[RADIOLAB INTRO]

LOU GARCIA: What we have over the criminal is the criminal actually thinks he's destroyed all the evidence. It's never all destroyed. Ever, ever, ever, never.

ROBERT: This is Lou Garcia.

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

SOREN WHEELER: How many fires do you think you've seen?

LOU GARCIA: Oh, tens of thousands of fires.

ROBERT: You've seen tens of ...

LOU GARCIA: Yes, absolutely.

ROBERT: You, you, you? You yourself?

LOU GARCIA: Yeah.

ROBERT: When he tells me a story ...

LOU GARCIA: There was—this is a true story. I'm not gonna get too many details about it, but there was a fire in an area of New York City.

ROBERT: It was in an apartment building in the South Bronx.

LOU GARCIA: As I pulled up to this building ...

ROBERT: The fire was already over when Lou got to it.

LOU GARCIA: ... there were people in the street, and we're questioning people.

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

LOU GARCIA: Pouring water on the fire.

ROBERT: ... trying to get the fire out. This guy was really something!

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

ROBERT: So he walks into the apartment. He looks around, and he knows right away ...

LOU GARCIA: Where the fire started.

ROBERT: How?

LOU GARCIA: Well, you just look at the fire patterns.

ROBERT: And he could tell that the fire started, first of all, in the bedroom with a mattress.

LOU GARCIA: The mattress. The mattress. Now mattresses go up if you put a match to it.

ROBERT: Really?

LOU GARCIA: Yeah.

ROBERT: Don't you have to put gasoline on the mattress?

LOU GARCIA: No, no, no.

ROBERT: You can just put a match onto a mattress and it will catch ...

LOU GARCIA: Fire, yes. If you hold it there long enough, yeah.

ROBERT: And he also knew that the mattress had been placed upright against the wall.

LOU GARCIA: You could tell by the fire pattern that it was standing on end.

JAD ABUMRAD: Wow, he can even know what position the mattress was in?

LOU GARCIA: Yes, absolutely. Believe me.

ROBERT: So he meets the woman whose apartment this is.

LOU GARCIA: She shows up.

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

LOU GARCIA: It just so happens that ...

ROBERT: "He used to live with me, but I kicked him out."

LOU GARCIA: And he still had a key, by the way. And ...

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

LOU GARCIA: So now I'm questioning this fellow. I said, "By the way, did you buy that mattress?" And he said, "Yes, I did." "And you weren't sleeping on it anymore. Was someone else sleeping in the mattress in your place?" And he says, "Yeah, well, she had a boyfriend." I said, "Boy, I'd be pissed. How much did it cost you? Like $400, 500?" He said, "No, more than that. It was like $800"

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

LOU GARCIA: And he looks at me, and he said, "Well, you're not so smart." I said, "Why?" He goes, "I used a lighter." [laughs] I said, "Oh, you're right. I'm not that smart." Then they put the cuffs on him.

JAD: Okay, so that was an easy one. We're gonna have some harder ones coming up.

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

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

ROBERT: Well, there's a whole lot of abnormal things coming your way. This is Radiolab.

JAD: I'm Jad Abumrad.

ROBERT: And I'm Robert Krulwich.

JAD: Stay with us. Okay, so this first story is about delivering a diagnosis. Comes to us from producer Lu Olkowski . It's about two doctors who start with that phrase, "Something's not right here," and end up going on a crazy adventure after a cure for a deadly disease.

ROBERT: Which is that?

JAD: Pancreatic cancer.

ROBERT: Oh, that's not good.

LU OLKOWSKI: It is the most deadly cancer. This is the one that people have nightmares about.

JAD: Why? It's deadly how?

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

JAD: Wow, is it that fast?

LU: It usually is that fast.

JAD: And how did you find this out?

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

[ARCHIVE CLIP, Teri Brentnall: It's just a tremendous pleasure to be here today.]

LU: And, like, press conferences are kind of never amazing.

JAD: [laughs]

[ARCHIVE CLIP, Teri Brentnall: And I hope to unfold a story for you. I hope it will capture your attention.]

LU: But ...

[ARCHIVE CLIP, Teri Brentnall: It's a fascinating story.]

LU: But then I heard this incredible story.

[ARCHIVE CLIP, Teri Brentnall: About 10 years ago ...]

LU: One morning ...

[ARCHIVE CLIP, Teri Brentnall: A 40-year-old guy came into my clinic.]

LU: Mr. X.

[ARCHIVE CLIP, Teri Brentnall: I was just finishing my ...]

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

JAD: Wow, four uncles, three cousins, father, grandfather all die of pancreatic cancer?

LU: And this guy was sure he was next in line.

TERI BRENTNALL: His uncles and his father looked like the healthiest people in the world, and six months later they're dead.

LU: He was terrified.

TERI BRENTNALL: He came to me as an act of desperation.

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

TERI BRENTNALL: You can't even process anything. You're just like almost in a trance.

LU: She'd gone through that before.

TERI BRENTNALL: Completely and utterly alone.

LU: She was diagnosed with breast cancer when she was 34.

TERI BRENTNALL: It's a sense of falling. It's truly a sense of falling. The world slides away from you. You literally—it's almost like it disappears from underneath you.

LU: When she got the news, the first thing her doctor did, he was a friend of hers ...

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

LU: And so when she was sitting there with patient X, she knew exactly what to say.

TERI BRENTNALL: You have to step forward. You can't step back, you have to step forward. I was young then, and so I felt like I had fixed this thing. [laughs] I'll take that on. I can help you, I don't care how horrible it sounds.

JAD: What happens next?

LU: So Teri runs back to her office, an office she shares with another doctor, Mary Bronner.

MARY BRONNER: I'm Mary Bronner. I'm a pathologist.

TERI BRENTNALL: So I was like, "Mary, Mary."

LU: Says, "You won't believe this."

TERI BRENTNALL: "This guy, Mr. X walked into my office."

LU: And he has this outrageous, this crazy family history.

MARY BRONNER: This horrible problem.

TERI BRENTNALL: I was floored.

LU: Teri had never heard ...

TERI BRENTNALL: That pancreatic cancer could be inherited in families. I'd never heard of anything like that.

LU: Teri comes in and she's like ...

TERI BRENTNALL: I've gotta help this guy.

LU: "I have to figure out what's making these people sick, and Mary I need your help."

JAD: And Mary? What did she say?

LU: Well, she's a pathologist.

JAD: And what does it mean to be a pathologist?

LU: Well, she's the person who physically does the diagnosis.

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

LU: She spends her time looking at tiny pieces of Teri's patients smeared on little slides.

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

JAD: Does she interact with patients?

LU: Almost never.

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

LU: So you're like, "I gotta go do this."

TERI BRENTNALL: Come with me.

