0:02

Welcome to Econtalk Conversations! For the

0:04

curious part of the Library of

0:06

Economics and Liberty, I'm your host

0:09

Rush, Robert Social I'm college in

0:11

Jerusalem and Stanford University's Hoover Institution.

0:13

go to econtalk.org where you can

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subscribe, comment on this episode and

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find links number information related to

0:19

today's conversation. Will also find our

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archives. But every episode we've done

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going back to two thousand and

0:25

six or email address is male

0:27

and he can talk.or we'd love

0:29

to hear from you. Today.

0:38

Is April Fourteenth? Twenty Twenty Four.

0:40

and we're going to do something

0:42

a little bit different today. Last.

0:46

Month mark to the eighteen

0:48

year anniversary of We Can

0:50

Talk. If all

0:53

goes as planned, this will

0:55

be episode nine hundred and.

0:57

Forty. Three which is kind

0:59

of amazing. Little

1:02

bit hard for me to believe. That

1:04

means that were about a year away

1:06

from episode one thousand. Barring any surprises

1:08

to my house, the world. Things.

1:11

I can anticipate. I

1:13

hope to do something special for that

1:16

one thousand episode. if

1:18

we get there. but I thought it appropriate

1:20

to bark the eighteen year anniversary we started.

1:23

In. March of two thousand and six. The

1:27

number eighteen. Represents.

1:30

Life. In the Jewish tradition the

1:32

word for life in Hebrew is

1:34

Fi which is spelled with to

1:36

Hebrew letters fat and good that

1:38

is the a letter of the

1:40

Hebrew alphabet you it is the

1:42

tenth letter which get you to

1:44

eighteen which is why of shoes

1:46

off and make donations to charity

1:48

and multiples of eighteen and one

1:50

hundred and eighty Eighteen hundred and

1:52

so on. Three hundred and sixty

1:54

so it eighteen years seems like

1:56

a nice landmark and I thought

1:58

of be useful to. do bit of

2:00

reflection. In addition,

2:02

I want to give you the results of

2:05

our annual survey and say some things about

2:07

the econ talk episodes of

2:09

2023, your

2:11

favorites and a few other things as well

2:14

as responding to some comments in

2:16

that survey. So

2:18

first some survey results. 1,105 people

2:21

voted. One

2:26

bit of feedback I asked you for is how do

2:28

you usually listen? 29% of you

2:30

usually listen while commuting,

2:32

17% while exercising, 13% while doing household

2:35

chores, and 21% said there is no

2:37

most of the

2:43

time. Here

2:46

are your

2:49

favorite episodes as you voted. It's

2:52

a funky list for

2:55

reasons not worth going into. I'll do it in reverse

2:57

order. 10th down

3:00

through first, the top 10 most

3:02

popular favorite episodes of yours in

3:05

your voting. 10th

3:07

the tie, Dwayne Betts on beauty,

3:09

prison, and redaction, Lydia Dugdale on

3:11

the lost art of dying. 7th

3:16

most popular

3:19

was a three-way

3:22

tie. Yeah, I think so, which

3:24

is why the numbers are running

3:27

the way they are. Adam

3:29

Mastriani on peer review in the

3:31

academic kitchen, Yossi Klineleve on the

3:33

Palestinian-Israeli conflict, Benai Prasad

3:35

on pharmaceuticals, the FDA, and

3:38

the death of duty. 5th

3:41

place, Benai Prasad on cancer screening

3:44

tie, Benai Prasad on

3:46

cancer screening, Peter Atiyah on lifespan,

3:48

health span, and outlive. Tie

3:51

for second place, three-way tie,

3:54

Tyler Cowan on the goat of economics

3:56

that is the greatest of all time,

3:59

Roland Ford. prior on race diversity

4:01

and affirmative action, and

4:06

Michael Munger on obedience to the unenforceable. First

4:08

place, the most popular or your favorite episode

4:10

of the year of 2023 was an extraordinary

4:15

introduction to the birth of Israel in

4:17

the Arab-Israeli conflict with Favi Verdegh-Gur. And

4:21

that I think got 34% of all ballots.

4:23

34% of you who voted said

4:25

that was in your top five.

4:29

A couple

4:32

of thoughts on that list of top 10. There

4:35

were two episodes with Fadi Prasad. There

4:39

were two of the 10 on what

4:41

we might call traditional economics or economists,

4:43

Tyler Cowan and

4:46

Roland Fryer. And

4:50

there were two episodes on

4:52

Israel, the Havi Verdegh-Gur and

4:54

the I. S. Eclina

4:56

Lavi. I want

4:59

to say something about the

5:03

way I choose guests. I

5:06

choose guests based on stuff

5:08

that interests me or that I want to

5:11

figure out. My favorite

5:13

conversations are when I make an

5:15

unusually powerful connection or have a

5:17

rapport with the guest or

5:20

learn something important. As

5:24

an example of the former of having

5:26

that connection, certainly

5:31

this year's episode of 2024 with

5:33

Charles Duhigg on conversation. We had

5:36

a wonderful rapport. I don't know Charles,

5:38

never met him before, never met him

5:41

in person. Something was

5:43

special about that conversation. I cherish

5:45

those. But I also,

5:47

of course, cherish the ones where I learned something important.

