and Cybercrime, Cybersecurity tactics to outsmart hackers and disarmed scammers.

Hey, Eric, welcome to something you should know. Hi, Mike. It's great to be here. I am a fan of the show, so I'm looking forward to our conversation. Great. So I've always wondered, and you would have insight into this, who are these cybercriminals, who are these people that their job is to try to

victimize people, is there like a profile or it's very, very varied? There are many different profiles. And that's a great question. I have said that cyber criminals, and that's who we're focused on here, are the new bank robbers. Why would you ever take a gun and go into a bank with a mask and try to get money from the teller and possibly be arrested, you know, have all sorts of collateral charges, be, you know, high-speed chases, when you can just send an email and make far more money. And that is the reason that cybercrime is right now the fastest growing business on Earth. The criminals are everywhere in every country,

and they're making an enormous astronomical sum of money off of our pain and misfortune. And are these people primarily overseas or not in this country? The largest cybercrime syndicates, the new mafia, the new gangs that we have to worry about today in crime, are primarily overseas. They're overseas because they're in countries typically that don't have extradition. They're in places that don't have developed cybercrime laws. They're in places that look the other way when they attack the West, like Russia or China. And so they're smart about where they base their operations, just like any business is.

And we have to think of them as businesses with verticals and different parts of the business like tech support and help. And, you know, if you get locked by ransomware, they have their help services that will come and help you get unlocked because they want to get paid and they want to continue to launch successful attacks. Are most of the attacks done with the cooperation of the victim? because most people will tell you, I think, I'm way too smart to fall for that. I'm not going to be handing over my information to anybody. I'm way too smart. So is it that they're somehow sneaking into my computer in the dead of night?

Or is it usually with my cooperation? Usually it is with your cooperation. Because it is far more difficult to launch attacks that are computer to computer. We have cybersecurity. Operating systems are built to resist this. It is easy to fool us. And in fact, I was almost breached

how an attacker was able to almost get me just to show that I'm trained to defend against this. But the attackers can be so clever and so deceptive. Even a trained spy hunter could almost fall for it. I remember a few years ago, I got an email from my bank, presumably. they sure looked like my bank and it was so realistic

to the point where I was really paying attention and it was asking me for this information and after a few minutes I thought well wait a minute they should have this information and then I realized this was fake but boy was it realistic and I almost fell for it

and exactly that's the essence of deception you know a good spy but want to gain the trust of their target or their asset, make them believe that a lie is true, and then exploit that in order to steal information. And that's what cyber criminals are doing. And in the case that you mentioned, Mike, what they're doing is they're sending a fishing email that can have broad implications, right? So all of us use banks. And they're sending this fishing email out to everyone hoping that, you know, you are a member of Chase Bank or Citibank. And you see that email and there's usually a pressure situation.

You know, this charge is pending but is going to come into effect if you don't respond. There was a problem with your account, respond now to unlock it, something that suggests you, oh, I better move quickly on this. And the reason for that is they don't want you to think too much. They want you to move quickly and click on the link and open the attachment and that's how they get in. obviously the best thing that anyone can do when you receive an email from something critical like your bank or your health care provider or any finance institution, even social media accounts

because that is a prime target for attackers, is not to open any link or attachment that comes in that email, but to delete the email, go directly to that institution and see if it's true. If you don't see it when you log on the correct way, then it was probably a scam. So when you say that if you click on the link, that's how they get in, what does that mean? So what does it mean to get in and what do they do once they get in? If they're trying to get into your account, often what they will do is provide links that take you to a dummy website. So if I wanted to attack you, I might find out what bank you use, send you that email as though it comes from your bank, and now using AI, it generates emails with perfect grammar,

perfect spelling, and they can even make it look like examples from the bank that would be sent to consumers or to customers. And then when you see the link that you're supposed to click to solve whatever problem they're making you worried about, it will take you to a dummy website, a mock website that they've created that looks like your bank. So, when you put in your username and your password and even your two-factor authentication, they now have access to your account. You've just given it to them.