MARY BRONNER: As she usually does.

LU: How did you decide that Mary should join you?

TERI BRENTNALL: She's my science partner. That's it. [laughs]

MARY BRONNER: And I hopped in the car.

LU: So they decide in order to help this guy they need to go to where his family is.

TERI BRENTNALL: Drove across the mountains of Washington state. A long drive.

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

MARY BRONNER: And we arrive at the little tiny town in Eastern Washington.

LU: This little town called Elmo.

MARY BRONNER: They didn't even have—they're so small they don't have a single medical facility. So in order to do the blood draw we basically had to use a Subway sandwich shop in town.

JAD: Why Subway?

LU: Well they have great sandwiches. [laughs]

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

TERI BRENTNALL: We set up a little corner booth with our box of blood drawing supplies, and they sort of come in waves.

LU: Uncles, cousins, nieces, nephews.

MARY BRONNER: And they brought their kids.

TERI BRENTNALL: We filled that Subway sandwich shop.

JAD: How many in all?

LU: About 30.

MARY BRONNER: It was funny because they hadn't seen each other in a long time. So they're like, "Oh my God, I haven't seen you in 10 years!" It's like, wow, you guys only live like five miles apart.

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

MARY BRONNER: And I'm Mary Bronner.

TERI BRENTNALL: I'm a GI doctor.

MARY BRONNER: I'm a surgical pathologist.

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

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

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

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

LU: You have to remember Mary doesn't come face to face with patients very often.

MARY BRONNER: It's not something a pathologist does very frequently. Pathologists have a—I don't even know if I want to tell you this. This is sort of like the black side of pathology. [laughs]

LU: Black humor to get you through, or what do you mean?

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

LU: I spent an afternoon with Mary going through slides, looking at pancreatic tissue.

MARY BRONNER: This looks pretty ...

LU: Trying to figure out, like, you know, if this person has cancer or not. Dozens of patients.

MARY BRONNER: Now this is another case with a terrible, terrible cancer.

LU: And that's when I really kind of got it, like, why she'd want to keep herself distant.

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

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

LU: Well, once they got the blood they worked on it for about five years.

JAD: Five years, whoa!

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

MARY BRONNER: One molecule.

LU: ... molecule.

TERI BRENTNALL: That's all it comes down to.

LU: One tiny molecule, yes.

[ARCHIVE CLIP, Teri Brentnall: So our discovery is—we're titling it "Paladin mutation causes familial pancreatic cancer and suggests a new cancer mechanism."]

LU: So they write a paper, they have a press conference.

[ARCHIVE CLIP, Teri Brentnall: First of all I want to acknowledge ...]

LU: And they celebrate.

JAD: So in the end do they find a cure?

LU: Well, no. Not yet, not yet. They're working on it though. But ...

JAD: Can they at least test for it now?

LU: Well, they can test but ...

JAD: What?

LU: You know, most pancreatic cancer isn't hereditary like this. This is actually a small subset.

JAD: Huh.

LU: Mm-hmm. Yeah.

JAD: So where does that leave Mary and Teri? I mean, where are they now?

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

JAD: Mm-hmm.

LU: But she's really tired, and thinks about it a lot.

TERI BRENTNALL: You know, the stakes are so high in this. Sometimes it's almost unbearable, sometimes I think I should quit.

LU: Really?

TERI BRENTNALL: Yeah, totally. I've talked to Mary about it.

MARY BRONNER: Yeah. She has. But you know what? I know she'll never stop doing it. Right Teri?

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

MARY BRONNER: Yeah.

TERI BRENTNALL: And then the worst thing that does is, "Oh, I killed the bush." We're like, "You loser. You killed the bush." [laughs] Yeah.

JAD: Thanks to Lu Olkowski for reporting that story.

ROBERT: The next story concerns a dad and his little boy. There's something about this little boy that is not quite right. But there's something about the dad that doesn't want to say so.

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

ROBERT: And I'm Robert Krulwich.

JAD: Radiolab will continue.

[MARY BRONNER: Radiolab is funded in part by the Alfred P. Sloan Foundation, the Corporation for Public Broadcasting and the National Science Foundation.]

JAD: Hey I'm Jad Abumrad.

ROBERT: And I'm Robert Krulwich.

JAD: This is Radiolab. This hour our topic is diagnosis.

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

BYRON FROWNER: Hello.

GREGORY WARNER: Hi.

BYRON FROWNER: Gregory?

GREGORY: I'm NPR's Gregory Warner.

BYRON FROWNER: Nice to meet you.

GREGORY: Nice to meet you.

GREGORY: Okay, just so you know it took me over a year ...

GREGORY: All right you can sit down and ...

GREGORY: ... to finally get an interview with Byron Frowner.

JAD: Yeah.

GREGORY: I'm wondering if the air conditioner ...

BYRON FROWNER: I can turn it off.

GREGORY: He's the dad in this story, and I'm up in his apartment in the South Bronx.

BYRON FROWNER: You'll have to excuse all this loose paperwork.

GREGORY: Are you moving out, or are you ...

BYRON FROWNER: No, it might look like that.

ROBERT: It was that messy?

BYRON FROWNER: I don't want to ...

GREGORY: Yeah.

GREGORY: No, that's good.

GREGORY: Boxes everywhere, crates, piles of stuff.

BYRON FROWNER: Oops. Okay.

GREGORY: Oh no, don't let go.

BYRON FROWNER: Don't worry about it.

GREGORY: Are you sure?

BYRON FROWNER: Yeah.

GREGORY: I'm sorry.

BYRON FROWNER: I'll clean it up.

GREGORY: It's in disarray. There's ...

ROBERT: So who is this guy?

BYRON FROWNER: I'm a retired electrical engineer.

GREGORY: And he worked for the subway most of his life.

BYRON FROWNER: Now I consider myself a science researcher.

GREGORY: And at 71 years old, he's basically teaching himself ...

BYRON FROWNER: Quantum physics. That's what all the books and stuff you see around. I love that stuff.

GREGORY: And he's written this book called ...

BYRON FROWNER: Einstein's Error. Criticizing special relativity, Einstein. I sent it to the New York Academy of Scientists, Caltech, MIT, Harvard, Stephen Hawking. Still waiting for him to get back.

GREGORY: Most people just ignore him.

BYRON FROWNER: These are the ravings of a maniac.

GREGORY: But then he points to this letter on the wall from ...

BYRON FROWNER: Neil deGrasse Tyson.

GREGORY: I know that name.

GREGORY: This major scientist.

ROBERT: Yes. The head of the Hayden Planetarium in Manhattan.

GREGORY: Exactly, yeah. And it says ...

BYRON FROWNER: "How dare you? You're just an engineer."

GREGORY: And he's beaming.

