Dec 29, 2008

Diagnosis

Humans love to solve problems. In this hour of Radiolab, diagnosis--our attempt to find out what's wrong, and give it a label.

In this day and age, we have astonishing technology--chemicals and computers and machines that can pinpoint things imperceptible to our senses. But humans aren't obsolete--intuition and creativity still lead the way both in discovering the nature of the problem, and in dealing with that knowledge.

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Speaker 1: 00:01 Hi everybody, this is Craig from Washington, DC. Radio Lab is supported by HSS, the number one hospital in the country for orthopedics for nine straight years according to US News and World Report. With locations in Nassau, Westchester, Bergen, and Fairfield Counties, the best is now nearby. Learn more at hss.edu.

Speaker 2: 00:22 WNYC Studios is supported by the Metropolitan Opera, presenting their new podcast Aria Code. The neon-lit production of Verdi's Rigoletto returns, followed by Falstaff with Ambrogio Maestri. Also on stage, Mozart's Don Giovanni and Kathleen Turner in La Fille du Regiment. And soon, Wagner's complete Ring Cycle. Metopera.org.

Speaker 3: 00:48 You're listening to Radio Lab from Public Radio WNYC and NPR.

Louis Garcia: 00:55 What we have over the criminal is the criminal actually thinks he's destroyed all the evidence. It's never all destroyed. Ever, ever, ever, never.

Robert Krulwich: 01:05 This is Lou Garcia.

Louis Garcia: 01:07 I recently retired from New York City Fire Department as the chief fire marshal. So, I've spent 25 years of my life looking at fires and investigating the causes of fires.

Robert Krulwich: 01:18 How many fires do you think you've seen?

Louis Garcia: 01:20 Oh, tens of thousands of fires.

Robert Krulwich: 01:22 You've seen tens of-

Louis Garcia: 01:24 Yes, absolutely.

Robert Krulwich: 01:24 You, you, you? You yourself?

Louis Garcia: 01:26 Yeah.

Robert Krulwich: 01:27 When he tells me a story ...

Louis Garcia: 01:28 There was, this is a true story, I'm not going to get too many details about it, but there was a fire in an area of New York City.

Robert Krulwich: 01:33 It was in an apartment building in the South Bronx.

Louis Garcia: 01:35 As I pulled up to this building-

Robert Krulwich: 01:36 The fire was already over when Lou got to it.

Louis Garcia: 01:39 There were people in the street, and we're questioning people.

Robert Krulwich: 01:43 People are saying, "Well, in the apartment where the fire was, there was this brave guy. Somehow he'd gotten in there, and he was pouring water"-

Louis Garcia: 01:49 ... Pouring water on the fire-

Robert Krulwich: 01:51 ... Trying to get the fire out. This guy was really something.

Louis Garcia: 01:53 You know, and he's a hero right now. Everybody's telling me what a hero he is. Everything they were saying in the street about this man was wrong.

Robert Krulwich: 02:05 So, he walks into the apartment, he looks around, and he knows right away-

Louis Garcia: 02:08 ... Where the fire started.

Robert Krulwich: 02:11 How?

Louis Garcia: 02:11 Well, you just look at the fire patterns.

Robert Krulwich: 02:15 And he could tell that the fire started, first of all, in the bedroom with a mattress.

Louis Garcia: 02:20 The mattress, the mattress. Now, mattresses go up if you put a match to it.

Robert Krulwich: 02:24 Really?

Louis Garcia: 02:24 Yeah.

Robert Krulwich: 02:25 Don't you have to put gasoline on the mattress?

Louis Garcia: 02:26 No, no, no.

Robert Krulwich: 02:27 You can just put a match onto a mattress and it will catch-

Louis Garcia: 02:30 Fire, yes, if you hold it there long enough, yeah.

Robert Krulwich: 02:32 And he also knew that the mattress had been placed upright against the wall.

Louis Garcia: 02:35 You could tell by the fire pattern that it was standing on end.

Jad Abumrad: 02:38 Wow, he can even know what position the mattress was in?

Louis Garcia: 02:40 Yes, absolutely. Believe me.

Robert Krulwich: 02:41 So, he meets the woman whose apartment this is.

Louis Garcia: 02:44 She shows up-

Robert Krulwich: 02:45 And he says to her, "So, do you know this fellow who was putting out the fire?" She says, "Yes, as a matter of fact, I do."

Louis Garcia: 02:50 It just so happens that-

Robert Krulwich: 02:51 He used to live with me, but I kicked him out.

Louis Garcia: 02:55 And he still had a key, by the way. And-

Robert Krulwich: 02:58 She now says, "I have a new boyfriend." So, Garcia naturally goes and finds the hero.

Louis Garcia: 03:05 So now, I'm questioning this fellow. I said, "By the way, did you buy that mattress?" And he said, "Yes, I did." And you weren't sleeping on it anymore. Was someone else sleeping in the mattress in your place? And he says, "Yeah, well, she had a boyfriend." I said, "Boy, I'd be pissed. How much did it cost you? Like four, 500 dollars?" He said, "No, more than that. It was like $800."

Louis Garcia: 03:24 I said, "So now, she is screwing somebody else on the mattress you bought? I would be pissed." I said, "You know, if it was me, if I were in your place, I would want this mattress to burn. I would probably stand it on end, I would take matches, matches, and I would put it to the mattress. That's what I would do. And in fact, I'm an expert on fires, and I know that's what you did. You really did do that, didn't you? You can talk about it. I don't blame you. I mean, at least you tried to put it out. That'll work in your favor in court."

Louis Garcia: 03:58 And he looks at me, and he said, "Well, you're not so smart." I said, "Why?" He goes, "I used a lighter."

Louis Garcia: 04:08 I said, "Oh, you're right. I'm not that smart." Then they put the cuffs on him.

Jad Abumrad: 04:16 Okay, so that was an easy one. We're going to have some harder ones coming up.

Louis Garcia: 04:19 Yep.

Robert Krulwich: 04:19 The point is, the whole hour, we're going to be addressing the same problem. We'll walk into one situation after another and discover that something is not right here.

Jad Abumrad: 04:27 That's right. Something's not right with my son. What do I do? Something's not right with my pancreas. What do I do? Something's not right with the very phrase "Something's not right," because it presumes that I know what's right and maybe I don't. Have we confused you enough?

Robert Krulwich: 04:40 Well, there's a whole lot of abnormal things coming your way. This is Radio Lab.

Jad Abumrad: 04:45 I'm Jad Abumrad.

Robert Krulwich: 04:46 And I'm Robert Krulwich.

Jad Abumrad: 04:47 Stay with us.

Jad Abumrad: 04:53 Okay, so this first story is about delivering a diagnosis. Comes to us from producer [Lu Olkowski 00:04:58]. It's about two doctors. Start with that phrase, "Something's not right here," and end up going on a crazy adventure after a cure for a deadly disease.

Robert Krulwich: 05:08 Which is that?

Jad Abumrad: 05:09 Pancreatic cancer.

Robert Krulwich: 05:10 Oh, that's not good.

Lu Olkowski: 05:12 It is the most deadly cancer. This is the one that people have nightmares about.

Jad Abumrad: 05:16 Why? It's deadly how?

Lu Olkowski: 05:18 Well, it's rare but it's deadly. It's the one where something's wrong, you go to the doctor, and they say you have six months to live.

Jad Abumrad: 05:26 Wow, is it that fast?

Lu Olkowski: 05:27 It usually is that fast.

Jad Abumrad: 05:29 And how did you find this out?

Lu Olkowski: 05:32 I found this out because my friend Amy said, "I've got a friend named Doctor Teri Brentnall. She made a big scientific discovery, and you should go to her press conference. This will be amazing. Like, go." And I go to the press conference.

Teri Brentnall: 05:45 It's just a tremendous pleasure to be here today.

Lu Olkowski: 05:47 It isn't like press conferences are kind of never amazing.

Teri Brentnall: 05:51 And I hope to unfold a story for you. I hope it will capture your attention. It's a fascinating story.

Lu Olkowski: 05:57 Then I heard this incredible story.

Teri Brentnall: 05:59 About 10 years ago-

Teri Brentnall: 06:01 One morning-

Teri Brentnall: 06:02 A 40 year old guy came into my clinic.

Teri Brentnall: 06:05 Mr. X.

Teri Brentnall: 06:06 He's just finishing my-

Teri Brentnall: 06:07 Very healthy looking. And he comes into my clinic and he says, "I'm worried I'm going to get pancreatic cancer. That I'm going to get the curse in my family." It was like good gooby, what are you talking about? And he said, "Well, in my family, my father got pancreatic cancer, and my grandfather, and my four uncles, and my three cousins."

Jad Abumrad: 06:29 Wow, four uncles, three cousins, father, grandfather all die of pancreatic cancer?

Lu Olkowski: 06:34 And this guy was sure he was next in line.

Teri Brentnall: 06:36 His uncles and his father looked like the healthiest people in the world, and six months later they're dead.

Lu Olkowski: 06:42 He was terrified.

Teri Brentnall: 06:42 He came to me as an act of desperation.

Lu Olkowski: 06:48 I mean it's not a feeling, I guess, that maybe I know or you know, but what happened when he walked in is Teri she knew exactly how he felt.

Teri Brentnall: 06:56 You can't even process anything. You're just almost in a trance.

Lu Olkowski: 07:01 She'd gone through that before.

Teri Brentnall: 07:03 Completely and utterly alone.

Lu Olkowski: 07:05 She was diagnosed with breast cancer when she was 34.

