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Speaker 2: Talk listeners. Karen and I are getting ready to head
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Speaker 2: stop buy and see us in Lubbock, Texas, Saturday, February
Speaker 2: twenty third, twenty nineteen, at lubbocn at two pm in
Speaker 2: the Civic Center, Room one oh one. Okay, it's actually
Speaker 2: quite unlike anything we've ever seen before.
Speaker 3: A giant, hairy preacher park ape part mats.
Speaker 1: In Larkness, a twenty four mile long bottomless lake in
Speaker 1: the highlands of Scotland, if a creature known as the
Speaker 1: Luckness Monster.
Speaker 2: Monster tal Welcome to Monster Talk, the science show about monsters.
Speaker 2: I'm Blake Smith.
Speaker 4: And I'm Karen Stolsner.
Speaker 2: In this episode, we begin an intermittent series on what
Speaker 2: I'm calling monstrous medicine. I think we're going to have
Speaker 2: some interesting in macab topics to cover around the history
Speaker 2: of medicine as it evolved over the past couple of
Speaker 2: thousand years. Up first in this series, we welcome Australian
Speaker 2: author Mike McCrae, who's going to talk with us about
Speaker 2: his new book Unwell, which looks at the meaning of
Speaker 2: the entire concepts of disease. I wouldn't give this episode
Speaker 2: an explicit tag, but we do talk a good bit
Speaker 2: about some disturbing terms and ideas, and we talk about
Speaker 2: human sexuality. So if you've got kids who listen, you
Speaker 2: just need to be aware of that. As a parent,
Speaker 2: I like to be forewarned, although to be honest, my
Speaker 2: kids have reached the age where they're more likely to
Speaker 2: shock me than vice versa more instrutal Off the air,
Speaker 2: Karen introduced me a little bit to who you are,
Speaker 2: But could you give a bio for the listeners who
Speaker 2: won't know who you are?
Speaker 3: Yeah? Sure. So I'm an Australian based science writer.
Speaker 1: I write for a science news service called Science Alert,
Speaker 1: which some readers might know of. My background is all
Speaker 1: over the place, so I started in pathology many years ago.
Speaker 1: I used to test bloods and urines and any other
Speaker 1: body fluid you can name, and I worked in a
Speaker 1: hospital doing that I moved from that into teaching, so
Speaker 1: I've taught in the UK, I've taught in various places
Speaker 1: over Australia, and I moved from that then into writing
Speaker 1: and developing educational resources. So I've written for children's magazines,
Speaker 1: I've developed various educational programs, and I kind of do
Speaker 1: a mix of things these days. So an additional science alert,
Speaker 1: I write books such as Unwell, and I also freelance
Speaker 1: for educational groups and other news services.
Speaker 2: So Kierra mentioned that you had met through the Australian Skeptics.
Speaker 2: How were they doing as an organization lately?
Speaker 3: Couldn't tell you.
Speaker 1: I have had very little to do with skepticism over
Speaker 1: the past say five years or so, largely because I
Speaker 1: found a lot of the values that I hold in
Speaker 1: that I can apply directly into science, communication and education,
Speaker 1: So that hasn't changed. But I think as a community,
Speaker 1: I sort of found there were two types of people
Speaker 1: in the community. There are those people who are practically
Speaker 1: minded and those people are morally minded. Moral skeptics tend
Speaker 1: to be the ones who get quite upset and angry
Speaker 1: when somebody doesn't share their views, and they tend to
Speaker 1: isolate and ostracize those people and almost vilify them in
Speaker 1: a way. I prefer the more practical side, which says,
Speaker 1: how do we change the world, how do we actually
Speaker 1: help people understand things differently? And that often requires you
Speaker 1: stepping into their shoes and understanding how they got there,
Speaker 1: and that could be quite uncomfortable for people who don't
Speaker 1: have that moral mindset.
Speaker 3: So I find it easier just to kind of go
Speaker 3: on alone.
Speaker 4: I was going to say, recently, seen the same thing
Speaker 4: here in the the US, with not only the organizations
Speaker 4: but the community itself.
Speaker 3: Yeah.
Speaker 1: Absolutely, and you see it also in science communication to
Speaker 1: a part, I think it's all over the place. It's
Speaker 1: a human thing to do. So it's not like, you know,
Speaker 1: I get frustrated. It's more just it's just easier sometimes
Speaker 1: I think buying those people who share a practical goal
Speaker 1: and say how do we work towards actually changing things
Speaker 1: without seeing them as the enemy.
Speaker 2: Yeah. I have a tremendous amount of empathy, and that's
Speaker 2: not always appreciate it, I think maybe in the hyper
Speaker 2: rational world.
Speaker 1: So yeah, yeah, empathy, it's a place you kin'd have
Speaker 1: to start in a way. I mean, I think that's
Speaker 1: one of the things in education I found over the
Speaker 1: years is if you're teaching students and you're wanting to
Speaker 1: actually give them the skills and the knowledge and the
Speaker 1: ability to think critically, the first thing that you need
Speaker 1: to give them is the ability to empathize with how
Speaker 1: did somebody else come to that belief?
Speaker 3: You know, you can't just reduce it to stupidity.
Speaker 1: You can't reduce it down to what they call an
Speaker 1: education the deficit model, which says you don't have this information,
Speaker 1: I'll give it to you. Now you have it, and
Speaker 1: it's just it's not how it works. And so you
Speaker 1: kind of have to say, well, how did you get there?
Speaker 1: How do I put my brain into it and go right,
Speaker 1: I see the steps you made, and how do I
Speaker 1: use your values to kind of try to help you
Speaker 1: arrive at a conclusion that's going to help you. And
Speaker 1: it's not always possible, but it's the most practical way
Speaker 1: to actually change your minds.
Speaker 2: It sounds very pragmatic, Well, yeah, I.
Speaker 1: Mean with it, it's a practical problem. In the end,
Speaker 1: education is a practical thing. You get so many teachers
Speaker 1: that are so upset with students. You know, you're not
Speaker 1: trying hard enough, You're being lazy and it's like, you know,
Speaker 1: it's I had an interview with the newspaper here recently
Speaker 1: and the conversation sort of found all these overlaps between
Speaker 1: medicine and education. Both of them are practically minded things
Speaker 1: to say, how do we take something that is not good?
Speaker 1: You don't value it, I don't value it, And how
Speaker 1: do we advance to a place that we all appreciate
Speaker 1: and like? And that means it's a practical problem. How
Speaker 1: do we change things? How do we actually move things
Speaker 1: along to a practical outcome? Otherwise it's just about you
Speaker 1: being angry that the world isn't the way that you
Speaker 1: want it, which we all get. But that's a discussion
Speaker 1: down the pub where you vent it's not a practical
Speaker 1: way to change the world.
Speaker 2: True enough.
Speaker 4: So, Mike, you've mentioned one well and we invited you
Speaker 4: on the show today to talk about Unwell, which is
Speaker 4: your latest book, and I believe it's published through the
Speaker 4: University of Queensland.
Speaker 3: That's right, So what can.
Speaker 4: You tell us a little bit about the book and
Speaker 4: what inspires you to write unwell?
Speaker 3: So?
Speaker 1: Unwell is an exploration of what makes one thing a
Speaker 1: disease and something just simply an undesirable trait or something
Speaker 1: we don't like. I think it goes back to many
Speaker 1: parts of my life. I keep trying to find the
Speaker 1: starting point. Part of it, I think might have been
Speaker 1: that I grew up with a father who battled with alcoholism,
Speaker 1: and one of the things he quite often said was,
Speaker 1: you know, some you have to understand, this is a disease.
Speaker 1: And I couldn't comprehend, you know, the difference between somebody
Speaker 1: choosing to put a drink in their mouth and be
Speaker 1: this way and somebody with a disease, you know, and
Speaker 1: how we dealt with that. I then went into pathology,
Speaker 1: and that's very much a clear clinical process. You know,
Speaker 1: you get in body of fluids and you test them
Speaker 1: and you get a number, and that number will tell
Speaker 1: you something and either you're close to that number, you're
Speaker 1: on that number, or you're over it, and that.
