The Serious Problems with AI & Why Humans Drink Alcohol

Junk mail seems like a relic of another era. Physical ads showing up in your mailbox feel easy to ignore in a world dominated by digital marketing. Yet companies still spend billions sending those mailers every year. Why? Because for certain groups of people, those pieces of mail are surprisingly effective — far more than you might expect. https://www.uspsoig.gov/sites/default/files/reports/2023-01/RISC-WP-20-009.pdf Artificial intelligence is suddenly everywhere — writing emails, answering questions, summarizing documents, and even helping people make decisions. But should we trust it? Linguist Emily Bender, a professor at the University of Washington and one of the world’s leading voices urging caution about AI hype, argues that we may be misunderstanding what these systems actually do. Named to the inaugural TIME 100 list of the most influential people in AI, she explains why tools like ChatGPT can appear intelligent while operating very differently from human thinking. She is co-author of The AI Con: How to Fight Big Tech’s Hype and Create the Future We Want (https://amzn.to/3P1v6tn) and she offers an important perspective on how we should — and shouldn’t — rely on AI. Humans have been drinking alcohol for thousands of years, and despite the well-known risks, it remains deeply embedded in cultures around the world. Why do people drink in the first place? Is alcohol simply a dangerous toxin, or does it serve psychological or social purposes that help explain its enduring appeal? Dr. Charles Knowles, Professor of Surgery at Queen Mary University of London and Chief Academic Officer at Cleveland Clinic London, brings both scientific expertise and personal experience to the discussion. Having struggled with alcohol dependency himself, he explores what alcohol does inside the body and brain, why some people develop problems while others do not, and how our culture shapes the way we think about drinking. He is the author of Why We Drink Too Much: The Impact of Alcohol on Our Bodies and Culture (https://amzn.to/4b8HHCd). Razor blades are small, simple pieces of metal — yet they often cost far more than people expect. You may even notice they’re locked behind glass at many stores. Why are they so expensive, and why haven’t competitors driven prices down? Several companies have tried to disrupt the razor business but it hasn't gone as well as many consumers hoped. https://www.forbes.com/sites/andriacheng/2018/01/24/pgs-gillette-woes-have-translated-to-this-good-news-for-consumers/ PLEASE SUPPORT OUR SPONSORS POCKET HOSE: Text SYSK to 64000 for your two free gifts with the purchase of any Pocket Hose Ballistic hose! DUTCH: If your pet is still scratching and you’ve tried everything at the pet store –it’s time to stop guessing and go prescription. Support us and use code SYSK for $40 off your membership at ⁠https://Dutch.com⁠ RULA: Thousands of people are already using Rula to get affordable, high-quality therapy that’s actually covered by insurance. Visit ⁠https://Rula.com/sysk⁠ to get started. QUINCE: Don't keep settling for clothes that don't last! Go to ⁠⁠⁠⁠⁠⁠⁠https://Quince.dom/sysk ⁠⁠⁠⁠⁠⁠⁠for free shipping on your order and 365-day returns. Now available in Canada, too! SHOPIFY: See less carts go abandoned with Shopify and their Shop Pay button! Sign up for your $1 per month trail and start selling today at ⁠⁠⁠⁠⁠⁠⁠⁠https://Shopify.com/sysk⁠⁠⁠⁠⁠⁠⁠⁠ EXPEDITION UNKOWN: We love the Expedition Unknown podcast from Discovery! Listen wherever you get your podcasts. Learn more about your ad choices. Visit megaphone.fm/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Mike Carruthers?

  Today on Something You Should Know, why some companies still send physical junk mail? And who actually likes to read it? Then AI. What's behind this new wave of technology?

• 0:16Speaker 01

  What is powering this wave is not major breakthroughs in technology. What is powering the rate wave is enormous amounts of capital. And these companies aren't making money. They're basically telling us we have to use it because they have invested so much money in it.

• 0:31Mike Carruthers?

  Also, why razor blades are so expensive? And the story of alcohol? And why so many people drink it?

• 0:40Speaker 02

  The production of alcohol dating about 15,000 years coincides with when we first started to live in groups, having to socially interact with other people. One wonders whether alcohol's fulfilled a purpose really since that early time.

• 0:56Mike Carruthers?

  All this today on Something You Should Know. Now here's something that might be worth a minute of your time. How would you like $1,000 to spend on shopping? Especially with the holidays coming? Well, the people behind Shopify have a shopping site called shop.com. And to celebrate the new shop.com, they're giving away $1 million in Shop Cash. But not to one person. A thousand people will each win $1,000 in Shop Cash. And shop.com is actually a really clever idea. It brings lots of different stores together in one place.

• 1:39Mike Carruthers?

  So instead of bouncing around from website to website, you can search across stores, find what you're looking for, and track your orders all in one place. Clothes, electronics, gifts, things for the house, all kinds of stuff. And whether you win or not, it's worth knowing. But with 1,000 chances to win $1,000, I'd certainly take a look. Enter to win the $1 million Shop Cash giveaway from now until November 1st. Just go to shop.com. There are so many ways to win. That's shop.com. Shopping designed around you. No purchase necessary. Restrictions apply. Official rules available at shop.com.