ROBERT: Why?

GREGORY: Why do you smile when you talk about that letter from Neil deGrasse Tyson?

BYRON FROWNER: Because I know how foolish it is. Einstein, they didn't even want to read his paper. They said, "Who is this guy—upstart? He's just a patent examination clerk in Bern."

GREGORY: Byron Frowner is a man who's proud to go against the grain.

BYRON FROWNER: I do the—what other people do I don't really do.

GREGORY: And that's especially true with how he raised his sons.

BYRON FROWNER: So now Gregory, you're going to do some kind of a story on Emanuel?

GREGORY: His youngest son.

GREGORY: Right.

GREGORY: Emanuel.

BYRON FROWNER: Okay.

GREGORY: And that's why I'm here.

GREGORY: Mostly focusing on ...

GREGORY: To question him about how he raised his son.

BYRON FROWNER: All right. I'd be glad to.

GREGORY: Okay, great.

GREGORY: So here's Emanuel.

EMANUEL FROWNER: Hi, I'm Emanuel Frowner.

GREGORY: Emanuel, could you take a drink of water for me?

EMANUEL FROWNER: Okay. Thank you.

GREGORY: No, don't thank me. Yeah, take as many drinks of water as you want.

GREGORY: He's 28.

GREGORY: So what things are you good at, Emanuel?

EMANUEL FROWNER: Writing essays, and making sure they are grammatically correct.

GREGORY: Mm-hmm.

EMANUEL FROWNER: Bowling.

GREGORY: And as you can hear ...

EMANUEL FROWNER: Analyzing stuff

GREGORY: ... there is something going on with him.

EMANUEL FROWNER: And—and not talking that much, I guess.

GREGORY: Now, if you ask dad he'll say ...

BYRON FROWNER: Emanuel's an excellent student, our future Nobelist.

GREGORY: He's gonna win a Nobel Prize.

BYRON FROWNER: You never know.

GREGORY: But, if you ask Blair ...

BLAIR FROWNER: I'm Blair Frowner.

ROBERT: Who's that?

GREGORY: Emanuel's half brother.

BLAIR FROWNER: I'm about 20 years older than Emanuel.

GREGORY: He'll tell you that even as a little kid ...

BLAIR FROWNER: Very little.

GREGORY: Like five years old ...

BLAIR FROWNER: There was something odd, and I just didn't know what it was.

GREGORY: It was a bunch of little things.

BLAIR FROWNER: Yeah.

GREGORY: Like he'd look at you really weird.

BLAIR FROWNER: Kind of like a doll face expression. He could stare at me without blinking for 15 minutes at a time. And I would notice, because you didn't blink once. Then there was the speech.

EMANUEL FROWNER: I did not talk as much as other people.

BLAIR FROWNER: There was something going on with Emanuel, but I did not have a word for it. And so I pushed several times to get speech therapy.

GREGORY: But every time he did, dad would just say ...

BYRON FROWNER: Are you kidding? He may have trouble, stumbling and stammering but ...

BLAIR FROWNER: He'll grow out of it. I stuttered too. Blair. you also stuttered.

BYRON FROWNER: Einstein, he didn't speak a word 'til he was six. He was considered retarded in school.

BLAIR FROWNER: He would say that this was some temporary problem that would pass.

BYRON FROWNER: I didn't see anything that was screaming out for attention. He was doing his work. He was interested in the Knicks. We would go out endlessly in cold weather to the park, and it seemed like things were okay.

GREGORY: What about Emanuel?

EMANUEL FROWNER: Well, I knew that I was a nicer person.

GREGORY: A nicer person?

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

GREGORY: So as long as Emanuel was a little kid this wasn't such a big deal, but then he got older.

BLAIR FROWNER: He was around 10 years old.

EMANUEL FROWNER: It was, I think, at the point where other people would point it out.

GREGORY: What did they say?

EMANUEL FROWNER: Well, I have been called retarded and idiot savant, the N word and stuff.

BYRON FROWNER: They lost the innocence of the elementary school.

GREGORY: Emanuel would come home with bruises on his arms.

EMANUEL FROWNER: Yeah.

GREGORY: Yeah.

BYRON FROWNER: It was something that I constantly thought about and worried about.

BLAIR FROWNER: I said, "Yeah, well it would be really good for him to get professional help with that."

GREGORY: But if you asked Dad he said the problem wasn't Emanuel.

BYRON FROWNER: No. It was all the other people.

GREGORY: The bullies.

BYRON FROWNER: The group. And this neighborhood, it was hard. There was fighting, constant fighting right down the street over here. People involved with crack. These are big guys, you know? I felt that it could have been a dangerous situation.

GREGORY: So his solution ...

BYRON FROWNER: I decided that I wanted to teach Emanuel home school.

GREGORY: ... was just to pull his son out of school.

EMANUEL FROWNER: Yeah.

GREGORY: And how do you feel about this at the time?

EMANUEL FROWNER: Well, I really didn't know.

BYRON FROWNER: Up here ...

GREGORY: So we're looking in a closet here.

BYRON FROWNER: I thought that whatever way he's kind of turned in ...

BYRON FROWNER: This is a binder from one of his classes.

BYRON FROWNER: ... that if he got bullied and tormented in going to school that it would turn him further in.

BYRON FROWNER: Let's see what this is.

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

GREGORY: It was a big deal for dad.

GREGORY: You hadn't home schooled anybody else before, right?

BYRON FROWNER: No, I had to get books. I had to go meet the principal.

GREGORY: He left his job, submitted a curriculum to the school.

BYRON FROWNER: And I had to register with the state of New York.

GREGORY: Created this syllabus for his son.

BYRON FROWNER: Grade 10, integrated math course.

GREGORY: And they would wake up each morning.

BYRON FROWNER: Rational numbers, geometry ...

GREGORY: Do their lessons.

BYRON FROWNER: ... isosceles triangle, equilateral triangle.

GREGORY: Have some lunch.

BYRON FROWNER: This is the work that he did at home.

GREGORY: And in the afternoon they'd go bowling.

ROBERT: Bowling?

GREGORY: Emanuel was an awesome bowler. His dad would videotape him.

[ARCHIVE CLIP, Byron Frowner: Today is Tuesday, December ...]

[ARCHIVE CLIP, Emanuel Frowner: 28th.]

[ARCHIVE CLIP, Byron Frowner: 28th. 1993.]

[ARCHIVE CLIP, Emanuel Frowner: Is it taping?]

GREGORY: It's weird footage. It's weird to watch because Emanuel's such an incredibly good bowler.

[ARCHIVE CLIP, Byron Frowner: Yeah, he took it out.]

GREGORY: But ...

[ARCHIVE CLIP, Byron Frowner: Beautiful shot!]