Speaker 3: Gives you a diagnosis. This person now has a disease.
Speaker 1: And you go back to the care provider and you
Speaker 1: give them the information and then they provide a plan.
Speaker 1: But in your mind it's still this is a clear line.
Speaker 1: We have diseases or we don't have diseases. And I
Speaker 1: think I've always kind of struggled with this concept of like, well,
Speaker 1: who gets to determine what this disease is? How do
Speaker 1: we find them? Is it like you have dinosaur bones,
Speaker 1: you dig them up, and you go, here is a disease.
Speaker 1: We didn't know this existed? What do we kind of
Speaker 1: invented as we go along. My previous book was Tribal Science,
Speaker 1: and that have a lot to do with this fuzzy
Speaker 1: line between what is science and what's not science and
Speaker 1: how do we communicate that? How do we think scientifically?
Speaker 1: So this was almost the next step on it was, well,
Speaker 1: how do we think about our health? You know, where
Speaker 1: is that fuzzy line between somebody feeling healthy and on
Speaker 1: top of things and somebody having a disease? And I
Speaker 1: love the history and the culture that goes into that.
Speaker 1: So that kind of culminated in writing Unwell.
Speaker 2: So how do you define a disease as opposed to say,
Speaker 2: a condition or a disorder, at least within the context
Speaker 2: of your book.
Speaker 1: Well, I don't go into too much detail about what
Speaker 1: defines say, syndrome from condition, disease disorder, because it's kind
Speaker 1: of a fuzzy mix of things as it is. With that,
Speaker 1: I kind of stand back and just kind of say, well,
Speaker 1: what really separates this disease concept from health? And there's
Speaker 1: kind of two answers to that. One's a bit more
Speaker 1: trite than the other one. The simple answer is, there
Speaker 1: is a group of people who decide for us. So
Speaker 1: you'll have authorities in the world who will have debates
Speaker 1: and discussions about this, and every now and then they'll
Speaker 1: put out big books, and those books will have whole
Speaker 1: lists of diseases in them.
Speaker 3: You know.
Speaker 1: One of them is the Diagnostic and Statistical Manual, which
Speaker 1: looks at mental health. Another one is the International Classification
Speaker 1: of Diseases. But they're both made by groups of people
Speaker 1: who put these out every now and then, and that
Speaker 1: if you're a care provider, you turn to that book
Speaker 1: and you find a code and it breaks everything down
Speaker 1: in a very methodical way. So for most of us
Speaker 1: it is an authority based decision. The thing is, there's
Speaker 1: also a philosophical conversation behind that. People who make these
Speaker 1: big books and kind of determine what is and is
Speaker 1: not a disease have a debate about these things and
Speaker 1: the lead up.
Speaker 3: So a recent.
Speaker 1: Edition of the ICD came out at number eleven, or
Speaker 1: at least the draft version has, and.
Speaker 3: That has changes in it.
Speaker 1: So an example of that is game disorder is now
Speaker 1: considered a bonifie disease. It wasn't previously before if you
Speaker 1: played too much computer games, then you know, that was
Speaker 1: just an issue you had to deal with, whereas now
Speaker 1: you can actually go along and have a talk to
Speaker 1: your doctor, you can talk to your psychologist and they
Speaker 1: have a code that they can go to to provide
Speaker 1: certain benefits because you now have a disease. But that
Speaker 1: didn't come out of nowhere. There was a big conversation
Speaker 1: that went into that, and that meant that they looked
Speaker 1: at the literature, they looked at petitions, they looked at
Speaker 1: discussions that are happening out there in conferences, and it's
Speaker 1: a slow build up to say, you know, maybe this
Speaker 1: thing we've.
Speaker 3: Been talking about should be considered disease.
Speaker 1: You know, we can label it certain ways, we can
Speaker 1: look at certain physiologies, and there's a lot that informs that. Now,
Speaker 1: what that philosophy is actually determined by is what I
Speaker 1: kind of explore in the book, and it sort of
Speaker 1: comes down to three things. So our culture of disease
Speaker 1: is informed by looking at what we consider to be
Speaker 1: biological normality. So you know, we look around us and
Speaker 1: there's variation, but if you have a disease, you're different
Speaker 1: to most of those variations in some way. You know,
Speaker 1: I've got a lot of gray hair, but no one's
Speaker 1: going to tell me that I've got a disease unless
Speaker 1: that gray hair actually happened, you know, when I was five.
Speaker 1: And then someone says, well, that's not a normality we're
Speaker 1: used to. So you're different, But that difference alone doesn't
Speaker 1: give you a disease. So the next step is does
Speaker 1: that difference actually interfere with how you engage with a
Speaker 1: responsibility in society. So all of us have certain expectations.
Speaker 1: That expectation might be that you have to work. You know,
Speaker 1: you have to get up out of bed each day
Speaker 1: and go and contribute. Maybe you're in part of a
Speaker 1: culture that doesn't have a capitalistic way of seeing things,
Speaker 1: but you still engage in another way. You might need
Speaker 1: to do some hunting or gathering or bringing food into
Speaker 1: the community. There's other expectations. You can't sit in a
Speaker 1: bus and talk to yourself. People expect something of you,
Speaker 1: a certain cordiality, or they expect, you know, for you
Speaker 1: to not inspire fear in others, so you have to
Speaker 1: behave in a certain way. There's also a look. You know,
Speaker 1: you have to look a particular way because otherwise people
Speaker 1: might be a bit comfortable. You're expected to be of
Speaker 1: a certain ways. You know, you're expected to look a
Speaker 1: certain way, or you're not fulfilling the obligations and the
Speaker 1: requirements of society. But there's a third one we don't
Speaker 1: think too much about, and that is you can be
Speaker 1: different and you won't fit certain social norms, but it
Speaker 1: has to not be your fault. You know, you have
Speaker 1: to kind of not have responsibility of this state if
Speaker 1: you do. If you chose to be this way, then
Speaker 1: you might not have a disease or an illness. So
Speaker 1: you can take a hangover, for instance, you can ring
Speaker 1: up and say, look, I'm feel a bit ill, But
Speaker 1: no one's going to say you have a disease because
Speaker 1: you've got up one morning and said I'm hungover because
Speaker 1: you put that alcohol into your system the night before.
Speaker 1: But if you wake up and say, look, i've food poisoning.
Speaker 1: You know I didn't mean to, then people are going
Speaker 1: to start thinking of that more of a disease like fashion,
Speaker 1: and the way we behave towards a hangover is going
Speaker 1: to be very different to the way we behave towards that,
Speaker 1: you know, having food poisoning. So again it's a bit
Speaker 1: of a fuzzy line, and that's why we have debates
Speaker 1: about this, But there's a lot of this philosophy that
Speaker 1: goes into what do we determine is the difference between
Speaker 1: you having a disease and you simply not feeling well
Speaker 1: or simply not fitting a certain obligation.
Speaker 4: So a little while ago you mentioned alcoholism, So how
Speaker 4: is that classified today because you were talking in terms
Speaker 4: of responsibility and blame is seen as an addiction or
Speaker 4: is it seen as more of a disease or a
Speaker 4: mental illness nowadays?
Speaker 3: Well, I mean the simple answer again it's yes.
Speaker 1: So you know, you can be seen as an alcoholic
Speaker 1: can have a disease, But I mean the history behind
Speaker 1: that is actually what you know, it's almost a focal
Speaker 1: point for this. So you can go back a good
Speaker 1: centrist to looking at the history of alcoholism, which was
Speaker 1: one of the first debates on is this a disease
Speaker 1: or not? So you had a lot of medical professionals
Speaker 1: to be looking at this question, and you know, the
Speaker 1: origins of alcoholics alcohol anonymous, for instance, is wrapped up
Speaker 1: in this question where we had somebody who didn't have
Speaker 1: a medical background, who did a lot of pseudo science.
