Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / What's the deal with death?

Transcript

What's the deal with death? · Wellness, Actually with Emily Oster & Perry Wilson, MD

• 0:01
  Speaker 1: Emily, it is our spookiest episode ever. We're talking about
• 0:06
  Speaker 1: death in time for Halloween. I'm so excited.
• 0:09
  Speaker 2: I oppose this, but I'm interested to get into it.
• 0:12
  Speaker 2: All right.
• 0:13
  Speaker 1: It's fair that I have been pushing the death episode
• 0:16
  Speaker 1: since we conceived. of wellness, actually. I think it's hugely important.
• 0:21
  Speaker 1: Let's see how we get at the end. But because
• 0:23
  Speaker 1: Halloween is coming up, I wanted to ask you, as
• 0:25
  Speaker 1: we get started, as an adult, do you wear a
• 0:28
  Speaker 1: Halloween costume when you go out trick-or-treating with your kids?
• 0:31
  Speaker 1: And if so, what's it going to be?
• 0:34
  Speaker 2: I do not.
• 0:35
  Speaker 3: But I am running a race the next day with
• 0:39
  Speaker 3: my friends, and I'm told there will be matching outfits,
• 0:43
  Speaker 3: although I haven't been told what they will be. And
• 0:45
  Speaker 3: so I'm going to be costuming post-Halloween.
• 0:48
  Speaker 1: Oh, that's economically one of the best times to purchase
• 0:51
  Speaker 1: a costume, by the way.
• 0:53
  Speaker 2: Do you dress up for Halloween? Oh, yeah.
• 0:55
  Speaker 1: Yeah, yeah, yeah. It will surprise you that I tend
• 0:59
  Speaker 1: to pick niche nerdy things to be that no one
• 1:03
  Speaker 1: would recognize. Is it Star Trek? Well, Star Trek is
• 1:08
  Speaker 1: a little too mainstream. So I might like stick my
• 1:13
  Speaker 1: head through a hole in Nehemiah's shirt and be crying.
• 1:17
  Speaker 1: from Teenage Mutant Ninja Turtles. I might be H.I. McDonough
• 1:21
  Speaker 1: from Raising Arizona, one of the best comedy movies of
• 1:25
  Speaker 1: all time. Put on my mustache.
• 1:28
  Speaker 2: Okay, so you go out trick-or-treating with your children.
• 1:32
  Speaker 1: My youngest is 11 now, so yeah, I'm walking around
• 1:35
  Speaker 1: with her.
• 1:36
  Speaker 3: How many years do you think you have left of
• 1:38
  Speaker 3: this before you just start going out by yourself with
• 1:40
  Speaker 3: your wife?
• 1:44
  Speaker 1: Yeah, probably a year or two, but it's actually, we
• 1:46
  Speaker 1: have a fun area in our town. So, you know,
• 1:49
  Speaker 1: I don't go up to the doors with them. I
• 1:51
  Speaker 1: just like stand on the street and make sure everything's okay.
• 1:53
  Speaker 1: But there's a couple of awesome parents who hand out
• 1:57
  Speaker 1: like alcohol and stuff to the adults. There's a moonshine
• 2:02
  Speaker 1: guy who makes like a 180 proof apple moonshine. Knock
• 2:08
  Speaker 1: your socks off.
• 2:10
  Speaker 2: That seems like a huge mistake.
• 2:12
  Speaker 3: OK, well, we better get this episode done because Perry
• 2:15
  Speaker 3: may actually be dead from the moonshine he'll be consuming
• 2:18
  Speaker 3: on Saturday.
• 2:19
  Speaker 2: So let's go. Let's talk about what's going to happen then.
• 2:32
  Speaker 2: I'm Emily Oster.
• 2:34
  Speaker 3: I'm an economist and a data expert.
• 2:36
  Speaker 1: And I'm Perry Wilson. I'm a medical doctor.
• 2:38
  Speaker 2: It's Thursday. October 29th, 2026. And this is Wellness Actually.
• 2:43
  Speaker 1: Because you're getting a staggering amount of health and wellness
• 2:46
  Speaker 1: information nowadays from every source imaginable. And some of it
• 2:50
  Speaker 1: is awesome.
• 2:51
  Speaker 2: And some of it is, well, actually bullshit.
• 2:56
  Speaker 3: Fortunately, we're both people who know how to read studies,
• 2:59
  Speaker 3: how to parse the data, and can tell you what's
• 3:01
  Speaker 3: worth thinking about and what you can safely ignore.
• 3:04
  Speaker 1: But before we dig in, a note that this podcast
• 3:07
  Speaker 1: is for educational purposes and should not be construed as
• 3:09
  Speaker 1: medical advice. We don't know your unique situation, so talk
• 3:13
  Speaker 1: to your doctor for personal health decisions.
• 3:15
  Speaker 2: This week, we're asking, what's the deal with death?
• 3:18
  Speaker 3: Perry and I will give the official smasher pass, and
• 3:21
  Speaker 3: then we'll get to your question of the week.
• 3:22
  Speaker 2: But first, let's do the health news roundup after the break.
• 3:42
  Speaker 1: And now for the health news of the week. Apropos
• 3:46
  Speaker 1: of Halloween, Emily, the curse of wellness actually has struck again.
• 3:51
  Speaker 1: I can't believe how often this happens that we mention
• 3:54
  Speaker 1: something and it comes to pass. So walk me through
• 4:00
  Speaker 1: the newest resignation from Health and Human Services. Callie Means
• 4:05
  Speaker 1: is out. Why is he out? And why is it
• 4:08
  Speaker 1: our fault?
• 4:09
  Speaker 3: RIP Callie Means as a government employee. So Callie Means
• 4:14
  Speaker 3: is an RFK friend, friend of the RFK, who came
• 4:18
  Speaker 3: in as part of the Baja movement. He is the
• 4:22
  Speaker 3: brother of Casey Means, failed Surgeon General nominee, who we've
• 4:27
  Speaker 3: talked about many times.
• 4:29
  Speaker 2: Callie Means has many of the same views.
• 4:32
  Speaker 3: And he had been working in a job with an
• 4:35
  Speaker 3: ambiguous title that involved, like, working with RFK on fixing stuff.
• 4:41
  Speaker 3: He is very interested in getting rid of ultra-processed foods.
• 4:44
  Speaker 3: He does not like food dyes at all. And he's
• 4:49
  Speaker 3: quit because he is, well, I think what he said was,
• 4:55
  Speaker 3: you know, spend time with my family or some version
• 4:58
  Speaker 3: of that. But it is clear he is upset at
• 5:01
  Speaker 3: the fact that many of the things that he believes
• 5:04
  Speaker 3: in and thought should happen, like LESC Glyco, I can't
• 5:09
  Speaker 3: say this word, Perry.
• 5:09
  Speaker 2: It's the thing you talk about a lot. Roundup. Okay, fine.
• 5:13
  Speaker 2: He wanted less of that stuff. And now they're going
• 5:16
  Speaker 2: to have more of it.
• 5:17
  Speaker 3: So I think just generally this part of the Maha
• 5:21
  Speaker 3: movement has not gotten what they hoped for out of
• 5:24
  Speaker 3: the RFK HHS rulership.
• 5:28
  Speaker 2: And this is just the latest casualty there. Yeah.
• 5:32
  Speaker 1: We talked about that glyphosate, aka Roundup. issue last week,
• 5:36
  Speaker 1: an organic food episode. It's a sticking point for the
• 5:41
  Speaker 1: MAHA movement. And then Trump, endorsed by RFK Jr., ramped
• 5:46
  Speaker 1: up production as part of the Defense Production Act. It
• 5:49
  Speaker 1: seems like Callie Means was not that interested in the
• 5:53
  Speaker 1: anti-vax stuff that RFK was really like a food guy.
• 5:56
  Speaker 1: And I have to say, I'm going to a little
• 6:00
  Speaker 1: bit credit where credit is due. Like, Maybe he has
• 6:03
  Speaker 1: the courage of his convictions, whether we agree with all
• 6:06
  Speaker 1: of them or not. Like, he saw that things were
• 6:08
  Speaker 1: going the wrong way and he left. Maybe good for you,
• 6:10
  Speaker 1: Callie Means.
• 6:11
  Speaker 2: Yeah.
• 6:11
  Speaker 3: I mean, I think Callie Means is a true believer
• 6:14
  Speaker 3: in this stuff. You know, he and I don't see
• 6:16
  Speaker 3: eye to eye. He's not a big Emily fan. And
• 6:20
  Speaker 3: I think some of what he believes is not well
• 6:22
  Speaker 3: supported by data. But he really does believe it. And,
• 6:28
  Speaker 3: you know, now he can... Say it from the outside.
• 6:31
  Speaker 1: At this point, I'll take it. I'll take a true
• 6:33
  Speaker 1: believer rather than like a grifter any day in the
• 6:37
  Speaker 1: current environment.
• 6:39
  Speaker 2: Okay. Next up, dengue. Dengue fever. We're having more of it.
• 6:44
  Speaker 2: It's on the rise in Florida. Should everyone be panicked?
• 6:49
  Speaker 1: Say more. I don't like dengue fever. No, don't panic.
• 6:52
  Speaker 1: The CDC has declared a level three emergency response for
• 6:57
  Speaker 1: Florida that Indicates that they're going to direct some resources
• 7:01
  Speaker 1: to controlling dengue in the area. They've had eight level
• 7:04
  Speaker 1: three emergency responses this year. So it's not like crazy
• 7:07
  Speaker 1: that they ramp it up. But, you know, it's something real.
• 7:11
  Speaker 1: There have been 721 dengue cases in Florida this year.
• 7:15
  Speaker 1: They had only reported 392 as of September. So last month.
• 7:20
  Speaker 1: So it seems to be ramping up. Most of this
• 7:22
  Speaker 1: is happening around Tampa. Dengue is a mosquito borne illness. flavivirus.
• 7:29
  Speaker 1: It causes what's colloquially known as breakbone fever because of
• 7:34
  Speaker 1: the incredible amount of muscle pain and aches. You get
• 7:37
  Speaker 1: fever and muscle aches, particularly behind the eyes, nausea and vomiting.
• 7:42
  Speaker 1: Quite unpleasant for people who become symptomatic from it. Actually,
• 7:46
  Speaker 1: most people don't. Just one out of four infections develop symptoms,
• 7:49
  Speaker 1: so maybe not as scary as you would think. But
• 7:52
  Speaker 1: of the people who develop symptoms, 5% can get severe dengue,
• 7:55
  Speaker 1: which can be fatal. There have been 2,470 cases nationwide
• 8:01
  Speaker 1: this year. The highest on record was 2024, which had
• 8:05
  Speaker 1: 3,700 cases. So I don't think we'll beat that. But
• 8:08
  Speaker 1: like the trend is generally up in dengue cases.
• 8:13
  Speaker 3: Is that because of some kind of climate change driven
• 8:16
  Speaker 3: mosquito thing or something else?
• 8:18
  Speaker 1: It is entirely due to climate change driven mosquito things.