And just as fast as you're putting it in, they're going on the legitimate website and logging in as you. They do this with medical accounts. They do this with businesses everywhere. And this is one of the primary ways that attackers will try to compromise a business. And once they're in, once they have become you with. in an environment or a computer system or a network, they have access to that network and they can expand their access by compromising other accounts. And against businesses, one of the typical ways that these attackers will make money is to

compromise so many accounts that they can bring it all down with an attack called ransomware, which means they encrypt everything, all the drives that they have access to, so that the data for the business is no longer available. It's encrypted. Without the decryption key, it might as well be completely useless. And then they say, hey, pay us a bunch of money and we'll give you the decryption key and you can have your data back. And if people say, yeah, we have a backup, we'll just restore from backup. They say that's fine, but we've also stolen all your data. And if you don't pay, and this is extortion, we're going to give it to your competitor. We're going to publish it online. We're going to use it to create more

damage. And that can be incredibly persuasive to make businesses pay. So the message we used to hear, which is you need really strong antivirus software, you need a firewall, you need these blocks on your computer to prevent people from getting in. That's really outdated. No, that's been outdated for decades. Now, you do need robust cyber security. And the best cybersecurity right now is looking for what we call anomalies. So it's looking for access points that don't seem right. The number one best thing you can do is turn on two-factor authentication. So don't rely on your password, have something else.

Like that text that comes to your phone or the app you open that gives you the six-digit number that changes every 20 or 30 seconds because that's harder for them to get. They can still fool you into giving them that, but that's an extra step that will save you from 90% of these attacks. If they really want to come after you, though, they will use the hard press. Sometimes it's a combination of email. Now, the new attacks are what they call call centers. They have people who actually sit there and manned phones. So you might get an email from your bank that doesn't give you a link or an attachment. It says, if you see this as a problem, call here, and it gives you a 1-800 number, and you call, and you're talking to someone.

sitting in Singapore, chained to a desk, who's just trying to make enough money to be released, you know, who's been captured by the bad guys. They work on commissions for release. It's indentured servitude. And they're just going to try to scam you by saying, yes, I am your bank. And this is a problem. We need to verify your credit card, something like that, just so they can steal your information and identity. I have some personal experiences I want to ask you about, things that I've encountered.

I'm talking with Eric O'Neill, he's author of the book Spies, Lies and Cybercrime, Cybersecurity Tactics to Outsmart Hackers and Disarmed Scammers. With Amex Platinum, $400 in annual credits for travel and dining means you not only satisfy your travel bug, but your taste buds too. That's the powerful backing of Amex. Conditions apply. Hi there, Fred Greenholt here. Director of audio dramas like DC high-volume Batman.

and Star Trek Khan. However, my one true love remains all things spooky, and I'm excited to say there's a new season of my horror podcast, Undertow. This season is called Familiar Haunts, standalone horror tales that reveal how the past is never truly gone, and humanity may be the most ruthless monster of them all.

Familiar Haunts is available now. Find it by subscribing to Undertoe wherever you get your podcasts, such as the app where you're listening to me right now. Search for Undertoe. So, Eric, I have a couple of examples of things where people have tried to get me, and I don't understand it because it makes no sense. For example, I get calls. Lately, I've been getting calls on my cell phone, and if you do answer it, it's just a recorded message, and it says, I've been trying to reach you, your file is almost

complete, your business loan is ready, but I don't have a business loan with them. I don't. So, I mean, so the premise is false. Who would fall for this? And to what end is this? So that attack right there is what I call a spray and prey smishing attack. So we have phishing, which is typically over email. We have smishing or mishing, which comes over voicemail or text. And what the attackers will do is they go in the dark web and they buy thousands of cell phone numbers and just send this out, right?

send this recording out because they are sending it to a large mass of people just trying to get the hundred of so who tried to open a loan. And sometimes you see this in different ways. Around tax season, it comes from the IRS. Around back to school, it comes from your kids sports team. You didn't pay the fee. Your son or daughter can't play their sport. Around the holidays, we're trying to send your package and there's a problem, can you call us back? All sorts of different ways. And it's just to try to hook the one person who actually did apply for a loan. And they'll be very polite and helpful and find out all your bank account information and then steal from you. And then it says press seven if you want us to remove you from the list. And I think, well, do you press that or

Or does that just say, no, there's a live person there and we'll keep bugging you? Yes. Once you press that button, you're on their list forever. They know that you're a real person. It's a real phone number. So you never want to do that. You simply want to hang up. If you get a call from the IRS, if you get a call from your school, if you get a call

from UPS saying we can't deliver your package, you say thank you, hang up and then call back at the actual number, right? because you want to make sure you're not being scammed. Well, I remember hearing years ago, and I believe it is still true, the IRS will never initiate a contact with you on the phone. It's always in the U.S. mail. So if you get a call from someone that says they're from the IRS about some new thing, it's not the IRS.

