Speaker 1: Welcome to Stuff to Blow your Mind from how Stop
Speaker 1: works dot com. Hey, you're welcome to Stuff with all
Speaker 1: your Mind. My name is Robert Lamb and i'm Christian Seger. Today,
Speaker 1: as you could probably tell from the title of this episode,
Speaker 1: we have, well, what is an unusual topic. We're gonna
Speaker 1: be talking about penile transplants, And we just wanted to
Speaker 1: say up front before we you know, dive into this
Speaker 1: episode that every time we've posted something about this subject,
Speaker 1: because there's been a lot of news about it lately,
Speaker 1: whether it's been to social media or we talked about
Speaker 1: it on like our live streams or something like that,
Speaker 1: it often kind of descends into these sort of like
Speaker 1: adolescent jokes, uh, And you know, we want to have
Speaker 1: a sense of humor about this, but at the same time,
Speaker 1: like doing this research, it really became apparent to us
Speaker 1: like how traumatizing this is for a lot of people,
Speaker 1: and how important this proced JR. Is. There's some weird
Speaker 1: science to it, certainly, but there's a lot of people's
Speaker 1: lives that are affected by this. Yeah, I mean we're
Speaker 1: talking about the loss of genitalia, the loss of a
Speaker 1: sex organ here, and that's that's a serious matter, and
Speaker 1: I think are our sort of conditioning is certainly in
Speaker 1: an American culture, in Western culture in general, Uh, are
Speaker 1: are conditioning to want to laugh, to want to make
Speaker 1: a joke about it? I mean, I guess a lot
Speaker 1: of that is coming from an area of just you know,
Speaker 1: you're uncomfortable. What can you do? What kind of what's
Speaker 1: my response? I can make a joke and then I
Speaker 1: can fill that space bred of your anxiety or something. Yeah,
Speaker 1: And that's and that's understandable. You know, for the most part,
Speaker 1: I feel like everything is on the table when it
Speaker 1: comes to humor. But in in in researching this, in
Speaker 1: talking with our special guests today, it really became apparent
Speaker 1: that this unwillingness to seriously engage with with this issue
Speaker 1: has actually held back some of the advances that can
Speaker 1: that that could help people who need it. Yeah. Absolutely,
Speaker 1: So that's a perfect segue into that. We were very
Speaker 1: lucky to be able to talk with Mary Roach for
Speaker 1: about half an hour about her upcoming book, Grunt. In particular,
Speaker 1: there are two chapters in that book that are about
Speaker 1: penile transplant surgery for soldiers. Uh. This is a very
Speaker 1: real issue for American soldiers coming back from overseas in
Speaker 1: particular who have been damaged by i e. D. Explosions UH,
Speaker 1: and the military's UH wing of doctors are trying to
Speaker 1: figure out what to do with that, and Mary consulted
Speaker 1: with a lot of those. But then there's also like
Speaker 1: a good like ten year history now of the science
Speaker 1: of penile transplants for everything from these wounded soldiers to
Speaker 1: cancer victims. And then also, as we'll talk about in
Speaker 1: South Africa, there is ritualistic circumcision that leads to penis
Speaker 1: is essentially falling off right and and and it's the
Speaker 1: situations where it's not full on penal transplant. I mean,
Speaker 1: we're still still dealing with with euro trauma. You're dealing
Speaker 1: with plastic surgery to correct injuries to the genitals. UH.
Speaker 1: And that is and and some of that science actually
Speaker 1: is what was we end up discussing ends up stemming
Speaker 1: from gender reassignment surgeries and advancements that have been made
Speaker 1: in that area. Yeah, And so a little bit of
Speaker 1: clarification to about like the conversation and then the like
Speaker 1: sort of turn of events since we recorded the conversation. UH,
Speaker 1: Mary's book was coming out soon. It should be out
Speaker 1: this week grant the Curious Science of Humans at War,
Speaker 1: and we actually interviewed Mary a couple of weeks ago
Speaker 1: in preparation for this, and since then, on May sixteenth,
Speaker 1: the first US UH penile transplant was achieved UH, and
Speaker 1: it was announced in the New York Times, I believe,
Speaker 1: UH and actually here at how stuff works. Our colleague
Speaker 1: Lauren Vogelbaum wrote an article and recorded a video about that.
Speaker 1: By the time you're hearing this episode, that maybe like
Speaker 1: two or three week old news. But when we recorded
Speaker 1: the interview with Mary, it actually hadn't been announced here.
Speaker 1: So we were focusing primarily on the research and transplants
Speaker 1: that have been done in China and South Africa, as
Speaker 1: well as what Mary had experienced in her research with
Speaker 1: military medicine right, and some of the depending um advancements there,
Speaker 1: like some of the procedures they're working up too. So yeah,
Speaker 1: just keep that timeline in mind as you listen to
Speaker 1: the interview, and you know, nothing's actually broken in the interview,
Speaker 1: just keep in mind when it was recorded. So we're
Speaker 1: gonna play the interview now, UH and let you hear
Speaker 1: our conversation with Mary about this fascinating topic. And then
Speaker 1: when we come back after that, Robert and I are
Speaker 1: going to go over the brief history and the science
Speaker 1: of what's going on here with penile transplants. Well, first
Speaker 1: of all, thanks for taking the time out of your
Speaker 1: day to chat with us here. UM. We've we've really
Speaker 1: been in going uh reading Grunt and UH and in
Speaker 1: the past I've been a big fan of I think
Speaker 1: I've I've read all of your previous books, Stiff, Spook, Gulp,
Speaker 1: Packing for Mars. Uh. So anytime I'm Mary Roach book
Speaker 1: comes out, we get excited. There should be some kind
Speaker 1: of special I don't know, bracelet or metal or something
Speaker 1: that you get if you've read all of them. Very
Speaker 1: few people have read all of them. Thank you, Thank you.
