← Something You Should Know
Something You Should Know
The Many Ways Music Affects Your Brain & How Safe and Effective Are Your Meds?
00:50:51
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- [00:01]
Mike Carruthers
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- [01:50]
Sarah Layla Sherman
Different types of music do different types of things for us. Our brains start firing our neurons 300 to 500 millimeters milliseconds after it's exposed to music. So that's faster than we have a conscious thought or before we can even recognize the melody.
- [02:05]
Mike Carruthers
Also, why do the good old days seem so much better than the present? And the prescription drugs you take, you'd like to think they've been tested by the fda.
- [02:16]
Jerry Avorn
Many people, including a lot of doctors, think that the FDA tests drugs. It doesn't. It doesn't test any drugs. It relies on studies that are submitted to it. Often the manufacturer will set up those studies in a way that will put the drug in the most favorable light.
- [02:31]
Mike Carruthers
All this today on something you should know. I know a lot of business people listen to this podcast because I hear from them on LinkedIn or in emails and if you're one of those people, there always comes that day when you have to hire someone, which I've had to do as well. And it's tough. Usually you need someone right away. You want to hire the right person, but how do you determine that? Which is why I've come to discover that when it comes to hiring, Indeed is all you need. Indeed has something called Sponsored Jobs. With Sponsored Jobs, your post jumps right to the top of the page for your relevant candidates so you can reach the people you want faster. And it makes a huge difference. According to Indeed data, Sponsored Jobs posted directly on indeed have 45% more applications than non sponsored jobs. And that's what you want. More applications from relevant, qualified candidates. Indeed works. In fact, in the minute I've been Talking to you, 23 hires were made on Indeed, according to Indeed Data worldwide. Look, there's no need to wait any longer. Speed up your hiring right now with Indeed and listeners of this show will get a $75 sponsor job credit to get your jobs more visibility@ Indeed.com something just go to Indeed.com something right now and support our show by saying you heard about Indeed on this podcast. Indeed.com something terms and conditions apply. Hiring Indeed is all you need. Something you should know, Fascinating intel, the.
- [04:15]
Jerry Avorn
World'S top experts, and practical advice you.
- [04:19]
Mike Carruthers
Can use in your life today.
- [04:21]
Narrator
Something you Should Know with Mike Carruthers.
- [04:26]
Mike Carruthers
So do you know which side of your face is your good side, the one you like to point towards the camera when someone's taking your picture? Hi and welcome to this episode of Something youg Should Know. If you've never taken the time to really determine which side of your face is the good side, I can tell you that it's probably the left side. Researchers from Wake Forest University studied the faces of male and female college students and took note of their personal preferences. And they almost always said the left side. The researchers say there's a reason most of us are drawn to the left side. That side of the face is controlled by the right side of the brain, which governs feelings. As a result, the left side of your face will usually show a greater intensity of emotion. This is also a difference that painters have seemingly known about for centuries. Go to any museum and you will notice most portraits depict a person's left side. And that is something you should know. Whether you realize it or not. Music plays a role in your life. You hear music more than you think. Get in your car, go to the store, go to the mall, go to the doctor's office, Watch tv, go to the movies. There will be music playing in all those cases. And then there is the music that you intentionally listen to because you enjoy it. Well, what effect does all this music have on you? And can you use music in an intentional way to actually help you to improve your life? Or maybe music is just something pleasant to listen to, to fill up the silence. Well, I think what you're about to hear about music and how it affects you is. Is going to surprise you. My guest is Sarah Layla Sherman. She is a musician and educator who has pioneered innovative approaches to use music as a tool for mindful learning and personal growth. She's co author of a book called Resonant the transformative power of music one note at a time. Hi, Sarah. Welcome to something you should know.
- [06:39]
Sarah Layla Sherman
Hi, Mike. Thank you for having me.
- [06:41]
Mike Carruthers
So let's start with how much music do we hear? How much do we listen to?
- [06:46]
Sarah Layla Sherman
70% of Americans listen to music for three to four hours a day. So then when we think of music and how much we're consuming music anyway, that's a lot of hours. But the idea of intentionally using music to help with our focus, our cognitive functions, our emotional awareness, community building, we don't necessarily put the thought into that in our everyday lives. And so that's what I love talking about, is how we can intentionally use music as that tool to bring presence into our everyday lives.
- [07:20]
Mike Carruthers
So when I hear you say using music in an intentional way, I think of the music like, you know, when you listen to those meditation tapes, and there's, you know, whatever that flutey sound is. And to me, that's music for that. That's. But I don't know what that music is. I have no interest in listening to it any other time in my life. That's just, you know, music to be mindful by. But can you give me an example of using music in an intentional way?
- [07:52]
Sarah Layla Sherman
Absolutely. But I have to ask, do you like that music or do you find, you know, the idea of the masseuse and the waterfall and the flute music. To me, that doesn't resonate with me. So it's almost makes me a little anxious instead of relaxed. Do you actually find that you are more relaxed when you hear that type of music in that setting?
- [08:11]
Mike Carruthers
It's a good question, but it's almost as if the music wasn't there. I'd think something's wrong. This person doesn't know what they're doing because they're not playing the mandatory flute music that I so expect to hear.