• 2:26Speaker 03

  Something you should know, fascinating intel, the world's top experts and practical advice you can use in your life today. Something you should know with Mike Carruthers.

• 2:38Mike Carruthers?

  So you probably get junk mail and you may have wondered why? Who reads junk mail? Well, you'd be surprised and that's why we're going to start by talking about junk mail on this episode of Something You Should Know. Hi, I'm Mike Carruthers and yeah, people often complain about junk mail and you might assume that younger generations, Gen Z's and millennials, really hate junk mail. But marketing research shows that Gen Z and millennials often pay more attention to physical mail than older generations do, largely because they grew up in a world flooded with digital ads.

• 3:20Mike Carruthers?

  When everything online is competing for your attention, a physical piece of mail can actually stand out. In fact, surveys from the US Postal Service found that younger consumers are more likely to read advertising mail and view it as more trustworthy than digital ads. One reason is simple. Digital ads feel disposable, but a physical catalog or a postcard feels more tangible and it tends to stick around on the counter or the table longer than an email stays in your inbox. So while junk mail may seem like an outdated marketing tool, for many companies, it's actually a way to cut through the digital noise.

• 4:05Mike Carruthers?

  And that's why you still get junk mail and it's something you should know. It seems like everyone is talking about AI, artificial intelligence, what it can do, what it might become, how it's going to change the world. But the conversation you are about to hear looks at artificial intelligence from a very different angle. The concern isn't that AI will suddenly become conscious and take over the planet. The concern is almost the opposite, that AI isn't actually thinking at all, at least not the way many people believe it is. And misunderstanding that may be where the real risk lies.

• 4:48Mike Carruthers?

  My guest argues that much of the excitement around artificial intelligence is built on a fundamental misunderstanding of what these systems actually do and what they don't do and what's driving all the hype. And essentially, what's driving all the hype is money. Emily Bender is professor of linguistics at the University of Washington. She was named in the inaugural Time 100 list of the most influential people in AI. She's co-author of a book called "The AI Con: How to Fight Big Tech's Hype and Create the Future We Want." Hi, Emily. Welcome to Something You Should Know.

• 5:28Speaker 01

  I'm so glad to be here. Thank you for having me on.

• 5:31Mike Carruthers?

  So first, I think we need to define what AI hype is because I'm not sure it's a term that people hear a lot, or I don't actually think I've heard it before I saw the cover of your book. So what is AI hype in a couple of sentences?

• 5:46Speaker 01

  Yeah, so it is hype about AI, and I'd love to try to define AI as well, but hype is this like salesmanship, the sense that if you don't get on board, you are going to be missing out. You've got to jump on the train with everybody else without necessarily there being a real there there.

• 6:03Mike Carruthers?

  Well, there certainly has been a lot of AI hype. I mean, there's a million books and podcasts. I mean, we've had several guests on who've written books about AI and how to use it and what it's good for and all of that. And we hear a lot that it's taking over jobs and that, but, but there does seem, from people who use it, there does seem to be some sense that it really is pretty wonderful, that some of the things it seems to do are great.

• 6:32Speaker 01

  Well, so we have to talk about what it is, though, because the term artificial intelligence doesn't refer to a coherent set of technologies. The main thing that everyone is super excited about right now is chatbots, or you might call them conversation simulators, and they are systems designed to mimic the way we use language in many different domains of activity. And so it seems like we have systems that can do many different things, but actually what we have is a system that mimics the way we use language.

• 7:01Mike Carruthers?

  Well, it may do that, but it seems like... The experience of using it is that it's more than that, that it's deeper than that, that it's doing a lot of things.

• 7:13Speaker 01

  Well, so what do you have in mind?

• 7:14Mike Carruthers?

  Well, from my own experience of using it and the way I use it, it seems as if it's looking for information that can help me, it's synthesizing that information, it's writing it in a way, if I ask it to, to make it more effective. It seems like it's doing a lot of things, not just mimicking language.

• 7:36Speaker 01

  Unfortunately, it's designed to look like it's doing that. There's a system addition called RAG, which is Retrieval Augmented Generation, where you put a query into one of these systems and the first thing that happens is that your input is turned into a web search. And then documents come back, just the way web searches work in general. And then the system is prompted to basically produce something that looks like a summary of the documents that came back to you. But there's no accountability there, there's no reliability there, and it's not searching the whole internet any more than an old-fashioned search engine does.

• 8:10Mike Carruthers?

  But it's certainly giving me information, it would seem, that I would have trouble coming up with myself, or would certainly take a lot longer, because it seems to be able to understand what I mean when I want to find out this information, whereas Google, if I'm not using the right words in the right order, I could get a completely different set of websites to look at, and Google doesn't synthesize the websites, it just gives me a list of websites.

• 8:42Speaker 01

  Yeah, well, actually, unfortunately, now they do this synthesis thing in their AI overview.

