Think You’re Too Smart to Be Scammed? & The Invention That Changed Medicine

People who live the longest aren’t always the ones with the “perfect” body weight. In fact, research suggests that being slightly overweight can actually increase your life expectancy. It sounds counterintuitive, but the science may surprise you. Listen as I explain what’s really going on. https://healthland.time.com/2013/01/02/being-overweight-is-linked-to-lower-risk-of-mortality/ Ever since the dawn of the Internet, we’ve been told to guard against hackers — but today’s biggest threat isn’t hacking, it’s scamming. Cybercriminals are more cunning than ever, tricking millions into giving up money and information every day. If you think you are too clever to be taken by cyber-scammers, think again. Eric O’Neill — former FBI undercover operative, national security attorney, and cybersecurity strategist — reveals how modern scams work and how to stop them before they get to you. He’s the author of Spies, Lies, and Cybercrime: Cybersecurity Tactics to Outsmart Hackers and Disarm Scammers (https://amzn.to/4nRvvv1). Imagine medicine without X-rays, CT scans, or MRIs. It’s impossible — these imaging breakthroughs revolutionized how doctors diagnose and treat disease. Yet not long ago, the idea of seeing inside the body without a single incision was pure fantasy. Dr. Daniel K. Sodickson, chief of innovation in radiology at NYU Grossman School of Medicine and author of The Future of Seeing: How Imaging Is Changing Our World (https://amzn.to/3KNz3zS), shares the fascinating story of how imaging transformed modern medicine — and what’s coming next. Sarcasm might seem like just a clever way to joke around but it’s actually good exercise for your brain. Using and understanding sarcasm requires multiple parts of your mind to work together. Listen as I explain why being sarcastic might make you sharper. https://www.hbs.edu/faculty/Pages/item.aspx?num=49283&utm PLEASE SUPPORT OUR SPONSORS!!! QUINCE: Layer up this fall with pieces that feel as good as they look! Go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://Quince.com/sysk⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for free shipping on your order and 365 day returns! ON POINT: We love the On Point podcast! Listen wherever you get your podcasts! ⁠https://www.wbur.org/radio/programs/onpoint⁠ SHOPIFY: Shopify is the commerce platform for millions of businesses around the world! To start selling today, sign up for your $1 per month trial at⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://Shopify.com/sysk⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ 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.

• 0:00Mike Carruthers?

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• 0:42Mike Carruthers?

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• 1:23Mike Carruthers?

  Just go to indeed.com/podcast right now and support our show by saying you heard about Indeed on this podcast. Indeed.com/podcast. Terms and conditions apply. Need the right hire fast? Then this is a job for Indeed Sponsored Jobs. Today on Something You Should Know, the science behind why many overweight people live longer than thin people. Then the latest cyber scams that victimize millions. Some will amaze you.

• 1:58Speaker 01

  One of the number one celebrities who gets impersonated is Brad Pitt. Thousands of people online fall in love with Brad Pitt, thinking they're actually talking to the actor, and they're just being scammed by a clever cybercriminal. And of course, they are always asking for money.

• 2:14Mike Carruthers?

  Also, the benefits of sarcasm, and the evolution of imaging, MRIs, CAT scans, and when X-rays took the world by storm.

• 2:24Speaker 02

  There used to be X-ray machines in shoe stores, and people were invited to come in and look at the bones of their feet. Because how cool is that? It took a while for people to put together that extended exposure could be dangerous.

• 2:38Mike 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 ShopCash. But not to one person. A thousand people will each win $1,000 in ShopCash. And shop.com is actually a really clever idea. It brings lots of different stores together in one place.

• 3:21Mike 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 a thousand chances to win $1,000, I'd certainly take a look. Enter to win the $1 million ShopCash 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.

• 4:04Mike Carruthers?

  Official rules available at shop.com.

• 4:09Speaker 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.

• 4:22Mike Carruthers?

  Could it be that overweight people statistically live longer than thin people? Well, that's what we're going to start with today on this episode of Something You Should Know. Hi, welcome. I'm Mike Carruthers and it's called "The Obesity Paradox", the idea that overweight people live longer than thin people. And this somewhat surprising conclusion comes from a review of over 100 previously published research papers connecting body weight and mortality risk among 2.88 million people. Now, this is not a reason to let yourself go. The researchers concluded that it's possible overweight and obese people

• 5:05Mike Carruthers?

  get better medical care, either because they show symptoms of disease earlier or because they're screened more regularly because they're at higher risk. There's also some evidence that heavier people may have better survival during a medical emergency, such as an infection or surgery. If you get pneumonia and lose 15 pounds, it helps to have 15 pounds to spare. And that is something you should know.

• 5:37Mike Carruthers?