Teri Brentnall: 07:07 It's a sense of falling, it's truly a sense of falling. The world slides away from you. You literally ... It's almost like it disappears from underneath you.

Lu Olkowski: 07:19 When she got the news, the first thing her doctor did, he was a friend of hers ...

Teri Brentnall: 07:23 He pulled out the whiskey, and he put it on the table, and we each had a shot. Which I was like, "Thank God he did that." Then he said, "I'm not going to quit on you. We're going to fight this thing, you are not alone." That's all I needed to hear.

Lu Olkowski: 07:42 When she was sitting there with patient X, she knew exactly what to say.

Teri Brentnall: 07:46 You have to step forward. You can't step back, you have to step forward.

Teri Brentnall: 07:53 I was young then, and so I felt like I had fixed this thing. I'll take that on. I can help you, I don't care how horrible it sounds.

Jad Abumrad: 08:02 What happens next?

Lu Olkowski: 08:04 Teri runs back to her office, an office she shares with another doctor, Mary Bronner.

Mary Bronner: 08:09 I'm Mary Bronner. I'm a pathologist.

Teri Brentnall: 08:12 I was like, "Mary, Mary."

Lu Olkowski: 08:13 Says, "You won't believe this."

Teri Brentnall: 08:14 This guy, Mr. X walked into my office-

Lu Olkowski: 08:16 And he has this outrageous, this crazy family history.

Mary Bronner: 08:19 This horrible problem ...

Teri Brentnall: 08:21 Was floored ...

Lu Olkowski: 08:22 Teri had never heard-

Teri Brentnall: 08:23 That Pancreatic cancer could be inherited in families. I'd never heard of anything like that.

Lu Olkowski: 08:28 Teri comes in and she's like-

Teri Brentnall: 08:29 I've got to help this guy.

Lu Olkowski: 08:30 I have to figure out what's making these people sick, and Mary I need your help.

Jad Abumrad: 08:35 And Mary? What did she say?

Lu Olkowski: 08:36 Well, she's a pathologist.

Jad Abumrad: 08:39 What does it mean to be a pathologist?

Lu Olkowski: 08:40 Well, she's the person who physically does the diagnosis.

Mary Bronner: 08:44 When your surgeon does an operation on you, or your internist takes a biopsy of you, they send that tissue to me, and I make it into glass slides to look at under the microscope.

Lu Olkowski: 08:58 She spends her time looking at tiny pieces of Teri's patients smeared on little slides.

Mary Bronner: 09:04 I love the emotional distance that you have in pathology. You're a step removed from the misery, and it makes it so much easier for me to handle it.

Jad Abumrad: 09:16 Does she interact with patients?

Lu Olkowski: 09:18 Almost never.

Mary Bronner: 09:19 Teri was right up against the misery, and she was just relaying the story to me, but I can sit very comfortably at my microscope and be very objective and just look at the tissue and decide where the cancer is because I don't know these patients.

Lu Olkowski: 09:34 So you're like I've got to go do this-

Teri Brentnall: 09:35 Come with me.

Mary Bronner: 09:36 As she usually does.

Lu Olkowski: 09:38 How did you decide that Mary should join you?

Teri Brentnall: 09:42 She's my science partner. That's it.

Mary Bronner: 09:46 And I hopped in the car.

Lu Olkowski: 09:50 They decide in order to help this guy they need to go to where his family is.

Teri Brentnall: 09:54 Drove across the mountains of Washington state. A long drive.

Lu Olkowski: 10:01 They wanted to get the family together, draw their blood, look at their blood to see if there's something in there that's making all these people sick.

Mary Bronner: 10:11 We arrive at the little tiny town in Eastern Washington.

Lu Olkowski: 10:14 This little town called Elmo.

Mary Bronner: 10:16 They didn't even have ... They're so small they don't have a single medical facility. In order to do the blood draw we basically had to use a Subway sandwich shop in town.

Jad Abumrad: 10:28 Why Subway?

Lu Olkowski: 10:29 Well it had great sandwiches.

Mary Bronner: 10:30 One of the family members worked there, and asked the boss if the family could all come and these doctors could come and draw their blood, and could we use the shop as the meeting place. All I remember is walking in and thinking this is small.

Teri Brentnall: 10:47 We set up a little corner booth with our box of blood drawing supplies, and they sort of come in waves.

Lu Olkowski: 10:54 Uncles, cousins, nieces, nephews-

Mary Bronner: 10:57 And they brought their kids.

Teri Brentnall: 10:58 We filled that Subway sandwich shop.

Jad Abumrad: 11:00 How many in all?

Lu Olkowski: 11:00 About 30.

Mary Bronner: 11:01 It was funny because they hadn't seen each other in a long time. So their like, "oh my God I haven't seen you in ten years." It's like, wow you guys only live like five miles apart.

Teri Brentnall: 11:11 We'd bring them over to our little tiny booth and we'd introduce ourselves. I'm Teri Brentnall ...

Mary Bronner: 11:17 I'm Mary Bronner.

Teri Brentnall: 11:18 I'm a GI doctor.

Mary Bronner: 11:19 I'm a surgical pathologist.

Teri Brentnall: 11:20 The purpose of our work today is that we are trying to find the cancer gene that causes the disease in your family. With your permission today we'd like to take a small blood sample. It's about the size of two tablespoons.

Mary Bronner: 11:34 You will not get any results back from this blood test. I want to be really clear about that. It's all for us to try, and find the gene. I can't even promise that we'll definitely find the gene. Here's your sandwich and now may I have some blood.

Teri Brentnall: 11:50 As we were waiting for most of the family to show up, Teri and I were sitting in this one booth with one of the family members who we had already identified as having the disease.

Mary Bronner: 12:01 He was young. He was in his 30s. All I could think was you have a time bomb inside your body. Then this little boy comes running into the Subway sandwich shop, just runs up to this guy that we're talking to, this patient of family X. Throws his arms around his daddy's neck, and kisses him and then all I could think was oh my God this beautiful little child, he has a 50% chance of having this hideous disease. I was so upset about that. I was just so torn apart inside, but I couldn't really start bawling right there in the restaurant. That wouldn't have been professional. I held it together until we were driving home, and I was telling Teri how sad I was about that little boy, and how it just really hit me. She said, "Oh, him, don't worry about him. He's adopted."

Lu Olkowski: 13:14 You have to remember Mary doesn't come face to face with patients very often.

Mary Bronner: 13:18 It's not something a pathologist does very frequently. Pathologists have a ... I don't even know if I want to tell you this. This is sort of like the black side of pathology.

Lu Olkowski: 13:31 Black humor to get you through, or what do you mean?

Mary Bronner: 13:34 Yeah. Really black humor. You know, we'll say things like somebody better tell this patient not to buy the big tube of toothpaste. Teri's laughing but that's why we do it, because it's so horrible.

Lu Olkowski: 13:51 I spent an afternoon with Mary going through slides, looking at pancreatic tissue.

Mary Bronner: 13:56 This looks pretty-

Lu Olkowski: 13:56 Trying to figure out if this person has cancer or not, dozens of patients.

Mary Bronner: 14:02 Now this is another case with a terrible, terrible cancer.

Lu Olkowski: 14:06 That's when I really kind of got it, why she'd want to keep herself distant.

Mary Bronner: 14:12 Oh, this cancer is even worse than the last one. This person, if they can, should go to a beautiful place on planet Earth and just stay there till it's over.

Jad Abumrad: 14:31 What happened after Subway though? I mean, were they able to figure out what's causing this thing?

Lu Olkowski: 14:35 Well, once they got the blood they worked on it for about five years.

Jad Abumrad: 14:39 Five years, whoa.

Lu Olkowski: 14:40 They went chromosome by chromosome, collaborated with all these other researchers and at the end of the day they discovered that the thing that causes familial pancreatic cancer comes down to a mistake. One little mistake, on one-

Mary Bronner: 14:54 One molecule.

Lu Olkowski: 14:55 ... molecule.

Teri Brentnall: 14:56 That's all it comes down to.

Lu Olkowski: 14:57 One tiny molecule, yes.

Teri Brentnall: 15:00 Our discovery is ... We're titling it Paladin Mutation Causes Familial Pancreatic Cancer and suggests a new cancer mechanism.

Lu Olkowski: 15:09 So they write a paper, they have a press conference.

Teri Brentnall: 15:11 First of all I want to acknowledge-

Lu Olkowski: 15:12 And they celebrate.

Speaker 11: 15:13 A little about me. Congratulations.

Mary Bronner: 15:17 Thank you.

Jad Abumrad: 15:18 So in the end do they find a cure?

Lu Olkowski: 15:20 Oh, no not yet, not yet. They're working on it though.

Jad Abumrad: 15:22 Can they at least test for it now?

Lu Olkowski: 15:24 Well, they can test but ...

Jad Abumrad: 15:28 What?

Lu Olkowski: 15:29 Most pancreatic cancer isn't hereditary like this. This is actually a small subset.

Speaker 11: 15:33 Roll up your sleeves, dig out the dirt.

Jad Abumrad: 15:34 Huh.

Lu Olkowski: 15:34 Mm-hmm (affirmative). Yeah.

Jad Abumrad: 15:41 So where does that leave Mary and Teri? I mean, where are they now?

Lu Olkowski: 15:44 Mary's really glad that the research phase is over and that she doesn't have to be with patients anymore. Teri knows they have more work to do and they can't really give up.

Jad Abumrad: 15:59 Mm-hmm (affirmative).