• 8:47Mike Carruthers?

  That's true, yes.

• 8:48Speaker 01

  Yeah. But if we want to distinguish sort of old-fashioned web search from the so-called AI search or chat interface, the big difference is that, yes, the way you interact with it is, instead of putting in some keywords that you hope will match the documents you're looking for, you phrase the question the way you might ask a person who could understand you. And that helps create the illusion that the system you are interacting with does understand you. But fundamentally, these systems are just set up to repeatedly answer the question, what is a likely next word? And what is a likely next word, given that question as input and the various documents

• 9:31Speaker 01

  that the web search returned, produces something that looks like an answer and is very easy to accept as an answer, but we are then cut off from really important sense-making work, where we understand where information is coming from, why somebody may have put those particular pieces of information together, and how to situate all of that in our understanding of the information landscape.

• 9:52Mike Carruthers?

  And is that really all bad?

• 9:55Speaker 01

  Unfortunately, yes. One of the examples I like to use is imagine you have a medical query, and let's say you're expecting a child and you discover that they are likely to have clubfoot. So how do I treat clubfoot? And if you put that into an old-fashioned web search and you got back answers, or not answers, but actually links to the Mayo Clinic and a local university medical center and something called WebMD and Dr. Oz's website and a chatroom, you probably already have opinions about many of those sites. And if, like me, the Mayo Clinic to you is associated in your mind with cancer, you might go, wait, what's this got to do with cancer? But also, I think of them as like a respectable institution, so I'm gonna go see why they might be talking about clubfoot.

• 10:38Speaker 01

  And anything in the chatroom, I'm gonna take with a grain of salt, but it is extremely valuable to connect with other parents who are going through the same thing. Right? If instead I put this into a chatbot and I get back something that might have come from one of any of those sources, I don't know where it came from, so I don't know how to situate it. I am cut off from my ability to sort of continually build up my understanding of these different sources and cut off from the chance to connect with those other people.

• 11:04Mike Carruthers?

  In your query, though, you could tell ChatGPT, please source all your information, please give me links to those sources. And then you get the summary from ChatGPT, and now you can go look at all the links to where it came from.

• 11:20Speaker 01

  So there's no guarantee that the summary is an accurate representation of those links, so you are better off not reading it and just doing the old-fashioned source, old-fashioned search.

• 11:32Speaker 01

  Rather than getting the idea of in the summary where it might have dropped a negation or put some word emphasis or whatever it is, because there's no accountability there. It has no understanding of what it is processing. It is just giving you likely next words, given that input.

• 11:47Mike Carruthers?

  But you're making the assumption that if I read it, I believe it, and therefore I shouldn't read it. But it seems to me I should read everything and then make my own determination.

• 11:58Speaker 01

  I believe it is important to read many different things, but I think it is dangerous to read things that nobody has any accountability for. So go read those different sources. Go read a summary that a person has produced. But this synthetic output that we actually can't locate in the information landscape because it comes from nowhere is just misleading.

• 12:19Mike Carruthers?

  Well, I like that. It does. It comes from nowhere. Like, you can't point out, well, where did you, how did you arrive at that? In fact, you could ask the same question tomorrow and get a completely different answer.

• 12:32Speaker 01

  Exactly. And you can input into the chatbot, how did you get to that? And it will give you an answer, but that answer is not truthful, right? It's just more likely next words. And so you can go down a big rabbit hole that way.

• 12:44Mike Carruthers?

  But most likely next, it's most likely next words and not truthful aren't mutually exclusive. It could be truthful and it could be just next words.

• 12:55Speaker 01

  Exactly. So if what comes out is truthful or valuable, that is also by chance. If what comes out is incorrect, harmful, or just misleading, equally by chance. And in neither case is there any accountability.

• 13:10Mike Carruthers?

  And so do you then dismiss all of this technology? Do you not use ChatGPT or any of the other chatbots because of what you're saying?

• 13:21Speaker 01

  For many reasons, I do my very best not to consume any synthetic media.

• 13:25Mike Carruthers?

  And define synthetic media.

• 13:28Speaker 01

  So synthetic media is text extruded from one of these chatbots or the images that someone has produced using a text-to-image system, the fake videos that are made. I don't want to spend time on things that don't reflect the either artistic effort of a person drawing an image or the thought processes and accountability of someone writing text.

• 13:53Mike Carruthers?

  So I want to explain how I use ChatGPT and get your views on that.

• 14:00Mike Carruthers?

  So Emily, when I do this podcast, one of the things I do is I write introductions to the segments, usually after the segment is over, so I know what I'm introducing. And sometimes, you know, some days I just don't have it. It just doesn't come out right, or I'm not explaining it well. So I'll write a pretty crappy intro and then feed it into ChatGPT and say, make this better, make this more compelling, make this more intriguing, make this snappier, whatever I say. And sometimes, man, it comes out with something that is really good. And I think, wow, I wish I had thought to say that, but didn't. And so I'll use it. I'll use some of it.