- [08:23]
Sarah Layla Sherman
Okay, so I'M gonna answer your question. And then you just spurred something else that I love talking about as music, as a cue in the absence of music and what that does to our brains. But so it's not always waterfalls and flutes. Different types of music do different types of things for us. Our brains start firing our neurons 300 to 500 milliseconds after it's exposed to music. So that's faster than we have a conscious thought or before we can even recognize the melody. And what it does, it goes through our auditory cortex to our amygdala, so where we process emotions. So you're right that it makes you feel something, but it doesn't just have to be that, because music can help lower our blood pressure and our cortisol levels. And maybe it's Bach. And in terms of reducing our stress levels and our cortisol, it usually is something with slower beats per minute, usually less than 80 beats per minute. And long melodies and not words. Words tend to actually interfere, but context.
- [09:21]
Mike Carruthers
Seems to play an important role in it. And, you know, for example, going back to the masseuse and the meditation music and all that. So if you walk into the masseuse's place and, you know, the candles are burning and the lights are flickering or whatever, you know, and she puts on Def Leppard instead of the flutey, you know, waterfall music. Even if I like Def Leppard, this is not the place.
- [09:45]
Sarah Layla Sherman
Well, absolutely. Def Leppard is then music to motivate or to have a different sight of our emotions activated. When we listen to different types of music, it interacts with our amygdala in different ways. So there is a part of our brain that has that section for focus and for kind of this calm music. And I think that's what you're talking about there. But then this other music ignite something called a groove. And a groove isn't just something that we think about when we're, you know, at a concert or a mosh pit. A groove is actually a neurological term when our brain waves are synchronizing. So if you think back to a concert or whatever it might be, or death leopard, when you're in a room with people listening to music that has usually 80 to 120 beats per minute, which I imagine Def Leppard does, it's usually most popular music. And it's the same amount of beats that most of us walk to. So the rhythm of our feet and our brain waves synchronize with each other, which creates a sense of community, and it Also has this way then of getting in touch with us emotionally. So whatever type of emotion Death Leopard is bringing to you, I imagine that upbeat that energized. It's not that flute masseuse music. It has a point and it has a purpose. And so it's about figuring out what music has a purpose in our lives and how we want to use it at a time to ignite that purpose that we're looking for in that moment.
- [11:09]
Mike Carruthers
I was surprised by your statistic that I think you said 70% of people listen to three to four hours of music per day. That seems like a lot.
- [11:21]
Sarah Layla Sherman
It is a lot. But it's also the idea that music is often on in the background or what we think of music on as background music or today's world scrolling and social media. And the numbers are actually higher for younger kids, for teenagers in particular, where it's eight to nine hours of media consumption a day. And how much of that media consumption is involved with music. Think back to what you were saying. If the music turns off, what's wrong here? What's happening? And that's actually like hold music. That was the rant I was going to go on before about hold music, where when we're on hold somewhere, we anticipate music and when it's not there as this cue we think we've been hung up on. So we're so ingrained to have music be a part of our everyday lives, whether it's in an elevator, in a store. And so with that three to four hours, if we even take just 20 to 30 minutes, even less two to three songs a day, and say, hey, I'm going to attach this song to focus. Or especially if you're a family and you have young kids, it works really well to have songs be cues. Hey, when we play this song, it's going to signal shoes and socks on, jackets on, and let's go out the door. And so those songs can again, through that repetition, become this queue. And the three to four hours then is not just in the background, which music never really is background, because like I mentioned, our neurons are firing purposefully according to the music, whether we realize it or not. That's why if you're writing, it might be harder to write when you're listening to music with words, it might be harder to focus if you're listening to Def Leppard versus classical music. And so that three to four hours is really staggering. But let's put some of that intention behind it.
- [13:04]
Mike Carruthers
You know what I really hate is the hold Music, you know, when they put you on hold for 20 minutes, but they play the same 30 second loop of music over and over and over again, knowing they know you're gonna be there for 20 minutes, that is maddening. I would rather have silence than hear that thing for the 400th time.
- [13:26]
Sarah Layla Sherman
So in the 1960s, this is one of my favorite stories. You know, switchboard operators and the story of hold music on phones happened because a switchboard operator accidentally crossed the cable with the local radio show. And so the person on the phone was all of a sudden hearing the radio instead of being switched to where they were supposed to go. And so all of a sudden the hold music was patented in the 1960s. It still is under the same patent. And it's really become this signal now in our everyday lives of hold. You know, there's a 19 8, 89, there is Cisco hold music. It's one of the most famous pieces of hold music out there. That's probably what you've heard on repeat. But there's all this research behind the type of hold music that certain businesses pick. You know, if you're on it with an insurance company, they might select types of music like we mentioned, to lower your stress levels of your or your cortisol. So I agree, I don't love hold music, but it's a signal because if you were met with silence, how would you know if somebody hung up on you or if you were disconnected from the call?
- [14:31]
Mike Carruthers
Right, yeah. That it very much serves as that we're still here. We're just ignoring you at the moment, but we're still here. And you say in your book that only 1.4% of people listen to classical music. That's surprising in the world.
