Diagnosis

you're listening to radio lab from public radio wnyc and npr what we have over the criminal is the criminal actually thinks he's destroyed all the evidence it's never all destroyed ever ever ever this is lu garcia i recently retired from the university fire department as the chief fire marshal so i've spent 25 years of my life looking at fires investigating the causes of fire how many fires do you think you've seen tens of thousands of fires you've seen tens of thousands you yourself yeah when he tells me a story there was a true story i'm not gonna get too many details about it but there was a fire in an area of new york city it was an apartment building in the south front as i pulled up this building the fire was already over when lu got there were people in the street and we're questioning people people are saying well in the apartment where the fire was there was this brave guy somehow he got in there and he's pouring water trying to get the fire out this guy was really something no and he's and he's a hero right now everybody's telling where he is everything they were saying in the street about this man was wrong so he walks into the apartment he looks around he knows right away where the fire started now how well how well you just look at the fire pattern and you could tell that the fire started first of all in the bedroom with a mattress mattress mattress now mattress go up if you put a match to it really don't you have to put a gasoline on the mattress no no no you just put a match onto a match mattress and it'll catch fire yes if you hold that one and he also knew that the mattress had been placed upright against the wall you tell by the fire pattern was standing on it wow he didn't even know what position the mattress was in yes absolutely believe me so he meets the woman who's apartment business she shows up and he says so do you know this fellow who was putting up the fire yes as a matter of fact i do it just so happens that he used to live with me but i kicked him out and he still had a key by the way and she now says i have a new boyfriend so garcia naturally goes and finds the hero so now i'm questioning this fellow i said by the way did you buy that mattress and he said yes i did and you weren't sleeping anymore was someone else sleeping in the mattress in your place and he said yeah she had a boyfriend i said boy i'd be pissed how much of the question like four or five hundred dollars he said no more than that was like eight hundred all i said so now she's screwing somebody else on the mattress you bought i would be pissed i said you know if it was me if i were in your place i would want that mattress to burn i would probably stand it out in i would take matches matches and i would put it to the mattress that's what i would do and in fact i'm an expert on fires and i know that's what you did you really did you can talk about it i don't blame you i mean at least you try to put it out that'll work in your favor in court and he looks at me he says well you're not so smart i said why he goes i use the lighter okay so that was an easy one we're gonna have some hard ones coming up your point is the whole hour we're gonna be addressing the same problem we'll walk into one situation after another and discover that something is not right here that's right something's not right with my son what do i do something's not right with my pancreas what do i do something's not right with the very phrase something's not right because it presumes i know what's right maybe i don't have we confused you enough well there's a whole lot of abnormal things coming your way this is reading lab i'm jab umrod and i'm robert kohl stay with us okay so this first story is about uh delivering a diagnosis comes to us from producer luokowski it's about two doctors start with that phrase something's not right here and end up going on a crazy adventure after a cure for a deadly disease what is that pancreatic cancer oh that's not that it is like the most deadly cancer this is the one that people nightmares about why you mean it's deadly how like well it's rare but it's deadly it's the one where you know you something's wrong you go to the doctor and they say you have six months to live wow is it that fast it usually is that fast how do you find this out i found this out because my friend amy um said i've got a friend named dr terry brenton she made a big scientific discovery and you should go to the press conference this will be amazing like go and i go to the press conference it's just a tremendous pleasure to be here today like press conferences are kind of never amazing i hope to unfold a story for you i hope it will capture your attention but it's a fascinating story and i heard this incredible story about 10 years ago uh one morning a 40 year old guy came into my clinic mr x very healthy looking and he comes into my clinic and he says i'm worried i'm gonna get pancreatic cancer that i'm gonna get the curse of my family i was like good gooby what are you talking about and he said well in my family my father got pancreatic cancer my grandfather and my four uncles and my three cousins well four uncles three cousins father grandfather all die of pancreatic cancer and this guy was sure he was next in line his uncles and his father look like the healthiest people in the world six months later they're dead he was terrified he came to me as a act of desperation i mean it's not a feeling i guess that maybe i know or you know but what happened when he walked in like terry she knew exactly how he felt you can't even process anything you're just like almost in a trance she'd gone through that before completely and utterly alone she was diagnosed with breast cancer when she was 34 it's a sense of falling it's truly a sense of falling the world slides away from you