• 14:44Mike Carruthers?

  Sometimes I don't use any of it because I think mine was better. But, boy, sometimes it really hits it out of the park.

• 14:52Speaker 01

  Yeah. As you might guess, I have some objections to that, and I sure hope that you don't do it for this segment. And by the time listeners are hearing this, they will have heard whatever it was, right? But I, so for one thing, you've been doing this show for a long time. You didn't use ChatGPT before November 30th, 2022, because it wasn't there. So this is something you can do, but it's also a practice skill. And I think every time we do the cognitive offloading of using some system to do something, instead of doing it ourselves, we lose that opportunity to practice. We also lose the opportunity to really hone our own unique voices and sort of end up towards this average, which I think is really quite bland.

• 15:37Speaker 01

  And then on top of that, every time we use these systems, we help build the case for training the next large model, for building the next hyperscale data center, with all of the economic labor and environmental impacts that goes entail.

• 15:52Mike Carruthers?

  But maybe, maybe I wasn't clear, but I do, I do do it myself. I then ask it to see if it could make me be better. If you, if you took this and then rewrote it, what would it look like? And sometimes I use some of what it gives me, sometimes I don't. But I at least have like another collaborator in the room. And I'm not, I'm not, it's not a medical thing, no one's going to die from this, but sometimes it comes up with a better way of saying what I was trying to say.

• 16:24Speaker 01

  So you can look at the output and recognize, yes, that expresses the meaning I was trying to express. But I think that every time we say this machine, which is making paper mache out of input of many, many people's words, some of which are people we respect, some of which are people we really don't, is better than us. We are sort of reinforcing the idea that we need this kind of assistance, that we can't, you know, day in and day out, hone our own craft, make it better on our own. And I also object to calling it a collaborator because it's not, right? That's a that's a personification or an anthropomorphization of a system that is just a bunch of math, processing a bunch of words, most of which were stolen.

• 17:08Mike Carruthers?

  From stolen from where?

• 17:10Speaker 01

  Uh, just scraped without consent. My co-author Alex Hanna likes to phrase it as they grabbed everything that wasn't nailed down on the internet. And there was a bunch of ongoing lawsuits about copyright, for example. Is this an okay to okay way to appropriate people's words at work? Right? And if you find that it has a nice turn of phrase that's coming out of the system, and you really like the way that was said, wouldn't it be so much better if you could have seen that turn of phrase in its original context and be able to credit the actual author of it, rather than saying, oh, I like that one. Thanks, ChatGPT.

• 17:45Mike Carruthers?

  So Emily, your views on this run contrary to what an awful lot of people are saying. And it in some ways feels like you're trying to stop a wave that you'll you just you can't stop.

• 18:00Speaker 01

  That's a that's a thank you. That's a new way of of phrasing the inevitability argument. What is powering this wave is not major breakthroughs in technology. What is powering the rate wave is enormous amounts of capital that have been invested. And these companies aren't making money. So they have to push it at us every single minute. Like every time you open your computer, there's the sparkle emoji. I see it right now on Zoom. I'll see it on my email and so on and so on. And they're basically telling us we have to use it because they have invested so much money in it.

• 18:34Mike Carruthers?

  Well, that I get, yeah, and that's certainly concerning. But but one doesn't negate the other. I mean, just just because they're trying to make money at it doesn't mean it's no good.

• 18:45Speaker 01

  So the thing that I'm trying to push back on is this idea that this is technological progress and that is why we all have to get on board. I don't think it's progress and I don't think that technological progress is the only kind of progress we should be focused on. The scholar Chris Giliard refers to these as technologies of isolation, that basically anything that encourages us to turn towards machines and towards these products rather than towards each other and towards strengthening community and connection is anti-progress, really.

• 19:15Mike Carruthers?

  So, given where we are, though, what is your, if you could wave a magic wand, what would you want to have happen, given that we're this far down the road?

• 19:24Speaker 01

  So, wish number one would be that any company that sets up a synthetic media extruding machine, be it text, image, video, is fully accountable for everything that comes out of that machine. So if it gives out medical misinformation, medical malpractice. If it gives out libel, they are, you know, accountable for libel as well and so on. Step number one. Step number two, I would love for everyone to remember that they have their own expertise and to take pride in that expertise and not fall for the marketing that says the computer is better at this than you are.

• 19:58Mike Carruthers?

  Is there, because it would seem to me that there are some relatively simple, low-consequence, low-risk things that I could spend a long time searching various websites for, when ChatGPT could probably give me a quick answer, it's not major and consequential, and I can get on with my day. And it seems like that's not a bad thing.

• 20:23Speaker 01

  So I think that the muscle that we build and maintain when we do web searches, even if it's not consequential, is important. This ability to say, is that a good source for that information? And if we only exercise that muscle on sort of the high stakes questions, we're going to have a much harder time doing it well.

• 20:44Mike Carruthers?