Lu Olkowski: 16:00 But she's really tired, and thinks about it a lot.

Teri Brentnall: 16:02 The stakes are so high in this. Sometimes it's almost unbearable, sometimes I think I should quit.

Lu Olkowski: 16:08 Really?

Teri Brentnall: 16:10 Yeah, totally. I've talked to Mary about it.

Mary Bronner: 16:11 Yeah. She has, but you know what, I know she'll never stop doing it. Right Teri?

Teri Brentnall: 16:20 Sometimes it's just too much. Mary and I love to garden, so sometimes we think about being landscape architects.

Mary Bronner: 16:32 Yeah.

Teri Brentnall: 16:32 Then the worst thing that does is oh I killed the bush. We're like you loser you killed the bush. Yeah.

Jad Abumrad: 16:57 Thanks to Lu Olkowski for reporting that story.

Robert Krulwich: 16:59 The next story concerns a dad, and his little boy. There's something about this little boy that is not quite right. There's something about the dad that doesn't want to say so.

Jad Abumrad: 17:09 That's coming up in about a minute. I'm Jad Abumrad.

Robert Krulwich: 17:11 I'm Robert Krulwich.

Jad Abumrad: 17:12 Radio Lab will continue.

Mary Bronner: 17:15 Radio Lab is funded in part by the Alfred P Sloan Foundation, the Corporation for Public Broadcasting, and the National Science Foundation.

Vera Devinye: 17:27 This is Vera Devinye calling from sunny Denver, Colorado. Fresh out of an appointment with my dentist, and a wee bit numb. Radio Lab is supported by what the constitution means to me, starting March 14th for 12 weeks only. Named the number one play of the year by The New Yorker, and New York Magazine, this boundary breaking new play breathes new life into our founding document and imagines how it will shape the next generation of American women. The New York Times says it's electrifyingly topical, and Rolling Stone calls it bracing and unnervingly relevant. What the constitution means to me, written by Obe award winner Heidi Shrek. Get tickets now at constitutionbroadway.com.

Robert Krulwich: 18:08 Hi, I'm Robert Krulwich. Radio Lab is supported by Capital One. With the new Capital One saver card you can earn 4% cash back on dining and entertainment. That means 4% on checking out that new restaurant everybody is talking about, and 4% on watching your team win at home. You'll also earn 2% cash back at grocery stores, and 1% on all other purchases. So now when you go out you cash in. What's in your wallet?

Kathy: 18:34 Hey folks, it's Kathy and Toben here from the Nancy podcast.

Toben: 18:38 And we want to tell you about a really exciting project we've been working on.

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Kathy: 18:55 So tune in on Apple Podcasts, Spotify or wherever you get your podcasts.

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Jad Abumrad: 19:08 Hey I'm Jad Abumrad.

Robert Krulwich: 19:09 And I'm Robert Krulwich.

Jad Abumrad: 19:10 This is Radio Lab. This hour our topic is diagnosis.

Robert Krulwich: 19:13 This next story begins with a dad, two sons, and a question. What do you do when you notice somebody's different? I heard it from reporter Gregory Warner.

Robert Krulwich: 19:22 Hello.

Gregory Warner: 19:23 Hi.

Bryon Frowner: 19:23 Gregory?

Gregory Warner: 19:23 I'm Chronicle's Gregory Warner.

Bryon Frowner: 19:25 Nice to meet you.

Gregory Warner: 19:25 Nice to meet you.

Gregory Warner: 19:27 Okay, just so you know it took me over a year ...

Gregory Warner: 19:28 All right you can sit down and-

Gregory Warner: 19:29 To finally get an interview with Byron Frowner.

Robert Krulwich: 19:32 Yeah.

Gregory Warner: 19:32 Well let me start telling you, I'm wondering if the air conditioner-

Bryon Frowner: 19:33 I can turn it off.

Gregory Warner: 19:34 He's the dad in this story, and I'm up in his apartment in the South Bronx.

Bryon Frowner: 19:38 You'll have to excuse all this loose paper work.

Gregory Warner: 19:42 Are you moving out, or are you-

Bryon Frowner: 19:43 No, it might look like that.

Robert Krulwich: 19:45 It was that messy?

Bryon Frowner: 19:46 I don't want to-

Gregory Warner: 19:46 Yeah.

Gregory Warner: 19:47 No that's good.

Gregory Warner: 19:48 Boxes everywhere, crates, piles of stuff.

Bryon Frowner: 19:50 Oops okay.

Gregory Warner: 19:52 Oh no, don't let go.

Bryon Frowner: 19:52 Don't worry about it.

Gregory Warner: 19:53 Are you sure?

Bryon Frowner: 19:54 Yeah.

Gregory Warner: 19:54 I'm sorry.

Bryon Frowner: 19:55 I'll clean it up.

Gregory Warner: 19:55 It's in disarray. There's-

Robert Krulwich: 19:57 So who is this guy?

Bryon Frowner: 19:57 I'm a retired electrical engineer.

Gregory Warner: 20:00 He worked for the subway most of his life.

Bryon Frowner: 20:02 Now, I consider myself a science researcher.

Gregory Warner: 20:07 At 71 years old, he's basically teaching himself-

Bryon Frowner: 20:10 Quantum physics. That's what all the books and stuff you see around. I love that stuff.

Gregory Warner: 20:15 He's written this book called-

Bryon Frowner: 20:16 Einstein's Error.

Gregory Warner: 20:18 Criticizing special relativity, Einstein-

Bryon Frowner: 20:21 I sent it to the New York academy of scientists, Caltech, MIT, Harvard, Steven Hawkins. Still waiting for him to get back.

Gregory Warner: 20:28 Most people just ignore him.

Bryon Frowner: 20:29 These are the ravings of a maniac.

Gregory Warner: 20:31 Then he points to this letter on the wall from-

Bryon Frowner: 20:33 Neil Degrasse Tyson.

Gregory Warner: 20:35 I know that name.

Gregory Warner: 20:36 This major scientist.

Robert Krulwich: 20:37 Yes. The head of the Hayden Plantarium in Manhattan.

Gregory Warner: 20:40 Exactly, yeah. It says-

Bryon Frowner: 20:41 How dare you. You're just an engineer.

Gregory Warner: 20:46 And he's beaming.

Robert Krulwich: 20:47 Why?

Gregory Warner: 20:48 Why do you smile when you talk about that letter from Neil Degrasse Tyson?

Bryon Frowner: 20:52 Because I know how foolish it is. Einstein, they didn't even want to read his paper. They said, "Who is this guy, upstart, he's just a patent examination clerk in Bern"

Gregory Warner: 21:04 Byron Frowner is a man who's proud to go against the grain.

Bryon Frowner: 21:09 What other people do I don't really do.

Gregory Warner: 21:13 That's especially true with how he raised his sons.

Bryon Frowner: 21:16 Now, Gregory you're going to do some kind of a story on Emmanuel?

Gregory Warner: 21:21 His youngest son.

Gregory Warner: 21:22 Right.

Gregory Warner: 21:22 Emmanuel.

Bryon Frowner: 21:22 Okay.

Gregory Warner: 21:23 That's why I'm here.

Gregory Warner: 21:24 Mostly focusing on-

Gregory Warner: 21:25 To question him about how he raised his son.

Bryon Frowner: 21:27 All right. I'd be glad to.

Gregory Warner: 21:30 Okay, great.

Gregory Warner: 21:30 So here's Emmanuel.

EmmanuelFrowner: 21:30 Hi, I'm Emmanuel Frowner.

Gregory Warner: 21:32 Emmanuel could you take a drink of water for me.

EmmanuelFrowner: 21:34 Okay. Thank you.

Gregory Warner: 21:37 No, don't thank me, yeah. Take as many drinks of water as you want.

Gregory Warner: 21:40 He's 28.

Gregory Warner: 21:41 So what things are you good at Emmanuel?

EmmanuelFrowner: 21:44 Writing essays, and making sure they are grammatically correct.

Gregory Warner: 21:50 Mm-hmm (affirmative).

EmmanuelFrowner: 21:50 Bowling.

Gregory Warner: 21:52 As you can hear-

EmmanuelFrowner: 21:53 Analyzing stuff-

Gregory Warner: 21:54 There is something going on with him.

EmmanuelFrowner: 22:02 ... and not talking that much I guess.

Gregory Warner: 22:05 Now, if you ask dad he'll tell say-

Bryon Frowner: 22:08 Emmanuel's an excellent student, our future Nobelist.

Gregory Warner: 22:11 He's going to win a Nobel prize.

Bryon Frowner: 22:12 You never know.

Gregory Warner: 22:13 But, if you ask Blaire.

Blaire Frowner: 22:14 I'm Blair Frowner.

Robert Krulwich: 22:16 Who's that?

Gregory Warner: 22:17 Emmanuel's half brother.

Blaire Frowner: 22:17 I'm about 20 years older than Emmanuel.

Gregory Warner: 22:20 He'll tell you that even as a little kid-

Blaire Frowner: 22:22 Very little.

Gregory Warner: 22:22 Like 5 years old-

Blaire Frowner: 22:23 There was something odd, and I just didn't know what it was.

Gregory Warner: 22:26 It was a bunch of little things.

Blaire Frowner: 22:27 Yeah.

Gregory Warner: 22:28 Like he'd look at you really weird.

Blaire Frowner: 22:29 Kind of like a doll face expression. He could stare at me without blinking for 15 minutes at a time. I would notice, because you didn't blink once. There was the speech.