Speaker 1: You know, they sort of went out and interviewed people
Speaker 1: and came up with this categorization, the steps that you
Speaker 1: went through to classify you as being an alcoholic, and
Speaker 1: it looked quite rigorous, but really when you pull it apart,
Speaker 1: there wasn't a lot of riger to it. So there's
Speaker 1: been this debate to kind of say, well, is it
Speaker 1: your fault? Are you going out and your drinking and
Speaker 1: you know, where does the youth start and stop? Or
Speaker 1: is it your physiology? And it's still a debate today.
Speaker 1: You know, we still debate about addiction and we still say,
Speaker 1: well where do you stop in your body start? And
Speaker 1: you know, the interesting thing is the conversation is shifting slowly.
Speaker 1: So this whole disease model that we've had for the
Speaker 1: past one hundred, one hundred and fifty two hundred years
Speaker 1: is gradually evolving to where we're kind of saying, well,
Speaker 1: where does that matter? You know, the practicality of it
Speaker 1: kind of says, we don't want you to suffer, and
Speaker 1: we don't want socide to suffer. How do we change that?
Speaker 1: So psychology is starting to blend more with neurology and
Speaker 1: psychiatry and medicine starting to blurt together to kind of say,
Speaker 1: you're an individual, how do we help you? But this
Speaker 1: is a slow process, so we may see in years
Speaker 1: to come, this whole disease model, these great big books
Speaker 1: of disease are getting more and more complicated kind of
Speaker 1: fall apart, and we'll look at medicine in a completely
Speaker 1: different way.
Speaker 2: That would be really interesting. It sounds like, you know,
Speaker 2: there's a couple of components going on. You've got the
Speaker 2: medical oversight sort of view, but you also have society
Speaker 2: sort of defining how diseases are perceived. I'm thinking here
Speaker 2: about not only new things like the video game addiction,
Speaker 2: but you know how alcoholism, where society gets to say,
Speaker 2: for right or wrong, that they think about an individual's
Speaker 2: ability to control their own behavior, you know, the self
Speaker 2: determination factor. And when you're dealing with something that is
Speaker 2: potentially like it has a moral stigma associated, like when
Speaker 2: AIDS happen, a lot of people felt like, well, AIDS
Speaker 2: was tied to morality, like if people hadn't have had
Speaker 2: the sort of behaviors that would lead to contamination with
Speaker 2: the virus, then they wouldn't have gotten the disease. And
Speaker 2: that in some way, because they were behaving in a
Speaker 2: way that they felt was immoral, that they somehow deserved
Speaker 2: the disease. Is did you do you cover that in
Speaker 2: the book?
Speaker 3: Absolutely?
Speaker 1: In fact, it's one of the core themes in the
Speaker 1: book that I keep going back to is the fact
Speaker 1: that diseases, really it's hard a moral concept. In many ways,
Speaker 1: you can't pull apart in the morality from the disease.
Speaker 1: You know, nature doesn't give what your variation is.
Speaker 3: You know, you you're.
Speaker 1: Sort of you're different in some way, and nature provides
Speaker 1: variation because well, you know, that's how we evolve. We
Speaker 1: have variation within a species, variation in a genetic level,
Speaker 1: you know, the environment shifts, there's difference. But as we
Speaker 1: humans who then kind of say what do we value
Speaker 1: as a community and what's important to us? Some things
Speaker 1: are going to be important in one culture that are
Speaker 1: not important in another. And so a variation of what
Speaker 1: we consider to be that defining line of disease, the
Speaker 1: other point that you made was to do with, you know,
Speaker 1: that that whole volition thing, that culpability. Where do you
Speaker 1: start and stop? And interestingly, science doesn't really have an
Speaker 1: answer to say, well, where does your free will start?
Speaker 1: You know, where does it stop. We sort of treat
Speaker 1: the whole consciousness free will thing as a little bit
Speaker 1: of a first year philosophy student type discussion. You know, yeah,
Speaker 1: it's in the two hard basket and it's something that
Speaker 1: young students debating. We don't talk about anymore because it
Speaker 1: is quite hard to kind of discuss any scientific way.
Speaker 1: We don't even have a philosophical definition of it. So
Speaker 1: when we then look at it in terms of not
Speaker 1: just health and medicine, but in law other a society
Speaker 1: that kind of say, you know, who are you and
Speaker 1: how much influence do you have over your biology? We've
Speaker 1: drawn a line. We kind of say, well, on one
Speaker 1: side you do have control and the other you don't.
Speaker 1: But we don't know what that line looks like yet.
Speaker 1: There is so much that does depend on it. So
Speaker 1: you know, one area I do go into in the
Speaker 1: book is with mental health and the legal system. So
Speaker 1: you know, we have things like the insanity plea for instance,
Speaker 1: which kind of says, look, I wasn't in my right
Speaker 1: mind or I didn't have control over what I was doing.
Speaker 1: And the courts debate this, but there is nothing in
Speaker 1: science that kind of says, oh, hang on a second,
Speaker 1: yeah you didn't have that line look at Yeah, let's
Speaker 1: look aside your brain.
Speaker 3: And find where volitions start and stop. Where is your agency?
Speaker 1: So we've got these big things, these big definitions that
Speaker 1: sort of rely very heavily on something we don't even
Speaker 1: have a definition for, let alone understand. And there's lots
Speaker 1: of consequences to that. It's not an easy thing to do,
Speaker 1: but you know, in the end we then need to ask, well,
Speaker 1: where are our definitions? You know, what points can we
Speaker 1: actually affect? What do we have control over and what
Speaker 1: we don't. And when it comes to disease, we've had
Speaker 1: a century or so of being so clear on it
Speaker 1: being a medical scientific problem, we don't stop to think
Speaker 1: what can society do?
Speaker 3: You know, we're so clear on kind.
Speaker 1: Of saying well, if your legs don't work, we can
Speaker 1: build your wheelchair, we can build you an extra skeleton,
Speaker 1: we can fix your you know, we don't often then
Speaker 1: say well.
Speaker 3: Can we build a ramp.
Speaker 1: Can we change society in ways to kind of deal
Speaker 1: with disability and disease as if you know, it's a
Speaker 1: variation and there are many things that we can do
Speaker 1: to try to address that.
Speaker 4: In your book, you talk about some really interesting phenomena
Speaker 4: that were historically treated as diseases, So concepts like hysteria
Speaker 4: and nostalgia. Could you talk a little bit about.
Speaker 1: These absolutely, So you know, you look back through history
Speaker 1: and we have different ways of defining diseases that we
Speaker 1: might be able to identify today, but there's whole areas
Speaker 1: there that were so big in terms of what we
Speaker 1: consider to be a disease that kind of fell away,
Speaker 1: which kind of shows again the disease has a very
Speaker 1: strong tie to culture all over the world today but
Speaker 1: also throughout the past. So you know, two examples, One
Speaker 1: was hysteria. So for centuries we viewed female bodies in
Speaker 1: such a way that there is an organ in there
Speaker 1: uterus that can move out of place or can disrupt
Speaker 1: in some way, and that can have a direct link
Speaker 1: to behavior and explain behavior. So you know, if a
Speaker 1: woman is not behaving in such a way that society
Speaker 1: might expect, we can then say, well, is it your
Speaker 1: fault or can we look to biology to explain it?
Speaker 1: And when where you look to biology to explain it,
Speaker 1: There's been philosophers and anatomous over time they going, well,
Speaker 1: we're in a different They got this uterus thing. There
Speaker 1: was a belief for a long time that organs weren't
Speaker 1: firmly anchored in place and could move, and then there
Speaker 1: was a hypothesis that said maybe that movement could account
Speaker 1: for behavioral differences. So the uterus was just one of them.
Speaker 1: It can move up in your chest and restrict breathing,
Speaker 1: it can move out of place and cause all sorts
Speaker 1: of behavioral problems, and that led to some pretty heinous things.