literally it's almost like it disappears from underneath you when she got the news the first thing her doctor did he was a friend of hers he pulled out the whiskey and put it on the table and we each had a shot which i was like thank god he did that then he said i'm not gonna quit on you we're gonna fight this thing you were not alone that's all i needed to hear and so when she was sitting there with patient x you know exactly what to say you have to step forward you can't step back you have to step forward i was young then and so i felt look i can fix this thing i'll take that on i can help you i don't care how horrible it sounds what happens next so terry runs back to her office help you an office she shares with another doctor mary brown i'm mary browner i'm a pathologist i was like mary mary says you won't believe this this guy mr x walk in my office and he has this outrageous crazy family history it's a horrible problem i was floored terry had never heard that pancreatic cancer could be inherited in families but never heard of anything like that terry comes in and she's like i gotta help this guy i have to figure out what's making these people sick and mary i need your help and mary what did she say well she's a pathologist so and what does it mean to be a pathologist well she's she's a person who physically does the diagnosis when your surgeon does an operation on you or your internist takes a biopsy of you they send that tissue to me and i make it into glass slides to look at under the microscope so she spends her time looking at tiny pieces of terry's patients smeared on little slides i i love the emotional distance that you have in pathology you're you know a step removed from the misery and it makes it so much easier for me to handle it does she interact with patients almost never uh terry was right up against the misery and uh she was just relaying the story to me but i can sit very comfortably at my microscope and be very objective and just look at the tissue and decide where the cancer is because i don't know these patients so you're like i gotta do this come with me as she usually does how did you decide that mary should join you she's my science partner that's it and i have in the car so they decided in order to help this guy they need to go to where his family is we drove across the mountains of washington state they want to get the family together draw their blood look at their blood to see if there's something in there that's making all these people sick and we arrive at the little tiny town in eastern washington's little town called elmo and they didn't even have they're so small they don't have a single medical facility so in order to do the blood draw we basically had to use the subway sandwich shop in town why subway one of the family members worked there and asked the boss if the family could all come and these doctors could come and draw their blood and could we use the shop as the meeting place all i remember was walking in and thinking this is small so we've set up a little corner booth with our box of blood drawing supplies and they sort of came in waves uncles cousins nieces nephews and they brought their kids that's always there it was funny because they hadn't seen each other in a long time they're like oh my god i haven't seen you in 10 years i was like wow you guys only live like five miles a day we'd bring them over to our little tiny booth and we'd introduce ourselves i'm terry gretnell i'm mary braunner g.i. doctor i'm a surgical pathologist the purpose of our work today is that we are trying to find the cancer gene that causes the disease in your family with your permission today i would like to take a small blood sample it's about the size of two tablespoons you will not get any results back from this blood test i want to be really clear about that it's all for us to try and find the gene i can't even promise that we'll definitely find the gene here's your sandwich and now may i have some blood as we were waiting for most of the family to show up terry and i were sitting in this one booth with one of the family members who we'd already identified as having the disease he was young he was in his 30s and all i could think was you have a time bomb inside your body and then this little boy comes running into the subway sandwich shop just like runs up to this guy that we're talking to this patient the family acts throws his arms around his daddy's neck and kisses him and and and all i could think was oh my god this beautiful little child he has 50 chance of having this hideous disease and i was so upset about that i was just so torn apart inside but i couldn't really you know start bawling right there that wouldn't have been professional i held it together until we were driving home and and i was telling terry how sad i was about that little boy and how it just really hit me and she said oh him don't worry about him he's adopted we have to remember mary doesn't come face to face with patients very often it's not something a pathologist does very frequently pathologists have a i don't even know if i want to tell you this it's sort of like the the black side of pathology black humor to get you through it yeah really black humor you know we'll say things like um somebody better tell this patient not to buy the big two with toothpaste terry's laughing but that's why we do it because it's so horrible i spent an afternoon with mary going through slides looking at pancreatic tissue trying to figure out like you know if this person has cancer or not dozens of patients now this is another case with a terrible terrible and that's when i really kind of got it like why do you want to keep herself distant oh this cancer is even worse than the last one this person if they can should go to a beautiful place on planet earth and