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The "Freakonomics" of Medicine | Harvard Physician-Economist and Freakonomics Host Dr. Bapu Jena
48 Plays1 month ago
In this episode, we're speaking with Dr. Bapu Jena — a Harvard physician-economist and former host of Freakonomics, MD — to explore the hidden forces that shape how medicine actually works. Drawing from his research and his book Random Acts of Medicine, Dr. Jena explains how healthcare's interactions with chance and incentives aren't always intuitive.
The conversation spans natural experiments in healthcare, why more care isn’t always better care, how physician training and demographics can affect outcomes, and what we often misunderstand when we read medical studies or headlines. Along the way, Dr. Jena shares how curiosity (not policy agendas) has driven his work, and why asking the right questions matters more than having easy answers. This episode is a deep dive into the “Freakonomics of Medicine," and a reminder that understanding healthcare requires looking beyond intuition, averages, and assumptions.
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Transcript
Introduction of Dr. Bapu Jena
00:00:00
Speaker
Welcome to the Healthcare Theory Podcast. I'm your host, Nikhil Reddy, and every week we interview the entrepreneurs and thought leaders behind the future of healthcare care to see what's gone wrong with our system and how we can fix it.
00:00:14
Speaker
Today's guest is Dr. Bapu Jena, and he's one of those rare physician economists, where he both is a physician at Massachusetts General Hospital, seeing what care how care is really delivered, and he's an economist and professor of health policy at Harvard Medical School, where he discusses the hidden incentives behind healthcare. care You may know him as the former host of Freakonomics, where he understands and shared to many people, one of the largest podcasts in the industry, what are the freaky economic concepts going on in healthcare care that drive our system forward? And through his book, Random Acts of Medicine, he uses natural experiments to understand surprising truths about healthcare.
00:00:51
Speaker
And today I'm really excited. We're going discussing how doctors make decisions, what the data really says about quality in healthcare, and what we often miss in the economics of healthcare. So hi, Dr.
Journey to Dual Roles
00:01:03
Speaker
Jaina. Thank you so much for coming on and welcome to the Healthcare Theory.
00:01:06
Speaker
Thank you for having me. Of course, I'm also really excited, but I want to start off with your background. You've been described as a rare double threat, both a physician and economist, which is getting more and more common, yes, but I'm really curious what ended up driving your interest in both being a physician and an economist.
00:01:23
Speaker
Did one drive the other? it kind of a thing that happened at the same time? I like to think of myself as a quadruple threat, but I'm trying to work on the other two things. I haven't figured figured out what those two will be, but when I do, I'll let you know.
00:01:36
Speaker
um you know i ah I fell into this a little bit by chance. I ah studied economics and biology in college and planned to to do an MD and a PhD in the basic sciences, so to be sort of a clinician bench scientist. That was always my plan.
00:01:53
Speaker
And when I was interviewing for MD-PhD programs, this is now 1999, I visited the University of Chicago, which is where you where you are. And the person who was running the program at the time noticed I'd studied economics in addition to biology.
00:02:11
Speaker
And he asked me whether I'd want to do my PhD in economics instead. And i was I was a little bit taken aback. I wasn't expecting that. And ah he called over the economics department that morning. I went over there. I met with some folks, applied a week later, and ah ended up enrolling in the PhD program that fall, basically, knowing that if I didn't like it or if I couldn't do it, I would just fall back on my original plan to do an MD and a PhD in the basic sciences. So that's sort of what happened. And and you know now fast forward 25, 26 years, you know we're chatting now.
00:02:45
Speaker
Yeah, it's very interesting how things can just come about by chance. Looking back, it always makes sense. But
Economic Influences on Healthcare
00:02:50
Speaker
i am curious. I mean, being an economist and and a physician is rare. So how did having that economic lens shape the way you view health care, interact with health care as a physician?
00:03:00
Speaker
it really add to things? I also know Stephen Levy was one of your mentors, which is really interesting. And I can imagine pushed you towards that. I think ah in probably a lot of ways. I mean, certainly the direction of the research that I went down is very different than if I had done economics. ah I spend a lot of my time doing now what I would kind of think about as Freakonomics meets medicine, sort of using big data tools or ideas from economics, but you know answering questions that are a little bit atypical or sometimes very strange. you know i like I'm attracted to those kinds of questions. um
00:03:35
Speaker
And i I wouldn't have gone down that path if I didn't have a background in economics, if I didn't interact with Levitt back in my training. So I think that my life would have looked very, very different. Obviously, there's a lot of ways in which economics and medicine or healthcare care ah interact, and we can talk about those things, but it's sort of everywhere in in medicine in the way that clinicians think.