Speaker 1: I mean, in the past, you'd have a hysterectomy, for instance,
Speaker 1: in extreme cases if you weren't behaving in a way
Speaker 1: that was to be expected. So of course a lot
Speaker 1: of the people who can't argue for themselves or may
Speaker 1: have other mental health issues that were the ones who
Speaker 1: were subjected to awful tortures on this path. And this
Speaker 1: was something that was mentioned back in ancient Greece, but
Speaker 1: kept coming back as a fairly fashionable type disease throughout
Speaker 1: history all the way up to the nineteenth century, and
Speaker 1: it's pretty much only been in the past centur or
Speaker 1: so that really what we've done is to replace this
Speaker 1: concept of the uterus being out of place with other things.
Speaker 1: You know, your hormones are acting up, or it's an
Speaker 1: endocrime thing, which can be very easy.
Speaker 3: To dismiss behaviors we don't like.
Speaker 1: So that's not saying that there aren't variations that people
Speaker 1: know that could affect how the brain works, But what
Speaker 1: it is saying is quite often we go and we
Speaker 1: look for an organ or a biological thing and go,
Speaker 1: I don't like your behavior. Therefore we can find this,
Speaker 1: fix it, and you will now behave in a way
Speaker 1: that we liked, rather than saying, well, maybe our expectations
Speaker 1: are out of place, you know, maybe the way we
Speaker 1: perceive things is different. One of the other classics is
Speaker 1: something called neurasthenia, which once just referred to pretty much
Speaker 1: any sort of neurological condition or anxiety, but was cemented
Speaker 1: in place as an actual mental health condition in the
Speaker 1: nineteenth century when we started to think more about how
Speaker 1: the brain worked, and there was an early model for
Speaker 1: how the nervous system worked that sort of looked at
Speaker 1: it in a very mechanical way, as if it was
Speaker 1: full of fluids, and you know, looking at certain energies,
Speaker 1: and so we thought, well, maybe some people who have
Speaker 1: high levels of anxiety or depression or other mental health issues,
Speaker 1: maybe they're just low on this nervous fluid in their body,
Speaker 1: this energy that drives them forward. And so throughout the
Speaker 1: nineteenth century there was started to be this that, well,
Speaker 1: in America especially, the world is changing.
Speaker 3: You know, we've got a society it's different.
Speaker 1: Today, and it's busy and it's full on, and that
Speaker 1: might explain why all these people just seem to be
Speaker 1: very anxious and very nervous.
Speaker 3: And so in neurasthenia.
Speaker 1: Became one of the most popular ways of describing health.
Speaker 3: So it was one of those whatever as, it's probably
Speaker 3: in neurasthenia.
Speaker 1: You know, if you're impotent, if you're hungry all the time,
Speaker 1: or you're not hungry all the time, or you've got
Speaker 1: anything from anxiety, it's probably neurasthenia. And they prescribed for
Speaker 1: women it was bed rest, so you should go lay
Speaker 1: down in a dark room and read a book. Unless
Speaker 1: it's really bad, then don't read a book. You know,
Speaker 1: you can be tended on by servants unless again it's
Speaker 1: really bad, in which case, don't talk to anybody. For men,
Speaker 1: it was to go out and experience nature again, so
Speaker 1: there was a prescription of sort like go west, young men,
Speaker 1: and experience the wild, and that will replenish your nervous energies.
Speaker 1: And this was something that sort of persisted in medical
Speaker 1: books right up into the mid twentieth century. It was
Speaker 1: still thought in some areas to actually be a thing,
Speaker 1: but of course we don't talk about neurasthenia anymore. It's
Speaker 1: really not a condition. You know, when it used to
Speaker 1: be number one, it now is not a thing. So
Speaker 1: it shows with these conditions that are understanding of what
Speaker 1: health and medicine is does shift over time. We sort
Speaker 1: of feel we're in a privileged place now where we
Speaker 1: feel we understand nature so much better. We've got so
Speaker 1: much more information that the reason we lost them is
Speaker 1: because we know more, and you know, they fell by
Speaker 1: the wayside, And there's truth to that, but there's also
Speaker 1: a truth to the fact that what's also changed is
Speaker 1: simply our expectations of how people should behave So culture
Speaker 1: has shifted, and both those forces act to say conditions
Speaker 1: we used to have we don't have anymore, which sort
Speaker 1: of makes you wonder, well, what about conditions today that
Speaker 1: we think are bona fide diseases?
Speaker 3: One day we might look at and go, well, the
Speaker 3: variation is there.
Speaker 1: Biology is different, but our expectations of people, our values
Speaker 1: have changed.
Speaker 2: Yeah. There was an episode of This American Life that
Speaker 2: talked about the effort to remove homosexuality from the DSM
Speaker 2: and how controversial that was, and that always stuck with
Speaker 2: me absolutely.
Speaker 1: Homosexuality is a classic example of that, where it started
Speaker 1: as a sin and then it was actually almost a
Speaker 1: benevolent sort of thing.
Speaker 3: You know.
Speaker 1: There were psychologists who would start to look at the
Speaker 1: behaviors and go, well, maybe it's not their fault, it
Speaker 1: shouldn't be a sin.
Speaker 3: But it still became a disease. It was still an
Speaker 3: abnormality that.
Speaker 1: We did not want for deca you know, and it
Speaker 1: was in the medical books to try to fix it
Speaker 1: because this is wrong and bad. In the end, people
Speaker 1: started stand up and going, why is this bad? You know,
Speaker 1: what are expectations of sexuality? What are these things you
Speaker 1: don't like? And these days it's much more broadly accepted
Speaker 1: as being a variation it's not a disease, it's not
Speaker 1: a sin. It's there are differences, and we're okay with differences,
Speaker 1: but there are still plus of society that will still
Speaker 1: treat this as an abdomality that needs to be fixed. So,
Speaker 1: you know, in sexuality as a perfect example that brings
Speaker 1: together all these elements of morality and expectation of biology,
Speaker 1: that kind of says, well, how do we define that
Speaker 1: difference between what a disease is and isn't.
Speaker 4: Yeah, it was treated as a crime for a period too,
Speaker 4: wasn't ever, I think with Oscar Wilde, wasn't He was
Speaker 4: sent to prison for being a sort of item.
Speaker 1: Absolutely, So that's that difference between what is an immoral
Speaker 1: act that we can actually punish you for because you
Speaker 1: can control, versus an act that is beyond your help.
Speaker 1: But there's still that sense of if you're broken, then
Speaker 1: all it means is you can't control it. Therefore an
Speaker 1: authority will you know, if Oscar while had been diagnosed
Speaker 1: with homosexuality, then it may simply have been well, we
Speaker 1: won't put you on a prison self because it wasn't
Speaker 1: your fault, but we will take you away and put
Speaker 1: you into an asylum. You know, we will take you
Speaker 1: away and we will subject you to some pretty awful
Speaker 1: acts in an effort to change your biology, because you know,
Speaker 1: we now feel pity for you, but we're still going
Speaker 1: to try to take away the thing we deem to
Speaker 1: be bad.
Speaker 2: Hmmm, wow, Well, what what is americanitis? I'm concerned as
Speaker 2: an American that this might be Soviet I think.
Speaker 4: I've got it.
Speaker 3: Yeah, it's neurasthenia.
Speaker 1: But it was a bit of a popular term for it, so,
Speaker 1: you know, neurasthenia became so associated with the American way
Speaker 1: of life. It was cheekily called American itis to to
Speaker 1: sort of link it in with being an American. And
Speaker 1: what's interesting is still today, you know, there's still that
Speaker 1: sense that the world is very different to the one
Speaker 1: that we used to be in, you know, the one
Speaker 1: we evolved in. And there are still questions on how
Speaker 1: does the human body actually cope with, you know, the
Speaker 1: the challenges of modern life. And I think it's going
Speaker 1: to be a pretty perennial thing.
Speaker 3: It's something we're going to be seeing forever.
Speaker 1: Is this question of when there are changes in society,
Speaker 1: how does it affect us? You know, how is it
Speaker 1: you know, we have lights until late in the night.