- [14:49]
Sarah Layla Sherman
So there are different statistics. The numbers are higher if you look at the UK and in Canada and America, but globally, which I think is important to look at, I think that there has been this shift of classical music. If you can go back to Mozart, Mozart's concerts were, for lack of better words, let's say raucous, where people cheered if they really loved this crescendo, which means the music gets louder and they would cheer. And he expected that. We have letters of Mozart writing to people and saying they applauded, just like I knew they would. And then when it got really soft, I could hear silence and like I wanted. And they were so excited at the end, end of this part that they applauded. And he was not against this type of interaction with the classical music. In fact, it was a social event. It was expected and the way classical music is often presented today. Here's a sonata, here's a symphony, and there's different sections, we call them movements. Do not clap. Be on your best behavior. Sit with your hands folded on your lap. And in the 1700s, early 1800s, music was not that way and it's really taken the shift. And again, I don't want to say elitist mentality, but it is on what is expected and how to perform. And be on your best behavior in a classical music concert, which is not how classical music started as a performance. And I think that really does a disservice to reaching new audiences and to exposing people to music. I don't think we need to have a whole bunch of classical music lovers, but appreciators and understanding because that is music that will help reduce our blood pressure, our stress levels. It's great for creativity, for activating our default mode network, and for so many different things. But classical music is not as accessible as we have the potential to make it as a society.
- [16:40]
Mike Carruthers
There's something else about classical music I want to ask you about in just a moment. Sarah Sherman is my guest. She is author of the book Resonant the Transformative Power of Music One Note at a Time. I am definitely not a big clothes shopper and probably like you, I've bought clothes online that were disappointing. But I have a very different experience with Quince and I've come to find out that so many people I know shop Quince. So far I've gotten a couple of shirts and sweaters from Quince and well, you'll know what I mean when I say this. Every time I get something new from Quince it goes right to the top of the rotation. My Quince clothes are my go to clothes. If you don't know Quince you are going to love their website. Quince has all the things you actually want to wear, like organic cotton silk polos like the ones I have, European linen beach shorts, pants for every occasion. Really nice pants. And here is the very best part. Everything at Quint's is priced 50 to 80% less than what you'd find at similar brands. You see, by working directly with top artisans and cutting out the middlemen, Quint's gives you luxury pieces without those big markups. I've really been amazed at how many people tell me they shop at Quint's. It's become like the place to go to buy clothes. Elevate your closet with quints. Go to quints.comSYSK for free shipping on your order and 365 day returns. That's Quincy to get free shipping and 365 day returns. Quince.comSYSK here is a dilemma that we have faced in our house. We don't always have time to cook or want to cook. Eating out has gotten so expensive. And fast food, that's no bargain either. Plus, it's fast food. We solve this dilemma with factor we love factor meals. Factor meals are freshly prepared restaurant quality meals, full meals delivered to you that you just heat for 2 minutes and serve. There are 45 weekly menu options to choose from. And as a factor meal eating veteran, I do two things. First, I always make sure to choose some of the meals with sauces because for some reason their sauces are spectacular. And the other thing we do is we always take the food out of the container it came in and put it on nice plates. When you do that, you swear you are eating a restaurant quality meal. Ginger teriyaki salmon truffle butter filet mignon, sweet and smoky barbecued grilled chicken. I'm telling you, factor meals are so good. Cheaper than going out. It's better than fast food. Just try it once and you will solve the there's nothing for dinner problem once and for all. And here's a significant discount just to try it. Get started@factormeals.com something 50 off and use code something50OFF to get 50% off plus free shipping on your first box. That's code something50OFF@factormeals.com something50OFF for 50% off plus free shipping. And that promo code is in the show notes. So, Sarah, what's interesting to me about classical music is I don't seek it out, but when I hear it, I really like it. And it does signal something. Like if you hear classical music in a hotel lobby, it classes up the place.
- [20:33]
Sarah Layla Sherman
I like that you chose the word classes up the place. So it already has to. You also this level of sophistication associated with it, correct?
- [20:41]
Mike Carruthers
Yeah. Just like in a restaurant with white tablecloths and classical music playing, you're gonna, you know, it's gonna be expensive. This is gonna be an expensive restaurant. Cause it's a classy place.
- [20:53]
Sarah Layla Sherman
And so I don't disagree. But I think again, then it puts this barrier. I like to think of the fourth wall and classical music in particular, breaking that fourth wall of what our expectations are at a concert or performance. I run a classical music concert series called Mozart for Munchkins. And it's an interactive experience. So we'll do that. We'll play the Flight of the Bumblebee, but we'll encourage the kids to buzz around like bumblebees or we'll play Bach. And we encourage this element of breathing with Bach to it. And it's amazing what a one year old and a two year old can do. When we give to be themselves and to experience this serious music, they don't have to get it, but they can feel it. And the more exposed they are to them, it becomes taken down from this pedestal almost as we often think about it. Like you said, this fancy restaurant or hotel or whatever it might be. And it can become more integral into accepting music like the Def Leppard, whether you like it or not. But it also then breaks this barriers of our expectations of it. And it's not put in a box. Here's classical music over here for when I do these fancy things.
- [21:58]
Mike Carruthers
Well, you know, I've never really thought about this before, but there is an expectation like if you go into a fancy restaurant and there's music playing, it's likely something classically or if not real classical music. And if you. Because what I'm thinking about is there's a grocery store not far from here that I go to now and again and they don't play the music you would expect to hear, which is why I noticed it. I can't tell you what the other grocery stores play and they're all playing music, I don't even notice it. But this place plays oldies from the 60s and I love it and I notice it. But there is this expectation that certain places play certain. You will hear certain music in certain places and you will not hear certain music in other certain places places.