• 8:22
  Speaker 1: So as the climate gets warmer, these mosquitoes can move
• 8:27
  Speaker 1: further north. Dengue is endemic in the Caribbean and stuff,
• 8:31
  Speaker 1: but now it's taken root in Florida as well. Also,
• 8:34
  Speaker 1: the longer the mosquito season lasts, like wetter, warmer seasons
• 8:39
  Speaker 1: just means mosquitoes can live for longer before the winter comes.
• 8:42
  Speaker 1: And that leads to more infections. as well. There's no
• 8:46
  Speaker 1: person-to-person spread here. This is all driven by mosquitoes, which
• 8:49
  Speaker 1: is why it's all driven by climate. No treatment. It's
• 8:54
  Speaker 1: a virus. Treatment is supportive. I should point out, actually,
• 8:56
  Speaker 1: that 43% of the reported cases in the US were hospitalized.
• 9:01
  Speaker 1: So clearly, we're missing cases. This doesn't mean that your
• 9:05
  Speaker 1: chance of getting hospitalized is 43%. It just means that
• 9:08
  Speaker 1: there's a bunch of people walking out there who have
• 9:10
  Speaker 1: a fever and aches and pains and never know they
• 9:12
  Speaker 1: have dengue. But Yeah, one of the examples of how
• 9:15
  Speaker 1: climate change will impact public health, for sure.
• 9:20
  Speaker 2: Great. Okay. Okay, Dengue, try not to. Wear your bug spray.
• 9:26
  Speaker 1: Yeah, bug spray. Prevention is the best thing here. Speaking
• 9:30
  Speaker 1: of prevention, Emily, did you see the latest bit of
• 9:35
  Speaker 1: epidemiologic sleuthing happening in San Francisco? So a couple of
• 9:39
  Speaker 1: cases of tuberculosis, active TB- in San Francisco were traced
• 9:47
  Speaker 1: back using epidemiology. Did you see where they were all
• 9:50
  Speaker 1: traced back to?
• 9:52
  Speaker 2: Strip club. I love it.
• 9:55
  Speaker 1: Good work.
• 9:56
  Speaker 3: Tuberculosis is so interesting because people do not talk about
• 10:00
  Speaker 3: it very much.
• 10:01
  Speaker 2: But it is the leading infectious disease cause of death
• 10:05
  Speaker 2: in the world.
• 10:05
  Speaker 3: It kills something like 1.2 to 1.3 million people a year.
• 10:08
  Speaker 2: There is an amazing book.
• 10:09
  Speaker 1: It's got to be lower than malaria. Sorry, I'll jump in.
• 10:12
  Speaker 1: It's got to be lower than malaria.
• 10:13
  Speaker 3: It's got to be lower too.
• 10:16
  Speaker 2: No, I don't think that's right.
• 10:18
  Speaker 3: Let's see.
• 10:20
  Speaker 1: Are we keeping this in? TB 1.25 to 1.3. Oh, malaria, 600,000,
• 10:23
  Speaker 1: a mere 600,000 people per year. mea culpa, Emily.
• 10:31
  Speaker 2: Yeah, thank you.
• 10:32
  Speaker 3: And you know how I know that is because of
• 10:34
  Speaker 3: an absolutely fantastic book called Everything is Tuberculosis, which like
• 10:38
  Speaker 3: everyone should like at the end of this episode, go read.
• 10:40
  Speaker 2: It's by John Green.
• 10:42
  Speaker 3: And it's just a really, really good history of tuberculosis,
• 10:45
  Speaker 3: which is a disease that kills like a billion people.
• 10:48
  Speaker 3: I mean, has killed not a billion, but has killed many, many,
• 10:51
  Speaker 3: maybe a billion.
• 10:52
  Speaker 2: It's killed a lot of people.
• 10:54
  Speaker 3: Over time, when you read about people having consumption, that
• 10:57
  Speaker 3: was tuberculosis. It's just a really really interesting disease and
• 11:01
  Speaker 3: it can be really bad and you can get it
• 11:05
  Speaker 3: at a strip club.
• 11:06
  Speaker 1: You can get a strip club.
• 11:07
  Speaker 2: TB is airborne. You can get it elsewhere too. Yeah.
• 11:09
  Speaker 1: I mean, the truth is this isn't as salacious as
• 11:12
  Speaker 1: you may think. TB is an airborne disease. It's not
• 11:15
  Speaker 1: a sexually transmitted disease. It's not through close contact. When
• 11:19
  Speaker 1: we have a patient with active TB in the hospital,
• 11:21
  Speaker 1: we wear N95 masks and they're in a negative pressure
• 11:24
  Speaker 1: room and everything like that. So You can get it
• 11:26
  Speaker 1: in a strip club. You can get it in the subway.
• 11:28
  Speaker 1: You can get it anywhere there's people breathing around other people.
• 11:32
  Speaker 1: Latent TB infection is very common, asymptomatic, and non-transmissible. That's
• 11:36
  Speaker 1: with the PPD test, if you remember when you were
• 11:38
  Speaker 1: a kid. Do they still do that for kids?
• 11:39
  Speaker 2: I don't think so.
• 11:40
  Speaker 3: Yeah.
• 11:42
  Speaker 1: We don't do that. But that was testing for latent
• 11:45
  Speaker 1: TB infection, which if you have, you can eradicate using
• 11:49
  Speaker 1: typically like a six-month course of an antibiotic. Then active
• 11:53
  Speaker 1: TB requires a four drug regimen. And now we have
• 11:56
  Speaker 1: extremely drug resistant TB out there, which is like very
• 11:59
  Speaker 1: scary and worth its own segment at one point in time.
• 12:03
  Speaker 1: But this episode is scary enough without talking about extremely
• 12:06
  Speaker 1: drug resistant tuberculosis.
• 12:08
  Speaker 3: I just want to say one other thing, which is
• 12:09
  Speaker 3: that people used to get a lot of TB from
• 12:11
  Speaker 3: raw milk.
• 12:12
  Speaker 2: That was one of the things that would spread TB
• 12:15
  Speaker 2: in the past. So anyway, fun. We should do an
• 12:19
  Speaker 2: episode on tuberculosis.
• 12:20
  Speaker 1: I love that idea.
• 12:21
  Speaker 3: Now that we learned that I'm right about its deadliness,
• 12:25
  Speaker 3: I think that's a great idea. But for today, that
• 12:28
  Speaker 3: is not today. And that's it for today's Health News
• 12:31
  Speaker 3: of the Week. And now, what's the deal with death?
• 12:36
  Speaker 1: What's the deal with death? There's so much to talk
• 12:40
  Speaker 1: about here because there's the amazing history of how people
• 12:46
  Speaker 1: try to cheat or avoid death. There's the science of
• 12:50
  Speaker 1: what happens when you die. There's the modern history of
• 12:55
  Speaker 1: trying to avoid death. There's tech bros. I don't know.
• 12:57
  Speaker 1: I think it has everything, Emily.
• 13:00
  Speaker 2: Okay, so.
• 13:01
  Speaker 3: What we're going to do is I think first we're
• 13:04
  Speaker 3: going to talk about how people have tried to avoid
• 13:08
  Speaker 3: death over time from the past to the present. Then
• 13:14
  Speaker 3: we're going to talk about what actually happens when people die,
• 13:16
  Speaker 3: how we understand near-death experiences to the extent that we do,
• 13:20
  Speaker 3: which is not very well, I think. And then we'll
• 13:23
  Speaker 3: talk a little bit about why it matters and some
• 13:25
  Speaker 3: more practical stuff about what does it mean to have
• 13:27
  Speaker 3: a good death.
• 13:28
  Speaker 2: Love it.
• 13:30
  Speaker 3: But let's start with what I think is the sort
• 13:33
  Speaker 3: of craziest, most interesting stuff, which is just all the
• 13:35
  Speaker 3: things that people like to do to try to avoid death.
• 13:39
  Speaker 3: So I'm going to let you start by telling me
• 13:42
  Speaker 3: the history of magical immortality elixirs.
• 13:45
  Speaker 1: Sure.
• 13:47
  Speaker 3: The Philosopher's Stone-style situation here.
• 13:51
  Speaker 2: Yeah.
• 13:52
  Speaker 1: I mean, it's interesting. You'll see as we talk about
• 13:54
  Speaker 1: as history moves forward and science moves forward, like the
• 13:59
  Speaker 1: the stuff people believe might help them avoid death also
• 14:02
  Speaker 1: moves forward. You know, it's like with the invention of electricity,
• 14:05
  Speaker 1: then all of a sudden we see people being like, Ooh,
• 14:07
  Speaker 1: we can use electricity to avoid death.
• 14:08
  Speaker 3: You know, this is like, so just to like, I
• 14:11
  Speaker 3: think part of what makes this so interesting is if
• 14:14
  Speaker 3: you think about the two things that people really, really want,
• 14:18
  Speaker 3: they want to be rich and not die. Those are
• 14:21
  Speaker 3: two like core human desires and, And many of the
• 14:27
  Speaker 3: innovations that we have seen in science and in capitalism
• 14:30
  Speaker 3: and everything else over the course of, you know, the
• 14:34
  Speaker 3: entire human history are in the service of either getting
• 14:37
  Speaker 3: rich or not dying.
• 14:39
  Speaker 2: And we learned a lot from alchemy, right?
• 14:41
  Speaker 3: Alchemy gave us all kinds of stuff, even though it
• 14:43
  Speaker 3: never actually figured out how to turn shit into gold.
• 14:46
  Speaker 1: Absolutely. Absolutely. Yeah. You could write a good popular science
• 14:50
  Speaker 1: book about how an effort to cheat death has led
• 14:53
  Speaker 1: to all modern innovation. But let's start with the magical
• 14:55
  Speaker 1: immortality elixirs because this is the oldest, at least I
• 14:59
  Speaker 1: could find, written evidence of people trying to do something
• 15:04
  Speaker 1: to stay alive forever. The oldest reference that I saw
• 15:07
  Speaker 1: was in the Epic of Gilgamesh, which is from 2100 BC.
• 15:12
  Speaker 1: They were out looking for some kind of potion that
• 15:14
  Speaker 1: would extend immortality. A little more modern, in 210 BCE,
• 15:19
  Speaker 1: we have Chinese Emperor Qin Shi Huang, who sent out
• 15:23
  Speaker 1: multiple expeditions to find an elixir of immortality. They never returned.
• 15:29
  Speaker 1: But he did have people giving him elixirs containing liquid mercury. Well,
• 15:33
  Speaker 1: mercury is always liquid. Containing mercury to drink in the
• 15:36
  Speaker 1: belief that this metal that flowed and looked magical would
• 15:40
  Speaker 1: extend life. Obviously, it's believed he died of mercury toxicity.
• 15:45
  Speaker 1: You may be familiar with this emperor. He was buried
• 15:47
  Speaker 1: with an army of terracotta soldiers, just in case he
• 15:51
  Speaker 1: wasn't dead. And that's where the famous terracotta army comes from.
• 15:57
  Speaker 1: I looked a little bit into The Holy Grail because
• 16:00
  Speaker 1: Indiana Jones, The Last Crusade, best Indiana Jones movie of
• 16:04
  Speaker 1: all time.
• 16:04
  Speaker 2: Totally, by far.
• 16:05
  Speaker 3: Yeah.