5:50

And I want to give a couple examples of those. Actually,

5:52

an amazing thing happened to me recently.

5:54

I was talking to

5:56

an Old time listener and

5:59

he said he. It has never

6:01

forgotten the lesson that he

6:03

learned from Paul Gregory on

6:05

Politics, smarter, and Love and

6:07

Stones Kremlin. That's a twenty

6:09

ten episode with Paul Gregory

6:11

and As. A

6:13

society said. That. When

6:16

he learned from that episode there was

6:18

so extraordinary is that you could wield

6:20

power without being at the top of

6:23

the pyramid. And Stalin

6:25

wielded power as the General

6:27

Secretary. Ah in the Kremlin.

6:30

ah. And.

6:32

That he was it at the top

6:34

but he had control of various things

6:36

through that position and it soon became

6:39

through his you submit an application. The.

6:41

Most powerful piece. Ah,

6:44

the most powerful position. And.

6:49

What this list or learned is

6:51

that sometimes controlling the agenda or

6:53

who was nominated to aboard can

6:55

be as important as who's the

6:58

chair of the board. Other that

7:00

was a fascinating insight that this

7:02

person learned from. A

7:05

pretty obscure ah episode of each

7:07

on Talk Back and twenty Ten

7:09

which was about be current who

7:11

was an early Iams communist to

7:13

sell them actually tells us where

7:15

a book programmers book I. It's

7:17

a great episode but he dallas

7:19

or get something out of app

7:21

that I'd forgotten I'd ever remember

7:23

learning it. And I think.

7:26

What's. Amazing is that if if you made a

7:28

list of the one saying are the two

7:30

things, if there are one or two things

7:32

you learn from an episode or it's quite.

7:35

Probably. Quite different for different people. On.

7:39

I thank god it was a Jacobson an

7:41

episode talked about the power of one thing

7:44

and he tries to write one thing. you

7:46

learn from a bar for one thing, you

7:48

learn from an interview and damn. I'd

7:51

want to share a few I learned

7:53

this year that saw Twenty Twenty Three

7:55

that I thought were interesting or important

7:57

for me personally or one would be.

8:00

The The and sites from

8:02

Adam Austrian A's or episode.

8:05

Or not the one that was voted into the

8:07

top ten? That was some. A.

8:09

Different one, but he also had an

8:11

episode on how You Can't Reach the

8:13

Brain through the years. And

8:15

that's a very unintuitive idea.

8:18

In fact he would think the only

8:20

way to reach the brain is through

8:22

the years. So the idea that you

8:25

can't reach the brain to the years

8:27

that by telling people things are lecturing

8:29

member or ranking them does it teach

8:31

them things they often either ignore, forget

8:33

that an emphasis and focus on what

8:35

they are it's were experienced or other

8:37

methods of education. Was

8:39

reading and. I like the

8:41

idea of course of close reading and seminars

8:43

assess what we do here. It's a lot

8:45

of salon college. As a

8:47

way to. Have lessons

8:50

be absorbed that. Are not

8:52

absorbed when you're talk that. That's

8:55

a. Mass. Out about that so many

8:57

times. After having that conversation

8:59

course, I read that originally in

9:02

an essay by Adam. But

9:05

having. Talked. To him about

9:07

it and then thought about have some or

9:09

it finally get into my brain. And

9:13

for said pretty sure we talked ironically about

9:15

the irony and that of say that episodes

9:17

producer we talked for the irony is listening

9:19

to someone tell you can read some friends

9:22

who the years. Another

9:24

example would be the episode with

9:26

Mike Monger of Obedience to the

9:28

unenforceable that phrase obedience to the

9:30

Hundred For a small, the idea

9:32

that we can be loyal. And

9:35

obedient to norms that are

9:37

not enforced through the state.

9:40

Butter. It forced. Not.

