What's the Deal with Death?

Perry: [00:00:00] Emily. It is our spookiest episode ever. We're talking about death in time for Halloween. I'm so excited.

Emily: [00:00:09] I oppose this, but I am interested to get into it.

Perry: [00:00:12] All right. It's fair that I have been pushing the death episode since we conceived of wellness. Actually, I think it's hugely important. Let's see how we get at the end. But because Halloween is coming up, I wanted to ask you, as we get started as an adult, do you wear a Halloween costume when you go out trick or treating with your kids? And if so, what's it going to be?

Emily: [00:00:34] I do not, but I am running a race the next day with my friends and I'm told there will be matching outfits, although I haven't been told what they will be. And so I'm going to be costuming post-halloween.

Perry: [00:00:48] Oh, that's economically one of the best times to purchase a costume, by the way. Yeah.

Emily: [00:00:53] Do you dress up for Halloween?

Perry: [00:00:55] Oh, yeah. Yeah, yeah, yeah. It will surprise you that I tend to pick [00:01:00] niche, nerdy things to be that no one would recognize. So is it Star Trek? Well, Star Trek is a little too mainstream. Um, so, uh, I might, like, stick my head through a hole in my shirt and be Krang, um, from Teenage Mutant Ninja Turtles. I might be high. Mcdonough from Raising Arizona, one of the best comedy movies of all time. Put on my put on my mustache.

Emily: [00:01:28] You go out. How old? Okay, so you go out trick or treating with your children with.

Perry: [00:01:32] My youngest is 11 now, so yeah, I still. I'm walking around with her.

Emily: [00:01:36] How many years do you think you have left of this before you just start going out by yourself with your wife?

Perry: [00:01:44] Yeah, probably a year or two. But it's actually we have a fun area in our our town. So, you know, I don't go up to the doors with them. I just like stand on the street and make sure everything's okay. But there's a couple of awesome parents who hand out like alcohol and stuff to the to the adults. [00:02:00] There's a there's a moonshine guy who makes like 180 proof apple moonshine. Knock your socks off.

Emily: [00:02:10] That seems like a huge mistake. Okay, well, we better get this episode done because Perry may actually be dead from the moonshine he'll be consuming on Saturday. So, uh, let's go. Let's talk about what's going to happen then. I'm Emily Oster, I'm an economist and a data expert.

Perry: [00:02:35] And I'm Perry Wilson, I'm a medical doctor.

Emily: [00:02:38] It's Thursday, October 29th, 2026. And this is Wellness, Actually.

Perry: [00:02:43] Because you're getting a staggering amount of health and wellness information nowadays from every source imaginable. And some of it.

Emily: [00:02:51] And some of it is, well, actually bullshit. Fortunately, we're both people who know how to read studies, how to parse the [00:03:00] data, and can tell you what's worth thinking about and what you can safely ignore.

Perry: [00:03:04] But before we dig in a note that this podcast is for educational purposes and should not be construed as medical advice. We don't know your unique situation, so talk to your doctor for personal health decisions.

Emily: [00:03:15] This week we're asking what's the deal with death? Perry and I will give the official smash or pass, and then we'll get to your question of the week. But first, let's do the health news round up after the break.

Perry: [00:03:42] And now for the health news of the week. Apropos of Halloween, Emily, the curse of wellness actually has struck again. I can't believe how often this happens that we mention something and it comes to pass. So walk me through [00:04:00] the newest resignation from Health and Human Services. Uh, Calley Means is out. Why is he out and why is it our fault?

Emily: [00:04:09] R.i.p Calley Means as a government employee. So Calley Means is an RFK friend friend of the RFK who came in as part of the Baja movement. Uh. He is the brother of Casey Means, failed Surgeon general nominee who we've talked about many times. Calley Means as many of the same views, and he had been working in a job with an ambiguous title that involved like working with RFK on fixing stuff. He is very interested in getting rid of ultra processed foods. He does not like food dyes at all, and he's quit because he is. Is. Well, I think what he said was, you know, spend time with my family or some version of that. But it is clear [00:05:00] he is upset at the fact that many of the things that he believes in and thought should happen, like less glycogen. Glycogen. I can't say this word, Perry. It's the thing we talked about. Round up. Okay, fine. Uh, he wanted less of that stuff. And, uh, now they're going to have more of it. So I think just generally this part of the Maha movement has not gotten what they hoped for out of the RFK, uh, HHS rulership. And, uh, this is just the latest casualty there.

Perry: [00:05:31] Yeah. We talked about that glyphosate aka roundup, uh, issue last week in our organic food episode. Um, it's a, it's a sticking point for the Maha movement. And then Trump, endorsed by RFK Jr, ramped up production as part of the Defense Production Act. It seems like Calley Means Like was not that interested in the anti-vax stuff, that RFK was really like a food guy. And I have to say like, I'm gonna a little [00:06:00] bit credit where credit is due. Like maybe he has the courage of his convictions, whether we agree with all of them or not. Like he saw that things were going the wrong way and he left. Maybe good for you. Calley Means.

Emily: [00:06:11] Yeah. I mean, I think Calley means is a true believer in this stuff. I, you know, he and I don't see eye to eye. He's not he's not a big Emily fan. Uh, but and I think some of what he believes is not well supported by data, but he really does believe it. And, uh, you know, now he can say it from the outside.

Perry: [00:06:31] At this point. I'll take it. I'll take a true believer rather than like a grifter any day in the current environment.

Emily: [00:06:39] Okay. Uh, next up, dengue. Dengue fever. We're having more of it. It's on the rise in Florida. Should everyone be panicked, say more.

Perry: [00:06:49] Yeah. I don't like dengue fever. No. Don't panic. The CDC has declared a level three emergency response for Florida. That indicates that [00:07:00] they're going to direct some resources to controlling dengue in the area. They've had eight level three emergency responses this year. So it's not like crazy that they ramp it up. But you know, it's something real. Um, there have been 721 dengue cases in Florida this year. They had only reported 392 as of September so last month. So it seems to be ramping up. Most of this is happening around Tampa. Um dengue is a mosquito borne illness. It's a flavivirus. It causes what's colloquially known as breakbone fever. Because of the incredible amount of muscle pain and aches you get like fever and muscle aches, particularly behind the eyes, nausea and vomiting, quite unpleasant for people who become symptomatic from it. Um, actually, most people don't. Just one out of four infections develop symptoms. So maybe not as scary as you would think, but of the people who develop symptoms, 5% can get severe dengue, which which can be fatal. Um, there have been 2470 [00:08:00] cases nationwide this year. The highest on record was 2024, which had 3700 cases. So I don't think we'll beat that. But like the trend is generally up in dengue cases. Um, is.

Emily: [00:08:14] That because of some kind of climate change driven mosquito thing or something else?