  From the moment we first went online, we've all been warned: "Protect yourself from hackers. Use antivirus software. Set up firewalls. Be careful what you click." For years, that was solid advice. But the truth is, today's cyber criminals don't just break into your computer, they break into you. The game has changed and the old defenses aren't enough. My guest, Eric O'Neill, knows exactly how that works. He's a former FBI undercover operative, turned national security attorney and cybersecurity strategist. And he is author of a book called "Spies, Lies, and Cybercrime:

• 6:19Mike Carruthers?

  Cybersecurity Tactics to Outsmart Hackers and Disarm Scammers." Hey, Eric, welcome to Something You Should Know.

• 6:27Speaker 01

  Hi, Mike. It's great to be here. I am a fan of the show, so I'm looking forward to our conversation.

• 6:32Mike Carruthers?

  Great. So I've always wondered, and you would have insight into this. Who are these cyber criminals? Who are these people that their job is to try to victimize people? Is there like a profile or it's very, very varied?

• 6:49Speaker 01

  There are many different profiles, and that's a great question. I have said that cyber criminals, and that's who we're focused on here, are the new bank robbers. Why would you ever take a gun and go into a bank with a mask? And try to get money from the teller? And possibly be arrested, you know, have all sorts of collateral charges, be, you know, high-speed chases, when you can just send an email and make far more money? And that is the reason that cybercrime is right now the fastest growing business on earth. Criminals are everywhere in every country. And they're making an enormous astronomical sum of money off of our pain and misfortune.

• 7:33Mike Carruthers?

  And are these people primarily overseas or not in this country?

• 7:40Speaker 01

  The largest cybercrime syndicates, the new mafia, the new gangs that we have to worry about today in crime are primarily overseas. They're overseas because they're in countries typically that don't have extradition. They're in places that don't have developed cybercrime laws. They're in places that look the other way when they attack the West, like Russia or China. And so they're smart about where they base their operations, just like any business is. And we have to think of them as businesses with verticals and different parts of the business, like tech support and help. And you know, if you get locked by ransomware, they have their help services that will come

• 8:24Speaker 01

  and help you get unlocked because they want to get paid and they want to continue to launch successful attacks.

• 8:30Mike Carruthers?

  Are most of the attacks done with the cooperation of the victim? Because, because most people will tell you, I think, I'm too, I'm way too smart to fall for that. I'm not gonna, I'm not gonna be handing over my information to anybody. I'm way too smart. So is it that they're somehow sneaking into my computer in the dead of night? Or is it usually with my cooperation?

• 8:57Speaker 01

  Usually, it is with your cooperation. Because it is far more difficult to launch attacks that are computer to computer. We have cybersecurity. Operating systems are built to resist this. It is easy to fool us. And in fact, I was almost breached how an attacker was able to almost get me just to show that I'm trained to defend against this. But the attackers can be so clever and so deceptive, even a trained spy hunter could almost fall for it.

• 9:30Mike Carruthers?

  I remember a few years ago, I got an email from my bank, presumably. They sure looked like my bank. And it was so realistic, to the point where I was really paying attention. And it was asking me for this information. And after a few minutes, I thought, well, wait, now, wait a minute. They should have this information. And then I realized this was fake, but, boy, was it realistic, and I almost fell for it.

• 10:00Speaker 01

  And exactly, that's the essence of deception. You know, a good spy will want to gain the trust of their target or their asset. Make them believe that a lie is true. And then exploit that in order to steal information. And that's what cyber criminals are doing. And in the case that you mentioned, Mike, what they're doing is they're sending a phishing email that can have broad implications, right? So, all of us use banks. And they're sending this phishing email out to everyone, hoping that, you know, you are a member of Chase Bank or Citibank. And you see that email, and there is usually a pressure situation. You know, this charge is pending, but is going to come into effect if you don't respond.

• 10:45Speaker 01

  There was a problem with your account. Respond now to unlock it. Something that suggests you, oh, I better move quickly on this. And the reason for that is they don't want you to think too much. They want you to move quickly and click on the link and open the attachment. And that's how they get in. Obviously, the best thing that anyone can do when you receive an email from something critical like your bank, or your healthcare provider, or any finance institution, even social media accounts, because that is a prime target for attackers. Is not to open any link or attachment that comes in that email, but to delete the email, go directly to that institution and see if it's true.

• 11:27Speaker 01

  If you don't see it when you log on the correct way, then it was probably a scam.

• 11:32Mike Carruthers?

  So when you say that if you click on the link, that's how they get in. What does that mean? What so what does it mean to get in? And what do they do once they get in?

