« Making Sense with Sam Harris

#129 — An Insider’s View of Medicine

2018-06-12 | 🔗

In this episode of the Making Sense podcast, Sam Harris speaks with Dr. Nina Shapiro about the practice of medicine. They discuss the unique resiliency of children, the importance of second opinions, bad doctors, how medical training has changed in recent years, medical uncertainty, risk perception, vaccine safety, and other topics.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Today, I'm speaking with Doctor Nina Shapiro Nina, is a Rick otolaryngology IST she's, a pediatric Ian T, surgeon and she's. Also a professor of head and neck surgery at UCLA she's been featured in the New York Times time. The Wall Street Journal N, P, r c n n and he's written a new book, the title of which is type a doctor's guide to medical myths, exaggerated claims and bad advice. How to tell what's real and what's not and Nina's just a fantastic doctor, someone to have on the podcast to give us an insider's view of medicine and wanted to know what it's like to be a patient as a doctor. What should patients know that doctors know so it's been most of the hour talkin about that, but then we touch on her book a little bit at the end. Anyway, was great to talk to me, and I hope you find
and this conversation useful and now I bring you Shapiro. I am here with Nina Shapiro Nina thanks for coming on the podcast, thanks for having me great to be here, unlike maybe my guess you are someone I know personally and as a client you're a fantastic doctor who has written a book that will be talking about that. So I just so. I just want to give that context, because I kind of test to the quality of your bedside manner and the quality of got a better view of you than most of before. We get into, practical questions of health in your book, just remind me and and tell our listeners about your background, because you were sort of born to be a doctor. If I'm not mistaken, I guess so yeah I do come from a medical family and you know I don't have one of those really really cool back stories about how
I was first on Broadway and then ended up in medical school. I pretty much follow the track to medical school all on the east coast. I did my residency. Our training and medical training back in Boston moved out to California for a year, and that was twenty two years a go and certainly kind of like arriving like Dorothy in OZ? I realized how how nice it was out here. So I decided to stay and I've been in academic medicine at UCLA for about twenty one years now and my specialty, which is really small, All in very narrow, is pediatric otolaryngology, so pediatric, ear, nose and throat surgery and I'm a professor at UCLA. So I do some teaching and a lot of what we call tertiary or ordinary care medicine. So you know sort of the referral cases that come from all over the country and actually all over the world.
Kerosene, pretty sick kids. So you did your medical degree at Harvard. Did you work anywhere else see? We went straight UCLA, so, yes, I did my medical school at Harvard. I did my residency at Harvard and then I did a combined Pediatric Otolaryngology fellowship part of the year at Great Ormond Street Hospital in London and then part of the year at read each Eldrin Hospital in San Diego. That's how I landed in California. Did you go straight into working with kids, or did you work with adults for any significant period of time, so my eight residents, he was a mix of kids and adults and that's pretty standard for all older laryngology residency and then, once I did my fellowship right after residency, I've been working with kids ever since then, I'm always struck by how different the careers are. Depending on what type of doctor you decide to be, I mean the overlap
between being an e r doc, and a dermatologist, as far as I can tell, is almost zero in terms of just what their life experiences like so at. Where would you put your specialty in terms of the hi stress side of things and they technically difficult side of things? Your surgeon, as well as someone who just actually diagnoses problems right, so I sort of put my specialty is sort of like playing the pick hello in an orchestra where you do a lot of sort of regular day to day stuff Monday, and you don't really notice that much most of the stuff is seem pretty healthy people and then every so often there's this piercing life threatening events that in a matter of seconds, can go from great, too horrific.
So it's sort of an I do play the piccolo, so I feel like there's there's some connection there, where you know we for the most part, we take care of healthy people and everybody smiles, and it's a pretty much. You know an enjoyable time, but because I take care of tiny in fans and we as a specialty are the last resort when it comes to an airway problem, so somebody can't breathe, and if that somebody happens to wait two or three pounds, we are the ones that are called so every so often we have this excruciating life threatening moment and that that just keeps us on our toes and we lose a little bit of sleep because of that also you're dealing with people's kids. It would have to raise the stakes. I can tell you just from the side of being a parent,
That definitely does I'm way more stressed out dealing with the uncertainty around my kids health than my own. So I I can imagine you are seen parents at their most stressed out where the news is seem in bad. It is yeah I need, and we eat a sort of we joke that. You know the kids are the easy part. The parents are the hard part, because you know kids are actually for the most part, a lot more resilient than adults and and they're healthier than adults, but rightly so. Parents are very very stressed about anything related to their kids and again rightly so, but you know taking care of kids. We have a little bit of a different perspective, because we know how much they can handle just a
got a lot more than we can handle. That's for sure, yeah well, so say more about that, because I think a lot of the parental stress is predicated on not being in touch with that fact. When you've got on to Google and read the fine print on whatever this scary diagnosis is, and you see all of the horrific possibilities you sort of transfer that knowledge or pseudo knowledge will talk about the problems with Google onto your kid. I think it just tacitly where you're, just assuming that you know this dark cloud hanging over your life, now is casting the same amount of shade in your kids, mind, or at least could be, and of is your kid. Depending on the age, I mean, if your kid is it in fact a kid. Your kid knows nothing of these possibilities unless you tell them and it's very likely that your concerns are out of proportion to the actual probabilities and now speaking of me and-
many of our listeners. You not being a doctor, are not way in these possibilities intelligently and so tell me a little more about how you perceive the experience of a child dealing with significant health adventures. You know I hear a lot of concerns from parents and some of these concerns are very, very well founded. You know, for instance, if they're concerned about anesthesia or concerned about medications. You know there's a lot of solid information about that they can find. But you know, as you mentioned, Google and that's what most people doctors included, actually use when we're looking something up. You know we're questioning something is set to. Five. Into the most extreme most exaggerated information that you know it it's devastating and, and it's it's it's all it does for the most part, is create some confusion and panic, and we love to
panic. We left to sort of find the most extreme whatever. It is certainly when to come to our health, our child's health, and it will be easily found if you do a search, so you know a lot of what I do day to day is calming people down and trying to put things into perspective and what often people think about is the risk of an intervention, whether it's a medicine or surgery. But few people are really thinking about the risk of not intervening and they think of that,
always as less invasive when often times, and certainly in my practice being less invasive less invasive. Our last proactive can actually be higher risk and more dangerous to a child, but apparent obviously just thinks of it as protecting their child from something, but that something can actually be much more beneficial than the risk of not doing something. It is an interesting view of human health. You get working only on kids because I think, as you say, kids are, for the most part, the healthiest people on earth, but obviously there there, the there are cases where there's something very serious going wrong and the stakes are that much higher. Is there more say by the resiliency of kids with respect to adults in terms of just recuperating from procedures that work out or just the most can do
since being self limiting? And how do you think about the resiliency of a kid verses, the resiliency of someone, our age? So for the vast majority of kids, they are much more resilient than most adults. There are hearts you're stronger there. Long, sir, are stronger when they have an infection they recover more quickly when they have any sort of surgery they recover
quickly- and you know it's astounding, as some you know, kids will go home the same day or the next day after a small heart surgery that you'd never see that in an adult. You know, kids, have these devastating illnesses or or a devastating event, and and they bounce back it's it's really. They are almost a different. You know, obviously not a different species, but they're really a different type of being than adults and because they seem so much more fragile and helpless. We write we want to protect them more, but but their resilience is so much better stronger and quicker than any adults. Resilience that you know we you take care.