Speaker 1: How does that affect our biological rhythms? You know, we
Speaker 1: look at digital technology. How is it that when we
Speaker 1: can communicate with one another out a whim? How does
Speaker 1: that affect us? You know, does that explain this growth
Speaker 1: in depression and anxiety we've seen over you? So we're
Speaker 1: still asking these questions a good two centuries after we started.
Speaker 3: Looking at it.
Speaker 4: And in your book, do you mention being left handed
Speaker 4: and how that was once perceived because you tell us
Speaker 4: a bit about that too.
Speaker 3: Yeah.
Speaker 1: Well, I mean it was kind of again at first
Speaker 1: to sin and then a disorder, and the subtle ways
Speaker 1: that we deal with the difference at first might seem
Speaker 1: again quite a positive, benevolent thing. We stop saying you're
Speaker 1: responsible for your hand, we start saying it's not your fault.
Speaker 1: But that empathy doesn't really change much. We would still
Speaker 1: have people throughout, you know, in living memory, we can
Speaker 1: still find people who grew up in an environment where
Speaker 1: they were left handed, and they'd have an authority, a teacher,
Speaker 1: a parent, even a doctor who would subject them to
Speaker 1: really what amounts of torture in the end, you know,
Speaker 1: with physical pain or psychological trauma and an effort to
Speaker 1: get them to change to the other, to their right hand.
Speaker 1: So against of saying it's a variation, we can live
Speaker 1: with this variation, there is a judgment of morality. There's
Speaker 1: this judgment of wrongness that kind of says, you know,
Speaker 1: this is not meeting a standard. We like, how do
Speaker 1: we change that in some way without ever really stopping
Speaker 1: to think, maybe being left handed really isn't a problem
Speaker 1: at all.
Speaker 2: Yeah, I'm a big fan of etymology, and I know
Speaker 2: that I used to be involved in the Society for
Speaker 2: the Creative Anachronism. So reading about heraldry and knowing that
Speaker 2: sinister means left and dexter that is right, and that
Speaker 2: the word sinister, you know, really like is tied to
Speaker 2: left handed. And this is such a a strange thing
Speaker 2: to realize how vilified people were for being different. And
Speaker 2: you know, I actually know people who went to schools
Speaker 2: where they were essentially abused for being left handed for
Speaker 2: exactly even you know, they're my age. That's not that
Speaker 2: long ago that there were was school.
Speaker 1: No, that's it. And you know it's the same all
Speaker 1: over the world. So we talk about sinister, which is
Speaker 1: you know, a Latin phrase. But you can find examples
Speaker 1: of that and cultures all over the world. So the
Speaker 1: very fact that there is a predominance in human physiology
Speaker 1: that favors the right hand all over the world, and
Speaker 1: the fact that you have fewer left handed people that
Speaker 1: seems to bring up this cultural thing to say you're different,
Speaker 1: therefore bad or wrong in some way. Ye, my left
Speaker 1: hand is weak. I can't use it, you can use yours.
Speaker 1: There must be something wrong and bad about you. And
Speaker 1: so that gives rise to this this whole sense of
Speaker 1: sin versus disease versus normality.
Speaker 3: That you know, sometimes we just need to question.
Speaker 4: It makes me think of The Simpsons. Wasn't there an episode,
Speaker 4: I think with mid Flanders who own a left hand
Speaker 4: store or something applies for some tools for the left
Speaker 4: hand left handed people?
Speaker 3: Absolutely?
Speaker 2: Yeah, Why did we lose some of these diseases that
Speaker 2: are no longer considered to be real diseases?
Speaker 3: Right?
Speaker 1: So, there's there's many reasons behind why some diseases get
Speaker 1: abandoned its concepts.
Speaker 3: You know. One thing is we we identify more things
Speaker 3: in terms.
Speaker 1: Of biology, physics, chemistry, so we make new discoveries, and
Speaker 1: those discoveries, I mean a model that we had before
Speaker 1: is no longer valid. So the whole bio mechanical biomedical
Speaker 1: model that we use these days to disease really came
Speaker 1: out of the fact that in the nineteenth century we
Speaker 1: started to discover bacteria, you know, we started to discover pathogens,
Speaker 1: and it was really really successful. So this whole discovery
Speaker 1: of this miniature microscopic world opened up new ways to
Speaker 1: treat a whole bunch of different diseases and infections and
Speaker 1: things like that. Especially once we found antibiotics, that was it.
Speaker 1: You know, we could actually make a whole lot of
Speaker 1: people feel a lot better and prevents a lot of
Speaker 1: people from dying. So that really was a scientific advance,
Speaker 1: and we went then from medical models that trusted ancient
Speaker 1: textbooks and looking at the ancient Greeks and trusting academics
Speaker 1: in times past, to start looking at a scientific approach
Speaker 1: to medicine. You look at medicine in terms of what
Speaker 1: doctors wore, and they stopped wearing clothes, you know, the
Speaker 1: upper class clothing that they would have had once and
Speaker 1: they started to be associated with with modern scientific investigation.
Speaker 1: So they started wearing lab coats. You can see in
Speaker 1: the early nineteenth century, these white coats that doctors wore
Speaker 1: simply to say I'm not just medical, I'm scientific. So
Speaker 1: we started to look more for these these physical causes.
Speaker 1: And when that changed back and forth and we started
Speaker 1: trust more the identification of something physical, that changed how
Speaker 1: we saw disease and a lot of diseases fell by
Speaker 1: the wayside. But that also set up this expectation that
Speaker 1: you need to find something physical in order for it
Speaker 1: to be a disease. If it's not organic, if you
Speaker 1: can't look at it and say that's different and broken,
Speaker 1: then we're not going to trust that you have a
Speaker 1: disease at all. So chronic fatigue syndrome is a classic example.
Speaker 1: You know, for decades you've had people say I'm suffering,
Speaker 1: you know, I don't like the way I feel, and
Speaker 1: people go, you know what, I can't find.
Speaker 3: Anything, So maybe you're just lazy.
Speaker 4: You know.
Speaker 1: If I can't find a break, it must be you.
Speaker 1: So that's one thing, is looking at the physical differences
Speaker 1: and the discoveries we've made over time. But then, of
Speaker 1: course culture has also changed, so the expectations of people
Speaker 1: have shifted over time.
Speaker 3: What we value, what we see as normal. So you know, we.
Speaker 1: Talked before about homosexuality, and I think one of the
Speaker 1: biggest things that's happened over time is having people who
Speaker 1: have variations in sexuality or in gender starting to feel
Speaker 1: like their story.
Speaker 3: Can be told.
Speaker 1: They can step up and say I feel this way,
Speaker 1: I behave this way, and it creates a dissonance in
Speaker 1: people's minds. You know, people start looking at those in
Speaker 1: their community and saying, but I like you, You're and my brother,
Speaker 1: you're my sister, you're my neighbor, and you're telling me
Speaker 1: you're different. That dissonance and means how do I resolve it?
Speaker 1: Do I continue to see you as broken or do
Speaker 1: I say, well, maybe that variation isn't so bad. So
Speaker 1: when people come out and tell their stories again, that
Speaker 1: shifts culture. What do we expect, what do we think
Speaker 1: of as good and bad? And diseases can fall by
Speaker 1: the wayside purely because you become more aware of other stories.
Speaker 1: So there's no one reason why diseases come and go.
Speaker 1: There's a lot of cultural elements that sort of affect
Speaker 1: how we define one thing as being a disease.
Speaker 4: And would you say that there's a difference between the
Speaker 4: goals of historical medicine versus the goals of modern medicine.
Speaker 3: Not really.
Speaker 1: I mean, if you really think about there's two goals
Speaker 1: really of medicine, and you can almost look at them
Speaker 1: as being a higher level society based goal and a
Speaker 1: low level personal goal. So one thing we all don't
Speaker 1: want is we don't want to suffer. We don't want
Speaker 1: to get up each day and feel worse than we
Speaker 1: think we need to. And that's a bit of a
Speaker 1: cultural thing as well. Some people sort of go, look,
Speaker 1: everyone has aches and pains, deal with it. Other people think, actually,
Speaker 1: this level of pain that I have, you know I
Speaker 1: shouldn't have to cope with it. You know, I don't
Speaker 1: have to be getting up each day and feeling the
Speaker 1: safe and pain. But you know, the bottom line is
Speaker 1: we don't want to suffer. We don't want to feel
Speaker 1: bad on a societal level. So if you are responsible
Speaker 1: for a society and divving up resources, you don't want
Speaker 1: to be spending undue amounts of resources on well being.
