When doctors don't know what's wrong

A 2015 review found that most people in the US will experience a diagnostic error in their lifetime. Some of those errors are less devastating than others, but how can we help people get better answers about their health? One family's search for answers with a mystifying illness highlights a different approach to diagnosis. Guest: Alexandra Sifferlin, author of The Elusive Body: Patients, Doctors, and the Diagnosis Crisis and deputy science editor at the New York TimesFor show transcripts, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unxtranscripts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠For more, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/unexplainable⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠And please email us! ⁠⁠⁠[email protected]⁠⁠⁠We read every email. Support Unexplainable (and get ad-free episodes) by becoming a Vox Member today: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vox.com/members⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Thank you! Learn more about your ad choices. Visit podcastchoices.com/adchoices

• 0:00Speaker 00

  Support for the show comes from Google Gemini. You know that moment when curiosity strikes? You're exploring a new city with the family and a sculpture catches your daughter's eye. What is that? Who made it? With Gemini, you can snap a picture and get a fully interactive breakdown of its history, architecture, and even hidden secrets. Gemini is built for moments like that. Whether you're learning something new, solving a problem, or looking for your next favorite thing, Google Gemini is here to help. Download Gemini, Google's AI app, or visit gemini.google.com to learn more.

• 0:38Speaker 01

  College football is back. So Hilton called to me, the superstition concierge, to make your fan rituals a reality. Need a room to match your lucky number? We got you. Want to make sure our team doesn't wash your lucky jersey? Oh, that smells lucky. Hilton's unmatched hospitality can keep up with any superstition, even a marching band wake-up call at 5:55 in 55 seconds. Hit it! When you need a team that will do whatever it takes on game day, it matters where you stay. Hilton, for the stay.

• 1:10Speaker 02

  As a journalist covering health and science, Alexandra Siverland got used to a very specific kind of email from readers.

• 1:16Speaker 03

  One of the top things that readers would email me about was their personal experiences with trying to find an accurate and timely diagnosis.

• 1:26Speaker 02

  They'd tell her how hard it was to get answers about what was going on with their health.

• 1:30Speaker 03

  And it happened with such frequency that I became very interested in understanding what was going on here.

• 1:37Speaker 02

  So she looked around for some numbers, like, how many people have had problems getting a diagnosis? Or how many people have gotten an incorrect or a delayed diagnosis? It's hard to answer those questions exactly, but there have been some attempts to gather data on this.

• 1:53Speaker 03

  One of the best versions was this big report released in 2015 by the National Academies of Sciences, Engineering, and Medicine. And they end up concluding that nearly every person will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.

• 2:13Speaker 02

  Now, that does not mean that every person will have a doctor miss a cancerous tumor or something. There is a spectrum here, and some of those errors are less devastating than others. But still, that is a lot of diagnostic error. In her research, Alexandra was also exploring questions about why this was happening, why it was sometimes so hard to get a diagnosis, what even goes into a diagnosis in the first place.

• 2:41Speaker 03

  And I realized, you know, there are so many different elements to this, and it just became a bigger and bigger project.

• 2:52Speaker 02

  Such a big project, in fact, that it turned into a book called The Elusive Body: Patients, Doctors, and the Diagnosis Crisis. And as Alexandra got deeper into her research for that book, she started digging into one story in particular, the story of a woman with an incredibly rare disease. That story reflected a lot of the problems that Alexandra was encountering with diagnosis more generally. And so, this is unexplainable. I'm Brad Pinkerton, and today on the show, we are doing a book club. Alexandra Siverland, author of The Elusive Body, will tell us about this one woman's journey to a diagnosis and how it illuminates both the problems with how we diagnose disease

• 3:35Speaker 02

  and how we might do a better job of answering people's unanswered health questions.

• 3:56Speaker 02

  Let's start with an introduction to a woman named Louise Proctor.

• 4:01Speaker 03

  Louise Proctor is the eldest of five Proctor siblings who all grew up in very rural Kentucky. You know, she describes her childhood as pretty ordinary. She was pretty active. She would play outside with her friends. She was in band.

• 4:19Speaker 02

  But in 1980, when Louise was 25 years old, her life started to change.

• 4:24Speaker 03

  She remembers very specifically this one day where she's walking during her lunch break and she's going up a hill. And all of a sudden, she experiences this excruciating pain and a very bizarre sensation whereby it feels as if her legs are turning to stone, as she describes it. It's like she's freezing in place and she can't move one step further. And that sort of sensation started happening with increasing frequency over the course of her life.