9:42

Literally and them but encouraged

9:44

through social forces was a

9:46

very powerful idea. We talk

9:48

may may times on this

9:51

program about the difference between

9:53

law, legislation, legislation being things

9:55

that. The. legislature passes

9:57

and law being said

10:00

that, even

10:02

though that word law is used

10:04

sometimes for legislation, it's better, according

10:06

to Hayek, likes to reserve it

10:09

for norms

10:11

and expectations of

10:13

behavior that emerge rather than

10:16

those that are passed by a top-down

10:19

form like a legislature. But

10:21

I love that formulation, obedience to the

10:24

unenforceable, and of course that episode in

10:27

that conversation and the power of that and

10:29

how it has diminished over time

10:31

that the unenforceable is less salient

10:34

to us and those

10:37

norms and social forces are

10:39

very different. And it used to be, it

10:41

was a great insight for

10:43

me. And finally, I'd point to

10:45

how we've read a Gour's episode where he talked

10:47

about most Israelis, more

10:49

than half of the people who live in

10:51

the country of Israel right now were

10:54

essentially refugees either

10:56

from the aftermath of the Holocaust or

11:00

were thrown out of Middle

11:03

Eastern countries, Arab countries where they had lived for

11:05

a long time and

11:07

that this did not, this

11:10

reality that most of the

11:12

people who live here in Israel do not have any place

11:14

to go home to is an

11:17

important reality that, according

11:19

to Aviv, whether he's right or not, is not

11:21

the main thing. But he

11:24

argues that the Palestinian narrative

11:26

and their strategy is often

11:29

predicated on creating

11:32

an unpleasant enough environment here in

11:34

Israel that people would give

11:37

up and leave when in fact

11:40

we have nowhere to turn to. I happen to, I

11:42

have two passports, I have an American passport

11:45

and an Israeli one, but most

11:47

Israelis do not. Nasrallah,

11:50

the head of Hezbollah, recently

11:53

made a claim similar to the claim

11:55

that Aviv is critiquing, saying

11:58

that Israelis should go back to their other countries. country,

12:00

they should go back to Brooklyn or wherever, but necessarily

12:02

don't come from Brooklyn. They come from

12:04

Tehran and other

12:07

places, Yemen

12:10

and post World

12:12

War II Poland, where they either don't want

12:14

to go back or can't, literally

12:17

can't go back. So I thought those were, it

12:20

changed the way I looked at this

12:22

country where I live. So

12:24

those are the ones that

12:27

are most precious to me,

12:29

and I'm sure yours are different, what

12:31

you, what speaks to you and what are

12:33

important to you are different. I

12:36

want to thank everybody who commented,

12:40

and many

12:43

of you did, and many of

12:45

them were positive and gracious

12:47

and nice, which I appreciate

12:49

about how we can talk has helped you in

12:51

your personal life and the way you speak to

12:54

others who you don't agree with. And

12:56

it's fascinating and a little bit weird to

12:58

me that much of this program has become,

13:01

its value to you is

13:03

a cultural value, not an educational

13:05

value of the normal sense of

13:08

learning about economics. I

13:11

think that's wonderful. It's a beautiful example of

13:14

an emergent phenomenon, of course.

13:17

Now, one of

13:19

you commented in the

13:21

survey that the focus this year

13:23

on artificial intelligence and Israel quote,

13:25

bummed me out. I

13:28

understand that. And another common

13:30

theme in the comments is we

13:32

should have more economics. You know,

13:35

I should say this show, which started

13:38

off as literally econ talk and is

13:40

now much more the subtitle of the

13:43

program Conversations for the Curious. It's

13:46

what it's really about are the things that I'm

13:48

interested in or I'm trying to figure out. So

13:51

typically what I've been doing, I think over the last, I

13:53

don't know how long, five to 10 years of the program

13:55

is something

13:58

happens, the most dramatic example. might

14:00

be the financial crisis and I realize I don't know

14:02

enough about it. And so

14:04

I interview a lot of smart people and ask questions

14:07

that I want to have answered and I

14:09

assume that you're interested in so

14:11

that you too can go on this journey of

14:14

exploration and discovery with me and figure these things

14:16

out. So we

14:18

did a lot of episodes on artificial intelligence, there are

14:20

a couple more planned, not too many more, don't worry

14:22

for those of you retired of it, but kind

14:25

of an important issue, I think some people

14:27

thought it's a threat to the future of

14:30

humanity. So I wanted to figure out whether

14:32

I should be worried about it or not.

14:35

The answer is a little bit, not as

14:37

much as I think

14:40

that most worried people are

14:42

feeling. We

14:45

should be aware of it, we should be aware of its potential

14:48

to do harm with anything else, but I

14:50

thought that was important and I was curious

14:52

about it. And similarly, you

14:55

know, I moved here to Israel three years ago on

14:58

October 7th, we

15:01

endured an unimaginable attack

15:03

of horror and

15:05

I wanted to understand the history

15:08

of that better than I did.

15:12

You'd have think as an American Jew who's interested

15:15

in Israel, I would be an educated on the topic.

