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0:17

I

0:18

i know about you but sometimes the

0:20

weather gives me Whiplash. It

0:22

just feels totally unpredictable. Well,

0:24

maybe not to some

0:26

people.

0:27

grandmother she would say that

0:30

she could predict weather that if it was going to be

0:32

colder or grabber her

0:34

arthritis would be more severe she would be

0:36

able to do less activities

0:38

and emphasis very clear connection for

0:40

there was no question that

0:42

doctor roberts merlin he's a former

0:44

clinical chief of the rheumatology division

0:47

at beth israel deaconess medical center

0:49

in boston

0:50

because he is the study of

0:53

rheumatic diseases which broadly

0:55

characterized or inflammatory

0:57

conditions especially once had

0:59

sec the joints the as well

1:01

as other joint diseases and other inflammatory

1:04

conditions that affect other parts the body

1:07

rob retired now and currently rights

1:09

for harvard health publishing an arm of the medical

1:12

school we reached out him

1:14

because i've been thinking lot about

1:16

this popular notion that weather

1:18

can affect joint pain as rheumatologist

1:22

robs had tons of relevant experience

1:24

with the practice spending more than thirty

1:26

years and there's and lot

1:28

to get handle on

1:30

first of all there are more than a hundred

1:32

kinds of arthritis a couple of

1:34

which you've definitely heard of well

1:37

for in away the most common causes

1:39

joint pain that we can least

1:41

leaks to disease is osteoarthritis

1:44

that's the wearing a way of the lining

1:46

the joints percent leads to

1:48

irregularities and friction discomfort

1:51

stiffness and limited motion it

1:53

, a non inflammatory conditioner

1:55

at least largely not inflammatory whereas

1:58

rheumatoid arthritis his inflammatory

2:01

and it's auto immune where

2:03

the immune system appears to be attacking

2:05

the lining of joints and causing

2:07

inflammation swelling redness

2:09

the warmth features that we don't

2:11

see as much as again osteoarthritis

2:14

the pain structures within the joints

2:16

are the same so we're talking about the

2:19

own and cartilage and tendons

2:21

and ligaments but that says

2:23

the logic changes within joint

2:25

are so different said that it does translate

2:27

to differences and symptoms so it's

2:30

important to pieces if the about one that

2:32

year thirty three

2:33

many of the existing studies

2:35

of the relationship between weather and

2:38

joint pain don't however

2:40

zero in on one kind of condition

2:43

sometimes it's osteoarthritis it has it's rheumatoid arthritis

2:45

sometimes it's a blanket term

2:47

called must feel skeletal pain

2:50

which can include tendinitis bursitis

2:53

injuries of various sorts back pain

2:55

so it really is important is

2:57

think to think try to separate them out

3:01

according to the cdc and twenty thirteen

3:04

the total medical costs and earnings

3:06

losses in the us that were

3:08

attributable to some kind of arthritis

3:11

or three hundred and three billion

3:13

dollars or one percent of

3:15

the us gdp the weather

3:18

is contributing to those cause it

3:20

sure would be great to know it's

3:23

, very hard to study given all