If kids have, you know, sort of a different view on what they can tolerate and it's a lot more than than what most adults can tolerate here I once saw my daughter fall down the stairs from a distance, and this is still it I'm, so I'm still horrified by the sight. I can't think I still have PTSD, I think from saying this, and this was a fall that would have absolutely paralyzed a stuntman. I mean this was just everything was wrong about. This fall look like her attempt to break her own neck and she was completely fine right, so you use or lose sight of that when you're being dragged through this labyrinth of
medical uncertainty with your child. And yes, some of you know the kids. If you, if you look at a little child- and you know we always say children are not just small adults they're built to to to withstand stuff like that, their their necks are smaller. Their heads are kind of puffy you're. In more you know, kind of cushion to than ours are so you know a lot of just physiologically and physically kids are physically built to tolerate falls. Their babies they're even like something as simple as a baby's vocal chords. What a baby's do when they're, not sleeping there crying, but they don't develop hoarseness or knowledge rules. Are you know what local issues from crying for ten hours per day, because they are built to withstand that. So you know it's some sort of evolutionary ability for kids to with stay and a lot of the trauma that we is uh. If we fell down the stairs, we crack our next or break our skulls, but
you know, literally we say they bounce and- and it's great you know, that's that's why they can go on to adulthood and then get hurt, yeah. I want your doctors, I view of being a patient essentially or or or the parent of a child who's. A patient and I want to know how you go through these experiences of getting sick or having people in your life to get sick, and just you know how it is, you would navigate a hospital, and you know how you think about second opinions, and all of that we've touched a couple. These issues already you get a diagnosis that sounds scary from one doctor. You go home and Google lead and get properly terrified by the what is, in many cases a very low probability risk and then It certainly standard procedure to get a second opinion, certainly if there's any significant intervention on the menu like a surgery. At this point I
have gone down this path enough that all this anecdotal. Obviously, but if you, judging from my experience both when I'm the patient and when my kids, then it's fairly alarming, how often I've gotten a false diagnosis? You know that it is overturned by a second opinion and in some cases the first diagnosed. This came with a very strong recommendation for treatment. That was significant intervention. I once left a doctor's office where I forget this is now one thousand and fifteen years ago I was having some problem. Thing I had pain in my hands or something that was a martial artist, I I might have pain in my hands, but I went up in the care of a rheumatologist who diagnose me with it with psoriatic arthritis and sent me out of the office with a month supply of Methotrexate and Humira, which are significant medications and
clear putting me on these drugs for the rest of my life, and you know it. It seemed quite crazy at the time and went and got a second opinion and another rheumatologist? You don't have psoriatic arthritis. You probably did something to your hands, but that kind of thing has happened with my daughters. It's fair really startling. In fact that I met you in this context, or at least I met you professionally in this context, where I think my daughter has been diagnosed with a cholesteatoma by a and then this is very much in your wheelhouse. I had never even heard of a Clusty Atoma and I brought to you and you took one look in our air, and so she doesn't have a class to Tom, but you know I: I had spent twenty four hours previously having Google old, a Cholesky Toma and realize how much I didn't want her to have one and do you know that it was a fairly stressful day. So how do you think about second opinions and what advice do you have for people, because doctors obviously can quite
confidently represent some state of affairs that isn't true. Yeah. Second opinions are, you know, surprisingly, a luxury, a lot of people, don't have the here with all or the means to obtain second opinions. Unfortunately, so a lot of people you know just are lucky and feel lucky that they can just get in to see a doctor and unfortunately, a lot of people are MIS diagnosed. Or you know receiving overly aggressive or underly aggressive treatment, and this is a big problem. You know I, as you know, you've had the experience with your daughter. You know I, I see patients and I you know sometimes they're a bit disappointed when I say nope. There's not the problem in your child doesn't need surgery and the family actually leaves a little bit frustrated because they were they almost
wanted there to be something, and I I tell them you will find a surgeon who will operate on your child guaranteed. So it is, it is a problem and it there isn't really the why this is happening. Why people in different medical centers recommend different treatment unless it's something that you know has several pathways. For instance, if, if you have a cancer patient, there are several different ways to approach it, whether it's surgery, chemotherapy surgery, chemo radiation. You know there are some variations to those sorts of paths, and a lot of that depends on the medical status of the patient, how healthy they are with their age, what they can tolerate, but you know this sort stuff where somebody doesn't have something, and then they end up getting a surgery. That is not.
