Radiolab Episode Summary: "How to Cure What Ails You"

Release Date: May 16, 2025
Hosts: Lulu Miller and Latif Nasser
Description: Radiolab delves into the complexities of diagnosing mental health conditions, exploring the intersection of technology, science, and human individuality. Through engaging discussions and historical anecdotes, the episode examines the promises and pitfalls of using brain imaging for psychiatric diagnoses.

1. The Quest for Biological Diagnosis of Mental Health

The episode opens with Lulu Miller reflecting on the timeless question of how to accurately diagnose mental health conditions like depression. She introduces the concept of using functional Magnetic Resonance Imaging (fMRI) to peer into the brain, aiming to objectively identify disorders that have traditionally relied on subjective assessments.

Jad Abumrad and Robert Krulwich engage in a dialogue highlighting the challenges of diagnosing depression:

[01:19] "Diagnosis, the easy kind. We're not going to talk about it. Easy would be you come into my office. I'm a doctor, you have a broken arm... But let's suppose you came into my office and you were sad."
– Jad Abumrad

Eric Kandel, a Nobel Prize-winning professor at Columbia University, supports the feasibility of photographic diagnosis:

[02:27] "This is happening. There is no question."
– Eric Kandel

Cynthia Fuhr, a psychiatrist at King's College London, discusses a pioneering study where machine learning algorithms correctly diagnosed depression with 86% accuracy using fMRI scans:

[06:55] "More than 85% of the time, 86% of the time, the algorithm correctly diagnosed whether that person was depressed or healthy."
– Cynthia Fuhr

This breakthrough promises a future where mental health diagnoses could be as straightforward as taking a brain scan, potentially revolutionizing psychiatry:

[07:38] "Psychiatry is going to be absolutely revolutionized by this."
– Eric Kandel

2. Debate on Biological Determinism vs. Holistic Approaches

Despite the promising technology, skepticism arises, particularly from Robert Krulwich, who is hesitant to fully embrace machine-based diagnoses. He questions the reductionist approach of equating complex human emotions and experiences solely to brain activity:

[08:17] "You mean to tell me that they're going to put people in machines and just go, boop?"
– Robert Krulwich

The discussion delves into the ethical implications of treating patients as mere data points:

[09:28] "But don't kind of get in my head and tell me what's right and what's wrong."
– Robert Krulwich

Lulu Miller provides a balanced perspective, acknowledging the advancements in brain imaging while emphasizing the importance of treating patients as whole individuals:

[24:XX] "We're certainly not living in the world that Eric Kandel predicted we might be... it's still forcing doctors to treat us as full individuals, as not just brains to reckon with our full personhood."
– Lulu Miller
(Timestamp approximated as the transcript provided ends at 27:02)

3. Historical Case Study: SIDS and Medical Misdiagnosis

The episode shifts to a historical narrative narrated by Robert Sapolsky, illustrating the dangers of premature scientific conclusions. He recounts the early 20th-century misdiagnosis of Sudden Infant Death Syndrome (SIDS) due to misinterpretation of thymus gland sizes.

Initially, doctors observed enlarged thymus glands in SIDS cases and hypothesized that these glands could suffocate infants by pressing on the trachea during sleep:

[16:00] "So people decided, let's go dissect SIDS's kids... If you're one of these babies with an enlarged thymus and you're asleep and somehow you roll over... that gland might press down on your trachea and suffocate you during the night."
– Robert Krulwich quoting Robert Sapolsky

This led to the controversial treatment of irradiating infants' throats to shrink the thymus glands:

[16:53] "They even came up with a name for it and it was called status thymicolymphaticus... and to do that, the best solution, obviously, is to irradiate their throats."
– Robert Sapolsky

The misguided intervention resulted in severe consequences, causing thyroid cancer deaths in thousands:

[17:25] "Decades later, you've killed 20 to 30,000 people with thyroid cancer."
– Robert Sapolsky

This cautionary tale underscores the importance of accurate scientific understanding and the ethical responsibilities of the medical community.

4. Conclusion and Reflection

Lulu Miller returns to update listeners on the advancements in brain imaging over the past 17 years. While machine learning has improved in predicting differences in brains affected by disorders like bipolar, schizophrenia, and depression, these technologies have not yet become reliable enough for everyday clinical use. As a result, the medical field continues to balance technological progress with the nuanced treatment of individuals:

[24:00] "We're definitely not living in the world that Eric Kandel predicted we might be... but we're not quite living in Jad's world either. We're sort of in this in-between still."
– Lulu Miller

She highlights the ongoing need for doctors to treat patients holistically, respecting their full personhood while leveraging scientific advancements:

[24:XX] "It's still forcing doctors to treat us as full individuals, as not just brains to reckon with our full personhood."
– Lulu Miller

The episode concludes on a hopeful note, recognizing the steady progress of science while valuing the complexity of human experience.

Notable Quotes:

• Eric Kandel:

  [02:25] "This is happening. There is no question."

• Cynthia Fuhr:

  [06:55] "More than 85% of the time, 86% of the time, the algorithm correctly diagnosed whether that person was depressed or healthy."

• Robert Krulwich:

  [08:17] "You mean to tell me that they're going to put people in machines and just go, boop?"

• Robert Sapolsky:

  [17:25] "Decades later, you've killed 20 to 30,000 people with thyroid cancer."

• Lulu Miller:

  [24:00] "We're definitely not living in the world that Eric Kandel predicted we might be... but we're not quite living in Jad's world either. We're sort of in this in-between still."

This episode of Radiolab meticulously explores the intersection of technology and mental health diagnosis, while providing a sobering historical perspective on the pitfalls of premature scientific conclusions. It invites listeners to consider the ethical dimensions of medical advancements and the enduring importance of treating individuals with empathy and respect.