Now, maybe they call, you know, back and forth after they've been investigating something. but to initiate anything, the IRS never calls anybody. You're exactly right. And yet, around April in the United States, everyone is getting calls from the IRS because attackers know that most people don't know that. In fact, the FBI last year had to put out a warning that scammers, attackers, were calling people saying that they were the FBI and there was a pending investigation and that they needed information from individuals.

And the longer they can give them to talk, the more information they could get. And the FBI was saying, we won't call you and do that over the phone. You know, we'll show up. So attackers will create these very clever schemes that can be very persuasive to someone who is caught at a weird moment.

So, I mean, the long and the short of it, what you really need to know here is that these cyber attacks are not computations. computer-to-computer. It's not that your computer is on and an attacker is somehow trying to get in through the internet. What they're trying to do is connect with you, create that personal connection that you believe in trust, and then get you to hand over the keys to your data or to your wallet. Just hand it right to them. And some of these attacks don't even use a single bite of data. They're simply over the phone or just with that personal connections,

Confidence schemes like romance fraud or pig butchering can cause incredible emotional and financial damage without ever sending a malicious file. What's romance fraud? So what they'll do is they will seed profiles into dating apps, Facebook, different places where people are going for connection. These are fake people that don't exist, but they'll create an entire backstory for them, right? Like espionage 101, when I worked undercover for the FBI, I had a legend sometimes. It was a complete fake backstory with fake identification so that my true identity wouldn't be exposed. Well, they'll create these things too for someone who doesn't exist, but looks very attracted.

And then spend so much time, sometimes months, talking through this avatar with their target that they fall in love. An older widow met a older gentleman on Facebook, and they took it from just comments on posts to talking on the phone, to sending these long emails. And over the course of a month, she fell in love with him. And then he asked for money. He had some problems with his business.

Could you just send me a quick loan? I'll pay you right back. And it was always that I'm coming up to see you. you know, I'm on hard times. And finally, when he was supposed to come out to see her and he didn't show up, he called her and said, I've been in a car accident and I can't pay. Can you send me another $10,000? She was in for over $100,000 before, you know, that gut instinct said,

this is too good to be true and it's probably not. So it pulls on the heartstrings and it uses a psychology that when we want to believe something is true, we will find a way to make it true. There are cases. People believe, people actually believe, and give thousands of dollars to scammers who impersonate celebrities. You know, one of the number one celebrities who gets impersonated is Brad Pitt, and thousands of people online fall in love with Brad Pitt thinking they're actually talking to the actor. And they're just being scammed by a clever cyber criminal who's using AI, sometimes. AI avatars that move and speak, sometimes just Brad Pitt's voice over AI generated deep bake

voicemails, and of course, plenty of emails. And, you know, the scammer will always using the actor's voice, say something like, I'm really lonely, it's hard to meet people when you're in the spotlight, I really have a connection with you, and of course, for some reason they are always asking for money and they always have some clever way. You know, if I pay, people will know that I'm coming. You need to pay for this plane ticket. Send me some money so I can come out.

I'll pay you back in cash when I see you. It's just incredibly clever. And people hear you say that and they think, come on. How dumb do you have to be that Brad Pitt is saying, I'm so lonely. Like Brad Pitt can't get a date and that he would come to you. and people think, see, I would never fall for any of these things that you're talking about, so I'm good. Yeah, right. Well, you would never fall for it until you do fall for it.