Perry: [00:08:18] It is entirely due to climate change driven mosquito things. So, um, as the climate gets warmer, these mosquitoes can move further north. Um dengue is endemic in the Caribbean and stuff, but now it's, it's taken root in Florida as well. Um, also the longer the mosquito season lasts, like wetter, warmer seasons just means mosquitoes can live for longer before the winter comes. And that leads to more infections. Um, as well. There's no person to person spread here. This is all driven by mosquitoes, which is why it's all driven by by climate. No treatment. It's a virus treatment is supportive. I should point out actually, that 43% of the reported cases in the US [00:09:00] were hospitalized. So clearly we're missing cases like this. Doesn't mean that your chance of getting hospitalized is 43%. It just means that there's a bunch of people walking out there who have like a fever and aches and pains and never know they have dengue. Um, but yeah, one of the examples of how climate change and change will impact public health for sure.

Emily: [00:09:20] Great. Okay, okay. Try not to wear your bug spray.

Perry: [00:09:26] Yeah. Bug spray prevention is the best thing here. Speaking of prevention, Emily, did you see the latest bit of epidemiologic sleuthing happening in San Francisco? So a couple of cases of tuberculosis, uh, active TB in San Francisco were traced back using epidemiology. Did you see where they were all traced? Back to a strip club. I love it. Good work.

Emily: [00:09:56] This is so interesting because people do not talk [00:10:00] about it very much, but it is the leading infectious disease cause of death in the world. It kills something like 1.2 to 1.3 million people a year. There is an amazing.

Perry: [00:10:09] It's got to be lower than malaria. Sorry. I'll jump in. It's got to be lower than malaria. It's got to be number two.

Emily: [00:10:15] I know, I don't think that's right.

Perry: [00:10:18] Let's see. Are we keeping this in. Tb 1.25 to 1.30. Malaria 600,000. A mere 600,000 people per year. Mea culpa. Emily. Yeah.

Emily: [00:10:31] Thank you. And you know how I know that is because of an absolutely fantastic book called Everything Is Tuberculosis, which, like everyone should like at the end of this episode, go read it. It's by John Green. And it's just a really, really good history of tuberculosis, which is a disease that kills like a billion people. I mean, has killed not a billion, but has killed many, many, maybe a billion. It's killed a lot of people over time. When you read about people having consumption, that was tuberculosis. It's just a really, really [00:11:00] interesting disease. And it can be really bad and you can get it at a strip club.

Perry: [00:11:05] You can get a strip club. Tb is airborne.

Emily: [00:11:07] Elsewhere.

Perry: [00:11:08] Too. Yeah. I mean, the truth is this isn't like as salacious as you may think. Tb is an airborne disease. It's not a sexually transmitted disease. It's not just it's not through close contact. Like when we have a patient with active TB in the hospital, we wear N95 masks and they're in a negative pressure room and everything like that. So you can get in a strip club, you can get it in the subway, you can get it anywhere. There's people breathing around other people. Latent TB infection is very common asymptomatic and non-transmissible. That's what the PPD test, if you remember when you were a kid, do they still do that for kids?

Emily: [00:11:39] I don't think so. Yeah. Yeah.

Perry: [00:11:41] We don't do that. So. But that that was testing for latent TB infection, which if you have you can eradicate using um typically like a six month course of a, of an antibiotic. And then active TB requires a four drug regimen. And now we have extremely drug resistant TB out there, which is like very scary [00:12:00] and worth its own segment at one point in time. But this, this episode is scary enough without talking about extremely drug resistant tuberculosis.

Emily: [00:12:08] And I just want to say one other thing, which is that, uh, people used to get a lot of TB from raw milk. That was one of the things that would spread TB in the past. Huh. So anyway, fun. Uh, we should do an episode on tuberculosis because.

Perry: [00:12:20] I love that.

Emily: [00:12:21] Idea. Now that we learned that I'm right about its deadliness, I'm. I think that's a great idea. But for today, that is not today. And that's it for today's health news of the week. And now what's the deal with death?

Perry: [00:12:36] What's the deal with death? There's there's, there's so much to talk about here because there's the amazing history of like how people try to cheat or avoid death. There's the science of what happens when you die. There's the modern history of trying to avoid death. There's tech bros. I don't know, I think it has everything. Emily.

Emily: [00:13:00] Okay, [00:13:00] so what we're going to do is I think first we're going to talk about how people have tried to avoid death over time from the past to the present. Then we're going to talk about what actually happens when people die, how we understand near-death experiences to the extent that we do, which is not very well, I think. And then and then we'll talk a little bit about why it matters and some more practical stuff about what does it mean to have a good death. But let's start with the what I think is the sort of craziest, most interesting stuff, which is just all the things that people like to do to try to avoid death. So I'm going to let you start by telling me the history of magical immortality. Elixirs.

Perry: [00:13:45] Sure. Um.

Emily: [00:13:47] The Philosopher's Stone. Yeah. Situation here.

Perry: [00:13:51] Yeah, yeah. I mean, it's interesting. You'll see as we talk about as history moves forward and science moves forward, like the the stuff people [00:14:00] believe might help them avoid death also moves forward. You know, it's like with the invention of electricity, then all of a sudden we see people being like, oh, we can use electricity to avoid death. You know.

Emily: [00:14:09] This is like, so just to like, I think part of what makes this so interesting is if you think about the two things that people really, really want, they want to be rich and not die. Those are two like core human desires. And many of the innovations that we have seen in science and in capitalism and everything else over the course of, you know, the entire human history are in the service of either getting rich or not dying. And we learned a lot from alchemy, right? Alchemy gave us all kinds of stuff, even though it never actually figured out how to turn into gold.

Perry: [00:14:46] Absolutely, absolutely. Yeah. The you could write a good popular science book about how, you know, an effort to cheat death has led to all modern innovation. But let's start with the magical immortality elixirs, because this is the oldest, at least I could find, um, [00:15:00] written evidence of people trying to do something to stay alive forever. The oldest reference that I saw was in the Epic of Gilgamesh, um, which is from 2100 BC. Uh, they were out looking for some kind of potion that would extend immortality a little more modern than 210 BCE. We have Chinese Emperor Qin Shi Huang, who sent out multiple expeditions to find an elixir of immortality. They. They never returned. Um, but he did have people giving him elixirs containing liquid mercury. Well, Mercury is always liquid containing mercury to drink in the belief that this like metal that flowed and looked magical would extend life. Obviously it didn't. It's believed he died of mercury toxicity. You may be familiar with this emperor. He was buried with an army of terracotta soldiers. Just in. Just in case he wasn't dead. Um, and that's where that the famous terracotta army comes from. I looked a little bit into the Holy Grail because [00:16:00] Indiana Jones, the Last Crusade, best Indiana Jones movie of all time.