just stay there till it's over what happened after subway though i mean were they able to you know figure out what's causing this thing well once i got the blood they worked on it for about five years five years you know they went chromosome by chromosome collaborated with all these other researchers and at the end of the day they discovered that the thing that causes familial pancreatic cancer comes down to a mistake one little mistake on one one molecule one one tiny molecule yes so our discovery is uh we're titling it paladin mutation causes familial pancreatic cancer and suggests a new cancer mechanism so they write a paper and have a press conference and they celebrate so in the end do they find a cure no no no no they're working on it can they at least um test for it now well they can test but what you know most pancreatic cancer isn't hereditary like this this is actually a small subset so where does that leave mary and terry i mean where are they now mary's really glad that the research phase is over and that she doesn't have to be with patients anymore terry knows they have more work to do and they can't really give up but she's really tired and thinks about it a lot you know the stakes are so high in this sometimes it's almost unbearable sometimes i think i should quit really yeah totally i've talked to mary about it but you know what i know she'll never stop doing it right terry sometimes it's just too much mary and i love to garden so sometimes you know we think about being landscape architects and then the worst thing that does is oh i killed the bush they were like you loser you killed the bush thanks a little kelsey for recording that story the next story concerns a dad a little boy there's something about this little boy that is not quite right but there's something about the dad that doesn't want to say so that's coming up in about a minute i'm jad abumrad and i'm a coach radio lab will continue radio lab is funded in part by the alfred p sloan foundation the corporation for public broadcasting and the national science foundation the federal emergency management agency is fighting for its life i've never been a big fan of fema who knows who get the job done you think it was a disaster people are waking up in groves to the fema camps how did the agency tasked with saving us become so distrusted and despised listen to american emergency the movement to kill fema on this week's on the media from wnyc find on the media wherever you get your podcasts hey i'm jad abumrad and i'm robert this is radio lab this hour our topic is diagnosis this next story begins with a dad two sons and a question what do you do when you notice somebody's different i heard it from reporter gregory water hello hi gregory for everyone nice to meet you nice to meet you in case just so you know it took me over a year to finally get an interview with byron crown yeah he's the dad in this story and i'm up in his market in the south west are you just are you moving out or are you well it might look like that it was that messy yeah boxes everywhere craze piles of stuff okay don't worry about it are you sure yeah it's in disarray there who's who is this guy i uh i'm a retired electrical engineer he worked for subway most of his life now i consider myself a science researcher and at 71 years old he's basically teaching himself quantum physics that's what all the books and stuff you see around i love that stuff and he's written this book called einstein's era criticizing special relativity einstein i sent it to the new york academy of science caltech m.it harvey steven hawkins still waiting for him to get back most people just ignore him but then he points to this letter on the wall from neil degrasse tyson this major scientist the head of the hayden plantarium exactly yeah and it says how dare you you're just an engineer and he's being why why do you smile when when you talk about that letter from neil degrasse tyson because i know how foolish it is einstein they didn't even want to read his paper he said who is this guy upscott he's just a patent determination clerk in burn byron burners is a man who's proud to go against the grain what other people do i don't really do and that's especially true with how he raised his son so now uh gregory you're going to do uh some kind of a story on emmanuel his youngest son right okay and that's why i'm here to question him about how he raised his son all right i'd be glad to okay great so here's emmanuel hi i'm emmanuel browner man could you take a drink of water for me thank you no don't take me yeah he's 28 so what things are you um writing essays and making sure they are grammatically correct bowling and it's you can hear analyzing stuff there is something going on um and and and not talking that much yes no if you ask that he'll say emmanuel's an excellent student a future nobelist he's gonna win a nobel prize we never know but if you ask blair i'm blair frowder who's that emmanuel's half-brother i'm about 20 years older than emmanuel he'll tell you that even as a little kid like five years old it was something odd and i just didn't know what it was a bunch of little things like he'd look at you really weird kind of like a doll face expression he could stare at me without blinking for 15 minutes at a time and i would notice you didn't blink once then there was a speech i did not talk as much as other people there was something going on with emmanuel but i did not have a word for it and so i pushed several times to get speech therapy but every time he did dad would just say are you kidding he may have trouble stumbling and stammering but he'll grow out of it i i studied too blair you also studied einstein he didn't speak a word till he was six he was considered retarded in school he would say that this was some uh temporary