• 4:59Speaker 02

  The amount of time that she could walk without experiencing pain got shorter, and the pain got worse. So, of course, she talked to her doctor about it.

• 5:09Speaker 03

  The initial diagnoses, if you will, were things like, you probably should just be exercising more. Like, this wouldn't be happening if you were a little bit more fit. Or she would hear things like, maybe you have early-stage arthritis. But she would be prescribed medications and they would have no effect. And she just felt really frustrated in the unknown and as if her pain just really wasn't being taken very seriously at all.

• 5:38Speaker 02

  This lack of a diagnosis went on for decades.

• 5:41Speaker 03

  She would talk about how it felt like nobody believed her. And because she otherwise appeared quite healthy, like, this was sort of a sensation that would come and go, she just felt like when she did need accommodations, like, she was going to the airport and needed a wheelchair, that, you know, people around her would kind of look at her like, what are you doing? Like, I just, you're over-exaggerating. And the pain was getting worse, like, the condition is getting worse over time. In addition, because she has no diagnosis, she has no prognosis, so she has no idea where this is going.

• 6:23Speaker 02

  In the midst of all this, Louise also had two children to take care of. And in 1984, her infant daughter Suzanne was diagnosed with cystic fibrosis.

• 6:34Speaker 03

  Today, there are promising treatments and therapies, though it is still a very challenging diagnosis. But at the time, there really weren't any options. It's a fatal disease. And so, you know, tragically, her daughter does end up dying of cystic fibrosis when she's a young teenager.

• 7:01Speaker 02

  This was devastating for Louise. But as Alexandra noted, Suzanne's experience also showed the power of a diagnosis. Even though it was terrible, the people in Louise's family and in her community knew what was happening to Louise's daughter.

• 7:19Speaker 03

  Everybody, from teachers to neighbors, were there to accommodate them. And when Suzanne did end up passing away, this whole community fills the hospital. They're there for her. And it was sort of like, this diagnosis gave people a context to understand what was happening to this girl and to support her and her family. And so, it was interesting for Louise, I think, I mean, it was awful, but, you know, she was able to sort of see the contrast in what a diagnosis can provide, even if it's not good news.

• 7:56Speaker 02

  After Suzanne's death, Louise redoubled her efforts to get answers about her own situation.

• 8:02Speaker 03

  She's really just angry, and she's like, I've had it. Like, I cannot handle this cosmic grief in addition to physical disability that nobody seems to believe me over. And so, she talks about having this appointment where she goes to her doctor and she has a total breakdown in the doctor's office. And she's very upset, and she's basically saying, you know, I can't even do my laundry because my laundry is in the basement and I can't walk downstairs. And so, she finally gets some imaging done of her legs. And I mean, this is decades since she has been complaining about this, that she finally gets some real ultrasound-related images.

• 8:47Speaker 03

  And it's revealed that she does have very abnormal buildup of calcium in her legs.

• 8:56Speaker 02

  Alexandra was actually able to speak to the lab technician who did the scans, because this was a small town, and the technician was a family friend of Louise's.

• 9:05Speaker 03

  And, you know, she mentioned to me, like, I had never seen this level of calcification in the legs of someone who's alive, much less someone who is young and otherwise seems very healthy.

• 9:17Speaker 02

  Basically, if you think of your big blood vessels as highways for your blood, it was like some of Louise's highways were full of big calcium rocks.

• 9:26Speaker 03

  And so, in some cases, the blood is still able to kind of go around the rocks, if you will. But in other cases, her vessels are so clogged with calcium that what ends up happening, and the reason that she is still alive, is that the vessels start sprouting other, smaller vessels, basically.

• 9:50Speaker 02

  Like little emergency side roads for the blood to move through. Those roads are not as big as the main highway.

• 9:58Speaker 03

  And because they're not the size of the highway, it's painful. Like, it just simply, there's backup, the blood isn't getting where it needs to go. And so, that's where the pain is coming from.

• 10:10Speaker 02

  There were other unusual things about this calcium buildup, but the main thing was that it was there, right on the scans, proof that Louise was not making things up.

