SGU Episode 1035

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SGU Episode 1035
May 10th 2025
"Stunning microscopic view of a sperm cell surrounded by nutrient-rich particles."
SGU 1034                      SGU 1036
Skeptical Rogues
S: Steven Novella
B: Bob Novella
C: Cara Santa Maria
J: Jay Novella
E: Evan Bernstein
Quote of the Week
“Sit down before fact as a little child, be prepared to give up every preconceived notion, follow humbly wherever and to whatever abysses nature leads, or you shall learn nothing”
T H Huxley
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Show Notes
SGU Forum

Intro

Voice-over: You're listening to the Skeptics' Guide to the Universe, your escape to reality.

S: Hello and welcome to the Skeptics' Guide to the Universe. Today is Wednesday, May 7^th, 2025, and this is your host, Steven Novella. Joining me this week are Bob Novella...

B: Hey, everybody!

S: Cara Santa Maria...

C: Howdy.

S: Jay Novella...

J: Hey guys.

S: ...and Evan Bernstein.

E: Good evening everyone.

S: Cara, welcome back. How was your trip?

C: It was amazing. I was gone for a month. Did you guys notice?

E: Yes.

S: We did. What was the most amazing thing?

E: Yes.

C: Oh, I can't pick the most amazing thing.

E: One of the most amazing things.

B: Well, then what's the least amazing thing?

E: Yeah, right.

C: I mean, for me, it's China. It's not my favorite country to visit, I'm going to be honest. I do love that I went and saw giant pandas at a breeding center. That was kind of cool. And red pandas, like right up close and personal. They're sort of just out in the reserve, but then they'll cross in front of you over little bridges and things. And red pandas are just the cutest. They're my absolute favorite.

S: Yeah, they are cute.

C: So yeah, that was pretty fun. But China on the whole is a little bit difficult. It's a closed country. And so it just feels different. You can't access things on the internet. Using money there is very difficult. I think I was really excited about Vietnam. I had never been there. So I went to Hong Kong for two weeks, mainland China up in the Chengdu in the Sichuan region. And I had really good hot pot, spilled it in my lap, got a horrific second degree burn.

E: Oh, no.

B: Second.

J: Cara it's a really good thing you don't have balls.

E: Did it come with a warning that it was hot?

C: I mean, I knew it was hot. The bowl was like flower shaped. And so when I put the soup in the bowl, it just like splashed right over the side.

B: Oh.

C: Yeah, it was brutal. So that put a little bit of a damper on the trip. But then I spent a week in central Vietnam. I happened to be there during reunification day.

S: Yeah.

C: Yeah. That's April 30th.

E: 50 years, right?

C: I know, the 50th anniversary of that.

E: Wow.

C: So it was kind of a really big deal while I was there. I was interested and surprised. And A, everybody's very, very warm towards Americans. I didn't feel any sort of hostility.

B: Really?

C: And I was in central Vietnam. I was near Da Nang hanging out in Hoi An, hanging out in Hue in a small town called Leng Co. This was the front lines in central Vietnam.

E: Yes. Yeah.

C: And so, yeah, I was like pleasantly surprised that when I asked people, they were like, it's a big Vietnamese holiday. And I was like, oh, what is it? And they were like, it's kind of like our independence day. But they didn't say like from you.

S: Yeah.

C: So it was really interesting. There were obviously Vietnamese flags everywhere. The hotels were really bumping with a lot of partying and stuff. There was a weird experience where they closed the main road to scooters. And I was there with a friend who lives in Asia and is very comfortable on a scooter. So that's how we rode around the whole time. I was on the back of a scooter. And we had to take a mountain pass to be able to get to different cities, which doubled our length of time. At the top of this one mountain is basically like a military fort, like a post from Vietnam that's now sort of a museum. And there were people doing tours there. And they were doing tours in American Jeeps. Like it was really kitschy. You know, there's a lot of this kind of propaganda posters and a lot of kitsch around Vietnam. But I thought it was really strange that there were Vietnamese folks running Vietnamese tours using American military vehicles with all of the like imagery that goes along with it. So it's interesting, you know, knowing that there are people alive right now, plenty of people, who fought in this war, who lost their lives, who lost limbs, who lost their mental health, who got diseases from the horrific chemicals that were used during this war. But also there are people, so many people alive right now to whom this was, it's history in a history book.

E: Right.

C: You know, I wasn't alive during this. I was born very soon after. But to me, you know, it's...

E: Bob was born on the 4th of July.

S: That's true. Cara, I just want to point out just because that you said there are people alive today who lost their lives in the Vietnam War.

C: Oh, I did.

B: Oh, that's awesome. Write that down.

C: That doesn't make a lot of sense, does it? You know what I mean.

S: I do know what you mean. But technically, that's what you said.

C: I am glad you did point that out. There are people, okay, you're right. There are people alive today who are deeply affected and who lost loved ones in the Vietnam War.

S: Yes.

C: Yes. So it is, I don't know, it's an interesting thing, history and living through history and not having lived through history. And how quickly things can change. Like while I was there, I felt not only so incredibly safe but really welcome. I actually loved Vietnam so much that I've added it to my list of, there are about four countries that I would like to live in if I leave the U.S. And I've added it to my list because I enjoyed it that much. But to think about how unstable it was not that long ago. I mean, and of course, all of the, whatever, we won't get into the politics of it. But how difficult the relationship was and all of the mistakes that, I don't want to call them mistakes, the very bad things that the U.S. did to that country.

S: Bad choices. Bad choices.

C: Yeah. Yeah.

S: When we were younger, because you think, I was born in 64. So essentially, the Vietnam War was the first 10 years of my life. And in our family, in our household, it was just the war. Right? And so I always just heard reference to the war. I thought there was one war. You know what I mean? Like in my mind, in my childhood, like five, six-year-old mind, there was just this one war.

C: Yeah. Like the world was at war out there. And yeah, that's always been going on.

S: And like there's only this one war.

C: That's very 1984.

S: When the war ended. It's like, oh, the war ended. There's no more war. You know?

E: That's that. We'll never see that again.

C: I went into this one shop that I really, really liked where they had a lot of propaganda and young artists reimagining things. And they sold a lot of t-shirts that had pretty provocative statements about communism or about these different inflection points. But one of the shirts that I really, really loved, it said, Vietnam, it's a country, not a war.

S: Yeah.

C: Because so many people only relate to an entire culture of people because of the war in Vietnam. But yes, when I hear the word Vietnam, I think of the country.

S: Yeah.

C: I would like to see that change.

S: But that's an artifact of media as well. Like if every time you're seeing Vietnam or people speaking Vietnamese, whatever, it's in the context of the Vietnam War, that's what you associate it with. I told you guys like when I went to Vienna and I heard people speaking German there, I realized that, oh, holy shit, every single time, pretty much in my life, I hear somebody speaking German, they're a Nazi in a movie. And so like that association was so strong. I didn't even realize it.

C: Yeah.

S: You know?

C: And it's so dangerous, you know? I think about just this idea that there's a whole beautiful culture, a whole interesting people, and propaganda did that, right? Like it was all propaganda. And when you see Vietnamese propaganda, that to me was some of the most fascinating, is seeing all this Vietnamese propaganda, you know, that people sell posters. I actually bought some of the posters. I think they're really interesting. And seeing that and thinking, oh, my goodness, look at all of this. And then going, we have the same thing. Like every time there's a war, it's one side making all these claims about how they're superior and that other group is evil. And then it's the other side doing the same thing.

E: True of everyone.

C: It's fascinating.

S: Yeah. And that's why it's so good to visit other cultures and get different perspectives and be cosmopolitan, right? You're not trapped in this very narrow perspective.

C: Oh, absolutely. And just to be lucky enough to be there on this really important day and to talk to some of the people about it. But yeah, I had a great time. Oh, and I have news. While I was gone, guess what happened? Breaking news. It was only a few days ago, actually. The Board of Psychology issued me my license.

B: Oh, nice.

S: Congratulations.

C: Thank you. I am now a licensed psychologist and do not have to practice under supervision anymore. Hooray.

S: Awesome. All right.

Quickie with Bob: Nuclear Fusion Rocket (08:19)

• Pulsar Fusion unveils nuclear fusion rocket concept for space travel - World Nuclear News 

S: Bob, you're going to start us off with a quickie. What's this about a nuclear fusion rocket? What?

E: What? No way.

B: Well, yeah, I mean, they're working on it. They're working on it. They don't have it, obviously.

E: It's not ready yet.

B: But I like some of their ideas. So this is, yes, fusion rockets in the news. This is Pulsar Fusion. It's a UK-based aerospace startup. It's founded by entrepreneur Richard Dynan. And they released some plans relatively recently. And I was quite intrigued. So they see nuclear fission rockets as a big thing. They do say that. But big in the midterm. And I've been waiting decades for that damn midterm. And it's not happened yet. But apparently it's coming. They say that if you want to move a lot of equipment to Mars and through deep space, rocket exhaust speeds become even more critical, obviously. And they call fusion the king of propulsion, which I can't disagree with. So they envision – it's interesting. They envision fusion space tugs in orbit, multiple space tugs waiting in orbit to attach to rockets that launch from the Earth and approach them and they will dock to the side of the rocket. And, of course, that would have to be built in a way that they can actually dock and then be used as fusion propulsion to speed them on their way wherever they happen to be going. So that's kind of a different interesting idea. And it makes a lot of sense because you can't launch fusion rockets from the surface of the Earth. So you'd have to kind of do it once you're out into space. So that's an interesting design, kind of creative. I hadn't seen that before. Now their design is magneto-inertial fusion, which we haven't talked about much. It's kind of a hybrid fusion approach.

S: It's a hybrid.

B: Yes, yes. Thank you. It uses deuterium and helium-3, and it does that by rapidly compressing a magnetized target. The plasma compression happens in repeated pulses, which creates bursts of fusion energy rather than maintaining this continuous plasma confinement as other methods. So here's some of the stats. I mean, obviously, this is not proven. This hasn't been accomplished yet, but they're working on it. They're planning on making this happen. They didn't give a timeframe of when it could be completed, just steps to get to those final prototypes or whatever. But some of their numbers are interesting. For example, going to Mars with a chemical rocket is typically seven to eight months. They said with their fusion design, it could be four months. So they cut that in half, which is pretty slick. But what really got my attention is their specific impulse measurements, which we've talked about before. It's related to the efficiency of the fuel usage. So the higher the number, which is in seconds, is the better. So chemical rockets have a specific impulse of 450. Their design, they say, is 10,000 to 15,000 seconds specific impulse. Steve, those are some damn big numbers. So that could imply that they could burn their rocket for far, far longer than a chemical rocket, depending on how the fuel is used, though. And typically, in those scenarios, there's less thrust. So there's a lot of variables to take into account. But an ISP of 10,000 to 15,000 is just like, wow, jaw-dropping. This one is even a little bit better. For Saturn, chemical rockets could take six and a half years. They say they could do it in a year with this technology once they perfect it. A year, that's a lot of years saving. And they threw a number out there of how much money it could save in U.S. dollars. They said $1.2 billion it would save.

E: So faster and less expensive?

B: Yeah, apparently.

E: Both.

B: Yeah, that's what they're saying.

S: Which makes sense because, you know, you don't have to maintain the mission for five years.

B: CEO Richard Dynamate, he made an interesting point when he said, people say doing fusion on Earth is proving to be really hard. Doing it in space must be a crazy proposition. But actually, there's a lower bar in space. Part of the problem is doing fusion in the atmosphere. And that's correct. You don't need to create a vacuum in space. It's already there. But if you're going to do this on the Earth, you're going to need that. And that's very—it's expensive. It's complex. It's a pain in the butt, especially when you need big vacuum areas in closer vacuum. The other angle here is that fusion reactors on the Earth, they're being made to make cheap, plentiful energy, right? That's the goal. You want to make as much energy as you can as cheaply as you can. And they will be able to do that once they have a nice reactor working. But for fusion rockets, though, it's a different deal. You don't need to be efficient. You don't need it to be cheap. If you make it work, that's probably going to be good enough. So space-based fusion propulsion seems to have a lower bar technologically and atmospherically. And if you think about that joke for a minute, I think you're going to really like it. This has been your Lower Bar Quickie with Bob. Back to you, Steve.