Here's another one I don't fully understand. I see on Facebook sometimes, you know, that thing that says, you know, you might want to be friends with. And there's these, like, really high-profile people like the director of the FBI or, you know, the Secretary of State. and like these people want to be friends with me. Who's doing that? And again, to what? I can imagine the end, but who would fall for, well, I guess I'm answering my own question. People do fall for it.

People, you know, what I try to do on stage in my writing, you know, my weekly newsletter and everything that I do is get people on your podcast, Mike, is to get people to open their eyes, to see the attacks, to recognize. the attack. That's what I call thinking like a spy to recognize the different vectors that people are using to attack you online and the fact that they're trying to do it with deception. And then the idea, of course, is once you can see it, once you have that moment of way this doesn't seem right, then you can act like a spy hunter and do the things, use the tools to defeat the attacker. Well, I've always thought that the trick was to protect yourself against hackers. But as you've pointed out in the last 20 minutes, today it's more scammers. I'm sure hackers are still hacking, but scammers are out there. And then you think, well, you know,

I'm too smart for that scam. Then they come up with another scam that maybe you might fall for. So I appreciate you explaining all this. Eric O'Neill has been my guest. He's a former FBI undercover operative turned national security attorney and cybersecurity strategist. He's author of a book called Spies, Lies and Cybercrime, Cybersecurity Tactics to Outsmart Hackers and Disarmed Scammers. There's a link to his book in the show notes. Eric, thanks for coming on today. Thank you very much. This has been a lot of fun. When they were young, the five members of an elite commando group nicknamed the Stone Wolves raged against the oppressive rule of the Kradarocan Empire, which occupies and dominates

most of the galaxies inhabited planets. The wolves fought for freedom. But they failed, leaving countless corpses in their wake. Defeated and disillusioned, they hung up their guns and went their separate ways, all hoping to find some small bit of peace amidst a universe thick with violence and oppression. Four decades after their heyday, they each try to stay alive and eke out a living, but a friend from the past won't let them move on, and neither will their bitterest enemy. The Stone Wolves is Season 11 of the Galactic Flores. Football League Science Fiction series by author Scott Sigler.

Enjoy it as a standalone story or listen to the entire GFL series beginning with season one, The Rookie. Search for Scott Sigler, S-I-G-L-E-R, wherever you get your podcasts. Hi, I'm Adam Gidwitz, host of Grim, Grimmer, Grimmist. On every episode, we tell a grim fairy tale, not the cute, sweet versions of the fairy tales that your children have heard so many times. No, we tell the real grim fairy tales. They're funny.

They're weird. Sometimes they're a little bit scary. But don't worry, we rate every episode, Grim, Grimmer, or Grimmist. So you, your child, your family can choose the episode that's the right level of scary for you. Tune in to Grim, Grimmer, Grimmist, and our new season, available now. when you hear the word images you probably think of photographs snapshots of people places and moments but images can do much more than capture memories

think x-rays MRIs catscans pictures that let us see inside the human body without ever making a single cut or telescopes and microscopes revealing entire worlds we'd never otherwise see. These kinds of images have transformed medicine, science, and how we understand reality itself. Here to explore this fascinating frontier is Daniel Sauticsson. He is a physicist in medicine

and chief of innovation in radiology at NYU's Grossman School of Medicine, and he's author of a book called The Future of Seeing How Imaging is Changing Our World. Hi, Daniel, welcome to something you should know. Hello, Mike. Thanks for having me. It's a pleasure to speak with you today. So the concept of imaging really encompasses a lot of things, telescopes, microscopes, cameras, MRIs, X-rays. But in your view, when did the history of imaging begin?

Like the 1600s to the beginning of what you might call artificial imaging or human-made imaging. That's when we first figured out how to bend light with lenses and, uh, that bending gave us the gift of magnification. It gave us telescopes and microscopes, and imaging was off to the races. People were utterly fascinated by the views through telescopes and microscopes. It sort of gave us the cosmos and also the microcosmos.