- [22:49]
Sarah Layla Sherman
Music in elevators, restaurants, department stores, grocery stores is again a business that was founded in 1932 called Muzak. So when we think of Elevator Muzak, it's actually the name of the LLC Muzak Holdings LLC that started this idea. When you go into a store and the idea was when you play certain type of music, it might make people buy more things. If you have this type of music, that will encourage them to pick up more items on their way out. It's the think of it like the little kids at and all the candy or all the chips that are right near the cash register and you see parents scrambling. No, no, no. But very rarely do you have classical music, which again is this calming music or it doesn't have to be classical, but instrumental music with a low amount of beats per minute that kind of keep us in this calm Grounded state. I love the oldies and I love that they do that. And so somebody somewhere is intentionally picking that soundtrack for that grocery store.
- [23:49]
Mike Carruthers
I'm always interested in how people get to like the music they like. And I imagine it has a lot to do with just the music you're exposed to in your home growing up or whatever. But I remember because I come from the radio, the music radio business, worked in music radio for a long time, and remember program directors at radio stations talking about this, about how they would play a song. They would choose whatever new song that they're gonna play. If you play a song over and over and over again, people get to like it. It becomes a hit. That's how hit records become hit records is if it's played enough, people become familiar with it, and that familiarity turns into liking.
- [24:39]
Sarah Layla Sherman
I love that. That story. And because it's when I talked about cues before, it's the idea of something becoming, listening to it consciously and having it all of a sudden go into our subconscious. And so then, oh, actually, I like this song. Or you heard it enough times, you know this song, whether you realize how you've learned it to begin with. And so it's the same if we think about buttoning our shirts or brushing our teeth or learning how to tie a shoe, it's this action that we purposefully focus on. It's something our explicit memory trying to remember how to do this action. And eventually it goes into our subconscious, our implicit memory, and we do it automatically. And music is exactly the same. Think about songs from your childhood or when you hear a song, and you can have a very vivid memory of what that's attached to, and it's because of the way you've listened to it however many times. Or if I sing this to you, da dum after two notes, what is that song?
- [25:38]
Mike Carruthers
Jaws.
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Sarah Layla Sherman
Yeah, two notes. And you know exactly what song it is. But you didn't sit there and think, here's two notes. Here's Jaws. It's because it has been ingrained from watching the movie. That song itself has become so used in pop culture that we have this association with it. So that absolutely makes sense that radio show hosts did this and that people were all of a sudden having favorite songs because it was prescribed for them on repeat. And they were then having these associations, maybe whatever they were doing, and creating these positive memories while they were listening to it, whether it was intentional or not.
- [26:14]
Mike Carruthers
Maybe you can explain this phenomenon to me. And I bet it's something that's happened to everyone listening to us. Talk right now, if you were to say to me, okay, here is a song and you name the song and it's a song I know. I've known it all my life. What are the lyrics? I couldn't tell you. I probably don't know the lyrics. I might know a few of them, but I don't know the lyrics. But if you play the song, I'll be able to sing along with it and not miss a word. So I did know the lyrics, but I couldn't tell you what they were unless I had the song playing with me. What's that?
- [26:51]
Sarah Layla Sherman
Music predates language. Neanderthals use music as a way of communicating. Some of our earliest instruments are vulture bones created and carved into a flute. And again, predating language is a form of early communication. So when we think about using music as this tool to connect with one another before language, whether it's rhythm, whether it's creating sounds to tie emotions, music and emotions are so linked together, when we hear certain sounds, like I mentioned, it ignites different parts of our amygdala, whether it's happy or sad. And sounds have that capability. So the more that you are singing a song and attaching it to a melody and to the harmony underneath it, especially if you've sang it with other people. Absolutely. It's easier to remember than if I ask you even Happy Birthday. I'm sure if you had to write down the lyrics to Happy Birthday, you have to think about it or sing it in your head in order to write it down. It doesn't just seem thing Happy Birthday. Our brains don't function that way. Everything is intertwined and integrated together when it comes to the music.
- [28:02]
Mike Carruthers
One question that I've always wondered about, and I think every parent and every student has wondered about, is, is it a good idea when you're studying to listen to music, or is silence better?
- [28:16]
Sarah Layla Sherman
A good question, and I think it's very individualized. Again, music as that cue can absolutely help if you're having a hard time focusing. But again, if you're listening to music lyrics, when you're trying to write or focus, it detracts from that because music never really is a background noise like we talked about. So it's finding that music that supports that. If you find that silence really works for you, wonderful. But I think it's worth experimenting with different types of music and with silence to see what works for you. With different types of sounds throughout the.
- [28:51]
Mike Carruthers
Day, well, it's really eye opening to realize how much music we're exposed to much of it just in the background. But as you point out, there's no such thing as just in the background. It all affects us in different ways. And I appreciate you explaining this, Sarah. Layla Sherman has been my guest and the name of her book is Resonant the Transformative Power of Music One Note at a Time. There's a link to her book at Amazon in the show notes. And Sarah, I thank you for coming by.