EmmanuelFrowner: 22:42 I did not talk as much as other people.

Blaire Frowner: 22:45 There was something going on with Emmanuel, but I did not have a word for it. So I pushed several times to get speech therapy.

Gregory Warner: 22:54 But every time he did dad would just say-

Bryon Frowner: 22:56 Are you kidding? He may have trouble stumbling and stammering but-

Blaire Frowner: 23:00 He'll grow out of it. I stuttered too, Blaire you also stuttered.

Bryon Frowner: 23:04 Einstein he didn't speak a word till he was six. He was considered retarded in school.

Blaire Frowner: 23:09 He would say that this was some temporary problem that would pass.

Bryon Frowner: 23:14 I didn't see anything that was screaming out for attention. He was doing his work. He was interested in the Nicks, we would go out endlessly in cold weather to the park, and it seemed like things were okay.

Robert Krulwich: 23:28 What about Emmanuel?

EmmanuelFrowner: 23:30 Well, I knew that I was a nicer person.

Gregory Warner: 23:34 A nicer person?

EmmanuelFrowner: 23:35 Yeah, and that I was sensitive and I don't automatically look people in the eyes, the face and stuff.

Gregory Warner: 23:50 So as long as Emmanuel was a little kid this wasn't such a big deal, but then he got older.

Blaire Frowner: 23:56 He was around 10 years old-

EmmanuelFrowner: 23:58 It was, I think, at the point where other people would point it out.

Gregory Warner: 24:04 What did they say?

EmmanuelFrowner: 24:04 Well, I have been called retarded and idiot savant, the N word and stuff.

Bryon Frowner: 24:13 They lost the innocence of the elementary school.

Gregory Warner: 24:16 Emmanuel would come home with bruises on his arms.

EmmanuelFrowner: 24:18 Yeah.

Gregory Warner: 24:19 Yeah.

EmmanuelFrowner: 24:20 It was something that I constantly thought about, and worried about.

Blaire Frowner: 24:23 I said, "Yeah well it would be really good for him to get professional help with that."

Gregory Warner: 24:27 If you ask dad he said the problem wasn't Emmanuel.

Bryon Frowner: 24:30 No.

Gregory Warner: 24:31 It was-

Bryon Frowner: 24:31 All the other people.

Gregory Warner: 24:32 The bullies.

Bryon Frowner: 24:34 The group. This neighborhood, it was hard. There was fighting, constant fighting right down the street over here. People involved with crack. These are big guys, you know. I felt that it could have been a dangerous situation.

Gregory Warner: 24:51 So, his solution-

Bryon Frowner: 24:52 I decided that I wanted to teach Emmanuel, homeschool.

Gregory Warner: 24:56 Was just to pull his son out of school.

EmmanuelFrowner: 24:58 Yeah.

Gregory Warner: 24:59 And how do you feel about this at the time?

EmmanuelFrowner: 25:00 Well, I really didn't know ...

Bryon Frowner: 25:05 Up here-

Gregory Warner: 25:06 We're looking in a closet here.

Bryon Frowner: 25:07 I thought that whatever way he's kind of turned in ...

Bryon Frowner: 25:10 This is a binder from one of his classes.

Bryon Frowner: 25:12 ...that if he got bullied and tormented in going to school that it would turn him further in.

Bryon Frowner: 25:18 Let's see what this is ...

Bryon Frowner: 25:19 But that if he were here he could develop along his own line till he became old enough that they wouldn't want to pick on him. Oh look what we turned to, Nature, Nurture.

Gregory Warner: 25:31 It was a big deal for dad.

Gregory Warner: 25:33 You hadn't homeschooled anybody else before right?

Bryon Frowner: 25:36 No I had to get books. I had to go meet the principal.

Gregory Warner: 25:39 He left his job, submitted a curriculum to the school.

Bryon Frowner: 25:43 I had to register with the state of New York.

Gregory Warner: 25:46 Created this syllabus for his son.

Bryon Frowner: 25:49 Grade 10, integrated math course 11.

Gregory Warner: 25:51 They would wake up each morning-

Bryon Frowner: 25:52 Rational numbers, geometry-

Gregory Warner: 25:54 ... do their lessons.

Bryon Frowner: 25:55 ... isosceles triangle, equilateral triangle.

Gregory Warner: 25:57 Have some lunch ...

Bryon Frowner: 25:58 This is the work that he did at home.

Gregory Warner: 26:00 In the afternoon they'd go bowling.

Robert Krulwich: 26:02 Bowling?

Gregory Warner: 26:05 Emmanuel was an awesome bowler. His dad would video tape him.

Bryon Frowner: 26:10 Today is Tuesday, December ...

EmmanuelFrowner: 26:13 28th.

Bryon Frowner: 26:14 28th 1993.

EmmanuelFrowner: 26:15 Is it taping?

Gregory Warner: 26:17 It's weird footage. It's weird to watch because Emmanuel's such an incredibly good bowler.

Bryon Frowner: 26:24 Yeah he took it out, beautiful shot.

Gregory Warner: 26:27 He's always by himself. Tape after tape of nothing but Emmanuel. Nobody else in the picture.

Bryon Frowner: 26:36 Now listen ...

EmmanuelFrowner: 26:38 I would fantasize about going on a tour and winning some titles and stuff.

Bryon Frowner: 26:43 Beautiful.

Gregory Warner: 26:46 Did you think about joining any youth league or anything like that?

EmmanuelFrowner: 26:50 Well I kind of ... Well, I vaguely thought about it, but for some reason my dad did not want me to.

Bryon Frowner: 27:03 I think you swung out. I think so.

Robert Krulwich: 27:11 Meanwhile, his brother is just ...

Gregory Warner: 27:12 Blaire's in Canada.

Blaire Frowner: 27:13 At a distance.

Gregory Warner: 27:14 Yeah. He followed a girl there. One day he picks a book off the shelf-

Blaire Frowner: 27:19 The DSM.

Gregory Warner: 27:20 And the DSM is?

Blaire Frowner: 27:21 The Diagnosis Statistical Manual of Mental Disorders.

Gregory Warner: 27:26 Okay.

Blaire Frowner: 27:26 I started to do, I guess, what a lot of people would do who get a hold of this thing is to start diagnosing all of their friends. I diagnosed my girlfriend. I diagnosed my dad, and then I saw-

Gregory Warner: 27:40 Right there in the page-

Blaire Frowner: 27:42 Marks impairment in the use of multiple non verbal behaviors such as eye to eye gaze, repetitive behavior patterns, problems seeking new friends, problems being able to understand what someone must be thinking. Problems, I went down this whole list, and everything seemed to fit. Marked impairments in eye to eye gaze-

Gregory Warner: 28:02 The problem is every time he tried to call his dad-

Blaire Frowner: 28:04 Dad what do you think?

Gregory Warner: 28:05 His dad would say-

Blaire Frowner: 28:06 Just stop whining.

Gregory Warner: 28:07 Go away.

Blaire Frowner: 28:07 He'll just go through this.

Gregory Warner: 28:08 And he shut him out.

Blaire Frowner: 28:09 Or he basically cut communication.

Bryon Frowner: 28:12 I know my son.

EmmanuelFrowner: 28:15 He would always tell me that whatever I had would go away when I was an adult.

Gregory Warner: 28:22 What does an adult mean? Does that mean 18?

EmmanuelFrowner: 28:26 20 maybe, 20 lets say.

Gregory Warner: 28:28 Okay, so you thought as soon as I reach the age of 20, then I won't have these problems?

EmmanuelFrowner: 28:35 Yeah.

Gregory Warner: 28:36 So did you wake up on your 20th birthday and think ...

EmmanuelFrowner: 28:39 I thought that maybe things would change right away, but they didn't.

Gregory Warner: 28:49 After that Emmanuel says he got really depressed. That's how things might have stayed, until ... Dad had a heart attack. Blaire comes to the hospital, finds dad unconscious on the bed, and he realizes this is my big chance.

Blaire Frowner: 29:08 Because he was not in a position to intervene.

Gregory Warner: 29:12 And you're thinking?

Blaire Frowner: 29:13 I'm thinking the first thing that's going to happen is that we're going to get a diagnosis because we had been waiting for it for so many years, 26 or older or whatever.

EmmanuelFrowner: 29:20 I think I was like 25 maybe.

Blaire Frowner: 29:22 He's going to get help, you know. He has to get help.

Gregory Warner: 29:25 New Years Eve, 2005.

Blaire Frowner: 29:27 All right, so where are we coming into now?

EmmanuelFrowner: 29:29 We're at 42nd street.

Gregory Warner: 29:31 Times square.

Blaire Frowner: 29:32 Times square is one of Emmanuel's favorite areas to hang out, and I figured I wanted it to be on his turf.

Gregory Warner: 29:39 So they're outside, the crowd is just beginning to arrive.

Blaire Frowner: 29:42 It was starting to snow a little bit.

EmmanuelFrowner: 29:45 And rain some too.

Blaire Frowner: 29:46 Yeah.

Gregory Warner: 29:47 Blaire turns to Emmanuel, and he says-

Blaire Frowner: 29:49 Have you ever heard of Autism? I said, "I highly suspect that you have some form of Autism. I want us to find some way for you to get a diagnosis."

EmmanuelFrowner: 30:09 10, 9, 8-

Blaire Frowner: 30:14 Oh, and I said-

EmmanuelFrowner: 30:16 ... 7, 6, 5-

Gregory Warner: 30:17 Don't breathe a word of this to dad.

EmmanuelFrowner: 30:17 ... 4, 3, 2, 1.