• 16:06
  Speaker 1: Interesting. It's not as like drink from this and you'll
• 16:12
  Speaker 1: live forever as Indiana Jones taught us. I was disappointed
• 16:15
  Speaker 1: to find. So the first reference to The Holy Grail
• 16:19
  Speaker 1: is from 1180. A guy named Christian de Troyes wrote Percival,
• 16:22
  Speaker 1: The Story of the Grail. It's a poem about where
• 16:26
  Speaker 1: the author, the poem narrator, sees a mysterious person with
• 16:31
  Speaker 1: a jeweled grail, but at the time that would have
• 16:33
  Speaker 1: been a large serving dish. And then the poem was
• 16:37
  Speaker 1: left unfinished and there was a bunch of fan fiction
• 16:40
  Speaker 1: writing and that sort of morphed into this idea that
• 16:45
  Speaker 1: the mysterious stranger was this person called the Fisher King
• 16:48
  Speaker 1: who had lived an obscenely long time. And then that
• 16:52
  Speaker 1: got conflated with this serving dish actually being the cup
• 16:55
  Speaker 1: that caught the blood of Christ around 1200. And then
• 16:59
  Speaker 1: we have Indiana Jones.
• 17:01
  Speaker 2: Anyway, so- The Indiana Jones part is like much simpler.
• 17:03
  Speaker 2: We should have just done that.
• 17:05
  Speaker 1: It's way simpler. And my last one, of course, if
• 17:07
  Speaker 1: we're talking about magical immortality elixirs, has to be the
• 17:10
  Speaker 1: Fountain of Youth and Juan Ponce de Leon looking for
• 17:14
  Speaker 1: it in Florida, where people still search for it to
• 17:17
  Speaker 1: this day. This is apocryphal, apparently. Ponce de Leon was
• 17:20
  Speaker 1: not actually, he was just a regular explorer looking for, well,
• 17:24
  Speaker 1: you know, like slaves and stuff.
• 17:25
  Speaker 2: He was looking for money. Is that the other thing? Yeah,
• 17:28
  Speaker 2: the other thing.
• 17:28
  Speaker 1: He just wanted the other thing. He was looking for money.
• 17:30
  Speaker 1: But after his death, I guess people applied this to him,
• 17:33
  Speaker 1: I think actually to sort of, to sort of smear
• 17:36
  Speaker 1: him a little bit, like, oh, that dude was crazy.
• 17:39
  Speaker 1: So that's magical immortality elixirs. And then the next spookiest
• 17:44
  Speaker 1: thing that I want you to tell me about, Emily, is,
• 17:47
  Speaker 1: stuff that people want to use to extend their life.
• 17:50
  Speaker 1: And this is really Halloween-y, is blood.
• 17:53
  Speaker 2: Blood.
• 17:54
  Speaker 1: And again, I think because science sort of is advancing, right?
• 18:01
  Speaker 1: And we're starting to learn that blood is this important substance,
• 18:04
  Speaker 1: not just this thing that fills your body like a
• 18:06
  Speaker 1: water balloon. So talk to me about people trying to
• 18:09
  Speaker 1: use blood to stay alive forever.
• 18:11
  Speaker 3: So Blood is great because it has sort of two periods.
• 18:16
  Speaker 3: We can talk about the past and then actually this
• 18:18
  Speaker 3: has become a more present discussion.
• 18:22
  Speaker 2: So in the kind of.
• 18:24
  Speaker 3: 14 to 1650 period, we have a set of people
• 18:29
  Speaker 3: doing various things involving blood. trying to keep them alive.
• 18:33
  Speaker 3: So in the 1490s, Pope Innocent VIII is accused, it's
• 18:38
  Speaker 3: not clear that he was doing this, of drinking boys'
• 18:42
  Speaker 3: blood to.
• 18:42
  Speaker 2: Try to keep himself alive. So this is a sort
• 18:44
  Speaker 2: of direct approach.
• 18:46
  Speaker 3: You take somebody else's blood, you consume it, and it,
• 18:49
  Speaker 3: I don't know, refills your blood. Biologically, that's not going
• 18:53
  Speaker 3: to work. It's going to go to your stomach. You
• 18:54
  Speaker 3: just digest it. Nobody's blood's going to work there, but
• 18:58
  Speaker 3: he died.
• 18:58
  Speaker 1: So we need to release the Pope Innocent VIII files. Right, exactly.
• 19:03
  Speaker 2: But he died despite this.
• 19:05
  Speaker 3: There's another claim about someone in the 1600s, Elizabeth Bathroy,
• 19:10
  Speaker 3: who claimed that she bathed in virgin blood to stay young.
• 19:14
  Speaker 3: This claim actually didn't appear until quite a bit after
• 19:17
  Speaker 3: she had also already died. And I think there it's unclear,
• 19:21
  Speaker 3: is it like that you're staying young and beautiful or
• 19:24
  Speaker 3: you're staying not dying? You know, there's all kinds of
• 19:26
  Speaker 3: ways to want to try to stay young. More science-y,
• 19:30
  Speaker 3: Jean-Baptiste Denis in 1667 transfuses lamb blood into humans with
• 19:38
  Speaker 3: the kind of, I guess, idea that baby, I don't know,
• 19:42
  Speaker 3: baby sheep blood would keep you young. That's definitely not encouraged.
• 19:46
  Speaker 3: Somebody did die. They banned that. You're just like, don't
• 19:50
  Speaker 3: do that. So that's kind of the early phase. And
• 19:53
  Speaker 3: then there's this sort of much more interesting later, more
• 19:57
  Speaker 3: recent phase. So there's actually a Nature paper from 2005.
• 20:01
  Speaker 3: in which they show that they take sort of two mice,
• 20:05
  Speaker 3: an older mouse and a younger mouse, and they like.
• 20:09
  Speaker 2: Interweave their circulation.
• 20:11
  Speaker 3: You can do all kinds of terrible stuff for mice.
• 20:12
  Speaker 2: That's probably another episode.
• 20:14
  Speaker 3: But they sort of put their circulations together, and that
• 20:17
  Speaker 3: actually rejuvenated some of the tissues of the older mice,
• 20:19
  Speaker 3: which is incredibly cool, but also potentially quite a good
• 20:24
  Speaker 3: example of where we are not too bad mice, at
• 20:29
  Speaker 3: extending lifespan in mice, uh, relative to how we do
• 20:33
  Speaker 3: it in people. But this hasn't kept people from trying
• 20:38
  Speaker 3: perhaps most famously, uh, Brian Johnson, the guy who doesn't
• 20:42
  Speaker 3: want to die, got these transfusions, like sort of plasma
• 20:46
  Speaker 3: transfusions from his son, who is a teenager. He did
• 20:49
  Speaker 3: that for a couple of years, but then he abandoned it,
• 20:52
  Speaker 3: saying it didn't do anything. Sort of unclear what outcome
• 20:55
  Speaker 3: you were exactly looking for.
• 20:56
  Speaker 2: He didn't die, so I don't know why that's not successful.
• 21:00
  Speaker 3: But at any rate, we haven't sort of seen any
• 21:02
  Speaker 3: evidence that transfusing yourself with the blood of the young
• 21:06
  Speaker 3: is effective, and it has some potential risks involved.
• 21:10
  Speaker 2: Not something I would necessarily recommend. It's also, this is
• 21:15
  Speaker 2: a bit related to this idea of vampires, I think. Totally.
• 21:17
  Speaker 3: The sort of like vampires, you know, when you eat
• 21:21
  Speaker 3: the blood of the vampire, then you get the vampire's immortality, obviously.
• 21:26
  Speaker 2: Well, but also.
• 21:28
  Speaker 1: The vampire isn't, okay, maybe I don't know enough about vampires,
• 21:31
  Speaker 1: but don't vampires die? Isn't it them drinking the blood
• 21:34
  Speaker 1: of humans that keeps them alive forever? Or are they
• 21:37
  Speaker 1: alive forever regardless but just hungry?
• 21:39
  Speaker 2: Vampires live forever. Oh, my God. What is wrong with you?
• 21:41
  Speaker 2: Vampires live forever no matter what. They need to eat
• 21:44
  Speaker 2: the blood of the human.
• 21:45
  Speaker 3: It's like how they can– you know, and they get–
• 21:47
  Speaker 3: like often they're sort of– like it's like their skin
• 21:49
  Speaker 3: gets dry if they don't do– you know, like they
• 21:51
  Speaker 3: won't die. They get very weak and it's like– like
• 21:54
  Speaker 3: anemia basically. They get like really bad anemia and they
• 21:57
  Speaker 3: have to re-up with the blood of the young but–
• 22:00
  Speaker 3: or of anyone. But– in some versions of vampire lore,
• 22:06
  Speaker 3: if you, if a vampire bites you, but then you
• 22:11
  Speaker 3: are fed their blood, that's how you turn into a vampire.
• 22:14
  Speaker 3: So there's like a sort of complicated back and forth
• 22:17
  Speaker 3: of the, of the vampire-ness, but no, they don't, they
• 22:20
  Speaker 3: don't need it to live.
• 22:21
  Speaker 2: They, yeah, they just need it to thrive. Okay. Yeah.
• 22:26
  Speaker 1: All right. There's some speculation that the folklore about vampires
• 22:31
  Speaker 1: actually came from death itself. Um, so Paul Barber advanced
• 22:36
  Speaker 1: this argument that, um, people would see, you know, after
• 22:41
  Speaker 1: someone would die, if they were ever dug up again,
• 22:43
  Speaker 1: they would find these bloated sort of ruddy corpses with
• 22:47
  Speaker 1: blood at their mouths, um, which can happen during the
• 22:49
  Speaker 1: decomposition process. Like, like it's called purge fluid. We'll talk
• 22:54
  Speaker 1: about how this all works, but like purge fluid will
• 22:56
  Speaker 1: come out through the mouth as the body's decomposing. And
• 22:58
  Speaker 1: if you dig someone up, cause you're suspicious that they
• 23:01
  Speaker 1: were evil or something, you know, And you see this
• 23:03
  Speaker 1: like body with like blood at its mouth. You're like,
• 23:06
  Speaker 1: oh my gosh, vampire.
• 23:09
  Speaker 2: All right.
• 23:09
  Speaker 3: So I think blood and magic elixirs are like the
• 23:12
  Speaker 3: sort of biggest components here.
• 23:14
  Speaker 2: But people have tried a lot of other things. One
• 23:16
  Speaker 2: of them was electricity.
• 23:18
  Speaker 1: Sure.
• 23:18
  Speaker 3: Which kind of, like, I mean, it doesn't work, but
• 23:21
  Speaker 3: it has, it's like more, there's more there.
• 23:24
  Speaker 1: We're getting science-ier as time goes forward.
• 23:27
  Speaker 2: Yeah.
• 23:27
  Speaker 1: So 1791, Galvani- Famously, he makes a dead frog's legs
• 23:33
  Speaker 1: twitch by zapping them with electricity. People freaked out about this,
• 23:37
  Speaker 1: thought like he was bringing the frog back to life. 1803,
• 23:41
  Speaker 1: so a little more than a decade later, Giovanni Aldini,
• 23:45
  Speaker 1: another scientist, does the same thing except with the corpse
• 23:48
  Speaker 1: of a hanged murderer. He puts some electricity through the
• 23:52
  Speaker 1: fresh corpse, and apparently the corpse's jaw quivered and one
• 23:56
  Speaker 1: eye opened, which... Definitely freaked people out. And 1818, Mary Shelley,
• 24:03
  Speaker 1: reading about some of these experiments were happening, writes one
• 24:07
  Speaker 1: of the all-time great Gothic fiction novels, Frankenstein.