Think you know if you have a new problem and you have the where, with all to obtain two or even three opinions, and it's not something urgent. I think I do encourage people to do that and for the most part you will find you know, for instance, if it's a surgical issue- and you see two surgeons, your you may find some minor variations and how they do the surgery or exactly what type of surgery. But if one surgeon says operate in the other's surgeon says absolutely don't operate, then you need a third opinion to break the tie. But you know it's a problem. What about bias built into the disciplines of so free euros? Surgeons have the tool of surgery, and I think it's a common concern and may be a valid one, that if you go to a surgeon for
nice, really the his or her choice will always be well to operate or not, and that could bias you in the direction of getting in surgery that perhaps you don't need armor. I guess that this is somewhat link to the question of whether or not to get certain kinds of test. Like I remember once again, this is back to my own personal martial arts generated problems, but I was having some back pain and I ask my doctor whether he thought I should get an mri of my back and he said well in a year or whatever it was at the time. Forty years old, I can guarantee you you have at least one bulging disc would be a miracle not to have something that we can image there and seeing it in your scan is not going to tell you whether it really is the source of your symptoms, and then you are going to want. Have a converse, with a surgeon and you will find one who will say yeah. We could get a shave that off for you- or this is something that we can talk about, and you know why start that process at all. When
what I'm going to recommend you do. Whatever we see on that film is: do physical therapy back off the martial arts and avoid surgery at at at almost any cost for a problem of this scale this problem of too much information an maybe there's this problem of talking to the wrong specialty too early. Well, hopefully not I like to tell people that they don't need that their child doesn't needs a jury, and I think you know we we have to sort of wonder you know where it is. If it's, if it's that much of a concern, if you, if people are feeling that you, you can't go to a surgeon for an evaluation, because They are a hammer and they're just looking for a nail. You know that that says that's a pretty negative give feeling or concern about Medison in general that you know, if you go to a certain specialty, they will find a problem related to their specialty
and I you know- and I think that's what's created a lot of you Know- sort of mistrust of medicine, and rightly so, because people are known to over operate. As you said, you know you have a small disk problem that could probably be remedied just by taking some physical therapy or resting or doing different exercises, as opposed to oh, you know, you have a disc bulge, we need to operate on it and you know. Unfortunately, there are a lot of doctors out there. A lot of surgeons out there who are sort of cutting
closely or unnecessarily, and you know, with the same result, is not doing surgery, but you know it's it's unfortunate that that that's how it's become that people feel that if they go to a rheumatologist you're going to leave the office with a room at a logic, disease or if you go to work, a spine, surgeon, you're gonna leave, you know schedule for spine surgery, and you know I think, that's I don't know how to sort of purify medicine or how we can sort of get back to. Well. If you go to a surgeon and the surgeon tells you, you don't need surgery. Actually, some people are disappointed with that recommendation and they'll go find someone else who will recommend surgery but I think: if there is something so drastic this recommended, then you do need to get a second or one slash three opinion. This is all just fall into the bin of there being a normal distribution in the talent and knowledge and ethics and any uh
relevant variable among doctors as there is in almost anything else. This is something that people don't realize or don't want to realize. 'cause, there's not really a good or obvious remedy for it, but we recognize that there is a normal distribution of ability in any domain. I mean baseball players, aren't all the same skill level and you could extend this to every profession, but I think we all want to assume that doctors are all of the same level or the differences between them. Don't matter. How do you as a doctor? Think about that? I mean when a friend of yours has to get a surgery and it is asking you you know how to find the surgeon. Is there a kind of insider knowledge of there being good surgeon, and bad surgeons in medicine or bad surgeons magically disappear. Bad surgeons said never disappear. Unfortunately, I
so I think there is a little bit of an insider track that that we in Madison are privy to you know. Certainly if you work in a large medical center, you know we sort of know certainly had a navigate, this very calm ' Plex system internally and then even around the country? You know, for instance, if I get a call from a friend across the country and there, child or they need a surgery or have a specific medical problem. You know it's one of those, almost like a six degrees of separation, but it's usually only two or three degrees within a phone call or two I could find them. The right person that is trustworthy has a good background. Has it, you know, has good ethics, as you said, and it's not just operating. 'cause. They feel everybody needs a certain type of surgery. So you know there is just as with most fields, though. There is a little bit of an insider tracked and in one of the benefits of being in
This thing is that we have pretty good access to other specialists pretty quickly alright, so it will give your phone number at the end of this podcast and you'll. Just get a few calls a day for medical referrals is my home address will be good. So this brings me to my wanting your doctors. I view of getting pushed or dragged into the machine of medical attention, and so you are sick or someone close to you is sick and you know I have to go to the hospital. What do you as a physician know about checking into a hospital that the average patient might not? What are your concerns? What do you want to avoid at all costs and what kind of questions do you ask that might not occur to
the average person to ask. How do you navigate a hospital? So you know that really depends on whether it's something that's planned. You know scheduled procedure or scheduled admission or surgery versus an emergency situation. Obviously, if there's an emerge since the situation and it's something in my home hospital, whether it's as when I was a resident in you know across the across the country or now here, in LOS Angeles, you know we do have. There is a little bit of professional courtesy, just as with, if you're, in any other line of work, you will get a little bit of professional courtesy and perhaps get in the door a little more quickly seen by who you want to get seen a little more quickly, but what I found- and you know certainly living and working in LOS Angeles, where we have a very substantial v- I p population. You know, as we say, everybody's a v. I p, but
we we have vips, they often try to create eight and navigate their own treatment plan, and it ends up being rating the worst possible medical care they may ask for somebody who they think is the best anesthesiologist, for instance, but because the person has at a high administrative title, but they have no experience with their medical, their their family members, medical condition. It may be the absolute wrong person. People also have this notion that they want to be the first procedure of the day. You know for a surgeon's busy schedule. Well, that's not always necessarily the best time to have surgery, or I don't want any. You know if you're in a t, hospital. I don't want any residents or medical students around well if we're used to it
certain way of practicing, and then somebody tries to change that routine because they think they'll get better hair and actually just makes for more anxiety on the part of the care givers and can create actually of a worse care situation so often times that you know it's best to just go with the flow of a hospital because they know what they do best. They know their routines, how they do them bass and sometimes trying to alter that. Even if doctors, we as doctors, try to alter the the routine king of the caregivers, it can actually backfire and get in the way. So you know a lot of hospitals, especially the big ones, are very frustrating. They feel very inefficient, but uh part of that is just the nature of how they work and in the care ends up being better. Sometimes by not making a big