00:04:01
Speaker
the things that affect what patients do, the way that healthcare markets operate, it's sort of everywhere. The economics is everywhere. Yeah, I think
Exploring Gender Pay Gaps and Training
00:04:09
Speaker
at a colloquial level, people think of economics as a study of like the greater economy, the stock market. But economics is, as you know, the study of decision-making. There's so many complex decisions and infrastructure and systems and healthcare that just like are super pervasive. But I think one thing you've been studying a lot is the economics of how doctors work in the healthcare system, which of course you have direct experience with, but have also studied directly yourself.
00:04:32
Speaker
And I mean, what is that interest in like the physician, and labor economics? Like what are those questions and studies that have been driving your research at Harvard that you've, I mean, generally been trying to answer? You know, I work on all sorts of different areas. I have done some things that look at sort of which you might call the physician workforce. ah Years ago, I did some work looking at the way in which we train doctors and whether that that impacts the way in which they provide care later in their careers. So you may know that um you know in the mid-2000s, there was a change in how doctors were trained. It used to be that doctors who finished medical school who were doing something called residency
00:05:11
Speaker
They used to train 90 to 100 hours a week. And that's very tiring, obviously. And people were concerned that that might harm patient care. And so there was a change nationally to reduce those work hours. Those are called duty hour reforms.
00:05:27
Speaker
And people were interested in how that was going to impact patients. People looked at that. But what hadn't been looked at was whether or not those reforms, which reduced the amount of hours that residents would train to become an independent doctor, whether that reduction in work hours had any impact on their ultimate quality as a physician. And so we looked at that. We found basically that there doesn't seem to be any effect. And and maybe the reason why is because if you're working 90 hours a week versus 80 hours a week, that's both a lot of hours. And so you probably learn everything that you need to learn in 80 hours ah that you're getting in 90 hours. So that's sort of one example.
00:06:06
Speaker
we've looked at things like gender differences in physician pay. um There is this longstanding interest in economics about the gender pay gap or gender wage gap.
00:06:19
Speaker
One of the interesting things about medicine is that we have data to look at that gap in a way that is really difficult to do in other occupations or other fields. So for instance, in medicine,
00:06:31
Speaker
You kind of know what the currency is. What is it that drives wages or or or salaries, let's say, in an academic medical center? It's what's your specialty? How many years of experience do you have? um What's your clinical productivity?
00:06:45
Speaker
What's your research productivity? What's your grant writing productivity? All of those things are things that we can get data on in a way that you can't get data in in most other occupations. you know How do you measure their productivity or the skills of a lawyer, of a journalist, of an engineer? Not easy to do. And it's also hard to get that data. Here we have that data. And so we were able to look at kind of studies around the gender pay gap in medicine. And we find that women holding a bunch of things constant get paid about 15% less than men in medicine.
00:07:17
Speaker
So I could go on, but those are the kinds of things that we've done in part leveraging the kind of data that we have available to us in in this field. Yeah, and I want to get into a
Female Physicians and Patient Outcomes
00:07:26
Speaker
couple examples. i mean we can start with the kind of difference in between different physicians. You've done a study that, of course, is a gender pay gap. But in fact, I think you found a study that female physicians were, yes, treated differently, but also had lower mortality and and different readmission rates for male physicians, which is somewhat interesting. I mean, of course, you have your year as a specialty. You have the specialty year and how rare that is, but also just in the actual patient outcomes. There's differences between females and males.
00:07:51
Speaker
And I'd love to know, I mean, there's also age, that's a huge factor. What do you make of these differences in the care quality but based on like a physician's demographics, experience or gender? What do they stem from? Is it more just like the bureaucracy or the actual structure within the hospital? Is it staying up to the best practices or just throughout those different nuances? What have you seen as a global trend as what makes different physicians perform better or worse than others?
00:08:16
Speaker
Oh, it's hard to know. I mean, we can look at, and we have looked at sort of course characteristics of individuals. We've looked at things like where they trained. We've looked at their age. We've looked at their ah gender. We've looked at like foreign medical graduates and non-foreign medical graduates. So we've tried to get a sense of, you know, let's say across gender.