Emily: [00:16:04] Totally by far.

Perry: [00:16:05] Yeah. Interesting. Like. It's not as like, drink from this and you'll live forever. As Indiana Jones taught us. I was disappointed to find. So the first the first reference to the Holy Grail is from 1180. A guy named Christian de Troyes wrote Perceval. The story of the Grail. It's a poem, um, where the author, the poem narrator sees a mysterious person with a jeweled grail, but at the time that would have been a large serving dish. And then the poem was left unfinished, and there was a bunch of fan fiction writing. And, and that sort of morphed into this idea that the mysterious stranger was this person called the Fisher King, who had lived an obscenely long time. And then they that got conflated with this serving dish actually being the cup that caught the blood of Christ around 1200. And then we have Indiana [00:17:00] Jones. Anyway, so.

Emily: [00:17:01] The Indiana Jones part is like much simpler.

Perry: [00:17:03] We should it's it's, it's, it's, it's, it's way simpler. And my last one, of course, if we're talking about magical immortality, elixirs has to be the fountain of youth and Juan Ponce de Leon looking for it in Florida where people still search for it to this day. This is apocryphal. Apparently, Ponce de Leon was not actually, he was just a regular explorer looking for, well, you know, like slaves.

Emily: [00:17:25] Looking for money because that the other thing. Yeah.

Perry: [00:17:28] The other thing he just wanted.

Emily: [00:17:29] Was looking for money.

Perry: [00:17:30] But after his death, I guess people applied this to him. I think actually to sort of, um, to sort of smear him a little bit like, oh, that, that dude was crazy. So so that's magical immortality elixirs. And then the next spookiest thing that I want you to tell me about Emily, of stuff that people want to use to extend their life. And this is really halloweeny is blood. Blood. Um, and again, I think because we like science sort [00:18:00] of is advancing, right? And like we're starting to learn that blood is this important substance, not just this thing that like fills your body like a water balloon. So talk to me about people trying to use blood to stay alive forever.

Emily: [00:18:11] So blood is great. Uh, because it has sort of two periods. We can talk about the past. And then actually this has become a more present discussion. So in the kind of 14 to 1650 period, we have a set of people doing various things involving blood. Trying to keep them alive. So in the 1490s, Pope Innocent the eighth is accused. It's not clear that he was doing this of drinking boys blood to try to keep himself alive. So this is a sort of direct approach. You take somebody else's blood, you consume it, and it, I don't know, refills your blood. Biologically, that's not going to work. It's going to go to your stomach. You just digest it. It's not not nobody's blood's going to work there. But he died.

Perry: [00:18:58] So we need to release the [00:19:00] pope. Innocent. The eighth files. Just saying.

Emily: [00:19:02] Exactly. But he died. Despite this, there's a another claim about someone in the 1600s, Elizabeth Bathory, who claimed that she bathed in virgin blood to stay young. Um, this claim actually didn't appear until quite a bit after she had also already died. Um, and I think there it's unclear. Is it like that you're staying young and beautiful or are you staying not dying? You know, there's all kinds of ways to want to try to stay, stay young. More sciency. Jean-baptiste Denise in 1667. Transfuses Lamb blood into humans. Uh, with the kind of, I guess, idea that baby, I don't know, baby sheep blood would keep you young. That's definitely not encouraged.

Perry: [00:19:46] Somebody did do this die.

Emily: [00:19:47] They banned that. It's like, don't, don't do that. So that's kind of the early phase. And then there's this sort of, I think much more interesting, uh, later, more recent phase. So there's actually a nature paper from [00:20:00] from 2005 in which they show that they take sort of two mice, an older mouse and a younger mouse, and they like interweave their circulation. You can do all kinds of terrible stuff for mice. That's probably another episode, but they sort of put their circulations together, and that actually rejuvenated some of the tissues of the older mice, which is incredibly cool, but also potentially quite a good example of where we are. Not too bad at extending lifespan in mice. Uh, relative to how we do it in people. But this hasn't kept people from trying. Perhaps most famously, uh, Brian Johnson, the guy who doesn't want to die. Got these transfusions, like, sort of plasma transfusions from his son, uh, who is a teenager. He did that for a couple of years, but then he abandoned it, saying it didn't do anything. Sort of unclear what outcome you were exactly looking for. He didn't die, so I don't know why that's not successful. [00:21:00] But at any rate, we haven't sort of seen any evidence that transfusing yourself with the blood of the young is, uh, is effective. And it has some, you know, potential risks. Not something I would necessarily recommend. It's also this is a bit related to this idea of vampires. I think the sort of like vampires, you know, when you eat the blood of the vampire, then you get the vampire's immortality, obviously.

Perry: [00:21:27] Well, but also the vampire isn't. Okay, maybe I don't know enough about vampires, but don't. Vampire's. Isn't it them drinking the blood of humans that keeps them alive forever? Are they alive forever?

Emily: [00:21:38] No. No, no. Vampires live forever. Oh my God, what is wrong with you? Vampires live forever, no matter what. They need to eat the blood of the human. It's like how they can, you know, they. And they get, like, often they're sort of like. It's like their skin gets dry if they don't do, you know, like they won't die. They get very weak. And it's like, like anemia, basically, they get like really bad anemia and they have to re-up with the blood of the, of the young, but or [00:22:00] of anyone. But, uh, in some versions of vampire lore, if you, if a vampire bites you, but then you are fed their blood, that's how you turn into a vampire. So there's like a sort of complicated back and forth of the, of the vampire. But no, they don't, they don't need it to live. They. Yeah. They just needed to thrive.

Perry: [00:22:24] Okay. Yeah. All right. Um, there's some speculation that the folklore about vampires actually came from death itself. Um, so Paul Barber advanced this argument that, um, people would see, you know, after someone would die if they were ever dug up again, they would find these bloated, sort of ruddy corpses with blood at their mouths, which can happen during the decomposition process. Like, like it's called purge fluid. We'll talk about how this all works, but like purge fluid will come out through the mouth as the body is decomposing. And if you dig someone up because [00:23:00] you're suspicious that they were evil or something, you know, um, and you see this like body with like blood at its mouth, you're like, oh my gosh, vampire.

Emily: [00:23:09] All right. So I think blood and magic elixirs are like the sort of biggest, uh, components here, but people have tried a lot of other things. One of them was electricity.

Perry: [00:23:18] Sure.

Emily: [00:23:18] Which kind of were like, I mean, it doesn't work, but it has it's like more there's more there.