  So this sounds vaguely like, and I know what you're going to say, but I'm going to ask it anyway. You know, you could sort of make the parallel argument that this is kind of like when the calculator showed up and people thought, oh, no, kids are going to get really stupid now. They're not going to have to add and subtract anymore because we've got this machine. But humans adapt and somehow it worked out and no one's complaining about the calculator anymore.

• 21:12Speaker 01

  So one thing about a calculator is that it's going to be consistently accurate, right? And I believe that even now in school, you do a lot of your math education with no calculators allowed. And then when you move on to something like algebra, when you're no longer focused on this arithmetic, then it's like, okay, you can use a calculator for the arithmetic because we're focusing on this other thing. And that is predicated on, A, understanding what it is the calculator's doing so that you can, you know, if the output doesn't look right, you can backtrack and see, oh, yeah, I put an extra zero there. That's why that makes no sense. And on the calculator being reliable, which these large language models, the synthetic

• 21:54Speaker 01

  text extruding machines are fundamentally unreliable because what they are doing is repeatedly answering the question, what's the likely next word? And that's it.

• 22:03Mike Carruthers?

  Has there been, though, has there been any kind of research, when you say they're not reliable, but how often they are wrong?

• 22:11Speaker 01

  So you'd have to zoom in on a specific area of concern because one of the problems here is that these are being sold as everything machines. You can ask it any question, even questions that don't make sense and so therefore should not be answerable. You will still usually get an answer out of the system. If you try to design an evaluation around, okay, what percent of the time is it right? What percent of what time? Where a calculator, there's a specific spec that we expect all calculators to adhere to, and they do. And the first minute you see a calculator that is not accurate, you toss it out, right?

• 22:48Mike Carruthers?

  How is using ChatGPT for finding information any worse than just using Google or any search engine to find other websites that have information that may just be as unreliable as what ChatGPT gives you? I mean, how is that any different? People have criticized that, saying Dr. Google, meaning using Google for medical advice, is a bad idea.

• 23:15Speaker 01

  That, I think, is actually a slightly different thing, because Google, in its original form, was directing you to sites. And so the accountability lies with the sites that you landed on, and then Google has accountability for how they are ranking those outputs. And that's what a lot of what their algorithm is. The problem with Dr. Google is that a person who's experiencing a medical concern can easily end up worrying themselves by looking at very many things, because they don't have the expertise to navigate that kind of information. Where you go to a medical professional, they are trained to do that navigation and also find out more, do the tests, and so on. This is, I think, made worse by the chatbots, because you can very easily, the user interface

• 24:00Speaker 01

  of it allows you to express your question and then receive something that you are ready to take in as an answer, and then become even more convinced.

• 24:08Mike Carruthers?

  Well, I really enjoyed this, because so much of the conversation about ChatGPT and those kinds of AI tools, and just AI in general, is that it's this great revolution, that it really is helpful and useful. And like with so many other things in life, there's another side to the story, and you've presented that side really, really well. I've been speaking with Emily Bender. She's co-author of the book, The AI Con: How to Fight Big Tech's Hype and Create the Future We Want. There's a link to her book in the show notes. Emily, thank you very much.

• 24:44Speaker 01

  Thank you so much. It's been a really interesting conversation.

• 24:51Mike Carruthers?

  Few topics spark stronger opinions than alcohol. Some people enjoy it, some avoid it completely, and most of us have heard the warnings about the health risks. In fact, attitudes towards drinking seem to be shifting. Alcohol consumption in the US is at an historic low, with about 54% of Americans saying they drink today compared with 67% just a few years ago. Yet alcohol is still deeply woven into our culture, from celebrations and socializing to business dinners and dating. So why do we drink at all? Why is alcohol so powerful socially, culturally, and biologically?

• 25:35Mike Carruthers?

  And why do so many people end up drinking more than they intended to? My guest has a fascinating perspective on this, both as a physician and as someone who has struggled with alcohol personally. Dr. Charles Knowles is Professor of Surgery at Queen Mary University London and Chief Academic Officer at Cleveland Clinic London. His book, titled Why We Drink Too Much: The Impact of Alcohol on Our Bodies and Culture, explores the science, psychology, and social forces behind drinking, and why alcohol continues to have such a powerful grip on society. Hey, Dr. Knowles, welcome to Something You Should Know.

• 26:17Speaker 02

  Mike, thank you very much for having me on.

• 26:20Mike Carruthers?

  So first of all, I think most people are aware that there are not a lot of health benefits to drinking, but there is some confusion, because there is some talk that, well, maybe a little wine, a glass of wine, might be good for you. Or maybe it's just not really bad for you. And then there are people who say, you know, alcohol is poison from start to finish, and you just shouldn't drink at all. So where are you on this?

• 26:45Speaker 02

  Well, I think the first thing to say is that I'm not anti-alcohol. I think alcohol's been with us in society for a very, very long time. We've been deliberately manufacturing it for 15,000 years, and there's a reason for that, and that is that people, many people, gain enjoyment from drinking. And that's why it's proved so enduringly popular.