think about who you are and who you know and- and you know, trying to sort of cut corners. Has this been quantified in anyway, it's hard to see how it would be quantified, but I'm sure there are some famous cases where some you know, Hollywood's Liberty got what was obviously substandard care, because the whole machine of the hospital was thrown into this equilibrium. Bio. All of his or her demands and all of the star re going on is that what you're thinking of when you're? When you talk about this yeah, I mean. Certainly there been some extreme cases. It was. He know that there is a trend. You know one of the babies at one of the hospitals in LOS Angeles Universe, You know, I I you know the thousand times the amount of at a certain medication and you know had a life through ending bleed, and that was you know a movie stars kid and and even if they weren't getting treated, you know different by a different team. You know everybody sort of has a little more anxiety when it's, you know, move
star or you know a politician or or a well known person. You know just it's human nature to feel a little more anxious. Because of that- and you know we all feel you know- we all take care of these- you know well known people and the one Did you sort of go with the flow again? No, no major track cities that I know of have happened, certainly in my experience, but I feel better almost when I don't know so who who they are this and and create a whole new sort scenario, because of because they who they are as opposed to just doing what we do, but there have been cases. I mean I've been in the news about. You know stars having these tragedies and hard to know. If it was because
they were who they were or just happen to be, no news worthy because because they're famous so you you touched on one point, which is a bit of a pet peeve of mine based on some personal experience, so that the issue of going into a teaching hospital my default demand in those situations, is that you, I don't want anyone learning a procedure that carries an e cig look risk on me or my children? And you know I'm I'm totally in touch with the paradox here of the ethics of pedagogy mean people have to learn how do these procedures, I want them to learn it. I just don't want them to learn it on me or my daughters. It's defensible in the moment because it's just she gets one chance receive this into Bashan or whatever it is, and I want somebody who's an expert doing it. What's your sense, I know you have to play both sides of this, but what's your sense of the reasonableness of that demand, you know, I think it's a very reasonable
demand and I think that more now than ever residents interns, medical students actually have less autonomy than they did years ago. It's not you know the notion of you know the anesthesiology, Just just you know out playing golf or in the cafeteria, while your you know, your family members, you know undergoing anesthesia is is certainly no longer the case you know usually if a resident or medical student is involved in a case, it's usually as an assistant. So you know that autonomy
This site is that I think because resident hours are restricted and they work fewer hours per week and they take last overnight, call I'm curious to see in a generation or two what sort of doctors we have, because they are getting a lot less experience during their residency training and a lot less hands on and then I did that's for sure, but there has to be a first time where someone is actually flying. That's the ship him or herself there's a fair time. You you're the one performing. You know that part of the surgery or any specific intervention that runs a risk of going wrong. I can imagine you can ride shotgun on that as many times you like, but at a certain point, you're holding the knife for the first time in there's no way to
make it any more incremental than that is there. There is actually I mean there's so many part. You know, for instance, in into Bashan, for instance, is not just you know it not like watching er, where there, oh, I'm in you know it's there, several steps to it. So you know a lot of times in a residency train, saying: it's it's a gradual rise to doing something or if you're, assisting in a you know. Let's say it's a liver transplant. You know there. You know I and eight hour surgery there. So many parts to it. You know the skin. Incision is the smallest part, but people think of that is you know the knife, but you're not you know cutting through the liver with the skin incision. So you know there is: there is sort of a gradual rise to what you do, certainly in a surgical field or an anesthesia field, it's not just all or nothing, and so how his training
changed. In recent years, I've I've heard rumors that residents are now no longer sleep deprived as they used to be at that to the lay person's sounds like a holy good thing excel, I just heard. You worry that maybe we're not producing a generation of doctors that are as pressure tested is. Your generation is just give me a picture of how training has changed in recent years remarkably it started with the Libby Zion case in the 80s, where you know a college girl came into an urgency, room in New York and she received a medication that interfered with her daily medication and she died, and the claim was that this was due to the residents one sleep deprivation and to not be
supervised, but primarily it was the issue of sleep deprivation and ever since that case became an issue. Residency work hours have been reduced did two hundred and sixty to eighty hours per week and and all so within that they had have a limited amount of numb of hours in a row that you and be working. So yes, for the most part, this is great and it makes for much happier residents much more balanced residents residents who will likely stay in Medison because they have a balanced life. I mean the word residency would literally mean that you would be a resident of a hospital and you would live pretty much lives there, and you know those of us who trains before these restrictions. You know we do feel that you know we worked over a hundred hours per week and we would stay in the hospital for two or three days at a time and so we would sort of joke that the the only
thing about being on call every other night. Is that you miss half the cases so it you know, it's just a different mentality of of you know what we know that how is certainly when it comes to surgeons. You know that we're sort of tough and we can work hard, and you know, we're invincible, but you know it's not a human way to be, and you know the the the early studies looking at the metrics of whether this is really beneficial have shown that you know there there's some in. Movements in you know the question is really: are fewer mistakes being made? That's really what the outcome is going to be
ical errors, better patient outcomes? And you know the studies have been mixed as far as you know, whether that's really the case, because there's so much less continuity of care. So even if it's a tired resident you're still taking care of the same patient you're, not passing the baton, every six or eight hours. So you know it's it's it's a little bit of a mixed bag and what about the augmentation of doctors, abilities or or degradation based on access to information, where we with that doctor Is there a residents who jumped on their smartphones to aid in the diagnosis it used to be that no one had a smartphone and you had to have? Presumably you had to have more facts in your head, although obviously they were, there were fewer facts to be known. How do you view the use of technology here? Is it