The next milestone is when we figured out how to capture images for posterity, and that was with the development of film, which led to the camera, something that we have in our pockets as we walk around that we use to consume countless hours of video every day. But then, amazingly, there was more. Not only could we see the outside world, but it turns out with a pretty remarkable invention at the end of the

19th century, we could see inside our own bodies as well, and that was with the invention of x-rays, which were sort of light on steroids that could blast their way through previously opaque objects. So how do x-rays work? And if there is a way to explain it easily for a layman to understand how somebody came up with the idea of how can we see inside something that we can't see with a naked eye? Absolutely. And in a way, it is remarkably simple. An x-ray is a shadow picture. So just like when you put a hand up against a light, you sort of see the shadow on the wall. Well, x-rays are light on steroids. They're very powerful light that blasts through many things, but dense things, like bones, for example, block them. And so when you shine an x-ray

source on a body, it leaves darker shadows of things that are denser. And that's what you see when you see the bones, for example, because they're denser than the tissue all around them. What's also remarkable about x-rays, though, is they're what we call a projection. Because as the x-rays blast their way through, they're blocked by anything along their path. So you can see very fine detail left to right, for example. But if the x-ray is passing the x-ray is passing front to back, what you see is a squashed version of everything the x-ray encountered. So it's like taking your body and squashing it flat. And when a doctor takes an x-ray, what are they looking for? Are they looking for what's unusual here? They're looking for normal landmarks, bones being in the

right place, and then they're looking for anything that's out of place, anything that they know from their training doesn't look like what should be in a normal human. And so that could be a growth that might indicate a tumor or that could be a piece of the cartilage in your knee that looks like it's worn away. Or it could be a foreign object like a piece of metal that unfortunately got stuck in you. It would seem that x-rays don't tell us a lot, that they tell us something's there or not there or out of place, but it doesn't tell us too much more than that, or does it? Well, back in the day, when it was first invented, it was utterly transformative because just seeing anything at all inside the body was kind of mind-blowing to people at the time.

That said, you're absolutely correct. These shadow pictures, though they revolutionized medicine in many ways, had many limitations. You couldn't tell front to back, for example, and there were only sort of a range of dense things that were really visible. I would argue that the next kind of glorious era of innovation came when people figured out to do something called tomography, which means slicing through the body but without making a single cut. And the trick there, interestingly enough, was to take lots of different projections from different angles, for example, and piece together what the inside of the body must have been to give all of those different shadows. Almost every other type of medical image that we take, an MRI, a CAT scan, a PET scan, an ultrasound, they all are forms of tomography, of slicing without cutting. and they all operate in one way or another by taking multiple different views and from those different views piecing together what the inside must have been.

So before we get deep into that, going back to x-rays and how transformative they were, but at what point did somebody finally say, well, wait a minute, if we're blasting the body with this light, might we be doing some damage, might be, might there be a risk to this? Yes, what a good question. It took, unfortunately, a little longer than it might have. There used to be x-ray machines in shoe stores, and people were invited to come in and look at the bones of their feet,

because how cool is that, and perhaps it sold shoes. It took a while for people to put together that over time extended exposure could be dangerous. And what is the danger? What is it happening during an X-ray that is potentially dangerous? Well, an X-ray, as it blasts its way through, can interact with tissue. So, for example, it can knock electrons off things and create what are called free radicals in the body, which are very reactive chemical compounds, and they can mess around with things like DNA and cause damage.

It is very important to note, though, because I think people have an inherent fear of radiation that it is now very straightforward to control the doses of radiation that people get in imaging. And there's been a remarkable advancement in reducing radiation doses so that now many imaging exams that use radiation

have less exposure than you might get while you're flying in an airplane. due to cosmic rays. So it's important that people know you shouldn't be avoiding scans for fear of radiation because the scans could also be saving your life. But also, because I remember the advice was

every time you go in to get your teeth clean, they would do an x-ray, and I remember hearing someone say, well, no, that's not necessary. But in fact, there is a fear because it all, right, it all adds up. It's a cumulative thing, and the fewer x-rays you have, the better,

unless there's a reason for it. If there's no reason for it, if we're just doing it for routine, then maybe we don't need to do it. It is true that you need to watch your kind of total lifetime dose. Again, the good thing is we are now in an era where people are aware of that. So what is an MRI? Because, boy, that has become so popular,

and you hear people talking, oh, I've got to get an MRI. and people talk about, oh, they've got to go in this machine and it makes so much noise and I get claustrophobic. But what's going on here? What is that? Well, now you're talking about one of the loves of my life because I am above all a developer of MRI. MRI, first of all, does not use ionizing radiation like x-rays. It generates its projections because, remember,

to create these slices through the body, you need multiple different views or projections. amazingly MRI creates its projections with a magnet. Now, how in the world might you do that? It turns out that inside the nuclei of the atoms of the water in you, there are these little magnets like compass needles, and they tend to point in the direction of a strong magnetic field. And when you bump them with a little radio pulse, they zip around rapidly and generate a signal.