• 10:21Speaker 03

  So now, suddenly, Louise is being sent to many more specialists, and people are really trying, and her primary care doctor is really trying, and everyone's really trying to figure this out, but nobody had seen this before, even the specialists. So it quickly then becomes clear that Louise is experiencing something very unusual.

• 10:47Speaker 02

  It was also starting to become clear that it wasn't just Louise. Her siblings were beginning to experience strange symptoms, too. Her youngest sibling was experiencing the leg freezing issue. Her brothers also had problems. And Louise's doctor was working with her sister Paula as well, who, much like Louise, had pain when she walked on treadmills for extended periods of time. So what did this mean? What did it mean for the siblings? If it was genetic, what did it mean for their kids? Were their kids at risk? What was the problem here? Wasn't clear how Louise or her family members were going to get answers to these questions until Louise's case wound up in front of a special group

• 11:31Speaker 02

  at the National Institutes of Health. More on that after the break.

• 11:46Speaker 01

  College football is back. So Hilton called to me, the superstition concierge, to make your fan rituals a reality. Need a room to match your lucky number? We got you. Want to make sure our team doesn't wash your lucky jersey? Oh, that smells lucky. Hilton's unmatched hospitality can keep up with any superstition. Even a marching band wake-up call at 5:55 and 55 seconds. Hit it! When you need a team that will do whatever it takes on game day, it matters where you stay. Hilton, for the stay.

• 12:17Speaker 04

  When you need to build up your team to handle the growing chaos at work, use Indeed sponsored jobs. It gives your job post the boost it needs to be seen and helps reach people with the right skills, certifications, and more. Spend less time searching and more time actually interviewing candidates who check all your boxes. Listeners of this show will get a $75 sponsored job credit at indeed.com/podcast. That's indeed.com/podcast. Terms and conditions apply. Need a hiring hero? This is a job for Indeed sponsored jobs.

• 12:47Speaker 05

  This episode is brought to you by Born in Roma Fragrances by Valentino Beauty, the iconic fragrance duo. Donna Born in Roma Eau de Parfum is a feminine fragrance featuring juicy black currant, central jasmine, woody cashmerin, and warm vanilla. Its masculine counterpart, Womo Born in Roma Eau de toilette, has notes of fresh violet leaf, aromatic sage, green betever, spicy ginger, and mineral salt. Shop at macy's.com.

• 13:22Speaker 06

  But it still doesn't account for her other symptoms. No, but it does tell us something. Though I have no idea what.

• 13:29Speaker 02

  In 2009, Louise's case was reviewed by a group known as the Undiagnosed Diseases Program.

• 13:36Speaker 03

  Which at the time was a very new program that the NIH was running.

• 13:42Speaker 02

  It was a successful program. And in the years since, the NIH has actually built on it and turned it into something called the Undiagnosed Diseases Network, a rare disease investigation unit, essentially.

• 13:54Speaker 03

  They were taking some of the most complicated medical mysteries that doctors were referring to them across the country. And geneticists, neurologists, you know, all sorts of physicians would come together and try to crack the case as a team.

• 14:12Speaker 02

  Right from the beginning, the program got a lot of applicants and could not accept them all. But Louise's case did get accepted, in part because it seemed quite unique, in part because it seemed like genetics were involved, and in part because the program was interested in cases that seemed broadly relevant.

• 14:32Speaker 03

  Cases where, even if this turns out to be a very rare condition, we think that there's something to be learned from that condition that could apply across the board.

• 14:42Speaker 02

  Louise clearly had an issue related to her blood vessels. And issues related to blood vessels are extremely common.

• 14:49Speaker 03

  So they had a feeling, you know, if we could crack this case, maybe the rare condition that these siblings are experiencing will have something to say about the wider issue of arterial diseases.

• 15:06Speaker 02

  And once the case was accepted, the program really kicked into gear.

• 15:10Speaker 03

  They're coming at it from this very unique method where they take experts from different fields. And even before a patient arrives at the clinic, they look through their medical history. They look through the letters that typically a doctor sends. Sometimes the patient sends a letter themselves or a family member. They read through all of that and they come up with a plan.

• 15:33Speaker 02

  The plan, in Louise and her sister Paula's case, involved them going into the NIH, getting a variety of tests. So there were a bunch of different types of scans, but also genetic tests. And then their other siblings were tested, too, as well as their parents.