3:25

variables there's either no connection

3:27

or we have a cracked the case case

3:29

the freakonomics radio network services

3:31

economics empty i baku

3:34

jenna i'm economist and i'm

3:36

also economist and doctor each episode

3:38

i dissect an interesting question at

3:40

the sweet spot between health and economics

3:43

today i'm betting most

3:45

of you know someone who complains about

3:47

joint pain during bad weather

3:50

people , been drawing links between the two

3:53

for a long time time

3:55

many hundreds of years old is probably

3:57

thousands of years old in fact

3:59

that

4:00

around four hundred bc a pocket

4:02

is the greek physician noted

4:04

the effect of whether on chronic illness

4:07

just , robs berlingske grandma i

4:09

was little kid i think first time ever that

4:12

that joints and joints

4:14

a lot of people believe it's people thing

4:17

but is it true and

4:19

if it's not why do so many

4:21

people still sick

4:40

some things are really hard to

4:42

figure out and this is one them not

4:44

that there have been plenty of studies out there

4:46

in last several decades none

4:49

of them is truly conclusive some

4:51

suggest that weather affects the joints others

4:54

don't that from those studies

4:56

what we do know the weather

4:59

seems to affect our perception

5:01

of pain when the weather is quote

5:03

unquote bear what

5:05

is bad weather mean exactly there

5:08

are lot of overlapping elements

5:10

right so when patient tells

5:12

me that they feel worse and

5:14

certain weather conditions sometimes

5:16

, say it's damp or

5:18

cold weather weather it's

5:20

temperature sometimes it's humidity sometimes

5:24

humidity is changes in weather barometric

5:26

pressure is a big one patients honestly

5:29

know that accept by watching the

5:31

weather reports so studies

5:33

have looked at all these things and other factors

5:35

as well wind gusts

5:38

average wind speeds variables

5:40

that i hadn't even thought about as being relevant

5:42

to joint pain there's some small

5:44

studies showing some effects

5:46

that positives there's two thousand

5:48

seven study from tough were

5:50

increase barometric pressure and lower temperature

5:53

seem to correlate with osteoarthritis

5:56

of the knee pain but

5:59

then there's kind of our literature review from

6:01

twenty twenty from the uk and

6:03

they concluded that we really

6:05

don't have a handle on this

6:07

the twenty fifteen steady from the netherlands

6:10

used data from eight hundred and ten people

6:12

with osteoarthritis and concluded

6:14

quote the causal relationship

6:17

exists between joint pain and

6:19

whether variables the associations

6:21

between day to day weather changes

6:23

and pain do not confirm

6:26

causes though they

6:28

thought that there might be a connection

6:30

seasonally the not between wednesday

6:32

and friday of the same week few

6:35

years ago i got interested in this very

6:37

same question the wondered

6:39

whether a big data approach might

6:42

have something useful though

6:44

my coauthors and i studied medicare

6:46

claims from over eleven

6:48

million office visits then

6:50

we lined up those doctors visits with information

6:53

from weather stations near doctors'