Perry: [00:23:24] We're getting science here as as time goes forward. Yeah. So, so 1791, um, Galvani famously makes a dead frog's legs twitch by zapping them with electricity. Um, people freaked out about this. He thought like he was bringing the frog back to life. 1803 so a little more than a decade later, uh, Giovanni Aldini, another scientist, does the same thing except with the corpse of a hanged murderer. He puts some electricity through the fresh corpse, and apparently the corpse's jaw quivered and one eye opened, which definitely freaked people out. [00:24:00] And, uh. 1818 Mary Shelley, reading about some of these experiments were happening, writes one of the all time great Gothic fiction novels, Frankenstein.

Emily: [00:24:11] And of course, it is true that your muscles, you know, electricity moves like moves muscles. And so if you have a dead frog leg and you shock it, you can get it to move. Yeah. I mean.

Perry: [00:24:22] It's still creepy, even if you know.

Emily: [00:24:23] It's super creepy. Super creepy.

Perry: [00:24:27] So and then I think the last sort of thing that you'll hear about. So we've done, we've done magic elixirs, blood electricity. I think it's ice, right? Like, like put people on ice. Ice, baby. So what do we have about ice?

Emily: [00:24:38] So the idea is, I guess, that if you freeze people very, very cold, then you could like defrost them later. And, uh, I don't know, they wouldn't be dead because, you know, your everything slows. I'm not really sure what this why exactly? I don't totally understand why anybody thinks that [00:25:00] this would work. But there is a book called The Prospect of Immortality in 1962 which found founds the cryonics movement. Um, and it is true that many sort of body processes slow down when you get very cold, and then maybe you could bring them back. I don't really have any reason to think that this is that this is right. It's also a bit different than living forever, because it's like you would have to be woken up later to like, live. It's like more like a, like a time portal to the future than a kind of immortality space.

Perry: [00:25:34] Although I think with the assumption, like, I think the sort of assumption is that when you get to the future, medicine will be so good that you could live forever, at least maybe I mean, cure, cure the disease that you that you died from or something like that.

Emily: [00:25:48] So people have frozen themselves. James Bedform, psychology professor, is the first frozen human. He's still frozen. That was from the 1960s. Um, there have been a lot of issues with this. People freeze [00:26:00] themselves and then, you know, the cryonics labs run out of money for liquid nitrogen, and then the people unfreeze. Um, but you can still get yourself frozen today. Uh, there are companies that will freeze you. It's expensive, a couple hundred thousand euros. So more expensive than freezing your embryos, for sure.

Perry: [00:26:17] Yeah. Economically, the proposition here for the company seems fraught to me. Right. Because it's like, okay, you're going to pay us some fee and then we're going to keep you frozen for we have to stay solvent for like what? Like a few hundred years? Like how many companies can do that? Actually, solvent is probably not the not the right word. We have to say frozen. We have to say liquid. You know what I mean?

Emily: [00:26:40] So I like don't freeze yourself. Um, or at least there's no evidence of freezing yourself would, uh, would work. Yeah. But there is some stuff, I think, before we go into like the more modern science piece of, of longevity, we have, of course, improved at our ability to bring people back from something [00:27:00] that we would describe as clinical death.

Perry: [00:27:03] Yeah. The sort of first, the birth of the modern CPR movement really is, is way back in 1767. There were these things called rescue societies in Amsterdam and London, which were put together to revive drowning victims. So I guess prior to this, if you drowned, it was like, oh, like, here's another dead body, you know, throw it on the pile. But people had begun to realize like, oh, you know, some of these, you might be able to get some of these drowning victims back. Um, and so the rescue societies standard practice was to use a bellows to blow tobacco smoke up the rectum. This does not work, nor is it where I read that. And I was like, oh, clearly this is where the phrase blowing smoke up your ass comes from. Uh. Apparently not. But fine, I choose to believe it anyway. Um, to be fair, these rescue societies also pioneered some of the early forms of what we would now call rescue breathing. Um, you know, breathing into someone's [00:28:00] mouth to revive them from drowning and actually brought some people back. They might have thought that they were bringing them back from the dead. We know today that they weren't actually dead likely at that time, but that's pretty cool.

Emily: [00:28:12] And then we have in the 19 late 1940s, defibrillation, uh, which can restart your heart with, uh, with electricity.

Perry: [00:28:20] And I mean, that's as close to Frankenstein as we get, right? I mean, yeah.

Emily: [00:28:25] And in 1960, Jama, uh, describes what closed chest CPR, which would be looking very much like what we would have now, where you press somebody's chest and breathe into their mouth as a way to, uh, to revive them. And we now have, you know, obviously people know about that. And there's also like portable defibrillators, which, uh, have saved many, many people by being accessible in a moment of cardiac arrest. So there are, there are ways we have improved our ability to bring people back from some version of being, uh, of being dead, but they are much [00:29:00] more limited than drink the blood of the young to live forever. Unfortunately, unfortunately. But, uh, don't tell that to the tech bros, because when we come back, we will talk about the modern attempts to find longevity in science.

Perry: [00:29:34] All right, we're back and we've gone through the amazing history of, you know, basically for as long as recorded history, people doing their best to cheat death using whatever tools they have. No one has figured it out yet, as far as we can tell. But the tech bros are on it. Fear not, they're going to do it. You throw enough money at something, we can solve this. So we'll talk about, I mean, in some ways, all of [00:30:00] the topics we talk about on one that's actually are somewhat geared towards this, this ultimate goal. But we'll talk about a few. I think m the. There's like a theme here of the modern movement, the modern longevity movement, which is basically like, let's use science. Let's find something intriguing in, you know, in a mouse study, in a cell culture, in, you know, DNA. And then let's decide that this thing is therefore going to extend human life and embrace it and orient our lives around it. And, you know, there's several examples of this.

Speaker 3: [00:30:35] Yeah. I mean, I think this is a.

Emily: [00:30:36] Very.

Speaker 3: [00:30:37] This is very.

Emily: [00:30:37] Interesting because there are so many things which work to make cells, individual cells live longer or improve DNA repair or even, as you said, improve the lifespan of yeast or, or rats that we have not been able to port into humans or has it ported [00:31:00] in, in a meaningful, in a meaningful way. And partly just people are not yeast And, you know, partly I think the the size of the effects people get excited about are kind of not really that important in people, and somehow it's hard to detect them. So, I mean, this starts with what I would say like is antioxidants. Yeah. Right. There's this idea of these free radicals theory. This is developed in the 1950s. There's that your body is full of these things that would give you cancer oxidants all around these free radicals. And you need to have these antioxidants, you know, whatever it is, if it's vitamins or something else, they're like, soak up the free radicals and like dispense with them. And, uh, though none of those work, some sometimes they're bad and certainly nothing, they're all null or harmful.