S: Yeah, it's interesting to think about that because using fusion to make electricity on Earth is really hard for a lot of reasons that just don't exist in space. If you're using it just for propulsion, it doesn't have to be sustained. It could be putts, like putt, putt, putt. It doesn't have to be a sustained fusion. You don't have to convert it into electricity, right? You don't have to, again, create a vacuum. And it's actually a lot easier technologically to do that.

B: Right. But by the way, they also said that it can also be used to generate power. So they said that you can get to your destination with 2 megawatts available. Like, damn. So that's pretty slick.

S: Right. And it doesn't have to be cheaper than solar. It just has to be cheaper than chemical rockets, which are really expensive.

B: Right, right. And don't forget, the deeper you go, though, solar becomes less and less helpful. So for deep space, you got to carry your power supply, essentially.

S: I mean, Bob, what I meant was, like on Earth for power, a fusion reactor would be competing with solar power for energy, for the cost of energy.

B: Right.

S: Or with wind. But as a propulsion system, it's competing with other propulsion systems, which are all really expensive.

B: Yep. Absolutely.

S: So again, yeah, the calculus gets a lot more favorable. So yeah, we may see fusion rockets before we see fusion power.

B: I think we might. I think we might. And it's funny because we might even have the potential to create working fusion reactors on the Earth. But it's like it's just not going to be worth it. It might not be worth it for them to do it. It's like, sorry, it's just not going to be worth it. It can't compete with solar and wind and all that stuff. So that's a future we may encounter where like, holy crap, it just never happens on the – it never happens for power generation.

S: On Earth, it's great in space.

B: Because it's just not worth it. But it's a good problem to have because that means there's other cheaper alternatives, which is fine. But I want to see it in space. And as we've said in our – forget it.

S: You're breaking the law of the quickie, Bob. All right. Jay.

B: This one was on the edge.

E: The law of quickie dynamics.

News Items

Falling Space Debris (15:10)

• Scientists chased a falling spacecraft with a plane to understand satellite air pollution 

S: Speaking of space, Jay, what comes up has to come down, right?

J: Right.

E: On Earth.

J: That's a very interesting way to put it. All right. I want to start with a question because I'm constantly looking up into the night sky. You guys have seen satellites in orbit, right?

E: Yes.

S: Oh, yeah.

E: Many times.

J: Yeah. I mean basically the – other than the space station, which I was tracking for a couple of years. Whenever it was passing overhead, I was watching it.

E: It is neat to see that thing go zooming by.

J: I've seen satellites, but they're just literally a pixel of light. There's like nothing to it. However, I have never seen a satellite enter the Earth's atmosphere. Have you guys ever caught that?

S: No.

E: No.

C: I don't think so.

B: Wait. Yeah. Wait. What did I see? No, I didn't see. You're right. Not entering. No.

S: Unless something that I thought was a meteor was a satellite re-entering.

B: That's true.

E: Or pieces of something that broke-

B: Steve remember that meteor we saw it back at mom's house.

S: Yeah.

B: That was awesome. That was the best I've ever seen.

S: Yeah.

B: Broke in two and it left a trail that persisted. You could see that trail. It was mind-boggling. I loved it. Loved it.

J: So this is a news item that I stumbled on recently that I found to be really interesting, particularly because of what the future holds. So there was a – considered to be a very rare and complicated field operation that happened. European scientists actually pursued a falling satellite in a business jet. I'm assuming they mean like a Learjet. They did this to collect data on what is considered to be a little understood but potentially pretty serious environmental issue. This is essentially satellite pollution in the Earth's upper atmosphere. Specifically, when the satellite burns up and breaks apart and everything, what is it putting into the atmosphere? So on September 8th of 2024, a retired European space agency, the satellite that was retired called SALSA, S-A-L-S-A. This is one of four satellites in something called the Cluster Mission. This particular satellite reentered Earth's atmosphere over the Pacific Ocean. So they took off from Easter Island and it was a multinational research team. I guess it was getting some hype because of what they were trying to do. This was a really crazy way to gain data, right? To like fly in a commercial – in a private Learjet-style jet to go up and go super high and see the satellite come down into the Earth's atmosphere. So what they wanted to do and what they successfully did do was they were able to capture the event. They had 26 high-speed multispectral cameras and the team successfully recorded the fragmentation and the chemical signatures of this disintegrating spacecraft. Now their findings were presented in April of 2025 and that's why we're talking about this now. This was at the European Conference on Space Debris in Germany. This is all important data to collect because approximately how many satellites do you think reenter the Earth's atmosphere on a daily basis?

C: Daily?

E: Daily?

J: Daily.

E: Daily?

B: Satellites?

S: 20?

J: How many?

E: No. Oh, my gosh. Every day?

B: That seems too high.

J: Evan, I'm curious to hear what your number is.

E: If it's one, that seems high.

J: So it turns out it's on average three satellites a day.

C: Jesus.

J: Which is over – it's pretty much –

E: I would have never guessed that.

J: It's over 1,000 a year.

C: That's insane.

J: That's right now.

E: That's crazy.

J: You have 1,000 satellites reentering the Earth's atmosphere. I think that's a lot. You know what I mean?

E: Maybe – yeah. I must be woefully ignorant about the number of satellites that are up there. Is there 100,000 items up there?

J: There is a ton, Evan. Oh, my God. There is so much stuff. Now, keep in mind, we have these mega constellations that are going up now by SpaceX and then Amazon's going to do it.

E: Oh, yeah.

J: And this is going to blow out that three satellite a day number. That number is going to dramatically increase and it's going to be – it's going to happen very quickly, right? It's going to be happening within the next couple of years. We're going to start to see a lot more reentries happening.

E: Controlled reentries?

J: Well, you hope that it's controlled enough where they can dump it in the ocean. You definitely don't want any of this happening over populated areas. But they're supposed to – like there's some protocols that have been put in place where they have to meet certain criteria in order to reenter, right? Meaning that they have to have that –

C: But they're really small, right?

E: Corridors.

J: They're not as small as you think.

C: Really? I figured they'd burn up in the atmosphere. They don't?

J: Yeah. Well, that's what I thought.

C: Oh, okay.

J: So Starlink is launching thousands of these – of their Starlink satellites into orbit and these satellites, they do – technically they burn up in the atmosphere. But that process of them burning up in the atmosphere, even if they do burn up in the atmosphere, it's not like this routine thing that, oh yeah, it comes down, burns up in the atmosphere, whatever's left just hopefully gets dumped in the ocean and we never have to talk about it again. That's not what's actually happening. So when satellites incinerate, unfortunately they release metallic aerosols into the upper atmosphere which is part of the atmosphere you don't want to mess with and particularly aluminum oxide and that can damage the ozone layer and it can alter Earth's thermal balance, by reflecting solar radiation which depending on how you look at it, that could be a good thing, it could be a bad thing. So these are definitely well-known and well-established mechanisms in atmospheric chemistry and the amount of aluminum oxide released into the atmosphere during reentry is – it's a complete mystery. But now we're onto it, right? So we figured out a way to essentially find the data that we need. In this first test that they did, it was definitely – they didn't know what the results were going to be. They had no idea if they were going to even find anything. But here's what happened. I thought it was pretty cool. So they – according to Stefan Lowell at the University of Stuttgart, he said it was unexpectedly faint, meaning they didn't capture a lot of light and this – the reason is that the satellite probably fragmented into super small pieces that would emit less light, right? Because there's – even though there might be more of it, each one individually produces less light and it's not like combined together anymore, right? So the team were able to track up the breakup for about 25 seconds and then they lost sight of it as it descended down to about 25 miles in altitude. So they did collect spectral analysis of that fragmentation cloud and it revealed chemical traces of lithium, potassium, and aluminum. And these are materials that you don't want in the atmosphere. Now it's unclear how much of the vaporized material, you know, turned into an aerosol form and will it have atmospheric effects? At what volume would the material have to be at to have atmospheric effects, you know, versus how much of it, you know, turned into microscopic debris that came all the way down to the earth's surface? The titanium fuel tanks as an example from the Salsa satellite – say that three times fast. They think that those fuel tanks survived and they landed in the Pacific Ocean intact and that is definitely a plausible outcome for larger and sturdier satellites. You know, that is a concern too because that debris could be dangerous. But, you know, this is not what they're specifically studying. So getting back to Starlink and to answer Cara's question, you know, these are new satellites. They're heavier than most people think and they're larger than most people think. So what do you guys think that a Starlink, a single Starlink satellite weighs?

E: Eight tons.

C: I was going to say like one ton.

J: So they're coming in at 2,750 pounds.

E: Yeah, you're right Cara.

C: One ton.

J: Yep. Or, you know, 1,250 kilograms.

E: Kilos.

J: Now SpaceX says, yes, they burn up completely and flowers come out when they burn, right? Like there's nothing to see here. But they did acknowledge that some fragments do occasionally reach the ground when they come back in. So, you know, again, these are bigger than we thought. You know, there's a ton of them. There's going to be a ton of these reentering because they don't have an incredibly long lifespan. So they're just going to be constantly coming back down and replenishing and coming down and replenishing. So there is a few things of particular concern. So one of them is molten aluminum, right? So as the satellite disintegrates, the aluminum compounds that are in it, they melt and they can either vaporize into aluminum oxide aerosols or they can cool into nano and micrometer sized droplets. Those two eventually fall to the earth. Of course, the aerosols don't. The aerosols are the ones that pose the most risk to the ozone and to the climate. And the researchers, they just can't quantify how much aluminum takes what form yet, right? Again, because this is the initial study that's going to set off. It's the flick of the marble that's going to set off a whole bunch of studies to come. So that's the real issue. You know, we have a data gap. You know, with over, like I said, with over 1,000 reentries per year, we could potentially be injecting a large amount of these exotic materials into a very sensitive layer of our atmosphere. You know, we don't want to do that. We don't want to do anything that's going to make global warming any worse. We don't want to have any bad negative health effects. If even a small percentage of it is, you know, turned into aerosol and it's up in the upper atmosphere, there could be a cumulative impact that could rival other existing pollutants that we are very well aware of. But of course, we won't know until they do further study. So what comes next? You know, there's other cluster satellites, the Rumba, Tango, and Samba, which are part of that set that I told you about before. They're going to come down this year and next year. And unfortunately, you know, they're going to happen during daylight hours, which is not ideal, but we'll still be able to collect data on it.

S: Yeah. So whenever you do anything on that scale, you got to really track it. You know, we're putting thousands of satellites up. There's going to be thousands of satellites coming down every year. It adds up.

J: Just another little thing to worry about, team.

S: There's a lot of issues with space. You know, just the sheer amount of space debris, we've talked about this before, is becoming a huge problem.

B: Oh, yeah, man. Just waiting for the event to happen.

E: The event.

S: The cascade of satellites crashing into other satellites.

B: Yeah, Kessler syndrome.

S: All right.

What Makes People Flourish (25:46)

• What makes people flourish? A new survey of more than 200,000 people across 22 countries looks for global patterns and local differences 

S: Cara.

C: Yep.

S: What does it take to make people flourish?

C: You know why I like this story? Because it's a good news everyone.

E: Yay, good news.

C: I feel like we don't have that often enough lately.

E: Not enough.

B: I got some good news too this week, so you go first.