GREGORY: ... he's always by himself. Tape after tape of nothing but Emanuel. Nobody else in the picture.

[ARCHIVE CLIP, Byron Frowner: Now listen ...]

EMANUEL FROWNER: I would fantasize about going on a tour and winning some titles and stuff.

[ARCHIVE CLIP, Byron Frowner: Beautiful!]

GREGORY: Did you think about joining any youth league or anything like that?

EMANUEL FROWNER: Well I kind of—well, I vaguely thought about it, but for some reason my dad did not want me to.

[ARCHIVE CLIP, Byron Frowner: I think you swung out. I think so.]

ROBERT: Meanwhile, his brother is just ...

GREGORY: Blair's in Canada.

ROBERT: At a distance.

GREGORY: Yeah. He followed a girl there. And one day he picks a book off the shelf.

BLAIR FROWNER: The DSM.

GREGORY: And the DSM is?

BLAIR FROWNER: The Diagnosis Statistical Manual of Mental Disorders.

GREGORY: Okay.

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

GREGORY: Right there on the page ...

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

GREGORY: The problem is every time he tried to call his dad ...

BLAIR FROWNER: Dad, what do you think?

GREGORY: His dad would say ...

BLAIR FROWNER: Just stop whining.

GREGORY: Go away.

BLAIR FROWNER: He'll just go through this.

GREGORY: And he shut him out.

BLAIR FROWNER: I mean, he basically cut communication.

BYRON FROWNER: I know my son.

EMANUEL FROWNER: He would always tell me that whatever I had would go away when I was an adult.

GREGORY: What does an adult mean? Does that mean 18?

EMANUEL FROWNER: 20 maybe. 20, let's say.

GREGORY: Okay. So you thought as soon as I reach the age of 20 then I won't have these problems?

EMANUEL FROWNER: Yeah.

GREGORY: So did you wake up on your 20th birthday and think ...

EMANUEL FROWNER: I thought that maybe things would change right away, but they didn't.*

GREGORY: After that, Emanuel says he got really depressed. And that's how things might have stayed, until Dad has a heart attack. Blair comes to the hospital, finds Dad unconscious on the bed, and he realizes, "This is my big chance."

BLAIR FROWNER: Because he was not in a position to intervene.

GREGORY: And you're thinking ...?

BLAIR FROWNER: I'm thinking the first thing that's gonna happen is that we're gonna get a diagnosis because we had been waiting for it for so many years, or—26 older or whatever.

EMANUEL FROWNER: I think I was like 25, maybe.

BLAIR FROWNER: He's gonna get help, you know? He has to get help.

GREGORY: New Years Eve, 2005.

[ARCHIVE CLIP, Blair Frowner: All right, so where are we coming into now?]

[ARCHIVE CLIP, Emanuel Frowner: We're at 42nd Street.]

GREGORY: Times Square.

BLAIR FROWNER: Times Square is one of Emanuel's favorite areas to hang out, and I figured I wanted it to be on his turf.

GREGORY: So they're outside, the crowd is just beginning to arrive.

BLAIR FROWNER: It was starting to snow a little bit.

EMANUEL FROWNER: And rain some too.

BLAIR FROWNER: Yeah.

GREGORY: And Blair turns to Emanuel, and he says ...

BLAIR FROWNER: Have you ever heard of autism? I said, "I highly suspect that you have some form of autism, and I want us to find some way for you to get a diagnosis."

[ARCHIVE CLIP, Emanuel Frowner: Ten, nine, eight ...]

BLAIR FROWNER: Oh, and I said ...

[ARCHIVE CLIP, Emanuel Frowner: Seven, six ...]

GREGORY: Don't breathe a word of this to dad.

[ARCHIVE CLIP, Emanuel Frowner: Four, three, two, one! Happy new year!]

GREGORY: Doctor, how do I pronounce your name?

DOCTOR: Anagnostin.

GREGORY: And pretty soon after New Year's ...

GREGORY: And where are you from?

DOCTOR: I'm Greek.

GREGORY: ... Emanuel gets his diagnosis.

DOCTOR: It was right here on this couch. I did get a feeling from our beginning of the interaction that he was going to meet criteria for autism.

GREGORY: And a month later ...

EMANUEL FROWNER: She told me that I was on the autistic spectrum.

GREGORY: ... it was official.

[ARCHIVE CLIP, Emanuel Frowner: Okay. Efumble ...]

[ARCHIVE CLIP, Doctor: Even more air.]

[ARCHIVE CLIP, Emanuel Frowner: Efumble.]

[ARCHIVE CLIP, Doctor: Great, good.]

GREGORY: And so at the age of 26 ...

[ARCHIVE CLIP, Emanuel Frowner: Assemble.]

[ARCHIVE CLIP, Doctor: Mm-hmm.]

GREGORY: ... finally ...

[ARCHIVE CLIP, Emanuel Frowner: Audible.]

[ARCHIVE CLIP, Doctor: More air.]

GREGORY: ... his life completely changed.

[ARCHIVE CLIP, Doctor: Audible.]

[ARCHIVE CLIP, Emanuel Frowner: Audible.]

GREGORY: So I gave him a tape recorder to record his life.

[ARCHIVE CLIP, Emanuel Frowner: Hello, it's me Emanuel.]

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

[ARCHIVE CLIP, Emanuel Frowner: Adaptations.]

GREGORY: And started making friends.

[ARCHIVE CLIP, Emanuel Frowner: What do I say?]

[ARCHIVE CLIP, Blair Frowner: Well, anything.]

[ARCHIVE CLIP, Emanuel Frowner: Hello. Hey Jason. Peace out.]

GREGORY: He got a girlfriend.

[ARCHIVE CLIP, Emanuel Frowner: Hey, it's me Emanuel once again. And there's one lady that I haven't talked about yet named Norma. And we went to Central Park and we took pictures, and it was great.]

ROBERT: But wait a sec. I thought that people who were diagnosed with autism, the definition is they don't want to socialize.

EMANUEL FROWNER: Well, it's not because I don't want to, but it's just hard to do, you know?

GREGORY: But here's the thing about Emanuel. He says his whole new life? He hasn't told dad about any of it.

ROBERT: Not anything?

GREGORY: Not the girl, the friends, the diagnosis. His dad doesn't know anything is different.

GREGORY: So how long have you been keeping it a secret?

BLAIR FROWNER: It's been since 2005. right?

EMANUEL FROWNER: Yeah.

GREGORY: So basically for the last two years Emanuel's been leading this double life. Outside he's this person with autism, then he comes home, nothing's wrong.

GREGORY: Why?

EMANUEL FROWNER: Well, I'm just afraid that Daddy won't really believe it.

GREGORY: But he knows he's gotta tell his dad who he really is.

EMANUEL FROWNER: Yes I do.

