Bad Medicine, Part 1: The Story of 9. We think modern medicine is pretty advanced, but what if we’re wrong about something as simple as the average body temperature? Photo: The College of Physicians of Philadelphia)Our latest Freakonomics Radio episode is called “Bad Medicine, Part 1: The Story of 9. You can subscribe to the podcast at i. Tunes or elsewhere, get the RSS feed, or listen via the media player above.)We tend to think of medicine as a science, but for most of human history it has been scientific- ish at best.

In the first episode of a three- part series, we look at the grotesque mistakes produced by centuries of trial- and- error, and ask whether the new era of evidence- based medicine is the solution. Below is a transcript of the episode, modified for your reading pleasure. For more information on the people and ideas in the episode, see the links at the bottom of this post. And you’ll find credits for the music in the episode noted within the transcript.*      *      *We begin with the story of 9.

You know the number, right? It’s one of the most famous numbers there is. Because the body temperature of a healthy human being is 9. Fahrenheit. Isn’t it?

Our latest Freakonomics Radio episode is called “Bad Medicine, Part 1: The Story of 98.6.” (You can subscribe to the podcast at iTunes or elsewhere, get the RSS. I’m 43 now, and I personally like the old school rap and hip hop myself.Some of my favorites were Public Enemy,Ice Cube,N.W.A.,Ice T.,and many other hardcore groups. As Eminem's reputation grew, he was recruited by several rap groups; the first was the New Jacks. After they disbanded he joined Soul Intent, who released a single on.

ANUPAM JENA: So, now I’m going to take your temperature, if you don’t mind just open your mouth and I’ll insert the thermometer. PATIENT: Ah! JENA: Perfect. The story of 9. 8. Watch The Power Of Few Online The Power Of Few Full Movie Online more. PHILIP MACKOWIAK: … dates back to a physician by the name of Carl Wunderlich. This was in the mid- 1. Wunderlich was medical director of the hospital at Leipzig University. In that capacity, he …MACKOWIAK: Oversaw the care and the taking the vital signs on some 2.

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Pretty big data set, yes? Twenty- five thousand patients! And what did Wunderlich determine? MACKOWIAK: He determined that the average temperature of the normal human being was 9. Fahrenheit or 3. 7 degrees centigrade.

This is Philip Mackowiak, a professor of medicine and a medical historian at the University of Maryland. MACKOWIAK: Well, I’m an internist by trade and an infectious- disease specialist by sub- specialty. So my bread and butter is fever. There’s one more thing Mackowiak is …MACKOWIAK:  I am by nature a skeptic. And it occurred to me very early in my career  that this idea that 9. Philip Mackowiak, you have to understand, cares a lot about what is called clinical thermometry.

And if you care a lot about clinical thermometry, you care a lot about the thermometer that Carl Wunderlich used to establish 9. MACKOWIAK: His thermometer is an amazing key to this story of 9. So you can imagine how excited Mackowiak was when, on a tour of the weird and wonderful Mutter Museum in Philadelphia, the curator told him they had one of Wunderlich’s original thermometers. MACKOWIAK: I said: “Good heavens, may I see it?” And she said: “Sure, would you like to borrow it?” And I said: “Of course!” And so I was able to take this thermometer back to Baltimore and do a number of experiments. The Wunderlich thermometer, Mackowiak realized, was not at all a typical thermometer. MACKOWIAK: First of all, it was about a foot long, fairly thick stem and it registered almost two degrees Centigrade higher than current thermometers or thermometers of that era.

Two degrees higher — centigrade? Uh oh! MACKOWIAK: In addition to that, it is a non- registering thermometer, which means that it has to be read while it’s in place. So it would have been awkward to use. Mackowiak noticed something else about the original Wunderlich research.

MACKOWIAK: Investigating further it became apparent that he was not measuring temperatures either in the mouth or the rectum. He was measuring axillary or armpit temperatures and so that in many, many ways his results are not applicable to temperatures that are taken using current thermometers and current techniques. As it turns out, the esteemed Dr. Carl Wunderlich …MACKOWIAK: … was not the most careful investigator ever to come on the scene. The more Mackowiak looked into the Wunderlich data, and how the story of 9. So he set up his own body- temperature study.

He recruited healthy volunteers, male and female, and took their temperature one to four times a day, around the clock for about two days, using a well- calibrated digital thermometer in the patients’ mouths. What did he find? MACKOWIAK: Of the total number of temperatures that were taken, only 8 percent were actually 9. And so if you believe that 9. Obviously that’s not even reasonable. In his study, Mackowiak found the actual “normal” temperature to be 9. Not a huge difference — and yet, the whole notion of a “normal” body temperature was looking more and more suspect.

Why? A lot of reasons. Temperature varies from person to person, sometimes so much that one person’s normal would nearly register as nearly feverish for another person. MACKOWIAK: It’s almost like a fingerprint. Temperature varies throughout the day — it’s roughly one degree higher at night than in the morning, sometimes even more. And an elevated temperature isn’t necessarily a sign of illness: MACKOWIAK: In women it goes up with ovulation, during the menstrual cycle. The temperature goes up during vigorous exercise and this is not a fever.

And so, Mackowiak concluded …MACKOWIAK: Looking at a rise in temperature as a reliable sign of infection or disease is inappropriately simplistic thinking. Inappropriately simplistic thinking.

It makes you wonder: if the medical establishment believed for so long in an inappropriately simplistic story about something as basic as normal body temperature — what else have they fallen for? What other mistakes have they made? I hope you’ve got some time; it’s a long list: JEREMY GREENE: You take a sick person, slice open a vein, take a few pints of blood out of them …JENA: Drilling holes into people’s skulls. VINAY PRASAD:  It was literally taking someone to hell and back.

TERESA WOODRUFF: It would cause a whole series of malformations and probably a lot of fetal death. JENA: Lobotomies. KEITH WAILOO: The overuse of a mercury compound. EVELYNN HAMMONDS: The Tuskegee case. WAILOO: Losing your teeth and having your gums bleed. WOODRUFF: DES and Thalidomide.

PRASAD: We use sort of a cement. WOODRUFF: Hormone replacement therapy. WAILOO:  The Oxycontin and opioid problem. MACKOWIAK: As a medical historian, it is patently obvious to me that future generations will look at what we’re doing today and ask themselves, “What was Grandpa thinking of when he did that and believed that?” And they’ll have to learn all over again that science is imperfect and to maintain a healthy skepticism about everything we believe and do in life in general, but in the medical profession in particular. On today’s show: Part 1 of a special three- part series of Freakonomics Radio.

We’ll be talking about the new era of personalized medicine; the growing reliance on evidence- based medicine; and especially — pay attention now, I’m going to use a technical term — we’ll be talking about bad medicine.*      *      *We have a lot of ground to cover in these three episodes: medicine’s greatest hits, the biggest failures, where we are now and where we’re headed. In the interest of not turning a three- part series about bad medicine into a twenty- part series, we’re not even going to touch adjacent fields like nutrition and psychiatry. Maybe another time.

Let’s start, very briefly, at the beginning. Nearly 2,5. 00 years ago, you had the Greek physician Hippocrates, who’s still called the “father of modern medicine.” You’ve heard, of course, of the Hippocratic Oath, the creed recited by new doctors. And you know the Oath’s famous phrase — “First, do no harm.” Even though, as it turns out, that phrase isn’t actually included in the Oath. It came from something else Hippocrates wrote. Nor do many contemporary doctors recite the original Hippocratic Oath; there’s a modern version, written in 1.