C: Okay. So a new study was published. Where was it published? I'm about to tell you. In Nature Mental Health, just about a week or two ago, called the Global Flourishing Study. Study profile and initial results on flourishing. And really, this is one of those large, multinational, multi-research site studies where multiple authors contributed. We're talking a longitudinal panel study of over 200,000 participants across 22 different countries that span all six populated continents. They use nationally representative sampling, and they intend to collect data for five years. And the idea here is to assess aspects of flourishing and possible determinants of flourishing. But what is flourishing? Well, I'm going to read you a quote directly from the publication. Flourishing is an expansive concept. And then there's like six different citations after just those words. And the working definition underpinning the GFS, that is the Global Flourishing Study, has been, quote, the relative attainment of a state in which all aspects of a person's life are good, including the contexts in which that person lives. So then they dive into different aspects of that definition, and they further break it down into different what they call well-being domains. So what do you think some of these different domains might be that make up how we measure or how these researchers at least have decided to measure flourishing?

S: Health.

C: OK. Yeah. They talk about physical well-being.

S: Happiness.

C: Happiness is emotional well-being.

B: Emotional, mental. Financial.

C: What's another?

S: Financial.

E: Financial.

C: Financial. Yep. And they talk about what they call material well-being, which they call financial security.

S: How about liberty, freedom?

C: Interestingly, they actually don't talk about that, but they do talk about volitional well-being, which they define as character.

E: OK.

C: So sort of their choice.

E: It's not quite the same thing.

C: And they also talk about cognitive.

E: Physical?

C: Yeah, we already did physical.

E: Oh, cognitive.

C: Yeah, they also talk about cognitive well-being, which they define—it's a little bit weird. They're well-being domains I wouldn't choose, but basically they talk about meaning. So we've got health, happiness, meaning or purpose, character, financial security, and then what do you think the last one is? We're leaving something really important out here. Do you exist in a vacuum?

B: What's that?

E: Oh, social?

S: Social?

C: Right. Yeah, relationships.

B: Yeah.

C: Yeah. And then they define each of them. So relationships, for example, is the relative attainment of a state in which all aspects of a person's social life are good.

E: Oh, my gosh.

C: So they go through, and yeah, what they want to do or what they did is they came up with basically an index of well-being across all these different domains, and they just used—basically this is a big data study, right? 200,000 people ask them a bunch of questions. Ask them all the same questions, which they do later define as both a study limitation, but also I guess a boon for the study. So I kind of want to stop there and not give you all of the results. Before we go into the result, which I can't give you all of them anyway. It would take too long. But before we go into some of the results, why do you think it's both a good thing and a bad thing that they asked all the different people in the study the exact same questions?

S: Well, you can do statistics and you can compare them.

C: Right. Yeah. It's much more feasible to do a large statistical analysis when you do a study this way. But as they define it, they did this study in an etic way, not an emic way. Do you guys know the difference between those two sociological concepts?

B: Say those two words again.

C: Etic, E-T-I-C, versus emic, E-M-I-C.

B: Oh, damn.

E: I don't know the comparison.

C: So in an etic study, what they're basically doing is they're saying, I am outside of your culture and I'm going to look inward and ask you questions and then make comments about your culture. Whereas an emic study utilizes researchers or individuals living within that culture and formulates the questions to be meaningful or contextualized within the culture. Okay.

S: Like endemic, same kind of word?

C: Maybe it's the same word. Yeah, I'm not sure, actually. Well, what's the word on that sometimes? But basically, we do see more of a movement towards emic approaches in sociology over time. When we think back to like super colonial approaches, they were all very etic. But it does, in this specific situation, allow direct comparisons. The problem is some context is probably lost and there's always going to be an implicit bias then because who defined these questions, right? And is that perspective now going to measure that more so in a culture that utilizes some of these different, these measures? We don't know. So it is important that they list that as a limitation of a study, but they also talk about why it made it really easy to compare all 200,000 participants to each other, to compare different countries, different age groups, different genders, all these different ways that you could slice and dice this demographic data. And they asked a lot of questions. They asked things like, let's see, how old are you? What's your gender? Are you married? Are you employed? Do you attend religious services? How much education do you have? What's your immigrant status? What country are you from? What was your relationship like with your mother growing up, your father growing up? What was the financial status of your family growing up? Was there abuse? You know, they asked so many different questions to try and understand what people's life is like now and what they went through throughout the lifespan to get to where they are today. And then they made a bunch of comparisons and they found some kind of interesting outcome. So let's start with what they basically define as who is flourishing and why. That's a big question that they asked. Who is flourishing and why? When it comes to age, what do you think? Who are flourishing the most across the lifespan?

S: I think generally speaking, the older you get, the more you're going to flourish.

C: That's true. But a lot of studies previously didn't show that. A lot of studies previously showed that older adults were the ones who were struggling the most. But this study shows that it's relatively flat between about 18 to 50. And then you just see a slow, steady increase in flourishing. And the highest flourishing is amongst the oldest group. In the past, studies showed a U-shaped curve where you had this dip in the middle, in middle age, but you had kind of higher earlier and older. But not this study. It just shows kind of a slow, steady increase.

S: Yeah. You get better at the whole life thing when you get older.

C: I find this one really, really interesting. They're showing that being married have higher flourishing scores across the board. So it goes married, then widowed, then domestic partner, then single, never married, then divorced, then separated. But they don't divide it by gender. And so I would be really interested to see because previous studies have shown that married men have the highest at least life satisfaction, followed by single women, followed by single men, followed by married women are at the bottom. So it would be interesting to see their flourishing scores divided not just by marital status, but also by gender. They do look at gender. And they find that gender is pretty even across the board. But there are differences from country to country. So in some countries, women flourish less than men. But across the board, when they look at all of the aggregate data, it's pretty even. 7.19 is, you know, they have this measure that they use. 7.19 for men, 7.12 for women, pretty much the same. This one might surprise you. What do you think across, and I know I didn't tell you what the 22 different countries are, but what countries do you think people are flourishing in the most?

S: I'd say high socioeconomic status countries.

C: Right. Yeah. You'd think kind of richer countries, countries with more wealth. So like the United States is on the list, and it is definitely in the bottom third.

B: That good, huh?

C: And they look at it with and without financial indicators. And across the board, the number one country was Indonesia, followed by Mexico, and then the Philippines.

B: Mexico. Excellent.

C: Yeah. And they, from their write-up in the conversation, quote, Indonesia is thriving. People there scored high in many areas, including meaning, purpose, relationships, and character. Indonesia is one of the highest scoring countries in most of the indicators in the whole study. And Mexico and the Philippines also show strong results. Even though these countries have less money than some others, people report strong family ties, spiritual lives, and community support. The lowest scores were in Japan and Turkey. And even though, for example, Japan has a strong economy, people reported lower happiness and weaker social connections. They also think maybe long work hours and stress contribute to lower flourishing scores. Turkey, obviously there they describe political and financial challenges and, you know, just difficulty with secure, like individual security. So they talk about how it's surprising that richer countries like the US and Sweden aren't actually flourishing, as well as some others. They do well on financial stability, but their scoring…

E: That doesn't translate necessarily to across-the-board flourishing.

C: No, because that was only one of the measures. They're showing lower scores in meaning, lower scores in relationships. They found that countries with higher income across the board do tend to show lower levels of meaning and purpose. And then countries with higher fertility rates often show higher ratings of meaning and purpose.

E: Mm-hmm. Okay. That seems reasonable.

C: Yeah. I mean, it's interesting when you look at these big takeaways because you can sort of predict some things and other things. It feels a little like science or fiction where you could make a case for it to go either way. Like one of the things that they talk about, and we've seen this across other studies, is that individuals who are highly involved in religious services tend to have higher ratings of flourishing. So those who go more than once a week are higher than those who go one time per week, higher than those one to three times a month, down to a few times a year, down to never. Never is on the very, very bottom. And they saw that this was the case even in secular, countries that were more secular. And so we've talked about this in the past. It doesn't really necessarily have anything to do with religion per se, but it has to do more with community. So they cite the literature in the psychology of religion where they talk about things that they call the four Bs, belonging, bonding, behaving, and believing. So belonging is social support. Bonding is spiritual connection. Behaving is cultivating character and virtue through practices and rituals and norms. And then believing, which does contribute to hope, forgiveness, spiritual convictions. So, you know, they do include the actual act of believing as something that contributes, but this is not the main sort of predictive variable here. We know that people who attend religious services tend to have more community, and that seems to carry a lot of weight there. But they also found that people who go to religious services reported more pain and suffering. And it's hard to know if that's because it's sort of a bias, right? They're going because they're experiencing more pain and suffering. That's why they're seeking out religious community or some other reason. And, of course, adverse childhood experiences do have some impact on flourishing. If you were a kid with excellent health, it's the most predictive of you flourishing later in life. If you're a kid who had a good relationship with your mom, if you went to religious services, if your family was financially comfortable, if you had a good relationship with your dad, that's less predictive. You tend to be flourishing more. If your parents were divorced, you had financial hardships, they were single, your parents died, your health was poorer, or you experienced abuse. Experiencing abuse was the most predictive of low flourishing, which makes sense. Not a lot of big wows here, but the main takeaway is that it's very, very hard to pick one variable. This is a very complex interplay of a lot of things, and it is probably very, very culture-bound. And so this massive group of researchers are excited to continue to dig through the data and to continue to ask questions, because we don't have a lot of studies on things like flourishing. We have a lot of studies on what happens when things go wrong. But it is exciting to say, okay, what are some of the reasons that people are feeling fulfilled in life and that they're doing well, and how can we learn from those reasons?

S: Yeah, and it's good to look at these big endpoint kinds of studies, like flourishing or happiness or whatever, because I do think that in life, people do a lot of things that they think will make them happy or think will make their life better, but they actually end up doing the opposite. Like working really hard to make money. They think, oh, money's going to make me happy, but you're working yourself to death and you're miserable.

E: The problem is until you do it, you don't know that.

S: Well, it's not like you don't have 8 billion other people on the planet that you could look at and you could learn from other people's life experiences. You don't have to necessarily make every mistake yourself. I know generally we do, but that's what mentors are for and parents and whatever.

C: And reading.

S: Yeah, and reading.

C: Science. Like talking to or reading what these researchers are finding. But I will be interested in more kind of culture-bound and culture-specific examples, because I think it's really easy to say, okay, this country versus that country or people who do this versus people who do that. But where are all of the moderating and mediating variables here? Like really understanding not just that these are interesting predictors, but these are how the predictors affect one another. I think it can get complicated really quickly statistically, but it could also give us a wealth of information.

S: All right. Thanks, Cara.

C: Yep.

Pig Heart Xenografts (40:52)

• Pig Heart Xenografts for Infants 

S: All right, guys, I'm going to talk to you about heart transplant.

C: Cool.

S: You know that we have a huge deficit in organs for transplant, right?

E: I imagine that's always the case.

S: So in the U.S. alone, there's generally speaking over 100,000 people on the waiting list for an organ transplant, but only about 23,000 organs become available each year, and about 6,000 people die each year while on the waiting list.

C: And that's for all organs?

S: Yeah.

C: Okay.

J: So this is in the U.S.?

S: Just the U.S.

J: Okay.

E: I'm a donor.

S: The numbers are a lot bigger in the world. Yeah, and this is a problem that could be solved if just more people become organ donors. There would definitely be a huge benefit to the health of the world if we had essentially an unlimited supply of donor organs, if the supply was greater than the demand. Like that wasn't the limiting factor.

C: Of course.

S: Yeah. So how do we get there?

C: Grow them.

E: Line them up. Take their organs.

C: Grow them.

E: Yeah, grow them.

C: Well, really, because like if you look at organ donation, I don't know. I work in a hospital, and I've worked with a lot of individuals on the heart transplant list, like with the psychology of what it means to get a new heart. I mean, it's really intense, right? And so I have noticed when I'm doing the inpatient work that there's a massive difference in the parameters and just the like rigidity between the heart transplant patients and, for example, a kidney transplant patient.

S: Yeah.

C: Because it's just easier to get a kidney.

S: It is.

C: There are more kidneys.