00:08:35
Speaker
We've looked at ah male female male and female physicians, and we focused on a group of physicians called hospitalists. And these are doctors who spend all of their clinical care time in the hospital. And the reason that's a ah useful group to look at is because in normal outpatient practice, doctors choose their patients and patients choose their doctors. And that creates a sort of problem, a statistical or econometric problem, because if you observe outcomes of female doctors to be better,
00:09:08
Speaker
than let's say male doctors in primary care. How do you know it's because the physicians, the female physicians are better versus the patients that they're treating are sort of unobservably healthier? So they are gonna do
Malpractice Risks Across Specialties
00:09:22
Speaker
better anyway.
00:09:23
Speaker
ah because you're not randomizing patients to male and female doctors, right? But in hospital medicine, you do get that pseudo-randomization or quasi-randomization, we call it, because you know i might work on Monday night, Lisa might work on Tuesday night, Tony might work on Wednesday night, and Christina might work on Thursday night.
00:09:44
Speaker
And patients don't know who's gonna be in the hospital when they when they show up. And so you're essentially randomized to male or female doctors. And the study that you're referencing is one that we had ah maybe five or six years ago, which showed that patients who are treated by female doctors in the hospital have lower mortality.
00:10:03
Speaker
So the likelihood that they are alive within 30 days of being hospitalized the likelihood that they're alive is higher if they are treated by a female physician then ah than a male physician. And you know we sort of speculate as to why that might be the ah the case. There is certainly some evidence that female doctors and male doctors sort of think about clinical problem solving differently. There may be differences in risk tolerance, what kind of clinical risks ah male and female doctors on average are are willing to take.
00:10:35
Speaker
So there's a lot of different mechanisms that might explain it. Yeah. And I think that's, of course, something we're still getting into. Another area that we found, i found quite interesting is the whole idea of like malpractice risk.
00:10:45
Speaker
I mean, but as you know, as a clinician, a lot of clinicians are facing a lot of burden just with paperwork and just overall other things that are slowing down their ability to be a clinician and actually deliver care. And I found it interesting. I mean, some high risk specialties like neurosurgery um have a much higher chance than others of getting sued. And like I think it's almost like 20%, which is it's very high.
00:11:06
Speaker
And almost everyone faces some sort of lawsuit at one point in their career, which to me is is quite startling and also difficult for the, it places a lot of burden on clinicians. um But I'd love to hear, like, how does the likelihood of this litigation um affect physicians in the practice of medicine? And what did you take away from those findings?
00:11:22
Speaker
in that study you did, i guess, I think was one of your most cited studies, but it was quite a few years ago. Yeah, that study was ah in 2011, and I wrote it as ah as a resident. Oh, really? Yeah, i remember it it. It was published in the in the New England england Journal of Medicine. I remember the there was a, I think it a front page article in the Boston Globe. And so I was a resident working in the emergency room on a shift one night, and someone comes up to me and says, you know, i saw your you know photo or, you know, saw your study and in the, uh,
00:11:51
Speaker
in the Boston Globe and the New England a Journal. That's not, it's not typical for, for a resident to publish there, but it was sort of a great, I mean, we were were're lucky. It's awesome. But, uh, we had access to really unique data where we had information on almost 40,000 physicians,
00:12:07
Speaker
um observed over many years so we could identify the risks of malpractice across different specialties. We could see how that evolved over time. And sort of our main conclusions were that in high-risk specialties, like you mentioned, neurosurgery, the risk of a ah malpractice claim is almost 100% by the end of these physicians' careers.
00:12:28
Speaker
If you're in something like primary care, let's say, family medicine, family practice, it's like 70%, so still really, really high. And the take home for me, at least in that study, was that this is sort of a risk that is sort of ever present for physicians. And there had been and there continues to be some work that looks at how that kind of risk influences physician behavior, influences burnout, decisions of physicians to remain in practice. And so there's lots of ways in which that kind of experience can influence the career ah and I think the life of physicians.