• 11:44Speaker 01

  If they're trying to get into your account, often what they will do is provide links that take you to a dummy website. So if I wanted to attack you, I might find out what bank you use, send you that email as though it comes from your bank. And now using AI, it generates emails with perfect grammar, perfect spelling, and they can even make it look like examples from the bank that would be sent to consumers or to customers. And then when you see the link that you're supposed to click to solve whatever problem they're making you worried about, it will take you to a dummy website, a mock website that they've created that looks like your bank. So when you put in your username and your password

• 12:28Speaker 01

  and even your two factor authentication, they now have access to your account. You've just given it to them. And just as fast as you're putting it in, they're going on the legitimate website and logging in as you. They do this with medical accounts. They do this with businesses everywhere. And this is one of the primary ways that attackers will try to compromise a business. And once they're in, once they have become you within an environment or a computer system or a network, they have access to that network and they can expand their access by compromising other accounts. And against businesses, one of the typical ways that these attackers will make money is to compromise so many accounts

• 13:14Speaker 01

  that they can bring it all down with an attack called ransomware, which means they encrypt everything, all the drives that they have access to, so that the data for the business is no longer available. It's encrypted. It's it without the decryption key, it it might as well be completely useless.

• 13:31Speaker 01

  And then they say, hey, pay us a bunch of money and we'll give you the decryption key and you can have your data back. And if people say, yeah, we have a backup, we'll just restore from backup. They say, that's fine, but we've also stolen all your data. And if you don't pay, and this is extortion, we're going to give it to your competitor. We're going to publish it online. We're going to use it to create more damage. And that can be incredibly persuasive to make businesses pay.

• 13:57Mike Carruthers?

  So the message we used to hear, which is you need really strong antivirus software, you need a firewall, you need these blocks on your computer to prevent people from getting in, that's really outdated.

• 14:12Speaker 01

  No, that's been outdated for decades. Now, you do need robust cybersecurity. And the best cybersecurity right now is looking for what we call anomalies. So it's looking for access points that don't seem right. The number one best thing you can do is turn on two-factor authentication. So don't rely on your password, have something else, like that text that comes to your phone or the app you open that gives you the six-digit number that changes every 20 or 30 seconds, because that's harder for them to get. They can still fool you into giving them that, but that's an extra step that will save you from 90% of these attacks. If they really want to come after you, though, they will use the hard press.

• 14:57Speaker 01

  Sometimes it's a combination of email. Now, the new attacks are what they call dark web call centers. They have people who actually sit there and man phones. So you might get an email from your bank that doesn't give you a link or an attachment. It says, if you see this as a problem, call here. And it gives you a 1-800 number and you call and you're talking to someone sitting in Singapore, chained to a desk, who's just trying to make enough money to be released, you know, who's been captured by the bad guys. They work on commissions for release, it's indentured servitude, and they're just going to try to scam you by saying, yes, I am your bank and this is a problem, we need to verify your credit card, something like that, just so they can steal your information and identity.

• 15:42Mike Carruthers?

  I have some personal experiences I want to ask you about, things that I've encountered. I'm talking with Eric O'Neill, he's author of the book Spies, Lies and Cybercrime: Cybersecurity Tactics to Outsmart Hackers and Disarm Scammers.

• 15:59Speaker 04

  Hey Spotify listeners. When you travel with American Airlines, you'll enjoy comfort and convenience at every altitude. Before takeoff, unwind in the Admirals Club Lounge with curated self-serve offerings of hearty bites and refreshments. In-flight, stay connected with high-speed Wi-Fi. Sponsored by AT&T. Your journey is designed to feel easy from the moment you check in to the moment you arrive. No matter where you're going, American gets you there. Book now at aa.com.

• 16:25Speaker 05

  Pink Pantheress here. Coach and Spotify are teaming up to bring music and style together, and they want you to be part of it. Grab your friends and head to the Tabby Tour, hitting cities around the country with live performances from special artists, exclusive experiences, and personalized products. And discover custom playlists on Spotify, booked just for you based on who you are and how you listen. Live your story with Coach. Learn more at coach.com.

• 16:52Mike Carruthers?

  So Eric, I have a couple of examples of things where people have tried to get me, and I don't understand it. Because it makes no sense. For example, I get calls lately. I've been getting calls on my cellphone. And if you do answer it, it's just a recorded message. And it says, "I've been trying to reach you. We've been... Your file is almost complete. Your business loan is ready." But I don't have a business loan with them. I don't... So, I mean, so the premise is false. Who would fall for this? And to what end is this?

• 17:31Speaker 01

  So that attack right there is what I call a spray and pray smishing attack. So we have phishing, which is typically over email. We have smishing or phishing, which comes over voicemail or text. And what the attackers will do is they go in the dark web and they buy thousands of cellphone numbers and just send this out, right? Send this recording out. Because they are sending it to a large mass of people just trying to get the hundred of so who tried to open a loan. And sometimes you see this in different ways. Around tax season, it comes from the IRS. Around back to school, it comes from your kid's sports team. You didn't pay the fee. Your, your, your son or daughter can't play their sport.