GREGORY: And he keeps saying he will.

EMANUEL FROWNER: I'm gonna say within a month.

GREGORY: Soon.

EMANUEL FROWNER: I'm not quite sure. I am a little bit nervous about telling him about my autism. Maybe within a few minutes or so. Let me tell him in like two weeks or so. Another day or so. I might tell him after I meet Blair. I'm gonna probably tell him—well, tomorrow. Maybe. I don't know yet. Maybe I'm just thinking about it a little bit too much, I don't know.

GREGORY: And then finally one night ...

[ARCHIVE CLIP, Emanuel Frowner: Hi, it's me. I just want to say that I told my dad about my diagnosis.]

EMANUEL FROWNER: I said, "I really have something important to say, and don't get angry." And then I told him that I was diagnosed with Asperger's Syndrome. And he asked me what it was, and then I told him it is high-functioning autism.

BYRON FROWNER: I was shocked. That would be a good way to put it.

GREGORY: So do you think he has Asperger's?

BYRON FROWNER: Yes. Yes, I do. When I look at this syndrome for a lot—good parts of it's Emanuel, but I never at any point felt that Emanuel was in need of any deep psychological or psychiatric help.

GREGORY: But I mean, what makes you qualified to say that?

BYRON FROWNER: Just being a loving parent.

GREGORY: As I'm talking to him, we're sitting there on the couch. In front of us on the coffee table is all of Emanuel's notebooks from age five onward.

BYRON FROWNER: And they're really good stuff. I mean it's stuff that you and I would write.

GREGORY: And he saved it all. But the question that I feel like I gotta ask ...

GREGORY: Byron, I just have one more question on my list if I could ask you that one.

GREGORY: ... is now that you know that there is something wrong with your son, that there always was this disorder, that it's incurable, do you think you did the right thing?

GREGORY: Do you wish that he had gotten the diagnosis earlier?

BYRON FROWNER: No.

GREGORY: Why?

BYRON FROWNER: Because I think that he's better off at this point in time.

GREGORY: Why wouldn't it make a difference to know earlier why you're acting so strangely?

BYRON FROWNER: I didn't want Emanuel to get a diagnosis that would put him in a box, like a label.

GREGORY: And then Dad says to me, "Look, I mean if I had let the school give him some kind of diagnosis, they would have thrown him in special ed."

BYRON FROWNER: And say, "Oh, he's a retard. Look, he can't even talk."

GREGORY: "I mean, that would have destroyed him."

BYRON FROWNER: It would cause irreparable damage.

GREGORY: I asked the doctor, like, was there any truth to that?

GREGORY: If Emanuel was put into special ed hypothetically ...

DOCTOR: If he was in a District 75 class ...

GREGORY: The technical word for special ed.

DOCTOR: ... he would not have reached his academic potential. He is a graduate from St. John's with a degree in psychology. Kids who graduate District 75 don't do that.

GREGORY: Just to put that in perspective, Emanuel comes from a neighborhood where about 10 percent of the kids ever graduate college.

EMANUEL FROWNER: And my GPA was like 3.4 and change.

ROBERT: Wow!

GREGORY: And he's got Asperger's.

GREGORY: So now what? We're kind of in the opposite. We're vindicating what his father did, right?

DOCTOR: Well, in terms of his academic achievement, his father did the right thing. The problem with his dad's choice, and he had no way of knowing at the time, was the lack of peer groups, which he missed out on.

GREGORY: It seems like a cruel choice but ...

DOCTOR: Yeah, it's a cruel choice.

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

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

ROBERT: That story from our correspondent Gregory Warner.

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

[LISTENER: This is Bonnie calling from Boston, Massachusetts. Radiolab is supported in part by the National Science Foundation, and by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world. More information about Sloan at www.sloan.org.]

JAD: Hello, I'm Jad Abumrad.

ROBERT: And I'm Robert Krulwich.

JAD: This is Radiolab. This hour we're gonna be talking about diagnoses.

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

JAD: Yeah, because you can see the break right there.

ROBERT: But, let's suppose you came into my office and you were sad.

JAD: Mmm.

ROBERT: You tell me that your sex drive is down.

JAD: Hey!

ROBERT: I'm the doctor, so it's just between you and me.

JAD: All right.

ROBERT: Well right away, my learning tells me that you may be a candidate for depression. But how do I know that you're depressed?

JAD: What do you mean, "How do I know?" We talk about it. You just said.

ROBERT: Well, you can't measure sadness or depression. You can't go to a test tube and count anything.

JAD: Right.

ROBERT: It's not hard science.

JAD: Yeah, because ...

ROBERT: Until now! What if I put you in, you know, one of those FMRI machines that we've talked about so often?

JAD: Yeah.

ROBERT: I snap a picture of your brain in action, and I look at it. And from your picture I say, "You are depressed."

JAD: You're gonna tell me I'm depressed just from looking at a picture of my brain?

ROBERT: Yes.

JAD: What? No way.

ERIC KANDEL: Look, it's now here.

ROBERT: Photographic diagnosis of mental illness.

ERIC KANDEL: This is happening. There is no question.

ROBERT: And that, by the way, is Eric Kandel, a professor at Columbia University who just happens to have won [coughs] the Nobel Prize for Medicine.

ERIC KANDEL: Let me give you a little historical background.

ROBERT: Did you get a Nobel? I don't think you did.

JAD: [laughs] I still don't believe you. And what, just because he's got a Nobel Prize, I'm gonna suddenly turn around and ...

ROBERT: No, no, no. You're not. So let's do this step by step, okay?

ANNOUNCER: Step one.

ROBERT: Imagine you're slipping into an FMRI machine, okay?

JAD: All right.

ROBERT: Now I want you to just look at my face.

JAD: Why?

ROBERT: Is that so difficult?

JAD: No, I just want to know where this is going. Anyway, I'm looking at your face.

ROBERT: So now that you're looking at my face ...

ERIC KANDEL: Different regions of the brain, they become active.

ROBERT: There are cells in your brain that are saying, "I know him."

ERIC KANDEL: The cells are more active. They need energy. Just like when you run, you have to breathe fast.

ROBERT: And to get the energy ...

ERIC KANDEL: Your heart pumps more blood.

ROBERT: The body sends a rush of fresh blood to that particular group of cells. And because the blood has iron in it, the magnet in the brain scanner can see the iron, and therefore see the blood flow and take pictures of it—many, many pictures in real time.

ERIC KANDEL: I'll show you a very nice example of this.

ROBERT: Eric's now heading off across his ample office with an extraordinary view of the Hudson Valley.

ROBERT: And he brought over a picture of a human brain with different colors in different areas. And he told me, when you look at a face ...

ERIC KANDEL: When you imagine the face, this area lights up.