- [29:21]
Sarah Layla Sherman
All right, thank you Mike. Thanks for really interesting questions.
- [29:25]
Mike Carruthers
We talk a lot about health on something you should know and I guess it motivates me. I mean I'm not a nut about it, but I try to take care of my health. I want to preserve my mobility and strength as I get older. And I recently started taking this supplement. Maybe you've heard about it. It's called Mitopure. Mitopure is a precise dose of something called Urolithin A that supports your health by encouraging cellular renewal. Since I started taking it, I can tell I have more energy and I notice I recover faster after I exercise. I did some research on this too. There's some real science here that supports what I'm saying and so does my experience. Mitopure is the only Urolithin A supplement on the market that is clinically proven to target the effects of age related cellular decline. And Mitopure is shown to deliver double digit increases in muscle strength and endurance without a change in exercise. From my own experience, I have more energy and strength and just overall feel better every day. And who doesn't want that? And I'm not just recommending it to you on this podcast. I tell friends and other people I know about it because of how it makes me feel. Now Timeline is the company behind Mitopure and timeline is offering 10% off your order of Mitopure. Go to timeline.com something that's T-I-M-E-L-I-N-E.com something.
- [30:59]
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- [31:34]
Mike Carruthers
I imagine, like me, that if your doctor prescribes you a medication, you don't question it very much. You figure the doctor knows what he or she is doing. They wouldn't prescribe something if they didn't think it would work or if it wasn't safe. And you may or may not worry about the cost, depending on whether or not you have insurance. And in any case you figure it's probably necessary, it's most likely the best thing out there to treat whatever is wrong with you. And so you go with it. If that is pretty much the way you operate, that's pretty much the way I operate. Then my guest you're about to meet would say you're making a lot of assumptions that you shouldn't be making and potentially putting your health at risk. And it just might be worth hearing what he has to say. Jerry Avorn is a medical doctor and professor of medicine at Harvard Medical School. He has built a leading research center at Harvard to study medication use, outcomes, costs, and policies. He has written or co written over 600 papers in medical literature, as well as opinion pieces in the New York Times and the Washington Post. He's author of a book called Rethinking Truth, Power and the drugs you take. Dr. Welcome to Something you should know.
- [32:53]
Jerry Avorn
Thank you for having me.
- [32:54]
Mike Carruthers
So first, explain your overall view on medications and what you think people might want to consider when the doctor prescribes them something to take.
- [33:05]
Jerry Avorn
Sure. I think anybody that that takes a medication has a number of questions that either they wonder about or they ought to wonder about. One is, does it work and how do we know if it works? The second is, is it safe and how do we know that? What side effects might it cause? The third is, why does it cost what it cost and can I get it for less money? And then there's a whole host of related questions about what are we doing as a nation to try to make sure that we get it right on those issues of does it work, is it safe, and is this the right price for it?
- [33:41]
Mike Carruthers
And we should be concerned about this why? And here's why I ask. I would assume my doctor is not giving me a pill that doesn't work. He must know why it works. He must think this is a good thing, my insurance is going to pay for it, so why do I need to listen and worry about any of the things you just mentioned?
- [34:01]
Jerry Avorn
Great question, Mike. And in fact, we do need to wonder about all of those things for a couple of reasons. One is we doctors do the very best we can, but we can only work with the information that is out there and available to us. And for that we rely on the FDA to tell us whether a drug is effective and safe. Many people, including a lot of doctors, think that the FDA tests drugs. It doesn't. It doesn't test any drugs to see if they are effective. It relies on studies that are submitted to it, usually from the manufacturer. And one of the more surprising issues is that often the manufacturer will set up those studies in a way that will put the drug in the most favorable light, even if it actually turns out not to help people. And, you know, we can't blame the physician on the front lines for that, because all we can do is rely on the decisions made by the fda. Over the years, FDA has gotten way too loosey goosey about accepting data that are presented to it by a manufacturer, even when that data does not demonstrate, as it really ought to, legally, that the drug is indeed safe and effective.
- [35:14]
Mike Carruthers
But even if the FDA doesn't do that, I would think my doctor has experience with his own or her own patients that would indicate, yeah, this seems to work in a lot of cases. So let's give this a try. And you know, my other patients aren't dead. So yeah, let's go.
- [35:32]
Jerry Avorn
Right. And that is exactly not a good way for a doctor or for a patient to determine if a drug works, because the experience of any one doctor is not going to be enough to reveal whether a particular drug is effective. And it's certainly not going to be able to reveal whether that drug works better than another drug that I might have prescribed for that patient. Really, the only way we can know that is by well designed, well conducted studies of hundreds or thousands of patients where all those issues are looked at carefully.
- [36:04]
Mike Carruthers
I know there have been individual cases of drugs that have been approved for use, put on the market, and then pulled because something was wrong. And that does happen. But generally speaking, and my assumption is that once drugs are approved, they've been tested rigorously enough that if they're approved, they're probably okay.
