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In this episode Hank talks about global medical history and recorded death certificates with journalist Jeremy Smith. Special guest from Animal Wonders and SciShow Kids Jessi Knudsen CastaƱeda brings Freya the Northern Pine Snake.

Hosted by: Hank Green
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(SciShow Intro plays)

Hank: Hello and welcome to SciShow Talk Show, that day on SciShow when we talk with interesting people about interesting things.  Today, we're talking to Jeremy Smith, who's not a scientist, so I just wanted to come out and say that immediately, just make sure everybody knows, so don't think that we're lying to you.  You are a journalist.  

Jeremy: A showman.  I'm the show part of SciShow.  

Hank: Well, no, I'm the show part of SciShow, thank you very much.  Um, Jeremy has written a book.  It's called Epic Measures: One Doctor, Seven Billion Patients and on the top here it says "Like The Social Network, but actually important.--Hank Green."  I blurbed your book.  

Jeremy: Thank you.

Hank: You're welcome.  Um, it was very interesting and I want you to tell me about it.

Jeremy: I would love to tell you about it.  Do you want the personal story or the science story first?

Hank: Can you do the personal story in like 15 seconds, 'cause I really don't care that much about you?

Jeremy: Of course.  Not my personal story, the main character's personal story, don't worry, you won't hear a word about me.  

Hank: Jeremy and I are friends from a while ago.

Jeremy: It's true.

Hank: So if I'm gently ribbing him, it's not because--

Jeremy: If it seems like we're enemies, it's because we're friends.

Hank: Right.  

Jeremy: So, there's a kid, he's 10 years old, he goes with his family to Niger in sub-Saharan Africa, and they take over an empty hospital and his dad becomes the chief surgeon, his mom and sister who, his sister is 17 or 14, is a nurse, his brother who's 17 becomes the sort of surgeon's assistant and guy who runs the ambulance with their land rovers, and he's the pharmacist.  And he sees amazing--this is all true, I should also say, this is nonfiction, you know, he sees sort of epic, you know, feats of life and death, and medical care in the absence of medical care, and he and his family keep going back to different sites in Africa and keep doing these sort of you know, medical aid work, and by the time he's 13, he's a co-author on a paper in The Lancet, the British medical journal, one of the, you know, biggest medical journals in scientific publications in the world.  By the time he's 18, he's at Harvard, he becomes a Rhodes Scholar, he goes to Harvard Medical School, and he decides, I want to deal with whatever the biggest problem is in the world is, and I wanna solve that, and so he goes and looks it up.

Hank: What's the biggest problem in the world?

Jeremy: And he realizes--

Hank: Leave in the comments what you think the biggest problem in the world is?

Jeremy: Yeah--leave--yeah.  

Hank: But this is--what did he think?

Jeremy: Well, he didn't know, he went to look it up, and then he realized, nobody has any idea.  

Hank: So the biggest medical problem in the world, we just don't know?

Jeremy: Well.  We just don't realize, there was no comprehensive count of what's killing people, what's making them sick, where, at what ages, how many people?  You have these piecemeal efforts, and if you think about it, this is something that's still there today.  We have advocacy groups for one cause or another, or they're in one country or another, but you know, people in Africa may suffer from AIDS, but they may have heart disease in even greater numbers, and people in Thailand may have AIDS, but there may not be the same focus there.  And in the United States, we may measure what people die from really well, we might have death certificates, which very few countries even have, but we don't have good records on what people get sick from, so how many people have back pain, anxiety, arthritis, depression?  And these are all things that really affect your life, if you live with a chronic illness or sudden injury, and so he said, okay, we have to measure everything wrong for everyone everywhere, what kills you and what doesn't?  I'm gonna make a giant map of world health and you can kind of zoom in like Google Health, and that's an ambitious project.

Hank: That sounds terrifying and huge and reading the book, it becomes very clear that the obstacles to that aren't just the size of the planet and the number of people.

Jeremy: Yeah, you don't wanna just live as long as possible, you wanna live as well as possible.  So, just a really basic thing, I mean, when he starts this project, the only thing that's being measured by the World Health Organization and really by almost anyone else, is child mortality, and the idea, the sort of implicit assumption there is if you can save the life of someone, make them live past the age of 5, then they'll all live to be like 85 year old Norwegians who are perfectly happy or whatever in their saunas and aquavit, and that's not the case. Y'know people who you save their life at 5 might die of a car crash at 15. They might die of AIDS at 25. They might die in childbirth at 35. And they may suffer a huge number of conditions just like we do uh, like y'know, as I said; back pain, neck pain, anxiety, depression, uh, and so you've got to measure adults and you've got to measure things that aren't killing people too. 

Hank: Yeah. Things that- things that don't kill anyone is- is another thing. Like- y'know- we tend to focus on disease that uh, that can be fatal at least. But there are many diseases that are debilitating and painful and are awful, um.

Jeremy: Car crashes kill a huge number of people. 

Hank: Yes.