Speaker 1: With this particular book, I guess the place I want
Speaker 1: to start is UM. I was particularly interested in the
Speaker 1: two chapters concerning euro trauma, genital reconstruction, surgery, and genital transplants,
Speaker 1: because I mean, there's the I mean, there's the morbidity
Speaker 1: and the squint, the squeamishness of the topic, but it
Speaker 1: ultimately provides some some you provide some powerful insights into
Speaker 1: the place where science and and to a certain extent,
Speaker 1: the war machine itself has to try and stitch everything
Speaker 1: back together again, both physically and psychologically. Was this a
Speaker 1: challenging subject matter to undertake? It was, Yeah, for just
Speaker 1: the reasons that you've just mentioned. It's it's it's a
Speaker 1: sensitive topic. And I'm not known as a sensitive writer.
Speaker 1: Uh if you're familiar with my book, but it's, um, yeah,
Speaker 1: I think that because it is sensitive, people shy away
Speaker 1: from it. And I feel like it's important to talk
Speaker 1: about it, and so does the people who do the work.
Speaker 1: Because somebody's sexual health and sex life and relationships are
Speaker 1: in the balance, and that's you know, that's important stuff.
Speaker 1: It's you know, I mean, it's important to get veterans,
Speaker 1: wounded warriors whatever you want to call them, you know,
Speaker 1: mobile and walking and able to take care of data
Speaker 1: day activities and be back on their feet. But sex
Speaker 1: is important too. And um, a substantial number of these
Speaker 1: men say injuries that do that do go up that high.
Speaker 1: I mean it's a it's a it's a fraction of them,
Speaker 1: but still enough that it's it's important to talk about it. Hey, Mary,
Speaker 1: this is Christian Sega, the COEs to the show to
Speaker 1: piggyback off of what Robert was just saying, I'm particularly
Speaker 1: interested here in the cultural and identity connections that you
Speaker 1: remarked on regarding penis reconstruction. And i'd like to know,
Speaker 1: you know, from the research and from the people you
Speaker 1: talked to, how much of the repair part is actually psychological.
Speaker 1: In particular, I'm thinking of the example you gave of
Speaker 1: men who are worried about having to sit down to urinate. Yeah,
Speaker 1: that's there is a cultural um. You know that what
Speaker 1: you're talking about is a euri thrust. To me, I
Speaker 1: believe I'm saying it right. Um, wherein if it's it's
Speaker 1: one option, if rebuilding the euretra isn't possible or doesn't work,
Speaker 1: you can take what remains of urethra and make an
Speaker 1: opening in the Paraneum. Okay, however you pronounce it. Uh?
Speaker 1: And then um, the the person would sit down to urinate,
Speaker 1: you know, as a as a woman does. And um,
Speaker 1: I asked. When I was in the operating room, I
Speaker 1: asked both the surgeons. They're like, how but how much
Speaker 1: of a big deal is this? And one of them said, well,
Speaker 1: you know, when you're talking about you've lost one part
Speaker 1: of one leg, and you know part of one hand,
Speaker 1: and you know, this is not a big deal. The
Speaker 1: other surgeon looked at me and said it's huge. So
Speaker 1: there's a difference of opinion there. But um, yeah, obviously
Speaker 1: it's I think it's And then she went on to
Speaker 1: say that she'd been at a neurological conference in Europe.
Speaker 1: It was a World urology conference, and it was very cultural.
Speaker 1: They were, she said, the Italian surgeons are like, are
Speaker 1: you kidding me? No, you know that that seemed to be,
Speaker 1: you know, an affront to masculinity. Other cultures were, you know,
Speaker 1: it was less. It seemed like less of a big deal. So, um,
Speaker 1: you know, as a woman, it's hard for me. That's
Speaker 1: an interesting thing. You know. There's sometimes, you know, every
Speaker 1: now and then that men who are like, yeah, I
Speaker 1: sit down the toilet because you know it keeps the
Speaker 1: carpet cleaner, where my wife likes me too, And and
Speaker 1: then there's other men are like, you sit down on
Speaker 1: the toilet to peace. So I think it's both cultural
Speaker 1: and personal. It's an interesting topic. So they're incorporating therapy
Speaker 1: into this then as well, I would assume, um, therapy
Speaker 1: is this is an area of sex, sexual health and
Speaker 1: intimacy counseling is is an area that I think the
Speaker 1: government would do well to dedicate more funding too. At
Speaker 1: the time I was at Walter Ree, there was not
Speaker 1: a full time staff person doing just that. You know,
Speaker 1: there's a sense that, um that that you know, we
Speaker 1: only have so much money to go around and this,
Speaker 1: you know, sex is it's LIFETI this is this lifestyle.
Speaker 1: You know that this is not going to be a
Speaker 1: priority for our taxpayer of dollars. And there are people
Speaker 1: at Walter Root who work with these patients who feel
Speaker 1: like this is really important, Like, yeah, it's important that
Speaker 1: they walk, but it's also important that they be able
Speaker 1: to have a sexual relationship that isn't fraught and that
Speaker 1: you know, and that and that once you know, once
Speaker 1: you come out of these operations and you know, there's
Speaker 1: just a lot of things to adjust to and and
Speaker 1: you know, how do you use this thing now that
Speaker 1: it's been reconstructed or you know, whatever has been done.