15:17

I was not, I

15:21

know a little something, but I've

15:23

learned a lot from the 10 plus

15:25

episodes we've done on the

15:27

Arab-Israeli conflict, the

15:30

Palestinians and so on. You

15:33

know, one of the things that's striking when you live

15:35

here is how

15:37

hard it is to appreciate what

15:40

it's like to live here, unless you do. And

15:43

you know, it's funny, I'm

15:46

recording this on April 14th, last night Iran

15:51

bombarded Israel with drones,

15:53

cruise missiles, ballistic missiles.

15:58

I awoke at two in

16:00

the morning, excuse me, I didn't

16:02

wake, the country awoke. I was actually awake. My

16:05

wife was sleeping next to me. I was trying

16:07

to figure out what was going on still. And

16:10

I heard an incredibly loud boom. It did

16:12

not wake up my wife, but it sure

16:14

scared me. I didn't know

16:16

what it was. It sounded like a missile

16:19

had landed. Then I heard

16:21

two more, and then the air raid sirens went off.

16:23

And at that point, you're

16:25

supposed to run to, you have 90 seconds to get

16:27

to a safe room. Our

16:29

apartment doesn't have a safe room. It's an old building.

16:32

And so we ran into the stairwell with

16:34

our son

16:36

and daughter-in-law and granddaughter who had been

16:38

visiting us, along

16:41

with people in the apartment across the hall.

16:45

And we huddled there and

16:47

heard another boom. And

16:50

those booms were Iron

16:52

Dome and other defensive

16:57

programs that Israel has. They also

16:59

have David Sling and Arrow. These

17:02

are anti-missile defense

17:04

systems, which, as you know by now,

17:07

worked incredibly well last night. It

17:10

might not work well every time. Hezbollah

17:12

in the north has supposedly

17:15

tens of thousands of missiles,

17:17

not hundreds that they could

17:19

launch at Israel. But

17:22

the point being that two points. One is that

17:25

I really think it's important to understand some

17:29

of what's going on on this

17:31

issue for almost everyone, not literally

17:33

everyone. But I think a lot of people are

17:35

curious about it and realize, like myself, they don't

17:37

know enough about it. And

17:40

secondly, I'm pretty tired. I'm

17:42

recording this sort of on fumes.

17:46

I went back to bed after

17:48

the air raid siren stops. I

17:50

think you're supposed to wait 10 minutes for debris to

17:53

stop falling. And then you can go back to your

17:55

house. So we went back out

17:57

of the stairwell after about 10 minutes and went back

17:59

to bed. it wasn't my

18:01

best night's sleep, obviously. And

18:05

it's, well,

18:07

we'll see what the next day is bring. It's going to

18:09

be a very interesting time. And,

18:12

you know, I'm sitting, I like to call it,

18:14

I'm sitting in the front row of history

18:17

right now, which is both exhilarating

18:19

and frightening. It was very scary last

18:21

night, especially for

18:24

my children and grandchild,

18:26

but it turned

18:28

out okay. But it seems

18:30

like that's something I'm going to want to

18:32

understand a little bit better. And so I'm

18:35

going to do a little more on Israel

18:37

than I am on say, fiscal and monetary

18:39

policy or Bitcoin. And that's

18:41

just the way the program's gone. It's, you

18:43

know, I'm very grateful to Liberty Fund who

18:47

funds the program that they've allowed

18:49

me to follow

18:52

my interests beyond

18:54

economics. But

18:56

that's the reality of the program. I

18:58

don't mind being told that you want more economics. I'm

19:00

happy to hear it, but it's just economics

19:03

is not what I'm so interested in anymore. I'm

19:06

more interested in what makes life meaningful. I'm

19:10

more interested in the Israeli-Palestinian conflict.

19:13

I'm more interested in human frailty. I'm

19:16

more interested in decision

19:18

making. So, you

19:21

know, you're on a journey with me,

19:24

most of you. Some of you have just started,

19:26

but many of you have been listening for a

19:28

long time, and you've

19:31

been with me as

19:33

I've explored these topics, and you've heard my

19:35

questions change depending on who

19:38

I'm talking to. And

19:40

I hope that's interesting.

19:42

It's not for everybody. I understand

19:44

that. And for those of you who missed

19:47

the old days where we were

19:49

all economics all the time, I'm

19:51

sorry. You

19:54

know, it reminds me a

19:56

little bit of Bitcoin. There

19:58

are listeners who wish we did a big deal. Bitcoin episode every

20:01

week. We

20:03

don't because I feel

20:05

like I've learned everything that

20:07

I can feasibly, reasonably learn

20:09

from talking to smart people

20:12

about it. Doesn't mean I know

20:14

everything about it. I don't. But

20:16

the marginal benefit of learning a little bit

20:18

more is very small. You know,

20:20

I figured out from the Bitcoin episodes

20:23

we've done over the years how roughly

20:25

how it works, not exactly, but roughly,

20:28

what's the likelihood it's going to survive?