- [36:26]
Jerry Avorn
I think probably okay is a good term to think of, because I think what Americans deserve is not probably okay. I think we deserve to know that even though every patient is different and you can never tell 100% of the time how something's going to work, we do rely a little bit more on probably okay than we ought to. So, for example, the drug that was in the headlines a number of years ago for Alzheimer's called Aduhelm. And it's part of this larger problem that going back to the AIDS epidemic in the 1980s, the FDA was trying to get drugs out there approved as Quick as possible. For obvious reasons, people were dying every single day and there's nothing good to treat them. So created this thing called the accelerated approval pathway, which made a lot of sense at the time. And it said, even if a company has a drug that may or may not work, if it looks like it maybe makes a lab test look better, let's approve it, get it out there, and then make the company do a study afterwards to see if it really works. And that way you won't have AIDS patients or cancer patients feeling like there was a drug that could have helped me. But the FDA took so long to study it that, you know, I died or my friend or my mother or father died before the drug was made available. So that made sense back in the 80s and the 90s. The problem is that has grown into a loophole big enough to drive a Brinks truck through. And what I mean by that is that the FDA has gotten way too comfortable with the idea of saying, well, nobody really showed this drug helps patients, but it makes the lab test look better. So let's just let everyone have it and then we'll ask the company to do better studies later. And that's where that Alzheimer's drug Adduhelm came from. The FDA said no evidence that this clearly helps patients with Alzheimer's disease to have any better memory, but it makes your brain amyloid levels seem a little lower. So let's approve it. And then they did not get around to making the company do follow up studies. And as a result, we have this drug that the initial list price was $56,000 a year, it can cause brain swelling and hemorrhage and stroke. So, you know, no drug is going to be without side effects, but you're willing to accept them if somebody has shown that the drug really works. But if nobody's shown the drug works and we know it causes side effects like brain swelling and bleeding, and it costs $56,000 a patient. That was probably one of the clearest examples of how we should not have approved that drug. And sure enough, later on, the drug needed to be pulled because after many years it became clear that it was not only not helpful, but it was dangerous. So, you know, given that we've got such wonderful drugs out there, we just need to do what FDA was assigned to do and has drifted away from.
- [39:20]
Mike Carruthers
Over the years, but from the patient's point of view, because I don't know if my doctor is going to prescribe a drug that's relatively new. It's been around for 50 years, should I be worried? And you can find plenty of examples like the one you just gave of pretty much disaster stories. And there are plenty of other examples, as you said, of great drugs that do wonders. So I don't as a patient know where should my worry be placed. I've heard, interviewed a doctor here that said, you know, they don't take a drug that hasn't been around and approved for a long time just to avoid the kinds of things you're talking about.
- [39:58]
Jerry Avorn
Right. And that we shouldn't have to rely on. Well, the drug's been around for many, many years before. I'll take it because frankly, the American public deserves to get access to drugs and not just, you know, make sure that it's been a decade and no one died from it. So I'll take it. I think the answer, and there, there are some very hopeful answers to these questions. It's not like we all need to throw up our hands and say, you know, I'm scared of drugs. Drugs are great. I love drugs. They are some of the best and most useful things we can do for our patients. I think we just need to hold the FDA to the standard that it was really expected to meet back in 1962 when its legislation was established, that it needs to make sure the manufacturer showed the drug is safe and effective before approving it. And one of the maybe scarier points is that because FDA has gotten lax on that and has accepted changes in lab tests and then as a marker for approving a drug, even though it doesn't show that it helps patients. And I think even worse, FDA has then failed to follow up on requiring that the companies do the follow up studies that the law requires them to, which of course the companies are happy to forget doing if they have a drug that may not pass those tests and they can leave it on the market, charge full freight for it, and then it may be years before we find out that it really doesn't help people. So I think all we need to really expect is that the FDA will do its job better than it has been doing and that companies essentially have their, their feet held to the fire and be told, look, you can charge a lot for this drug and if it's a great drug, that's okay and we'll pay for it. But you can't not study it adequately and then not do the follow up studies that the law requires you to do and expect that somebody is gonna come up with either $50,000 or in some cases $300,000 a year as we See in the drugs for muscular dystrophy, for drugs that have not been shown to help.
- [41:59]
Mike Carruthers
As a doctor, maybe not you, because you're so into this, but generally speaking, a doctor begins prescribing a new drug, he's gotta feel pretty comfortable or else he's gotten a good sales pitch. What does it take for you or other doctors to say, here's this new drug, this drug company's been asking me to prescribe it, and so I'm going to start prescribing it because now I know what.
- [42:26]
Jerry Avorn
So I think one of the things that I, when I teach doctors, I urge my colleagues to do is just because it's new and shiny and there's a tremendous sales pitch that you're presented, you know, maybe off over a delicious dinner at the best restaurants in town. I think all of us as doctors ought to have a, just a high level of want, wanting to see more about the evidence. And that doesn't mean that every doctor needs to study every drug. But to not assume that if it's new and it's expensive and it's FDA approved, it's got to be better than what we've already got. Sometimes it is, and we need to be very open to that, but sometimes it isn't. And, you know, you can just turn on the TV and see all the different psorias and eczema drugs that are so lavishly advertised. And frankly, a lot of them are not a lot better than the older ones that we have that are way cheaper. So I think doctors and patients alike need to basically have a high level of scrutiny about how do we know it's better? And doctors can ask that of the sales reps that come to visit them from the companies. And I think patients can also ask their doctors, first of all, you should ask, what is this going to cost me? Because we've got an awful lot of prescribing that we as doctors do. We have no way of knowing what it's going to cost the patient. And I've often had patients, I write them a script, it looks like a good, good drug for them, and then they go to the drugstore and they find out what it's going to cost, even if they have health insurance and they can't afford it. So I think there is a responsibility of us doctors to learn more about what things cost. And for patients, when you're with the doctor, I think it's perfectly fair to say, is there a related drug that is going to be more affordable and work just as well and any doctor worth his or her salt ought to be willing to answer that question.