all to the good? Or is it undermining people's abilities in any respect? Well, you know, for the most part, it's good in in because most people who are working in Madison, know how to navigate technology and fine valid articles or useful pieces of information? But the problem is, you know we would have to go to the library and figure out what to search, and maybe, if we had a computer, we can put in some search terms, but the what people have lost is the thinking ability to figure out how to find what they're looking for how to sort of investigate it as oppose you're just pushing a few buttons on your smartphone with the key word and you'll dig around and the the informational sort of come to you. So it's a little bit of a a spine defect as opposed to a shark, where you're actually going to look for the information and figure out how to find the information, because you have a smartphone or tablet that you're walking around with it takes out a little bit of the the F
search to get the information, but you can get it very quickly is a I yet making any inroads into your experience. As a doctor, I thought that, like IBM, Watson has a medical product where it's not just a matter of a human brain surgeon, a database, but it's significantly facilitated by some form of narrow ai. Is that showing up yet or not in the mainstream, I mean certainly we talk about it and heard about it. You know, I think, we're more. Let the level of robotics, which is a little bit of it's, not really ai, but it's a little bit of artificial function. We don't we don't touch the patient anymore. A lot of the time when we're doing surgery is a robot who's, doing the surgery and we're sitting across the room. So you I think there's certainly some. I guess the a part is definitely part of medicine, but the ai, not not quite yet in the mainstream. So what percentage of
more surgeries are done with a robe Azure mine are not a lot of head and neck surgeries are, though, so. A lot of surgeries in my department might probably one thousand five hundred and twenty percent or done with a robot, and is that totally different skill set manual. Liam is just you have to learn how to pilot a robot as opposed to actually work on a human body yeah? So it's an extra extra training, sometimes it's a full year of fellowship or or several no extra training courses, depending on where you are in your career, to learn how to to work the robot. It's pretty amazing it it's pretty cool to see. It is literally, you know feels like rocket science, because the robot arms can get to areas that that human instruments- you know you you and fingers with instruments can't get too. So you know it's really it's a revolutionary technique, it's in its infancy. I'm
only it's not perfect yet, but but it has really improved patient outcomes, because you can do these tiny little surgeries without being so aggressive and and get the same outcome, and is this one of the things where most hospitals would not have this resource and it's the difference between being in a big city hospital like UCLA and being elsewhere? Yes, it's to me, it's pretty it's at this point limited to large, academic, centers or large. You know medical centers in in cities, because it's it's a pretty specialized device. So take me back to
are you in the hospital with a caring for a loved one and let's not make it UCLA so you're, just in through tinted. Bad luck to you and your family are in some other city, and someone has to be hospitalized. How do you think about risk mitigation from the side of being a patient? Is there anything you do you think you do differently or questions that you ask that most people would notice because they're, not they haven't seen the other side of Madison. Oh absolutely, I mean we're. You know we're two surgeon family So you know we can't help ourselves by, you know sort of become, involved in whatever our family member is going through. So it's sort of you know we're stuck with that information. So clearly we're going to have bias an clearly we're going to question the doctors different
be in question the medical care, but you know we try. You know. We've had been in this situation. I have been traveling with my family, where family member has needed urgent hospice. Azatian in the middle of what we thought was the middle of nowhere. It seemed like the middle of nowhere is very beautiful, but it was you know up in the mountains and Northern California and you know it was. The question was and we were faced with this- we were in this very small. Lovely hospital with very little care, and the question was whether we should take the risk of driving seven hours home with with a critically ill child or whether we should sort of tough it out and stay in this very rural hospital, and we rightly decided to hey and we we ended up getting very good care, and I think you know it's hard as a doctor and it's hard as a doctor working in a tertiary medical center just should give some trust
people outside of your sort of known area, but you know we did end up just taking a step back and being the patient, being the patient, family and- and everything worked out. I think you know you have you know if you were in a travel around the world as a family. You can, you know, have everything at your fingertips at all times, and you do you have to you know, serve relinquish some some control in those situations. What would you do differently than a naive patient? Would like you're in a hospital? It's a big city hospital. It's just not your hospital, you don't know anyone personally in the hospital and your now in dialogue with the doctor who What are you asking the doctor that I won't think to ask? That's a great question. You know it's it's!
Lee hard not to just sort of participate in the decision making. When you know, especially if it's a family member, you know, I think I would probably just ask more specific questions about a particular medical issue. Just because I'm I'm I'm you know, even though I have it a narrow sub specialty, you know we're all doctors, we have some basic medical knowledge, so I would probably be asking different questions than you know: someone who's, not medical, just as when I take care of doctors, kids, or sergeant. You know, indoor surgeons, kids, they are going to be asking me different questions. Then then someone who's not in Medison and it you know it's just the nature of it and you know it's kind of it's a little bit of a club. So we have you know this quiet understanding among amongst ourselves. That you know they know that I know- and you know so, there's a little bit of you know it's almost like a little bit of a club that that they know that I'm gay.
No, some medison and they're going to have to speak to me a little bit differently, Then, if it was someone who was Non medical, does it come down to things like just to take surgery as an example, I got you if you're in a big The hospital is a big knowledge that there's a range of abilities and outcomes. You know the the statistics associated with each sub specialty with with each surgeon or each anesthesiologist is a coherent to say something. Like it. Would you say something like you know. I want you to give me your best anesthesiologist. Would it be acknowledge that there's a best anesthesiologist or would it be just a guarantee that everyone would be thinking insane well. All of our anesthesiologists are good. I think I think the latter actually and I get that question all the time is there. You know I want your top anesthesiology
sure I want your best team and there is no, you know every there's. There are a lot of really good ones, and you know what I tell people as I only work with people. I want to work with, and I have the luxury to do that and I think that you know people get sort of Wrapped up in oh, I want the I want the chair. I want the most senior person or the most experienced. That's not always in your best interest. You know, I think that you want somebody good. You want somebody to do a
job, and I think if I were you know with my family member and at a hospital- and it was it, you know, surgical situation or even a medical situation. I would just want people who are good and and not necessarily, I want the best. I think people that there is no bass. There is no worst, I'm and you know a lot of those choices are out of our control and I think when you start to do that, and you know again, we talked about how, in LOS Angeles people try to create a they're out there, our team, because they're the v I p is, and they think they can create this best team that that that's when care gets sort of decline. Dan, and I actually try not to do that. If we were, you know if I was in this situation in and out you know across the country, in a city hospital where I didn't know anybody, I wouldn't demand the or you know, the top or the most senior, because those may not necessarily be the right group at the time.