20:30

What's the likelihood it's going to make

20:32

it? How is it like money? How is

20:34

it not like money? Why it

20:37

might be important? Why it might be

20:39

overhyped? And so on. And at that

20:41

point, you know, there is there are

20:43

a few more things to learn. Again, I don't mean

20:45

to suggest I'm an authority on Bitcoin, I'm not. And

20:48

I'm not authority on the

20:50

financial crisis. And I'm not

20:52

an authority on their Israeli

20:55

or Palestinian conflict. But

20:57

I've tried to get smarter. And my

20:59

goal is to help you get smarter.

21:02

So I hope that is

21:04

of interest to you. If

21:08

I'm not interested, it's not going to be a good interview. I'm

21:11

sure there are listeners out there who can tell when

21:13

I'm not so interested in the topic

21:16

or the speaker. Sometimes I'll invite

21:18

someone on the program having read say the first

21:20

chapter of the book only to discover that the

21:23

remaining chapters are not as interesting as the first

21:25

one. And it's

21:27

hard for me to be enthusiastic about it.

21:30

I don't ever want to do that happens from

21:32

time to time. But I generally don't don't want

21:34

to do that. Some

21:38

of you asked for econ

21:41

talk merchandise, we have it, we'll put a

21:43

link to this program for

21:45

the notes for this episode of where

21:47

you can find it. You know, we have t shirts, we

21:50

have baseball caps. I

21:53

think we have beach blankets. One

21:56

sees you know, the important things. So

22:01

they're out there love for you to coffee

22:03

cups we would love for you to spread

22:06

the word with you can talk through

22:08

our merchandise selection their

22:11

price to basically break even. So

22:15

we're not trying to make money on it is just a way

22:17

for you to be part of the team and club.

22:23

A couple more things and

22:25

before i close

22:27

this out and. The

22:30

first is that i want

22:32

to add something about last

22:34

week's episode with paul bloom which

22:37

is about immortality

22:39

and digital living

22:41

a digital existence rather than a

22:43

quote real existence is one

22:45

of the issues that came up with the experience machine

22:47

the idea of robert knows that you

22:49

would tire self to a machine. And

22:53

you would you would imagine it would feel

22:55

like you were doing all the things you

22:57

had programmed the machine to make you feel.

23:00

But in fact you would just be plugged into

23:02

the machine so well it would feel like you

23:04

had cured cancer or one the masters or

23:07

become president of the united states or. You're

23:10

a great rock star you're not actually you're

23:12

just feeling what it like what it's like

23:15

to experience that but

23:17

in reality you're laying on a. On

23:20

a table hooked up to the machine

23:23

and one of the things we talked about in the

23:25

program was in that episode was

23:28

that. If you

23:30

are a religious person. Or

23:33

you believe in god that there's something troubling

23:36

about the experience machine and i talked about

23:39

the soul and and i also talked about

23:41

that with respect to. You

23:44

know creating an avatar of one's loved one.