problem that would pass i didn't see anything that was that was screaming out for attention he was doing his work he was interested in the mix we would go out endlessly in cold weather to the park and it seemed like things were okay what about emmanuel well i knew that i was a nicer person a nicer person yeah and that i was sensitive and i don't automatically look at people in the eyes the face and stuff you know so as long as emmanuel was a little kid this wasn't such a big deal but then he got older he was around 10 years old and it was i think at the point where um other people would point it out what did they say well i have been called um retarded and idiot savant the end word and stuff they they lost the innocence of the elementary school emmanuel would come home with bruises on his arms yeah yeah it was something that i constantly thought about and worried about i said yeah well it would be really good for him to get professional help with that if you asked dad he said the problem wasn't emmanuel no it was all the other people the bullies the uh the group in this neighborhood it was hard there was fighting constant fighting right down the street over here people involved with crack these are big guys you know i thought that it could have been a dangerous situation so his solution i decided that i wanted to teach emmanuel home school which is to pull his son out of school yeah and how do you feel about this at the time well i i really didn't know up here so we're looking in the closet here i thought that whatever way he just kind of turned in this is a binder from one of his classes that if he got bullied and tormented and going to school that it would turn him further in let's see what this is that if he were here he could develop along his own line till he became old enough that they wouldn't want to pick on him oh look what we turned to nature nurture it was a big deal for dad you uh hadn't homeschooled anybody else before right no i had to get books i had to go meet the principal he left his job submitted a curriculum to the school and i had to register with the state of new york created this syllabus for his son grade 10 integrated math course and then we wake up each morning rational numbers geometry do their lessons this is the work that he did at home and in the afternoon they go bowling bowling emmanuel was an awesome bowler his dad would videotape him today is um tuesday december 28th it's weird footage it's weird to watch because emmanuel is such an incredibly good bowler yeah check it out but he's always by himself tape after tape of nothing but emmanuel nobody else in the picture i would fan decides about throwing on a tour and winning some titles and stuff did you think about joining any youth league or something well i kind of well i vaguely thought about it but um but for some reason my dad uh did not want me to i think you swung out i think so meanwhile his brother is just blair's in canada at a distance yeah he followed a girl there and one day he picks a book off the shelf the dsm and the dsm is the uh diagnostic statistical manual of mental disorders and i started to do i guess what a lot of people would do who could get a hold of this thing is to start diagnosing all of their friends i diagnosed my girlfriend i diagnosed my dad and then i saw right there on the page marks impairment the use of multiple non-verbal behaviors such as eye-to-eye gaze repetitive behavior patterns problems seeking new friends problems being able to understand what someone must be thinking problems i put down this whole list and everything seemed to fit the problem is every time he tried to call his dad dad what do you think his dad would say stop waiting he'll just go through this and he shut him out we basically cut communication i know my son he wouldn't always tell me that whenever i had would go away when i was an adult what does an adult mean does that mean 18 um 20 maybe 20 must say okay so you thought as soon as i reach the age of 20 then i won't have these problems yeah so did you wake up on your 20th birthday and think i thought that maybe things would change right away but they didn't after that emmanuel says he got really depressed and that's how things might have stayed until dad had a heart attack blair comes to the hospital finds dad unconscious on the bed and he realizes this is my big chance because he was not in a position to intervene and you're thinking i'm thinking the first thing that's going to happen is that we're going to get a diagnosis because we're waiting for it for so many years 26 or older or whatever i think i was like 25 maybe he's going to get help you know he has to help new year's eve 2005 so where are we coming into now we're at 42nd street times square times square is one of emmanuel's favorite areas to hang out and uh i figured i went to be of his surf so they're outside the crowd is just beginning to arrive it was starting to snow a little bit and rain sometimes yeah and blair turns to emmanuel and he says um have you ever heard of autism i said i i highly suspect that you have some form of autism and i want us to find some way for you to get a diagnosis oh and i said don't be aware that's the dad doctor how do i pronounce your name and pretty soon after new year's and where are you from emmanuel gets his diagnosis he was right here on this couch i did get a feeling from my beginning of the interaction that he was going to meet right here for autism and a month later she told me that i was on the autistic spectrum it was official and so at the age of 26 finally his life completely changed so i get my tape recorder to record his life hello it's me emmanuel he's meeting with a speech pathologist a couple of hours a week also he's doing this program adaptations and started making friends hello hey jason peace