6:55

offices information covering

6:57

the seven days leading up to the

6:59

patience visits the look

7:01

to see whether doctors were more likely

7:04

to report diagnoses of joint

7:06

pain on rainy days compared

7:09

with non rainy days or

7:11

during really rainy weeks vs

7:14

not so rainy weeks then we

7:16

made these comparisons with sin the same

7:18

area since places like seattle

7:20

are clearly different in places

7:22

like miami rob wasn't

7:24

involved with the research but he heard

7:26

about it

7:27

over at one point five million patients and

7:29

over eleven million

7:32

outpatient visits or me that's

7:34

some major data looking

7:36

at rainy days and on rainy days and

7:38

back pain and actually found

7:41

very slight increase in fact pain on

7:43

a non rainy days

7:46

it's true we didn't find that

7:48

doctors were more likely to bill for

7:50

joint pain on rainy days

7:53

but that doesn't mean patients didn't

7:55

have more joint pain on rainy days

7:58

for example my study only your

8:00

cases in which patients saw

8:02

a doctor and that leaves

8:04

out a lot of people if you call your

8:06

doctor with back pain you might see them

8:08

in few days my seen the same day or

8:10

you might see him in two weeks when your

8:12

appointment coming up anyway

8:14

we thought about that in reasoned

8:17

that if joint pain really was

8:19

affected by the weather

8:20

people who'd scheduled visit with your doctor

8:23

weeks or months ago might still

8:25

complain of joint pain on that

8:27

day if it was raining outside in

8:30

that the doctors about recorded but

8:33

doctors didn't seem to which to us

8:35

suggested that if paces the have

8:37

more pain on rainy days it

8:39

didn't rise to high enough level

8:41

to get a doctor's attention

8:43

wait give us some time and cc

8:45

gets better that is sort of for

8:48

better or worse the state the art with

8:50

respect to this question

8:52

so what could be going on here why

8:54

do so many people still believe

8:57

here's a link between joint pain and

8:59

bad weather the even when

9:01

it's been hard to actually show

9:04

start by looking at the most frequent

9:06

complaints from robs patience

9:08

in terms of whether the most common thing i was

9:10

here is damping cold i

9:13

was here that over and over from

9:15

patients all right damn

9:18

how would higher humidity effect

9:20

say your knees when in has

9:23

osteoarthritis which is the most common

9:25

joint ailment how would that work

9:27

the right question and i don't

9:29

have already explanation i have read

9:31

about the this concept of the

9:33

microclimate around

9:36

, skin that surrounds the joint

9:38

and that if it's more humid and

9:41

the so called vapor pressure

9:43

from sweat sweat glands

9:46

and outside humidity those

9:48

up the net vapor pressure

9:51

again whatever that is somehow

9:53

gets transmitted to the joy and causes

9:55

more paints but ah yet i don't find

9:57

very satisfying it sounds like a

10:00

as we call it a hand ways it's

10:02

really just a theory

10:04

what physiological mechanisms

10:07

could also possibly be at work

10:09

it

10:09

really comes down to pretty much

10:12

just pure speculation it's very

10:14

hard come up with anything it's

10:17

compelling are reasonable i think the

10:19

things that been posited most

10:21

commonly are perhaps

10:23

there are nerve endings are nerve fibers

10:26

within ligaments or tendons

10:28

or the joint itself let

10:30

because they are sensitive to mechanical

10:33

pressure they can some

10:35

people at least be so sensitive that they

10:37

can sense atmospheric

10:39

pressure or atmospheric changes

10:42

no evidence for that to support or refute

10:45

really but that's one theory

10:47

another theory is that it say lubrication

10:50

problem within the joint we

10:52

all have small amount of something

10:54

called snow be a fluid in

10:56

our joints

10:57

the idea is that may be this fluid

11:00

is somehow altered by cold

11:02

or humidity

11:03

or barometric pressure or fluctuations

11:06

have any of those

11:07

drivers for that but that's another theory

11:10

ethic maybe the most common one i have heard

11:13

is it it's kind of mind body psychological

11:16

collection that we know

11:19

the weather can have second our psychological

11:21

outlook and we also know

11:23

that are psychological state can alter

11:25

our perception of pain all that

11:27

sort of well accepted dogma

11:30

so if that's true then

11:32

why shouldn't the weather be able to change our perception

11:34

of pain what your doctor arthritis

11:37

or tendinitis or something else

11:39

don't forget your brain is physical

11:41

part of your body to

11:43

this is why you know when people say as at all in

11:45

your head will all hand is your

11:47

head because that's how we perceive paints

11:49

so i think if you're person living with chronic

11:51