ROBERT: You're pointing to an area of the brain?

ERIC KANDEL: An area of the brain.

ROBERT: Up above your—on your forehead kind of.

ERIC KANDEL: That's right. That's right. If you look at a house, some other area lights up, but this area does not light up. You look at another face, this area lights up again.

JAD: Every time you see a face, the same area?

ROBERT: Yep.

JAD: Hmm. But you haven't told me anything about emotions yet.

ROBERT: That's true. So let's move onto step ...

ANNOUNCER: Two.

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

ERIC KANDEL: ... an area deep in the brain that is concerned with emotion.

ROBERT: Called the amygdala.

ERIC KANDEL: [clears throat]

ROBERT: Now very recently ...

ERIC KANDEL: A number of people have looked at the amygdala while looking at faces, and it's extremely interesting.

ANNOUNCER: Step three.

CYNTHIA FU: Okay.

ROBERT: I'm gonna take you now to London.

CYNTHIA FU: Hello?

ROBERT: Hi.

CYNTHIA FU: Yeah, hi.

ROBERT: Yeah, that's good. That's good.

JAD: Hey, who's this?

ROBERT: Oh, right. Sorry.

ROBERT: Who are you?

CYNTHIA FU: I'm Cynthia Fu. I'm a psychiatrist at The Institute of Psychiatry, King's College, London.

ROBERT: And are you, like, in your 30s or your 40s or your 50s?

CYNTHIA FU: [laughs] Is this is part of the interview?

ROBERT: [laughs] Because I ...

JAD: Rude!

ROBERT: No, I wanted to establish that she came into psychiatry ...

CYNTHIA FU: I'm trying to think. When did I graduate medical school?

ROBERT: ... at a very critical time.

CYNTHIA FU: I finished my training in '97, my training in psychiatry in '97.

ROBERT: That's 1997, when the FMRI machines were first becoming available. And so Cynthia was able to do a rather amazing study.

JAD: What?

CYNTHIA FU: In this study ...

ROBERT: ... she got together a group of people who were clinically depressed.

CYNTHIA FU: Depressed people.

ROBERT: And then another group of people who were normal.

CYNTHIA FU: Healthy people.

ROBERT: And she put them in the brain scan machine and showed them ...

CYNTHIA FU: ... facial expressions.

ROBERT: ... faces.

CYNTHIA FU: Ranging from more neutral expressions to more sad expressions.

ROBERT: So they saw a sad face and then a neutral face and then a sad face?

CYNTHIA FU: That's right.

ROBERT: And what the person in the machine was supposed to do is ...

CYNTHIA FU: ... to look at these faces, and decide whether it was a man or a woman's face.

JAD: Huh? What does that have to do with anything?

ROBERT: Because—because while they were doing that ...

CYNTHIA FU: While they're making this decision, the emotion of the face is being processed automatically.

ROBERT: The amygdala sees the emotion on the faces at that moment, and the machine ...

CYNTHIA FU: ... is like "Tick, tick, tick, tick, tick." [laughs] And there were hundreds of pictures.

ROBERT: Tenth of a second to tenth of a second to tenth of a second.

CYNTHIA FU: That's right.

ROBERT: Did you see a difference between the people who were depressed and the people who were normal?

CYNTHIA FU: Yes.

ROBERT: Was it a significant difference or a just barely difference?

CYNTHIA FU: As a group, it was a significant difference.

ROBERT: And now she takes the big step.

ANNOUNCER: Step four.

ROBERT: From the pattern she sees in bunches of people, she feeds all those patterns into a computer ...

CYNTHIA FU: ... called machine learning. Told the program, "This is a pattern of brain activity in depressed people, and this is a pattern of brain activity in healthy people." And then ...

ROBERT: ... she shows the computer a brain scan of a new person.

JAD: So this is someone the computer's never met before?

CYNTHIA FU: Exactly.

ROBERT: And she did this a bunch of times.

CYNTHIA FU: Right. A whole bunch of people.

ROBERT: And each time, the computer tries to guess. Is this new person ...

CYNTHIA FU: ... depressed or not?

JAD: Oh!

ROBERT: And what happened?

CYNTHIA FU: More than 85 percent of the time, 86 percent of the time, the algorithm correctly diagnosed whether that person was depressed or healthy.

ROBERT: With just a brain scan, a computer and a patient, no doctor needed, Cynthia's computer got the diagnosis right 86 percent of the time. A computer.

CYNTHIA FU: So we saw the results. It was like, "Wow, this is amazing!"

JAD: Wait a second. Has she repeated this?

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

CYNTHIA FU: The potential is fantastic.

ERIC KANDEL: Psychiatry is going to be absolutely revolutionized by this.

CYNTHIA FU: I think this method can be applied to any psychiatric disorder.

JAD: Any?

ROBERT: Autism.

ERIC KANDEL: Schizophrenia.

ROBERT: Obsessive-compulsive disorder.

JAD: No way! Come on!

ERIC KANDEL: Why not? Every one of these illnesses ultimately must have an anatomical basis. Every one of these illnesses.

ROBERT: So this means that it will soon or one day be possible for a patient to come in, and you take a picture of him in real time—or of her, and you will have a diagnostic tool. That's what you're saying.

ERIC KANDEL: Absolutely. Absolutely.

JAD: You mean to tell me that they're gonna put people in machines and just go boop!

ROBERT: No, no. Wait, wait. This is not a casual thing. You go to the doctor, you tell the doctor that you're feeling a certain way. The doctor will talk to you, and then he would come to you and say, "Well, my learning and the test tells me that you're ill." So that's all that's happening here is now the mental doctor will say ...

JAD: Okay. Yeah, sure, sure, sure. But there's nothing—there's nothing in this that feels invasive to you?

ROBERT: Well, obviously ...

JAD: It's tunneling into the deep depths of your personhood.

ROBERT: No you're not. No, this is—if you believe that mental illness is a mental illness, it is a structural condition which can be fixed. So it's not the deep inner you, it's the broken you.

JAD: So it's like the broken arm thing you started off with.

ROBERT: Yes.

JAD: So you would put the two side-by-side?

ROBERT: I think I would. And then of course you get to the next ...

JAD: No. Come on, Robert. I mean, human beings are way too messy for that. They're too messy for it to be that easy. No. No way.

ROBERT: So you think this is out of science's reach? Really? It's just too ...

JAD: There's a part of me that does think it is out of science.

ROBERT: I think it's because you think—you think that they're looking deep inside you. That's what you don't like.

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

ROBERT: What if you're feeling sad and sick? Don't you want to get better?

JAD: Yes, but I enjoy the comfortable ambiguity that would come from a situation like sitting in a therapist's office and saying, "Well, how am I feeling? I'm feeling this way or that way." And in the messiness of trying to describe how you're feeling, there's a vast landscape of things that can happen, choices you can make, therapies you can pursue.