S: Because people can donate one kidney.

C: Yep. Like a family member can give you a kidney, and then you have a kidney. You have to wait until somebody dies.

E: I can't give you a liver.

C: Exactly. Right. Well, and even liver transplant is a little less intense.

S: You can give a lobe.

C: Yeah, because you can give a lobe of a liver, and it regenerates it.

E: That's enough to keep someone alive?

C: Yeah.

E: Ah.

C: Heart is a very, very different animal.

S: Yeah.

C: And the threshold for how healthy you have to be to be able to get that heart, or not healthy, but how capable you have to be to be able to get that heart is much higher.

S: Yeah, so that's a good point, and that raises another wrinkle here is that the numbers I just gave you are a massive underestimate of the demand because people don't even get on the waiting list if it's like, listen, you're never going to get an organ, right?

C: Yeah, I saw a lot of patients like that where they fail out of the actual.

S: Yeah, they're already filtered out at the first level.

E: Prescreened.

S: Yeah, they're prescreened out.

C: Ineligible for transplant.

S: Not because it couldn't work. It's because there's no way we're going to get that far down the list to get to somebody with your characteristics, right? You're a high risk or whatever, so just forget about it. No point even putting you on the list. But again, if the source were no limit, then a lot of people who don't even get on the list would be able to get a transplant. We know somebody, a very dear friend of ours, Michael Lacelle, who died on the waiting list for a heart transplant, and actually he didn't even get on the list. They were like, yeah, you know.

C: That's hard.

E: Yeah, and this didn't develop later in his life. He needed it. They knew early on, right?

S: It was congenital. He was born with a heart defect. And his whole life was like at some point it's going to get bad enough that you're going to need a transplant. And then they said it's too bad. It's like he was waiting, waiting, waiting. Oh, it's too late is basically what happened.

C: It's so hard.

E: He died at like 40.

C: I've met patients who were eligible, who made it to the top of the list, who got a new heart, and then there was some rejection or some sort of –

S: Oh, yeah, it's not a guarantee either way. All right. So what are the options for alternatives to organ donation, right? Cara, you mentioned growing them. What do you mean by that?

C: Well, I mean like organoids or something like that.

S: Yeah.

C: So whether we're growing it in another animal or in a Petri dish, like basically that's been a huge goal, right?

S: It's tricky because it's hard to get the organ to develop properly outside of the environment of a full organism. But that's one approach. Another approach is to print them with stem cells, right? But then you need a scaffolding, and usually those are obtained from the organ itself, so it doesn't really solve the problem. You need the donor organ to – then you denuded of cells and you 3D print stem cells on it. The only advantage there potentially is that you could use stem cells derived from the ultimate recipient, right? So you don't lose this rejection. We're not anywhere close to that at this point.

C: What about animals?

S: There you go.

C: Right now we're talking about cadavers, but yeah, animals.

S: Animals are, in my opinion, the best chance and the closest. For some organs, for the heart, the heart is different than the liver and the kidney in that you can make a mechanical heart. You can't really make a mechanical kidney. I mean you can. It's a dialysis.

C: That would be so complicated.

S: But it's really – you can't have it inside the patient, right? But yeah, we might be able to at some point make a mechanical kidney, and again, we do have them. They're just not really for transplant. They're more just for dialysis.

C: But not liver, right?

S: But not liver. Not anytime soon, like a bionic liver. It's not even on the drawing board at this point in time.

C: But yeah, lots of patients are on bridge to transplant where they're waiting for a heart and they're on LVAD for like a while.

S: Exactly.

E: Keep them standing, right?

S: There's a bridge to transplant, and then there's the ultimate transplant, and then there might be a retransplant. So let's talk about pig hearts for xenografts because, again, hearts are difficult, and we definitely don't have enough to go around, and we're nowhere close to printing hearts or growing them in a vat or whatever. But what you can do is genetically engineer, genetically modify a pig so that it has something more like a human immune system, and then you basically are growing. It's a xenograft technically. That means from another species. That's put to an allograft, same species. But it's a xenograft that behaves like an allograft because you've genetically modified the immune markers on it. And then you just raise a pig, right? You just clone these pigs. You raise them up, you know, and then you harvest their organs. It's the lowest tech way to do it, and the highest tech aspect of it is the genetic modification, and we got that. We are all over that. You know what I mean? We have the technology to do the genetic modification.

E: We have the technology.

S: We do, and we can make clones. So essentially the technology is you take a pig genome, you make edits to specific genes that, again, alter the immune system so that it won't look like a different species to the intended recipient, and then you clone it. You put that DNA into an embryo where the DNA was removed, and then you induce it to form, you know, to reproduce and divide and then form a fetus, right? So there's a company already doing that, and this is the news item is they've completed a trial where they're donating pig hearts into baboons. They did 14 transplants. The 14 baboon recipients survived for at least several months with the longest surviving one being 21 months, which is a pretty long time. And then in one of the cases they followed up the xenograft with the genetically engineered pig heart with an allograft, basically another baboon heart, because they wanted to just proof of principle show that that could happen and there would be nothing about the xenograft that would prevent the allograft from working. Now why did they do that though? Because as you said, Cara, they're first looking at this as a bridge, not as the final transplant. So if you could get this to work so that on average, you know, the recipient of this genetically modified xenograft, the pig heart, can survive for three or four years, then that's your bridge. That gives you time to be on your waiting list for a permanent human heart for three to four years without requiring the LVAD, right? Which is basically a mechanical heart. It's a left ventricular assist device. It's not a completely mechanical heart. It just helps pump blood through your own ventricle.

C: And some people have to be like in the hospital the whole time they have it.

S: Yeah, they're in the hospital for months.

C: Yeah, yeah, yeah.

S: It's not great. And there's another population where this might be especially useful and that is the pediatric population, especially infants. So some infants are born with congenitally bad hearts that need to be replaced, like they're incompatible with life kind of hearts. Like they have a single ventricle. And those don't make a good connection to the mechanical hearts that we have and don't work well with LVAD. And so a lot of these infants die while they're on the waiting list for a transplant because infant hearts are in really short supply, right? So this may be the first thing that they go for is to do a pig heart, a genetically modified pig heart as a bridge heart for an infant while they're on the waiting list for a donated human heart. Of course, the ultimate goal is to make these so good that it can be your permanent forever heart or organ, any organ. We're just growing and harvesting organs that are as good as allograft transplants and maybe even eventually better. Now the company that did this recent study, they did 10 genetic modifications. Just 10 modifications, that's not a lot. But what happens when we figure out 20 or 50 or 100 modifications that we can do that will essentially eliminate any rejection? So in the ideal world, the ultimate expression of this technology is genetically modified animals like pigs from which we can harvest organs where there's zero rejection and they survive for the lifetime of the recipient. And then we just have essentially an unlimited supply as much as we need of any of those organs to donate without having to do cadaveric donation or somebody donating a kidney or whatever, without having to do any of that, without having to do any bridging maneuvers. We can just say, oh yeah, we'll just grow you a heart. Here you go. I don't know if we can get to that with a generic pig xenograft or if in order to get that good, if you would have to basically give it the recipient's immune system, you know what I mean? Where you have to raise the pig for them. But that's totally plausible, right? Or at the very least, we might have subdivisions, right? Where it's like basically there are people fall into different groups in terms of their immune system markers. And we could say, you know, if you have like one of 10 immune types, we're going to give you a donation from a pig that's in your type. Even though it may not be individual to you as a specific person, it's like blood type. You can think about it that way. We're going to give you a pig that has your type. You're a blood type. You're an immune type. And that will be better than just like a generic human pig. It's not just humanized. It's specific to a subtype and then maybe eventually specific to an actual individual person.

C: Yeah, I could see getting there. I mean I feel like –

S: We could absolutely get there.

C: I know it's different but things like CAR T therapy, you know, CAR T cell, like where we take the information from us and then we modify it and put it right back in us, like modify it, put it in the pig.

S: The thing is we can do it. We can use CRISPR or whatever to genetically modify these genomes. We can clone them and we can raise viable animals. We can harvest their organs. We can transplant them and they work. The whole thing from soup to nuts works. It's just a matter of getting incrementally better at this point. And the next step they're going to do, they're applying to the FDA for permission to do human trials. So that's the next step. So we could be – I know this is the joke on the show. We could be 5 to 10 years away from this being in the clinic, from actual patients receiving pig xenografts from this technique. That's way closer, decades closer than any of the other techniques. The other techniques may not even ever pan out. But this is happening now, at least at the animal level, and human research is coming up. That's the next step. So we may see this in our lifetime. People start to receive pig xenografts.

C: So how different are – obviously we talk about rejection being an issue, like an immune issue. But how different is the physical organ? Are all the connections really easy or do we have to modify things?

S: There's a reason why they chose a pig. It's very similar. It just happens to be very similar to the human. And so their hearts are good. They're mechanically a good fit for a human. And we know how to genetically modify them to make them smaller so they're human-sized.

C: Yeah. I wasn't sure if, like, because we are bipedal and pigs are quadrupedal, like sometimes that affects the orientation of, like, vessels and things like that. But I guess –

S: Yeah, as long as the hookups are close enough that you can surgically connect them.

C: Yeah, you can kind of bend them.

S: Yeah. Yeah. So it's plug and play basically. And, of course, a living organ is better than, like, a mechanical heart in that it's more physiologically responsive, like moment to moment to the demands of blood flow to the lungs and to the body.

C: Right. And potentially more resilient too.

S: Yeah. And gentler on the blood. The biggest limitation with mechanical hearts is that they're very destructive to blood cells. You know, first of all, you've got to give blood thinners so they don't clot. And then, you know, people, their blood cells don't survive as long when they're being pushed around by a mechanical heart. Now, again, that technology may advance to the point where it gets as good as a human heart, and that'd be great. Of course, you know, it's going to be a lot harder to do that for other organs. But I don't know how far away we are from that. That's very, very tough nut to crack. Again, I think this is the best way to go.

C: Yeah. And we've got to remember that even if you're lucky enough to get a human heart, you are on anti-rejection medication for the rest of your life.

S: Yeah. Even if you can make this so good that there's no rejection, you don't have to be on any suppressive drugs.

E: That's the holy grail.

S: That's the holy grail. Again, that's the ultimate expression of this. It's a new heart, no rejection, no drugs. Have a nice day. You know, that's it. And yeah. And again, we're just incrementally away from that. We just have to keep making advancements. But it works. All the pieces are in play. So very exciting.

Chiropractic Stroke (56:25)

• https://archive.is/hxZsc 

S: All right, Evan, give us an update on chiropractic and stroke, something we've talked about a few times in the past.

E: We have, and it has come up again in a recent article. But I want to ask you all a couple of things. But I want to, I want to. Let's see how much we all remember about chiropractic. Steve, maybe you should give others a chance to answer these before you. I know you've written quite a bit over the years about the history of chiropractic.

S: Yeah.

E: Okay. When do you think it started? What year was the practice invented?

B: Oh, of chiropractic?

C: 1920.

E: Okay.

C: Maybe that's too new. 1840.

B: 1885.

E: Oh, you're close, Bob.

J: 1850s, I think.

E: 1895, Bob. Good job. And who is credited with its invention? What's the name of the film?

B: Oh, that punk. That dude.

C: Dr. Chiropractor.

E: Dr. Punk.

S: Can I say it now?

E: You can, Steve.

S: D.D. Palmer.

E: D.D. Palmer, yes.

B: Yup, yup.

J: Yo, D.D.

B: It's still in my memory banks.

E: His first patient had an ailment that was said to be cured by his chiropractic procedure. What was that ailment?

S: Deafness.

E: Yes, deafness, hearing loss.

C: Deafness, what?

E: That's right.

C: Come on.

E: And do we know what the word chiropractic is or from what words you put together to make chiropractic?

S: Chiro is hand.

E: Yes, hand.

C: Hand manipulation? Like practice?