00:13:03
Speaker
Yeah, and I
Intellectual Curiosity Over Policy Impact
00:13:04
Speaker
think it just, I can imagine that ever-present fear would, of course, add to that burden. and But it to me, it's on it's it's quite surprising. i guess you see at one point in time that it you don't exactly see the, from a patient perspective, you don't see the overall difficulties behind the scenes that clinicians have to undergo. And that's something I was curious about, is I think you're not only just an economist, but you're also a doctor at the same time, and you're answering really important questions that are honestly difficult to answer in one study. They're much more nuanced and probably to require years of work to answer.
00:13:33
Speaker
um But what kind of changes or conversations are you looking for or or hoping that your research will spark in medicine and health policy moving forward? like what is the overall goal? I imagine some it's some intellectual interest on your end, but what is the kind of purpose driving your work and the impact you're hoping to create? Oh, I would say it's not some, it's ah it's all. It's 100% intellectual interest. Really? Yeah. I only work on things, or for the most part, I work on things where I'm very curious to know the answer.
00:14:03
Speaker
um And I consider myself to be really lucky to be able to have the ability to... You know, live my life in that way and work on questions in that way.
00:14:14
Speaker
um a lot of people in in the field work on topics that I think are very germane to pressing health care policy issues. um and And, you know, they find those interesting, they they find those ideas interesting and important.
00:14:29
Speaker
and And I think that they are interesting and important. But for me, I've just always wanted to chase down the next question. It's, you know, an idea pops into my head or someone comes to me with a really clever idea.
00:14:41
Speaker
i want to i want to do it. um And so there is no rhyme or reason except to say that... if If I see a question, I'm like, oh, I you know i really want to know the answer to that question, or it would be cool if we saw x Y, and z That's really the driver for me.
00:14:57
Speaker
um you know If it has an impact on policy, great. But I kind of think of it more as a sort of basic science approach where i if I do something, I'm not doing it because it has to be directly linked to some policy ah down the road. Maybe it is, maybe it isn't.
00:15:14
Speaker
Oftentimes, or most of the time it probably isn't. but 100% of the time I'm interested in it. Yeah. And I think,
Hosting Freakonomics MD
00:15:20
Speaker
I guess I almost see like two buckets when it comes to science. You see like the basic science approach where you're just answering the simple questions, important questions.
00:15:28
Speaker
And then I think you'll see later researchers, a decade later, a few years later, just other studies at the same time, the contemporaries would answer about how to commercialize that knowledge or how to put that knowledge into legal frameworks. And I think um I don't know, I guess, depending on someone's intellectual interest, it's interesting how people are curious about both. But I mean, speaking of curiosity, as I mean, you're the host of or we're the host of Freakonomics, MD, which seems like you guys are answering completely new questions every single week or every single month when you guys upload an episode. But I love to hear. I mean, you're already a clinician. You're already an economist.
00:16:00
Speaker
um How did that opportunity come about? I imagine through Stephen Lee, but how did that come about to start a podcast and work on a podcast to And why was this something you chose to pursue among your other responsibilities um at the time?
00:16:12
Speaker
I think the timing was right and the opportunity was right. I had been on the Freakonomics podcast, the main podcast, a couple of times before that. i think first time was some sometime around 2015 or so when we had a study about patients doing better when cardiologists are out of town at national cardiology conferences.
00:16:36
Speaker
Um, that was sort of a very Freakonomic style study. i did the the Freakonomics main podcast with Stephen Dubner at that time. And then, um, a few years later he did and a series, i think it was called bad medicine or something, something like that. And, um, and there's a few episodes and, uh, in that series and I was a part of that. And then sometime in, I can't remember it was 2020 2021,
00:17:02
Speaker
ah Stephen Dovenor emailed and said, you know would you be interested in and launching a podcast? because you know they had their main baby for economics, but had also started some other shows. And um I think they were interested in expanding um you know expanding to different types of topics and areas and and healthcare is something that people think a lot about.
00:17:23
Speaker
And ah so that was how the opportunity presented itself. And from my perspective, You know, it was I'd already been doing research now at that point, probably 10 years. I was at ah at a good point in my career where I could say, let me do something different than spending all my time doing research. And it allowed me to talk to lots of interesting people. ah think about new ideas.
00:17:49
Speaker
I love the aspects of ah production. I mean, probably during that couple year period when we did the show, one of the best parts of my week would be to hear a draft episode of each week's episode. And the thing that I actually looked forward to the most was sort of the musical score.