ROBERT: But let me just do it this way. Let's say you are sick and you know that you're sick—machine or no, okay?

JAD: Uh-huh.

ROBERT: If you are feeling badly, wouldn't it be nice if a machine could help you find the right kind of help?

JAD: What do you mean?

ROBERT: Well, Eric took me through a little thought experiment.

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

JAD: Oh, so you can audit the doctor.

ROBERT: Audit the doctor, and give you evidence that it's working or no.

JAD: Okay, I think I'm a little bit on board.

ROBERT: Yay! [laughs]

JAD: I can give you 10 percent buy-in now.

ROBERT: Okay.

JAD: So how far off is this stuff? Is it gonna come soon?

ROBERT: This is very early in the game, obviously, but I did ask him, like, how far into the future are we talking about here?

ROBERT: Soon? Or after—long after you're dead?

ERIC KANDEL: I'm gonna be around a long time.

ROBERT: [laughs] But the question stands: will you make it to see that people will actually have ...

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

ROBERT: So you're saying we got to this story too early. That's what you're suggesting.

ERIC KANDEL: Just right. It's not gonna be interesting 20 years from now, it'll be obvious.

JAD: Or in 20 years, it'll be obvious that we were wrong.

ROBERT: [laughs]

JAD: Okay? That's a real possibility, because what we don't know is a lot. Is vast.

ROBERT: Yeah.

JAD: And I want to tell you a story now about just how wrong people can be.

ROBERT: Okay.

JAD: It begins with a mystery.

ROBERT SAPOLSKY: Sudden Infant Death Syndrome. A perfectly healthy child goes to sleep and dies during the night.

JAD: It's about the worst thing that can happen to a parent. And each year it does happen about 7,000 times. And still no one knows why. Oh, and by the way, that was Robert Sapolsky. He's a ...

ROBERT SAPOLSKY: Professor of neuroscience at Stanford University.

JAD: And Sapolsky tells this story of the moment SIDS was diagnosed for the first time—or at least classified—in a terrible mistake that was made.

ROBERT SAPOLSKY: Around 1900 or so, people were beginning to recognize this is a disease entity, and nobody knew what was up. So people decided let's go dissect SIDS kids.

JAD: Meaning when a baby would die, they would perform an autopsy.

ROBERT SAPOLSKY: Exactly.

JAD: You know, check the baby's insides.

ROBERT SAPOLSKY: And see if there's anything different in them from normal kids.

JAD: That seems logical.

ROBERT SAPOLSKY: Absolutely.

JAD: They'd measure the size of the baby's lungs.

ROBERT SAPOLSKY: Yup.

JAD: That looked normal. And then they'd measure the size of the heart.

ROBERT SAPOLSKY: Yup.

JAD: Nothing strange there. Stomach.

ROBERT SAPOLSKY: Yup.

JAD: Kidney.

ROBERT SAPOLSKY: Yup.

JAD: Liver.

ROBERT SAPOLSKY: Yup.

JAD: Those are all fine. Then they would look in the throat.

ROBERT SAPOLSKY: They'd look in there and they'd say, "Oh, my God, these SIDS kids, they have enormous thymus glands!"

JAD: The thymus!

ROBERT: The thymus!

JAD: What is the thymus, you may wonder?

ROBERT: [laughs] Yeah, what is a thymus?

JAD: Well, it is a little tiny pink gland that is right here behind your collarbone at the base of your throat. And its job is to help you fight disease.

ROBERT SAPOLSKY: It makes one type of cell critical to your immune system.

JAD: Especially in times of stress.

ROBERT: Hmm.

JAD: In any case, normally this little organ is about the size of a tiny tube of toothpaste, like the travel kind.

ROBERT: Uh-huh.

JAD: But in these SIDS kids, it was ...

ROBERT SAPOLSKY: Huge. Humongous. Enormous.

JAD: ... twice the size.

ROBERT SAPOLSKY: Exactly.

JAD: And since the thymus is dangerously close to the windpipe, doctors came up with a hypothesis.

ROBERT SAPOLSKY: A perfectly reasonable hypothesis.

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

ROBERT: Uh-huh.

JAD: Well, that gland might ...

ROBERT SAPOLSKY: ... press down on your trachea and suffocate you during the night.

ROBERT: Oh!

JAD: So ding ding ding! Medical mystery solved.

ROBERT: Really?

JAD: No.

ROBERT SAPOLSKY: They even came up with a name for it. It was called Status thymico-lymphaticus. It was in all the pediatric textbooks by the 1920s. And you would look in there and there'd be pictures, there would be pictures of the dissected thymuses. Normal size, and here on the right?

JAD: Enlarged.

ROBERT SAPOLSKY: Abnormally large Status thymico-lymphaticus.

JAD: And in no time at all, doctors came up with a treatment.

ROBERT SAPOLSKY: A perfectly logical therapy.

JAD: Which is that if we're gonna help these babies, we've gotta shrink their thymus glands. And to do that, the best solution obviously is to ...

ROBERT SAPOLSKY: Irradiate their throats. Irradiate their throats to shrink their thymus gland.

JAD: Zap the child's throat with trillions of radioactive particles.

ROBERT: Literally?

ROBERT SAPOLSKY: You betcha.

JAD: And this was considered, like, something every good, loving parent should do?

ROBERT SAPOLSKY: Absolutely. If you worry about your child being at risk for SIDS, go and get their throats irradiated to shrink the thymus glands.

JAD: And—and did it work?

ROBERT SAPOLSKY: Yes, it shrank the thymus glands.

JAD: But he says it did have another effect.

ROBERT SAPOLSKY: Decades later, you've killed 20 to 30,000 people with thyroid cancer.

ROBERT: 20-30,000 deaths. That's a—that's a real number.

ROBERT SAPOLSKY: Yeah. That's a—that's a fairly big one.

JAD: So here's my question.

ROBERT: Uh-huh.

JAD: How could these doctors have gotten it so, so, so, so, so wrong? Do you know what I mean?

ROBERT: I do. Well, don't you know what you mean? You just answered your own question a minute ago.

JAD: No, I didn't. I'm about to answer it right now.

ROBERT: They're—they're playing with radiation. You just said that. But what they—what they didn't know that radiation would hurt you. They had no—it was a brand new technology.

JAD: Yeah, but that's not what I was gonna—ah!

ROBERT SAPOLSKY: This was, you know, a couple of decades into radiation having been discovered.

[NEWS CLIP: Isotopes are performing near miracles of diagnosis and discovery.]

ROBERT SAPOLSKY: People were just tossing around radiation all over the place.

[NEWS CLIP: Iodine-131.]