E: Well, practice, right. And practicus. Yes, done by hand. And finally, the idea that misalignments of the vertebrae, called subluxations, can interfere with the nervous system and cause a wide range of health problems beyond back or neck pain is basically what Palmer came up with. So that's the origin.

B: Yeah.

E: And that's the history. Just a little back story for you guys. Now, New Yorker Magazine recently put out an article on their health section in which the headline reads, Instagram has made chiropractic neck adjustments more appealing than ever before, but physicians say the maneuver is dangerous. This is not new news, okay, to us and many people in this audience. The author of this article, her name is Katie Arnold Ratliff. She's a freelance writer and editor for their health section. Here are the relevant parts of this article. Last fall, a tweet by Los Angeles cardiologist Daniel Bilardo, MD, illustrates the stakes involved with chiropractic manipulation and strokes. Quote, here's the tweet from that doctor. Heartbroken after seeing a young patient with no medical history end up with a BIFFL grade two dissection of the vertebral artery and subsequent acute PICA, P-I-C-A, infarct immediately after a neck adjustment from the chiropractor. This has to stop. Chiropractors, you have to stop, in caps. So what does that mean? Yeah, a neck adjustment caused a tear in the tissue lining of the patient's vertebral artery, which is known as a vertebral artery dissection, and the tear impacted their blood flow so severely that it cut off a portion of their brain from oxygen. Immediately, that patient experienced vision changes, difficulty walking, and started to develop weakness on one side of her body. And this person had their neck adjusted, and then they, what, had a stroke.

S: Yeah, it's a lateral medullary stroke, and it's like a brain stem stroke. It's pretty severe.

E: Pretty severe. I don't recall us speaking about this particular case before. It was also written about in Women's Health magazine. This was back in November of 2024. They covered it. They went on to say in that article, they indicate that this was the fourth time in Dr. Bilardo's career, she's the cardiologist, where one of her patients suffered a stroke due to chiropractic manipulation. Dr. Bilardo says she wished she had spoken up sooner. After seeing the first patient with this condition, she feels guilty for not having alerted people to this health problem sooner. Now, her tweet, Dr. Bilardo's tweet, has been shared almost 6 million times. And we can think, okay, that's good. Her post has been shared quite a bit and hopefully made many more people aware of the risk. However, we have Instagram and we have TikTok and other social media platforms. That is an ocean in which chiropractors and their patients share videos and experience on all the joys and wonderfulness of chiropractic. No mention whatsoever of this particular risk or any other risks associated with chiropractic. Now, I don't have the numbers to share. I tried looking it up to try to quantify it, but that's almost impossible. But a cursory search for chiropractic on these sites opens up the floodgates. So much so to the point that even a respected cardiologist warning people the dangers of stroke via chiropractic and with 6 million views, that really doesn't even hold a candle to those who are promoting the practice. Back to the New Yorker magazine article, we have a local connection here inside of that article for us, the SGU, right here in our home state, Connecticut, University of Bridgeport. Oh, my gosh. How long have we been talking about the University of Bridgeport? Even before we were Skeptics Guide to the Universe, when we were the Connecticut Skeptical Society, basically.

S: Going on 30 years.

E: Exactly. I know. 30 years of that as well. We've been skeptical activists for like half of our lives. It's amazing to think of that. The University of Bridgeport, yeah, mainly since the 1980s, which is when the university was basically bought out or taken control of by the Unification Church, Dr. Sung Young Moon, the Moonies. They owned, they operated the university right up through 2019. I didn't realize they were still involved that late into it, but 2019. We are very familiar with the antics and pseudoscience and cult-like atmosphere that has permeated the University of Bridgeport now for decades. Well, in any case, they quote in that article, gentleman James Lehman, a chiropractic orthopedist and the director of the health scientist postgraduate education department at the University of Bridgeport. He is a neck adjustment defender. Here's what he says. Statistically, if you had 57 chiropractors do 100 cervical manipulations a week for 52 weeks for 20 years, one out of those 57 chiropractors would encounter this particular situation, meaning an arterial dissection and subsequent stroke.

C: That's too many.

E: Well, yeah, that is too many. And it doesn't exactly jive with other research on this. Now, the research also that has been done on this is a bit spread out. There are studies apparently in which the frequency of this takes place in 1 in 20,000 events, one time out of 20. And then there's another one that I think was like 1 in 2 million. So you have kind of this very large range here. So I imagine that has to do with quality of the study and so many other mitigating factors. Really hard to kind of pinpoint exactly. So I'm not even really sure where he is coming up with this particular set of numbers. I imagine he found the most favorable one and he just kind of parrots that as he goes along in defense of this practice.

S: But as Cara said, so yeah, first of all, he's probably using the most favorable numbers. And even the worst numbers are probably an underestimate because chiropractors have no motivation and no incentive to track this. And so they don't. So we're basically only most of the data comes from physicians who are on the receiving end of the strokes, of the dissections. So that's just not a thorough sample. And it's probably undercounting them. But even still, even if those numbers were correct, as Cara said, it's too many because medicine is a risk versus benefit game.

E: That's the bottom line.

S: And there's no benefit. So zero benefit compared to, yes, statistically rare, but when they do occur, you're basically causing a stroke and or death to an otherwise young healthy person. So there's a pretty bad – it's not like a mild adverse event. This is a serious, potentially fatal adverse event. None of it's justified if there's no proven benefit, and which there isn't. There's no proven benefit to chiropractic manipulation of the neck. And let me clarify that because that's a specific thing. It's not any manipulation of the neck. It's not any physical therapy. Like physical therapists do neck mobilization, for example, right, when they're trying to like, you know, if you have like a locked joint in your neck or you have muscle spasm or whatever, that's different. What chiropractors are doing are high velocity, very rapid manipulations of the neck. It's much more violent. It's way more risky.

B: It's rough.

S: Yeah, and it's –

E: Like a whiplash event almost.

S: Exactly, and there's no indication for it. There's no theoretical basis for it, and there's no evidence of any benefit from it. It's just pure risk. Saying that the risk is low is not a defense. It's just an illustration of their ignorance of how clinical medicine works.

E: And Steve, not only do they say that they offer these very low, you know, statistics, but they also said that, look, how do you know the patient didn't already have some kind of tear in there and just the manipulation revealed that issue?

C: Well, you don't, which is why you don't go manipulating their necks.

E: Right.

S: That's not a defense because you absolutely should not be manipulating somebody's neck if they have a dissection. So they're basically saying, no, it's not this kind of malpractice. It's this completely other different kind of malpractice. It's not a defense.

E: Right.

S: It is not a defense. But also there are cases, there are plenty of cases where the cause and effect is pretty clear, where the person like basically stroked out on the chiropractor's table.

E: Yep.

S: You know? So it's just silly.

C: It's terrifying. And that's only one of so many possible negative outcomes.

S: Right.

C: It's just a pretty violent one.

E: Right, right. And there does not appear to be either laws or guidance in place in which the chiropractors are supposed to be disclosing this to all of their patients.

S: They're basically self-regulating.

E: Right. They self-regulate. And in fact, the person who wrote this particular article said, who said, look, I didn't come into this one way or the other, pro or con, but basically the reason why she said she would not do this is because if she knows about even this very small chance of risk of this stroke, regardless of which set of statistics you want to use, she would choose to not do it based on that. So if you had more people ahead of time being made aware of this or it was mandatory to be made aware of this, then you would have people making better decisions about going to the chiropractor for this specific purpose.

C: There's also like this whole secondary thing, which I don't think we've talked about, which is that because chiropractors are not physicians, when something bad does happen, they're not trained in what to do. So like there are situations where there are lower risk outpatient procedures, where patients will be working with nurse practitioners or physicians. And sometimes there's a complication, but there's a protocol in place for how to get them to an ED quickly and for what kind of first aid to do in the meantime. But like a chiropractor isn't trained in how to do that. They don't have those pipelines in place.

S: They don't.

C: That's so terrifying.

S: They say they are, but it's a lie. They are absolutely not. They do not have the same training that physicians have.

C: Terrifying.

S: They like to pretend that they do. Listen, if all chiropractors were doing was like lower back manipulation for acute uncomplicated lower back strain, which is like the one thing for which you could say that maybe there's some evidence that it's as good as other things that you can do for lower back strain.

C: What, like massage?

S: Yeah, exactly. Or even giving a pamphlet on good back hygiene is just as effective, you know, in the literature. But whatever, if they were just doing that or if they basically was another avenue to become like a sports medicine person or whatever, then who cares, right? But it's because they do this sort of thing, because they're not science-based and they don't really have the same kind of ethical structure that mainstream medicine has. And, right, they don't really self-police well. There's just so much pseudoscience and crankery and malpractice happening under the umbrella of chiropractic. They just need to just purge themselves of that, get rid of subluxation theory, just practice evidence-based, you know, whatever, chiropractic, and then nobody would care. It would be fine.

C: But they don't.

S: But they don't.

C: And lest we forget that they do this on animals and children too. Children and babies.

E: Babies. Much higher risk group.

S: The thing is, it's their fault. It is 100% their fault. So a little bit more of a history lesson. If you go back 120 years, you know, when chiropractic was in early days, there was another similar profession that also believed in manipulation to free up the flow of life energy, but they thought it was flowing through the blood vessels, not the nerves. You know who those were?

C: The bloodletters?

E: Not bloodletters, osteopaths.

C: Oh, osteopaths.

E: I forgot that. That's how they started.

C: But they cleaned up their act.

E: Yeah, they got rid of it.

S: After medicine, you know, basically there was a huge shakeup where American medicine decided to adopt the standards of European medicine and become very scientific. Half of American medical schools closed down. They merged. The standards were put in place, et cetera, et cetera. Basically, they went to chiropractors and osteopaths and said, well, do you want to join us and become science-based and ethical? And the osteopaths said yes, and the chiropractors said no. They said, screwed nerds to you. We're going our own way. We don't need your stinking science. So they were given the olive branch, and they rejected it. And they've had a hostile relationship with medicine ever since, but it's all on them. It really is. Whereas DOs are basically MDs. And we don't care. I practice side-by-side with DOs. They're basically MDs. It's not about like competition or whatever. It's just about, you know, what they do. It's about being legitimate. And this is one of the reasons if they, you know, there's no way physicians would get away with this. A procedure that doesn't have a proven efficacy that occasionally strokes people's out and kills them, forget about it.

E: Right.

C: It's insanity.

S: It's insanity. All right. Let's move on before I have an aneurysm.

E: Oh, my gosh.

Breathable Algae Drug Delivery (1:11:22)

• It's hard to get meds to the lungs: Breathable algae offers a new path 

S: Bob, tell us about this breathable drug delivery system.

B: All right. All right, guys. So researchers have developed a noninvasive treatment for respiratory diseases that use, get this, an inhalable form of green algae. How does this work? Why do we even need such a thing? So you can read about it in Nature Communications. The title of the paper is Inhalable Biohybrid Microrobots, a Noninvasive Approach for Lung Treatment. Okay. Now we know respiratory diseases are on the rise. Scientists are increasingly looking for ways to treat ailments like pneumonia, asthma, tuberculosis, COPD. So part of the problem is that the lungs, even though they're inside us, they're potentially at risk with every breath we take from pollutants, viruses, bacteria, irritants, on and on. You know, they are inside us, but they have such a direct line with everything you breathe in. It's like it makes them almost uniquely vulnerable compared to other, you know, internal organs that we have. The evolutionary development of lungs has actually done an impressive job protecting that pathway to our lungs. So tell me, what do you guys think? What are some of the ways that the lungs protect itself from anything getting in? What's going on in the body?

S: They have a lot of ciliary things that, you know, the cilia that are constantly moving stuff out of the lungs.

J: And you can cough to expel things from your lungs.