00:18:08
Speaker
because we had ah a group of terrific, and Freakonomics has a group of terrific producers and and audio engineers. And I just love to see like the creativity behind the music. like How do they fit certain types of music or certain scores to the content that was being described, how they match the mood? So that was for me, like that artistic part of it was actually one of the the most fun parts.
00:18:32
Speaker
Yeah, that's actually really interesting. I know like Freakonomics has a huge set of resources at their disposal, but I can imagine. I mean, you've spoken to so many different guests, explored so many different topics, and of course we can't go over all of them, but ah i love to hear. I mean, looking at all these different perspectives, were there any overall conversations or patterns that you saw that really stuck with you or somewhat unexpected that maybe you would not have picked up as a physician? Like, was there anything that you're like, wow, I never thought of it this way, or that's really surprised me?
00:19:00
Speaker
um I think a couple of the episodes that I enjoyed the most, one was an episode with um a gentleman who had sickle cell disease who received a gene therapy for sickle cell.
00:19:14
Speaker
And most of the episodes we were talking to sort of experts in some domain, economists, physicians, other kinds of social scientists.
00:19:26
Speaker
um Those are the types of people who are sort of you know expert in their fields. But you never really talk to patients, for instance. And so here was an an opportunity to talk to a patient who by all means is actually an expert in their disease. And so it' was really interesting to sort of talk to them in that way and and hear about how sort of a revolutionary treatment changed their life over the course of, you know, months and what that sort of build up and process looked like. so that was one of my favorite episodes. If you listen to that one, I sometimes actually, when I'm driving, I just pull up that episode because the way that it started, the music, um the gentleman's voice, it's just so cool to me. It was inspiring to me. And, you know,
00:20:15
Speaker
If you're listening to this podcast, listen that don't even listen the whole episode. Just listen
Natural Experiments in Healthcare
00:20:19
Speaker
to the first two minutes and you'll see what I'm talking about. And then the other kind of episodes that I liked a lot or actually towards the end where it was between where we weren't necessarily interviewing guests, but it was me talking to the producer.
00:20:33
Speaker
um And we were just talking about you know ideas. We'd have a topic and then we would brainstorm together. And that was, for me, really interesting because it's sort of gave listeners a look into the parts of research that I find the most interesting, which is just coming up with ideas, many of which don't work, some of which do work.
00:20:55
Speaker
And um that process of sort of brainstorming and in real time and making that open to the world, I think was was kind of cool for me. Yeah, I can imagine. i'm Now, first two minutes after this, I know I'm going to be doing a popular tune into that and just see um how you guys approach that episode. But I can imagine, like I think, with a podcast, it's it's a little bit different where you're like exploring new ideas in a different... i don't know. It's almost like you're getting new perspectives every time instead of people outside of your bubble almost, where you're like just in research or as an economist.
00:21:24
Speaker
It seems like the opinions you might get might be a little closed off as opposed to speaking to a patient, right? you don't get that perspective. And I think that kind of ties into your book a little bit. I mean, in your book, um love love for you to speak to that. But I mean, I think in your book, you use natural experiments as a way to answer these important questions. a little bit different from like a causal experimental study or randomized control trial.
00:21:46
Speaker
i mean, it's ah it's a completely natural experiment. And I'd love to hear like for people that haven't heard that term, how would you describe what is a natural experiment? Why is that so valuable? And Why was that kind of a focal point in your book to answering important questions about medicine and healthcare?
00:22:01
Speaker
um So the way I would describe it as sort of a natural experiment. Maybe the best way to describe a natural experiment is to start with an actual experiment. So in an actual experiment, if you want to figure out, let's say, whether a drug um improves health, the way you would do that is you would take a bunch of people who have a given disease You would randomize some of them to receive that drug, others not to, and then you would follow those individuals out and see whether the people who by chance received the drug had better health outcomes.
00:22:33
Speaker
That's the way you conduct that study. If you didn't have access to randomization, what you might then do is look in the real world at instances in which people received the drug and instances in which they didn't and compare outcomes between those two groups.
00:22:50
Speaker
The problem with that kind of analysis is that it's not random who receives the drug. So you might find, for instance, that people taking a cancer drug or have higher mortality than people who don't take a cancer drug. And you would conclude incorrectly that the cancer drug increases your mortality. It kills you.