• 27:11Speaker 02

  In regard to the consumption question and the amounts that you mentioned, I don't agree that alcohol is solely a poison. People say this, and it is a popular way of looking at alcohol and its consumption. But the the truth is, if it were just a poison, we wouldn't do it. I think what has changed is an appreciation of the health consequences of alcohol. And here I'm talking more about the long term health consequences rather than problems of dependence and mental health, particularly in relation to heart disease, cancer, obesity, et cetera.

• 27:53Speaker 02

  And actually, the data that underpin those observations have been around a very long time. For instance, alcohol has been a class one carcinogen since the 1990s. But I think people are coming to realise that more and to critically evaluate their relationship with alcohol as they evaluate their health in general.

• 28:17Mike Carruthers?

  Well, the idea that alcohol is a carcinogen certainly scares a lot of people. And and I think ultimately, people who drink, who enjoy having a drink, wonder how much is too much? And if it's a carcinogen, it seems like, well, you would be better not to put any carcinogen into your body. So what's the answer here?

• 28:39Speaker 02

  Let's just start with the carcinogenicity. So as a class one carcinogen, it's up there with smoking, asbestos, radiation, et cetera. And we've known that since studies in the 1970s. In regard to that, the most important cancer is breast cancer. And it's relevant to mention this because it's probably the only health consequence that is associated with an appreciable increase in risk, even whilst drinking a very small amount of alcohol, i.e. below the government recommended limits of safe consumption. So for a woman, even drinking one small glass of wine every day

• 29:24Speaker 02

  will increase the risk of breast cancer. That's also partially true for stroke. Most of the other health consequences only occur with heavier consumption as a general rule, unless a person is also obese, in which case some of those effects are synergistic.

• 29:43Mike Carruthers?

  Well, you've mentioned what is considered the limit to safe drinking. What is that? What is the limit? What is considered safe?

• 29:52Speaker 02

  Well, that depends where you are in the world, Mike. So rather inconveniently and confusingly, both the definition of a unit of alcohol and the safe limits vary country by country, and they vary by about a factor of three. They also vary by men and women. Some countries have the same limits for men and women, and some have different ones. And this is what makes it problematic for an individual to determine whether they're drinking excessively either on a weekly basis or on an episodic basis, which we mostly call binge drinking.

• 30:27Mike Carruthers?

  Well, we must know, we must know, though, that there's, there's a line somewhere that's based on science rather than where you live.

• 30:36Speaker 02

  That's actually not entirely true. I mean, there is a line, if you put that line, a consumption level of 30-plus units a week, which would be 20 standard US drinks, then clearly that is a line where the majority of people, were they to consume that, would incur health effects from alcohol. But I mean, it's not a straightforward relationship at all. I mean, you and I both know people who drink very heavily and have no health consequences from it. So as an individual, it's only a question of probabilities.

• 31:14Mike Carruthers?

  So is there, is there any good news about alcohol? This idea that, you know, a little wine is actually good for you, but I think that's kind of been debunked, but is there any good news about it?

• 31:29Speaker 02

  Well, it's not entirely debunked. Actually, it is a true observation that a small glass of wine or a small amount of alcohol in another form, taken daily, at least in white European populations, results in a lower risk of having what's called a myocardial infarction, a heart attack. But this doesn't hold true for anything else. There are arguable data on Alzheimer's disease and on several other rarer diseases like kidney cancer where it may also be protective. But the World Health Organisation and any doctor you talk to would basically tell you that there is no safe level of alcohol consumption.

• 32:14Mike Carruthers?

  The other thing that people hear is that drinking alcohol kills brain cells. True or false?

• 32:22Speaker 02

  True-ish. Certainly, heavy chronic alcohol consumption is related to a loss in volume of grey matter, which is where the majority of the cell bodies of our nerves are in the brain, and it also alters something called white matter connectivity, which are the main connections between areas of the brain. The question really is not so much whether that occurs, it does occur, and there are elegant studies in journals like Nature that show that from UK Biobank data and other sources. But whether it's significant in terms of one's mental functioning? Clearly, in a minority of people, it's very significant for their mental functioning.

• 33:05Speaker 02

  And there are conditions like wet brain that result with very heavy alcohol consumption, particularly in relation to vitamin B deficiency. But for the rest of us, it's a bit of a lottery, to be perfectly honest. The vast majority of people probably drinking within reasonable limits will not experience a loss in brain cells that will be clinically apparent.

• 33:31Mike Carruthers?

  What about the difference between hard alcohol and wine? There's always been that argument that wine, and maybe beer as well, because it has less alcohol and it has other things in it, that... Does the body care, or is alcohol alcohol?

• 33:49Speaker 02

  Alcohol is alcohol on the whole. I mean, people who drink spirits may tend to drink more alcohol, in which case that matters. But in the most part, it doesn't matter what form you take alcohol in. In fact, the stomach best absorbs alcohol in the sort of wine range. So you could argue that you get more bang for your buck in terms of alcohol in the bloodstream by drinking wine than drinking something that's either stronger or weaker. But the sort of mythology around wine being better for your health than, for instance, other drinks is just simply not true.