• 18:16Speaker 01

  Around the holidays, it's, you know, we're trying to send your package. And there's a problem, can you call us back? Right? All sorts of different ways. And it's just to, to try to hook the one person who actually did apply for a loan. And, you know, they'll be very polite and helpful and find out all your bank account information and then steal from you.

• 18:40Mike Carruthers?

  And then it says, press seven if you want us to remove you from the list. And I think, well, do you press that? Or does that just say, no, there's a live person there and we'll keep bugging you?

• 18:52Speaker 01

  Yes, once you press that button, you're on their list forever. They know that you're a real person. It's a real phone number. So you never want to do that. You simply want to hang up. If you get a call from the IRS, if you get a call from your school, if you get a call from UPS saying, we can't deliver your package, you say, thank you, hang up and then call back at, at the actual number. Right? Because you want to make sure you're not being scammed.

• 19:19Mike Carruthers?

  Well, I remember hearing years ago, and I believe it is still true. The IRS will never initiate a contact with you on the phone. It's always in the US mail. So if you get a call from someone that says they're from the IRS about some new thing, it's not the IRS. Now, I, maybe they call, you know, back and forth after they've been investigating something. But to initiate anything, the IRS never calls anybody.

• 19:48Speaker 01

  You're exactly right. And yet, around April in the United States, everyone is getting calls from the IRS because attackers know that most people don't know that. In fact, the FBI last year had to put out a warning. That scammers, attackers, were calling people saying that they were the FBI and there was a pending investigation and that they needed information from individuals. And the longer they can get them to talk, the more information they could get. And the FBI was saying, "We won't call you and do that over the phone. You know, we'll show up." So attackers will create these very clever schemes that can be very persuasive to someone who is caught at a weird moment.

• 20:33Speaker 01

  So, I mean, the long and the short of it, what you really need to know here is that these cyber attacks are not computer-to-computer. It's not that your computer is on and an attacker is somehow trying to get in through the internet. What they're trying to do is connect with you, create that personal connection that you believe and trust, and then get you to hand over the keys to your data or to your wallet. Just hand it right to them. And some of these attacks don't even use a single byte of data. They're simply over the phone or just with that personal connections. Confidence schemes, like romance fraud or pig butchering, can cause incredible emotional and financial damage.

• 21:18Mike Carruthers?

  What's romance?

• 21:19Speaker 01

  Without ever sending a malicious file.

• 21:20Mike Carruthers?

  What's romance fraud?

• 21:23Speaker 01

  So what they'll do is they will seed profiles into dating apps, Facebook, different places where people are going for connection. These are fake people that don't exist, but they'll create an entire backstory for them, right? Like Espionage 101. When I worked undercover for the FBI, I had a legend sometimes. It was a complete fake backstory with fake identification so that my true identity wouldn't be exposed. Well, they'll create these things too for someone who doesn't exist but looks very attractive. And then spend so much time, sometimes months, talking through this avatar with their target that they fall in love.

• 22:08Speaker 01

  An older widow met an older gentleman on Facebook.

• 22:13Speaker 01

  And they took it from, you know, just comments on posts to talking on the phone, to sending these long emails. And over the course of a month, she fell in love with him. And then he asked for money. He had some problems with his business. Could you just send me a quick loan? I'll pay you right back. And it was always that I'm coming up to see you. You know, I'm on hard times. And finally, when he was supposed to come out to see her, and he didn't show up, he called her and said, I've been in a car accident and I can't pay. Can you send me another 10,000? She was in for over a hundred thousand dollars before, you know, that that gut instinct said, this is too good to be true, and it's probably not.

• 22:55Speaker 01

  So it pulls on the heartstrings and it uses a psychology that when we want to believe something is true, we will find a way to make it true. There are cases, people believe, people actually believe, and give thousands of dollars to scammers who impersonate celebrities. You know, one of the number one celebrities who gets impersonated is Brad Pitt. And thousands of people online fall in love with Brad Pitt, thinking they're actually talking to the actor. And they're just being scammed by a clever cybercriminal who's using AI, sometimes AI avatars that move and speak, sometimes just Brad Pitt's voice

• 23:38Speaker 01

  over AI-generated deep fake voicemails, and of course, plenty of emails. And, you know, the scammer will always, using the actor's voice, say something like, I'm really lonely, it's hard to meet people when you're in the spotlight, I really have a connection with you. And of course, for some reason, they are always asking for money. And they always have some clever way, you know, you know, if I pay, people will know that I'm coming. You need to pay for this plane ticket. Send me some money so I can come out. I'll pay you back in cash when I see you. It's just incredibly clever.

• 24:16Mike Carruthers?