[NEWS CLIP: Radioactive sodium.]

[NEWS CLIP: Radon.]

[NEWS CLIP: Gamma rays.]

[NEWS CLIP: Neutrons.]

ROBERT SAPOLSKY: And this was a period with Madame Curie, like, dipping her arm into vats of uranium.

[NEWS CLIP: Radioactivity is harmless.]

ROBERT SAPOLSKY: And dying soon afterward from cancer. People would go into shoe stores, and they would have their feet x-rayed.

[NEWS CLIP: Yes, x-ray is a wonderful invention.]

ROBERT: I had that!

ROBERT SAPOLSKY: You had that?

ROBERT: I did! Yeah. Take off your shoes, and then you could look at your bones.

ROBERT SAPOLSKY: That's exactly what they'd do.

JAD: Why would you do that?

ROBERT: That's what—that was the thing you could do at the shoe store. It was very cool.

ROBERT SAPOLSKY: Yeah, it's showing how cutting edge of a shoe store they are.

ROBERT: [laughs] Yeah.

ROBERT: So that's your explanation.

JAD: No! That may look like the explanation. I mean, sure, radiation played a role, but if you'd have let me say what I was gonna say, I would have told you the real explanation ...

ROBERT: Yes?

JAD: ... Preceded the radiation by, like, a couple hundred years.

ROBERT: Whoa! I have no idea what you're talking about.

JAD: [laughs] I'm gonna tell you. Back in the 1700s, okay?

ROBERT: Oh, that far back? Okay.

JAD: That far back. Before radiation, before your grandpa.

ROBERT: Before—before the Civil War or the Eiffel Tower or Napoleon!

JAD: I'm talking when the Redcoats ...

ROBERT: Were still wearing red.

JAD: Yeah.

ROBERT SAPOLSKY: Yeah. This was shortly after the Revolutionary War.

JAD: Right about this time, says Sapolsky, the first med schools started to pop up in America, and a supply and demand issue came into effect, because with these med schools came med students.

ROBERT SAPOLSKY: Medical students.

JAD: Who needed to learn about anatomy. And of course, in order to do that ...

ROBERT SAPOLSKY: ... they needed bodies.

JAD: You know, to dissect.

ROBERT SAPOLSKY: This produced this whole occupation. You could be a resurrectionist.

ROBERT: A resurrectionist?

ROBERT SAPOLSKY: Yup. And they would go out and dig up bodies at night, and sell them to the anatomists, to the medical schools.

[ACTOR, anatomist: "I'll need two more by Thursday."]

JAD: Now here's the key point: since demand was so high, the resurrectionists had to go where the bodies were easiest to get, which meant, you know, avoiding the fancy graveyards.

ROBERT SAPOLSKY: If you were wealthy you could have yourself buried in what was called a "patent coffin," which was a triple-layer coffin, which was meant to be resurrectionist proof.

JAD: But if you were not wealthy, no fancy coffin for you. You'd probably just be buried in a sack in some paupers' field just a few inches under the soil. Very accessible for these resurrectionists.

ROBERT SAPOLSKY: Not surprisingly, that's where they went.

ROBERT: Are we still on the same topic? Are you explaining why children die?

JAD: Yes, yes, yes. Bear with me.

ROBERT: All right.

JAD: What I'm trying to make is that the graverobbers targeted the poor so much so that sometimes when, you know, people would catch these resurrectionists in the act and see, like, "Oh my God, that's my dad you're digging up!" There'd be riots!

ROBERT SAPOLSKY: Troops were called out and rioters were shot.

JAD: Are we talking, like, hundreds of people, torch-bearing?

ROBERT SAPOLSKY: Yeah, it was townies versus the people who were trying to dissect their dead relatives.

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

JAD: All right. Let me bring it home.

ROBERT: Not that it hasn't been interesting, but bring it home.

JAD: Okay. As a result of all of this hubbub over graverobbing, country after country throughout Europe decided well, let's standardize how science gets its cadavers. Forget all this graverobbing. So they passed laws.

ROBERT SAPOLSKY: Which formalized anyone who died in a poor house, their body would be turned over to the anatomists.

JAD: This was like the cadaver version of direct deposit, okay? So graverobbing was gone, but now all the bodies used by medicine—not just some, but nearly all—now came from the poor.

ROBERT SAPOLSKY: Estimates were by the end of that century, 99 percent of the bodies used for anatomy lessons had been derived from poor houses.

JAD: And that seemed okay. Until ...

ROBERT SAPOLSKY: 1936, a guy named Hans Selye showed ...

JAD: ... that being poor actually warps your body. And now, Robert, now we come back to the case of the mysteriously enlarged thymus. Because if you're poor ...

ROBERT: Mm-hmm.

JAD: ... you're worried about your job. You're worried about feeding your family, you're worried about the bills. In other words, you are stressed out.

ROBERT SAPOLSKY: And during chronic stress, your immune system goes down the tubes.

JAD: And since the thymus is part of the immune system ...

ROBERT SAPOLSKY: If you are chronically stressed, the thymus gland shrinks.

JAD: Oh!

ROBERT: Oh!

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

ROBERT SAPOLSKY: People had no idea what was normal and what was abnormal. And they got it backwards.

JAD: Killing about 30,000 people in the process. Now the scary thing, says Sapolsky, is that these doctors were not dumb.

ROBERT SAPOLSKY: No. These were the best, most careful researchers at the time. And these were the only logical conclusions that could have been made. And nonetheless, it produced an utter disaster. There's, you know, not the slightest reason to think we're not doing the same thing right now.

JAD: Robert Sapolsky is a professor of neuroscience at Stanford University. He's the author of many great books, including Monkeyluv and The Trouble With Testosterone. For more information on him or anything that you heard in this hour, visit our website, Radiolab.org. And you can send us an email while you're there.

ROBERT: Radiolab(@)wnyc.org is actually ...

JAD: That is the address.

ROBERT: Remember that.

JAD: Yep. I'm Jad Abumrad.

ROBERT: I'm Robert Krulwich.

JAD: Thanks for listening.

[ANSWERING MACHINE: Message 10. New. From an external number.]

[ROBERT SAPOLSKY: Okay. Radiolab is produced by Ellen Horne and Jad Abumrad. Our staff includes Lulu Miller, Jonathan Mitchell, Soren Wheeler, Amanda Aronczyk and Jessica Benko.]

[LISTENER: With help from Ann Boiko-Weyrauch, Ike Sriskandarajah, Hsi-Chang Lin, Heather Radke and Sally Herships. Special thanks to Karen Hablick, Justin Paul, Dr. Allen Olstrike and Taylor Dupree of 12K.com.]

[LISTENER: Radiolab is produced by WNYC, and distributed by National Public Radio.]

 

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