Jeremy: And they injure probably an order of magnitude more. And if you get in a car crash when you're 20 and you're paralyzed for the rest of your life, you still will show in any life expectancy measure that you lived to be 80 or whatever, and what kills you might be something totally different, like a stroke. In those statistics it will never show up that you had a car accident or that you were paralyzed. So, how many years of life have people lost against an ideal of say of living 85 years? If you die at 85 you haven't, you're right at that ideal. If you die at 20, you're 65 years short.

Hank: But at the same time if you die at 85 and you've been chronically debilitated and in pain for the last 60 years, does that still count as 85?

Jeremy: So for that there's this measured years of healthy life lost, or healthy life expectancy. And what that is is not just how many years you fall short of the ideal in lifespan, but also how much illness you suffered along the way. So say you're paralyzed, you know that might be only half as well as perfect health. So if you're paralyzed for 40 years, that's 20 years of healthy life lost.

Hank: It seems very, sort of subjective.

Jeremy: It does sound subjective. What they did is they did part of this one piece among the many that I sort of talk about in this book the kind of constellation of scientific projects they have to do. Which includes massive data gathering. I mean going to cemeteries in Nigeria, going- getting police records in India, not just taking the public health statistics that are available as they can. Another part of it is they do this epic sort of survey of people in like- 20,000 people in 5 countries plus you know maybe another 20,000 over the internet, uh trying to be uh, representative of all sorts of people. Rich, poor, educated, uneducated, men, women, different, ages, and they basically poll them on what they would rate the sort of most severe or least severe kind of chronic conditions. And the crazy thing is that people generally agree on a lot of these measures there's like I think on average over the 220 conditions they surveyed. It's like a 97% consistency.

Hank: Wow. Among different demographics, and different countries, different cultures.

Jeremy: Right. People you know in rural Indonesia, people in urban you know America, they don't want to be blind, they don't want to have AIDS, and they you know don't want to have back pain and anxiety and they don't want to have arthritis. And not only do they not want to have all these things, but they rate how bad they are compared to each other and compared to death on a really consistent scale. That was kind of shocking to me. And even that's a sort of giant project that's just a teeney part of the sort of story of the final numbers of the book. 

Hank: And how are we doing figuring out how to measure all of these things? Have we- have we gotten there?

Jeremy: We're getting there. The data is kind of crazy But you know it shows, it's a world map that shows what countries have death certificates uh, that are considered reliable and then what countries of those death certificates, how accurate are those. Senility is a very common listing as a cause of death. That is not an official cause of death. No coroner would've should be- listing senility.

Hank: He was old. It was just- he was old. Died of old. 

Jeremy: And, another thing is just things that are too vague to be possible. Like heart failure. Well, check the heart of every single dead person on earth. They will all have had heart failure. They will all have had brain failure. Uh, they will all have had liver failure. That is not an acceptable cause of death. You need to know, was they- death  because of car accident, hanging? You know, uh ischemic heart disease? Basically what are the incentives to code correctly. You're a doctor, someone just died, you've got another patient who's alive in the next room, you want to move on. And again, most people in most places don't have the luxury of dying in a hospital, even. I mean it's funny to say dying can be a luxury but unfortunately it can. And we think, who cares about the dead? We have to care for the living. But if we don't know what people are dying from, we can't care for the living. 

Hank: Well, uh, it was a fascinating story and it's fascinating to hear you talk about it. I - I wanna talk about it forever um, would you like, though, to meet an animal? 

Jeremy: I would love to meet an animal. Is it- is it going to be safe or is it going to be deadly?

Hank: I don't know! I don't think it's going to be deadly, though...

Jeremy: You'll just edit that part out, if necessary. 

Hank: Yeah if you die, yeah, we'll just - we've got enough to put together an outro.

Jeremy: It would be a stirring story. OK.


Hank: We're back! We're back with Jessi, and Jessi has a present for us. A friend.

Jessi: Yeah, she's a friend but she's not friendly.

Hank: Okay, I won't touch then.

Jessi: Yeah. Well we can try maybe a little bit later. 

Hank: Well you just said, so I think not.

Jessi: Maybe not.

Hank: Who's this? What is this?

Jessi: Shh! You didn't hear, you didn't hear. This is Freya and she's a Northern Pine Snake.

Hank: Okay, so is Freya from around here, around these parts?

Jessi: Not in Montana, but in the United States it's more the eastern, northern eastern part of the United States. And what does she resemble?

Hank: A snake. 

Jessi: Does she look like any type of scary snake?

Hank: She might kinda look like a rattlesnake, kinda coloration and patterns.

Jessi: Yeah, yeah, she's trying to do a - she's doing two things. She's mimicking but she's also camouflaging. These guys are really, they're fossorials so they hang out underground under piles of logs and stuff like that so people will go out and they're walking along and they come across a pine snake, and the pine snake is really, I guess aggressive in their meeting of someone new and so they get to - to - it's really fun, I think, I find it exciting because they get, they are such big hissers. What they do is they'll fill their whole body up with air, and then it's like, they double in size, they'll just (inhale) tssssss. And they're just so loud about it. And then they vibrate their tails, so it does sound like a ch-ch-ch-ch-ch-ch-ch-ch-ch.