00:23:11
Speaker
Of course, what you're missing there is that cancer drugs are taken by people with cancer, and cancer is what's killing that person. So the the first step is you have to try to account or adjust for those things, those differences between the treatment group and the control group.
00:23:25
Speaker
But what we know very well is that all of the things that ah differ between two groups cannot be controlled for or adjusted for simply because you don't know what those factors are. They are unobserved to you as ah as a researcher or an analyst.
00:23:40
Speaker
So that's where natural experiments come in. Natural experiments try to identify situations where nature... by chance exposes some people to one intervention versus another.
00:23:52
Speaker
So in the drug context, what it might be is looking at someone who has a particular condition who is about to take a drug, but then the drug has a national shortage, and so they can't take it.
00:24:05
Speaker
So you look at people who had that condition during periods of a national drug shortage versus surrounding people periods where the drug was available. And if you see, for instance, that during the period of the shortage, people with that condition do worse, then you might and and sort of intuit from that that the drug is helpful because when it went on shortage, which is totally random with respect to that person, those people did worse. and Therefore, the drug is helpful. So that's sort of the general idea. you You use nature to find these situations where people are by chance randomized to one path or another.
00:24:40
Speaker
And I think the hospital
Public Trust in Science
00:24:41
Speaker
example you brought up earlier is like a perfect example. know, a quasi random, naturally random experiment where people get assigned to male or female doctors almost by chance, rather than the selection.
00:24:51
Speaker
some ah So you're not in the hospital the whole day being like, do you get a female, you get a male, right? So exactly. yeah It's random. Yeah, exactly. And I think there's one example that stuck with me a lot, just going through your book. I mean, when cardiologists are away for a conference or something like that,
00:25:07
Speaker
healthcare care actually improves within that town. I mean, that doesn't sound like something that would make sense. Obviously, cardiologists are not hurting patients directly. So it sounds confusing. I mean, in this random national or random natural experiment, I mean, and why were fewer cardiologists able to actually improve the outcomes in some cases?
00:25:26
Speaker
the So the the the logic is that when there's fewer cardiologists around, there's fewer procedures to be performed. And in in some cases, when you do a procedure, you could do more harm than good.
00:25:40
Speaker
Yeah. So imagine this. Imagine you have 100 people with a ah condition. and you randomize 50 of them to a treatment and 50 of them to no treatment. And you find that the 50 who get treatment randomly, they do better on average than the people who didn't get treatment.
00:26:01
Speaker
So you conclude from that that that treatment on average improves health. What that means is that if you had to take 100 people and give all of them treatment or give none of them treatment, it was just black or white,
00:26:18
Speaker
you would do better off, you'd be better off by giving all of them treatment. Because on on average, the treatment is helpful, it improves health. But what it doesn't mean is the following, is that maybe people in that group of 100 for whom the benefit of treatment is actually outweighed by the risks of treatment,
00:26:39
Speaker
And if you could accurately identify who those people were, you would actually generate more overall improvement because you wouldn't be treating people for whom there's no benefit to them of being treated. So you systematically sort of remove people from treatment for whom the benefit is going to be outweighed by the clinical risk. And that's what I think is happening during these cardiology meetings.
00:27:03
Speaker
We see that there's a reduction in certain types of procedures during the dates of those meetings because the cardiologists aren't there to perform those procedures. And even though those procedures are on average beneficial, when you start to be a little bit more disciplined,
00:27:19
Speaker
and constrain yourself and say, right, does this patient really need this procedure? Yes, no. All right, yeah, this person really needs it. I'm going to give it to them. But this person here, yeah plus or minus, maybe i might maybe I'm not going to give it to them.
00:27:32
Speaker
And when cardiologists exercise that judgment, of having to be you know have more discretion in what they're doing in terms of procedures, it could be the case that outcomes overall improve ah because they're forced to make that decision in a way that normally they wouldn't be constrained in any other period of the year.
00:27:52
Speaker
Yeah, and I think that's that's a really interesting example. And I want to like almost step back a little bit. i mean, you have these natural experiments. And I feel like something I've seen is that we have more and more research going on, which is great,
00:28:03
Speaker
But as you've seen technology kind of grow, it's almost like the interpretation of these studies has kind of wavered a little bit, not just like within the new administration, but I mean, also Colloquially, we see different studies, but then people interpret it wildly differently or the headline comes out that doesn't actually fit what the data really says.