pain when it's gonna get better or worse

11:54

whites here in first place i'm imagining

11:56

a my patient watching the weather

11:59

forecasts and says three days

12:01

it's gonna be rainy and cold i

12:03

think having this expectation

12:05

that you might feel worse in three

12:07

days then if it happens

12:09

it's understandable i

12:12

think that we're reissuing to lot people

12:14

and then also they know one day forty five

12:16

when weather clears up they can have expectation

12:18

of improving

12:22

there is some other explanations to ones

12:24

that aren't physiological

12:26

way back in nineteen eighty six the

12:28

physician donna redelmeier who's been

12:30

guest on the show and psychologist

12:33

a most diverse key

12:34

found no association between

12:37

joint pain and weather in people

12:39

that the steady but they

12:41

did fine that people do

12:43

something caught selective magic

12:46

which can lead people to proceed patterns

12:48

were non actually exist that's

12:51

one psychological explanation there

12:53

others i have belief

12:56

that there is

12:57

the correlation or connection between

12:59

the weather and joint pain then

13:01

and it had him high notes stake

13:03

in that hypothesis that

13:05

carry more which is a social psychologist

13:08

and professor of marketing at the question

13:10

school of business at boston university

13:13

my research broad these studies that causes

13:16

consequences and how to mitigate

13:18

cognitive biases

13:20

what

13:20

the cognitive bias basically

13:22

it's tendency to process certain

13:25

information in consistently

13:27

wrong way the cognitive bias

13:29

is

13:31

the kind of systematic error

13:33

that results from the either

13:35

some kind of way that we perceive

13:37

the world or some kind of way

13:39

that we process information

13:41

is there a cognitive bias that might

13:43

explain why people perceive a relationship

13:46

between joint pain and bad weather

13:48

the

13:49

one at leaps the minors confirmation bias

13:51

if we're just looking for things that confirm

13:53

our beliefs and did confirm their alternatives

13:57

though if it's raining and i feel joint

13:59

pain the the

14:01

relationship between joint

14:03

pain and the weather but i'm

14:05

not necessarily attending to joint

14:07

pain when it's sunny dry

14:10

laura i'm not paying attention to the absence

14:12

of joint pain when it's raining

14:14

in in what context or we most likely

14:17

to find confirmation bias driving

14:19

this well they don't call it the echo

14:21

chamber for nothing the

14:23

internet is another way that people

14:26

are biased in there casting

14:28

of these kinds of hypotheses because there's

14:30

so much information out there now and

14:32

in general people find the

14:34

stories and anecdotes to be much more

14:36

compelling than they do data and

14:38

so when they're searching and

14:40

sifting through this evidence to try to explain

14:42

their joint pain story that are

14:45

going to resonate with the hypothesis

14:47

that they start with the

14:49

ring more true or see more credible

14:51

to them as well what if the

14:53

connection is not actually true

14:55

that

14:56

they're still be benefit to believing

14:58

that the weather makes your joints hurt

15:00

that's

15:01

really fascinating question and there is

15:03

some work in this area and

15:05

would that work suggests that lot

15:08

of the kinds of emotional responses

15:10

that we have both positive and negative

15:12

or heightened by uncertainty

15:15

like the uncertainty of chronic

15:17

pain condition that just comes

15:19

and goes the know kind of cases

15:21

that uncertain seeking how

15:23

long those kinds of negative states

15:26

and people will the

15:28

open kind of comfort for having an explanation

15:31

or having some kind of reason or

15:33

ending the uncertainty

15:37

in other words assigning blame

15:39

to the weather for joint pain

15:41

can give some people a sense

15:43

control over what is really

15:45

an uncontrollable often

15:47

unpredictable symptom coming

15:50

up the relationship between weather

15:52

and joint pain is just the tip

15:54

of the iceberg when it comes to widely

15:57

held but hard to prove police

15:59

and

16:00

it based on as much older cultural

16:03

understanding of medicine that has died out and

16:05

westboro hundred three hundred forty years

16:08

i am babu jenna industry economics

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18:35

now before the break we explored

18:37

the widely held belief that weather

18:40

affects joint pain

18:41

but there are so many other beliefs

18:44

and medicine that just like that the

18:46

be true that not lot

18:48

of good evidence one way or the other

18:51

then i wondered how these sorts of beliefs

18:53

comes to be the

18:55

atom thank you for takumi today

18:57

i realize that we're the same tab another we've

18:59

ever met in person for