23:48

Or commuting with famous

23:51

people or dead people through a i

23:53

avatars. And

23:55

i i missed what i wanted to say that was

23:58

the most important thing so. I

24:00

thought I'd added here, which

24:03

is that if you lead a religious life or

24:05

believe in God, you think you're supposed to

24:07

achieve something with your life. Now, of course, you

24:09

don't have to be religious or believe in

24:11

God to feel that way. Many people who

24:15

are not religious, purely secular,

24:17

atheist lead a secular, unreligious,

24:19

non-religious life feel

24:21

that their life should have purpose and that they

24:24

should try to do things to make the world

24:26

better. But certainly religious

24:28

people feel that. And

24:31

what I should have made clear

24:33

is the reason I find the experience machine

24:36

interesting is that it forces

24:39

you to recognize that. And

24:41

I think, I don't

24:45

know where I saw this, but I'm pretty sure

24:47

that people

24:49

are more willing to be on

24:51

the experience machine than they were when

24:54

Nozick proposed it back in the early

24:57

1970s. When Nozick proposed it,

25:01

if you did a survey, and again, I

25:03

saw this somewhere, I don't remember where, but it

25:05

rings true. If you did a survey, people said, would

25:07

you like to be on the experience machine? And you

25:10

could feel like you've done all these amazing things that

25:12

most people would say, oh, no, that'd

25:14

be weird. But younger

25:16

people today are more

25:18

likely to be interested

25:21

in the experience machine. And my

25:24

only observation, which I think I was trying to

25:26

make in that conversation with Paul, which I didn't

25:28

do very well, is

25:30

that I think if

25:32

you aspire to a

25:35

religious life or to a

25:37

connection to the divine, at

25:39

least in the Judeo-Christian perspective,

25:42

the one I know better than

25:44

others, you're supposed to

25:47

do something with your life. God put

25:49

you here for a purpose. You may not know what

25:51

it is, you may struggle to discover it. But

25:54

laying on a table and

25:56

feeling good, but not actually doing good,

25:58

would Be. Problematic for

26:00

most religious people. Again, it will be

26:02

problematic for many people religious it's are

26:04

not religious but I think they're related

26:06

and I that was appointed I wanted

26:09

to make. I don't think I made

26:11

it up As far as I remember

26:13

that episode hasn't aired yet as I'm

26:15

recording this. Ah, but it will the

26:17

very last week. And

26:20

anyway, I wanted to add that I

26:22

it's. Often. The case. That.

26:26

In. The. Aftermath

26:30

of an episode I think of things are should have

26:32

said or should have said better. And

26:34

if I. If. He can talk was my

26:37

full time job. I would spend I

26:39

be able to spend more time on this

26:41

kind of in a post mortems but some.

26:44

Some a fulltime job, So

26:46

I'd I'd do the best I can buy. I wanted to

26:48

add that since it was just last week, For.

26:55

Forget I want to thank the team

26:57

at Liberty Fund and all the people

26:59

who helped me with saw it on

27:02

talk. Of Lauren

27:04

Landsberg Amy well us to play

27:06

them was cook Marla Gold Singer

27:08

and to Foundation for it's it's

27:10

Support And of course to my

27:13

sound engineer Rich Guy at who

27:15

does the heaviest of the listing.

27:17

Ah many of those people have

27:20

been with the program for. From

27:22

the very beginning, some have been added

27:25

to to help on the way, but

27:27

I could do without them and I

27:29

certainly couldn't do it. It

27:33

was my responsibilities here at school and college

27:36

so I'm very grateful to to that group

27:38

for all that they do. A

27:41

one of those with the story. I

27:44

think it. Will. Lot

27:46

interesting and. Ah,

27:50

and I tell it with my mom's

27:52

permissions. Acts as

27:54

a story about my mom. And

27:56

Dad. A recent challenge she

27:59

had. And. It gets

28:01

at many of the issues that we've

28:03

spoken about on the program that I alluded

28:06

to earlier. Decision

28:09

making, human frailty,

28:14

self-deception, self-awareness,

28:17

human flourishing, a meaningful life, and so

28:19

on. So here's a story

28:21

about my mom. My

28:25

mom is 91 years old. She

28:29

lives on her own, which is a wonderful

28:31

thing. And

28:35

she has her own house until six months ago. She

28:37

drove her own car, which

28:40

is amazing. But

28:42

now she sold her car. She relies on Uber. And

28:45

I don't

28:47

know, a couple months ago or so, she called

28:49

me to say that she'd done something stupid. She'd

28:52

fallen. But she

28:54

was okay, she said. She was at a local

28:57

emergency clinic and they were going

28:59

to give her an

29:02

x-ray and see if she broke anything. And

29:04

that she was in some pain, but she

29:07

was okay. I felt bad

29:10

for her, obviously. And

29:13

then I found she called me later and

29:15

the pain had gotten dramatically worse.

29:18

Although the emergency clinic had given her a

29:20

clean bill of health, she

29:22

hadn't broken anything. It was pretty

29:24

clear that something was wrong. And

29:28

so she went on to get an MRI.

29:31

She went to the hospital and

29:35

got an MRI to discover that

29:37

she had a compression fracture, which

29:39

is basically a

29:43

crushing of the vertebra

29:45

in her back. So

29:48

my other question was what to

29:50

do. And, you know,

29:52

I thought, well, I'm an expert

29:54

on this Because we have

29:56

had many episodes on this, even

29:59

on this. Zach Problem Syracuse

30:01

these are the choices. First.

30:05

Number one was to do nothing. Ah

30:08

hope a got better. Choice

30:10

number two was to get a

30:13

special brace made that would allow

30:15

the vertebra to heal. On.

30:17

Their own. Ah,

30:21

Which. I was told would

30:23

take a couple of months but

30:25

but would avoid surgery. Interest number

30:27

three was surgery and there's different

30:30

kinds of surgery in this particular

30:32

situation but there variations on what's

30:34

called dumb. For. Turbo Plastic,

30:36

which we've talked about a

30:39

number times on this program.

30:41

It's basically the injection of

30:43

cement. Into

30:46

ah. The. Diverted

30:48

the spinal column to

30:50

ah, Solidify.

30:52

The vertebrae back to Worth where they were before

30:55

the fall. And.