  And people hear you say that and they think, come on, how dumb do you have to be that Brad Pitt is saying, I'm so lonely, like Brad Pitt can't get a date and that he would come to you. And people think, see, I would never fall for, I would never fall for any of these things that you're talking about. So I'm good.

• 24:37Speaker 01

  Yeah, right. Well, you would never fall for it until you do fall for it.

• 24:41Mike Carruthers?

  Here's another one I don't fully understand. I see on Facebook sometimes, you know, that thing that says, you know, you might want to be friends with, and there's these like really high profile people like the director of the FBI, or, you know, the secretary of state, and like, like, these people want to be friends with me. Who's doing that? And again, to what? Well, I can imagine the end, but who would fall for, well, I guess, I guess I'm answering my own question.

• 25:12Speaker 01

  People do fall for it. People, you know, what I try to do on stage in my writing, you know, my weekly newsletter and everything that I do is, is get people, on your podcast, Mike, is to get people to open their eyes, to see the attacks, to recognize the attack. That's what I call thinking like a spy, to recognize the different vectors that people are using to attack you online, and the fact that they're trying to do it with deception. And then the idea, of course, is, once you can see it, once you have that moment of way, this doesn't seem right, then you can act like a spy hunter and do the things, use the tools to defeat the attacker.

• 25:54Mike Carruthers?

  Well, I've always thought that the trick was to protect yourself against hackers. But as you've pointed out in the last 20 minutes, it's, today, it's more scammers. I'm sure hackers are still hacking, but scammers are out there. And then you think, well, you know, I'm too smart for that scam. Then they come up with another scam that maybe you might fall for. So I appreciate you explaining all this. Eric O'Neill has been my guest. He's a former FBI undercover operative turned national security attorney and cybersecurity strategist. He's author of a book called Spies, Lies and Cybercrime: Cybersecurity Tactics to Outsmart Hackers and Disarm Scammers. There's a link to his book in the show notes. Eric, thanks for coming on today.

• 26:38Speaker 01

  Thank you very much. This has been a lot of fun.

• 26:42Speaker 04

  Hey Spotify listeners! When you travel with American Airlines, you'll enjoy comfort and convenience at every altitude. Before takeoff, unwind in the Admirals Club Lounge with curated self-serve offerings of hearty bites and refreshments. In flight, stay connected with high-speed Wi-Fi. Sponsored by AT&T. Your journey is designed to feel easy from the moment you check in to the moment you arrive. No matter where you're going, American gets you there. Book now at aa.com.

• 27:08Speaker 05

  Pink Pantheress here. Coach and Spotify are teaming up to bring music and style together, and they want you to be part of it. Grab your friends and head to the Tabby Tour, hitting cities around the country with live performances from special artists, exclusive experiences, and personalized products. And discover custom playlists on Spotify, booked just for you based on who you are and how you listen. Live your story with Coach. Learn more at coach.com.

• 27:38Mike Carruthers?

  When you hear the word "images," you probably think of photographs, snapshots of people, places, and moments. But images can do much more than capture memories. Think X-rays, MRIs, CAT scans, pictures that let us see inside the human body without ever making a single cut. Or telescopes and microscopes revealing entire worlds we'd never otherwise see. These kinds of images have transformed medicine, science, and how we understand reality itself. Here to explore this fascinating frontier is Daniel Sodikson. He is a physicist in medicine and chief of innovation in radiology at NYU's Grossman

• 28:23Mike Carruthers?

  School of Medicine, and he's author of a book called "The Future of Seeing: How Imaging Is Changing Our World." Hi, Daniel. Welcome to Something You Should Know.

• 28:32Speaker 02

  Hello, Mike. Thanks for having me. It's a pleasure to speak with you today.

• 28:36Mike Carruthers?

  So the concept of imaging really encompasses a lot of things: telescopes, microscopes, cameras, MRIs, X-rays. But in your view, when did the history of imaging begin?

• 28:49Speaker 02

  Like the 1600s to the beginning of what you might call "artificial imaging," or "human-made imaging." That's when we first figured out how to bend light with lenses, and that bending gave us the gift of magnification. It gave us telescopes and microscopes, and imaging was off to the races. People were utterly fascinated by the views through telescopes and microscopes. It sort of gave us the cosmos and also the microcosmos. The next milestone was when we figured out how to capture images for posterity, and that was with the development of film, which led to the camera, something that we have in our pockets as we walk around, you know, that we use to consume countless hours

• 29:33Speaker 02

  of video every day. But then amazingly, there was more. Not only could we see the outside world, but it turns out with a pretty remarkable invention at the end of the 19th century, we could see inside our own bodies as well. And that was with the invention of X-rays, which were sort of light on steroids that could blast their way through previously opaque objects.

• 30:01Mike Carruthers?