Perry: [00:31:49] Yeah. And it's such a, that's, you know, they had, this wasn't just someone pulling it out of their ass. It was like, oh, look, here's a cell culture. And, you know, if we stress it out and don't give [00:32:00] it enough oxygen or whatever it's going to, or too much oxygen, it's going to produce these free radicals. And look, at damages DNA. And like, that's all true. And we can even add stuff like vitamin E and antioxidant to the cell culture and fix this problem that we induced artificially in our experiment. And that worked too. And then you do a big randomized trial of vitamin E versus placebo, and there's no effect on health. And in fact.

Emily: [00:32:22] In fact, it's.

Perry: [00:32:23] Bad. The vitamin E arm, um, had an increased rate of heart failure for reasons that are unclear. But like, yeah, it's a classic story and it happens again and again. I think the next big one that's was red wine, right? The, the resveratrol paper. So this is a paper like there was science here. So, so we're in 2003, um, this is a paper appearing in nature and scientists found that this, this stuff, resveratrol which is in is, is found in red wine prolonged the life of sarcoma S cerevisiae. [00:33:00] That's brewer's yeast. My favorite same yeast you get when you're making bread from the store. And so it was like, oh my gosh, you know, this is going to like it. You add this stuff to yeast. The yeast live longer. That's awesome. Glaxosmithkline bought the company that was spun out of this paper for $720 million in 2008. So that's nice. And they're going to test supplements and stuff like that. And nothing worked and didn't improve health. And GSK actually shut down that company that they had bought in 2013. So that was a $720 million boondoggle for red wine. I'm still a fan of red wine, but I can't lie to myself and tell me like I'm doing something particularly.

Emily: [00:33:41] Good for.

Perry: [00:33:41] My body. Yeah.

Emily: [00:33:43] And you know, the and then the, the follow up on that is, is rapamycin, which is a compound that's been shown to extend lifespan in mice. You could probably talk about that for an entire episode, but.

Perry: [00:33:55] Also it is something we use to suppress the immune system in transplant. So like [00:34:00] it's not a benign. It's it's not red wine. It's like a real drug.

Speaker 3: [00:34:04] It's like a real drug.

Emily: [00:34:06] Uh, but they're the sort of systematic review data on this shows no clear lifespan benefit in people. There's maybe something around aging in the immune system or something, but again, not anything especially useful or meaningful or things that would really matter for this. And our favorite Don't Die influencer, Bryan Johnson used to take this and then he stopped. And so that suggests it doesn't work.

Perry: [00:34:34] Um, yeah, I think there's actually a parallel between these things and like mercury in the, you know, Ching dynasty. Like it's, there's something exciting there. There's something novel. Um, it's interesting. You might even have some data that's compelling and then, but people are in such a rush to embrace these things. And the truth is, this is like a truism [00:35:00] of medicine that's quite depressing, but most things don't work. Like it's really hard to find stuff that does what you want it to do. Most trials fail us. Most things never get into trials in the first place.

Emily: [00:35:14] So the bottom line at this point is that there really isn't anything that's going to prevent death. So let's actually talk about what what happens when you die.

Perry: [00:35:26] So is.

Emily: [00:35:27] That all? Yeah. That's it. Now we're going to do what happens when you die, which it seems like you won't be able to prevent with rapamycin or some kind of blood. Blood of the young. So, Terry, your doctor. Tell me. Yeah, tell me what happens.

Perry: [00:35:42] Well, I, I mean, I can tell you what happens when you die. I can tell you what happens to your body. I can't I can't tell you what.

Emily: [00:35:47] No, that's what I'm asking.

Perry: [00:35:48] Okay.

Emily: [00:35:49] From the doctor's standpoint.

Perry: [00:35:51] All right. Um. Okay. I mean, it's interesting From a medical standpoint, death [00:36:00] is slightly harder to define than people might think. Like the binary of living versus dead is a little more subtle. I'll go through it because the truth is, your body is a bunch of different cells and they don't all die at the same time. So here's the timeline. All right. Let's say circulation stops, your heart stops beating. You've got about ten to 20s of consciousness there. Okay, so heart stop brain rapidly loses consciousness, but not immediately. There's there's a bit. And then around 20 to 40s after circulation arrest, the EEG goes flat. So if you're if you've got an EEG on someone's brain, like, okay, brainwaves are gone. So I think at that point you might be like, okay, this yes, maybe we can still bring this person back if we restart their heart, but like, they're kind of gone now, right? Like they're not conscious. Eeg is flat. And then this weird thing happens around 50s. There's a fascinating paper that looks at [00:37:00] this, but it's called this. It's called a gamma surge. So the brain and what you might think are it's sort of last moments. So it's gone flat. It's like there's no circulation. The brain has gone flat. Then there's this surge of activity that spreads across the brain. Super fascinating study actually investigated this in six people who were going to be taken off the ventilator.

Perry: [00:37:21] So these were people who were not yet dead but weren't going to recover. They were on a mechanical ventilator, not conscious. They were all comatose. The brain activity was minimal, but they weren't brain dead. They were comatose. And the researchers consented their families to say, like, look, can we put an EEG on their brain? And then we'll pull out the breathing tube and they're going to die, and we're going to record everything that happens as they die. And they found this. This is appearing in the proceedings of National Academy of Sciences in 2023. Um. I'm sorry. These are for patients, not 6 in 2 out of four of the patients. They saw this [00:38:00] high frequency gamma power surge occur across the brain. It was localized in the somatosensory cortex and the dorsolateral prefrontal cortex. These are areas associated with conscious experience. And then they did what's called connectivity mapping, which suggested which looks similar to like a dreaming state. So okay, these people all died. We have no idea what their experience was. Yeah. But from, from an EEG standpoint, there was a brief like these were comatose patients with really little brain function. And then as the brain was dying, there was this brief surge of something that looks like conscious dreaming. And then obviously it stopped. Um, which I find fascinating and like mysterious and really cool. We'll talk about near-death experiences, but I think it's an interesting phenomenon for sure.

Emily: [00:38:49] Yeah.

Perry: [00:38:50] Um, but just to walk you through like, let's, let's get oh. So now the brain is basically at for 4 to 6 minutes, brain is dead. There's irreversible neuronal injury, I should [00:39:00] say. That's at body temperature, 98.6 degrees. It is very well documented that this is slowed down at cold temperatures. So plenty of plenty of cases of, of people, kids, adults who like drown under the ice or something and can be revived like way later. So there's a saying in medicine, you're not dead until you're warm and dead. So like, we will not declare death on someone who's still cold. Basically, within minutes of that circulatory arrest, you get what's called autolysis cells start to digest themselves. Um, that is going to occur. That's like particularly like your pancreas and stuff is going to start digesting itself. Bacteria will take over this process. About two days later, the heart is recoverable for about 30 minutes. So after that, there's irreversible heart injury that's relevant not to bring you back to life, but it is relevant for transplant. Kidneys about 60 minutes, 2 to 6 hours after circulatory arrest, you get rigor mortis. That's where the muscles are [00:40:00] bound up. And then as the muscles break down, that goes away. You have about 24 hours before the corneas are so injured that they couldn't be transplanted. So that's what happens when you die.