B: Yeah, all good stuff. So the first line of defense is the nose hairs. They're encountered first. They filter out the largest things like dust and pollen, you know, to a certain extent. They're not perfect, of course. The next step is the mucus in our windpipes, and we know how nasty and sticky that stuff is, right? That just grabs the dust and pollen as well as other micro, you know, as well as microorganisms itself. And they're caught in these little hair-like structures called cilia, and that moves the stuff up, you know, in a coordinated way, up and away from our lungs. Sometimes it's coughed up. So you guys are basically right. Now, whatever makes it past those defenses, though, can end up right in our lungs, but then they face the gatekeepers of our lungs' immune system, the macrophages, the dreaded macrophages. So these guys do many, many beneficial things, but in this context, they clear away anything that you breathe in that you shouldn't, from bacteria, viruses, fungi, and on and on. And they also can do one of the other things that they can do in this way is they could bring in other types of immune cells as needed, like lymphocytes. Ironically, I didn't know this. Ironically, some of these macrophages have actually been implicated in some disease progressions like asthma and COPD. So whoops, evolution. So yeah, nothing's perfect. Kind of weird that the protectors of the lungs can actually damage it in that way. But all of these layered lung defenses, they're great. They're obviously fantastic, but with all these layered defenses, it's really great, but it does have a downside. It makes it harder for doctors to heal the lungs because they have to get by that stuff too. So in order to do that, they often have to take an indirect route to the lungs, right, like injecting antibiotics. But the problem with that is that you have to give a big dose, right, because only some of that medicine that you inject is actually going to find its way to the lungs, which means you need, like I said, you need a larger dose than what is strictly necessary, and that can create unwanted side effects. So you always want to do the minimal dose necessary and indirectly injecting antibiotics to get a pathway to the lungs that's not direct, not ideal. So researchers have actually tried other inhaled forms of medicines like nanoparticles filled with medicine that go straight to the lungs. So that's great, but the problem is that they get cleared away by those damn macrophages. So it doesn't work as good as they wanted it to do. So the researchers needed a new approach, a completely new approach for this direct medical treatment of the lungs, something that's noninvasive, but also with the ability to last long enough to spread this medicine around and get it all over the lungs. So surprisingly, they turned to a tiny green ally. I'm not talking about Yoda or even kazoo. Look that one up. But something much more microscopic, green algae. I did a little bit of a dive into green algae, so to speak. It's really quite fascinating.

E: Oh, okay.

B: Yeah, yes.

E: Right.

B: They're like plants in that they use photosynthesis to make food, but there's nothing classically plant-like about them. There's no leaves. There's no roots or anything like that. Interestingly, did you know that plants actually evolved from green algae, they think, about 480 million years ago? So I didn't know that. Did you know that plants evolved from green algae? I didn't. So thank you, green algae. So why use green algae for drug delivery? This is a tough one. I don't expect that you would have any idea. So why green algae is the one that they went to probably fairly quickly? That's because they chose green algae because it's better than bacteria and blue-green algae because those two have surface features that make them relatively easy to be detected by our immune system. So green algae does not have any of those structures on its surfaces, so it's just generally safer for biomedical uses. So that's the one that they jumped to. But there's also other reasons. So they take these green algae, and they say in the paper, I love this use of the word, they say they functionalized each cell by coating them with the medicine that they want to deliver to the lungs. But you can't just take any old green algae. You need a green algae that has very specific characteristics. So number one, they had to be very, very small. So they picked this pico-eukaryotic algae, pico-eukaryotic algae, very tiny, about 150th the size of a hair, each one. You can line up 50 of them before it matches the diameter of a hair. So that tiny size was needed so that they can be absorbed by aerosolized water droplets. So you've got these water droplets that can be easily, they're so small, they're just suspended in the air, and you can just breathe them in without even thinking about it by using a nebulizer, and it just bypasses the nose hairs, it bypasses the throat mucus, and it gets inhaled directly right into the lungs. So number two, the green algae needed to have flagella so that they can swim away fast enough to escape the dreaded macrophages. So that was one of the critical benefits of the green algae is that flagella can let them move away at a decent enough speed to escape their macrophages, and that's something that some of the other microorganisms wouldn't have been able to do. So that was a key component right there. There was one other final obstacle, guys. The medicine that they put on the green algae could potentially be detected by the macrophages, and that would just set off its immune alarms, and they wanted to avoid having that happen before the drug can spread itself around in the lungs. So to deal with that, they actually cloaked the drug in a membrane from a platelet cell. So they took the drug, and they coated basically in the membrane of another cell that the macrophages, if they came across it, they would say, oh, okay, that's fine. They would basically say, it's an older platelet code, but it checks out. They would just let it go by, and they wouldn't bother that weird medicine that's on the green algae. So here's the question. So pay attention, punks. This is the question. So we got green algae cells, and they're coated with the medicine, and that medicine has been covered with a common cell membrane to hide it, and the researchers called these micro-robots. Does that annoy you a little bit, calling these micro-robots? It's basically-

E: Is that a very technical definition?

B: No, it's not. I don't know. It's not. I mean, it's-

C: Yeah, that's not a robot.

B: A robot has baggage. It's got these implications, these things that make you think. I don't think of a natural cell. I mean, this is essentially 99% of natural cells, and they're calling it a robot.

C: Yeah, call it like a biomedicinal packet or something, a delivery device.

J: I like that Cara.

B: Yeah. Now, to be fair to the authors of the study, half the time they refer to it as a bio-hybrid micro-robot, and that's a little bit more palatable to me, that bio-hybrid is nice.

C: But why is it a robot? It's not programmable.

B: I know.

C: It's not-

E: It's not all caps, like an-

B: And it's not constructed. It's not- Even though it's funny, though, because even though I think of single cells as very, very complex machines, calling them micro-robots just rubbed me the wrong way, and I wanted to get your take on that. Steve, you didn't say anything about that. What do you think? Robot?

S: I no likey.

B: Okay, very good.

C: He no likey.

B: We have an accord. Okay, great. So the end result here, good participation, people. The end result here is you end up, we have green algae that has three to five days, a lot of time, a lot more time than ever before, three to five days to distribute the medicine throughout the lungs. The overall dose is lower, which greatly minimizes any side effects. And after a few days, the green algae is cleared out naturally by the lungs. So it's all good. So the next question is how does it work? So they tested these on mice with nasty MRSA infections. That's bad stuff. I guess for people it is. I guess it is for mice as well. Actually, I know it is for mice because of what I'm going to say in about 11 seconds. The results were pretty amazing if you ask me. All the poor control mice that had conventional treatment or no treatment at all died within three days. All of the green algae mice survived. It's like, okay, that's pretty perfect if you ask me, as far as I can tell anyway. All right, so what about the future of this technique? So I'll quote the co-lead of this project, Professor Liangfang Zhang. He said, as basic research in micro-robotics continues to advance, I expect these technologies will gradually move toward clinical testing for a range of biomedical applications, particularly for the localized and active delivery of medicine. So, yes, he's very confident, I think, as he should be. I'm going to end the quote by Liza Labios from University of California, San Diego. She wrote an article about this in PhysOrg. She said, this sort of breakthrough, which could one day be a game-changing medical treatment, is all thanks to federal funding that allows researchers to push past science fiction and into the vault. The vault, she means the lungs are the vault because they're very locked down and very hard to get into. But I just loved that she says – to me, in my mind, she stresses it's all thanks to federal funding. So let's please not cut federal funding because without it, we wouldn't have some potentially life-saving treatments for people in the future. It's all because of federal funding without any necessary endgame. Just like let's see what we can discover by happy accident. It's been done in the past. It's saved so many lives that you can't even count it. So I just want to end with that quote. Thank you.

S: All right. Thanks, Bob.

Who's That Noisy? + Announcements (1:22:38)

S: Jay, it's Who's That Noisy time.

J: All right, guys. Last week, I played this noisy. [plays Noisy]

E: Exterminate.

J: I know, right?

S: No, no, no. It's the Millennium Falcon trying to go to light speed.

E: Oh, yes, and failing.

J: So a listener named Jason S. wrote in and said, he said his name is Jason, the dual patron here. He said this week's noisy definitely sounds like an electric motor spooling up and shifting through some gears. I think it's Hoover's new five-speed electric ride on vacuum cleaner. Okay, that's not it. He said, seriously, though, it's a kilocycle or similar electric motorcycle. If you haven't seen this thing, it's a drag racer that does zero to 60 in .97 seconds and it pulls 2.5 Gs. Not correct, but that was definitely a cool guess. A listener named Jokrian Zeke, and that is not how his name was spelled. It's just that he gave me the pronunciation. I would never, if my life counted on it and I had a year to research it, I wouldn't have been able to pronounce that name. Love what you do. Whatever comes, please keep going in these weird times, and we will. As a matter of fact, we're going to do more than we're doing right now very soon. Just pay attention and you'll see all the new stuff we have coming down the pike. He said this week's noisy sounds extremely familiar. I think it's an electric motor from a tram train, probably on a test bench in a workshop. You can hear the gears switching up and down exactly like the trams I used to get into Cologne, my hometown, to party as they accelerated and deaccelerated before and after each stop. So, yeah, I mean, you're not 100% wrong, but you didn't get close enough. A listener named Marcus Digny from Parksville, Western Australia says, good day there. Love the show and listen to every episode since discovering it several years ago. First time having a guess, is it the sound from inside the cockpit of a Formula 1 car or some other high-powered racing car? It is not, but you represent many people who wrote a very similar guess to that. So I'm going to click right over to the winner. This winner's name is Frank Burgum, and he said, I'm pretty sure that this noisy is an AC motor controller with a variable frequency three-phase inverter, probably on a large motor such as an electric train engine. And then he goes on to say, like in the 1980s, he worked on developing AC motor speed controllers, which made exactly that noise. The gear changes are required because the switching frequency of the inverter has to be kept in a narrow range. It's technical stuff, but basically, after doing some research and looking up about what this thing is, specifically, it's a variable frequency drive, VFD, an electronic device used to control the speed and torque of an AC electric motor by varying the frequency and voltage of the power supplied to the motor. And this capability allows for precise control of motor operation, leading to improved energy efficiency and performance in various applications. Let me play that back for you guys. I won't play the whole thing, but you'll get the idea. [plays Noisy] It has a Tron noise to it.

S: Oh, yeah, totally. A Tron cycle. Yeah, totally.

E: Oh, I remember that now.

J: I thought that was a really cool sound. All right, guys, I have a new noisy for you, and it was sent in by a listener named Wayne Sibley. [plays Noisy] If you think you know this week's noisy or you heard something cool, don't hesitate, because I need those noisies. Send them to WTN@theskepticsguide.org.

J: Steve, why am I so freaking excited? What is tonight?

S: This is the last episode to go up before NOTACON.

J: Correct. Yeah. So what's happening is this will be the last time you hear us talk about NOTACON before NOTACON. And this is the last time you'll hear us say that there are tickets still available if you're interested. We actually had a lot of people buy tickets over the last week, which is exactly what I predicted, because I've done this so many times. I know that that happens. But please do consider coming if you're free. It's going to be in White Plains, New York, which means that you could use the Westchester Airport or the New York City airports. It's not that long of a wait. And this conference, guys, is essentially we call it NOTACON because it's not like your standard conference. This isn't a bunch of lectures, you know, skeptical and science based lectures. This conference revolves around, you know, basically celebrating our podcast, our patrons, you know, listeners of the show. There's lots of time to socialize. We have a ton of super fun events that we're going to be putting on both Friday and Saturday. And then we have nighttime activities as well. We're going to be doing a Boomer versus Zoomer game show. We're going to pick people out of the audience to be the contestants. And then Saturday night, we have a Beatles sing along. There is going to be heavy activity by all of us involved in the music playing. It's good. It's really a big deal. We're really excited about it. We came up with some awesome bits that we're so psyched about. The content that we have for this year, we're all looking forward to it. There will be some brand new swag. And it's just going to be a great time. So if you're interested, go to notaconcon.com or go to theskepticsguide.org. And you can get a link there to the website. Please join us. It's going to be great. And we hope that everyone has safe travels. And I can't wait to see everybody.