19:01

no we haven't is as we literally

19:03

probably work what like a tenth of mile from

19:05

each other adam rodman is just

19:07

the guy we need my name's adam

19:09

rodman i am general internist so

19:12

i'm i'm practicing clinician i work in both

19:14

the inpatient anyhow patience and that

19:16

israel deaconess ah and i'm a huge nerd

19:18

i was i'm a historian

19:21

of of diagnosis and medical epistemology

19:23

and i run podcast or with the

19:25

american culture physicians lead to be little bit about

19:27

it it's called bedside rounds and whole

19:29

idea is it say i'm a historical

19:31

exploration of how modern medicine came

19:34

to be like what does it mean be

19:36

evident space and this is like particularly

19:38

obsession with me just wouldn't start to really

19:40

dig down definite this the maltese we

19:42

know things as positions in different ways

19:45

so courageous define when you say

19:47

epistemology would you me yeah

19:49

so piss demolish he is how

19:51

we know things so a

19:53

classic epistemology might be experimentation

19:56

right you know things by running experiments

19:58

for a new enemies controlled trials for you

20:00

look by compiling bunch of

20:02

data together and looking for patterns i'd

20:04

might be personal experience personal that's what i

20:06

mean by different epistemology different epistemology just means different

20:08

ways of knowing the you you've

20:11

probably heard this relationship between joint

20:13

pain and rain and

20:15

cold weather that people describe have you thought about

20:17

this issue you know what's sense of it oh

20:19

so that's this is assassinate him when says

20:21

this association read as many hundreds of

20:23

years old i'd probably thousands

20:25

of years old it's based on this like much

20:27

older cultural understanding

20:29

of medicine that has died out in western

20:31

one hundred thirty hundred forty years let's call

20:33

it a traditional western no solid eats

20:36

the whole idea is that all health is based

20:38

on the balances the for fundamental body

20:40

humours which acts yellow bile block

20:42

bile slam and blood

20:46

okay let's slow down a second i'll explain

20:48

what adam just said because it feels like

20:50

something out game of thrones these

20:52

, so called humours of

20:54

body or yellow bio black

20:57

bio slam and blood a

20:59

long time ago human health was

21:01

thought to depend on the balance

21:03

of these humours to prevent disease

21:06

this disease the dominant medical

21:08

id at really let's say to

21:10

the eighteenth century an elite circles and

21:12

what's crazy is it at last until the early twentieth

21:14

century and in some may areas

21:17

in united states

21:18

this humor isn't as strange

21:20

as it may sound to us today with at least

21:22

a naturalistic theory based

21:24

on physical concepts these

21:27

are not supernatural body fluids even though

21:29

i'm not one hundred percent sure what yellow beyeler

21:31

black beyeler but

21:34

like what imbalances what imbalances of the big answers

21:36

as the environment trade so it's a really

21:38

really old idea that our joint pain might

21:40

act up because of shifts in humor

21:42

that's caused by shifts and weather and

21:44

that's why think it's such a fascinating idea because

21:47

we've somehow seeing this spoke belief

21:49

that has been transferred probably

21:51

millennia that people still believe

21:53

today still obviously the a person logic framing

21:55

with no one believes the humorous anymore but we

21:57

still have the police so i would have

21:59

the square

22:00

what you're saying and break it in two way so

22:02

there's a perceived relationship

22:04

between the way or body

22:06

feels would say it's joint pain in

22:09

, weather and it could

22:11

either be a true

22:13

relationship like with is literally something about

22:15

the weather that influence the joints

22:17

or could be perceived relationships

22:19

and it makes wonder like are there situations

22:22

where their old wives' tales that

22:24

are actually true that are causal

22:26

you know people say that you're more likely get

22:28

sick when it's cold outside obviously there's lot

22:31

of reasons why that might be true if

22:33

you're just rattle off couple of explanations

22:35

of why that might be the case what comes

22:37

to mind

22:38

this is your classic old wives' tale had put

22:40

on your code you'll get cold and i think

22:42

most of us who you

22:45

know use the framing of germ theory are like that's

22:47

ridiculous it is caused by a virus but

22:49

let's say from a merchant

22:51

in like eighteenth century a london

22:53

right they would have had no idea of

22:55

obviously the at know the of germ theory or god forbid

22:57

burriss probably never heard contagious

23:00

but they would still see this observation

23:02

and they would fit it into their explanatory models

23:05