Emily: [00:40:16] Can I ask you what it is like to watch someone die and declare that they've died?

Perry: [00:40:24] Yeah. Um, let me start. Okay. Let me start with the death exam. This is terrifying for a doctor. Not because death is super scary. Um, because we obviously see it a lot. In fact, I really appreciated when I was an intern in the ICU at Penn, they actually had someone come and talk to us about death because they pointed out, and this has always stuck with me, like you guys are seeing, you know, we would typically, you know, you'd have like a patient or two die per day in the ICU. That's sort of the cadence there. And, and they were like, you realize you guys are seeing like more death in a, in a more compressed period of time [00:41:00] than like most humans see in their lifetime, at least in their modern humans. And we were like, oh, yeah, like, damn, actually. Right. And it was about sort of not getting desensitized to it, but, um, the death exam is very scary. So what happens is a patient dies. If they're full code, then you run a code, right? That's like the code blue and CPR and the injections and stuff. And that's, that's a very interesting process. But let's now say we've got a patient who's like not going to be resuscitated. They have a DNR or something like that. The nurse calls you and is like, I think Mr. Johnson has passed. So it's not official until you do this time of death thing, right? So you go into the room, there might be family there and you apologize and say like, you have to examine Mr.

Perry: [00:41:43] Johnson. And it's very nerve wracking because you cannot be wrong. Like this is the diagnosis that if you get wrong, it's the worst kind of the worst thing you could possibly do. And yes, doctors have gotten this wrong. Um, [00:42:00] so what you do is you visually inspect to make sure they're not breathing, and then you listen for a heartbeat. And the recommendation is to listen for a full minute. And I can tell you it's a nerve wracking minute because you're like, you know, you can, you're almost like hallucinating. You're like, wait, what was that sound like? It was that, could that possibly be in a heartbeat? You're feeling for a pulse. You want to see if they respond to any painful stimuli. So you might, you know, press on their nail beds or something like that to make sure there's no withdrawal. You check the pupils, they should be dilated and fixed. You shine a light in them. The pupils cannot react. Right. That's a brainstem. That's a brain reflex. Brain can't work if you're dead. All of those things being in place, you can say, okay, you know, time of death, whatever time it is, that's the death exam. Um, yeah. Watching someone die. Um, there is variable, I will say. I mean, there's been really peaceful [00:43:00] times, like, you know, patients who are on inpatient hospice or something where it's just like they drift off and it's very nice and you just kind of everything goes and, and as you might imagine, there are, you know, more, more upsetting versions of that.

Speaker 3: [00:43:17] So I find this.

Emily: [00:43:20] I mean, thank you for that. Part of what's interesting about this, to go back to the like, science and maybe even back to the past is that it seems hard. So I think for, for a lot of people, we have this idea in our head that like, okay, you're dead or you're not dead. Like I watched E.R., I understand, you know, like the across the thing and then that's it. You're done. But, particularly in like, you know, the the 1800s, it was quite difficult to tell whether someone was dead. And so there was all kinds of stuff that people had to try to avoid ending up being [00:44:00] people deciding you were dead, when actually you were just like having a solid nap. So there are there are these things in the 1800s called safety coffins, which were coffins that had bells or tubes or flags or things where you could like, ring the bell if they buried you and you weren't actually dead. You'd be like, I'm still here, you know, and you have your.

Perry: [00:44:20] Not dead yet.

Emily: [00:44:22] This is the scariest thing. Okay. I mean, I have a word for this, but like I the fear of being buried alive is like a real that's a real one.

Perry: [00:44:31] Oh my gosh. Totally. The, um. What's the Poe? A cask of amontillado. So terrifying. Oh, terrible. Good. Another good gothic fiction. Yeah, yeah. I tried to find if there are any cases of people of the safety coffins, like working like someone ringing the bell. And I could not, I did not, I did not find any.

Speaker 3: [00:44:51] But people have.

Emily: [00:44:52] Woken up in the morgue.

Perry: [00:44:53] Yes. In the morgue? Yeah.

Emily: [00:44:54] Yeah, I mean, rarely, but there are times in which people do this wrong, and then somebody wakes [00:45:00] up in the morgue.

Speaker 3: [00:45:01] Totally.

Perry: [00:45:02] Um, there there is a phenomenon called the Lazarus phenomenon. After the biblical guy who was raised from the dead. So this is this is real. It is defined as the spontaneous return of circulation after CPR stops. So. So I talked about the death exam, but let's do the code right. So the patient's heart stops but their full code. So it's like code blue. So you run in and someone's doing CPR and someone's doing rescue breathing and all that kind of stuff. And then if you're the doctor running a code, you're at the end of the bed and you're not doing any of that, but you're telling people what to do and what medications to do, and checking for a rhythm and then deciding whether to defibrillate or not. It's a whole it's a whole thing. And then, you know, ideally you get a return of circulation. We call it rosc return of spontaneous circulation. And you pat yourself on the back and they go off to the ICU. And that's a good code. But then not infrequently you do not. And you do this. You try and try and try, and eventually you just have to call [00:46:00] it right. Okay, like we're done. And you stop CPR and the patient's dead. Except these rare cases of the Lazarus phenomenon, where sometimes, even though everything has stopped, their heart, which was stopped, just starts to beat again. There was a review of this in the Journal of Clinical Medicine in 2023 that actually found 76 cases of what they called auto resuscitation. The mean time, median time after CPR stopped when their heart started beating again on its own was five minutes. Um, so that's a long time without a heartbeat that it just starts up again. Um, 32% of these patients actually ended up surviving, but only 15% had an intact neurologic outcome. I mean, that's still not zero.

Emily: [00:46:47] But do we have any idea what like, why?

Perry: [00:46:51] No. Well, no. I mean, the heart is an electrical organ. [00:47:00] You've got cells that, you know, I would assume there's cells that are kind of firing still. They're not dead yet. Fully dead yet. And it's like I'm imagining like trying to turn over the engine in a, in a car, right? It's like, and then maybe just one just hits at the right point and the whole thing kind of starts working again. I don't know. It's crazy. Um, but this is why this Lazarus phenomenon is when there's something called donation after cardiac death. So organ donation usually happens after brain death. So heart's still beating, everything's working, but the brain is dead. And we can talk about what that means. That's another weird exam to do. Uh, but donation after cardiac death is like, yeah, your heart stopped. Your brain is dead. Yes, but your heart is also dead. But so the way that works typically is someone's on a ventilator. They're not technically brain dead, but they're going to be removed from the ventilator and they will die. So you move them down to the operating room, you take out the ventilator, and you sit there and wait because [00:48:00] they're not breathing on their own. And so you wait and wait and wait and you watch, and then the heart stops. And you would think that at that point you could like harvest the organs, like take their lungs and kidneys and heart or whatever to transplant into people. But you don't because of this Lazarus phenomenon. So you actually wait for the heart to stop. And I think the waiting time is ten minutes, but you can check me on that. And you just sit there in the operating room and wait until the heart has been stopped for ten minutes. And then it's like go time. Because obviously, the longer you leave these organs in the body, like without the special, without them being on ice and all that kind of stuff, the worse they'll, they'll perform in the in the transplant patients. So it's a, it's, um, it's a macabre thing for our Halloween episode for sure.