Hank: So, uh, as you bring Freya over, before the camera started rolling you said that we had met venomous snakes. You've brought venomous snakes on the show before, or at least - 

Jessi: Yeah! Yeah you were asking is it venomous or not, is it deadly, right? Yeah. I know you said -

Jeremy: I think I just wanna know if I was gonna die, you know it could fall on me and I could just get knocked out it doesn't matter -

Jessi: You could die.

Jeremy: Venom is not the only way a snake can kill you. I mean, more people die from falls than almost anything else. 

Hank: You maybe have done a little bit too much research on causes of death. 

Jeremy: 80,000 people a year die from animal contact and that - more people die from snake bites than from, uh, I think acts of war and natural disaster combined. So you read the newspaper every day it's all war, war, war, disaster, disaster, disaster, but you know if you want to save, you know, people's lives, forget about world peace. Like
invent -

Hank: Leggings!

Jeremy: Like leggings! Exactly!

Jessi: Rubber boots.

Jeremy: I think those things like the - the shin guards for hockey players or soccer players. Soccer players never die from snake bites. Have you ever noticed that?

Hank: They always wear those shin guards.

Jeremy: A lot of ACL issues though, so you know.

Jessi: But, but you're more likely to die of being struck by lightning than you are by dying of a venemous snake.

Jeremy: I would have to check that with my data. I -

Jessi: You probably have better data than I do, but look I really got a ton of research done on snake bites because a lot of them go on, on record and are documented, especially if it's not venemous.

Jeremy: I mean the estimates certainly, you know, in somewhere like India is that snake bites are a huge killer. I haven't heard the numbers on lightning though. So. I'll have to look into it. 

Hank: I, uh, yeah. I would not have thought that. I like that animal contact category. 

Jeremy: There's an animal contact and then there's a separate venemous animal contact category, because, you know, rabies and snakes are just -

Hank: Animal contact sounds so pleasant. 

Jeremy: It sounds like a sitcom. With animal contact because slow motion like golden retriever getting a Frisbee or something.

Hank: It's like a Carl Sagan book but, uh, instead it turns out that it's not aliens, it's dogs.

Jeremy: Yes, dogs. Assuming dogs are not aliens, yes.

Hank: They may be. Um, so yeah, I see, like, can I have some animal contact?

Jessi: Sure.

Hank: Because I'm having animal contact now and I'm not dying.

Jessi: Sure, she's not upset.

Hank: Yeah that's good.

Jeremy: Should I... I should be like the person who can fly the plane in case you do.

Jessi: You're not dying. So we need to document this, right? We're gonna document that? 

Hank: So that was documented animal contact but not deadly.

Jessi: Without him dying.

Jeremy: At the same time, he was also not struck by lightning. So, zero to zero. It is not one-zero, snakes. Snake bites are a pretty famous example because, in this field because a lot of people die out of them and where people die of them it's a place where there's little death recorded, there's poor death certificates, and so it doesn't mean they're not dying of it, you know. So again, you could save tens of thousands of lives if you're out there, uh, and you invent an EpiPen for snake bites.

Jessi: Exactly, and research on venom, exactly. That's because there's, it's almost zero percent of people die from a venomous snake bite in America, but that's because we have anti-venom for our most deadly species like the Eastern Diamond-Back. And so, in other countries, it's much more prevalent, of course, because they don't have the research into anti-venoms.

Hank: Yeah, anti-venoms are complicated, too, to produce and they don't last very long.

Jessi: Nope.

Hank: So you have to keep making them and they're expensive.

Jessi: Lots of money into it, and yeah. Yeah, and if there's some more research to see this is a huge issue and so it's worth putting money into the research.

Hank: Well, pleasure to meet you, Freya, and thank you for not biting me. I would not have enjoyed that. Or killing me. Because there's, apparently there's so many different ways a snake might kill you.

Jeremy: I'm also glad to be alive. Yeah, thank you. 

Hank: Uh, Jessi, you can watch her videos at Animal Wonders Montana on YouTube and also

Jessi: Yay!

Hank: Jeremy, uh, your book is in stores now as of a couple days ago. Oh yeah there's - it's not as long as it looks because, because you, you have such a gigantic further resources section.

Jeremy: Oh yeah, totally.

Hank: Because you just can't stop wanting to know more.

Jeremy: It's the never-ending adventure.

Hank: Yeah, death.

Jessi: There is an end.

Jeremy: Yes, yes, you're giving - you've given away the end.

Hank: It's that everyone dies. Thank you for watching this episode of SciShow Talk Show. It's been a pleasure to have you. If you want to keep getting smarter with us here at SciShow go to and subscribe.

[SciShow outro plays]