- [44:12]
Mike Carruthers
When you get pitched by a drug company, a guy comes, a rep comes in and tells you, do they not volunteer? And do you typically not ask, what's this going to cost my patient?
- [44:26]
Jerry Avorn
They do not volunteer it because that's not a selling point. They are trained heavily on what are the selling points. And affordability is usually not a selling point. And I don't see sales reps anymore because it's, it is not a useful way to learn about drugs. But when I used to, and if I would ask that question, they would say, Dr. Avorn, I'm just here to tell you about the new product. I don't get into pricing, but what you can do is there's a couple of apps that are out there that people can look up and find out what is this drug going to cost? Doctors can look it up, patients can look it up, and to see if there's maybe another drug that works as well and is going to end up, end up being much more affordable because 1 in 5Americans cannot afford the drugs that we doctors prescribe for them. So something is wrong. If we make a careful prescribing decision, the patient gets to the drugstore, and then they can't buy what we prescribe because it's too expensive.
- [45:22]
Mike Carruthers
Well, you said something about how a lot of the drugs that you see on TV for eczema and whatnot aren't any better or probably very little better than what we've already got. Is that a fair assessment of what you said?
- [45:36]
Jerry Avorn
Absolutely.
- [45:38]
Mike Carruthers
So why do they come up with these new drugs? Is it just kind of like introducing the new model car? We just need something a little more fancy and expensive and to kind of churn interest up again?
- [45:49]
Jerry Avorn
Yeah, I think that is exactly, and I think you said it perfectly that if we have a system in which any drug can show, all it really has to show is that it's better than placebo or better than nothing. That is the legal standard that unless it's a condition where you've got a treatment, you know, like, like HIV or cancer, where you have a drug you know works, you can't test your new drug against just a sugar pill. But for a condition like eczema, which is not going to kill anybody or psoriasis, it is okay. I mean, is allowed by the law to test the drug against nothing. And the legal standard is that if you can show, if you're a drug company, you can show your new drug works better than Placebo. The FDA is kind of legally obliged to approve it. And that is problem one. Problem two is that the company then gets to decide what it wants to charge for it. And it can charge whatever in the world it wants to charge.
- [46:47]
Mike Carruthers
So clearly you are not a big fan of the way the drug approval process works, but the process that's in place had to have been approved by somebody or some people. If I were to call them and say, defend it, defend the way things are done now, what would they say?
- [47:05]
Jerry Avorn
They would say we are under a ton of political pressure to not make enemies in high places. And this is the case for both the Democrats and the Republicans. This is an equal opportunity problem we've got. Most people don't know that about half of the salary that FDA pays to the doctors and other scientists who review the drugs that it's evaluating are actually paid by the drug industry. And that has a long history where the Congress has not given FDA enough money. And that was before the current cutbacks hasn't got given FDA enough money to hire enough people to review the drugs. And back in 1992, the drug industry came along and said, well, that's a problem for us too, because we want our drugs approved quickly. Why don't you let us pay something that's known as user fees, and we will simply pay the FDA a huge amount of money for each drug that it reviews. And that's how you can give, you can meet salary for your scientists to review the drugs. You know, for me, that makes about as much sense as saying, well, you know, the court system is kind of strained, so why don't we let all the plaintiffs attorneys, or the defendants attorneys pay the judges, because that way we'll have enough judges. I think, you know, if the judge is getting paid by one side in the courtroom, we all know where that can lead. But unfortunately, that's the system we've sort of backed into with these user fees that now comprise, as I said, about 50% of FDA salaries in its drug approval branch. So one thing I would say to the hypothetical person at the FDA is we need to figure out a way that you, that you can actually get enough money from Congress that you can pay your own staff and not rely on user fees from the drug makers that you're supposed to regulate to be able to meet payroll.
- [48:52]
Mike Carruthers
But your analogy of the court system is different in that theoretically approving drugs is not an adversarial situation where you have defendants and plaintiffs. It's, we're all in this together to see if this drug works.
- [49:06]
Jerry Avorn
Works. Actually, Mike, I see it. I don't see it that way at all. I do think of it, although it shouldn't be, you know, sort of nasty with people, you know, kind of pounding the table, but I think in a very, kind of quiet and careful way. A lot of science is sort of adversarial in the sense that you're. You're describing it. And that is, I think the assumption needs to be that when a new drug comes to the fda, there's no. No assumption that it works. There's no assumption that it doesn't work. I think one needs to just say, I don't know if this is a good drug. I don't know if it's a bad drug. I just want to look at all the evidence and let the people who are bringing it forward give me their best shot. And I, as an FDA reviewer, for example, if I worked at the fda, I'm going to basically say that may or may not be true. I want you to convince me. I think that's a very healthy, scientific, gentle way to proceed without any assumptions being made one way or the other. And that's probably the best way to do science.