• 34:27Mike Carruthers?

  And I guess it has a lot to do with the amount of alcohol. That's kind of what people think, that hard liquor has more alcohol in it, so it must be worse for you. It's more of a math thing than it is science.

• 34:41Speaker 02

  Well, it may also be a velocity aspect, so that obviously you can drink more alcohol faster as spirits than you tend to drink as beer. And that's important, because the liver can metabolize a certain amount of alcohol in an hour. And so if you drink more rapidly, then more alcohol appears in the bloodstream than if you drink more slowly. So, I mean, certainly my experience, Mike, when I was drinking, and I wasn't really a spirit drinker much at the time, but funnily enough, when I was in the US, because I didn't much like the beer, I would tend to drink spirits, and certainly that didn't result in a great outcome as a general rule.

• 35:25Mike Carruthers?

  And you don't drink now?

• 35:27Speaker 02

  I haven't drunk for 10 years.

• 35:30Mike Carruthers?

  And that's because?

• 35:31Speaker 02

  That's because I developed dependence and significant mental health problems from drinking, and I had to stop. And before those 10 years, I spent seven years trying to stop.

• 35:44Mike Carruthers?

  Which brings up that whole issue of, you know, some people seem to be able to have a glass of wine with dinner, and that's fine, and they're done, and they don't need any more. And other people can't even understand how that could be possible, that once you start, it's very hard to stop.

• 36:03Speaker 02

  Yes, I mean, I'm one of those people who used to watch people drinking one glass of wine for hours in a pub and just think, what are they doing here? Because for me, I always drank for the effect of alcohol on my brain. I didn't drink to sip a glass of wine socially. My book, of course, covers in great detail what differs in terms of risk of people developing that loss of control for alcohol, which only a minority do to a level of dependence, versus much of the population, who, as you say, can just take it or leave it.

• 36:42Mike Carruthers?

  But I notice, I notice that when I drink, and I'm a wine drinker, it's very easy for me not to drink at all. But if I have a glass, I'm probably gonna have another one.

• 36:55Speaker 02

  Well, Mike, I don't know about your... You may just choose to have another one, and that may be a perfectly reasonable decision in your particular instance. But there are people like me who, whose experience has been, you have one glass of wine, and then it's a bottle of wine, and then it's another bottle of wine. And in fact, I measured my alcohol consumption when I drank wine in bottles rather than glasses.

• 37:21Mike Carruthers?

  What does the science say? Not just your... Well, your personal story is interesting too, and plays a part. But people who don't have a problem with drinking can look at people who do have a drinking problem and not understand, well, why don't you just stop? If it's such a problem, why don't you stop? Or stop sooner, have a couple of drinks and call it a day? And there's an intellectual understanding that problem drinking is a real, real problem. But it's hard to put yourself in that place because if you don't have that problem, it's hard to understand that problem.

• 38:01Speaker 02

  You don't, in a sense, drink your way to being an alcoholic. You differ to start with. Now, part of that's genetic. And in fact, alcoholism is 50% heritable, for instance. But a great deal of it is based on the environment you've grown up in, particularly during early childhood. And to do with psychological drivers that push towards self-medication. The big ones there, that I have, for instance, are ADHD, depression and neuroticism. And there are even stronger drivers like post-traumatic stress disorder. 68% of Vietnam veterans

• 38:44Speaker 02

  have a substance misuse problem, and the majority of that is alcohol, for instance. But also schizophrenia, bipolar disorder, impulsive disorders, certain other personality types. Those are the things that drive abnormal alcohol consumption and dependence.

• 39:03Mike Carruthers?

  So if you grew up in a household where there was a lot of drinking, that makes you more likely to drink, just like smoking, if your parents smoked, you're more likely to smoke. If your parents drink, you're more likely to drink.

• 39:17Speaker 02

  That's not entirely true. The age of first drinking is important. So if you start drinking before the age of 14, for instance, then that has a difference between, say, starting after the age of 18 or 21. But there's not strong evidence that being from a drinking household makes a difference over and above that.

• 39:44Mike Carruthers?

  Alcohol has certainly served a purpose in society in that it lowers inhibitions. It's a focal point for socializing. It has had positive social effects, as well as some pretty devastating negative effects.

• 40:01Speaker 02

  Yes, and I mean, this has been extensively studied. I mean, from a historical perspective, actually, the deliberate production of alcohol, fermentation, dating about fifteen thousand years, coincides pretty accurately with when we first started to live in groups. So around that period of time, with early agricultural practices, people would congregate and live in early civilizations of about a hundred to a hundred and fifty people. And one can speculate that that's no coincidence. And I mean, back in those days, there were no mobile phones, or board games, or anything else to play, sitting around the campfire, having to socially interact with other people.

• 40:47Speaker 02

  One wonders whether alcohol's fulfilled a purpose really since that early time. And of course, that's another really important driver, that people who have a drive to consume alcohol to make them more socially fit, and by that I mean to be able to engage with other human beings in a manner that fulfills your own self-esteem, then that's an extremely strong driver of consumption.