Gregory Warner: 30:26 Doctor how do I pronounce your name?

Speaker 20: 30:29 [inaudible 00:30:29].

Gregory Warner: 30:30 Pretty soon after New Years.

Gregory Warner: 30:32 [Doteanagnostia 00:30:32] and where are you from?

Speaker 20: 30:33 I'm Greek.

Gregory Warner: 30:33 Emmanuel gets his diagnosis.

Speaker 20: 30:35 It was right here on this couch. I did get a feeling from our beginning of the interaction that he was going to meet criteria for Autism.

Gregory Warner: 30:43 A month later ...

EmmanuelFrowner: 30:44 She told me that I was on the Autistic Spectrum.

Gregory Warner: 30:48 It was official.

EmmanuelFrowner: 30:49 Okay Efumble ...

Speaker 20: 30:54 Even more air.

EmmanuelFrowner: 30:54 Efumble.

Speaker 20: 30:57 Great, good.

Gregory Warner: 30:57 So at the age of 26 ...

EmmanuelFrowner: 31:00 Assemble.

Speaker 20: 31:00 Mm-hmm (affirmative).

Gregory Warner: 31:00 Finally ...

EmmanuelFrowner: 31:00 Audible ...

Speaker 20: 31:00 More air.

Gregory Warner: 31:03 His life completely changed.

Speaker 20: 31:04 Audible.

EmmanuelFrowner: 31:05 Audible.

Gregory Warner: 31:05 So I gave him a tape recorder to record his life.

EmmanuelFrowner: 31:08 Hello it's me Emmanuel.

Gregory Warner: 31:10 He's meeting with a speech pathologist a couple of hours a week. Also, he's joined this program.

EmmanuelFrowner: 31:15 Adaptations.

Gregory Warner: 31:16 And started making friends.

Speaker 21: 31:18 what do I say?

EmmanuelFrowner: 31:20 Well anything.

Speaker 21: 31:21 Hello.

EmmanuelFrowner: 31:22 Hey Jason.

Speaker 21: 31:23 Peace out.

Gregory Warner: 31:24 He got a girlfriend.

EmmanuelFrowner: 31:25 Hey it's me Emmanuel, once again.

Robert Krulwich: 31:28 Oh.

EmmanuelFrowner: 31:29 There's one lady that I haven't talked about yet named Norma. We went to Central Park and we took pictures, and it was great.

Robert Krulwich: 31:41 But wait a sec. I thought that people who were diagnosed with Autism the definition is they don't want to socialize.

EmmanuelFrowner: 31:48 Well, it's not because I don't want to, but it's just hard to do, you know.

Gregory Warner: 31:56 Here's the thing about Emmanuel, he's got this whole new life, he hasn't told dad about any of it.

Robert Krulwich: 32:03 Not anything?

Gregory Warner: 32:04 Not the girl, the friends, the diagnosis. His dad doesn't know anything is different.

Gregory Warner: 32:09 So how long have you been keeping it a secret?

Blaire Frowner: 32:12 It's been since 2005 right?

EmmanuelFrowner: 32:15 Yeah.

Gregory Warner: 32:16 Basically, for the last two years Emmanuel's been leading this double life. Outside he's a person with Autism. Then he comes home, nothings wrong.

Gregory Warner: 32:24 Why?

EmmanuelFrowner: 32:26 Well, I'm just afraid that daddy want really believe it.

Gregory Warner: 32:34 He knows he's got to tell his dad who he really is.

EmmanuelFrowner: 32:37 Yes I do.

Gregory Warner: 32:38 And he keeps saying he will.

EmmanuelFrowner: 32:39 I'm going to say within a month.

Gregory Warner: 32:42 Soon.

EmmanuelFrowner: 32:43 I'm not quite sure.

EmmanuelFrowner: 32:46 I am a little bit nervous about telling him about my Autism.

EmmanuelFrowner: 32:50 Maybe within a few minutes or so.

EmmanuelFrowner: 32:52 Let me tell him in like two weeks or so. Another day, say. I might tell him after I meet Blaire. I'm going to probably tell him ... Well ... Tomorrow. Maybe ... I don't know yet. Maybe I'm just thinking about it a little bit too much, I don't know.

Gregory Warner: 33:06 Then finally one night ...

EmmanuelFrowner: 33:09 Hi, it's me. I just want to say that I told my dad about my diagnosis.

EmmanuelFrowner: 33:18 I said I really have something important to say, and don't get angry. Then I told him that I was diagnosed with Asperger's Syndrome. He asked me what it was, and then I told him it is high functioning Autism.

Bryon Frowner: 33:36 I was shocked. That would be a good way to put it.

Gregory Warner: 33:44 Do you think he has Asperger's?

Bryon Frowner: 33:46 Yes. Yes I do. When I look at this syndrome for a lot, good parts of it's Emmanuel, but I never at any point felt that Emmanuel was in need of any deep psychological, or psychiatric help.

Gregory Warner: 34:07 I mean, what makes you qualified to say that?

Bryon Frowner: 34:13 Just being a loving parent.

Gregory Warner: 34:15 As I'm talking to him, we're sitting there on the couch, in front of us on the coffee table is all of Emmanuel's notebooks from age five onward.

Bryon Frowner: 34:25 They're really good stuff. I mean it's stuff that you and I would write.

Gregory Warner: 34:28 He saved it all, but the question that I feel like I've got to ask ...

Gregory Warner: 34:33 Byron I just have one more question on my list if I could ask you that one.

Gregory Warner: 34:37 Now that you know that there is something wrong with your son, that there always was this disorder, that it's incurable, do you think you did the right thing?

Gregory Warner: 34:45 Do you wish that he had gotten the diagnosis earlier?

Bryon Frowner: 34:49 No.

Gregory Warner: 34:51 Why?

Bryon Frowner: 34:52 Because I think that he's better off at this point in time.

Gregory Warner: 34:56 Why wouldn't it make a difference to know earlier why you're acting so strangely?

Bryon Frowner: 35:02 I didn't want Emmanuel to get a diagnosis that would put him in a box, like a label.

Gregory Warner: 35:10 Then dad says to me ... Look I mean if I had let the school give him some kind of diagnosis they would have thrown him in special Ed.

Bryon Frowner: 35:17 And say oh he's a retard. Look, he can't even talk.

Gregory Warner: 35:20 That would have destroyed him.

Bryon Frowner: 35:21 It would cause irreparable damage.

Gregory Warner: 35:24 I asked the doctor, was there any truth to that?

Gregory Warner: 35:27 If Emmanuel was put into special Ed hypothetically-

Speaker 20: 35:30 If he was in a District 75 class ...

Gregory Warner: 35:31 The technical word for special Ed.

Speaker 20: 35:33 He would not have reached his academic potential. He is a graduate from Saint Johns with a degree in Psychology. Kids who graduate District 75 don't do that.

Gregory Warner: 35:43 Just to put that in perspective, Emmanuel comes from a neighborhood where about 10% of the kids ever graduate college.

EmmanuelFrowner: 35:51 My GPA was like 3.4 and change.

Robert Krulwich: 35:55 Wow.

Gregory Warner: 35:55 And he's got Asperger's.

Gregory Warner: 35:56 So now what? We're kind of vindicating what his father did, right?

Speaker 20: 36:02 Well in terms of his academic achievement his father did the right thing. The problem with his dads choice, and he had no way of knowing at the time, was the lack of peer groups which he missed out on.

Gregory Warner: 36:14 It seems like a cruel choice but-

Speaker 20: 36:16 Yeah, it's a cruel choice.

Gregory Warner: 36:18 So if you were your father, and you were raising your kid at that time would you have made the same choice he did?

EmmanuelFrowner: 36:25 Well, if I had known what I know now then maybe I would have maybe begged him a little more for me to interact with others who were like I am, who are like I am.

Robert Krulwich: 37:02 That story from our corespondent Gregory Warner.

Jad Abumrad: 37:05 Greg's reporting was made possible in part by the Roselyn Carter Fellowship for Mental Health Journalism. Thanks to them, and thank you to Lulu Miller for producing that piece. We will continue in a moment.

Bonnie: 37:16 This is Bonnie calling from Boston, Massachusetts. Radio Lab is supported in part by the National Science Foundation, and by the Alfred P Sloan Foundation. Enhancing public understanding of science and technology in the modern world. More information about Sloan at www.sloan.org.

Jad Abumrad: 37:39 Hello I'm Jad Abumrad.

Robert Krulwich: 37:41 I'm Robert Krulwich.

Jad Abumrad: 37:42 This is Radio Lab. This hour we're talking about diagnosis.

Robert Krulwich: 37:45 Diagnosis, the easy kind, we're not going to talk about it, no. Easy would be you come into my office and I'm a doctor, you have a broken arm. I take a picture, I say, "Hey, you've got a broken arm. The picture says so."

Jad Abumrad: 37:55 Yeah, because you can see the break right there, but-

Robert Krulwich: 37:57 Let's suppose you came into my office and you were sad.

Jad Abumrad: 38:00 Mm-hmm (affirmative).

Robert Krulwich: 38:01 You tell me that your sex drive is down.

Jad Abumrad: 38:03 Hey-

Robert Krulwich: 38:03 Yeah, I'm the doctor so you know this is just between you and me.

Jad Abumrad: 38:06 All right.

Robert Krulwich: 38:06 Well right away my learning tells me that you may be a candidate for depression, but how do I know that you're depressed?

Jad Abumrad: 38:14 What do you mean how do we know? We talk about it.