Speaker 1: You kind of want to share out your resources in
Speaker 1: such a way so you can ease suffering. But then
Speaker 1: you don't want to be putting too much into one
Speaker 1: basket as well, and so there is now a question
Speaker 1: that can say, well, how do I deal with health
Speaker 1: care in such a way so it provides benefits for
Speaker 1: everybody but not too much benefits. And that's what you
Speaker 1: have in governments around the world. They do it different ways,
Speaker 1: whether it's in certain capitalist societies or a socialist society,
Speaker 1: to say, how do we divvy up our resources in
Speaker 1: a fair way, because you know, we want to ease
Speaker 1: suffering to a certain extent, and that can create conflict.
Speaker 1: You'll have some parts of society that will make choices
Speaker 1: on their own. You know, if you look at anti
Speaker 1: vaccination groups, they kind of say, look, chances are my
Speaker 1: kids not going to get measles, and I don't want
Speaker 1: them to take the risk. You know, I don't want
Speaker 1: them to get a vaccination and suffer the possible downsides.
Speaker 1: I don't want them to get a fever or I
Speaker 1: don't want them to actually suffer. And chances are, in
Speaker 1: our society that doesn't have measles, they're not going to
Speaker 1: get measles, and if you don't give them a vaccination,
Speaker 1: well they're going to be fine. But then the rest
Speaker 1: of society says, well, we all need to be kind
Speaker 1: of making sacrifices on healthcare. So there's this antagonism that
Speaker 1: sort of exists between individuals and society, and that's that's
Speaker 1: been throughout history. We've always had this kind of sense
Speaker 1: to say, how do we ease suffering in the individual
Speaker 1: because I empathize with you, but how do we also
Speaker 1: make that a fair and equitable system on a social
Speaker 1: life level? And what is the tension that pulls back
Speaker 1: and forth and how we actually is suffering for everybody?
Speaker 2: Has science based medicine been effective in removing sort of
Speaker 2: cultural biases from what we consider to be diseases in
Speaker 2: your opinion, Ah.
Speaker 3: That interesting question.
Speaker 1: Not really simply with the fact that what we've done,
Speaker 1: we've shifted focus to the authority from one group into another.
Speaker 1: So there's still a group of people who will determine
Speaker 1: what is and is not a disease. And when we don't,
Speaker 1: when we're not part of that conversation, when we're not
Speaker 1: telling our stories, then there's just going to be that
Speaker 1: assumption that.
Speaker 3: This is a defined line.
Speaker 1: So for the past century or so, science based medicine
Speaker 1: has done amazing things. So that's one thing I try
Speaker 1: to stress in the book is I'm far from anti science.
Speaker 1: I'm far from anti medicine. I'm a big fan of it.
Speaker 1: It saves lives. It saved a lot of lives, and
Speaker 1: it saved a lot of suffering. It's a very powerful tool,
Speaker 1: and it's so powerful we put so much belief that
Speaker 1: there is a system of people that this authority who
Speaker 1: can say that is and that is not a disease.
Speaker 1: And what it does is stops us from kind of
Speaker 1: telling our stories. It stops us from kind of saying, well,
Speaker 1: this is what suffering means to me. And so for
Speaker 1: a long time, if you have people say well, homosexuality
Speaker 1: is a disease, and we can show that scientifically, we
Speaker 1: can show there's a gene that's different, we can show
Speaker 1: the brain is a bit different, people go, oh, yeah,
Speaker 1: they found a gene or they've found neurons connected whill
Speaker 1: they've found hormones out of place. Huh, I guess that's
Speaker 1: a disease. And that kind of slams in place that
Speaker 1: there is a clear, naturally defined line because science says
Speaker 1: so what we're not doing is saying, well, variation exists everywhere,
Speaker 1: and I want to tell my story and adding that
Speaker 1: human element back into it. So we have a discussion
Speaker 1: not just about what genes we can find or what
Speaker 1: lines we can find, but what that means in an
Speaker 1: actual human story based sense. I do think we're getting there, though.
Speaker 1: I do think science has opened up a lot in
Speaker 1: the past ten twenty years to share stories between different
Speaker 1: areas of community. This is why we need science communicator
Speaker 1: to actually share stories. We need scientists to get out
Speaker 1: there and actually understand, you know, what does this look
Speaker 1: like in a societal way?
Speaker 3: What does this look like in a personal way.
Speaker 1: So it's a lot different these days than it used
Speaker 1: to be, and I think that's a lot of what's
Speaker 1: behind this trend that is changing how we see medicine.
Speaker 1: Medicine is becoming more personalized. We're starting to see that
Speaker 1: everybody has different groups of genes, different microflora, different physiologies.
Speaker 1: And it comes down to a conversation that kind of says, well,
Speaker 1: how does your difference that we found scientifically make a
Speaker 1: difference to you? You know, what is that suffering that
Speaker 1: you actually have The big problem with All of that
Speaker 1: goes back to what I was saying before about the
Speaker 1: difference between the personal experience and social resources. Actually having
Speaker 1: those stories, sitting and talking to your GP or a
Speaker 1: medical care provider, that takes time, that takes them understanding you,
Speaker 1: that takes more than a fifteen minute consultation, that takes
Speaker 1: a long conversation to be had, and societ he doesn't
Speaker 1: really see that as a valuable way to spend resources.
Speaker 1: We seem to be almost going the other way and
Speaker 1: trying to find more ways to cut costs so individuals
Speaker 1: don't sit and share their stories with medical care providers.
Speaker 1: We've had a lot of controversy in Australia recently with
Speaker 1: a centralized database that connects together a whole lot of
Speaker 1: different medical systems, largely because in going into that there's
Speaker 1: missing the point that your medical history is also a
Speaker 1: moral history. So where most of us are quite happy
Speaker 1: and confident to sit down and say, yeah, you know
Speaker 1: what I've You know, I've had chicken poks, I had
Speaker 1: an instance earlier in life where you know, I sort
Speaker 1: of had some headaches. There are a lot of other
Speaker 1: people who said I'd an abortion when I was younger, I've.
Speaker 3: Had a drug addiction.
Speaker 1: You know, I've had a couple of STIs and that
Speaker 1: story isn't better in one place now, that personal story
Speaker 1: is important if we're to provide care, but it's also
Speaker 1: a moral history of many individuals, and treating this in
Speaker 1: that way is really important if we're to actually provide
Speaker 1: adequate care in a lot of tension in these the
Speaker 1: centralized databases that says it contains your story. How do
Speaker 1: we open that up so we provided you with the
Speaker 1: best care without actually having an insecure or a place
Speaker 1: that you can't control containing your medical history.
Speaker 3: So, you know, it's it's been interesting.
Speaker 1: Kind of looking I guess that that change over time
Speaker 1: and how we see medicine as a scientific exercise but
Speaker 1: also looking at as a personal story based exercise, an
Speaker 1: anecdotal one.
Speaker 3: In a way.
Speaker 4: Yeah, I remember receiving frantic text messages from my mother saying,
Speaker 4: Karen got to opt out of the Medicare healthcare record thing.
Speaker 4: And she can really explain why. She just said, you know,
Speaker 4: it's just not good for the government to have this
Speaker 4: kind of information. So just as a kind of default thing,
Speaker 4: I ended up opting out and opting out for my
Speaker 4: son as well. And yeah, I think there was quite
Speaker 4: a panic about it really in those last few weeks
Speaker 4: as well.