Speaker 1: I mean, and it's not just with reconstruction and transplants.
Speaker 1: It's also, um there's a lot of heavy medication that
Speaker 1: goes on, especially in the early months after an injury.
Speaker 1: There's nerves stabilizers and antidepressants and pain meds, all of
Speaker 1: which can affect um a man's ability to get an
Speaker 1: erection or to keep an erection. And that's you know,
Speaker 1: that's that's also should be part of the council. And
Speaker 1: there are people there who do it, but there there
Speaker 1: need to be more of them. Yeah. So I'm going
Speaker 1: to jump ahead a little bit here because that you
Speaker 1: connected right to another thing I wanted to ask about,
Speaker 1: which is this idea that that sex isn't as valued
Speaker 1: financially as walking, for instance. And so I'm curious from
Speaker 1: your experience researching this book, do you think the fear
Speaker 1: of just sex talk in general is preventing us from
Speaker 1: making strides in health sciences. Yes, I think the part
Speaker 1: of part of it. I mean the woman that I
Speaker 1: um that I spoke to, Christine Delorier, who runs the
Speaker 1: Wall to Read. It's a sexual health and Intimacy working
Speaker 1: group and it's something she does on her own time.
Speaker 1: There's about fifty people who get together and share resources
Speaker 1: and who've been working in this area. And that was
Speaker 1: what she said to me. She said, this isn't just
Speaker 1: a budget issue. This is the government not wanting to
Speaker 1: embrace sex, and and not just out of prudishness. I
Speaker 1: think just as it's out of a sense of you know,
Speaker 1: we we spend taxpair dollars and you know the way
Speaker 1: that taxpayers want us to and and that sex is perceived.
Speaker 1: It's certainly, certainly certain segments of the population. You know,
Speaker 1: that's that's not perceived as a worthy expense. You know
Speaker 1: that that is uh um, yeah, it's it's it's considered
Speaker 1: lower priority. And yeah, I think it is. It is
Speaker 1: in some way tied in with kind of a not
Speaker 1: a prudishness, but you know it to be spending taxpayer
Speaker 1: dollars promoting sexual pleasure, you know, it's it's it's treacherous
Speaker 1: grounds in terms of getting negative media attention or what
Speaker 1: have you. But it's also you know, I should also
Speaker 1: say the number of I mean, if you look at
Speaker 1: the number of veterans whose injuries have left them in
Speaker 1: need of surgery or infertile or what have you, it's
Speaker 1: a small percentage because most I mean most of the
Speaker 1: injuries in the lower part of the body. It's the
Speaker 1: foot and the calf and below the need higher up
Speaker 1: you go to the less frequent. These injuries are so
Speaker 1: something like three genital ural euro genital. However you want
Speaker 1: to um term it injuries for something like a hundred
Speaker 1: and fifty thousand amputations or sorry, sorry, so I know
Speaker 1: I think it was it's three D genital eurological patients
Speaker 1: very eighteen thousand limb amputees. So it's it's a it's
Speaker 1: a lower priority in that sense, and you know that's
Speaker 1: when you're looking at a budget and where to spend
Speaker 1: the money. That's also part of it. So it's not
Speaker 1: just squeamishness regarding sex. But I do I do think
Speaker 1: that probably places a factor. Yes, But as you you
Speaker 1: point the point out in the book, and this I
Speaker 1: thought was the really important factors. Just we are our
Speaker 1: medical technology has has reached the point where more soldiers
Speaker 1: are surviving the sort of injuries that would in previous
Speaker 1: uh decades would have just killed them out right, but
Speaker 1: now just surviving with more grievous grievous injuries. Correct, Yeah,
Speaker 1: that's right, Yeah, exactly. The I E. D s have
Speaker 1: gotten larger, so the injuries are going higher up the
Speaker 1: limb and to the extent where they're affecting the genitals,
Speaker 1: and that used to be a fatal and you know
Speaker 1: that size of an explosion you used to be a
Speaker 1: fatal injury for the most part. That if you if
Speaker 1: you're hitting the level of someone's hips, you're also going
Speaker 1: to be damaging organs and so so that's a a
Speaker 1: very serious injury. And yes, these patients are now surviving
Speaker 1: more than they used to. But not only are the injuries,
Speaker 1: the explosions are getting bigger, but also the ability to
Speaker 1: keep these folks alive has it ANSWD a lot. So yeah,
Speaker 1: there's there's there are more people surviving to need this
Speaker 1: kind of surgery and counseling. So, Mary, I'm curious in
Speaker 1: the conversations you had with medical professionals about this, how
Speaker 1: much did they acknowledge the contributions of fallow plastic from
Speaker 1: the transgender community as contributing to their work. UM that
Speaker 1: one the very first conversation I had was someone at UM.
Speaker 1: It was a meeting I had It uses the Uniform
Speaker 1: Uniform Services, University of Health Sciences, and that first person
Speaker 1: that I spoke to, UH, that's what he said, some
Speaker 1: of the you know that these are techniques that are
Speaker 1: stemming from work from transgender work. I mean that it
Speaker 1: makes perfect sense. I mean that is what has pushed
Speaker 1: the advances in rebuilding building a penis from various other
Speaker 1: pieces of anatomy. That's where the demand has been, you know,
Speaker 1: I mean it started out with war injuries way way back,
Speaker 1: but the very early on one of the first you know,
Speaker 1: I think one of the first cosmetic surgeons who started.