You might be just dragging someone in who who's in the sort of fund raising period of his or her career is actually not the best. Even though there are the chair or whatever, but we've already acknowledged that there's a range of abilities among surgeons and presumably every other discipline, so you know if there are bad surgeons out there. Presumably you don't want to get one. So what would you do to avoid getting a bad surgeon or any other specialist is not as good as you want? Well, you know again, it depends on this. If it's an emergency situation, unfortunately you get what you get and you don't get upset, but if it's you know if it's uh, what more elective you know again, even though you know for in this strange place, you know we can always make a few phone calls and and and find out. You know kind of the inside scoop a little bit, but I think for someone who's not in medicine and can't do that. You know you can eat it. I'm always reluctant to look at those online reviews of doctors. People you know, yelp and all those other systems are are
xtremely, inaccurate uhm. You know, I think you know even just asking around you know your hospital team, you can, you can usually find out? You know the nurses are usually the best judges of doctors, so you know they'll they'll often tell you whether you have a good surgeon or not. Are there good, unbiased sources of information with respect to outcomes of like if you need heart surgery and they're too big hospitals in your city? Is it easy to get the outcome measures for that specific surgery in those two hospitals? There are some metrics. You know there's something called the leapfrog group. We looks at hospital in a larger hospital outcomes and it you know you, for instance, if it's a heart surgery or you know a major major surgery that you're you're considering for you are your family member. You can get the outcomes for hospitals and for individual surgeons, but you know even with that
There's always going to be a little bit of internal bias, for instance, or were they taking care of more complicated patients, and that's why they had higher risks and more complications because they were taking care of. You know the sickest of the sick as opposed to the healthy patient that just coming off the street for their first surgery. So you know it is it's hard to obtain a lot of this. We have pure data on surgical outcomes because there's so much more involved, because these are patients with other sort of issue just going on yeah I mean UCLA. You've got people being flown in by helicopter to deal with something that the other hospital couldn't deal with. Ok, so I've spent a lot of time talking to you about everything, that's
not in your book, because I wanted to get your on view of all this, and- and this is fine because our conversation will not exhaust the interest of it in your book, and people just have to read it, but let's have it now to your book and what you think people should know about how to maintain their health and the health of their families. Your book is hype, a doctor's guide to medical myths, exaggerated claims and bad advice and how to tell what's real and what's not and you go through all these areas and some of which we've touched, but many which we haven't like diet and alternative medicine vitamins. The kind of things that people should reach for his remedies were to reach for his remedy is in ways that may be ill considered and the kinds of a perception of risk that guide these to say,
things which aren't really at the end of the day, all that rational. So if you could give in five minutes advice for a member of our species in the year, twenty eighteen with respect to how a person should think about staying healthy, whether the first things, you would say but you know, I think, one of the Inspira or one of the main inspirations. For for writing. The book was that I was hearing whether it was at work or you know socially or family, you know outside families. My inspiration was there were so many people, who wore misguided on the ideas of what is healthy is such a basic idea that I would come home from work or come home from school drop off often my head would be spinning wondering where people getting this information an did. I miss something. You know, what's good, for you, what's risky, what's harmful what
toxic was contaminated. All these buzzwords going around. So you know the goal was really to to help people roll facts and we're all you know. We all worry we're all concerned about our health, our families, health, the health of this planet, the health of our species, and we are grasping at all of these extr. Reem measures to obtain this so called perfect health or adequate health, that we've lost sight of the basics- and you know risk was- is one of the biggies and I you know I have a whole chapter on risk because people have this kind of he for their families and they're completely missing the boat on on, what's really risky and what's really healthy. So you know, I think that the goal of the book was
to put people's minds at ease a little bit and also put some perspective into what we are so worried about what we're so focused on, Matt. What really matters and was really basic to keep ourselves alive and healthy. I mean what what do we we want to live long. We want our families to live long, we want to live well, we want to have healthy living, not just long number of years. It doesn't matter if we live to ninety five. If we are, you know in a vegetative state for the last fifteen years of our lives, we want to live healthy lives, you know and long a you know. That's the other issue is how many years what's the magic number of years, we want to live. So you know they're, they're, very simple things we need to do not necessary and it doesn't necessarily involve a juice cleanse, aura detox or an extreme dia
or you know all you know. All of these. You know kind of crate, which me crazy notions of you know how how to keep ourselves healthy. What are the primary piece of advice? You would give all start you off with don't smoke cigarettes and if you're smoking quit don't smoke, cigarettes quit smoking. You know, and then you know just a briefly about smoking. You know so what what was created to help people stop smoking. It was first, you know, nicotine patches, nicotine gum and then vaping and now vaping has become the gateway for kids to start smoking so You know that's sort of turned one hundred and eighty degrees to the negative where electronic cigarettes were supposed to be used to help people quit smoking, and now it's you, used in middle schools.
Cooling is the new term only to you know a to get kids to start smoking because it tastes like candy arms, so you're obviously stop smoking base, except if you bike, wear a bicycle helmet that you know people die biking just from not wearing a helmet. In the sun, wear sunscreen people die from skin cancer every day. Eight. You know if you're in a car where a seat belt in these you know they seem so obvious, but this is how people don't survive. If you have a phone, don't text and drive. If you have a teenager who's learning to drive, make sure they know they can not text and drive. This is how people die in car accidents. They're not dying from evil hello infections, they're dying from texting and driving. So these are very basic things that you know everyone say: oh, yes, yes, of course not, of course not, but we all do it. We all we all put our
of our lives in danger every day. You know if we live in a big city, even if we live in a small town, we all drive. You know we put our kids in the car. We, you know we have our phones going off. We have so much distraction an this is you know, is numb. You know pure boring numbers wise. This is how people don't survive. I want to link I'm texting and driving for a second, because I'm sure this true of a significant percentage of our audience that there's a range of concerns that they have with respect to how to mitigate scan you know they might be afraid to fly. They might be afraid of catching an esoteric illnesses when they hit the news, but they don't feel any fear when reaching for their phone and texting while driving or texting while walking is as a pedestrian crossing the street, which you see more and more, and if that's you there's such a mid
match between the actual risk, you're incurring what with what you do casually and what you're spending your time worrying about. It's just there's no reason to worry about anything if you're still texting while driving. That's the first thing. You need to worry about it, I heard on radio that the incidence of pedestrians being killed had doubled in a big city or where I was listening to this, and the reason is proffered for is never referenced a smartphone and they were saying well, maybe there's just more pedestrians. Now people are out walking more but from the side of war, who now is scrupulous about not texting while driving. But you know I I certainly had my moments once we were first getting these phones in hand. It strikes me absolutely obvious what would be killing pedestrians in greater numbers now,
because the moment which is most tempted to text is the moment when you're at a year, you're at a red light, and you just decide to check your phone and that checking of the phone begins to extend past the point where you're, you're now the lights, green and you're moving, but you're still going slow enough that you imagine you can tolerate a few more seconds of phone interaction, and so it is with the pedestrians that you see people crossing the street all the time, never looking at anything, but their phones, you've got in attention on both sides of this and it's not so I don't know what the numbers are, but I'm sure we're talking about thousands of people every year who are being killed or injured by this one.