Speaker 1: Absolutely, and it's still going on because I mean, it's
Speaker 1: still something that we can out of. And in its
Speaker 1: early day, there was a question do we make this
Speaker 1: opt in or do we make it opt out? And
Speaker 1: you know, it came down to a resource question, a
Speaker 1: question of budget. You know, if you make it opt in,
Speaker 1: then you have to go out and convince people to
Speaker 1: join on board and hope to get those numbers up
Speaker 1: enough to make it equitable. Opt out means you've already
Speaker 1: got those people in there and hopefully they won't actually
Speaker 1: ask too many questions. And in the early days when
Speaker 1: they did reviews on this thing to see how equitable
Speaker 1: it would be, you know how if there would be
Speaker 1: in terms of budget, they only guessed maybe roughly one
Speaker 1: in ten people might opt out. I'm not sure currently
Speaker 1: what the numbers are at, but there's been a lot
Speaker 1: of controversy around it, a lot of insecurity over the
Speaker 1: question of privacy, and a lot of that is just
Speaker 1: simply this assumption that most people are quite happy to
Speaker 1: share their medical data with anybody. It didn't put the
Speaker 1: keys in the hand of the individual, and I think
Speaker 1: if those people who were setting up this system had
Speaker 1: have actually seen it differently and gone there are a
Speaker 1: lot of people out there who see their medical history
Speaker 1: as you know, as a moral statement. You know that
Speaker 1: that's a very personal thing. We just don't think about it,
Speaker 1: and where we do, we tend to actually think, well,
Speaker 1: people deserve that. So if there is an individual who
Speaker 1: has a history of drug abuse, well they made that choice.
Speaker 3: You know, we'll open up their history.
Speaker 1: And if they go into you imagine that you have
Speaker 1: a history of opium abuse and you go into emergency
Speaker 1: and they see that, there's going to be that question,
Speaker 1: what sort of painkillers do we give you? You know,
Speaker 1: they wouldn't do that for anybody else. So there are
Speaker 1: these questions that sort of open up on like well,
Speaker 1: who owns your medical story? On one hand, we treat
Speaker 1: it very scientifically and so that gives the keys to
Speaker 1: the authority.
Speaker 3: Well we're not doing is saying, But.
Speaker 1: It's also very personal. There is a cultural aspect to this.
Speaker 1: You might want to have the keys.
Speaker 2: Yeah, it's tricky on a lot of levels. In my
Speaker 2: day job, I'm an it guy, and so dealing with
Speaker 2: data issues, a lot of times the capabilities are there
Speaker 2: to learn a lot from this data, but not necessarily
Speaker 2: thinking through for what the the long term consequences of
Speaker 2: having that data exposed improperly will be and and it's
Speaker 2: really it's really hard to guess that, and so things
Speaker 2: like the you know, Facebook social media data breaches, we
Speaker 2: don't really I think understand. We're willing to sacrifice privacy
Speaker 2: for like short term benefits a lot of times without
Speaker 2: really thinking about what the long term consequences will be.
Speaker 2: But the flip side of that is that the power
Speaker 2: of those huge data sets of medical data might be
Speaker 2: really really useful for helping us learn a lot more
Speaker 2: about what health really is. And that's not absolute understand
Speaker 2: On the so much of health and science in general
Speaker 2: is based on statistics, which really needs a lot of data.
Speaker 3: Yeah, big data is really where it's all heading.
Speaker 1: You know, that personalized medicine I was talking about before
Speaker 1: is really coming down to, you know, getting large data
Speaker 1: sets and crunching the numbers and trying to find small
Speaker 1: variations in there, whether it comes to gene or the
Speaker 1: big futures.
Speaker 3: In microflora gut microflora.
Speaker 1: We're finding there's so many links between the species of
Speaker 1: bacteria you have in your gut and the rest of
Speaker 1: your healthy mental health is a big field that's being
Speaker 1: linked with microflora, and that requires crunching big numbers and
Speaker 1: looking at variation over a large scale and finding relationships,
Speaker 1: which means not just looking at variation, but finding links
Speaker 1: between variation and individuals. The problem with that is to
Speaker 1: find all those links, we need more and more information
Speaker 1: about you as an individual. So even though we might
Speaker 1: not use your name, we'll have all this information about
Speaker 1: you and we try to find links between them. But
Speaker 1: in the end, it doesn't matter if we have your
Speaker 1: name or not. We have you as a data set
Speaker 1: on record, and the question then becomes who can access
Speaker 1: it and do we trust them. A lot of people
Speaker 1: think about security, so you know, can somebody hack in
Speaker 1: and get it? And that is a concern, but it's
Speaker 1: also just about well, who is the authority now and
Speaker 1: who are they going to be in the future. Authorities change,
Speaker 1: and so we might all sort of think, look, I
Speaker 1: trust my g I trust the people I trust as
Speaker 1: scientists in charge. That's all well and good, but that
Speaker 1: data persists, and the next regime that comes in in
Speaker 1: twenty years, thirty years, who may have your information, Well
Speaker 1: they might not like you now, you know the things
Speaker 1: that you think of right now and go, look, I'm fine,
Speaker 1: I'm a moral, upstanding citizen. I've got nothing to hide.
Speaker 1: But they might find something that they don't like, and
Speaker 1: it's not going to be as necessarily as invasive as
Speaker 1: we're going to be sending the brown shirts around to
Speaker 1: your door and knocking.
Speaker 3: It could simply be as subtle as well.
Speaker 1: We've now found these variations we don't like, and we're
Speaker 1: going to set up a policy that means you actually
Speaker 1: suffer for that you don't get certain types of insurance.
Speaker 1: We might find certain genes in part of the population
Speaker 1: we don't like and say there's a good chance that
Speaker 1: that's going to give you cancer. But I don't have cancer. Yeah,
Speaker 1: but you've got the gene. So we're going to deny
Speaker 1: you certain types of insurance. Little things we think we
Speaker 1: have full control over now we might not in the future.
Speaker 1: That does not mean that we abandon this whole data
Speaker 1: collection exercise. It does mean the conversations we have around
Speaker 1: them need to be transparent and open, and we need
Speaker 1: to tell us stories. We need to say what we're
Speaker 1: afraid of and have people take that seriously.
Speaker 4: So I'm just wondering if there are any modern day
Speaker 4: phenomena that are now medicalized. For example, something like mental illness,
Speaker 4: which you think that one day we might look at differently,
Speaker 4: perceive differently.
Speaker 1: I think there's a lot of things we look at
Speaker 1: so that are already changing.
Speaker 3: You know. We can look at, for.
Speaker 1: Instance, autistic spectrum disorder ASD that startup as autism and
Speaker 1: then we looked at it, you know, the additional condition
Speaker 1: of aspergers, and that was brought in. Now there's an
Speaker 1: argument to take it out again. And so we're seeing
Speaker 1: this fracturing. So that variation I was talking about before
Speaker 1: is really under the microscope. Now schizophrenia may actually be
Speaker 1: a bunch of different conditions. We may need to divide
Speaker 1: them up. We're questioning whether obesity is a disease, you know,
Speaker 1: you see that headlines, so that is obesity a disease
Speaker 1: without thinking that very that that one word actually sums
Speaker 1: up could be a whole mess of different things. So
Speaker 1: we're starting to actually see a whole lot of different diseases,
Speaker 1: not as single entities this one category, but as something
Speaker 1: that's far more variable, and we're breaking them into smaller
Speaker 1: and smaller pieces. So I think the whole disease model
Speaker 1: in the next generation or so will have seen its time.
Speaker 1: That doesn't mean we don't refer to things as diseases.
Speaker 1: That doesn't mean that things we think of the diseases
Speaker 1: now won't be referred to.
Speaker 3: In a name.
Speaker 1: But I do think we're going to start seeing this
Speaker 1: whole concept of disease in a much more fractured way.
Speaker 1: There's big books I was talking about before. You know,
Speaker 1: they're not going to sustain being broken into smaller and
Speaker 1: smaller codes. As time goes on, it's going to get
Speaker 1: to the point we'll have to start thinking how do
Speaker 1: we actually look at a person's individual health and say, look,
Speaker 1: I've looked at your genes, I've asked you your story,
Speaker 1: I've looked at your microflora, I've looked at your history.