• 41:15Mike Carruthers?

  Yeah, because if you remember back to your first drink, it probably tasted terrible. I mean, if you're a kid and you sip whiskey, it's not going to taste good, so why would you ever want it again? But, but, you know, peer pressure and, and the results of feeling that buzz, they're pretty strong drivers.

• 41:41Speaker 02

  Well, here, I think this is where you can get some inkling of where your life is going to go from an early age, that if alcohol is an immediate solution when you're young and you first try it, I think, you know, your cards may be dealt for later in life. I mean, there's an adage that you sometimes hear, that if alcohol's a problem, then you're in with a chance. If it's your solution, then you've already lost. And the, for me, for example, as a child, when I first tasted it, I loved it. I'd had three pints of beer by the time I was extracted, at the age of thirteen, within an hour.

• 42:26Speaker 02

  And that was my experience from the age of seventeen away at boarding school, not terribly popular, slightly nerdy, bullied individual. Alcohol was a revelation for me, was a solution to all my problems.

• 42:44Mike Carruthers?

  It is such an interesting topic because it affects some people as it has affected you and your life so severely and yet other people, as we spoke about, you know, the woman who has a glass of wine and can nurse it for hours and never has a problem. It's so weird, it's so strange.

• 43:07Speaker 02

  Well, if you if you look at the stats, about two to three percent of Western populations like the US and the UK, for example, will develop medically diagnosed alcohol dependence like me, what in old man's terms was called alcoholism. It is important to note, though, and highly topical at the moment, the subject to what's called grey area drinking. I don't know if you've heard of that, Mike?

• 43:33Mike Carruthers?

  I have, yeah, but I don't know much about it.

• 43:37Speaker 02

  So grey area drinking is not a medical term, is the first thing to say, but it probably affects about twenty percent of the population. And these are people, particularly the people who are reviewing their relationship in adulthood now with alcohol. And there are many, many groups worldwide, community groups for grey area drinking and people who are looking at changing that relationship. And what typifies grey area drinking compared with dependence is that the situation has reached one of what's described as hazardous alcohol use rather than harmful alcohol use. So it's a person who worries that those harms may be coming down the line.

• 44:22Speaker 02

  It's I haven't crashed the car yet, I haven't lost my job yet because I've turned up with hangovers, I haven't, you know, had problems with my obesity yet. But worrying about things like your appearance, about performance at work, relationships, the amount of money you're spending on alcohol. But the the yet's are yet to happen. And at the same time, the realization that when you then try to stop or modify consumption, that habit isn't as easy to break as you thought.

• 44:57Mike Carruthers?

  So if you don't mind me asking, what caused you to stop? Why did you finally stop drinking?

• 45:04Speaker 02

  So after my last night of drinking, which followed 24 hours after sitting with a gun and a bottle of Bacardi and considering taking my own life, I woke up in the morning, kneeling on the floor to any god that would listen with alcohol withdrawal. And I reached the point where I realized I could never drink again. I just was sick and tired of being sick and tired. And that often actually is the way it is.

• 45:34Mike Carruthers?

  Well, you certainly have a unique and interesting perspective on this topic, and I appreciate you sharing it and sharing your personal story as well. I've been talking with Dr. Charles Knowles. He is a professor of surgery at Queen Mary University of London and chief academic officer at Cleveland Clinic London. And his book is called Why We Drink Too Much: The Impact of Alcohol on Our Bodies and Culture. And there's a link to his book in the show notes. Thank you, Doctor.

• 46:02Speaker 02

  Thank you very much, Mike, for having me on.

• 46:07Mike Carruthers?

  You don't have to go back too far to remember when the razor blade market was totally dominated by two brands, Schick and Gillette. And razor blades were very expensive, costing 20 bucks for just a few blades. Then, you may recall that Dollar Shave Club and Harry's showed up and promised to make razor blades cheap. And for a while, it looked like they might. Dollar Shave Club launched in 2012 with the slogan, "Great Razors for a Dollar a Month." Harry's followed soon after that, selling directly to consumers by subscription, which cut out retail markups and forced the big brands to respond.

• 46:48Mike Carruthers?

  Gillette even cut some prices by about 12% as these newcomers grabbed some significant market share. But razor blade prices never really dropped the way people expected. Why? Well, because these disruptors eventually became part of the system. Unilever bought Dollar Shave Club for a billion dollars. Harry's almost sold out to Gillette, but that was blocked by regulators. And it's important to consider that the razor blade business is a difficult business to break into with high manufacturing barriers. So the razor revolution did happen. It just didn't cut prices the way people had hoped. And that is something you should know.

• 47:34Mike Carruthers?

  Hey, you'd be doing me a big favor by telling some people, or even just one person, about this podcast and getting them to give it a try and listen. It's a great way to spread the word and help our audience grow, which we always need. I'm Micah Rutherford. Thanks for listening today to Something You Should Know.