out he's got a girlfriend hey it's me emmanuel once again and there's one lady that i haven't talked about it named norma and we went to central park and we took pictures and it was great i thought that people who diagnosed with autism don't that's the definition they don't want to socialize well it's not because i don't want to but it's just hard to do you know but here's the thing about emmanuel he's had his whole new life he hasn't told that about any of it about anything not the girl the friends the diagnosis his dad doesn't know anything's different so how long have you been keeping it a secret oh it's been since 2005 right yeah so basically for the last two years emmanuel's been leading this double life outside he's a person with autism then he comes home nothing's wrong why well i'm just afraid that then he won't um really um believe it he knows he's got to tell his dad who he really is yes i do and he keeps saying he will i'm gonna say within a month soon i'm not quite sure um i am a little bit nervous about telling him maybe within a few minutes or so let me tell him in like two weeks or so another day or so i might have to tell him after i meet blair i'm gonna probably tell him well tomorrow uh maybe i don't know yet maybe i'm just thinking about it could only be too much i don't know and then finally one night hi it's me um i just want to say that i told my dad about my diagnosis um i said i really have something important to say and don't get angry and then i told him that i was diagnosed with asperger's syndrome and they asked me what it was and then i told him it is high functioning autism i i i was shocked that would that would be a good way to put it so do you think he has asperger's yes yes i i do when i look at this syndrome for a lot of good parts of it it's emmanuel but i never at any point felt that that emmanuel was in need of any deep psychological or psychiatric help but i mean what makes you qualified to say that just being a loving parent as i'm talking to him we're sitting there on the couch in front of us on the coffee table is all of emmanuel's notebooks from age five onward and they're really good stuff i mean it's stuff that you and i would write and you saved it all but the question that i feel like i gotta ask is um now that you know that there is something wrong with your son that there always was this disorder that it's incurable do you think you did the right thing so do you wish that he had gotten the diagnosis earlier no why because i think that he's better off at this point in time why wouldn't it make a difference to know earlier what's why you're acting so strangely i didn't want emmanuel to get a diagnosis that would put him in a box like a label and then dad says to me look i mean if i'd let the school give him some kind of diagnosis they would have thrown him in special ed and say oh he's a retard look he can't even talk i mean that would have destroyed him it would cause irreparable damage i asked the doctor was there any truth to that if emmanuel was put into special ed hypothetically if he was in district 7-5 class the technical word for special ed just to put that in perspective emmanuel comes from a neighborhood where about 10% of the kids ever graduate college and my gpa was like 3.4 and change wow and he's got asperger's so now what we're kind of in the opposite we're kind of vindicating really what his father did right well in terms of his academic achievement his father did the right thing the problem with his dad's choice and he had no way of knowing at the time was the lack of peer groups which he would have done it seems like a cruel choice but it's a cruel choice so if you were your father and you were raising your kid at that time would you have made the same choice he did uh well well if i had known what i know now then maybe i would have maybe begged him a little more for me to interact with others who were like i am who are like i am a story from our correspondent gregory winner great supporting was made possible in part by the rosalyn carter fellowship for mental health journalism thanks to them and thank you to lulu miller for producing that piece we will continue in a moment this is bonnie calling from boston massachusetts radio lab is supported in part by the national science foundation and by the alfred p sloan foundation enhancing public understanding of science and technology in the modern world more information about sloan at www.sloan.org hello i'm jad abumran and i'm robert krol this is radio lab this hour we're talking about diagnosis diagnosis the easy kind we're not going to talk about it easy would be you come into my office and i'm a doctor you have a broken arm i take a picture i say hey you've got a broken arm the picture says so yeah you can see the break right there but let's suppose you came into my office and you were sad you tell me that your sex drive is down hey i'm the doctor so it's just between you and me well right away my learning tells me that you may be a candidate for depression but how do i know that you're depressed what do you mean how do we know we talked about it you just said well you can't measure sadness or depression you can't go to a test tube and count anything right it's not hard science yeah because until now what if i put you in one of those fmri machines that we talk about so often i snap a picture of your brain in action and i look at it and from your picture i say you are depressed you're going to tell me i'm depressed just from looking at a picture of my brain yes what no way look it's now here photographic diagnosis of mental illness this is happening there's no question and that by the way is eric kandel professor of clump university who just happens to have won the nobel prize for medicine let me give you a little historical did you get