that diseases caused by changes in the weather

23:07

so imbalances or humorous that's gotta be what's going

23:09

on you can see how some of these ideas

23:11

are formed and processed into the modern day now

23:13

i'm just thinking about like all the things over the last

23:15

couple of weeks at him by the way most physically

23:17

here for my mom ah vitamin

23:20

c and cold so you know when you go that the

23:22

cbs or walk is whatever they like this whole

23:25

they'll

23:26

the things designed

23:28

to improve cold symptoms oh

23:30

that's the i do they work on

23:33

why me know the only thing

23:35

only thing think does seem to shorten cold

23:37

symptoms to me the more in his classes why

23:39

are people convinced that vitamin c does work

23:41

yeah why are they well

23:43

as and gives a couple reasons vitamin c

23:45

actually it is a so dilatory the you can seal

23:47

taking high doses of vitamin c it's your

23:50

flesh little bit so people feel this is what

23:52

exactly some it works more so think

23:54

vitamin c has that i the want

23:56

to call exactly the thought the right word but it has this

23:58

like i'm cool factor to it

24:00

yeah that's what sees that for five inflicted

24:02

see one it's funny because it's a super

24:04

like if you have scurvy mean literally

24:07

vitamin c as a score big asset it's anti

24:09

scurvy acid the great treatment

24:11

for that

24:15

call that perfect therapy for

24:17

any sort of treatment because they get better on their own

24:19

the up as thick as it's really important so

24:22

know how we think of by the disease that

24:24

is gonna get better on it's own

24:27

much of time it

24:29

, itself to the situation where we

24:31

were described the improvement the

24:33

something else else could be anything

24:35

literally anything , methodologically

24:37

this is why you need a control group is you actually

24:39

can't tell whether not

24:41

the improvement that you observe is because then

24:43

intervention or something else

24:45

we like to attribute the things that we

24:47

do was having an effect and

24:50

it happens all the time both in my impatient

24:52

and outpatient practice often with herbal

24:54

medicines are traditional medicine which you worry

24:57

for example in a patient has cancer if they

24:59

are seeking out alternative

25:01

like herbal treatments instead

25:04

of seeking like appropriate cancer chairs

25:06

and i mean i understand read i if

25:08

anything being a historian gives you good

25:10

insight into why people believe that the things

25:12

that they do so my own personal approach is to try

25:14

to be very understanding of what psychological

25:17

war those therapies might be playing

25:19

i've definitely seen harm from these beliefs

25:22

and it's challenging right because people the

25:25

you know there's mistrust of the medical system

25:27

and to be clear doctors also

25:30

guilty of ah of having lot

25:32

of police desperate not necessarily

25:35

based in reality right when

25:37

was a medical student some my fellow medical

25:39

students and i'm probably guilty of this as well and

25:41

it would scoff when a

25:43

patient comes in and says you what my

25:45

normal temperature i run low so ninety

25:48

nine point nine is a fever for me a

25:50

lot of health care professionals now would roll their eyes

25:52

at this but was really interesting as

25:54

if you look at where ninety eight six as the regular

25:56

temperature come from it's from the eighteen sixties

25:58

as the birth of clinical term monetary there's

26:01

like no action said ninety eight point six

26:03

of the average human body temperature until

26:05

we are that nineteen eighties and vaccine trials

26:08

when there's like really well done studies that

26:10

pretty much definitively prove that the

26:12

average human body temperatures probably ninety seven

26:14

eight so like when

26:16

you're patient was so you turns out to be completely right

26:19

and we we dismiss that and if you actually

26:21

look at the strength of the evidence that doctors

26:23

were operating on well it's no different

26:25

than the patients insisted vitamin c makes their

26:27

called better right we're passing

26:29

down information and we are really

26:31

looking at our own beliefs you

26:34

can imagine seeing a patient

26:36

either in the hospital when

26:38

your clinic who has

26:41

the temperature reading of nine point eight

26:44

and that would not prompt

26:46

someone in the hospital to

26:48

obtain blood cultures or to get chest

26:50

x ray rice to evaluate for

26:52

cause of that seaver at it it doesn't

26:54

matter frau comes there's great analysis

26:57

dine of outpatients hundreds

26:59

of thousands of data point that mgh that

27:01

looked at fever and predictive things

27:03

for fever and variation from that person

27:06

baselines is what matters and has real

27:08

outcomes

27:09

in other words if your baseline temperature

27:11