• 24:11
  Speaker 3: And of course, it is true that your muscles, you know,
• 24:13
  Speaker 3: electricity moves muscles. And so if you have a dead
• 24:17
  Speaker 3: frog leg and you shock it, you can get it
• 24:20
  Speaker 3: to move.
• 24:21
  Speaker 1: Yeah. And it's still creepy, even if you know. It's
• 24:24
  Speaker 1: super creepy.
• 24:25
  Speaker 2: Super creepy. Yeah.
• 24:27
  Speaker 1: And then I think the last sort of thing that
• 24:29
  Speaker 1: you'll hear about, so we've done magic elixirs, blood, electricity.
• 24:33
  Speaker 1: I think it's ice, right? Like putting people on ice, ice, baby.
• 24:37
  Speaker 1: So what do we have about ice?
• 24:39
  Speaker 3: The idea is, I guess, that if you freeze people very,
• 24:44
  Speaker 3: very cold, then you could like defrost them later.
• 24:47
  Speaker 2: And I don't know, they wouldn't be dead because, you know,
• 24:51
  Speaker 2: you're everything slows.
• 24:55
  Speaker 3: I'm not really sure what this, why exactly, I don't
• 24:58
  Speaker 3: totally understand why anybody thinks that this would work, but
• 25:00
  Speaker 3: there is a book called The Prospect of Immortality in 1962,
• 25:04
  Speaker 3: which founds, founds the cryonics movement. And it is true
• 25:09
  Speaker 3: that many sort of body processes slow down when you
• 25:12
  Speaker 3: get very cold and then maybe you could bring them back.
• 25:17
  Speaker 3: I don't, really have any reason to think that this
• 25:20
  Speaker 3: is right. It's also a bit different than living forever
• 25:23
  Speaker 3: because it's like you would have to be woken up
• 25:26
  Speaker 3: later to live.
• 25:28
  Speaker 2: It's more like a.
• 25:29
  Speaker 3: Time portal to the future than a kind of immortality space.
• 25:34
  Speaker 1: Although I think with the assumption, I think the sort
• 25:37
  Speaker 1: of assumption is that when you get to the future,
• 25:40
  Speaker 1: medicine will be so good that you could live forever.
• 25:43
  Speaker 1: At least maybe, I mean, cure, cure the disease that you,
• 25:45
  Speaker 1: that you died from or, or something like that.
• 25:48
  Speaker 3: So people have frozen themselves. Uh, James Bedform, a psychology
• 25:52
  Speaker 3: professor is the first frozen human.
• 25:53
  Speaker 2: He's still frozen. That was from the 1960s.
• 25:56
  Speaker 3: Um, there have been a lot of issues with this.
• 25:59
  Speaker 3: People freeze themselves and then, you know, the cryonics labs
• 26:03
  Speaker 3: run out of money for liquid nitrogen and then the
• 26:06
  Speaker 3: people unfreeze. Um, But you can still get yourself frozen today.
• 26:10
  Speaker 3: There are companies that will freeze you. It's expensive, a
• 26:12
  Speaker 3: couple hundred thousand euros. So more expensive than freezing your embryos,
• 26:16
  Speaker 3: for sure.
• 26:17
  Speaker 4: Yeah.
• 26:17
  Speaker 1: Economically, the proposition here for the company seems fraught to me, right?
• 26:23
  Speaker 1: Because it's like, okay, you're going to pay us some
• 26:24
  Speaker 1: fee and then we're going to keep you frozen for...
• 26:27
  Speaker 1: We have to stay solvent for like, what? Like a
• 26:30
  Speaker 1: few hundred years? Like how many companies... can do that. Actually,
• 26:34
  Speaker 1: solvent is probably not the right word. We have to
• 26:37
  Speaker 1: say frozen. We have to say liquid. You know what
• 26:40
  Speaker 1: I mean?
• 26:41
  Speaker 3: So don't freeze yourself, or at least there's no evidence
• 26:44
  Speaker 3: of freezing yourself would work. But there is some stuff,
• 26:49
  Speaker 3: I think, before we go into the more modern science
• 26:52
  Speaker 3: piece of longevity. We have, of course, improved at our
• 26:56
  Speaker 3: ability to bring people back from something that we would
• 27:01
  Speaker 3: describe as clinical death?
• 27:03
  Speaker 1: Yeah. The birth of the modern CPR movement really is
• 27:10
  Speaker 1: way back in 1767. There were these things called rescue
• 27:13
  Speaker 1: societies in Amsterdam and London, which were put together to
• 27:17
  Speaker 1: revive drowning victims. So I guess prior to this, if
• 27:19
  Speaker 1: you drowned, it was like, oh, here's another dead body,
• 27:23
  Speaker 1: throw it on the pile. But people have begun to
• 27:26
  Speaker 1: realize like, oh, you know, some of these you might
• 27:28
  Speaker 1: be able to get some of these drowning victims back.
• 27:31
  Speaker 1: And so the Rescue Society's standard practice was to use
• 27:35
  Speaker 1: a bellows to blow tobacco smoke up the rectum. This
• 27:39
  Speaker 1: does not work, nor is it where I read that.
• 27:43
  Speaker 1: And I was like, oh, clearly this is where the
• 27:44
  Speaker 1: phrase blowing smoke up your ass comes from. Apparently not,
• 27:49
  Speaker 1: but fine. I choose to believe it anyway. To be fair.
• 27:53
  Speaker 1: These rescue societies also pioneered some of the early forms
• 27:56
  Speaker 1: of what we would now call rescue breathing, you know,
• 27:59
  Speaker 1: breathing into someone's mouth to revive them from drowning and
• 28:02
  Speaker 1: actually brought some people back. They might have thought that
• 28:05
  Speaker 1: they were bringing them back from the dead. We know
• 28:06
  Speaker 1: today that they weren't actually dead, likely, at that time.
• 28:10
  Speaker 1: But that's pretty cool.
• 28:12
  Speaker 3: And then we have in the late 1940s, defibrillation, which
• 28:17
  Speaker 3: can restart your heart with electricity.
• 28:20
  Speaker 1: And I mean, that's as close to Frankenstein as we get, right?
• 28:24
  Speaker 4: Yeah.
• 28:25
  Speaker 3: And in 1960, JAMA describes what closed chest CPR, which
• 28:30
  Speaker 3: would be looking very much like what we would have now,
• 28:33
  Speaker 3: where you press somebody's chest and breathe into their mouth
• 28:36
  Speaker 3: as a way to revive them. And we now have,
• 28:40
  Speaker 3: you know, obviously people know about that.
• 28:42
  Speaker 2: And there's also like portable defibrillators, which.
• 28:46
  Speaker 3: Have saved many, many people by being accessible in a
• 28:49
  Speaker 3: moment of cardiac arrest. So there are ways we have
• 28:53
  Speaker 3: improved our ability to bring people back from some version
• 28:56
  Speaker 3: of being dead, but they are much more limited than,
• 29:01
  Speaker 3: you know, drink the blood of the young to live forever.
• 29:05
  Speaker 1: Unfortunately.
• 29:06
  Speaker 2: Unfortunately.
• 29:07
  Speaker 3: But don't tell that to the tech bros, because when
• 29:11
  Speaker 3: we come back, we will talk about the modern attempts
• 29:16
  Speaker 3: to find longevity in science.
• 29:34
  Speaker 1: All right, we're back and we've gone through the amazing
• 29:38
  Speaker 1: history of you know, basically for as long as recorded history,
• 29:42
  Speaker 1: people doing their best to cheat death using whatever tools
• 29:47
  Speaker 1: they have. No one has figured it out yet, as
• 29:49
  Speaker 1: far as we can tell. But the tech bros are
• 29:51
  Speaker 1: on it. Fear not. They're going to do it. You
• 29:53
  Speaker 1: throw enough money at something, we can solve this. So
• 29:57
  Speaker 1: we'll talk about, I mean, in some ways, all of
• 30:00
  Speaker 1: the topics we talk about on Moments actually are somewhat
• 30:04
  Speaker 1: geared towards this ultimate goal, but we'll talk about a few.
• 30:07
  Speaker 1: I think there's a theme here of the modern movement,
• 30:12
  Speaker 1: the modern longevity movement, which is basically like, let's use science,
• 30:17
  Speaker 1: let's find something intriguing in a mouse study, in a
• 30:21
  Speaker 1: cell culture, in DNA, and then let's decide that this
• 30:26
  Speaker 1: thing is therefore going to extend human life and embrace
• 30:30
  Speaker 1: it and orient our lives around it. And You know,
• 30:33
  Speaker 1: there's several examples of this.
• 30:35
  Speaker 2: Yeah.
• 30:35
  Speaker 3: I mean, I think this is a very, this is
• 30:37
  Speaker 3: very interesting because there are so many things which work
• 30:44
  Speaker 3: to make cells, individual cells live longer or improve DNA repair,
• 30:50
  Speaker 3: or even as you said, improve the lifespan of yeast or,
• 30:54
  Speaker 3: or rats and, that we have not been able to
• 30:57
  Speaker 3: port into humans or hasn't ported in in a meaningful way.
• 31:02
  Speaker 2: And partly just people are not yeast.
• 31:06
  Speaker 3: And partly I think the size of the effects people
• 31:10
  Speaker 3: get excited about are kind of not really that important
• 31:13
  Speaker 3: in people, and somehow it's hard to detect them. So,
• 31:16
  Speaker 3: I mean, this starts with what I would say is antioxidants.
• 31:21
  Speaker 3: There's this idea of these free radicals theory. This is
• 31:24
  Speaker 3: developed in the 1950s. There's that your body is full
• 31:27
  Speaker 3: of these things that would give you cancer oxidants all
• 31:31
  Speaker 3: around these free radicals. And you need to have these antioxidants,
• 31:34
  Speaker 3: you know, whatever it is, if it's vitamins or something else,
• 31:37
  Speaker 3: you know, like soak up the free radicals and like
• 31:40
  Speaker 3: dispense with them. And though none of those work, some
• 31:45
  Speaker 3: sometimes they're bad and certainly nothing.
• 31:47
  Speaker 2: They're all null or harmful. Yeah.
• 31:50
  Speaker 1: And it's such a, that's, you know, they had, this
• 31:53
  Speaker 1: wasn't just someone pulling it out of their ass. It
• 31:54
  Speaker 1: was like, oh, look, here's a cell culture. And, you know,
• 31:58
  Speaker 1: if we stress it out and don't give them oxygen
• 32:00
  Speaker 1: or whatever, it's going to, or too much oxygen, it's
• 32:03
  Speaker 1: going to produce these free radicals and look, it damages DNA.
• 32:05
  Speaker 1: And like, that's all true. And we can even add
• 32:08
  Speaker 1: stuff like vitamin E and antioxidant to the cell culture
• 32:11
  Speaker 1: and fix this problem that we induced artificially in our experiment.