a nobel i don't think you did i still don't believe you no no you're not so let's do this step by step okay step one imagine you're slipping into an fmri machine okay now i want you to just look at my face why is that so difficult no i just want to know what this is doing okay i'm looking at your face so now that you're looking at my face different regions of the brain they become active there are cells in your brain that are saying i know him the cells are more active they need energy just like when you run you have to breathe fast and to get the energy you'll have possible more blood the body sends a rush of fresh blood to that particular group of cells and because the blood has iron in it the magnet in the brain scanner can see the iron and therefore see the blood flow and take pictures of it many many pictures in real time i'll show you a very nice example of this eric's now heading off across his ample office with an extraordinary view of the hudson valley and he led over a picture of a human brain with different colors in different areas and he told you when you look at a face when you image the face this area lights up you're pointing to the area the area of the brain on your forehead kind of that's right if you look at a house some other area lights up but this area does not light up you look at another face this area lights up again every time you see a face same area yep but you haven't told me anything about emotions yet that's true so let's move on to step two because we use faces to tell what someone else is thinking or someone else is feeling step three okay i'm going to take you now to london hello hi yeah hi hey who's this oh really sorry who are you i'm cynthia if you're my psychiatrist at the institute of psychiatry king's college london and are you like in your 30s or your 40s or your 50s is this part of the interview i want to like rude no no i want to establish that she came into psychiatry trying to think when did i graduate medical school at a very critical time i finished my training in 97 my training in psychiatry in 97 that's 1997 when the fmri machines were first becoming available and so cynthia was able to do a rather amazing study what in this study she got together a group of people who were clinically depressed and then another group of people who were normal and she put them in the brain scan machine and showed them facial expressions faces ranging from more neutral expressions to more sound expressions so they saw a sad face and then a neutral face and then a sad face that's right and what the person in the machine was supposed to do is look at these faces and decide whether it was a man or woman's face huh where'd that do anything because because while they were doing that while they're making the decision the emotion of the face is being processed automatically the amygdala sees the emotion on the faces at that moment and the machine it's like there were hundreds of pictures 10th of a second 10th of a second 10th of a second that's right did you see a difference between the people who were depressed and the people who were normal yes was it a significant difference or just barely difference as a group it was a significant difference and now she takes the big step step four from the pattern she sees in bunches of people she feeds all those patterns into a computer it's called machine learning told the program this is a pattern of brain activity in depressed people this is a pattern of brain activity in healthy people and then she shows the computer a brain scan of a new person so this is someone the computer's never met before exactly and she did this a bunch of time a whole bunch of people and each time the computer tries to guess is this new person depressed or not oh and what happened more than 85 percent of the time 86 percent of the time the algorithm correctly diagnosed whether that person was depressed or healthy was just a brain scan a computer and a patient no doctor needed cynthia's computer got the diagnosis right 86 percent of the time a computer we saw the results like wow this is amazing wait a second has she repeated this well this is actually the very first time that this has been done with depression and so it's just a pilot study and like you say someone else will have to do it again and again and again but according to cynthia the potential is fantastic it's a client who's going to be absolutely revolutionary i think this method can be applied to any psychiatric disorder any autism schizophrenia obsessive compulsive disorder no way come on why not every one of these illnesses ultimately must have an anatomical basis every one of these illnesses so this means that it will soon or one day be possible for a patient to come in and you take a picture of him in real time of her and you will have a diagnostic tool that's what you're saying absolutely absolutely absolutely you mean to tell me but they're going to put people in machines and just go boop no no wait wait this is not a casual thing you go to the doctor you tell the doctor that you're feeling a certain way the doctor will talk to you and then he would come to say well my learning and the test tells me that you're ill there's nothing in this that feels um invasive to you well obviously it's tunneling into the deep depths of your personhood no this is if you believe that mental illness is a mental illness it is a structural condition which can be fixed so it's not the deep inner you it's the broken you so it's like the broken arm you started off with that so you would put the two side by side i think i would and then of course you get to the no come on i mean human beings are way too messy for that you're too messy for it to be that easy no no so you think this is out of science's reach really it's just too there's a part of me that does