Speaker 1: And I think the fact that you've come in saying
Speaker 1: I don't feel this, or I don't feel well, I
Speaker 1: I feel as if I put on too much weight
Speaker 1: or something, I think I've got a way to help you,
Speaker 1: and at no point are we saying, hello, here is
Speaker 1: your your diagnosis. As such, it's going to become a
Speaker 1: lot more complicated, and I think that's going to suit
Speaker 1: this whole tension between individual suffering and what we do
Speaker 1: in society. I think it's going to help in the
Speaker 1: long run, but it does mean the concept of disease
Speaker 1: will have seen it to day.
Speaker 2: Well, Mike, I think this has been a really interesting conversation,
Speaker 2: and we'll put a link in our show notes to
Speaker 2: your book, and I hopefully, I think the listeners will
Speaker 2: like it. But we've really not been on topic for monsters,
Speaker 2: which is kind of what our show's theme is typically.
Speaker 2: But that's okay. But yep, we do like to ask
Speaker 2: all our guests, especially the first appearance, what is your
Speaker 2: favorite monster? And I know this will seem a little
Speaker 2: weird coming out of the rest of this.
Speaker 3: Yep.
Speaker 1: You know, I've always had a fascination with creatures out
Speaker 1: of place and time, ever since I was a little lie.
Speaker 1: In fact, I when I was little, I used to
Speaker 1: collect all books on monsters, like you know I've got,
Speaker 1: in fact, i've got my shelf still a book that
Speaker 1: I nicked from my grandparents called Into the Unknown, which is,
Speaker 1: you know, an old reader's digest book.
Speaker 3: I think that's quite common.
Speaker 1: I used to love flicking through those pages and reading
Speaker 1: stories of experiences people had, not just with you know,
Speaker 1: your traditional Bigfoot and creatures like that, but but with
Speaker 1: like dinosaurs that you know, happened to be glimpsed in
Speaker 1: the jungle, or you know, with terodactyl's just flying next
Speaker 1: to a plane and stuff. It just it seemed so
Speaker 1: ludicrous and so crazy. And yet I think there was
Speaker 1: a part of me as a kid that sort of
Speaker 1: still wanted access to something that we just don't have anymore.
Speaker 3: I wanted to see what dinosaurs really look like.
Speaker 1: And so anytime that we've sort of found a creature
Speaker 1: out of place for real, actual things like the seal
Speaker 1: of Cans for instance, I've sort of I found a
Speaker 1: real fascination with that link to something that should not
Speaker 1: exist anymore.
Speaker 4: That's good answer.
Speaker 2: Yeah, those are awesome. The the these uh, and there's
Speaker 2: so many where they overlap on that, you know Machillam
Speaker 2: of Bembay and yeahs these uh you know it with
Speaker 2: the terosaurs in the American Southwest, I I love it. Yeah,
Speaker 2: you know, but I wish they were real. But you
Speaker 2: know so far, you know, no, but.
Speaker 3: This is just that importance like, oh is that really
Speaker 3: what it looks like?
Speaker 4: Yeah?
Speaker 1: I will have about our pterodactyl enclosure some way, you know.
Speaker 2: Well, it's funny. I occasionally mentioned this, but I've been uh,
Speaker 2: you know, you go out in the wild and you run.
Speaker 2: Like for me, I my grandfather has about three hundred
Speaker 2: and sixty acres of land and so, uh he's got
Speaker 2: swamp land and you know, flat land and river bed
Speaker 2: type stuff and creek running through it, and a lot
Speaker 2: of cattle and different things. And sometimes I would go
Speaker 2: out there and see strange things. You know, you're you're
Speaker 2: on the shore of a swamp and suddenly, you know,
Speaker 2: a beaver comes up out of nowhere's prizes you. It's
Speaker 2: just it's very you know, Uh, it could be in
Speaker 2: saddling to see something that you don't expect. And I've
Speaker 2: had some really strange encounters. It turned out to be
Speaker 2: really mundane. But always lurking on there is the it's
Speaker 2: the mysterious, weird explanation that pops up first and then
Speaker 2: I have to sort of, oh, no, it's just a beaver.
Speaker 2: Oh no, it's just a muskrat or whatever, you know.
Speaker 2: But I've always you know, I'm the skeptic who's always looking.
Speaker 2: I always want to see those things.
Speaker 4: So yeah, I think we all love.
Speaker 1: The thing I love about a lot of that stuff, admittedly,
Speaker 1: is what it actually shows about human culture itself. I
Speaker 1: think that's where I've sort of you know, when I
Speaker 1: was little, I really hoped a lot of these things
Speaker 1: would exist, and then you kind of go through that
Speaker 1: period of disappointment where you're try and hard.
Speaker 3: You know.
Speaker 1: I was a big alien fan when I was a kid,
Speaker 1: and you know it was both terrified of the concept
Speaker 1: of aliens and get thrilled that one day first contact
Speaker 1: might be made and so all these UFOs and I
Speaker 1: then went through the phase where you look at the
Speaker 1: past and how the culture of what constant choose.
Speaker 3: You know, your your stereotype alien changed.
Speaker 1: You know, you go through your Nordic phase, in your
Speaker 1: robot phase, and then there's the gray phase.
Speaker 3: And I then shifted.
Speaker 1: Looking at it from a disappointment of oh, I wouldn't
Speaker 1: be you know, it's a shame these aliens don't exist,
Speaker 1: to Wow, this really shows how humans think about themselves.
Speaker 1: And so I kind of went from being fascinated in
Speaker 1: the paranormal from a.
Speaker 3: I wish it was real phase too.
Speaker 1: This really is a fascinating way to understand humanity and
Speaker 1: how we operate.
Speaker 2: Absolutely, I think we've come to the same conclusion. Yeah, yeah, Well, Mike,
Speaker 2: thank you so much for taking the time to talk
Speaker 2: to us.
Speaker 4: Everyone needs to go out and get your book. And
Speaker 4: could you recommend where is the best place to get
Speaker 4: it from because it's inaccessible in some ways.
Speaker 1: It is in Yeah, it's inaccessible in the US, and
Speaker 1: mean you could probably I think book topia dot com
Speaker 1: might have so you know you can order it otherwise.
Speaker 3: Am Yeah, most bookshops in.
Speaker 1: Australia, well we'll have copies of it still, so dimicks
Speaker 1: they stock it.
Speaker 3: I've been into a lot of independent book stores will
Speaker 3: stock it.
Speaker 1: It's easy to order in so if you're in Australia,
Speaker 1: not a problem overseas. I do know some friends in
Speaker 1: the UK and the US have had success just ordering
Speaker 1: it through booktopia dot Com.
Speaker 2: We'll put a link in that to that in the
Speaker 2: show notes. And I know that we have a lot
Speaker 2: of listeners down under, so that I'm sure they'll be
Speaker 2: able to take advantage of it.
Speaker 3: That'd be great. All right, Thank you so much, guys
Speaker 3: from finding me on.
Speaker 4: Thank you so much. It was good to hear you.
Speaker 2: All Right, we'll have a good day, we'll have good nights.
Speaker 4: Good good day for him, good night for us.
Speaker 3: Monster.
Speaker 2: You've been listening to Monster Talk, this science show about monsters.
Speaker 2: I'm Blake Smith and I'm Karen Storlsno, you've been listening
Speaker 2: to an interview with author Mike McCrae, whose new book
Speaker 2: Unwell discusses the meaning of the entire concept of disease.
Speaker 2: Mike's book is only easily available in Australia, but we
Speaker 2: have put a link to it at book Topia in
Speaker 2: our show notes at monster talk dot org, where he
Speaker 2: says you can get the book state side if you're
Speaker 2: interested after hearing this discussion. Monster Talks an official podcast
Speaker 2: of Skeptic Magazine. The views expressed here are those of
Speaker 2: myself and my guests and don't necessarily reflect the opinions
Speaker 2: of Skeptic Magazine or the Skeptic Society. We hope you've
Speaker 2: enjoyed this episode of Monster Talk. Each episode we strive
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