Robert Krulwich: 38:16 Well-

Jad Abumrad: 38:16 You just said.

Robert Krulwich: 38:17 Well you can't measure sadness or depression. You can't go to a test tube and count anything.

Jad Abumrad: 38:24 Right.

Robert Krulwich: 38:24 It's not hard science.

Jad Abumrad: 38:26 Yeah, because-

Robert Krulwich: 38:27 Until now. What if I put you in one of those FMRI machines that we've talked about so often.

Jad Abumrad: 38:35 Yes?

Robert Krulwich: 38:35 I snap a picture of your brain in action and I look at it. From your picture I say you are depressed.

Jad Abumrad: 38:43 You're going to tell me I'm depressed just from looking at a picture of my brain?

Robert Krulwich: 38:46 Yes.

Jad Abumrad: 38:47 What? No way.

Robert Krulwich: 38:48 Look, It's now here. Photographic diagnosis of mental illness.

Eric Kandel: 38:53 This is happening. There is no question.

Robert Krulwich: 38:55 That, by the way, is Eric Kandel, a professor up at Colombia University, who just happens to have won the Nobel Prize for medicine.

Eric Kandel: 39:03 Let me give you a little historical background.

Robert Krulwich: 39:05 Did you get a Nobel, I don't think you did.

Jad Abumrad: 39:08 I still don't believe you. What? Just because he's got a Nobel Prize I'm going to suddenly turn around and like-

Robert Krulwich: 39:12 You're not, so let's do this step by step, okay?

Speaker 24: 39:14 Step one.

Robert Krulwich: 39:17 Imagine you're slipping into an FMRI machine okay.

Jad Abumrad: 39:19 All right.

Robert Krulwich: 39:21 I want you to just look at my face.

Jad Abumrad: 39:22 Why?

Robert Krulwich: 39:23 Is that so difficult?

Jad Abumrad: 39:26 No, I just want to know where this is going. Here, okay I'm looking at your face.

Robert Krulwich: 39:27 So now that you're looking at my face-

Eric Kandel: 39:29 Different regions of the brain they become active.

Robert Krulwich: 39:33 There are cells in your brain that are saying, "I know him."

Eric Kandel: 39:37 The cells are more active, they need energy. Just like when you run you have to breathe fast.

Robert Krulwich: 39:41 To get the energy-

Eric Kandel: 39:42 Your heart pumps more blood.

Robert Krulwich: 39:45 ... the body sends a rush of fresh blood to that particular group of cells. Because the blood has Iron in it, the magnet in the brain scanner can see the Iron, and therefore see the blood flow, and take pictures of it. Many, many pictures in real time.

Eric Kandel: 40:04 I'll show you a very nice example of this.

Robert Krulwich: 40:06 Eric's now heading off across his ample office with an extraordinary view of the Hudson Valley and he brought over a picture of a human brain with different colors and different areas, and he told me when you look at a face ...

Eric Kandel: 40:17 When you image the face, this area lights up.

Robert Krulwich: 40:20 You're pointing to an area of the brain.

Eric Kandel: 40:22 An area of the brain.

Robert Krulwich: 40:23 Up above your ... On your forehead kind of.

Eric Kandel: 40:25 That's right, that's right. If you look at a house, some other area lights up, but this area does not light up. You look at another face, this area lights up again.

Jad Abumrad: 40:34 Every time you see a face, the same area?

Robert Krulwich: 40:35 Yep.

Jad Abumrad: 40:36 But you haven't told me anything about emotions yet.

Robert Krulwich: 40:38 That's true so let's move on to step-

Jad Abumrad: 40:40 Two.

Robert Krulwich: 40:42 Because we use faces to tell what someone else is thinking or someone else is feeling, looking at faces also triggers ...

Eric Kandel: 40:49 An area deep in the brain that is concerned with emotion-

Robert Krulwich: 40:52 Called the Amygdala. Very recently-

Eric Kandel: 40:55 A number of people have looked at the Amygdala looking at faces and it's extremely interesting.

Speaker 24: 41:01 Step three.

Cynthia Fu: 41:04 Okay.

Robert Krulwich: 41:04 I'm going to take you now to London.

Cynthia Fu: 41:06 Hello?

Robert Krulwich: 41:07 Hi.

Cynthia Fu: 41:07 Yeah, hi.

Jad Abumrad: 41:08 Hey.

Robert Krulwich: 41:08 Yeah that's good, it's good.

Jad Abumrad: 41:08 Who is this?

Robert Krulwich: 41:10 Oh right sorry. Who are you?

Cynthia Fu: 41:12 I'm Cynthia Fu. I'm a psychiatrist at the institute of psychiatry, Kings College, London.

Robert Krulwich: 41:16 Are you like in your 30s or your 40s or your 50s?

Cynthia Fu: 41:18 Is this part of the interview?

Robert Krulwich: 41:20 Well I just ... I wanted to-

Jad Abumrad: 41:22 Rude.

Robert Krulwich: 41:23 No, I wanted to establish that she came into psychiatry ...

Cynthia Fu: 41:29 I'm trying to think. When did I graduate medical school? I think-

Robert Krulwich: 41:29 In the very critical time.

Cynthia Fu: 41:30 I finished my training in '97. My training in psychiatry in '97.

Robert Krulwich: 41:34 That's 1997 when the FMRI machines were first becoming available, and so Cynthia was able to do a rather amazing study.

Jad Abumrad: 41:42 What?

Cynthia Fu: 41:42 In this study we produced-

Robert Krulwich: 41:46 She got together a group of people who were clinically depressed.

Cynthia Fu: 41:47 Depressed people.

Robert Krulwich: 41:49 And then another group of people who were normal.

Cynthia Fu: 41:50 Healthy people.

Robert Krulwich: 41:50 And she put them in the brain scan machine and showed them-

Cynthia Fu: 41:54 Facial expressions.

Robert Krulwich: 41:55 ... faces.

Cynthia Fu: 41:55 Ranging from more neutral expressions to more sad expressions.

Robert Krulwich: 41:59 So they saw a sad face, and then a neutral face, and then a sad face.

Cynthia Fu: 42:04 That's right.

Robert Krulwich: 42:05 What the person in the machine was supposed to do is ...

Cynthia Fu: 42:07 Look at these faces and decide whether it was a man or a woman's face.

Jad Abumrad: 42:11 Huh? What does that have to do with anything?

Robert Krulwich: 42:13 Because while they were doing that-

Cynthia Fu: 42:14 While they're making this decision the emotion of the face is being processed automatically.

Robert Krulwich: 42:20 The Amygdala sees the emotion on the faces at that moment, and the machine ...

Cynthia Fu: 42:26 It's like tick, tick, tick, tick. There were hundreds of pictures.

Robert Krulwich: 42:29 10th of a second to 10th of a second to 10th of a second.

Cynthia Fu: 42:31 That's right.

Robert Krulwich: 42:32 Did you see a difference between the people who were depressed and the people who were normal?

Cynthia Fu: 42:38 Yes.

Robert Krulwich: 42:39 Was it a significant difference, or a just barely difference?

Cynthia Fu: 42:43 As a group it was a significant difference.

Robert Krulwich: 42:45 Now she takes the big step.

Speaker 24: 42:47 Step four.

Robert Krulwich: 42:49 From the pattern she sees in bunches of people, she feeds all those patterns into a computer.

Cynthia Fu: 42:54 It's called machine learning. Tell the program this is a pattern of brain activity in depressed people. This is a pattern of brain activity in healthy people, and then-

Robert Krulwich: 43:03 She shows the computer a brain scan of a new person.

Cynthia Fu: 43:06 New person.

Jad Abumrad: 43:06 So this is someone the computers never met before?

Cynthia Fu: 43:08 Exactly.

Robert Krulwich: 43:09 She did this a bunch of times.

Cynthia Fu: 43:10 Right, a whole bunch of people.

Robert Krulwich: 43:13 Each time the computer tries to guess, is this new person ...

Cynthia Fu: 43:17 Depressed, or not.

Robert Krulwich: 43:19 And what happened?

Cynthia Fu: 43:20 More than 85% of the time, 86% of the time the algorithm correctly diagnosed whether that person was depressed or healthy.

Robert Krulwich: 43:32 Was just a brain scan, a computer, and a patient. No doctor needed. Cynthia's computer got the diagnosis right 86% of the time. A computer.

Cynthia Fu: 43:43 When we saw the results it was like wow this is amazing.

Jad Abumrad: 43:47 Wait a second. Has she repeated this?

Robert Krulwich: 43:50 Well this is actually the very first time that this has been done with depression and so it's just a pilot study and like you say, someone else will have to do it again, and then again, and again. But according to Cynthia-

Cynthia Fu: 44:03 The potential is fantastic.

Speaker 26: 44:03 Psychiatry is going to be absolutely revolutionized by this.

Cynthia Fu: 44:04 I think this method can be applied to any psychiatric disorder.

Jad Abumrad: 44:08 Any?

Robert Krulwich: 44:08 Autism.

Speaker 26: 44:09 Schizophrenia.

Robert Krulwich: 44:10 Obsessive compulsive disorder.

Jad Abumrad: 44:11 No way. Come on.

Speaker 26: 44:12 Why not? Everyone of these illnesses ultimately must have an anatomical basis. Every one of these illnesses.

Robert Krulwich: 44:21 This means that it will soon, or one day, be possible for a patient to come in, and you take a picture of him in real time, or of her, and you will have a diagnostic tool. That's what you're saying?