Emily: [00:48:43] All right. So actually now I want to talk a little bit about near-death experiences because I think that this is if we sort of move out of the, the sort of biological pieces of this into the back into a little bit of the more, I don't even know what word I'm looking for into the like [00:49:00] zeitgeist of this. Uh, there is a lot of interest in the question of near-death experiences, partly because I think people see it as a window to, you know, is there something after which is of course, the ultimate there's the like, I want to avoid death. And then there is like, I want to know that there's something there after. And near-death experiences are where people pull on their. And this is an almost universal kind of across all cultures and actually sort of some pretty similar universal feelings, like a sense of peace. Something about a tunnel, a light. Uh, you know, people see angels or they see. But that's not everybody describes this the same way, but you'll see a surprising amount of similarity across across descriptions. And I'm curious, you going back to what you said a few minutes ago about this gamma surge, you know, to what extent do we think that that's there's something your brain does immediately before [00:50:00] death that that is driving that almost dreamlike state?

Perry: [00:50:05] Yeah. I mean, it's it's totally reasonable speculation. Obviously, we don't know from the gamma surge study because all of those patients died. So we we couldn't ask them what they remembered. But certainly this, these near-death experiences where people have come back. And by the way, when we say come back, we don't mean come back from brain death or from being declared clinically dead. Like using the exam that I told you. Although doctors have gotten that exam wrong, those are what we're talking about in near-death experiences generally, people whose heart has stopped for some period of time, usually a very brief period of time, and then gotten restarted. So, you know, again, it's like, what is death in the in the olden days would have said, well, if your heart stops, you're dead. But we know now that, well, actually your heart might stop, but we can do CPR and we can restart it in some circumstances [00:51:00] with a defibrillator and so on and so forth. So, you know, it is near death. It's it's it's not death, but I, I clearly something is happening in the brain. One of the kind of cool things is, is what people have done to test this. Um, so a lot of people, one of the universals of the near-death experience is this out of body sensation.

Perry: [00:51:21] Like you're floating people describe floating above the operating room or like they, they look down and see the doctors, um, doing CPR or something like this. So there's a pretty, uh, there's a pretty cool study called the aware study, which was published in the Journal of Resuscitation in 2014. 15 hospitals across the US, UK, Austria, they what they did is they installed these shelves high on the walls of the rooms where CPR happens, like the E.R. and the ICU. So shelves way up high. And then on top of that shelf, they would put a picture like an animal or like a religious symbol or a number or something like that, like [00:52:00] on a big piece of paper, but it's too high. No one can see it. Right. But in theory, if you're floating above your body and looking down, you would be able to see the image on the on the thing. And so in these hospitals, there were 2060 cardiac arrests. Unfortunately, only 22% of them happened in rooms that had these shelves. And of the people who were brought back with CPR and could, you know, were awake and alert enough eventually to describe what happened to them. No one correctly identified one of the images, but.

Emily: [00:52:34] These people didn't know there was going to be a test. Like, it's not like they didn't bring them in. They're like, just, okay, you're going to have the after the heart attack. Just pay attention. I'm going to be doing a little test afterwards.

Perry: [00:52:45] Listeners, uh, should you find yourself in this situation, take some notes.

Emily: [00:52:48] Look around, pay attention. Look around.

Perry: [00:52:50] Yeah. Uh, people absolutely, though do identify sounds and, um, and like accurately identify sounds and things that and even [00:53:00] like music that's playing in the room while they're undergoing CPR. This doesn't seem quite as mystical to me. I'm just sort of like, okay, that's good CPR like they were restoring perfusion to your brain a little bit.

Emily: [00:53:10] And yeah, I mean, I think this is extremely interesting space and one that's obviously very hard to learn about because most of the people die. So then you can't ask them what happened afterwards.

Perry: [00:53:22] Can't ask them.

Emily: [00:53:23] I want to end end this by talking about why death is important for life, which is maybe a little like, you know, more philosophical than my than my usual. But, you know, they're so far on the existence of human history. There have been about 117 billion people born, and 7% of those people are alive now, which means 93% of them died. And pretty much everyone, not just everyone, dies. The case fatality rate of life is 100 is 100%. [00:54:00] And this is a really, really important part of basically every society. Every culture now has funeral rituals mornings. It is a sort of universal human experience. One of the very, very few things other than being born that literally every human will go through and That it's there's just almost nothing. I think that is why people are so drawn to thinking about this and talking about it and trying to understand it and being afraid of it because it is just universal and because it limits our the things that we can do with our time here changes how we live.

Perry: [00:54:44] And that limit is meaningful, right? Like the fact that life is limited, doesn't it increase the relevance of every moment to some extent?

Emily: [00:54:57] Yeah. I mean, it sort of it sort of has to. I'm not sure we [00:55:00] all live that way. You know, we'll say in the in the psychology literature, you know, people tend to regret the stuff they didn't do. Uh, and, you know, there's a lot of, there's a lot of regret in people's at the end of people's lives. They have many regrets about things that they did not accomplish.

Perry: [00:55:19] That they did not do, as opposed to things that they did do. Yeah. Um, yeah. And I think if I mean, yeah, if we were immortal, that would not be salient, right? There's always, there's always more time to. You can always put off whatever it is you wanted to do because there's more time. So, so knowing that time is limited, like increases your ability to do those things because you'll regret it if you don't. Um, I think, you know, thinking about this really in the, in the context of the tech bros. And I had this theory, which was like, okay, as societies become more secular and people are less religious, maybe it's like, oh, you know, these tech guys, they don't believe in an afterlife. They're materialists fundamentally. [00:56:00] And so it's like, well, if this is, this is all I got, then like, I obviously want as much of it as I can. Right. Philosophically speaking, um, I actually couldn't find any support for this in the social science literature. In fact, um, the study they found suggested that increased religiosity goes along with increased fear of death in general, which didn't entirely make sense to me. So. But anyway, that sort of smashed that hypothesis. But nevertheless, maybe I'm a defeatist here, but it feels to me like one of the things we're supposed to do in life is come to terms with death. Like it's the, it's the hardest thing to really adjust to. It is simultaneously the most true, the most certain. You can be about anything, right? Like of all the things that are going to potentially happen to you in your life.