think it is out of science i think it's because you think you think that they're looking deep inside you that's what you don't like i do i mean don't be wrong i find brain scans fascinating when it comes to questions like where is the soul what is consciousness that kind of stuff but don't kind of get in my head and tell me what's right and what's wrong what if you're feeling sad and sick don't you want to get better yes but i enjoy the comfortable ambiguity that would come from a situation like sitting in a therapist's office and saying well i'm feeling this way or that way and in the messiness of trying to describe how you're feeling there's a vast landscape of things that can happen choices you can make therapy let's say you are sick and you know that you're sick machine or no okay if you are feeling badly wouldn't it be nice if a machine could help you find the right kind of help what do you mean well i took me through a little thought experiment a mind experiment you've developed a psychotherapy and i've developed the psychotherapy we each claim it's the best in the world now we have an objective way of seeing this machine allows you to independently of any evaluation see the outcome of treatment so you can audit the doctor audit the doctor and give you evidence that it's working or no okay i think i'm a little bit on board i can give you 10 percent by now okay so how far off is this stuff is it going to come soon this is very early in the game obviously i can ask you like how far into the future are we talking about here soon or long after you're dead i'm going to be around a long time but the question stands will you make it to see that people actually have you know one can't in medicine in all honesty give a timeline for many of these things imaging methodology right now is quite sophisticated but it's still primitive compared to where it needs to be you're picking this up in status descendant you become excited as the thing is beginning to emerge we see it for the first time on the horizon you're saying we got to the story too early just right it's not going to be interesting 20 years or in 20 years it'll be obvious that we were wrong okay that's a real possibility because what we don't know is vast and i want to tell you a story now about just how wrong people can be begins with a mystery sudden infant death syndrome perfectly healthy child goes to sleep and dies during the night it's about the worst thing that can happen to a parent and each year it does happen about 7000 times still no one knows why oh and by the way that was robert spolsky he's a professor of neuroscience at stanford university and the spolsky tells this story of the moment sids was diagnosed for the first time or at least classified and a terrible mistake that was made around 1900 or so people were being recognized this is a disease entity and nobody knew what was up so people decided let's go dissect sids kids meaning when a baby would die they would perform an autopsy exactly you know check babies inside see if there's anything different in them from normal kids that seems logical absolutely they measure the size of the baby's lungs not normally they measure the size of the heart that's strange there stomach kidney liver was all fine then they would look in the throat they look in there and they say oh my god these sids kids they have enormous thymus glands the thymus the thymus what is the thymus wonder well it is a little tiny pink gland that is right here right behind your collar at the base of your throat and its job is to help you fight disease makes one type of cell critical to your immune system especially in times of stress in any case normally this little organ is about the size of a tiny tube of toothpaste but in these sids kids it was huge enormous twice the size exactly and since the thymus is dangerously close to the windpipe doctors came up with a hypothesis a perfectly reasonable hypothesis which was that maybe if you're one of these babies with an enlarged thymus in your sleep and somehow you roll over wrong uh-huh well that gland might press down on your trachea and suffocate you during the night oh so medical mystery solved really no they even came up with a name for it it was called status phymic lymphaticus it was in all the pediatric textbooks of the 1920s and you would look in there and there'd be pictures there'd be pictures of the dissected thymuses normal size and you're on the right in large abnormally large status phymic lymphaticus in no time at all doctors came up with a treatment perfectly logical therapy which is it we're gonna help these babies gotta shrink their thymus glands to do that the best solution obviously is to irradiate their throats irradiate their throats to shrink their thymus glands clapped the child's throat with trillions of radioactive particles literally you betcha this was considered like something every good loving parent should do absolutely if you worry about your child being at risk for sids go and get their throats irradiated to shrink their thymus glands and did it work yes shrink their thymus glands but he says it did have another effect decades later you've killed 20 to 30,000 people with thyroid cancer 20 to 30,000 yeah that's a that's a real number yeah that's a that's a fairly big one so here's my question uh-huh how could these doctors have gotten it so so so so so wrong do you know what I mean yeah I do well don't you know what you mean you just answered your own question a minute ago no no I'm about to answer right now they're they're playing with radiation you just said that but they but they didn't know that radiation would hurt you they had no new uh technology this was no a couple of decades into radiation having been discovered isotopes are performing near miracles of diagnosis and discovery people