• 32:15
  Speaker 1: And that worked too. And then you do a big
• 32:17
  Speaker 1: randomized trial of vitamin E versus placebo, and there's no
• 32:21
  Speaker 1: effect on health. And in fact, the vitamin E arm
• 32:25
  Speaker 1: had an increased rate of heart failure for reasons that
• 32:27
  Speaker 1: are unclear. But like, yeah, it's a classic story. And
• 32:31
  Speaker 1: it happens again and again. I think the next big
• 32:34
  Speaker 1: one that was red wine, right? The resveratrol paper. So
• 32:42
  Speaker 1: this is a paper, like there was science here. So
• 32:45
  Speaker 1: we're in 2003. This is a paper appearing in Nature,
• 32:50
  Speaker 1: and scientists found that this stuff, resveratrol, which is found
• 32:56
  Speaker 1: in red wine, prolonged the life of Sarcomyces cerevisiae. That's
• 33:00
  Speaker 1: brewer's yeast, my favorite. Same yeast you get when you're
• 33:04
  Speaker 1: making bread from the store. And so it was like,
• 33:08
  Speaker 1: oh my gosh, you add this stuff to yeast, the
• 33:11
  Speaker 1: yeast lives longer. That's awesome. GlaxoSmithKline bought the company that
• 33:15
  Speaker 1: was spun out of this paper for $ 720 million in 2008.
• 33:20
  Speaker 1: So that's nice. And they're going to test supplements and
• 33:23
  Speaker 1: stuff like that. And nothing worked and didn't improve health.
• 33:27
  Speaker 1: And GSK actually shut down that company that they had
• 33:29
  Speaker 1: bought in 2013. So that was a $ 720 million boondoggle
• 33:33
  Speaker 1: for red wine. I'm still a fan of red wine,
• 33:36
  Speaker 1: but I can't lie to myself and tell me like
• 33:39
  Speaker 1: I'm doing something particularly good for my body.
• 33:42
  Speaker 2: Yeah.
• 33:43
  Speaker 3: And then the follow-up on that is rapamycin, which is
• 33:49
  Speaker 3: a compound that's been shown to extend lifespan in mice.
• 33:52
  Speaker 2: We could probably talk about that for an entire episode.
• 33:55
  Speaker 1: Also, it is something we use to suppress the immune
• 33:58
  Speaker 1: system in transplants. It's not red wine. It's like a
• 34:03
  Speaker 1: real drug.
• 34:04
  Speaker 2: Like a real drug. But the sort of systematic.
• 34:08
  Speaker 3: Review data on this shows no clear lifespan difference. benefit
• 34:12
  Speaker 3: in people. There's maybe something around aging in the immune
• 34:16
  Speaker 3: system or something. But again, not anything especially useful or
• 34:22
  Speaker 3: meaningful or things that would really matter for this. And
• 34:26
  Speaker 3: our favorite Don't Die influencer, Brian Johnson, used to take
• 34:30
  Speaker 3: this and then he stopped.
• 34:31
  Speaker 2: And so that suggests it doesn't work.
• 34:34
  Speaker 1: Yeah, I think there's actually a parallel between these things
• 34:39
  Speaker 1: and like mercury in the you know, Qing dynasty. Like it's,
• 34:45
  Speaker 1: there's something exciting there. There's something novel. It's interesting. You
• 34:51
  Speaker 1: might even have some data that's compelling and then, but
• 34:53
  Speaker 1: people are in such a rush to embrace these things.
• 34:57
  Speaker 1: And the truth is, this is like a truism of
• 35:00
  Speaker 1: medicine that's quite depressing, but most things don't work. Like it's,
• 35:04
  Speaker 1: it's really hard to find stuff that does what you
• 35:07
  Speaker 1: want it to do. Most trials fail. Most things never
• 35:12
  Speaker 1: get into trials in the first place.
• 35:14
  Speaker 3: So the bottom line at this point is that there
• 35:18
  Speaker 3: really isn't anything that's going to prevent death. So let's
• 35:22
  Speaker 3: actually talk about what happens when you die.
• 35:26
  Speaker 2: So what happens?
• 35:28
  Speaker 1: Yeah, that's it.
• 35:29
  Speaker 3: Now we're going to do what happens when you die,
• 35:31
  Speaker 3: which it seems like you won't be able to prevent
• 35:33
  Speaker 3: with rapamycin or some kind of blood of the young.
• 35:39
  Speaker 2: So, Perry, you're a doctor. Tell me. Tell me what happens.
• 35:42
  Speaker 1: Well, I mean, I can tell you what happens when
• 35:44
  Speaker 1: you die. I can tell you what happens to your body.
• 35:46
  Speaker 1: I can't tell you what.
• 35:47
  Speaker 2: No, that's what I'm asking. Okay. From the doctor standpoint.
• 35:51
  Speaker 1: All right.
• 35:54
  Speaker 2: Okay.
• 35:54
  Speaker 1: I mean, it's interesting. From a medical standpoint, death is.
• 36:01
  Speaker 1: Slightly harder to define than people might think. The binary
• 36:06
  Speaker 1: of living versus dead is a little more subtle. I'll
• 36:09
  Speaker 1: go through it because the truth is your body is
• 36:11
  Speaker 1: a bunch of different cells and they don't kind of
• 36:14
  Speaker 1: all die at the same time. So here's the timeline.
• 36:17
  Speaker 1: All right, let's say circulation stops. Your heart stops beating.
• 36:20
  Speaker 1: You've got about 10 to 20 seconds of consciousness there. Okay,
• 36:24
  Speaker 1: so heart can stop. Brain rapidly loses consciousness, but not immediately.
• 36:30
  Speaker 1: There's There's a bit. And then around 20 to 40
• 36:37
  Speaker 1: seconds after circulation arrest, the EEG goes flat. So if
• 36:40
  Speaker 1: you've got an EEG on someone's brain, like, okay, brainwaves
• 36:43
  Speaker 1: are gone. So I think at that point, you might
• 36:46
  Speaker 1: be like, okay, yes, maybe we can still bring this
• 36:48
  Speaker 1: person back if we restart their heart. But they're kind
• 36:50
  Speaker 1: of gone now, right? They're not conscious. EEG is flat.
• 36:53
  Speaker 1: And then this weird thing happens around 50 seconds. There's
• 36:57
  Speaker 1: a fascinating paper that looks at this, but it's called
• 37:01
  Speaker 1: a gamma surge. So the brain and what you might
• 37:04
  Speaker 1: think are its sort of last moments. So it's gone flat.
• 37:07
  Speaker 1: It's like there's no circulation. The brain has gone flat.
• 37:09
  Speaker 1: Then there's this surge of activity that spreads across the brain.
• 37:12
  Speaker 1: Super fascinating study actually investigated this in six people who
• 37:17
  Speaker 1: were going to be taken off the ventilator. So these
• 37:21
  Speaker 1: are people who were not yet dead. but weren't going
• 37:24
  Speaker 1: to recover. They were on a mechanical ventilator, not conscious.
• 37:28
  Speaker 1: They were all comatose. The brain activity was minimal, but
• 37:31
  Speaker 1: they weren't brain dead. They were comatose. And the researchers
• 37:36
  Speaker 1: consented their families to say, look, look, can we put
• 37:38
  Speaker 1: an EEG on their brain? And then we'll pull out
• 37:41
  Speaker 1: the breathing tube and they're going to die. And we're
• 37:43
  Speaker 1: going to record everything that happens as they die. And
• 37:47
  Speaker 1: they found this. This is appearing in the Presidium's National
• 37:51
  Speaker 1: Academy of Sciences in 2023. I'm sorry. These are four patients,
• 37:56
  Speaker 1: not six. In two out of four of the patients,
• 37:59
  Speaker 1: they saw this high frequency gamma power surge occur across
• 38:03
  Speaker 1: the brain. It was localized in the somatosensory cortex and
• 38:07
  Speaker 1: the dorsolateral prefrontal cortex. These are areas associated with conscious experience.
• 38:12
  Speaker 1: And then they did what's called connectivity mapping, which looks
• 38:17
  Speaker 1: similar to a dreaming state. So, okay, these people all died.
• 38:21
  Speaker 1: We have no idea what their experience was. But from
• 38:25
  Speaker 1: an EEG standpoint, there was a brief... Like these are
• 38:29
  Speaker 1: comatose patients with really little brain function. And then as
• 38:32
  Speaker 1: the brain was dying, there was this brief surge of
• 38:34
  Speaker 1: something that looks like conscious dreaming. And then obviously it stopped,
• 38:40
  Speaker 1: which I find fascinating and like mysterious and really cool.
• 38:44
  Speaker 1: We'll talk about near death experiences, but I think it's
• 38:46
  Speaker 1: an interesting phenomenon for sure.
• 38:49
  Speaker 2: Yeah.
• 38:51
  Speaker 1: But just to walk you through, now the brain is
• 38:54
  Speaker 1: basically at four to six minutes, brain is dead. There's
• 38:58
  Speaker 1: irreversible neuronal injury, I should say. That's at body temperature,
• 39:02
  Speaker 1: 98.6 degrees. It is very well documented that this is
• 39:05
  Speaker 1: slowed down at cold temperatures. So plenty of cases of people, kids,
• 39:10
  Speaker 1: adults who drown under the ice or something and can
• 39:15
  Speaker 1: be revived like way later. So there's a saying in medicine,
• 39:18
  Speaker 1: you're not dead until you're warm and dead. So like
• 39:20
  Speaker 1: we will not declare death on someone who's still cold, basically.
• 39:25
  Speaker 1: Within minutes of that circulatory arrest, you get what's called autolysis,
• 39:29
  Speaker 1: cell start to digest themselves. That is going to occur.
• 39:33
  Speaker 1: That's particularly like your pancreas and stuff is going to
• 39:36
  Speaker 1: start digesting itself. Bacteria will take over this process about
• 39:40
  Speaker 1: two days later. The heart is recoverable for about 30 minutes.
• 39:46
  Speaker 1: So after that, there's irreversible heart injury. That's relevant not
• 39:49
  Speaker 1: to bringing you back to life, but it is relevant
• 39:51
  Speaker 1: for transplant. Kidney's about 60 minutes. Two to six hours
• 39:55
  Speaker 1: after circulatory arrest, you get rigor mortis. That's where the
• 39:59
  Speaker 1: muscles are bound up. And then as the muscles break down,
• 40:04
  Speaker 1: that goes away. You have about 24 hours before the
• 40:07
  Speaker 1: corneas are so injured that they couldn't be transplanted. So
• 40:13
  Speaker 1: That's what happens when you die.
• 40:16
  Speaker 3: Can I ask you what it is like to watch
• 40:20
  Speaker 3: someone die and declare that they've died?
• 40:24
  Speaker 1: Yeah. Let me start with the death exam. This is
• 40:33
  Speaker 1: terrifying for a doctor, not because death is super scary,
• 40:36
  Speaker 1: because we obviously see it a lot. In fact, I
• 40:38
  Speaker 1: really appreciated when I was an intern in the ICU
• 40:40
  Speaker 1: at Penn. they actually had someone come and talk to
• 40:43
  Speaker 1: us about death because they pointed out, and this has
• 40:46
  Speaker 1: always stuck with me. Like you guys are seeing, you know,
• 40:48
  Speaker 1: we would typically, you know, you'd have like a patient
• 40:50
  Speaker 1: or two die per day in the ICU. That's sort
• 40:52
  Speaker 1: of the cadence there. And, and they were like, you,
• 40:55
  Speaker 1: you realize you guys are seeing like more death in
• 40:58
  Speaker 1: a short, in a more compressed period of time than
• 41:00
  Speaker 1: like most humans see in their lifetime, at least in
• 41:03
  Speaker 1: their modern humans. And we were like, Oh yeah, like,
• 41:06
  Speaker 1: damn actually.