Speaker 1: I think you're doing rebuilding noses, etcetera. I think one
Speaker 1: of those, um was a was the very first transgender surgery.
Speaker 1: You spent a lot of time with Dr Richard J.
Speaker 1: Read It at John Hopkins discussing the continued efforts to
Speaker 1: conduct the first successful penis transplant in the United States. Um,
Speaker 1: you know, where are we currently in that process? Yeah,
Speaker 1: right now as of a lot of last week. I
Speaker 1: checked in with him, and there's a recipient that's been
Speaker 1: identified who uh And they're trying to find a suitable
Speaker 1: match because it's a it's a you know, in addition
Speaker 1: to all the other things that you look for with
Speaker 1: an organ with organ transplant, in this case, there's skin color.
Speaker 1: And I mean that's the case is similar to it,
Speaker 1: you know, like a hand transplant or a face transplant.
Speaker 1: But anyway, they're they're they're trying to identify a donor.
Speaker 1: And I'm not sure how much of it is. Much
Speaker 1: of it is is also the discomfort that the family
Speaker 1: might have that I don't know. I don't know why
Speaker 1: things are white, why it's been slow to happen, because
Speaker 1: as you, as you point out in the book, the
Speaker 1: first procedure of this sort took place in Guangzho, China,
Speaker 1: back in two thousand six. H Yes, And of course that,
Speaker 1: as you point out, that did not exactly that was
Speaker 1: not a successful surgery in the in the long run,
Speaker 1: the this this early attempt at it, though, does that
Speaker 1: do you think that speaks to anything culturally about a
Speaker 1: more you know, a more openness to engage with the
Speaker 1: sexual questions involved here, or is it just uh, you know,
Speaker 1: more eagerness to h to carry out the endeavor. I mean,
Speaker 1: probably more the latter. I think probably um more eagerness
Speaker 1: to plunge ahead and be the first. And you know,
Speaker 1: in this case, it was they claimed it was a
Speaker 1: psychological issue, but two weeks later that removed it, after
Speaker 1: having transplanted it there, they removed it, and they cited
Speaker 1: a severe psychological problem, but they didn't elaborate at all.
Speaker 1: And I wasn't able to get in touch with They
Speaker 1: didn't respond to emails, so I don't know. I don't
Speaker 1: know exactly there was some necrosis, there was some and
Speaker 1: the and they didn't attach all of the same. And
Speaker 1: I believe that the cavernosal artery, there's a there's an
Speaker 1: artery that the U S. Surgeons are planning to hook
Speaker 1: up that. I believe that they didn't, so that what
Speaker 1: there was in the China operation, But a lot of
Speaker 1: it is speculation because there hasn't been a lot of
Speaker 1: open communication between the Chinese surgeons in the in the
Speaker 1: U S. I mean, I wasn't able to get a
Speaker 1: lot of details about that procedure, only what is in
Speaker 1: the paper, which is that the there was some psychological
Speaker 1: distress and it was removed and it looked like the U. S.
Speaker 1: Surgeons told me that from looking at the photographs, that
Speaker 1: looked like there was some necrosis, some tissue that was
Speaker 1: not being receiving blood and getting oxygenated, and that that
Speaker 1: um may have contributed as well. But you're asking why
Speaker 1: did they go ahead so quickly? And I think that
Speaker 1: just maybe a yeah, I desire to go ahead and
Speaker 1: give it a whirl and be a little less perhaps
Speaker 1: a little less cautious, and a little less inclined to
Speaker 1: work out all the details. I don't know, I'm not sure. Well,
Speaker 1: I hesitate to call this a lighter note, but Robert
Speaker 1: and I were both very interested in how a rectile
Speaker 1: tissue can be constructed from the sinuses and also from
Speaker 1: mouth tissue. Can you speak to that a little bit more? Like?
Speaker 1: Why is it so good for reconstructive penile surgery? Uh, cheek, Yeah,
Speaker 1: but for rebuilding a euresra or part of a urethra.
Speaker 1: And this is, of course a tube that is transporting
Speaker 1: liquid um. The the inside of the cheek is good
Speaker 1: because it's it's used to moisture. It doesn't doesn't steriorate
Speaker 1: in moisture, it doesn't break down, it's it's it's evolved
Speaker 1: to be wet all the time. And if you just
Speaker 1: use skin, uh, you can end up with um infection
Speaker 1: and fistulas, which is when infection kind of eats through,
Speaker 1: uh to the outside, and you have sort of a
Speaker 1: tube going off where you don't want it to the
Speaker 1: other thing. Uh. You want you want a patch of
Speaker 1: tissue that for the penis or the eis. You don't
Speaker 1: want hair growing on it. For there three, you don't
Speaker 1: want hair because there's minerals and urine which can collect
Speaker 1: and build up on the strands of hair, and that
Speaker 1: can cause problems. You get little calcls, little stones basically.