Emily: [00:56:51] It's for sure.

Perry: [00:56:52] This for sure. So of all the things you could prepare for, this is the one, right? Like it is 100% chance. [00:57:00] And it seems to me like a lot of these efforts in the wellness and tech bro longevity space is an effort to avoid having to confront that reality and maybe confronting that reality, like makes life better. Like maybe if you really come to terms with the fact that you're going to die someday, you're a happier person.

Emily: [00:57:22] I also think, and here I want to end on this because I think it is the most practical thing in this episode. I think sometimes the focus on like not dying can take away from our ability or our ability to die. Well. So I want to put a plug in for palliative care. So palliative care is a care that people get towards the end of the end of life. It's related to being in hospice and that sort of thing. But there are forms of it, forms of palliative care that don't go as far as, uh, as hospice, but we see just incredibly clearly in the data. Uh, [00:58:00] and there's trials in metastatic lung cancer, for example, that people who are given palliative care, which is focused on quality of life as opposed to lengthening survival, have less depression, they get less aggressive end of life care, but actually survive a bit longer. Yeah. Um, and so, but even if it is not for survival, there is, it is worth people thinking about the experience they want to have at the end of their life. And sometimes that experience should involve less medical intervention rather than more.

Perry: [00:58:39] I love that I remember that study coming out. Um, the metastatic lung cancer study, this was New England Journal in 2010. And we all thought like, oh, clearly palliative care is going to have less intense interventions and less side effects of chemo. And like, that'll be great. We all assumed that it was going to have sort of similar outcomes in terms of lifespan. But the fact that the the palliative care [00:59:00] arm had longer median survival was like a real eye opener for the medical community. Be like, oh, okay. You know, and I guess it makes sense, you know, I mean, there's times when just like giving more chemo is probably not the right answer, but, um, yeah. Uh, you know, No.

Emily: [00:59:17] Happy Halloween. What? Happy Halloween. How are you? How are you planning to wrap this up, Perry?

Perry: [00:59:21] Well, I was gonna. I'm maybe not wrapping it up in a happy way, but I was going to talk about Seneca, who wrote that? If you have learned to die, you have unlearned being a slave. The Stoics were sort of all over this being like, look, you know, memento mori. Like, remember that you're mortal. Remember that you're going to die. And it does keep things in perspective. Um, so Emily death smash or pass?

Emily: [00:59:51] I mean, I love to pass, but I think I'm gonna have to smash because I'm told. No, look, I mean, I don't this is a I will [01:00:00] reframe by saying, I think, uh, constantly trying to live forever at the expense of all other things. I'm going to pass on that.

Perry: [01:00:09] Yeah, I will, I will, I'll, I'll smash death. It's good that it's out there, but let's live the best life we can, and a longer life is a wonderful thing to to hope for, but not forever.

Emily: [01:00:28] That's it for death. Your mailbag. Question of the week. After the break.

Mailbag: [01:00:48] Hello, this is Tamar, the producer, reading a question from a file that was unintentionally corrupted. Sorry about that, but the question is, I'd be interested to hear [01:01:00] more about extended blood panels that companies like Function Health offer, and how actionable these extra results are. Thank you.

Emily: [01:01:09] Okay, Perry, so let me tell you how they decide reference values for blood tests, which I'm sure you know. But for the listener, when we decide on the reference value, like what is the sort of normal range for any blood tests, you have a bunch of healthy people and you take the middle 95%. So in a sample of healthy people, for any given blood test, you expect about 5% of the people to be like outside of the reference ranges.

Perry: [01:01:35] Despite the fact that they are healthy, like they don't have a problem.

Emily: [01:01:38] Totally healthy. It's just like, I don't know, there's like some variation. You're just random. And usually when, when doctors interpret a whole blood panel, they're interpreting like along with the symptoms, the reason that you're testing this, etc., going out and getting a, a comprehensive blood panel, which typically would contain, you know, I don't know, 75, 100, 150, God knows what, like a tremendous [01:02:00] number of these tests, you will certainly find some that are out of range, even if you are healthy, because 5% of the time, every one of them will be out of range. And if you have 100 of them, you expect at least five of them to be out of the range. And I think that's the big concern with these is that everyone's going to get some result. That's like Red star. Your mix is too high. And it's like, who cares? That actually is totally irrelevant unless you're having a problem that we're testing for there. So I think, you know, it's, I mean, having your blood taken and getting a bunch of numbers, like it's not going to kill you, but there's a tremendous amount of potential over reaction just because of what these numbers mean.

Perry: [01:02:42] That's very well said. The problem with all screening tests is false positives. And these are all screening tests. Unless you have specific symptoms. If you do have specific symptoms, you should talk to your doctor about it. And listen, I appreciate the fact that these direct to consumer companies exist because the medical system often fails [01:03:00] our patients, right? You have a symptom. You call your doctor, they're like, oh, I'll get you in three months from now. And, um, you know, or you can just pay to get tests. So it's it's in part on us that we don't do a good enough job communicating with our patients about what tests are good and what tests are bad, and what how we manage false positives and all these kind of things. But you're, you're right, you're destined to find something. And, um, sometimes, you know, ignorance really is bliss.

Emily: [01:03:32] All right. That's it for us today. Stick with us next time when we'll ask what's the deal with food dyes? Well, this actually is produced in association with iHeart media. Our senior producer is Tamar Avishai. Our executive producer at iHeart is Jennifer Bassett. Our theme music is by Eric Deutsch, and our content is for educational purposes only.

Perry: [01:03:55] If you like the show, help other people find us, leave a rating and review on Apple Podcasts [01:04:00] or your podcatcher of choice and help us spread the word about the show. You can follow us on Instagram at pod. And don't forget, we want to hear from you. Head over to wellness.fm and leave us a question for our mailbag or suggest a topic for a future show.

Emily: [01:04:16] We'll let the influencers have the last word.

Death Becomes Her: [01:04:19] Ernest, I'm in the morgue. Why am I in the morgue? Shh.

Death Becomes Her: [01:04:24] It's okay. It's okay.

Death Becomes Her: [01:04:25] They think I'm dead.

Death Becomes Her: [01:04:26] Yes. Yes.They think you're dead, but you're not dead. In the whole of recorded medical history, this has never happened to another single human being.

Death Becomes Her: [01:04:36] Yes. So why did it have to happen to me?

Death Becomes Her: [01:04:39] Do you know what you are, darling? You're a sign. You're an omen. You're a burning bush. Don't you see, Madeleine? It's a miracle!

Grey's Anatomy: [01:05:04] She [01:05:00] is not dead until she is warm and dead.