Case. I don't know if you are on the side of I'm sure. Er docs see this all the time, but it is a very strange situation where and where we're quite obviously worried about the wrong things. Yeah I mean, I think, that the what you said and and and I think it's this notion of control- that I can do it- I I'm a great driver- I can you know or across the street all the time I I I am in control of my phone. I'm pushing the buttons, and so people feel that there's less risk if they're doing the action as opposed to something being foisted on them like a virus, or you know some crazy infection on an airplane? They feel that that that it's it's somewhat safer, which is completely erroneous, okay
What other actions will advise you have here? What? What about? With respect to diet, diet is obviously an area where people, I think, for understandable reasons, live with significant uncertainty of that I've said this somewhere before. I consider it one of the greatest embarrassments of modern science that there's any diversity of opinion at all about what human beings should eat so as to be healthy, and how is it that we still don't have a rock solid consensus on what is a healthy diet and not only do not have a consensus. You can have seemingly scientifically trained people recommend the opposite diet that you can get just to eat as much saturated fat as you possibly can diet to whatever you do, cut out, saturated fat and as far as I can tell the only thing that you can get every, going to agree on is that cutting down sugar is virtually always a good idea,
there's no one who will say by all means eat as much sugar as you can, but that's where total lack of controversy stops. So I miss you, a sense of what people should be eating in so as to Idiot proof their diets. Well, I think you know, I think it it's it's people love they can talk about their diets and Leslie and very what diet there on and Leslie. And you know just what your your point about sugar is kind of interesting because, yes, you should you know it's common sense and common knowledge. You to limit your sugar, but sugar has become vilified to the point where people think that sugar is causing cancer, which you know you. Certainly it can be associated with some cancers, but then people twist that to say I'm gonna cut out sugar and that's going to cure. My cancer and sugar is feeding my cancer cells. So if I don't eat sugar,
in my diet I will my cancer will go away, which is complete nonsense, an deadly. Obviously you know I think, for for dietze. You know again in my head is spinning. When I hear about the newest, you know there's it used to be called Atkins now. It's called keys oh and then there's palaeo and glue free, and you know sugar, free and I'm cutting this and I'm cutting that and You know the boring idea of moderation, which seems so uninteresting and you're not going to you know write a book about, have a moderate diet and eat a little bit of everything and eat until you're. Full an eating should not be something that you're doing from a pouch, because we have teeth that. You know it's come this overwhelming. You know whether it's a fad or a trend that comes and goes it is. It is complete, utter nonsense.
In my, in my view, I think that you know this notion of foods having more power than they actually do. Has created society of you know we're so focused on food and and people can spend their days. We are talking about their diet and focusing on their diet, and you know certainly gives people something to do, but it
no it's a complete waste of of time and energy and it doesn't necessarily make make somebody healthier. I think people sort of jump, the gun by saying if you eat a certain food, it's going to do this certain thing to my body and it's not that simple. You know we have a pretty complex system going on inside of our bodies that if you eat a super food, it's not going to make you a super human person. So, yes, certain foods have been fetish eyes. I I think I've noticed recently that Cale, which was you know, probably this decade's most remarked super food. Now has some downside I think there's been some rip. Board on if you're, replacing Sally, all salad with Kale you're, probably getting too much of some toxin. The other shoe is continually dropping on many of these recommendations, but
It is slightly alarming that there's again, this is just anecdotal information when getting advice from medical authorities. You know, let's say a cardiologist, you can get nutritional advice that seems starkly antiquated, was recently talking to a cardiologist. Who recommend did that? I eat less cholesterol and, as far as I know, I mean there's basically no nutrition scientists now who thinks the dietary cholesterol is, what moves the needle in terms of a person's lipid profile and risk for heart disease. I don't know if that is still controversial point, but a year like a you know, an outside of medicine and just consuming more of what one reads from people who are spending all their time focused on the nutrition science side of it that's just a kind of a crazy twenty or thirty year old recommendation, and yet I've had a car
just give it to me in the last three months. Is there a way in which it's reasonable to worry that medicine isn't necessarily up to speed on all of these questions? Well, yeah. I think some of it is you know over. You know, how would you be a cardiologist in not say you know, cut down your cholesterol and fat, it just seems kind of sort of flipped to say that, and you know you know, I think some of the sort of older school people may have sort of that older notion that you know you shouldn't have this kind of food. You know eggs have been considered. I remember you know in the 70s and 80s when all of a sudden eggs were the toxin of the time, and now you know we're back to eating eggs. So you know certainly there's some things missed and then also
you know in medicine and cardiology, specifically, sometimes the the information gets flip, for instance, a few years ago or within the last year or two coconut oil was the big thing that the American Heart Association was was recommending for heart health instill. Some new data came out saying that coconut oil was never mind. It's actually bad for your heart. Don't have coconut oil. What about all those people that, were you know drinking coconut oil for the last two years? So you know some of it is just that the information changes over time and he you know. I think that you know I have read patient, you know, I always say: vitamins are
necessary and then some people have been telling me what my doctors recommending vitamins. So what is it is it? You know the doctor says it's good or bad. So you know there is you know, just as you're gonna have to surgeons recommend two different pieces of information. You may have some doctors to say you know they have this kind of diet or that kind of diet, but you know, I think, diet in it of itself is is more than just what we eat. It's it's the how we eat it's become. You know. Sort of this is kind of funny activity. That has you know because of that we've lost the enjoyment in food. You know you do starvation diets or detox diets. Where you know this notion of cleansing your body of toxins which is complete nonsense or.