• 41:07
  Speaker 3: Right.
• 41:07
  Speaker 1: And it was about sort of not getting desensitized to it. But, um,
• 41:11
  Speaker 1: The death exam is very scary. So what happens is
• 41:14
  Speaker 1: a patient dies. If they're a full code, then you
• 41:17
  Speaker 1: run a code, right? That's like the code blue and
• 41:19
  Speaker 1: the CPR and the injections and stuff. And that's a
• 41:23
  Speaker 1: very interesting process. But let's now say we've got a
• 41:26
  Speaker 1: patient who's like not going to be resuscitated. They have
• 41:28
  Speaker 1: a DNR or something like that. The nurse calls you
• 41:30
  Speaker 1: and is like, I think Mr. Johnson has passed. So
• 41:34
  Speaker 1: it's not official until you do this time of death thing, right?
• 41:36
  Speaker 1: So you go into the room. There might be family
• 41:39
  Speaker 1: there and you apologize and say like, you have to
• 41:42
  Speaker 1: examine Mr. Johnson. And it's very nerve wracking because you
• 41:48
  Speaker 1: cannot be wrong. Like this is the diagnosis that if
• 41:53
  Speaker 1: you get wrong, it's the worst, kind of the worst
• 41:56
  Speaker 1: thing you could possibly do. And yes, doctors have gotten
• 41:58
  Speaker 1: this wrong. So what you do is you visually inspect
• 42:03
  Speaker 1: to make sure they're not breathing. And then you listen
• 42:05
  Speaker 1: for a And I can tell you it's a nerve
• 42:11
  Speaker 1: wracking minute because you're like, you know, you can almost
• 42:14
  Speaker 1: like hallucinate. You're like, wait, what was that sound? Like,
• 42:16
  Speaker 1: could that possibly be in a heartbeat? You're feeling for
• 42:18
  Speaker 1: a pulse. You want to see if they respond to
• 42:21
  Speaker 1: any painful stimuli. So you might, you know, press on
• 42:24
  Speaker 1: their nail beds or something like that to make sure
• 42:26
  Speaker 1: there's no withdrawal. You check the pupils. They should be
• 42:30
  Speaker 1: dilated and fixed. Shine a light in them. The pupils
• 42:33
  Speaker 1: cannot react, right? That's a brain reflex. Brain can't work
• 42:37
  Speaker 1: if you're dead. all of those things being in place,
• 42:40
  Speaker 1: you can say, okay, you know, time of death, whatever
• 42:43
  Speaker 1: time it is. That's the death exam. Yeah. Watching someone
• 42:51
  Speaker 1: die is variable, I will say. I mean, there's been
• 42:59
  Speaker 1: really peaceful times, like, you know, patients who are on
• 43:02
  Speaker 1: inpatient hospice or something where it's just like they drift
• 43:06
  Speaker 1: off and it's very nice and you just kind of,
• 43:09
  Speaker 1: everything goes. And, and as you might imagine, there are,
• 43:12
  Speaker 1: you know, more, more upsetting versions of that.
• 43:17
  Speaker 2: So I find this, I mean, thank you for that.
• 43:22
  Speaker 3: Part of what's interesting about this to go back to
• 43:25
  Speaker 3: the like science and maybe even back to the past
• 43:29
  Speaker 3: is that.
• 43:30
  Speaker 2: It seems like hard.
• 43:32
  Speaker 3: So I think for a lot of people, we have
• 43:34
  Speaker 3: this idea in our head that like, okay, you're either
• 43:36
  Speaker 3: dead or you're not dead. Like I watched ER, I understand,
• 43:39
  Speaker 3: you know, like the Koga's across the thing and then
• 43:42
  Speaker 3: that's it, you're done. But particularly in like, you know,
• 43:46
  Speaker 3: the 1800s, it was quite difficult to tell whether someone
• 43:51
  Speaker 3: was dead. And so there's all kinds of stuff that
• 43:55
  Speaker 3: people had to try to avoid ending up people deciding
• 44:01
  Speaker 3: you were dead when actually you were just like having
• 44:03
  Speaker 3: a solid nap. So there are these things in the
• 44:07
  Speaker 3: 1800s called safety coffins, which were coffins that had bells
• 44:11
  Speaker 3: or tubes or flags or things where you could like
• 44:15
  Speaker 3: ring the bell if they buried you and you weren't
• 44:17
  Speaker 3: actually dead.
• 44:18
  Speaker 2: You'd be like, oh, I'm still here, you know, and
• 44:20
  Speaker 2: you have your tube.
• 44:20
  Speaker 1: Not dead yet.
• 44:22
  Speaker 2: This is the scariest thing, okay?
• 44:23
  Speaker 3: I mean, I have, there's a word for this, but
• 44:26
  Speaker 3: like I, the fear of being buried alive is like
• 44:28
  Speaker 3: a real thing.
• 44:29
  Speaker 2: That's a real one.
• 44:31
  Speaker 1: Oh, my gosh.
• 44:31
  Speaker 3: Totally.
• 44:32
  Speaker 1: What's the Poe? Sorry, A Cask of Amontillado. So terrifying.
• 44:36
  Speaker 2: Oh, terrible.
• 44:37
  Speaker 1: Another good Gothic fiction.
• 44:39
  Speaker 3: Yeah. Yeah.
• 44:40
  Speaker 1: I tried to find if there were any cases of
• 44:43
  Speaker 1: people actually of the safety coffins like working, like someone
• 44:47
  Speaker 1: ringing the bell. And I could not. I did not.
• 44:50
  Speaker 1: I did not find any.
• 44:51
  Speaker 2: But people have woken up in the morgue.
• 44:53
  Speaker 3: Yes.
• 44:53
  Speaker 1: In the morgue.
• 44:54
  Speaker 2: Yeah. Yeah.
• 44:55
  Speaker 3: I mean, rarely, but there are times in which people
• 44:58
  Speaker 3: do this wrong and then somebody wakes up in the morgue.
• 45:01
  Speaker 1: Totally. There is a phenomenon called the Lazarus phenomenon after
• 45:07
  Speaker 1: the biblical guy who was raised from the dead. So
• 45:09
  Speaker 1: this is real. It is defined as the spontaneous return
• 45:14
  Speaker 1: of circulation after CPR stops. So So I talked about
• 45:19
  Speaker 1: the death exam, but let's do the code, right? So
• 45:21
  Speaker 1: the patient's heart stops, but they're full code. So it's like, woo, woo, woo,
• 45:24
  Speaker 1: code blue. So you run in and someone's doing CPR
• 45:27
  Speaker 1: and someone's doing rescue breathing and all that kind of stuff.
• 45:29
  Speaker 1: And then if you're the doctor running a code, you're
• 45:32
  Speaker 1: at the end of the bed and you're not doing
• 45:34
  Speaker 1: any of that, but you're telling people what to do
• 45:35
  Speaker 1: and what medications to do and checking for a rhythm
• 45:38
  Speaker 1: and then deciding whether to defibrillate or not. It's a
• 45:40
  Speaker 1: whole thing. And then ideally you get it return of circulation.
• 45:46
  Speaker 1: We call it ROSC, return of spontaneous circulation. And you
• 45:49
  Speaker 1: pat yourself on the back and they go off to
• 45:50
  Speaker 1: the ICU and that's a good code. But then not infrequently,
• 45:55
  Speaker 1: you do not. And you do this, you try and
• 45:57
  Speaker 1: try and try. And eventually you just have to call it, right? Okay,
• 46:01
  Speaker 1: like we're done. And you stop CPR and the patient's dead,
• 46:08
  Speaker 1: except these rarer cases of the Lazarus phenomenon, where sometimes,
• 46:12
  Speaker 1: even though everything has stopped, their heart, which was stopped,
• 46:15
  Speaker 1: just starts to beat again. There was a review of
• 46:19
  Speaker 1: this in the Journal of Clinical Medicine in 2023 that
• 46:21
  Speaker 1: actually found 76 cases of what they called autoresuscitation. The
• 46:25
  Speaker 1: mean time, median time after CPR stopped when their heart
• 46:29
  Speaker 1: started beating again on its own was five minutes. So
• 46:33
  Speaker 1: that's a long time without a heartbeat that it just
• 46:35
  Speaker 1: starts up again. 32% of these patients actually ended up surviving,
• 46:41
  Speaker 1: but only 15% had an intact neurologic outcome. But I mean,
• 46:45
  Speaker 1: that's still not zero.
• 46:47
  Speaker 2: But do we have any idea what, like why? No. Well, no.
• 46:55
  Speaker 1: I mean, the heart is an electrical organ. You've got
• 47:00
  Speaker 1: cells that, you know, I would assume there's cells that
• 47:04
  Speaker 1: are kind of firing still. They're not dead yet, fully
• 47:07
  Speaker 1: dead yet. And it's like, I'm imagining like trying to
• 47:11
  Speaker 1: turn over the engine in a car, right? It's like,
• 47:14
  Speaker 1: and then maybe just one just hits at the right
• 47:16
  Speaker 1: point and the whole thing kind of starts working again.
• 47:18
  Speaker 1: I don't know. It's crazy. But this is why this
• 47:22
  Speaker 1: Lazarus phenomenon is when there's something called donation after cardiac death.
• 47:26
  Speaker 1: So organ donation usually happens after brain death. So heart's
• 47:29
  Speaker 1: still beating, everything's working, but the brain is dead. And
• 47:32
  Speaker 1: we can talk about what that means. That's another weird
• 47:34
  Speaker 1: exam to do. But donation after cardiac death is like, yeah,
• 47:38
  Speaker 1: your heart stopped. You're Brain is dead, yes, but your
• 47:41
  Speaker 1: heart is also dead. So the way that works typically
• 47:45
  Speaker 1: is someone's on a ventilator. They're not technically brain dead,
• 47:49
  Speaker 1: but they're going to be removed from the ventilator and
• 47:51
  Speaker 1: they will die. So you move them down to the
• 47:53
  Speaker 1: operating room. You take out the ventilator and you sit
• 47:58
  Speaker 1: there and wait because they're not breathing on their own.
• 48:02
  Speaker 1: And so you wait and wait and wait and you
• 48:03
  Speaker 1: watch and then the heart stops. And you would think
• 48:06
  Speaker 1: that at that point you could like, harvest the organs,
• 48:10
  Speaker 1: like take their lungs and kidneys and heart, whatever to
• 48:12
  Speaker 1: transplant into people. But you don't, because of this Lazarus phenomenon.