So in other words, believe it or not, inside a magnetic field, we are all living, breathing radio transmitters. So an MRI picks up those radio signals, sorts them out, and creates a map of the water inside your body. And that's the image? That is the image. So the image is a map of the watery tissues and it shows you what is where, unlike an x-ray, rather than showing the bones predominantly, the calcium, the dense things. MRI is specifically sensitive to the soft, squishy things in your body. So it's a very complementary picture.

And that's why MRI is used, for example, to characterize tumors or to look inside cartilage in the knee or to to look, for example, with exquisite and interesting detail in the brain. And is it 100% accurate? Do people ever look at an MRI and then open somebody up and go, ooh, I wasn't expecting that or they know exactly what they're going to get? Well, this raises an interesting general question about imaging, which is what do you mean by accurate? Every image is in some ways an approximation of the real thing. It's like a photograph, A photograph has a certain resolution, it has a certain color palette, which may or may not be accurate. So MRI likewise is a representation of the internal structures.

There are certainly things that can be missed. There are certainly artifacts, as we call them. There are sort of stray signals that can be misinterpreted. That's why radiologists train so hard to develop their expertise. But that said, modern MRIs can have exquisite detail, and if they are interpreted properly, basically if they're read by somebody who understands how the image is made and what's supposed to be bright and what's supposed to be dark, they can reveal all kinds of both normal and abnormal things.

Whenever anybody gets an MRI or a CAT scan, I'd like to know what the difference between those two terms is. But before we get to that, and you ask the technician, you know, how does it look? They say, well, you know, you got to talk to the doctor. The doctor's got to see it. I can't tell you. But he could tell me. He's doing this all day long. He or she knows whether it looks right or it looks wrong, right? Often experienced technologists will have a sense, but the interpretation of images is a tricky business. There are different types of anomalies that can look very much the same on an MRI. Imagine if you're taking a black and white photo, it's going to be very hard to tell apart

a set of balls, for example, that are painted different colors. There's sort of an analogy with medical imaging. So in some ways for somebody to call right on the spot what they think is going on without incorporating the context of you, of what your medical history is, what the questions are, that could be irresponsible. And that's why they do it. It's not that they're, you know, covering themselves or anything like that. It's that really these images need to be interpreted in context. What is the image, because I've never had an MRI? Well, I guess I have had an MRI. Yeah, I remember being in that machine, but I don't remember the image. It's, is it,

What does it look like? Does it look like a picture? Is it in color? What is it? In its raw form, it's in black and white or shades of gray, although it can be colorized in any way. And to somebody who hasn't looked at a lot of anatomy, it's almost like an abstract painting of curving shapes with interrupting dots and curvy lines. it basically, well, and I can tell you, many people are familiar now with images of the brain, right? You see them in newspaper articles about medical discoveries and so on. So what does that look like? That looks like this orb, which has all these little sort of bright curly cues in it that are showing the folds of your brain. That's what an MRI image looks like.

And what's the difference between an MRI and a CAT scan? Remember, tomography is looking from different views at a body. Basically, a CAT scan, it does that with x-rays. Cat stands for computed tomography. An MRI does it with magnets. So they're both tubes that you'll roll into, but in one case, there's an X-ray source that's shining, on you and zipping around your body to capture all the different angles, in another case,

the inside of the tube for MRI is really the magnet and the radio transmitter is that you need in order to create and detect the signal. And why would you use one and not the other? Well, a CAT scan tends to be exquisitely sensitive to dense tissues like bone. So you might use it to look for breaks in a bone or calcium deposits in the heart, which might indicate that one of your coronary arteries is having an issue, whereas MRI you would use to characterize soft tissues like tumors growing in places they shouldn't. Cat scans also tend to be very, very fast, so they're often used in an emergency room to get a quick look. MRI scans can take a little longer, but they tend to be used when you really want to characterize the details of a tissue