• 15:47Speaker 03

  So when they have all these results back, all of these NIH scientists or clinicians, what have you, they're, you know, experts in their particular field, come together. And through that process, they try to come to a diagnosis or a conclusion.

• 16:08Speaker 02

  There were a few possible outcomes for this process. Either the researchers would be able to come up with some kind of an answer, maybe this is such and such a particular disease, or, you know, this is a new disease that we have not seen before. Or, as does happen, the researchers, despite their best efforts, still wouldn't be able to get to a firm diagnosis.

• 16:32Speaker 03

  But once you're in this program, you're invited back every single year. So that's another element that I think is really important is there's this sort of commitment that this team is going to be with you on this journey, even if it is going to continue to take a long time because we can't quite figure it out yet either because we don't have the technology available yet. You might be a case that's sort of on the edge of current medical knowledge. But the hope is that, over time, we will be able to figure it out. We'll do further investigation. And perhaps we will ultimately reach a diagnosis together.

• 17:07Speaker 02

  In Louise's case, though, a team came together. And then there was a bit of serendipity. There happened to be a postdoc on the team who had done her PhD thesis on mice. She was studying what happened when those mice were missing a particular gene. And it gets a little complicated. But basically, when that gene was missing, it resulted in a strange pattern in the mouse's blood vessels that kind of matched the strange calcification pattern in Louise's family.

• 17:39Speaker 03

  So they thought that was very intriguing, but were also like, what are the odds that this random thing that the postdoc had been studying would be relevant to this case? It turns out, it was very relevant.

• 17:53Speaker 02

  Once they went through all the tests and the data, they discovered that the proctor's condition was very much related to the postdoc's research, which helped them figure out that the problem here was a deficiency of an enzyme called CD73.

• 18:08Speaker 03

  And that was like, you know, in some ways, just an incredible coincidence. But in other ways, I think, just underscored how much can be gained by having this bigger team approach where you're including people who have different insights, different areas of research. They've come across different things. And through that, you end up raising potential, you know, possibilities that you wouldn't have otherwise.

• 18:35Speaker 02

  And so, after 30 years, Louise Proctor finally got a diagnosis. And her siblings finally got a diagnosis. They all had this newly named disease called arterial calcification due to deficiency of CD73, also known as ACDC for short.

• 18:56Speaker 03

  You know, it's so, it's so fun to hear them talk about it because in so many ways, they were just amazed that anyone had taken it this seriously. Like, to have gone to the NIH, to have undergone all of these tests, to know that this entire team of just really smart, dedicated scientists were focusing so much attention on this thing that they had gone decades experiencing with really, you know, not feeling like they were getting any support.

• 19:31Speaker 02

  There's a lot to take away here. In 2011, the researchers published their findings about this disease. They'd found a few other people that had it. Alexandra says the estimate is now 20 people worldwide. But the, the postdoc who spotted the connection to her thesis is actually still studying it. She's gone on to open her own lab, where she studies CD73 and peripheral arterial disease full-time.

• 19:57Speaker 03

  And her whole research has been informed by this and with the goal to develop more treatments, hopefully for ACDC, but also for diseases of the arteries in general.

• 20:11Speaker 02

  But in Alexandra's reporting, some of the biggest takeaways might be less about this one specific disease and more about what we might learn from the Undiagnosed Diseases Network. She says there are lessons to be learned here, even if we're trying to diagnose more regular things.

• 20:30Speaker 03

  The issues related to getting a diagnosis for a rare disease are actually, in many ways, the same issues that people run into if they're trying to get diagnosed with something that is not rare. People are dealing with and complaining about the same issues with the healthcare system.

• 20:52Speaker 02

  Like, I think it's possible to see Louise's story, for example, and think that as soon as she got the right scans and tests, doctors were able to find solutions for her. But not every disease shows up on a scan. And Alexandra says that in one of the reports she read, she warned against the idea that scans or tech would solve everything. Instead, she says diagnostic error is this thorny, complex problem connected to a lot of different systemic issues. So, for example, one thing she encountered over and over when she talked to patients who'd had a diagnostic issue was the problem of time.

• 21:29Speaker 03

  They would say, "It took me forever to get a doctor's appointment. Then I finally got the appointment and I was in there for maybe 10 minutes most with the doctor. And during that appointment, the doctor was looking at their computer the entire time, typing into it. And I don't feel like they were listening to me. And that's why I think I didn't get the correct diagnosis to start." And then I would go and talk to physicians and I would say, "From your perspective, what do you think are some of the factors that play into situations where you might have gotten the diagnosis wrong or you just couldn't quite figure it out?" And I would basically hear the same complaints. They would say, "I have to see 20 patients in a given day. I'm only allotted a tiny amount of time.