C: Yey.

S: Thank you, Jay.

Emails (1:28:38)

S: A couple of quick emails. These are both sort of not so much corrections as additional information about two topics. Bob, let's start with you actually. Last week, I think we talked about the email about the Big Bang and the universe expanding at greater than the speed of light. But it's actually more complicated than what we said.

B: Yeah, there's more to it. I want to approach this from probably a better angle. Primarily, the premise is wrong that the universe was – science says that the universe was expanding faster than the speed of light during the Big Bang. So that premise is – it's a common misconception. The universe's expansion, in fact, does not really have a speed. Its expansion rate doesn't use the same units as speed. So you can't even directly compare the two. Just not meaningful at all. Instead, the universe's expansion rate is all about how distance changes an object's apparent velocity. That's what Hubble's famous parameter tells us. The farther away two objects are, the faster they're separating from each other. We know that at enough of a distance, that speed can be faster than light. General relativities, mathematics tells us that. That faster-than-light separation of objects beyond a certain distance, it's true now. It's true during inflation even though the forces that are driving that expansion are quite different. Dark energy is doing it now. It was not dark energy after the Big Bang. So this expansion of space isn't the same as an object's speed through space. It's kind of like the bottom line maybe for the email writer. So no laws of physics are being broken during the Big Bang.

S: Yeah, it's a nuance, right? I mean you're being a little pedantic, but yeah, we want to be technically accurate here. I just was interpreting that charitably. If you look at two objects within the universe, they can be moving away from each other at greater than the speed of light. If that movement is due to the expansion of the universe. And that's because they're not moving within the universe at greater than the speed of light. They're just being carried along with the expansion of the universe. And that's why at some point, like the visible universe, there's the visible universe. How do you describe the universe that we could theoretically get to? Because the visible universe is more about the age of the universe, right? It's only as far away as the universe is old.

B: Yeah, let's not even go there, Steve.

S: I'm just saying there's a point. Something could be so far away that we could never theoretically get there because it's moving away from us as fast as the speed of light.

B: Oh, yeah. There's a big chunk of the universe itself that we will never be able to get to because you would have to go faster than the speed of light. But still, there's something like 18 billion galaxies that we could get to if we started really trying. But, yeah, that number is getting smaller and smaller all the time, which is not a fun fact.

S: All right. And then the other—we got a bunch of emails about our autism discussion, which is, you know, it was a good conversation because, you know, this is a very, very complicated issue. I tried to reflect that complexity. We're talking about RFK's comments about autism but how narrow his perspective is when, in fact, you know, autism is a very complicated spectrum, right? But at one point, the issue of self-diagnosis came up and several people pushed back on the fact that both Cara and I had the immediate same knee-jerk reaction like, oh, self-diagnosis, you don't want to do that. And they were like, really? Well, what is wrong with somebody self-diagnosing with autism? If you're interested, I wrote an article about it on Neurologica explaining why Cara and I as clinicians both had that reaction, which I think is legitimate. Self-diagnosis is essentially fraught with a lot of logical pitfalls and cognitive biases.

C: We can't diagnose ourselves with—I don't diagnose myself with anything psychological.

S: It's generally not a good idea. You could fall for confirmation bias.

C: Yeah, you don't diagnose yourself with neurological things when you talk to another neurologist.

S: Exactly. Like, I wouldn't even diagnose myself with something neurological.

C: Exactly.

S: You can't be objective.

C: No, you can't.

S: But also, there's so many types of errors that you could make in diagnosis. And, like, for example, you might—there's the representativeness heuristic. There's also the availability heuristic. Like, you're going to settle on a diagnosis that's available to you, that's in the popular culture. You won't necessarily be considering the full differential diagnosis.

C: True. Yeah, it could be something else. Also, there's the thing—and I'm not saying that this is what our listeners did, but we've all seen this. Every, like, neuro or psych student who goes through training thinks they have a lot of things that they're actively learning about.

S: Every medical student. It's a joke in medical school.

C: Yeah.

S: Medical student syndrome. Like, you think you have every disease. That's the Forer effect, right? Because, you know, you have to learn how to put symptoms into context. And, you know, you have to know the difference between symptoms that are specific versus nonspecific, et cetera, and how predictive value works and all that stuff.

C: Yeah, but the DSM, it's really hard because things are mostly—

S: It's even harder.

C: Dimensional.

S: Exactly.

C: Yeah, and you can kind of go, well, I've been depressed or I've had anxiety.

S: Yeah, I'm fidgety. Whatever, yeah.

C: Exactly.

S: Everything requires judgment, and you could see yourself almost in any description. But having said that, that doesn't mean that any self-diagnosis is wrong, and some are easier than others. And, you know, so just putting things into context, like I've been practicing neurology now for 30 years. People come in to see me almost on a daily basis with some kind of self-diagnosis, even if just to say, I'm concerned that I have X, right? So I have a pretty good feel for how people are at thinking about what the diagnosis they might have. There's a massive false positive problem, and there are some diagnoses that people self-diagnose that are almost always incorrect, and there are some that are almost always correct. There are some where it's actually pretty easy to self-diagnose because there are some pretty specific symptoms that people recognize.

C: Like when I have a UTI or a yeast infection, it's pretty easy for me to tell my doctor my symptoms and say, I think this is a UTI. They go, yeah, it sounds like one. Here's what we'll do about it. But that doesn't mean I'm going to the pharmacist and saying, I think I have a UTI.

S: Writing yourself a prescription, yeah.

C: Exactly. That's the difference. I'm coming with a hypothesis, and then I'm working with a professional to determine whether it meets the threshold for diagnosis.

S: Right. Exactly. Going through a clinical algorithm of workup and treatment and making sure it's not something else.

C: Because also it doesn't help. If you are somebody with diagnosable autism spectrum disorder and you are looking for accommodations for that diagnosis, you have to have a diagnosis on paper.

S: Yeah. A few people pointed out, though, that sometimes they were referring to themselves. Like I diagnosed myself because I don't have the resources to get a formal diagnosis. It's hard to find a practitioner who will do it.

C: True. Yeah, it's hard.

S: And it's too expensive. Our insurance doesn't really cover it very well, et cetera, et cetera. So it was basically my only choice. And I get that. And of course, I think the solution to that is better resources, not relying on self-diagnosis. But in the world we live in today, that may be your only option. But the thing is, what do you then do about it?

C: Yeah, it doesn't mean anything in a practical sense. It means something from an identity perspective.

S: From an identity perspective. That's what I think what they were saying.

C: Of course.

S: Just help me deal with my life and understand myself. It's like, okay, that's fine as long as you're not then going for chelation therapy, whatever, like getting a treatment based upon that without going through a professional or like making major life decisions. Or then, again, just got to be aware of the fact that it's like thinking that you're a certain astrological sign. You start to then perceive yourself. Then the confirmation bias kicks in, right?

C: For sure.

S: Once you think that you have a label, then you will make it make sense.

C: And there are things on the spectrum. There are diagnostic criteria that all of us could point to and say, I'm a little bit like that. I've got a little bit of that.

S: And the other thing is like you may be right but incomplete. You may have autism and you may be correctly seeing the signs and symptoms of that in yourself. But that doesn't mean you don't also have another diagnosis and maybe something else that does need to be treated.

C: Or you may be neurodivergent and not qualify for a diagnosis. And I think that's a big thing that I talk to a lot of people in my life about where they're like, I want to go get diagnosed. And I'm like, here's what you do. This is the protocol for doing it. But I can tell you right now based on the MIGDAS or the ADOS that I've done in the past, you will not qualify for a diagnosis. And that does happen. And it's a bummer. But there is a minimum threshold.

S: Yeah. And sometimes they actually make sense in medicine. They're based on the evidence shows at this threshold it predicts your response to treatment or whatever. There's some reason for it. Not always. It always depends on where we are and sort of our understanding of the disease and the availability of treatments, et cetera.

C: But almost everything in the DSM, and this is a bigger question of whether or not this is, you know, like with deafness, an identity versus a, quote, disorder. And I'm just saying that because it's the Diagnostic and Statistical Manual of Mental Disorders. But like everything in the DSM, there is a range where you might be on the spectrum of, let's say, anxiety or sadness where you do not have a clinical diagnosis. You do not hit the threshold because everybody gets depressed. Everybody gets sad. Some people are sad more than others. But there's a point where it falls under some form of clinical depression, you know, persistent depressive disorder, whatever.

S: And I have, you know, seen people misdiagnose family members as autistic because they are based on a superficial understanding of what it is.

C: For sure.

S: It happens.

C: And again, this isn't a perfect system. When we talk about it like this is how you do it. And I know that people will often be like, yeah, but you're relying too heavily on a medical model or you're relying too heavy. This is what we have. It's all constructed, all of it. The labels are constructed. The way that we identify people and put people in different boxes are constructed. The books we use, the way that we – it's all constructed. But we have to work within the same system. Otherwise, we'd be all over the place.

S: Right. So if you are interested in this topic generally or just for you personally, I do recommend you read my articles because I do go through all of the aspects that we consider when we make a diagnosis of why and all of the potential pitfalls of self-diagnosis. So at least go into it with your eyes open if you feel like you need to do that. All right, guys. Let's go on with science or fiction.

Science or Fiction (1:39:43)

Theme: None Item #1: Scientists have developed a micropipette capable of delivering ions only, without fluid, to a single neuron. Item #2: A new extensive analysis finds that climate change is now the most significant driver of biodiversity loss in insects. Item #3: Engineers have developed a process for spinning industry quality cellulose fibers from cow manure.

Answer	Item
Fiction	A new extensive analysis finds that climate change is now the most significant driver of biodiversity loss in insects.
Science	Scientists have developed a micropipette capable of delivering ions only, without fluid, to a single neuron.
Science	Engineers have developed a process for spinning industry quality cellulose fibers from cow manure.

Host	Result
Steve	clever

Rogue	Guess
Bob	Scientists have developed a micropipette capable of delivering ions only, without fluid, to a single neuron.
Evan	Engineers have developed a process for spinning industry quality cellulose fibers from cow manure.
Cara	A new extensive analysis finds that climate change is now the most significant driver of biodiversity loss in insects.
Jay	A new extensive analysis finds that climate change is now the most significant driver of biodiversity loss in insects.

Voice-over: It's time for Science or Fiction.

S: Each week I come up with three science news items or facts, two real and one fake, and then I challenge my panel of skeptics to tell me which one is the fake. Just three regular news items this week. You guys ready? Here we go. Item number one, scientists have developed a micropipette capable of delivering ions only without fluid to a single neuron. Item number two, a new extensive analysis finds that climate change is now the most significant driver of biodiversity loss in insects. And item number three, engineers have developed a process for spinning industry quality cellulose fibers from cow manure. Bob, go first.

B: All right. You know, none of these are leaping out at me in any real way. I mean, of course, this micropipette delivering just an ion, no fluid to a single neuron. What the hell? I really want that to be true. I might not be able to vote against it. So climate change in insects, biodiversity, are they that sensitive? Who knows? Let's see. Let's see. Engineers, industry quality cellulose fiber from cow manure. I mean, you got to be shitting me.

S: Good one.

B: Care, what do you think? Never mind. All right. I'm going to say that the micropipette, because if I'm right, I'm happy. And if I'm wrong, I'm also happy. So fiction.

S: All right. Evan?