  So, how do X-rays work? And if there is a way to explain it easily for a layman to understand, how somebody came up with the idea of how can we see inside something that we can't see with the naked eye?

• 30:20Speaker 02

  Absolutely, and in a way, it is remarkably simple. An X-ray is a shadow picture. So, just like when you put a hand up against a light, you sort of see the shadow on the wall. Well, X-rays are light on steroids. They're very powerful light that blasts through many things, but dense things, like bones, for example, block them. And so, when you shine an X-ray source on a body, it leaves darker shadows of things that are denser. And that's what you see when you see the bones, for example, because they're denser

• 31:04Speaker 02

  than the tissue all around them. What's also remarkable about X-rays, though, is they're what we call a projection, because as the X-rays blast their way through, they're blocked by anything along their path. So you can see very fine detail, left to right, for example, but if the X-ray is passing front to back, what you see is a squashed version of everything the X-ray encountered. So it's like taking your body and squashing it flat.

• 31:31Mike Carruthers?

  And when, when a doctor takes an x-ray, what are they looking for? Are they looking for what's unusual here?

• 31:40Speaker 02

  They're looking for normal landmarks, bones being in the right place. And then they're looking for anything that's out of place. Anything that they know from their training doesn't look like what should be in a normal human. And so that could be a growth that might indicate a tumor. Or that could be a piece of the cartilage in your knee that looks like it's worn away. Or it could be a foreign object like a piece of metal that unfortunately got stuck in you.

• 32:15Mike Carruthers?

  It would seem that x-rays don't tell us a lot, that they tell us something's there or not there or out of place. But it doesn't tell us too much more than that, or does it?

• 32:27Speaker 02

  Well, back in the day when it was first invented, it was utterly transformative. Because just seeing anything at all inside the body was kind of mind blowing to people at the time. That said, you're absolutely correct. These shadow pictures, though they revolutionized medicine in many ways, had many limitations. You couldn't tell front to back, for example. And there were only sort of a range of dense things that were really visible. I would argue that the next kind of glorious era of, of innovation came when people figured out

• 33:12Speaker 02

  to do something called tomography, which means slicing through the body, but without making a single cut. And the trick there, interestingly enough, was to take lots of different projections from different angles, for example, and piece together what the inside of the body must have been to give all of those different shadows. Almost every other type of medical image that we take, an MRI, a CAT scan, a PET scan, an ultrasound, they all are forms of tomography, of slicing without cutting. And they all operate in one way or another by taking multiple different views and from those different views, piecing together what the inside must have been.

• 33:57Mike Carruthers?

  So before we get deep into that, going back to X-rays and how transformative they were. But at what point did somebody finally say, "Well, wait a minute. If we're blasting the body with this light, might we be doing some damage? Might there be a risk to this?"

• 34:18Speaker 02

  Yes, what a good question. It took, unfortunately, a little longer than it might have. There used to be X-ray machines in shoe stores, and people were invited to come in and look at the bones of their feet, because how cool is that? And perhaps it sold shoes. It took a while for people to put together that, over time, extended exposure could be dangerous.

• 34:44Mike Carruthers?

  And what is the danger? What is happening during an X-ray that is potentially dangerous?

• 34:50Speaker 02

  Well, an X-ray, as it blasts its way through, can interact with tissue. So, for example, it can knock electrons off things and create what are called free radicals in the body, which are very reactive chemical compounds, and they can mess around with things like DNA and cause damage. It is very important to note, though, because I think people have an inherent fear of radiation, that it is now very straightforward to control the doses of radiation that people get in imaging. And there's been a remarkable advancement in reducing radiation doses, so that now

• 35:34Speaker 02

  many imaging exams that use radiation have less exposure than you might get while you're flying in an airplane due to cosmic rays. So it's important that people know, you shouldn't be avoiding scans for fear of radiation, because the scans could also be saving your life.

• 35:52Mike Carruthers?

  But also, because I remember the advice was, you know, every time you go in to get your teeth cleaned, they would do an x-ray. And I remember hearing someone say, well, no, that's not necessary. But in fact, there is a fear because it all, right? It all adds up. It's a cumulative thing. And the fewer x-rays you have, the better. Unless there's a reason for it. If there's no reason for it, if we're just doing it for routine, then maybe we don't need to do it.

• 36:21Speaker 02

  It is true that you need to watch your kind of total lifetime dose. Again, the good thing is we are now in an era where people are aware of that.

• 36:32Mike Carruthers?

  So what is an MRI? Because, boy, that has become so popular. And you hear people talking, oh, I gotta get an MRI. And people talk about, oh, they gotta go in this machine and it makes so much noise and I get claustrophobic. But what's going on here? What is that?