Speaker 1: Uh So, the cheek is advantageous in two ways. It's
Speaker 1: it's used to moisture and it's hairless. You know, the
Speaker 1: um for rebuilding a penis they tend to use. You know,
Speaker 1: the underside of the arm doesn't have hair. Also, that
Speaker 1: behind the ear is another little strip there that is
Speaker 1: a little careless stretch. Um. And in that case, just
Speaker 1: you don't want a penis probably right. I mean can't
Speaker 1: I can't speak. Yeah, So anyway, that's that's why those
Speaker 1: particular um patches of tissue are selected. Yet in reading
Speaker 1: you some of your past books, I've often found this
Speaker 1: pattern where they'll be like a section of one book
Speaker 1: and then uh in retrospect, you can I sort of
Speaker 1: look back and see like, oh, that's maybe where she
Speaker 1: got the idea for the following book. Um So, so
Speaker 1: I had to ask, when did you decide that Grunt
Speaker 1: was your next book? And if we look back into
Speaker 1: previous books, is there a particular chapter in a previous
Speaker 1: book that that basically gave birth to this volume. No,
Speaker 1: you have to look into the pages of Smithsonian magazine
Speaker 1: and you even then would never be because it was
Speaker 1: a story I had to do with the world. But
Speaker 1: as chili peppers which are grown in Naga land in India. UH.
Speaker 1: And while I was reporting that Piezz, somebody told me
Speaker 1: that the Indian Defense Ministry had basically weaponized this chili
Speaker 1: pepper and made a kind of tear gas or mace
Speaker 1: with this uh, with a nature's own tear gas. So
Speaker 1: I felt like I needed to report on that. I
Speaker 1: went over to the neighboring state of Asam, India, and
Speaker 1: they went to this lab and while I was there,
Speaker 1: I just there were a number of projects going on
Speaker 1: that struck me as kind of fascinating and esoteric. There
Speaker 1: was a leach repellent project going on, and I remember
Speaker 1: that was the moment where I thought, oh, military science,
Speaker 1: there's this whole world out there of things that uh,
Speaker 1: I have nothing to do with building better weapons. There's
Speaker 1: there's just there's it's a whole world of the kind
Speaker 1: of stuff I like to report on. There's a lot
Speaker 1: of biology and um human related science that goes on
Speaker 1: in the name of keeping people alive, which is I
Speaker 1: also liked that it was as kind of counterintuitive for
Speaker 1: a military book. It's not really about so much of
Speaker 1: what you see is about the technology of weaponry and
Speaker 1: bombs and high tech lasers and drones, et cetera, so
Speaker 1: that the human side of it seemed just it seemed
Speaker 1: to fit in it. But anyway, it didn't grow out
Speaker 1: of anything in any of the earlier books. It was
Speaker 1: from a story I was doing in between books. Yeah,
Speaker 1: that's interesting for us because we just maybe a month
Speaker 1: or two ago, did an episode on the history of
Speaker 1: the weaponization of animals for military purposes. So it was
Speaker 1: really nice to see in your book, like the flip
Speaker 1: side to it where it was more of the like
Speaker 1: healing function that all this you know, d G research
Speaker 1: goes towards. Did you cover the I saw something about
Speaker 1: about owls. Did you cover that one where the coast
Speaker 1: Guard wanted to use an owl? No? No, look for
Speaker 1: uh yeah, that was anyway, but that's not weaponization. That
Speaker 1: was more like almost more like a cadaver rescue dog.
Speaker 1: It was. We've talked about going back anyway doing a
Speaker 1: second episode where we talked about the use of animals
Speaker 1: and more like spying, surveillance, you know, other other uses
Speaker 1: aside from just killing people. I think the craziest one
Speaker 1: we got into was the bat bomb. Did you ever
Speaker 1: hear about that during World War Two? Yeah? I did. Yeah,
Speaker 1: I almost put it in the book, but I thought
Speaker 1: I had to remind myself that a little off topics. Yeah,
Speaker 1: were amazing, It's totally insane. So how does science and
Speaker 1: sort of generally speaking, and you know, I know your experience,
Speaker 1: how does science that orbits military endeavors, you know, not
Speaker 1: necessarily the weaponized stuff, but the stuff you've covered in
Speaker 1: this book, How does that How does it differ from
Speaker 1: other areas of science and scientific research and inquiry. Um,
Speaker 1: It's well, it's an interesting mix because they're there. There's
Speaker 1: a whole world of kind of science that gets funded
Speaker 1: through DARPA, which is very um it's with an eye
Speaker 1: to the future. And then like, for example, there'd be
Speaker 1: UM and I didn't. I didn't do cover a lot
Speaker 1: of darper stuff, but I was fascinated by it because
Speaker 1: it was it would be so idea of like, you know, well,
Speaker 1: how can we with a what's a way to make
Speaker 1: you know soldiers, you know, more effective and better at
Speaker 1: what they do. Wouldn't it be great if they were
Speaker 1: away where they could not be sleep to provide so
Speaker 1: they could be they could sleep but have what kind
Speaker 1: of one eye open, like be partially looking out for
Speaker 1: things um and but still sleep and not get sleep deprived.
Speaker 1: And and so they were looking at animals, marine mammals
Speaker 1: and also some birds that have UM one that are
Speaker 1: awakened with and in one hemisphere and a sleep in
Speaker 1: the other. Like there are there are geese and ducks
Speaker 1: that can you know, they have sleep in a group
Speaker 1: in the one on the perimeter, will sleep but also
Speaker 1: be watching out for predators. And so there's there's some
Speaker 1: um biologists or zoologists who have gotten funded by DARPA
Speaker 1: to just to study unique hemispheric sleep. So that and
Speaker 1: you'll you'll look at this paper and they'll think why
Speaker 1: is DARPA funding Like oh okay, they're looking forward to
Speaker 1: the future, like how can we make this kind of
Speaker 1: invincible modulated soldier, Like what what could we do to
Speaker 1: the sight soldier to make him or her more efficient,
Speaker 1: more awake, uh, just less of a human and more
Speaker 1: of a fighting machine. So there's that very strange world
Speaker 1: which I didn't spend much time and I just sort
Speaker 1: of would come across the papers and go, WHOA really
Speaker 1: surgically installed gils? Really? So that's that's sort of futuristic
Speaker 1: surreal stuff. And then there's, um, there's just a tremendous
Speaker 1: amount of work that kind of goes on under the
Speaker 1: a R. That's just you know, like the Naval Submarine
Speaker 1: Medical Research Lab, which is just you know, looking at
Speaker 1: sleep deprivation and you know, air levels and and and
Speaker 1: the you know, the various things that people deal with
Speaker 1: when they're out on a submarine, and um, how to
Speaker 1: sort of make that existence better, more efficient, healthier, etcetera.