Speaker 26: 44:34 Absolutely.

Robert Krulwich: 44:34 Absolutely.

Speaker 26: 44:35 Absolutely.

Jad Abumrad: 44:36 You mean to tell me that they're going to put people in machines and just go boop, OCD.

Robert Krulwich: 44:40 No, no wait. Wait.

Jad Abumrad: 44:41 Boop, Schizophrenic.

Robert Krulwich: 44:42 Let me make this clear. This is not a casual thing. You go to the doctor, you tell the doctor that you're feeling a certain way. The doctor will talk to you, and then he would come to you and say well my learning and the test tells me that you're ill.

Jad Abumrad: 44:55 Okay, yeah, sure, sure.

Robert Krulwich: 44:55 That's all that's happening here.

Jad Abumrad: 44:56 Okay, okay.

Robert Krulwich: 44:56 Now I'll call the medical doctor. I'll say I have a test.

Jad Abumrad: 44:58 There's nothing in this that feels invasive to you?

Robert Krulwich: 45:03 Well obviously-

Jad Abumrad: 45:04 It's tunneling into the deep depths of your personhood.

Robert Krulwich: 45:07 No you're not. No, this is if you believe that mental illness is a mental illness. It is a structural condition which can be fixed. It's not the deep inner you, it's the broken you.

Jad Abumrad: 45:20 So it's like the broken arm thing.

Robert Krulwich: 45:21 Yeah.

Jad Abumrad: 45:21 That you started off with. You would put the two side by side?

Robert Krulwich: 45:24 I think I would. Then of course you get to the next step-

Jad Abumrad: 45:26 No, come on Robert. I mean, human beings are way too messy for that. We're too messy for it to be that easy. No, no way.

Robert Krulwich: 45:33 So you think this is an out of sciences reach, really? It's just too ...

Jad Abumrad: 45:36 There's a part of me that does think that it is out of sciences reach.

Robert Krulwich: 45:38 I think it's because you think that they're looking deep inside you. That's what you don't like.

Jad Abumrad: 45:43 I do. I mean, don't get me wrong, I find brain scans fascinating when it comes to questions like where is the soul? What is consciousness? That kind of stuff, but don't kind of get in my head and tell me what's right and what's wrong.

Robert Krulwich: 45:55 What if you're feeling sad and sick? Don't you want to get better?

Jad Abumrad: 45:56 Yes, but I enjoy the comfortable ambiguity that would come from a situation like sitting in a therapist's office and saying well, how am I feeling? I'm feeling this way, or that way. In the messiness of trying to describe how you're feeling there's a fast landscape of thing that can happen, choices you can make, therapies you can pursue.

Robert Krulwich: 46:15 Let me just do it this way. Let's say you are sick, you know that you're sick, machine or no, okay. If you are feeling badly wouldn't it be nice if a machine could help you find the right kind of help.

Jad Abumrad: 46:26 What do you mean?

Robert Krulwich: 46:26 Well Eric took me through a little though experiment.

Eric Kandel: 46:29 A mind experiment. You've developed a psychotherapy, and I've developed a psychotherapy. We each claim it's the best in the world, now we have an objective way of seeing. The machine allows you to independently of any evaluation see the outcome of treatment.

Jad Abumrad: 46:46 So you can audit the doctor.

Robert Krulwich: 46:49 Audit the doctor, and give you evidence that it's working or no.

Jad Abumrad: 46:52 Okay. I think I'm a little bit on board.

Robert Krulwich: 46:56 Yay.

Jad Abumrad: 46:56 I can give you 10% buy in now.

Robert Krulwich: 46:58 Okay.

Jad Abumrad: 46:58 So how far off is this stuff? Is it going to come soon?

Robert Krulwich: 47:01 This is very early in the game, obviously, but I did ask him how far into the future are we talking about here? Soon, or long after your dead?

Eric Kandel: 47:11 I'm going to be around a long time.

Robert Krulwich: 47:16 But the question stands. Will you make it to see that people will actually have a-

Eric Kandel: 47:21 One can't, in medicine, in all honesty give a timeline for many of these things. Imaging methodology right now is quite sophisticated, but it's still primitive compared to where it needs to be. You're picking this up in status Necendy. You're become excited as the thing is beginning to emerge. We see it for the first time on the horizon.

Robert Krulwich: 47:41 So you're saying we got to this theory too early. That's what you're saying.

Eric Kandel: 47:44 Just right. It's not going to be interesting 20 years from now. It'll be obvious.

Jad Abumrad: 47:47 Or, in 20 years it'll be obvious that we were wrong. Okay, that's a real possibility because what we don't know is-

Robert Krulwich: 47:56 A lot.

Jad Abumrad: 47:57 ... vast.

Robert Krulwich: 47:58 Yeah.

Jad Abumrad: 47:59 I want to tell you a story now about just how wrong people can be.

Robert Krulwich: 48:03 Okay.

Jad Abumrad: 48:03 It begins with a mystery.

Robert Sapolsky: 48:04 Sudden Infant Death Syndrome. Perfectly healthy child goes to sleep and dies during the night.

Jad Abumrad: 48:13 It's about the worst thing that can happen to a parent. Each year, it does happen about 7000 times. Still no one knows why. Oh, by the way, that was Robert Sapolsky. He's a-

Robert Sapolsky: 48:22 Professor of Neuroscience at Stanford University.

Jad Abumrad: 48:26 Sapolsky tells this story of the moment SIDS was diagnosed for the first time, or at least classified. In a terrible mistake that was made.

Robert Sapolsky: 48:35 Around 1900 or so people were beginning to recognize this is a disease entity and nobody knew what was up so people decided let's go dissect SIDS kids.

Jad Abumrad: 48:45 Meaning when a baby would die, they would perform an autopsy.

Robert Sapolsky: 48:48 Exactly.

Jad Abumrad: 48:50 You know, check the baby's insides.

Robert Sapolsky: 48:50 See if there's anything different in them from normal kids.

Jad Abumrad: 48:53 That seems logical.

Robert Sapolsky: 48:54 Absolutely.

Jad Abumrad: 48:54 They'd measure the size of the babies lungs.

Robert Sapolsky: 49:00 Yep.

Jad Abumrad: 49:00 That looked normal. Then they'd measure the size of the heart.

Robert Sapolsky: 49:02 Yep.

Jad Abumrad: 49:02 Nothing strange there. Stomach-

Robert Sapolsky: 49:04 Yep.

Jad Abumrad: 49:04 ... kidney-

Robert Sapolsky: 49:04 Yep.

Jad Abumrad: 49:04 ... liver-

Robert Sapolsky: 49:05 Yep.

Jad Abumrad: 49:05 Those are all fine. Then they would look in the throat.

Robert Sapolsky: 49:10 They look in there and they say, "Oh my God these SIDS kids they have enormous thymus glands."

Jad Abumrad: 49:17 The thymus.

Robert Krulwich: 49:18 The thymus.

Jad Abumrad: 49:19 What is the thymus?

Robert Krulwich: 49:20 Yeah, what is a thymus?

Jad Abumrad: 49:21 You wonder, well it is a little tiny pink gland that is right here, right behind your collar bone.

Robert Krulwich: 49:28 Yeah. Mm-hmm (affirmative).

Jad Abumrad: 49:28 At the base of your throat. It's job is to help you fight disease.

Robert Sapolsky: 49:32 It makes one type of cell critical to your immune system.

Jad Abumrad: 49:35 Especially in times of stress. Any case, normally this little organ is about the size of a tiny tube of toothpaste, like the travel kind. In these SIDS kids it was-

Robert Sapolsky: 49:48 Huge, humongous, enormous-

Jad Abumrad: 49:51 Twice the size.

Robert Sapolsky: 49:52 Exactly.

Jad Abumrad: 49:53 And since the thymus is dangerously close to the wind pipe doctors came up with a hypothesis.

Robert Sapolsky: 49:58 A perfectly reasonable hypothesis.

Jad Abumrad: 50:00 Which was that maybe if you're one of these babies with an enlarged thymus and you're asleep, and somehow you roll over wrong ...

Robert Krulwich: 50:06 Mm-hmm (affirmative).

Jad Abumrad: 50:07 Well that gland might-

Robert Sapolsky: 50:08 Press down on your trachea and suffocate you during the night.

Robert Krulwich: 50:11 Oh.

Jad Abumrad: 50:12 So, medical mystery solved.

Robert Krulwich: 50:16 Really?

Jad Abumrad: 50:18 No.

Robert Sapolsky: 50:18 They even came up with a name for it. It was called Thymicolymphaticus [inaudible 00:50:22]. It was in all the pediatric text books by the 1920s. You would look in there and there would be pictures of the dissected thymus', normal size, and here on the right.

Jad Abumrad: 50:38 Enlarged.

Robert Sapolsky: 50:39 Abnormally large thymicolymphaticus.

Jad Abumrad: 50:42 And in no time at all doctors came up with a treatment.

Robert Sapolsky: 50:45 A perfectly logical therapy.

Jad Abumrad: 50:48 Which is that if we're going to help these babies we've got to shrink their thymus glands, and to do that the best solution, obviously, is to-

Robert Sapolsky: 50:57 Irradiate their throats. Irradiate their throats to shrink their thymus glands.

Jad Abumrad: 51:05 Zap the child's throat with gillions of radioactive particles.

Robert Krulwich: 51:10 Really? Literally?

Robert Sapolsky: 51:10 You betcha.

Jad Abumrad: 51:11 This was considered like something every good loving parent should do?