30:58

I don't have you as monsters. Remember this

31:00

Who were. A similar program. Back.

31:03

Then, but I fixed and

31:05

two episodes on why vertebroplasty

31:08

doesn't work. Ah, that it's

31:10

a failure. Ah

31:12

me just check Ah may

31:14

see this. The. First

31:17

one was some back ends.

31:21

On. C. Or twenty

31:24

sixteen. Adam Seafood. I

31:26

had. Written. A Book. With that,

31:28

I proceed. And Book was

31:30

ending medical reversal. And basically

31:32

the idea that Book which

31:34

fascinated me is so does

31:36

is that many of the

31:38

most common. And.

31:41

Implemented medical procedures,

31:44

Which. Originally start off with some

31:46

evidence and and favor when they're

31:48

looked at more carefully than a

31:50

work or even worse they are

31:52

harmful. so in

31:55

this case ah for turbo

31:57

blast classy which was this

31:59

or application of cement

32:02

into the spine was finally

32:07

tested against a placebo at some point and

32:09

was found to be no better than the

32:11

placebo. And the

32:13

placebo was insane. The placebo was half

32:16

the patients get the surgery

32:18

where there's an incision made in their

32:20

back and cement is

32:24

inserted. In the second

32:27

group, they opened the

32:29

tube of cement so

32:31

that the patient can smell it and

32:34

believe that they're going to

32:36

get the surgery, but they don't actually do the surgery.

32:38

All they get is the smell.

32:44

And this study

32:47

with controls found that the actual

32:49

surgery didn't do better than opening the tube

32:51

of cement. And of course, the surgery is risky.

32:54

Get infections, things can go wrong. Some people

32:57

do it with anesthesia. Anesthesia always

32:59

has risk associated with it. And

33:04

the implication was that this procedure was an

33:07

illusion or that

33:09

the brain could fight the

33:11

pain from the compression

33:14

fracture on its own. Once

33:17

you smelled the tube of cement and had a

33:19

belief, the placebo effect

33:21

that something happened, I

33:23

may have told the story. I'm going to make a side

33:26

note for a different story. A

33:29

friend of mine is a pain doctor. And

33:33

I went into his office. I was having shoulder

33:35

pain. I

33:38

damaged my rotator cuff. And

33:41

I went into his office for a

33:43

steroid shot. And

33:46

it's a wonderful procedure. There's

33:51

an imaging device

33:54

that lets the

33:56

doctor see exactly where the

33:58

steroid is being inserted. in

34:00

the needle into the shoulder, and

34:03

it's relatively painless, the insertion. And

34:07

while we're waiting for the

34:09

doctor, I was talking to his nurse

34:11

and I said, what's your favorite thing

34:15

in this office? And she said, oh, my favorite thing

34:17

is when we inject cement into

34:19

somebody's, into their spine

34:22

and they walk out pain-free. And

34:26

this is right after I'd done the episode with

34:28

Sifu. And I wanted

34:30

to say, you know, that's an illusion. That's

34:32

just the placebo effect, but I didn't say

34:34

anything. And

34:37

years go by and then my mom falls.

34:40

So now I have to make a choice with my mom

34:43

and my brother and sister consulting, the three

34:45

of us with her. What

34:47

should my mom do? Should

34:50

she wear a brace for a

34:52

few months? Should she,

34:54

and hope it just heals on its own,

34:56

which of course many times things heal on

34:58

their own, which is why

35:01

many procedures are overrated. Or

35:05

should she get the surgery, which has,

35:07

she's 91 years old, I'm thinking, this

35:09

is insane. You're gonna put an

35:11

incision in her back. And

35:13

her doctor insisted on general anesthesia. It just

35:15

seemed like a terrible idea. So

35:18

I called my friend, the pain doctor, and he said,

35:21

oh no, he said, you gotta do the, you

35:23

gotta do the cement. It's fantastic. He

35:26

said, often they walk out pain-free.