No eating on the run or eating all you can eat, you know that sort of this whole other idea like. Why do you need to eat all you can eat? Can't you just eat until you're full or why do you have to eat so much? So you know, I think whatever the doctor recommends is you know you need to sort of understand if that, if that's something logical or just you know old school, you know cut down your salt or cut down your cholesterol. But I think it's also just this whole notion of diet has become you know it's it's just it's not just part of your life. It becomes this whole sort of way of of beating some of these diets to acquire a kind of quasi religious significance in people's lives, but a a I I think. A lot of this is also justified by the fact that there are people who have specific needs where a change in diet can radically change their own perception of their health, and there are people who are gluten intolerant ori. I guess you have celiac disease and for them, obviously a change in diet change,
the game entirely and then that message begins to migrate and get exported to every Nelson. We assume that okay, we'll all be better off if we stop eating gluten yeah- and you know Gluten- is that is a biggie, and you know: Celiac disease is on the rise and it's a horrible illness. When it's not, I could not ized and and addressed in when it is, you know, by cutting out gluten it's you know, it is a life changing for for this population, and I know there are some people who are. You know quote on Coke gluten intolerance, where you know they get some stomach upset when eating gluten and they stop eating gluten and they feel better, but that doesn't make gluten is horrible. And today you know most people think gluten is a car. If it's not even a carbohydrate is a protein. So people translate, you know the gluten and celiac disease or for people who are gluten intolerant to I'm, going to cut out gluten and be healthier, and you know that
I'm is then you substitute other things which are not necessarily a lot of the gluten free food. It tastes so good because they add a lot of oil or rice flour which isn't necessarily better than wheat, but people you know, have this sort of false notion that they're doing something. That's helpful because you know it's in the health food section of the store. Is there anything else that you think you would dispenses as generic advice to people that, as far as on some level, it's freeing up some bandwidth around war
in about health and how to modify one's life so as to be as healthy as possible. Is that it the net result of reading your book and talking to you, it always comes down to less worry on some level which attest to your bedside manner. What do you think, as we get to the end of our conversation here? Well, what do you think people should have as a strategy for thinking about these things in their lives, because everyone, if you live any amount of time, especially in the developed world, everyone will find themselves being faced with that kind of a wide range of fairly intricate and startling medical decisions and life choices. And your advice is that you can be simpler to navigate that and many people recognize yeah. I mean, I think you know. Obviously, diet is a big part of everybody's life and I think you know the problem with with these extreme
changes in diet is that you know people will make is an equivalent eating something too an outcome, and that's that's usually not the case. You know, for instance, if you have, you know, eat anti oxidants, that's that's another buzz were that you were going to not oxidized and have free radicals and, and you will not get cancer and people put. You know, I'm going to drink my anti cancer shake and not get cancer, and I think, there's a little bit of a false sense of control. When people do that and you know I think, in general we are bombarded with health information on a minute to minute basis. All of US doctors included. So when you know we hear this dream piece of information in the news, it's very easy to panic and you know or jump on the bandwagon. So you know cell phones cause cancer
and you know or Ebola is hitting the United States or you know, watch out for Zeca this summer. You know these are extreme terrifying pieces of information or you know the opposite. Go you know coconut, Oil is going to help you live forever and you know I always recommend that when you hear something, that's so extreme and so different from what you're used to doing on a daily basis, that you have to take a step back and think about what that really means in perspective, what it means, your life and not lose, focus and perspective on, what's really important, not basic eating, a balanced diet, getting a flu shot, not texting and driving other things that are not going to be headline news. It's not going to pop up on your on your
phone as an alert. Oh by the way, this number of people didn't get the flu because they got the flu shot. This is not going to be headline news, but that's what people are sort of losing sight of an focusing in controlling trying to control these other aspects of their lives, and you know and being less hell the for it. You know, for instance, I'm going to cross the street and do this one text, because I know the timing of the car and I'm not going to get hit by a car, because I have control over it and that you know that's a completely false sense of of security, and that's you know, I think, as you said, you know why we're seeing so many people die in pedestrian car accidents because people are you know not thinking or so before. I let you go. I think we should touch on the vaccine quest
briefly to you, you and I actually did a blog interview a couple years ago. It was entirely focused on that question, so people can read that if they want the full story, but the short form admonition here, what is it Nina? Do vaccines cause autism, or should we get our children backs netted Maxine's do not cause autism, we should get our children vaccinated and we should get our children vaccinated on time, meaning that there are designated schedules that are created by the CDC by the American Academy of Pediatrics by the American Association of family. Practitioners are that are on schedule for a reason, and that reason is that most of the vaccines don't work after the first or second shot. Even you need, but that's what these booster sharp shots are and when kids start falling through the cracks and making up these completely ridiculous. Unfounded vaccine schedules by there are few
doctors who actually promote these. This is why we are seeing these illnesses come back. It's purely related to large populations not being vaccinated and not getting vaccinated on time- and you know there's this idea that might my precious perfect clean your child doesn't want to be tainted with these toxins. Well, I you know they're more back bactrian viruses during the birth process that a child is exposed to then then getting a vaccine, the smallpox vaccine and most of us that all of us God in this you know if you were born before one thousand nine hundred and seventy five had more immuno logic hit. Then all of the vaccines that kids get from ages zero to two, but we didn't have an increase in autism back in the 60s and 70s. So it is not vaccines that has been showed countless times across multiple countries, hundreds and hundreds of thousands of children getting vaccines. Getting
multiple vaccines during one visit has zero impact on development on growth. The only thing it does is it prevents these illnesses and these illnesses. Some of them were close to being a radic heated in till people stopped vaccinating their kids yellow. Obviously this is confounded by the fact that, as with any intervention, there's some percentage of people who have a bad reaction, it's possible to have a bad reaction to a vaccine and it's possible to have a false association between the timing of a vaccine and the discovery that a child has autism. Hence the sense that there's still a story to be told about the downside of vaccines right, it's not a cause and effect, though, so you know it going back to an
you sort of risk. You know it's like I tell patients, you know, there's more of a risk of a car accident getting to your surgery than having the surgery itself. So you know the vaccine. Timing is timed with a lot of autism diagnosis. Vaccines are not zero percent risk, but the the percent. Risk of real major vaccine injury. Is you know on the billions of percents, so it's six, so extremely small and so extremely rare to have a true. You know negative outcome from a vaccine that you know it's still. The risks of the illness far outweigh the risks of the vaccines. Well, Nina, I'm not sure what you saved lives with this conversation, but I expect you saved some worry and some misappropriation of energy and effort here. So hopefully it's benefited many people to hear us discuss these
choose and pretty soon will be Monday, and you can actually go and save lives in your day. Job thanks. It was a lot of fun to talk and you know raise some good issues. Thank you again. The book is hype and I highly recommend people get it next time. Data will allow when we have another discovery, that the private schools in our nation's cities have vaccination rates lower than Sub Saharan Africa, which occasion our last conversation on the topic will will who will do it again and and remind people that children need to be vaccinated? Xo, hopefully not, but yes could happen. If you find this podcast viable. There are many ways you can support it. You can review it on Itunes or Stitcher or wherever you happen to listen to it. You can share it
social media with your friends. You can block about or discuss it on your own podcast or you can support it directly and you can do this by subscribing to my website at SAM Harris, DOT, org and there you'll find subscriber only content which includes my ask me anything episodes. He also get access to advance tickets to my live events as well as streaming video of some of these events, and you also get to hear the bonus questions
Transcript generated on 2019-10-05.