00:28:20
Speaker
And I think a hard part for people is to build that maybe scientific intuition behind like, is this a is this what the experiment is actually saying? Is this what the data shows? It's it's not a thing you can just grasp by reading a headline or the abstract of an article.
00:28:34
Speaker
And I'd love to hear, mean, through your book, what is the kind of, what does that really show? I mean, the hidden side of healthcare, what is it exactly showing through these natural experiments? And how can people basically build better intuition of this science? And also just like, we need more
Book's Aim: Entertainment and Curiosity
00:28:49
Speaker
public trust of science and healthcare too, I think at this time.
00:28:52
Speaker
i mean, what are your opinions on that? how has your book helped to maybe push that forward? Well, I'd say my goal, and I can't speak for Chris Worsham, who's my co-author, my goal in the book was to entertain.
00:29:05
Speaker
That's the goal. It wasn't to change how people view ah their health or to make better decisions. I guess I wouldn't describe it as sort of a how-to book or a self-help book. It's sort of the purpose of the book is to...
00:29:17
Speaker
entertain and to sort of, um you know, peak curiosity and creativity on questions related to to health. That was the goal. ah You know, I do think that one thing that we do in the book is try to tell readers or or sort of educate readers about causality and, you know, when you read studies in the news that suggest that peanuts might lower the risk of dementia or increase the risk of dementia in a study the following week, you know, like How do you make sense of those studies? What do they mean? and And can you take them as being causal? And and the answer is many of those studies you cannot.
00:29:54
Speaker
So that is something that comes out of the book. There's like a little bit of health literacy or or sort of study literacy that that comes out of it, meaning how do you interpret studies in the right way. But really what I hope people get out of the book is sort of an excitement about the possibility of large data being applied to their health and their lives and using some of these tools of natural experiments, but just also just being more creative to think about how can you use these data um to to teach us something about how the world works or doesn't work when it comes to our healthcare. I want people to read that book and think to themselves, I feel a little bit more creative today than I felt you know three weeks ago when I picked up the book.
00:30:35
Speaker
Yeah, and I think with the advent of LLMs, and we're seeing a little bit more interoperability and more accessibility with data and healthcare a little bit, but, and with LLMs, hopefully more and more people, whether it's either a startup or just under their own volition, can actually explore and answer their own questions about healthcare. care or at least find answers online with existing research. But I mean, you've had a pretty interesting career. Of course, you're a physician, economist, podcast host, author, and a whole host of things, um almost like that quadruple threat. But I mean, looking ahead, um is there like anything else that you're excited about within your career? I mean, what's kind of next for you?
00:31:08
Speaker
um Because you've, I guess, explored healthcare, you're on your own, you've educated people about it, but love to hear what the next chapter of your, I guess, intellectual exploration will look like. Dude, next for me is direct childcare.
00:31:21
Speaker
yeah know you know you know You didn't mention like you know the most important job I have actually as parent. you know We've got two young kids. And ah you know I think you know we we talk a little bit about this sort of theme in the book. and And again, I think I've been really lucky to be able to spend my work life doing stuff that really excites me and interests me. And I
Balancing Personal Life and Work
00:31:45
Speaker
really do look forward to to doing work every day because it's fun. The kind of stuff that I do is fun. um
00:31:54
Speaker
And my father is also ah ah an academic. He's a physicist. And you know he shares that same sort of spirit because he loves what he does. he's past 80 years now and he's still doing research. He loves it. um But at the end of day, this is sort of one part of, ah part of life. And the other part is sort of what happens in in the home. And so, you know, my goal is just to keep on doing more of the same.
00:32:16
Speaker
Okay. Of course. Yeah. It'll be a while till I get there, but I think that. Yeah. Hopefully. Yeah. Hopefully not too soon. Yeah. Hopefully. um But yes. Yeah. i think that's, that's awesome. And I'm excited to see where like everything else pans out.
00:32:29
Speaker
And of course, already left like a lasting legacy within healthcare. But I really do appreciate your time today, Dr. Tian, for coming on just showing us what some of your work has been and how, I guess, almost crossing different disciplines and modalities that's in media can answer different questions on healthcare.
00:32:44
Speaker
um So I really appreciate the time again. Thank you. Of course. The pleasure is all mine.