- [50:06]
Mike Carruthers
But so what's the way now?
- [50:09]
Jerry Avorn
The way now is that the industry's gotten an enormous amount of influence about these decisions. And the FDA is under a lot of pressure to basically, you know, please the industry because that is the side their bread is buttered on. And the industry is always complaining that, oh, FDA is keeping these great drugs away from the American people because they. They're so sluggish and obstinate. In fact, when we and others have looked at the data, the FDA is about as fast an approval agency as any in the world. Traditionally, the FDA has been able to turn around a decision within six months of getting, you know, terabytes of data that it reviews very carefully. And I don't think you'd want them to do it too much faster.
- [50:53]
Mike Carruthers
So put this in some perspective, because you've been talking about some instances and some procedures and some things that are in place that might tend to make someone think, well, you can't trust drug companies, so what's a consumer to think?
- [51:09]
Jerry Avorn
Again, I certainly don't want to leave listeners with the sense that most drugs on the market are unsafe or don't work. You know, most drugs on the market are safe and do work. And I guess I just would love it if we could be more scientific about getting it right nearly all the time instead of most of the time.
- [51:27]
Mike Carruthers
Well, so much of what you've said I've never heard before, and maybe I have tried to ignore it too, because I want to believe that if drugs are available, they've got to be safe, they've got to be effective. If a doctor's prescribing it, he must or she must know what they're talking about. There's all this gray area, but I appreciate you explaining it. Jerry Avorn has been my guest. He is a medical doctor and professor of medicine at Harvard Medical School, and the name of his book is Rethinking Truth, Power and the Drugs yous Take, and there's a link to that book at Amazon in the show notes. Jerry, thanks for coming on and sharing your expertise about this.
- [52:06]
Jerry Avorn
Thanks, Mike. I've really enjoyed talking with you and thanks for having me.
- [52:13]
Mike Carruthers
If you remember the good old days, you probably don't remember them very accurately. It seems that people who long for the good old days have a very idealized memory. According to some research at Carnegie Mellon University's Tepper School of Business, people have a tendency to block out their negative past experiences while we fondly remember the good times. The research shows that we cherry pick our memories and leave out the unpleasant ones. While we look at the past through rose colored glasses and remember the best moments, we look at the present for both the good and the bad. So naturally, the present never seems as good or as enjoyable as the good old days. And that is something you should know. If you haven't left us a rating or review recently or ever, this would be a good time. A rating? Well, that takes no time at all. You just, you know, pick how many stars. Preferably five stars would be good. A review is even better. It just takes a few minutes to write something. Write a comment about this podcast. We read them all. We appreciate getting them and it also lets other people know what other people think about this podcast. I'm Micah Ruthers. Thanks for listening today to something you should know.
- [53:33]
Anne Foster
Have you ever heard about the 19th century French actress with so many lovers that they formed a lovers union? Or what about the aboriginal Australian bandit who faked going into labor just to escape the police, which she did it escape from them. It was a great plan. How about the French queen who murdered her rival with poison gloves? I'm Anne Foster, host of the feminist women's history comedy podcast Vulgar History. Every week I share the saga of a woman from history whose story you probably didn't already know and you will never forget after you hear it. Sometimes we re examine well known people like Cleopatra or Pocahontas sharing the truth behind their legends. Sometimes we look at the scandalous women you'll never find in a history textbook. Listen to Vulgar History wherever you get podcasts. And if you're curious, the people I was talking about before, the Australian woman is named Marianne Bug and the French actress was named Rochelle, no less. Name just Rochelle. And the queen who poisoned her rival is Catherine de Medici. I have episodes about all of them.
- [54:34]
Amy Nicholson
I'm Amy Nicholson, the film critic for the LA Times.
- [54:36]
Narrator
And I'm Paul Scheer, an actor, writer and director. You might know me from the League, Veep, or my non eligible for Academy Award role in Twisters.
- [54:45]
Amy Nicholson
We love movies and we come at them from different perspectives.
- [54:49]
Narrator
Yeah, like Amy thinks that, you know Joe Pesci was miscast in Goodfellas, and I don't.
- [54:54]
Mike Carruthers
He's too old.
- [54:55]
Amy Nicholson
Let's not forget that Paul thinks that Dune 2 is overrated.
- [54:58]
Mike Carruthers
It is.
- [55:00]
Amy Nicholson
Anyway, despite this, we come together to host Unspooled, a podcast. We talk about good movies, critical hits.
- [55:06]
Narrator
Fan favorites, must sees, and in case.
- [55:08]
Amy Nicholson
You missed ems, we're talking the Home.
- [55:10]
Narrator
Alone From Grease to the Dark Knight.
- [55:12]
Amy Nicholson
We've done deep dives on popcorn flicks. We've talked about why Independence Day deserves a second look.
- [55:17]
Narrator
And we've talked about horror movies, some that you've never even heard of, like Ganja and Hess.
- [55:21]
Amy Nicholson
So if you love movies like we do, come along on our cinematic adventure.
- [55:24]
Narrator
Listen to Unspooled wherever you get your.
- [55:26]
Amy Nicholson
Podcasts, and don't forget to hit the follow button.
- [55:30]
Jerry Avorn
Sam.