were just tossing around radiation all over the place iodine-131 radioactive sodium right off galleray lupon and this was a period with madame curie like dipping her arm into vats of uranium radioactivity and dying soon afterwards from cancer people would go into shoe stores and they would have your feet x-ray yes x-ray is a wonderful invention i had that you had that i did yes you take off your shoes and then you can look at your balloons that's exactly what happened i would do that that's what that was the thing you could do at the shoe store it was very cool yeah it's showing how cutting edge of a shoe store they are so that's your explanation no that may look like the explanation i mean sure radiation would play a role but if you let me say what i was gonna say i would have told you the real explanation yes preceded the radiation by like a couple hundred years oh i don't know i know what you're talking i'm gonna tell you back in the 1700s okay that far back before uh radiation before uh your grandpa well before uh before the civil war of the eiffel tower of napoleon i'm talking when the red coats were still wearing red yeah yeah this was shortly after the revolutionary war right about this time so supposedly the first med schools started to pop up in america and a supply and demand issue came into effect because with these med schools came med students who needed to learn about anatomy and of course in order to do that they needed bodies you know to that exact this produced this whole occupation you could be a resurrectionist a resurrectionist yep and they would go out and dig up bodies at night and sell them to the anatomist at medical school i'll need two more by thursday now here's the key point since the man was so high the resurrectionist had to go where the bodies were easiest to get which meant you know avoiding the fancy graveyards if you were wealthy you could have yourself buried in what was called a patent coffin which was a triple layer coffin which was meant to be resurrectionist proof but if you were not wealthy no fancy coffin for you you'd probably just be buried in a sack in some popper's field just a few inches under the soil very accessible for these resurrectionists not surprisingly that's where they went are we still on the same topic are you explaining why children died yes yes what i'm trying to make is that the grave robbers targeted the poor so much so sometimes when they you know people would catch these resurrectionists in the act and see like oh my god that's my dad you're digging up there'll be riots get them get them stop stealing our bodies troops were called out rioters were shot are we talking the kinds of people torch-bearing those counties versus the people who were trying to dissect their dead robbers okay okay this is a lot of history i'm very fascinated in quotes what does this have to do with kids dying all right let me bring it home not that it hasn't been interesting but bring it home okay as a result of all this hubbub over uh grave robbing country after country throughout europe decided well let's standardize how science gets its cadavers forget all this grave robbing so they passed laws which formalized anyone who died in a poorhouse uh their body would be turned over to the anatomist this was like the cadaver version of direct deposit okay so grave robbing was gone but now all the bodies used by medicine and not just some but nearly all now came from the poor estimates were by the end of that century 99% of the bodies used for for anatomy lessons had been derived from poor houses and that seemed okay until 1936 a guy named han sellier showed that being poor actually warps your body and now robert now we come back to the case of the mysteriously enlarged thymus because if you're poor you're you're worried about your job you're worried about feeding your family you're worried about the bills in other words you are stressed out and during chronic stress your immune system goes down the tubes and since the thymus is part of the immune system if you are chronically stressed the thymus gland shrinks for 150 years doctors had been dissecting cadavers pointing at organs which they thought were normal but which were in fact shrunken from a life of poverty and stress and saying that's normal so when these cid babies show up with these gigantic thymuses oh my god in fact that was the first time they'd ever seen a normal one people had no idea what was normal and what was abnormal and they got it backwards killing about 30 000 people in the process now the scary thing says we'll see is that these doctors were not dumb no these were the best most careful researchers at the time and these were the only logical conclusions that could have been made and nonetheless it produced an utter disaster there's you know not the slightest reason to think we're not doing the same thing right now robert spilski's professor of neuroscience at stanford university he's the author of many great books including monkey love the trouble with testosterone for more information on him or anything that you heard in this hour visit our website radiolab.org and you can send us an email while you're there radio lab at wnyc.org actually i'm jad abumrad thanks for listening message 10 new from an external number okay radio lab is produced by ellen horn and jad abumrad our staff includes lulu miller jonathan mitchell soren wheeler nanda oronchick and jessica banko with help from and we go way rock ice shriekhan deraj she changlin hetereraki and saline her ships special thanks to karen ablick justin paul dr alan olstreich and tell you free of 12k.com radio lab is produced by wnyc and distributed by national public radio and this message and this message is provided by national public radio and this message is provided by national public radio