• 36:48Speaker 02

  Well, now you're talking about one of the loves of my life because I am, above all, a developer of MRI. MRI, first of all, does not use ionizing radiation like x-rays. It generates its projections because, remember, to create these slices through the body, you need multiple different views or projections. Amazingly, MRI creates its projections with a magnet. Now, how in the world might you do that? It turns out that inside the nuclei of the atoms of the water in you, there are these little magnets like compass needles.

• 37:32Speaker 02

  And they tend to point in the direction of a strong magnetic field. And when you bump them with a little radio pulse, they zip around rapidly and generate a signal. So in other words, believe it or not, inside a magnetic field, we are all living, breathing radio transmitters. So an MRI picks up those radio signals, sorts them out, and creates a map of the water inside your body.

• 38:03Mike Carruthers?

  And that's the image?

• 38:05Speaker 02

  That is the image. So the image is a map of the watery tissues.

• 38:11Speaker 02

  And it shows you what is where, unlike an X-ray, rather than showing the bones predominantly, the calcium, the dense things. MRI is specifically sensitive to the soft, squishy things in your body. So it's a very complementary picture. And that's why MRI is used, for example, to characterize tumors or to look inside cartilage in the knee, or to look, for example, with exquisite and interesting detail in the brain.

• 38:41Mike Carruthers?

  And is it 100% accurate? Do people ever look at an MRI and then open somebody up and go, "Ooh, I wasn't expecting that"? Or they know exactly what they're gonna get?

• 38:52Speaker 02

  Well, this raises an interesting general question about imaging, which is, what do you mean by accurate? Every image is, in some ways, an approximation of the real thing. It's like a photograph, right? A photograph has a certain resolution, it has a certain color palette, which may or may not be accurate. So MRI likewise is a representation of the internal structures. There are certainly things that can be missed. There are certainly artifacts, as we call them, there are sort of stray signals that can be misinterpreted. That's why radiologists train so hard to develop their expertise.

• 39:33Speaker 02

  But that said, modern MRIs can have exquisite detail. And if they are interpreted properly, basically if they're read by somebody who understands how the image is made and what's supposed to be bright and what's supposed to be dark, they can reveal all kinds of both normal and abnormal things.

• 39:56Mike Carruthers?

  Whenever anybody gets an MRI or a CAT scan, and I'd like to know what the difference between those two terms is, but before we get to that, and you ask the technician, how does it look, they say, well, you know, you got to talk to the doctor. The doctor's got to see it. I can't tell you, but he could tell me. He's doing this all day long. He or she knows whether it looks right or it looks wrong, right?

• 40:19Speaker 02

  Often, experienced technologists will have a sense, but the interpretation of images is a tricky business. There are different types of anomalies that can look very much the same on an MRI. Imagine if you're taking a black and white photo, it's going to be very hard to tell apart a set of balls, for example, that are painted different colors. There's sort of an analogy with medical imaging. So in some ways, for somebody to call right on the spot what they think is going on without

• 41:00Speaker 02

  incorporating the context of you, of what your medical history is, what the questions are, that could be irresponsible. And that's why they do it. It's not that they're covering themselves or anything like that. It's that really, these images need to be interpreted in context.

• 41:19Mike Carruthers?

  What is the image? Because I've never had an MRI. Well, I guess I have had an MRI. Yeah, I remember being in that machine, but I don't remember the image. It's, is it, what does it look like? Does it look like a picture? Is it in color? What is it?

• 41:34Speaker 02

  In its raw form, it's in black and white or shades of gray, although it can be colorized in any way. And to somebody who hasn't looked at a lot of anatomy, it's almost like an abstract painting of curving shapes with interrupting dots and curvy lines. It basically, well, and I can tell you, many people are familiar now with images of the brain, right? You see them in newspaper articles about medical discoveries and so on. So what does that look like? That looks like this orb, which has all these little sort of bright curly cues in it that

• 42:16Speaker 02

  are showing the folds of your brain. That's what an MRI image looks like.

• 42:24Mike Carruthers?

  And what's the difference between an MRI and a CAT scan?

• 42:28Speaker 02

  Remember, tomography is looking from different views at a body. Basically, a CAT scan, it does that with X-rays. CAT stands for Computed Tomography. And MRI does it with magnets. So they're both tubes that you'll roll into. But in one case, there's an X-ray source that's shining on you and zipping around your body to capture all the different angles. In another case, the inside of the tube for MRI is really the magnet. And the radio transmitter is that you need in order to create and detect the signal.

• 43:09Mike Carruthers?

  And why would you use one and not the other?

• 43:12Speaker 02

  Well, a CAT scan tends to be exquisitely sensitive to dense tissues like bone. So you might use it to look for breaks in a bone or calcium deposits in the heart, which might indicate that one of your coronary arteries is having an issue. Whereas MRI, you would use to characterize soft tissues, like tumors growing in places they shouldn't.