Speaker 1: So but there's like that work goes on and has
Speaker 1: gone on and just is not it's kind of um invisible.
Speaker 1: I mean it's not that it just doesn't get a
Speaker 1: lot of attention, and it's you know, it's it's heartening
Speaker 1: to me to see that that's there and that the
Speaker 1: people that are doing it are very committed and dedicated
Speaker 1: and caring. You know, the reasons ultimate reasons some of
Speaker 1: this work is being done. You know, when you get
Speaker 1: right down to it's like how to make soldiers better
Speaker 1: at what they do and keep them alive so they
Speaker 1: can keep being soldiers, which is less sort of heartwarming,
Speaker 1: but take it down to the level of the actual scientists,
Speaker 1: and they're really caring people who are very dedicated to
Speaker 1: the lives of men and women who are serving the military.
Speaker 1: And that's so so it was anyway, I don't know
Speaker 1: if I answered your question. No, No, that's that's exactly
Speaker 1: what I was wondering, just sort of the the difference,
Speaker 1: you know, what what the energy of the research is
Speaker 1: like as opposed to like non military research. Uh so, yes,
Speaker 1: I think that's that That answers the question perfectly. I
Speaker 1: can only imagine you're getting a lot of interview questions
Speaker 1: about the euro trauma and the pianot transplant sections of
Speaker 1: the books as we ask you and I and again
Speaker 1: I want to stress that I thought you handled it
Speaker 1: just perfectly with you know, utilizing the the expected Mary
Speaker 1: wrote voice, but also you know, handling some potentially delicate
Speaker 1: subject matter. But can you tell our our listeners and
Speaker 1: readers about something that you explored in the book that's
Speaker 1: getting less coverage that maybe you wish more interviewers we're
Speaker 1: asking you about. Well, I'm actually you know the book.
Speaker 1: Since I'm talking, I'm talking to you a month before
Speaker 1: the book is out, so you are really among the
Speaker 1: first folks that I've spoken to. I've done um, I've
Speaker 1: done some q and as, and to be honest, this
Speaker 1: is the first time where I've talked in much detail
Speaker 1: about it, probably because there just haven't been many interviews yet. UM.
Speaker 1: But UM. And it'll be interesting to see whether this
Speaker 1: is something that people focus on or whether they'd rather
Speaker 1: leave it alone because it is you know, it is
Speaker 1: sensitive and it's UM there's a level of discomfort with
Speaker 1: the conversation and with I guess how listeners, readers, whatever,
Speaker 1: will react to it. And so I think I don't
Speaker 1: know whether that will be discussed. I would think it
Speaker 1: would be discussed a lot, but we'll see. Um, it's
Speaker 1: hard to imagine it coming up like the late night
Speaker 1: talk shows. Yeah, depending on who's um, yeah, well or
Speaker 1: or I was thinking more like you know CBS Sunday
Speaker 1: morning or the morning mainstream TV, you know, while people
Speaker 1: are having their breakfast. Yeah, we really gravitated for that section.
Speaker 1: It just I think it felt like it fit the
Speaker 1: voice of the show. The whole book did. But this
Speaker 1: in particular. We were like, that is something we can
Speaker 1: make a whole episode around. Oh yeah, I agree, I
Speaker 1: mean I think. I mean, there's two chapters in the book,
Speaker 1: and I had originally planned one, and um, then I
Speaker 1: heard about the transplant that the the folks at Johns
Speaker 1: Hopkins working towards, and then I obviously wanted to cover that.
Speaker 1: I mean partly because I'm Mary Roach and that's the
Speaker 1: kind of thing I covered, but also just how could
Speaker 1: it how could I not want to cover that. It's
Speaker 1: it's just really interesting because it's it's it's it's Tara
Speaker 1: incognito for for the transplant. You know, the face face
Speaker 1: first face transplantment tremendously compelling to people because it's, you know,
Speaker 1: we've we've left behind the world of organs are they're hidden.
Speaker 1: You don't really look at somebody and you think, okay,
Speaker 1: they've got a new liver. That's great, But that doesn't
Speaker 1: have to say there's not a psychological component that's as
Speaker 1: kind of immediately fascinating. Yeah, I feel like a lot
Speaker 1: of this research to just like strays right alongside like
Speaker 1: some borderline science fiction pop culture stuff too. You know,
Speaker 1: like when we're talking about these sleep experiments. Thinking about
Speaker 1: Robert and I have done episodes in the past about
Speaker 1: like people speculating about all these myths about theoretical Russian
Speaker 1: military sleep experiments, you know, and then like, of course,
Speaker 1: you know, you just mentioned the face transplant thing, and
Speaker 1: it brings to mind that with that nineties movie Face
Speaker 1: Off where they swap face. Yeah, you know, and it's
Speaker 1: it's this is exac Yeah, and people have been thinking
Speaker 1: thing about it in sort of silly terms for a while,
Speaker 1: but this has some very serious real world applications. Yeah,
Speaker 1: and the fact that the immuno suppressive regiments have have
Speaker 1: made tremendous strides, And so now you can do something
Speaker 1: like faith transplant, which because it wasn't because it wasn't
Speaker 1: matter life and death, people sort of shied away from
Speaker 1: it because the burden of the drugs that you take
Speaker 1: to suppress the immune system so it doesn't reject the
Speaker 1: tissue um that that seemed, you know, it was questionably ethical.