• 22:13Speaker 03

  And during that time, I'm supposed to be typing information into the electronic health record. And I feel like I'm not able to give the patient my full attention. Or I wish I had more time in that appointment with the patient. Or I wish I had more time to review that patient's medical record. Or I wish I had more time to think, to like, really sit with the information provided and try to piece it together."

• 22:37Speaker 02

  In the NIH program, these doctors were able to give Louise time, not just in the sort of thorough initial meetings, but also in the follow-ups that occurred across the years. And that care was also coordinated, which was another factor that Alexandra heard and read about as she was trying to suss out the reasons for diagnostic error.

• 22:58Speaker 03

  Often, patients feel that they themselves are the ones that have to be in charge of bringing their entire medical history from doctor to doctor. Like, there's not a lot of coordination. It ends up, you know, one physician may say, "I don't have an answer for you, but I'm going to send you to this specialist. And they're an expert in XYZ and they can be able to help." But the problem is that the patient then feels like they're starting from scratch, so they get to that next person. And they might come with literal binders of information because they just feel like, you know, this doctor isn't talking to this doctor and things are being missed in that handoff.

• 23:37Speaker 02

  That really stands in stark contrast with this undiagnosed diseases model where doctors get into a room and talk to each other about the patient before the tests are run and then talk about the test together again afterwards. Now, Alexandra did tell me that there are a lot of issues that contribute to diagnostic error. Like, how tired a doctor is when they see you can be a factor. Or, like, a bigger picture sense, it can be hard for some doctors to get feedback on whether their diagnosis was correct or not and to therefore learn from their mistakes. So, the undiagnosed diseases model is not going to solve, like,

• 24:15Speaker 02

  every problem here, but she still thinks it would be useful to borrow from it.

• 24:23Speaker 03

  I mean, I would love to see most hospital systems have a version, even if it's much more modest, of the undiagnosed diseases network. Physicians need somewhere or someone to send cases that they simply don't necessarily have the time to figure out or they don't have the technologies available to them to figure out. But you can't just dump people from one doctor to the next. And of course, it's never going to be a guarantee that you'll get an immediate diagnosis, especially for something very complicated. But at least you can go somewhere where you know that they're going to throw everything at the wall and try.

• 25:04Speaker 02

  Alexandra has seen medical clinics and systems that are recognizing the value of getting more people that are involved in a patient's care, just kind of talking with each other. And she's even seen people with models that look something like the undiagnosed diseases network.

• 25:19Speaker 03

  Dr. Lisa Saunders at Yale, who writes a diagnosis column for The New York Times, for instance, largely, her clinic is focused on long COVID. Her approach, the way that she sets up her appointments and the way that she interacts with other experts, it is, in many ways, very similar to the undiagnosed diseases network. You know, even just having a little bit more time with patients who have these more complicated conditions, I think, can go a long way.

• 25:50Speaker 02

  Even if every system does learn from the undiagnosed diseases model, though, and doctors have the time and the resources and the coordination to come to a diagnosis, that is just the beginning of the story.

• 26:04Speaker 03

  To go back to the Proctor siblings, it's a little bit bittersweet as well. Because though they got this diagnosis and they contributed to medical science because it was the discovery of a completely new disease, there isn't a cure or really a very effective treatment yet for ACDC. And I was really interested in that aspect of their story, too, because it made me wonder, a diagnosis without a cure, what does that really get you? Because ultimately, you're still experiencing the same symptoms and you're not getting relief. And, you know, they're honest that that's really frustrating.

• 26:46Speaker 03

  However, when you talk about how with this diagnosis, they found out that this particular genetic disorder cannot be passed down to their children. So, that was huge. And then, too, all of the siblings are really interested in this idea that scientists are going to be able to learn something, potentially, from their case that could inform future care. And lastly, again, this part of the undiagnosed diseases network ethos of staying with people over time, the hope is that they will continue to research them. The siblings go back every single year to the NIH to go through, again, a lot of physical exams, tests.

• 27:29Speaker 03

  And the hope is that, over time, they will find a treatment and they will get relief. And so, they feel like this has been worthwhile because they're at least on a path somewhere.