• 48:16
  Speaker 1: So you actually wait for the heart to stop. And
• 48:17
  Speaker 1: I think the waiting time is 10 minutes, but you
• 48:20
  Speaker 1: can check me on that. And you just sit there
• 48:22
  Speaker 1: in the operating room and wait until the heart has
• 48:24
  Speaker 1: been stopped for 10 minutes. And then it's like go time,
• 48:27
  Speaker 1: because obviously the longer you leave these organs in the body,
• 48:31
  Speaker 1: like without the special, without them being on ice and
• 48:34
  Speaker 1: all that kind of stuff, the worse they'll, they'll perform
• 48:36
  Speaker 1: in the, in the transplant patients. So it's a, It's
• 48:40
  Speaker 1: a macabre thing for our Halloween episode for sure. All right.
• 48:44
  Speaker 3: So I actually now want to talk a little bit
• 48:45
  Speaker 3: about near-death experiences because I think that this is, if
• 48:48
  Speaker 3: we sort of move out of the sort of biological
• 48:53
  Speaker 3: pieces of this back into a little bit of the more,
• 48:57
  Speaker 3: I don't even know what word I'm looking for, into
• 48:59
  Speaker 3: the like zeitgeist of this, there is a lot of
• 49:03
  Speaker 3: interest in the question of near-death experiences, partly because I
• 49:06
  Speaker 3: think people see it as a window to, you know,
• 49:10
  Speaker 3: is there something after, which is of course the ultimate,
• 49:13
  Speaker 3: there's the, like, I want to avoid death. And then
• 49:15
  Speaker 3: there is like, I want to know that there's something thereafter.
• 49:18
  Speaker 3: And near-death experiences are where people pull on there. This
• 49:21
  Speaker 3: is an almost universal kind of across all cultures. And
• 49:28
  Speaker 3: actually sort of some pretty similar universal feelings, like a
• 49:34
  Speaker 3: sense of peace, something about a tunnel, a light.
• 49:36
  Speaker 2: Yeah.
• 49:38
  Speaker 3: Uh, you know, people see angels or they see, but
• 49:40
  Speaker 3: that's not everybody describes this the same way, but you'll
• 49:43
  Speaker 3: see a surprising amount of similarity across, across descriptions. And I'm,
• 49:48
  Speaker 3: I'm curious, you're going back to what you said a
• 49:50
  Speaker 3: few minutes ago about this gamma surge. To what extent
• 49:53
  Speaker 3: do we think that that's, there's something your brain does
• 49:59
  Speaker 3: immediately before death that, that is driving that almost dreamlike state?
• 50:05
  Speaker 1: Yeah, I mean, it's totally reasonable speculation. Obviously, we don't
• 50:12
  Speaker 1: know from the gamma surge study because all of those
• 50:15
  Speaker 1: patients died, so we couldn't ask them what they remembered.
• 50:19
  Speaker 1: But certainly, these near-death experiences where people have come back,
• 50:24
  Speaker 1: and by the way, when we say come back, we
• 50:27
  Speaker 1: don't mean come back from brain death or from being
• 50:31
  Speaker 1: declared brain clinically dead, like using the exam that I
• 50:34
  Speaker 1: told you, although doctors have gotten that exam wrong. What
• 50:38
  Speaker 1: we're talking about in near-death experiences is generally people whose
• 50:40
  Speaker 1: heart has stopped for some period of time, usually a
• 50:43
  Speaker 1: very brief period of time, and then gotten restarted. So again,
• 50:48
  Speaker 1: it's like, what is death? In the olden days, we
• 50:51
  Speaker 1: would have said, oh, if your heart stops, you're dead.
• 50:53
  Speaker 1: But we know now that, well, actually, your heart might stop,
• 50:56
  Speaker 1: but we can do CPR and we can restart it
• 50:59
  Speaker 1: in some circumstances with a you know, it is near death. It's, it's,
• 51:04
  Speaker 1: it's not death, but I, I clearly something is happening
• 51:07
  Speaker 1: in the brain. One of the kind of cool things is,
• 51:12
  Speaker 1: is what people have done to test this. Um, so
• 51:17
  Speaker 1: a lot of people, one of the universals of the
• 51:19
  Speaker 1: near death experience is this out of body sensation. Like
• 51:21
  Speaker 1: you're floated, people describe floating above the operating room or
• 51:24
  Speaker 1: like they, they, they look down and see the doctors, um,
• 51:27
  Speaker 1: doing CPR or something like this. So there's a pretty
• 51:32
  Speaker 1: cool study called the AWARE study, which was published in
• 51:36
  Speaker 1: the Journal of Resuscitation in 2014, 15 hospitals across the US, UK, Austria.
• 51:43
  Speaker 1: What they did is they installed these shelves high on
• 51:46
  Speaker 1: the walls of the rooms where CPR happens, like the
• 51:49
  Speaker 1: ER and the ICU. So shelves way up high. And
• 51:53
  Speaker 1: then on top of that shelf, they would put a
• 51:54
  Speaker 1: picture like an animal or like a religious symbol or
• 51:58
  Speaker 1: a number or something like that, like on a big
• 52:00
  Speaker 1: piece of paper. But it's too high. No one can
• 52:02
  Speaker 1: see it, right? But in theory, if you're floating above
• 52:07
  Speaker 1: your body and looking down, you would be able to
• 52:09
  Speaker 1: see the image on the thing. And so in these hospitals,
• 52:14
  Speaker 1: there were 2,060 cardiac arrests. Unfortunately, only 22% of them
• 52:19
  Speaker 1: happened in rooms that had these shelves. And of the
• 52:23
  Speaker 1: people who were brought back with CPR and could, you know,
• 52:27
  Speaker 1: were awake and alert enough eventually to describe what happened
• 52:30
  Speaker 1: to them. Uh, no one correctly identified one of the images.
• 52:34
  Speaker 2: These people didn't know there was going to be a test.
• 52:36
  Speaker 2: Like it's not like they didn't like bring them in.
• 52:38
  Speaker 3: They're like, just, okay, you're going to have after the
• 52:40
  Speaker 3: heart attack, just pay attention.
• 52:42
  Speaker 2: We're going to be doing a little test afterwards.
• 52:45
  Speaker 1: Listeners, should you find yourself in this situation? Take some notes.
• 52:48
  Speaker 2: Look around.
• 52:49
  Speaker 1: Pay attention. Just look around. Yeah. People absolutely though do
• 52:54
  Speaker 1: identify sounds and like accurately identify sounds and things that,
• 52:59
  Speaker 1: and even like music that's playing in the room while
• 53:02
  Speaker 1: they're undergoing CPR. This doesn't seem quite as mystical to me.
• 53:05
  Speaker 1: I'm just sort of like, okay, that's good CPR. Like
• 53:07
  Speaker 1: they were restoring perfusion to your brain a little bit
• 53:10
  Speaker 1: and Yeah.
• 53:11
  Speaker 3: I mean, I think this is an extremely interesting space
• 53:14
  Speaker 3: and one that's obviously very hard to learn about because
• 53:17
  Speaker 3: most of the people die.
• 53:19
  Speaker 2: So then you can't ask them what happened afterwards.
• 53:22
  Speaker 1: Can't ask them.
• 53:23
  Speaker 3: I want to end this by talking about why death
• 53:30
  Speaker 3: is important.
• 53:31
  Speaker 2: For life, which is maybe a little more philosophical than
• 53:39
  Speaker 2: my usual, but.
• 53:42
  Speaker 3: So far, in the existence of human history, there have
• 53:45
  Speaker 3: been about 117 billion people born. And 7% of those
• 53:50
  Speaker 3: people are alive now, which means 93% of them died.
• 53:53
  Speaker 3: And pretty much everyone, not just pretty much, everyone dies.
• 53:57
  Speaker 2: The case fatality rate of life is 100%.
• 53:58
  Speaker 3: And this is a really, really important part of basically
• 54:05
  Speaker 3: every society. Every culture now has funeral rituals, mournings. it
• 54:11
  Speaker 3: is a sort of universal human experience. One of the very,
• 54:16
  Speaker 3: very few things other than being born that literally every
• 54:20
  Speaker 3: human will go through. And there's just almost nothing. I
• 54:28
  Speaker 3: think that is why people are so drawn to thinking
• 54:30
  Speaker 3: about this and talking about it and trying to understand
• 54:32
  Speaker 3: it and being afraid of it because it is just
• 54:37
  Speaker 3: universal and because it limits our the things that we
• 54:40
  Speaker 3: can do with our time here changes how we live.
• 54:44
  Speaker 1: And that limit is meaningful, right? Like the fact that
• 54:50
  Speaker 1: life is limited, doesn't it increase the relevance of every
• 54:55
  Speaker 1: moment to some extent?
• 54:57
  Speaker 2: Yeah.
• 54:58
  Speaker 3: I mean, it sort of has to. I'm not sure
• 54:59
  Speaker 3: we all live that way. I will say in the
• 55:03
  Speaker 3: psychology literature, you know, people tend to regret the stuff
• 55:07
  Speaker 3: they didn't do. Uh, and there, you know, there's a
• 55:10
  Speaker 3: lot of, there's a lot of regret in people's, at
• 55:13
  Speaker 3: the end of people's lives, they have many regrets about
• 55:16
  Speaker 3: things that they did not accomplish.
• 55:19
  Speaker 1: That they did not do as opposed to things that
• 55:21
  Speaker 1: they did do.
• 55:21
  Speaker 2: Yeah.
• 55:22
  Speaker 4: Um, yeah.
• 55:23
  Speaker 1: And I think if, I mean, if we were immortal,
• 55:26
  Speaker 1: that would not be salient, right? There's always, there's always
• 55:30
  Speaker 1: more time to, you can always put off whatever it
• 55:32
  Speaker 1: is you wanted to do because there's more time. So,
• 55:34
  Speaker 1: so knowing that time is limited, like, increases your ability
• 55:40
  Speaker 1: to do those things because you'll regret it if you don't.
• 55:43
  Speaker 1: I think, you know, thinking about this really in the
• 55:47
  Speaker 1: context of the tech bros, and I had this theory,
• 55:50
  Speaker 1: which was like, okay, as societies become more secular and
• 55:53
  Speaker 1: people are less religious, maybe it's like, oh, you know,
• 55:56
  Speaker 1: these tech guys, they don't believe in an afterlife. They're
• 55:58
  Speaker 1: materialists fundamentally. And so it's like, well, if this is
• 56:02
  Speaker 1: all I got, then like, I obviously want as much
• 56:05
  Speaker 1: of it as I can, right? Philosophically speaking. I actually
• 56:09
  Speaker 1: couldn't find any support for this in the social science literature.
• 56:11
  Speaker 1: In fact, the studies I found suggested that increased religiosity
• 56:16
  Speaker 1: goes along with increased fear of death in general, which
• 56:20
  Speaker 1: didn't entirely make sense to me. But anyway, that sort
• 56:23
  Speaker 1: of smashed that hypothesis. But nevertheless, maybe I'm a defeatist here,
• 56:29
  Speaker 1: but it feels to me like one of the things
• 56:33
  Speaker 1: we're supposed to do in life is come to terms
• 56:35
  Speaker 1: with death. Like it's the, it's the hardest thing to
• 56:40
  Speaker 1: really adjust to. It is the simultaneously, the most truth,
• 56:45
  Speaker 1: the most certain you can be about anything, right? Like
• 56:48
  Speaker 1: of all the things that are going to potentially happen
• 56:50
  Speaker 1: to you in your life.
• 56:51
  Speaker 2: It's for sure.