E: All right. The micropipette. That's not a word I come across often in my life. If I knew what the significance of being able to deliver a ion to a single neuron is, perhaps this would be maybe more impressive. Okay. Let's deliver an ion to a neuron. So why? What's big about it? Why is that a big deal? But apparently it is. I'll assume it is. The second one about climate change, now the most significant driver of biodiversity loss in insects. I have a feeling that one's correct, because if history has shown us everything, we are certainly responsible for the majority of climate change going on. And we are excellent at kind of destroying things. And this would, I think, fit neatly into that package. This last one about spinning industry quality cellulose fibers from cow manure. I guess that'd be a good use for cow manure. Quality cellulose fibers. Maybe, I don't know, it's either going to be the micropipette or the cow manure one. I'll spread it out. I'll spread it around. I'll spread the cow manure around, and I'll say the cow manure one is fiction. But I can't really pinpoint why.

S: Okay, Cara.

C: The micropipette capable of delivering ion, that doesn't sound – I mean, it's cool as hell, but I don't understand why this is that different from patch clamping. With patch clamping, you're reading the ion transfer. You're sort of looking at the voltage.

E: Oh, so you understand what the significance of this is.

C: Of course, yeah. I mean, this is the kind of research I used to do. If we had a micropipette, like a teeny, tiny glass thing that sucks to the outside of a cell, back in the day, we would already do this, and we'd clamp to the cell, and then we could measure intra versus extracellular voltage changes to understand excitability of the cell. So I don't see why it would be that hard to pump some sodium or potassium in or out.

E: So if you have some laboratory experience, this means a lot more to most people.

C: Yeah, I mean, it's probably hard. That's probably why we didn't do it until now, but it doesn't blow my mind or anything. It's cool. Yeah, we could do a lot with it. Like, we could change the excitability of tissue and stuff. And then you chose the process for spinning industry-quality cellulose fibers from cow manure. Yeah, I guess cows eat grass. So if you could take the cellulose back out, there's cellulose. Can they digest it? I don't think so. I don't think animals can digest cellulose. I think the only time you see that is in, like, termites, but it's not actually the termites. It's, like, the bacteria inside of them. I feel like I remember that from somewhere. So, yeah, there's probably a bunch of cellulose in the poop. So they figured out how to recapture the cellulose. I don't know. So that leads me to think that the insect one is not climate change, that it's, like, pesticides or something or, like, monocropping or, I don't know, something that's, like, it's probably climate change is a driver. But I feel like there's all sorts of other stuff. So I'm going to say that one's the fiction.

S: All right, Jay, so they're all spread out. You're going to break the tie.

J: Well, I want to first say that I am so happy that they finally found something useful to do with poop.

E: Finally.

J: There's a lot. I mean, I'm half joking and half serious because there is a lot of cow poop in the world, guys. Like, lots of cow poop.

E: Cow manure is for lots of different things, actually.

S: It fertilizes half of our food.

E: Yeah. It's an accelerant.

J: I'm glad they found something else to do with cow poop.

E: And I think they used to use it in mortar in adobes or something as a thing they would build.

J: You ever been to a dairy farm? I've been to a couple. And they have poop pits.

E: Sure.

J: It's a big deal. It's a lot to manage.

E: Oh, you have to, yeah, corral that stuff.

J: So I agree with Cara. Yeah, the grass has a ton of cellulose in it. You know, cows are eating it. I mean, they've got to be able to digest cellulose, though. They have to. I mean, I'm sure they have multiple stomachs.

E: One of their four stomachs, right?

J: Or a four-chambered stomach or whatever, right? So, yeah, I think that one is science. I think that – I got to just say I don't know a lot about the micropipette. And I don't really know a lot about that. I mean, it wouldn't surprise me that they were able to do something like this. But it's very hard for me to comment on that. But the one thing that is sticking out to me, it's the one about the climate change and how they're saying it's the most significant driver of biodiversity loss in insects, right? I thought that pesticides were the number one killer of insects. I don't know about climate change having a massive effect yet on insects. I'm sure it's going to. I just don't think we've hit that marker yet for their habitats. So I think that one's a fiction.

S: All right, so you guys are nicely spread out. So we'll take these in order. Number one, scientists have developed a micropipette capable of delivering ions only without fluid to a single neuron. Bob, you think this one is the fiction. Everyone else thinks this one is science. And this one is science. So you're happy, Bob. It's science.

B: Cool, man.

S: Yes. So there's a couple of things here that are new. One of this is smaller than any previous micropipette. And they designed it specifically because they want to be able to manipulate the environment both inside and outside of a single brain cell. Not just the neurons, but also the glia.

C: That's cool.

S: Because they haven't really been able to study that before. But the other bit, which none of you commented on, and Cara, you didn't comment on either, was the without fluid part. Like it's just delivering ions. It's not delivering ions in water or in fluid. It's just ions. The reason for that is because if you are studying the reaction of a neuron, let's say, to changing the potassium concentration outside the cell, but you're also injecting fluid at the same time, that also influences the environment.

C: Yeah, you'd have to calculate it perfectly.

S: And so many things happen. Pressure and whatever. So you can't really isolate the ions as the variable. But now they can. And so this is going to be a huge boon to research, especially with the glia, actually, even though I mentioned neuron. Because I just say with patch clamping, we can study the electrical activity of neurons. But glia are mostly, they're not electrically active. They are chemically active, right? And they're basically half the brain, right? Half of the cells in the brain are glia. And they're not just support cells. They are support cells, but they're not just support cells. They actually influence the functioning of the brain as well. But chemically more than electrically. And we haven't really been able to study it that well before this reason.

B: Really? Even now?

S: No, but it's limited for the reasons that I stated. Like we can't do the kind of like manipulating the environment in order to see how they respond, how they react to it.

B: Have there been any good discoveries with glia?

S: Yeah, there have been. But again, it's difficult because you have all these other variables that come into play. We haven't had the level of control we would like to have in order to like really control these variables. So anyway, this is like just taking that research to the next level. Where now we can manipulate the environment inside and outside of single cells with the ionic environment without having to introduce a lot of fluid as another variable. All right. Let's go on. Number two, a new extensive analysis finds that climate change is now the most significant driver of biodiversity loss in insects. Jay and Cara, you think this one is the fiction. Bob and Evan, you think this one is science. Now, of course, the key phrase here is a new extensive analysis. Whoever they used to think about what was the primary cause may be different now. And I think the idea is that climate change is now the most significant driver of biodiversity.

E: But?

S: But this one is the fiction.

C: Is it the other way around?

S: No, no.

C: It was climate change?

S: We're not there yet. Climate change is a contributor, but it's not anywhere near the biggest one.

E: Is it still pesticides?

S: It's not pesticides per se. It's a bigger concept. It's agriculture.

C: Oh, OK. So like pollution kind of or just like—

S: Well, it's—

C: Oh, yeah, because I also said like monocrop. Yeah, yeah, yeah.

S: Yeah, so monocrop. But not just that. It's basically habitat loss. That's the biggest single—

C: Yeah, of course. That makes sense.

S: That's the biggest single contributor is habitat loss because—

C: We're clear-cutting forest.

S: Yeah, we're clear-cutting land.

C: Just the one crop. Yeah, yeah.

S: And replacing it with monocropping or with agriculture.

E: And remember, there are a lot of insects.

S: Yes, there are.

E: I mean, a lot more than we think.

S: And then the insects that can thrive in that environment are the ones we kill, right? Because they're the pests.

E: Yeah.

S: We call them pests, and we try to kill them.

E: Oh, my gosh. We must be eliminating insects we don't even know they're there, and we're eliminating them.

S: Yeah. So there's a pretty significant loss of— So what the study showed was, first of all, yes, the biodiversity is taking a nosedive. But they actually separate out two different kinds of biodiversity, what they call taxonomic diversity and phylogenetic diversity. So it's not just a loss of diversity within a species. Actually, there's less evolutionary branching. You know what I mean? Like you're actually losing evolutionary branches so that you have fewer genera, fewer families, et cetera. It's pretty significant. You know, about 44% total insect species diversity in agricultural landscapes specifically. That's the amount of decline. So it's just land use is the big factor. And everything that goes along with that, of course, yes, absolutely, it's pesticides. It is monocropping. It is climate change now as well. All these things are just all stressors. But land use is the loss of habitat due to land use is the big one. Which means that engineers have developed a process for spinning industry-quality cellulose fibers from cow manure is science. So yes, so first of all, cows do digest cellulose. But Cara, you're correct in that it is also not the cows themselves but the microorganisms in their rumen that are doing it. That's why they have to have different chambers. They have to sit there so that the microorganisms can break down the cellulose.

J: Well, that goes for all mammals. You know, we have a flora that we can't live without.

S: Yeah, but we don't eat like the heavy cellulose. We don't eat grass, right?

E: We're not grass eaters.

S: Or leaves or things like that. We eat stuff that's easy to digest. We don't have the stomachs to do it.

E: Or we cook it, right? We process it.

S: Yeah. But some cellulose still survives. So there's undigested cellulose in cow manure. And they basically modified a preexisting technique. The same researchers, the same people developed about 10 years or so ago developed a technique that uses a jet. They call it pressurized spinning. But it's arranged vertically, like the jet stream is arranged vertically. Basically, all they found is that they have to just make it horizontal. And they got it to work with, they basically, you know, clean up the manure so that they just have just the cellulose left. And then they use now horizontal pressurized fiber spinning in order to turn that into, you know, actual cellulose fibers. And they were able to create what they call industry grade cellulose fibers using this technique. This is huge because this horizontal nozzle pressurized spinning technique can be very easily adapted and cost effective. And this kind of cellulose fibers are widely used in industry from all kinds of textiles and plastics and masks and all kinds of stuff. And so having another method, not just another method, but another source material, feedstock for creating these cellulose fibers could be huge. Yeah. Could be huge. So good job, Cara and Jay.

E: Yeah.

C: Yey, Jay.

E: Well done, folks.

J: Good job, Cara.

C: Yeah.

Skeptical Quote of the Week (1:53:57)

“Sit down before fact as a little child, be prepared to give up every preconceived notion, follow humbly wherever and to whatever abysses nature leads, or you shall learn nothing”  – T H Huxley, (description of author)

S: All right. Evan, give us a quote.

E: "Sit down before a fact as a little child. Be prepared to give up every preconceived notion. Follow humbly wherever and to whatever abysses nature leads or you shall learn nothing." Thomas Henry Huxley.

S: Evan, this was the quote in my yearbook, my school book at college.

E: No. Are you kidding me?

S: Nope. That was my personal quote.

E: I didn't know you knew this quote for that long.

S: Yeah.

E: From way back.

S: It's great. It's great. T.H. Huxley.

E: It's quite a quote.

S: He was something. Very skeptical philosopher. Darwin's mouthpiece, of course. Instrumental in promoting acceptance of evolutionary theory.

E: Yeah.

S: But also, yeah, just a great critical thinking, logical philosopher. Quotes like this indicate that.

E: The quote was suggested by a listener, Hannah. Hannah T. Thank you, Hannah.

S: Thank you, Hannah.

E: We appreciate that very much.

S: All right, guys. So when this episode goes up, you'll have one week to buy tickets for NOTACON. There's still time.

J: Less than a week.

C: But not much time.

E: Yeah, right? Yeah, not much time.

S: And we will do tickets at the door. So if you just want to show up, you can show up. But it does help if you buy tickets. We know how many people are going to be there. And the next episode will be coming out on the Saturday during the second day of NOTACON, essentially.

E: Yeah, we warp time and space to make that happen when we do live performances on a weekend.

S: And we'll be recording two live shows during NOTACON.

E: Oh, that's more reason to come out and see us.

S: Absolutely. All right. Well, we look forward to that. And thank you all for joining me this week.

C: Thanks, Steve.

J: Thank you brother.

E: Thank you, Steve.

Signoff

S: —and until next week, this is your Skeptics' Guide to the Universe.

S: Skeptics' Guide to the Universe is produced by SGU Productions, dedicated to promoting science and critical thinking. For more information, visit us at theskepticsguide.org. Send your questions to info@theskepticsguide.org. And, if you would like to support the show and all the work that we do, go to patreon.com/SkepticsGuide and consider becoming a patron and becoming part of the SGU community. Our listeners and supporters are what make SGU possible.

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