carefully. And why is it so loud? This is one of the most persistent and very good questions that everybody has about MRI. So remember how I said that you need different views in order to generate this slice, that is the MRI image. each time you change views you need to change the distribution of magnetic fields a little bit and to generate a magnetic field that changes like that you need to run current in a wire well when you run current in a wire inside a strong magnet like the MRI machine that creates a force so that wire goes sort of clunk so the buzzing and the humming that you hear inside the MRI machine

amazingly is a whole bunch of little clunks that go together very fast fast. So thump, dunk, thump, da-da-da-da-da-da-k, me, me, me, me. That was me speeding up the thunks until you get the characteristic sort of pounding, buzzing noise of an MRI machine. So that's never going to fix itself. There's never going to be a quiet MRI machine, it seems. Oh, believe me, so many people are trying. Really? Yeah. There are all kinds of ways to change the sequence of views that you're gathering. So it's a little bit quiet. or to try to muffle things mechanically. It is inherent to the process of generating the image,

but definitely things can get quieter. And one interesting thing is, nowadays, even though the trend has been to go to stronger and stronger magnets to get clearer and clearer pictures, there's been an interesting trend to develop weaker and weaker magnets that are cheaper and more accessible so that more people can get an MRI. Those types of machines could be very quiet indeed.

An MRI machine, I mean, I have no idea what it costs, but it must be really expensive. It is starting at a million dollars and going up. Wow. Can we briefly talk about the microscope because we haven't, we've been talking about medical imaging, but the microscope had to have been just like outrageously innovative. It certainly was. to people back in the 17th century, it was completely like magic.

You took this strange tube, you trained it on a drop of water, and you discovered that there was a whole invisible world inside that water drop that nobody had ever imagined. And so, in fact, microscopes were some of the origin of microbiology, of the study of all kinds of organisms that we now take for granted

and are associated with disease or with life in general. And that's kind of a general trend. Every time a new imaging tool has come along, it has created new science, new discoveries, new ways of life. Well, and the same thing must have happened when somebody feels. figured out and made a telescope and looked up at the stars and the planets and the heavens and thought, oh my God, we had no idea. Absolutely.

In fact, the view through telescopes is credited in some circles as driving the Copernican Revolution. The notion that there were bodies out there that behaved according to certain rules, well, that came from observations through telescopes, which gave us this brand new view of the heavens. Well, it is such a great story, and you can't really even begin to imagine the impact that medical imaging in particular has had on health and longevity and saving people's lives. I've been speaking with Daniel Sauticsson. He is a physicist in medicine and chief of innovation and radiology at NYU's Grossman School of Medicine, and he is author of a book called

The Future of Seeing how imaging is changing our world. And there's a link to that book in the show notes. Daniel, great. Thank you. Thanks for being here. Well, thank you so much for having me, Mike. I very much enjoyed our conversation. Did you know that sarcasm can be good for you? Studies show it serves two main purposes. First, to soften criticism through humor and second, to create a sense of connection.

Understanding sarcasm is surprisingly complex. It requires several parts of the brain to work together to detect tone, context, and intent. Using and interpreting sarcasm can even give your creativity a temporary boost because it engages abstract thinking. People who use sarcasm often tend to have strong verbal and social intelligence, though it's not a direct measure of IQ. Interestingly, research suggests that adults and children alike can appreciate sarcastic humor. Kids typically start to understand it between ages six and eight.

Cultural factors also play a role. In some regions or within some groups, sarcasm is seen as clever banter. In others, it comes across as just plain rude. And that is something you should know. I know you know someone who would enjoy this podcast as much as you do, so please share it, tell them about it, and ask them to give a listen. Kerruthers, thanks for listening today to something you should know. I'm often asked, as you might imagine, what podcast do I listen to? And I actually have an eclectic taste, and I jump around, try different ones. But I will say that I have a couple I'm very consistent about, and one of them is the Jordan

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