• 56:52
  Speaker 1: This for sure. So of all the things you could
• 56:55
  Speaker 1: prepare for, this is the one, right? Like it is
• 56:58
  Speaker 1: a hundred percent chance. And yeah, It seems to me
• 57:02
  Speaker 1: like a lot of these efforts in the wellness and
• 57:05
  Speaker 1: tech bro longevity space is an effort to avoid having
• 57:09
  Speaker 1: to confront that reality. And maybe confronting that reality makes
• 57:15
  Speaker 1: life better. Maybe if you really come to terms with
• 57:17
  Speaker 1: the fact that you're going to die someday, you're a
• 57:20
  Speaker 1: happier person.
• 57:22
  Speaker 3: I also think, and here I want to end on
• 57:24
  Speaker 3: this because I think it is the most practical thing
• 57:26
  Speaker 3: in this episode.
• 57:27
  Speaker 2: I think sometimes the focus.
• 57:30
  Speaker 3: On like not dying can take away from our ability
• 57:36
  Speaker 3: or our ability.
• 57:37
  Speaker 1: To die well.
• 57:38
  Speaker 3: So I want to put a plug in for palliative care.
• 57:41
  Speaker 3: So palliative care is a care that people get towards
• 57:44
  Speaker 3: the end of life. It's related to being in hospice
• 57:48
  Speaker 3: and it's sort of– but there are forms of it,
• 57:51
  Speaker 3: forms of palliative care that don't go as far as,
• 57:54
  Speaker 3: as hospice.
• 57:55
  Speaker 2: But we see just incredibly clearly in the data.
• 57:59
  Speaker 3: And there's trials in metastatic lung cancer, for example, that
• 58:04
  Speaker 3: people who are given palliative care, which is focused on
• 58:08
  Speaker 3: quality of life, as opposed to lengthening survival, have less depression.
• 58:13
  Speaker 3: They get less aggressive end of life care, but actually
• 58:16
  Speaker 3: survive a bit longer.
• 58:17
  Speaker 2: Yeah. And, So but even if it is not for survival,
• 58:23
  Speaker 2: there is it.
• 58:26
  Speaker 3: Is worth people thinking about the experience they want to
• 58:28
  Speaker 3: have at the end of their life. And sometimes that
• 58:33
  Speaker 3: experience should involve less medical intervention rather than more.
• 58:40
  Speaker 1: I love that. I remember that study coming out, the
• 58:43
  Speaker 1: metastatic lung cancer study. This was New England Journal in 2010.
• 58:46
  Speaker 1: And we all thought like, oh, clearly palliative care is
• 58:48
  Speaker 1: going to have less intense interventions and like less side
• 58:51
  Speaker 1: effects of chemo. And like, that'll be great. We all
• 58:54
  Speaker 1: assumed that it was going to have sort of similar
• 58:55
  Speaker 1: outcomes in terms of lifespan. But the fact that the
• 58:59
  Speaker 1: palliative care arm had longer median survival was like a
• 59:02
  Speaker 1: real eye opener for the medical community to be like, oh, okay.
• 59:06
  Speaker 2: You know?
• 59:07
  Speaker 1: And I guess it makes, you know, I mean, there's
• 59:09
  Speaker 1: times when just like giving more chemo is probably not
• 59:12
  Speaker 1: the right answer, but, um, yeah.
• 59:15
  Speaker 2: Uh, you know, Happy Halloween. Happy Halloween. How are you
• 59:19
  Speaker 2: planning to wrap this up, Barry?
• 59:21
  Speaker 1: Well, I was going to... I'm maybe not wrapping it
• 59:24
  Speaker 1: up in a happy way, but I was going to
• 59:25
  Speaker 1: talk about Seneca, who wrote that if you have learned
• 59:29
  Speaker 1: to die, you have unlearned being a slave. The Stoics
• 59:32
  Speaker 1: were sort of all over this being like, look, you know,
• 59:35
  Speaker 1: memento mori. Like, remember that you're immortal. Remember that you're
• 59:39
  Speaker 1: going to die. And it does keep things in perspective.
• 59:44
  Speaker 2: So....
• 59:45
  Speaker 1: Emily, death, smash or pass?
• 59:51
  Speaker 3: I mean, I'd love to pass, but I think I'm
• 59:54
  Speaker 3: going to have to smash because I'm told, look, I mean,
• 59:57
  Speaker 3: I don't, this is a, I will reframe by saying,
• 1:00:02
  Speaker 3: I think constantly trying to live forever at the expense
• 1:00:07
  Speaker 3: of all other things.
• 1:00:08
  Speaker 2: I'm going to pass on that.
• 1:00:09
  Speaker 1: Yeah, I will. I'll smash death. It's good that it's
• 1:00:14
  Speaker 1: out there. But let's live the best life we can.
• 1:00:21
  Speaker 1: And a longer life is a wonderful thing to hope for,
• 1:00:25
  Speaker 1: but not forever.
• 1:00:28
  Speaker 2: That's it for death. Your mailbag question of the week
• 1:00:31
  Speaker 2: after the break.
• 1:00:48
  Speaker 4: Hello, this is Tamar, the producer, reading a question from
• 1:00:52
  Speaker 4: a file that was unintentionally corrupted. Sorry about that. But
• 1:00:58
  Speaker 4: the question is, I'd be interested to hear more about
• 1:01:00
  Speaker 4: extended blood panels that companies like Function Health offer and
• 1:01:05
  Speaker 4: how actionable these extra results are.
• 1:01:08
  Speaker 2: Thank you. Okay, Perry, so.
• 1:01:11
  Speaker 3: Let me tell you how they decide reference values for
• 1:01:15
  Speaker 3: blood tests, which I'm sure you know, but for the listener,
• 1:01:18
  Speaker 3: when we decide on the reference value, like what is
• 1:01:21
  Speaker 3: the sort of normal range for any blood tests, you
• 1:01:23
  Speaker 3: have a bunch of like healthy people and you take
• 1:01:26
  Speaker 3: the middle 95%. So in a sample of healthy people
• 1:01:30
  Speaker 3: for any given blood test, you expect about 5% of
• 1:01:33
  Speaker 3: the people to be like outside of the reference ranges.
• 1:01:36
  Speaker 1: Despite the fact that they are healthy, like they don't
• 1:01:38
  Speaker 1: have a problem.
• 1:01:38
  Speaker 2: Totally healthy. It's just like, I don't know, there's like
• 1:01:40
  Speaker 2: some variation. You're just random.
• 1:01:42
  Speaker 3: And usually when doctors interpret a whole blood panel, they're
• 1:01:45
  Speaker 3: interpreting like along with the symptoms, the reason that you're
• 1:01:49
  Speaker 3: testing this, et cetera. Going out and getting a comprehensive
• 1:01:54
  Speaker 3: blood panel, which typically would contain, you know, I don't know, 75, 100, 150,
• 1:01:58
  Speaker 3: God knows what, like a tremendous number of these tests.
• 1:02:02
  Speaker 3: you will certainly find some that are out of range,
• 1:02:05
  Speaker 3: even if you are healthy, because 5% of the time,
• 1:02:07
  Speaker 3: every one of them will be out of range. And
• 1:02:09
  Speaker 3: if you have a hundred of them, you expect at
• 1:02:11
  Speaker 3: least five of them to be out of the range.
• 1:02:13
  Speaker 3: And I think that's the big concern with these is
• 1:02:15
  Speaker 3: that everyone's going to get some results.
• 1:02:18
  Speaker 2: That's like red star, your MCH is too high. And
• 1:02:22
  Speaker 2: it's like, who cares?
• 1:02:24
  Speaker 3: That actually is totally irrelevant unless you're having a problem
• 1:02:27
  Speaker 3: that we're testing for there. So I think, you know,
• 1:02:31
  Speaker 3: I mean, having your blood taken and getting a bunch
• 1:02:33
  Speaker 3: of numbers, like, it's not going to kill you, but
• 1:02:36
  Speaker 3: there's a tremendous amount of potential overreaction just because of
• 1:02:39
  Speaker 3: what these numbers mean.
• 1:02:42
  Speaker 1: That's very well said. The problem with all screening tests
• 1:02:45
  Speaker 1: is false positives. And... these are all screening tests unless
• 1:02:48
  Speaker 1: you have specific symptoms. If you do have specific symptoms,
• 1:02:52
  Speaker 1: you should talk to your doctor about it. And listen,
• 1:02:54
  Speaker 1: I appreciate the fact that these direct-to-consumer companies exist because
• 1:02:58
  Speaker 1: the medical system often fails our patients, right? You have
• 1:03:01
  Speaker 1: a symptom, you call your doctor, they're like, oh, I'll
• 1:03:04
  Speaker 1: get you in three months from now. Or you can
• 1:03:08
  Speaker 1: just pay to get tests. So it's in part on
• 1:03:12
  Speaker 1: us that we don't do a good enough job communicating
• 1:03:14
  Speaker 1: with our patients about what tests are good and what
• 1:03:16
  Speaker 1: tests are bad and how we manage false positives and
• 1:03:19
  Speaker 1: all these kind of things. But you're right. You're destined
• 1:03:24
  Speaker 1: to find something. And sometimes, you know, ignorance really is bliss.
• 1:03:30
  Speaker 3: All right. That's it for us today. Stick with us
• 1:03:34
  Speaker 3: next time when we'll ask, what's the deal with food dyes?
• 1:03:41
  Speaker 3: Wellness Actually is produced in association with iHeartMedia. Our senior
• 1:03:45
  Speaker 3: producer is Tamar Abishai. Our executive producer at iHeart is
• 1:03:49
  Speaker 3: Jennifer Bassett. Our theme music is by Eric Deutsch. And
• 1:03:53
  Speaker 3: our content is for educational purposes only.
• 1:03:55
  Speaker 1: If you like the show, help other people find us.
• 1:03:58
  Speaker 1: Leave a rating and review on Apple Podcasts or your
• 1:04:00
  Speaker 1: podcatcher of choice. And help us spread the word about
• 1:04:03
  Speaker 1: the show. You can follow us on Instagram at wellnessactuallypod.
• 1:04:08
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• 1:04:10
  Speaker 1: over to wellnessactually.fm and leave us a question for our
• 1:04:13
  Speaker 1: mailbag or suggest a topic for a future show.
• 1:04:16
  Speaker 2: We'll let the influencers have the last word. Ernest, I'm
• 1:04:20
  Speaker 2: in the morgue.
• 1:04:23
  Speaker 1: Why am I in the morgue? Shh, it's okay, it's okay.
• 1:04:25
  Speaker 2: They think I'm dead.
• 1:04:26
  Speaker 1: Yes, yes, they think you're dead, but you're not dead.
• 1:04:30
  Speaker 3: In the whole of recorded medical history, this has never
• 1:04:33
  Speaker 3: happened to another single human being.
• 1:04:36
  Speaker 2: Yes, so why did it have to happen to me?
• 1:04:39
  Speaker 1: Do you know what you are, darling? You're a sign.
• 1:04:44
  Speaker 3: You're an omen.
• 1:04:45
  Speaker 1: You're a burning bush. Don't you see, Madeline?
• 1:04:49
  Speaker 2: It's a miracle! Shh!
• 1:05:04
  Speaker 1: She is not dead until she is warm and dead.