Speaker 1: Do you put somebody you should you put someone through
Speaker 1: the risks and inconveniences and problems of this very heavy
Speaker 1: immuno suppressive regiment just for a faith was not a
Speaker 1: matter of life and death. And now that they know
Speaker 1: with marrow infusion and other advances and immun suppression. Now
Speaker 1: it's it's that's kind of falling away, and it's, um,
Speaker 1: they're they're transplanting whole arms, They're transplanting faces and you know,
Speaker 1: now penises and probably at some point legs, although legs
Speaker 1: are problematic for various reasons. Uh, and and because um
Speaker 1: there's they're also at the same time making great strives
Speaker 1: with prosthetics. With prosthetic Yeah, so, um, you definitely want
Speaker 1: to You're a leg transplant is not going to be
Speaker 1: the best option for a very long time, I think so.
Speaker 1: But then yeah, this is the guy and Eleeve is
Speaker 1: talking about a whole body transplant or what is sort
Speaker 1: of commonly talked about in the press as a head transplant,
Speaker 1: but really the head is the person. The transplantation is
Speaker 1: the whole body of the brain dead person. So and
Speaker 1: there's some guy in Italy. I don't know how much
Speaker 1: of that is bluster and how much of that is real,
Speaker 1: but he's talking about, oh, yeah, I've got a patient
Speaker 1: and I'm ready to go, which I can't even imagine
Speaker 1: because that, um, there's so many unknowns with that and
Speaker 1: so many potential problems. I don't know, and I haven't
Speaker 1: spoken to him, But anyway, this whole Frankenstein science fiction
Speaker 1: realm is rapidly coming to be not science fiction, and
Speaker 1: it's it's fascinating now. In all of your books, I've
Speaker 1: I always enjoyed the footnotes so much because there's always
Speaker 1: they're always these little little nuggets of a fascination that
Speaker 1: kind of spring off from the main material. And and
Speaker 1: in this one there were several great ones, but that
Speaker 1: the rabbit eye transplant by one Dr H. Bradford, that
Speaker 1: one really floored me. Were you able to learn much
Speaker 1: about this? Just it was in the paper? You know,
Speaker 1: I couldn't interview him, he's long gone, But that was
Speaker 1: so like there were so many things that fascinating me
Speaker 1: about that. First of all the fact that rabbit eyes
Speaker 1: are very similar to human eyes. If you go on
Speaker 1: the internet, you can sort of verify this, and I
Speaker 1: don't really recommend that because when you do the search,
Speaker 1: this weird thing comes up about a guy who was
Speaker 1: selling a box of rabbit heads um anyway purposes. I
Speaker 1: don't know why. They seemed like he was offering a
Speaker 1: pretty good deal on those, right, But no, and I
Speaker 1: was like, well, somebody transplanting eyeballs, why would you want
Speaker 1: these rabbit heads? What are you doing with them? But
Speaker 1: and he was like, make me an offer that. But anyway,
Speaker 1: see this is what happens when I got on these tangents.
Speaker 1: But the UM, Yeah, but there was some It was
Speaker 1: some guy who he was. He was a sailor I
Speaker 1: think where he was anyway, he worked on ships and
Speaker 1: he um for some reason that was there saying well, Lett,
Speaker 1: for that reason, we you know, a glass eye won't work.
Speaker 1: I guess it was an occupational issue. So they wanted
Speaker 1: to do something that wouldn't break when you were hitting
Speaker 1: your in the face or something. And then I thought, well,
Speaker 1: you have pirates have eye patches, so maybe there's a
Speaker 1: there is a high level of ocular injury on ships.
Speaker 1: I don't know why. Anyway, that was what the reason
Speaker 1: they gave for why they were going to do this. UM.
Speaker 1: And of course I should point out to listeners, Um,
Speaker 1: the eye this is just it was cosmetic. It wasn't
Speaker 1: gonna be hooked up and you would be able to
Speaker 1: the person couldn't see because there's never been a successful
Speaker 1: eye transplant because hooking up the eye it's a much
Speaker 1: more complicated. It's insteadily hooking up a telephone cable. You know,
Speaker 1: I'm talking about the nerves here. You're hooking up, you know,
Speaker 1: a complicated computer system, and the body doesn't know how
Speaker 1: to regrow and reattach and make it all work again.
Speaker 1: So the there hasn't been an eye transplant other than
Speaker 1: this cosmetic eighteen what was it ninete early nineteen hundreds.
Speaker 1: I don't have the date handed yeah, yeah, yeah, So
Speaker 1: other than the guy who tried to do it for
Speaker 1: transparent reasons, yeah, there hasn't. There's there's not any but
Speaker 1: nobody else's transplanting eyes rabbit or pop or otherwise or otherwise.
Speaker 1: All right, well, you know those were our main questions
Speaker 1: for you here today. Uh again, thank you for taking
Speaker 1: time out of your day to chat with us. UH
Speaker 1: greatly enjoyed the book, and we certainly encourage all of
Speaker 1: our listeners to go and pick it up. Um when
Speaker 1: this episode comes out, it should be available and all
Speaker 1: the physical and digital um ways that one normally acquires
Speaker 1: a a good book. Well, thanks thanks so much for
Speaker 1: having me on this program. Thanks once again to Mary Roach. Again.