is ninety seven degrees than arrays

27:14

temperature of one hundred degrees will

27:16

have a bigger effect on your house that on

27:18

someone who's baseline temperature is

27:20

higher they be around ninety

27:22

eight point six

27:24

going back to this question about the joint pain

27:27

and rainy days and cool weather then

27:29

you can articulate why

27:31

there could be a causal link

27:33

well i can imagine right i mean if you look at the

27:35

bursa in her joints they are fluid filled sax

27:37

cie you could imagine situation where the atmosphere

27:40

pressure changes that are associated with weather changes

27:42

causes swelling changes

27:44

in those who had felt that there is i

27:46

think there is it reasonable a

27:48

piss them logical model by like fuzzy logic

27:51

standpoint of of how that would happen

27:53

so i don't think it's crazy to think

27:55

that would that be your hypothesis

27:57

as well so think this right to things that

27:59

could happen one it's sort of

28:01

something mechanical with the actual joint

28:03

and to is how the mind perceives

28:06

any given level of symptoms mean that you know

28:08

on a on rainy day you're going to perceive the world

28:11

differently than you are on a sunny

28:13

day your aches and pains might

28:15

be more noticeable to yeah that's great i didn't even

28:17

and

28:19

accutane it lingers gets you

28:21

thinking all kinds of catastrophic

28:23

things are going on again rheumatologist

28:26

rob swirling this happened

28:28

with me just , week

28:31

i had had back pain

28:33

and of it's pretty sure it's from have been very heavy

28:35

plants but after it did get better in few

28:37

a i served to imagine

28:40

all kinds of all scenarios a

28:42

yellow little a little information from you can

28:44

can be about that i went a bad

28:46

place and then next a better soaps

28:49

eating at learn from previous experience

28:51

but everybody does this he knows how

28:54

to talk to his patients about their out

28:56

doubt brush it off and say well there's

28:58

no good science on this therefore it's not happening

29:01

if someone says the pain i

29:04

believe they're having thing i hear it too often

29:07

the discount and when i say usually

29:09

is that we just haven't figured this out yet

29:14

medicine is complicated it's

29:17

easy to forget how much we don't know

29:19

when we're surrounded by how much we do

29:21

know that , which

29:23

is so different today than

29:26

it was fifty years ago as obviously

29:28

made a lot of things possible but

29:30

it's also probably made us more skeptical

29:33

things that we don't understand

29:36

things that we can't measure with blood

29:38

test or see with an image from city

29:40

skin or m or i

29:43

i actually don't know whether our

29:45

joints are affected by the weather or

29:48

if it's something that many people perceive

29:51

to , the best available data don't

29:53

suggest clearly and there

29:55

are good explanations for why people

29:57

may proceed the patterns said they

29:59

do

30:00

not just with whether in joint pain

30:02

but with lots of medical folklore that

30:05

is always worth being cautious

30:08

which is why i went to end with robs

30:10

merlin sh ,

30:12

good dose of humility is an order

30:15

when you don't really understand

30:17

something as well as you would like like

30:19

always been skeptical and does

30:21

a person who says show me the evidence

30:24

but once you realize we

30:26

don't have the perfect evidence to make perfect evidence

30:29

i think we're all serve best to

30:31

keep an open mind

30:34

there

30:35

you have it that's it for today show thanks

30:37

to rob swirling adam rodman in

30:39

theory more which by the way if

30:41

you wanna try to devise is self checkout

30:44

a video on show page as freakonomics

30:46

tactile it's , on some

30:48

series research also

30:51

if you enjoyed this episode you may

30:53

like an earlier one followed his

30:55

the placebo effect for real

30:58

coming up next week doctors and

31:00

training don't work as many

31:02

hours as they used to we show

31:04

that the shorter duration says results

31:06

and reduction in medical

31:08

errors

31:10

though those the good side

31:12

the study for there is some unintended

31:14

consequences work ,

31:16

hours means an increase in something

31:18

else handoffs poorly

31:21

done hand off resulted in more

31:23

errors and adverse events

31:25

the talk about what it means for patients when

31:27

a doctor's shift ends in the hospital

31:30

and also the challenges of another

31:32

sign of transition sixteen nuggets

31:35

air is that many

31:37

pieces i softened say this

31:39

value having value relationship with their

31:41

has has that's all

31:43

coming up on the next episode freakonomics

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forget was gonna say i have that effect on people

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