• 27:44Speaker 02

  Have they talked, do they talk to you at all about just the idea of having a name, like, something to sort of point to and say, "Yes, this is what I have"? Like, has that changed their lives at all?

• 28:00Speaker 03

  Definitely, because it's, you can tell people, "I have this ultra-rare condition. It's ACDC." And you're able to say, "This is what the symptoms of this disease are. This is why they happen." And it helps, I think, people around them understand that, you know, Louise needs to park really close to the entrance of a restaurant so it's easier for her to walk in. Or she does need to use a wheelchair in the airport, perhaps, or at places where there's going to be, you know, walking long distances. And I think having that information is really useful.

• 28:38Speaker 02

  I think on our show, we celebrate the unknown so much. You know, we celebrate, like, uncertainty. And I think this story has just really driven home for me how devastating an unknown can be and how, like, again, even bad news is at least an answer.

• 29:00Speaker 03

  Definitely. I think when it's your health and you're experiencing really difficult symptoms, or, you know, a lot of people I interviewed in my book, like, it's their children who have something rare or are experiencing a health complication that they can't explain. It's excruciating. There's never, ever going to be a time where there's no uncertainty in medicine. Like, it's such a field full of that. And like, we do have to become a little bit more comfortable in the uncertainty. But I think ultimately, when it comes to your health, like, people really do desire answers. Or if there's not going to be an answer,

• 29:44Speaker 03

  some kind of commitment that someone's going to sit with their questions and give them that attention and time and try to provide a more human experience to a medical system that can feel so inhumane.

• 30:15Speaker 02

  Alexandra Sifferlin is the Deputy Science Editor at The New York Times. Her book is The Illusive Body: Patients, Doctors, and the Diagnosis Crisis. And we only touch, really, on material in a few chapters of the book. She also writes about topics like AI in diagnosis, long COVID, even the question of overdiagnosis. So, if you'd like to read more about diagnosis in general, check out our book. This episode was produced by me, Rick Pinkerton. It was edited by Meredith Hodnot. Christian Ayala did the mixing and the sound design. Melissa Hirsch checked the facts. Noam Hassenfeld does our music. Lissa Soep, Valerie Shankman, Sally Helm, and Joanna Solotaroff

• 30:57Speaker 02

  are the fact that hummingbird moths exist and you should look them up. Thanks always to Brian Resnick for co-creating the show with me and Noam. Thanks also to Louise Proctor for taking the time to speak to me about the details of her story. And thanks to Dr. Cynthia St. Hilaire, who is no longer a postdoc, but an associate professor of medicine at the University of Pittsburgh. She took time to explain her work to me and I really appreciate it. And if you have thoughts about diagnosis or further topics in this vein that we should dig into, we are at [email protected]. If you would like to support this show and the journalism that Vox does, we would love it if you would become a member. It is very easy to do. Just go to vox.com/members.

• 31:42Speaker 02

  You will get access to all of Vox's journalism, but you also know that you are supporting all of Vox's journalism. And for those of you who have emailed us to let us know that you signed up because of Unexplainable, just thank you. Thank you so much. Thank you also to those of you who have left us a nice review on your podcast platform or told someone in your life about the show. You are the best. Unexplainable is part of the Vox Media Podcast Network and we will be back very soon with another episode about everything that we don't know.

• 32:31Speaker 05

  This episode is brought to you by Born in Roma Fragrances by Valentino Beauty, the iconic fragrance duo. Donna Born in Roma Eau de Parfum is a feminine fragrance featuring juicy black currant, central jasmine, woody cashmerin, and warm vanilla. Its masculine counterpart, Womo Born in Roma Eau de Toilette, has notes of fresh violet leaf, aromatic sage, green vetiver, spicy ginger, and mineral salt. Shop at macy's.com.

• 33:01Speaker 07

  Your heart can tell you a lot about your health. Apple Watch Series 12 measures your heart rate every five seconds with the most accurate heart rate sensing in wearable. So, your vitals app, now with heart rate variability, can tell you when something is off. And your readiness score can let you know when to rest and when to push. Hear the story in every heartbeat with Apple Watch Series 12. The features described are for wellness purposes only and not for medical use. iPhone 11 or later required. Based on Apple conducted study of heart rate accuracy, August 2026. Visit apple.com slash apple watch series 12.