• 43:40Speaker 02

  CAT scans also tend to be very, very fast. So they're often used in an emergency room to get a quick look. MRI scans can take a little longer, but they tend to be used when you really want to characterize the details of a tissue carefully.

• 43:54Mike Carruthers?

  And why is it so loud?

• 43:56Speaker 02

  This is one of the most persistent and very good questions that everybody has about MRI. So remember how I said that you need different views in order to generate this slice that is the MRI image? Each time you change views, you need to change the distribution of magnetic fields a little bit. And to generate a magnetic field that changes like that, you need to run current in a wire. Well, when you run current in a wire inside a strong magnet, like the MRI machine, that creates a force. So that wire goes sort of clunk.

• 44:38Speaker 02

  So the buzzing and the humming that you hear inside the MRI machine amazingly is a whole bunch of little clunks that go together very fast. So thump, thump, thump, da, da, da, da, da, da, da, da, da, da, da, da, da, da, da, da, da, da, da, da, da. That was me speeding up the thunks until you get the characteristic sort of pounding, buzzing noise of an MRI machine.

• 44:59Mike Carruthers?

  So that's never gonna fix itself. That's, there's never gonna be a quiet MRI machine, it seems.

• 45:05Speaker 02

  Oh, believe me, so many people are trying.

• 45:07Mike Carruthers?

  Really?

• 45:08Speaker 02

  There are all kinds of ways to change the sequence of views that you're gathering. So it's a little bit quieter, or to try to muffle things mechanically. It is inherent to the process of generating the image, but definitely things can get quieter. And one interesting thing is nowadays, even though the trend has been to go to stronger and stronger magnets to get clearer and clearer pictures, there's been an interesting trend to develop weaker and weaker magnets that are cheaper and more accessible, so that more people can get an MRI. Those types of machines could be very quiet indeed.

• 45:46Mike Carruthers?

  And an MRI machine, I mean, I have no idea what it costs, but it must be really expensive.

• 45:53Speaker 02

  It is, starting at a million dollars, and going up.

• 45:58Mike Carruthers?

  Wow. Could we briefly talk about the microscope? Because we haven't, we've been talking about medical imaging, but, but the microscope had to have been just like outrageously innovative.

• 46:13Speaker 02

  It certainly was. To people back in the 17th century, it was completely like magic. You took this strange tube, you trained it on a drop of water, and you discovered that there was a whole invisible world inside that water drop.

• 46:34Speaker 02

  That nobody had ever imagined. And so, in fact, microscopes were some of the origin of microbiology, of the study of all kinds of organisms that we now take for granted and are associated with disease or with with life in general. And that's a kind of a general trend. Every time a new imaging tool has come along, it has created new science, new discoveries, new ways of life.

• 47:09Mike Carruthers?

  Well, and the same thing must have happened when somebody figured out and made a telescope and looked up at the stars and the planets and the heavens and thought, oh my God, we had no idea.

• 47:21Speaker 02

  Absolutely. In fact, the view through telescopes is credited in some circles as driving the Copernican revolution. The notion that there were bodies out there that behaved according to certain rules. Well, that came from observations through telescopes, which gave us this brand new view of the heavens.

• 47:43Mike Carruthers?

  Well, it is such a great story, and you can't really even begin to imagine the impact that medical imaging in particular has had on health and longevity and saving people's lives. I've been speaking with Daniel Sodikson. He is a physicist in medicine and chief of innovation in radiology at NYU's Grossman School of Medicine, and he is author of a book called The Future of Seeing: How Imaging Is Changing Our World. And there's a link to that book in the show notes. Daniel, great, thank you. Thanks for being here.

• 48:17Speaker 02

  Well, thank you so much for having me, Mike. I very much enjoyed our conversation.

• 48:25Mike Carruthers?

  Did you know that sarcasm can be good for you? Studies show it serves two main purposes. First, to soften criticism through humor, and second, to create a sense of connection. Understanding sarcasm is surprisingly complex. It requires several parts of the brain to work together to detect tone, context, and intent. Using and interpreting sarcasm can even give your creativity a temporary boost, because it engages abstract thinking. People who use sarcasm often tend to have strong verbal and social intelligence, though it's not a direct measure of IQ.

• 49:08Mike Carruthers?

  Interestingly, research suggests that adults and children alike can appreciate sarcastic humor. Kids typically start to understand it between ages six and eight. Cultural factors also play a role. In some regions or within some groups, sarcasm is seen as clever banter. In others, it comes across as just plain rude. And that is something you should know. I know you know someone who would enjoy this podcast as much as you do, so please share it, tell them about it, and ask them to give a listen. I'm Mike Carruthers, thanks for listening today to Something You Should Know.

• 49:47Speaker 05

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