Robert Sapolsky: 51:15 Absolutely. If you worry about your child being at risk for SIDS go and get their throats irradiated to shrink the thymus glands.

Jad Abumrad: 51:23 And did it work?

Robert Sapolsky: 51:24 Yes it shrank the thymus glands.

Jad Abumrad: 51:26 But, he says it did have another effect.

Robert Sapolsky: 51:28 Decades later you've killed 20 to 30 thousand people with thyroid cancer.

Robert Krulwich: 51:35 20 to 30 thousand deaths, that's a real number.

Robert Sapolsky: 51:39 Yeah, that's a fairly big one.

Jad Abumrad: 51:42 So heres my question.

Robert Sapolsky: 51:43 Mm-hmm (affirmative).

Jad Abumrad: 51:44 How could these doctors have gotten it so, so wrong? Do you know what I mean?

Robert Krulwich: 51:51 Yeah I do. Well don't you know what you mean? You just answered your own question a minute ago.

Jad Abumrad: 51:54 No I didn't. I'm about to answer it right now.

Robert Krulwich: 51:57 They're playing with radiation. You just said that. What they didn't know that radiation would hurt you. They had no ... It was a brand new technology.

Jad Abumrad: 52:10 Yeah but that's not what I was going to ... Agh.

Robert Sapolsky: 52:10 This was a couple of decades into radiation having been discovered.

Speaker 28: 52:14 Isotopes are performing near miracles of diagnosis and discovery.

Robert Sapolsky: 52:18 People were just tossing around radiation all over the place.

Speaker 28: 52:21 Iodine 131, radioactive sodium, radon, Gama rays, neutrons.

Robert Sapolsky: 52:26 This was a period with Madam Curie like dipping her arm into vats of Uranium.

Speaker 28: 52:30 Radioactivity is harmless.

Robert Sapolsky: 52:32 And dying soon afterwards from cancer. People would go into shoe stores and they would have their feet X-rayed.

Speaker 28: 52:39 Yes X-ray is a wonderful invention.

Robert Krulwich: 52:42 I had that X-ray.

Robert Sapolsky: 52:43 You had that?

Robert Krulwich: 52:43 I did, yeah. You take off your shoes and then you can look at your bones.

Robert Sapolsky: 52:47 That's exactly what they did.

Jad Abumrad: 52:48 Why would you do that?

Robert Krulwich: 52:50 That was the thing you could do at the shoe store. It was very cool.

Robert Sapolsky: 52:53 Yeah, it's showing how cutting edge of a shoe store they are.

Robert Krulwich: 52:56 Yeah. That's your explanation?

Jad Abumrad: 52:59 No, that may look like the explanation. I mean sure radiation played a role but if you would have let me say what I was going to say. I would have told you the real explanation-

Robert Krulwich: 53:08 Yes?

Jad Abumrad: 53:09 Preceded the radiation by like a couple hundred years.

Robert Krulwich: 53:11 What? I don't ... No idea what you're talking about.

Jad Abumrad: 53:14 I'm going to tell you. Back in the 1700s, okay.

Robert Krulwich: 53:16 Oh, that far back, okay.

Jad Abumrad: 53:18 That far back, before radiation, before your grandpa.

Robert Krulwich: 53:21 Well before the civil war, the Eiffel Tower, and Napoleon.

Jad Abumrad: 53:25 I'm talking when the red coats-

Robert Krulwich: 53:28 Were still wearing red.

Jad Abumrad: 53:29 Yeah.

Robert Sapolsky: 53:29 Yeah this was shortly after the Revolutionary War.

Jad Abumrad: 53:33 Right about this time, says Sapolsky, the first med schools started to pop up in America. A supply and demand issue came into effect, because with these med schools came med students who needed to learn about anatomy. Of course, in order to do that-

Robert Sapolsky: 53:47 They needed bodies.

Jad Abumrad: 53:49 You know, to dissect.

Robert Sapolsky: 53:50 This produced this whole occupation. You could be a resurrectionist.

Robert Krulwich: 53:54 A resurrectionist?

Robert Sapolsky: 53:56 Yep. They would go out and dig up bodies at night, and sell them to the anatomists, the medical schools.

Jad Abumrad: 54:10 I'll need two more by Thursday. Dig, dig. Now, heres the key point, since demand was so high the resurrectionist had to go where the bodies were easiest to get. Which meant avoiding the fancy graveyards.

Robert Sapolsky: 54:26 If you were wealthy, you could have yourself buried in what was called a patent coffin.

Jad Abumrad: 54:31 Huh?

Robert Sapolsky: 54:33 Which was a triple layer coffin, which was meant to be resurrectionist proof.

Jad Abumrad: 54:38 But if you were not wealthy. No fancy coffin for you. You'd probably just be buried in a sac in some paupers field just a few inches under the soil, very accessible for these resurrectionist.

Robert Sapolsky: 54:51 Not surprisingly that's where they went.

Jad Abumrad: 54:54 Dig, dig.

Robert Krulwich: 54:56 Are we still on the same topic? Are you explaining why children died.

Jad Abumrad: 55:00 Yes, yes. Bare with me.

Robert Krulwich: 55:01 Oh okay.

Jad Abumrad: 55:01 What I'm trying to make is that the grave robbers targeted the poor. So much so that sometimes when people would catch these resurrectionist in the act and see like, oh my God that's my dad you're digging up.

Robert Krulwich: 55:12 Mm-hmm (affirmative).

Jad Abumrad: 55:12 There would be riots.

Speaker 29: 55:20 Get them. Get them. Stop stealing our bodies.

Robert Sapolsky: 55:21 Troops were called out, rioters were shot.

Jad Abumrad: 55:22 Are we talking like hundreds of people torch bearing ...

Robert Sapolsky: 55:26 Yeah it was townies versus the people who were trying to dissect their dead relatives.

Robert Krulwich: 55:30 Okay, okay. This is a lot of history, and I'm very fascinated, in quotes, but what does this have to do with kids dying of that?

Jad Abumrad: 55:39 All right, let me bring it home.

Robert Krulwich: 55:40 Not that it hasn't been interesting, but bring it home.

Jad Abumrad: 55:42 As a result of all of this hubbub over grave robbing country after country throughout Europe decided well let's standardize how science gets its cadavers. Forget all this grave robbing, so they passed laws.

Robert Sapolsky: 55:54 Which formalized anyone who died in a poor house their body would be turned over to the anatomists.

Jad Abumrad: 56:00 This was like the cadaver version of direct deposit. Okay, so grave robbing was gone, but now all the bodies used by medicine, not just some, but nearly all now came from the poor.

Robert Sapolsky: 56:11 Estimates were by the end of that century 99% of the bodies used for anatomy lessons had been derived from poor houses.

Jad Abumrad: 56:19 That seemed okay, until-

Robert Sapolsky: 56:21 1936 a guy named Hans Selye showed-

Jad Abumrad: 56:25 That being poor actually warps your body. And now, Robert, now we come back to the case of the mysteriously enlarged thymus. Because if you're poor you're worried about your job, you're worried about feeding your family. You're worried about the bills. In other words you are stressed out.

Robert Sapolsky: 56:44 During chronic stress your immune system goes down the tubes.

Jad Abumrad: 56:48 And since the thymus is part of the immune system-

Robert Sapolsky: 56:51 If you were chronically stressed the thymus gland shrinks.

Jad Abumrad: 56:54 Oh.

Robert Krulwich: 56:54 Oh.

Jad Abumrad: 56:57 For 150 years doctors had been dissecting cadavers, pointing at organs, which they thought were normal but which were in fact shrunken from a life of poverty and stress, and saying that's normal. So that when these SIDS babies show up with these gigantic thymus, oh my God. In fact, that was the first time they'd ever seen a normal one.

Robert Sapolsky: 57:18 People had no idea what was normal, and what was abnormal and they got it backwards.

Jad Abumrad: 57:26 Killing about 30 thousand people in the process. The scary thing, says Sapolsky, is that these doctors were not dumb.

Robert Sapolsky: 57:34 No, these were the best most careful researchers at the time, and these were the only logical conclusions that could have been made. None the less it produced an utter disaster. There's not the slightest reason to think we're not doing the same thing right now.

Jad Abumrad: 57:59 Robert Sapolsky is a professor of Neuroscience at Stanford University. He's the author of many great books, including Monkey Love the Trouble With Testosterone. For more information on him or anything that you heard in this hour visit our website radiolab.org, and you can send us an email while you're there.

Robert Krulwich: 58:14 Radiolab@WNYC.org is actually-

Jad Abumrad: 58:18 That is the address.

Robert Krulwich: 58:19 Remember that.

Jad Abumrad: 58:20 Yep. I'm Jad Abumrad.

Robert Krulwich: 58:21 I'm Robert Krulwich.

Jad Abumrad: 58:22 Thanks for listening.

Speaker 30: 58:23 Message 10 moved from an external number.

Robert Sapolsky: 58:26 Okay. Radio Lab is produced by Ellen Horne and Jad Abumrad. Our staff includes Lulu Miller, Jonathon Mitchell, Soren Wheeler, Amanda Aronchek and Jessica Banco.

Speaker 31: 58:40 With help from Ann Boiko, Wade Roxikes, Srejkahn Jaraj, Chi Chang Lin, Heather Bradley and Sally Herschups. Special thanks to Karen Hablick, Justin Paul, Dr. Allen Olstrike and Taylor Dupree of 12K.com.

Mary Bronner: 58:59 Radio Lab is produced by WNYC, and distributed by National Public Radio.

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