35:29

And I thought to myself, and I probably even told him, yeah,

35:32

but that could be just the placebo effect. But

35:34

then the truth is, is that, well,

35:36

maybe that's the best way to get the

35:38

placebo effect. I'm not really gonna call her

35:41

doctor and say, look, do

35:43

me a favor. Instead of doing the actual

35:45

procedure, would you just open the tube? It

35:50

just seemed ridiculous. So

35:52

we chose the surgery, which

35:55

with great unease. Actually,

35:57

we tried the brace for like a day. That

36:00

would seem like a really attractive, the brace

36:02

works very well in

36:04

studies versus the surgery also. The

36:08

problem is, it's really hard to wear

36:10

the brace. You put it on, it's like, it's not so

36:12

bad. You wear it for 16 hours

36:14

a day or maybe you have to wear it for 24. It's

36:17

insanely unpleasant. And to

36:19

ask my 91-year-old mom to wear this brace

36:21

for X months while this

36:25

herbacchio seemed insane. So

36:28

we didn't do that and we decided

36:30

to do the surgery. And

36:34

as we're waiting for the surgery to take place,

36:36

my brother and sister and I are of course

36:38

talking about it and I'm also talking with my

36:41

mom about it. And

36:43

I didn't hide anything from her that

36:45

I had this evidence

36:48

that this procedure was not necessarily

36:50

effective on its own, that it

36:52

was something of a

36:54

sham with risks. But

36:58

I had to make a call. The

37:01

four of us had to make a call. And

37:05

we decided to do the surgery. And was

37:09

that rational? Was

37:11

it irrational? I mean, should

37:13

I have trusted the evidence of the

37:16

study that Adam

37:18

Sifu and Vinay Prasad presented an

37:20

ending medical reversal that this, it

37:22

was enough to open the tube? Should

37:25

I have trusted the brace to have the

37:27

effect and avoid the risk

37:29

of invasive surgery

37:32

even though it was relatively

37:35

small incision, risk

37:37

of infection, the risk

37:39

of the general anesthesia? I

37:41

went into the surgery secondhand

37:44

of course. I didn't

37:46

enter it personally, but loving

37:48

my mom, I went into that surgery with some,

37:51

actually tremendous unease. And

37:55

I rationalized it, saying

37:58

to myself, well. I

38:07

don't know how that study was done that

38:09

found it was no better

38:11

than a placebo. Was

38:14

it really true that

38:18

the people who were given the

38:20

surgery versus the people who got

38:22

the tube of cement opened, that

38:24

they had the same level of pain beforehand?

38:26

I mean, I just, I didn't

38:29

know. But I

38:31

was forced to confront the reality that I've talked

38:33

about a number of times on this program that

38:36

we feel very differently about omission

38:39

and commission. Doing

38:42

things is different than things that happen

38:44

because we take action are different

38:47

from things that happen because we don't take

38:49

action. We talked about the

38:51

trolley problem as an example of this. But

38:54

the truth is, in this case, it just seemed really

38:58

cruel to my mom at 91 to tell her, oh,

39:03

yeah, this surgery doesn't really usually, it's

39:05

really not that effective. It

39:08

only seems to be. And

39:10

it's risky. So we're in this brace for three

39:12

months or whatever it was. It

39:15

seemed absurd. So I

39:18

bet on my

39:20

friend, the pain doctor, who said it usually

39:22

works. And

39:27

we did the surgery. And

39:30

she walked out of

39:32

that surgery pain-free.

39:36

Incredible. So was

39:39

it real? Was it a

39:41

placebo? I

39:44

don't know. Just to mention, we did an

39:47

episode with Gary Greenberg on the placebo effect. I think

39:49

that Richard Roplasty also came up

39:51

in that episode. It's really

39:53

crazy. So pain-free.

40:00

been mysterious. The brain

40:02

pain connection is

40:04

very mysterious. Was she

40:07

just getting the

40:10

benefit of the placebo effect and the incision

40:13

and the anesthesia turned out to

40:15

be relatively risk-free in this case?

40:18

Did it actually do something that

40:21

reduced the pain through

40:24

stabilizing her back? Don't

40:27

know. But that

40:29

was the choice I made and at

40:31

least the position I advocated for with

40:34

my brother and sister who thought it was crazy that

40:36

I would even consider not doing it. For

40:40

them, again, the commission part of it seemed the

40:42

right way to go, not the omission, not to

40:44

do. They wanted to do something rather than nothing.

40:47

And so did my mom. She wanted the pain to

40:49

stop and her doctor assured

40:52

her that it often would stop after

40:54

this. And so we

40:56

did it. And got

41:00

a good draw from the urn, as they

41:02

say. So I don't have much

41:05

more to say about that. Be interested in any comments

41:08

you have and anything else you

41:10

have to say about what I have said

41:13

before. I want

41:15

to thank you for listening. I want

41:17

to thank you for being along for the ride,

41:19

especially those of you who've been listening for 18

41:21

years. I would

41:24

have never imagined this journey.

41:26

And it's been

41:29

a great ride. I hope it goes, keeps

41:31

going for some time. So

41:34

thank you. This

41:41

is econ talk, part of the Library of

41:44

Economics and Liberty. For more econ talk, go

41:46

to econtalk.org, where you can also comment on

41:48

today's podcast and find links

41:50

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41:53

Sound Engineer Free Con Talk is Rips

41:55

Coyette. I'm your host, Russ Roberts. Thanks

41:58

for listening. on trying

42:00

to hide yourield

42:02

back on Monday.