Speaker 1: The book is Grunt the Curious science of Humans at War.
Speaker 1: Thanks to Mary for coming on the show and chatting
Speaker 1: with us. We're gonna take a quick break and when
Speaker 1: we come back, Christian and I are going to discuss
Speaker 1: the topic further. So, well, let's back up a little bit.
Speaker 1: We've had myths and legends of penis loss and probably
Speaker 1: replacement as well, to go back pretty far. It's the
Speaker 1: sort of thing that's likely lost in the midst of history.
Speaker 1: I mean, the myths of are full of castration and
Speaker 1: um penectomy accounts with a with a primordial castration of
Speaker 1: the god urine Us being one of the big ones.
Speaker 1: And I've I've read various the European tales that have
Speaker 1: involved which is, stealing men's penises, sometimes hiding them away
Speaker 1: in trees, and then uh, sometimes the men are able
Speaker 1: to steal the penises back and they are somehow magically
Speaker 1: reattached the body. So and this is probably like a
Speaker 1: legend that is deeply seated in psychological fear of you know,
Speaker 1: as we're gonna talk about that, there's like a real
Speaker 1: deep psychological cultural connection to your genitals, of course, but um, yeah,
Speaker 1: something like that seems like, you know, it's sort of
Speaker 1: pre lorraina Bobbitt style, like fear of the woman's stealing
Speaker 1: uh manliness. Yeah, and even then there has there's like
Speaker 1: a sense of humor and uneasiness, unwillingness to like confront
Speaker 1: the horror or in terror of it and therefore wrapping
Speaker 1: it then in the in something a little more whimsical.
Speaker 1: And then as far as just simply as far as
Speaker 1: just simply reattaching a penis that has been uh cut
Speaker 1: from the body. UH penis reattachment surgery has been around
Speaker 1: for a little while. Um. In fact, Dr Surasak Moon
Speaker 1: Sumbat of Thailand actually became something of an expert in
Speaker 1: it uh during the nineties due to an upswing in
Speaker 1: such attacks on philandering men um by their wives um
Speaker 1: and transplanting you know, one's own member back is challenging enough,
Speaker 1: especially if said member has been fed to a duck,
Speaker 1: which was apparently the practice at the time. I wonder why,
Speaker 1: in particular a duck as rather than any other animal.
Speaker 1: That's something we should look into, that would I would
Speaker 1: be curious to see what the sort of cultural implications
Speaker 1: of that or just the ducks are around. Maybe they're
Speaker 1: just plentiful. Yeah, Well, if you out there. No, let
Speaker 1: let us know about that. Yeah, I mean, maybe it's
Speaker 1: a worse fate than a fish. I'm not sure, but
Speaker 1: certainly it's one thing too. It's complicated enough involving microsurgery
Speaker 1: to to to put one penis back onto an individual,
Speaker 1: but then to transplant another's member, that's a more complicated scenario.
Speaker 1: So before we get into the like real nitty gritty
Speaker 1: specifics about how these penile transplants work, I think it's
Speaker 1: worth doing just like a brief overview of organ transplantation
Speaker 1: in general, because a lot of the same stuff applies here.
Speaker 1: So uh. To start with, researchers originally had success in
Speaker 1: early twenty century with transplanting organs in animals but not
Speaker 1: in humans, and that they were basically they had a
Speaker 1: lot of failures. They could not make it work until
Speaker 1: the nineteen fifties when the first kidney transplants started to
Speaker 1: work out. And this is important because it was saving
Speaker 1: lives in these instances. These are organs that people need
Speaker 1: to live, right, kidneys, hearts, uh, And so they need
Speaker 1: these transplants and oftentimes even today still don't get them
Speaker 1: because of the availability. And that's something that we're going
Speaker 1: to talk about as well, but um genitals were kind
Speaker 1: of off the table. Nobody had been able to pull
Speaker 1: that one off. Uh. And the problem here is that
Speaker 1: the demand for organs, with all of the diseases that
Speaker 1: are affecting us as human beings, way outweighs the supply
Speaker 1: of the actual organs. There's just not enough. UM donors
Speaker 1: can wait for years. Sometimes they die while they're waiting. Uh.
Speaker 1: And we're talking about thousands of people here. This isn't
Speaker 1: pano transfers, which just organ transplants in general. Uh. And
Speaker 1: even though here in the US, people in general favor
Speaker 1: organ donation, right, Like if you walk up to most
Speaker 1: people in the street and ask them, I'm sure they
Speaker 1: would say, yeah, sure, I would you know, after I
Speaker 1: pass away, get my organs a science or something like that, right,
Speaker 1: or or to somebody who needs them. But actually only
Speaker 1: a small percentage of people do this. They actually go
Speaker 1: through the procedure of filling out the paperwork for it. Uh. Uh.
Speaker 1: This is how serious it is. Sixteen potential recipients die
Speaker 1: every single day from something that's totally curable if they
Speaker 1: had transplants. Uh. And then we're also obviously looking into
Speaker 1: artificial organs. You're hearing a lot about this lately, not
Speaker 1: just in bioengineering, but then also with like the advent
Speaker 1: of three D printing, what people can do with that, right,
Speaker 1: the creation of the necessary scaffold thing and then the
Speaker 1: growing of tissue over that to create a suitable replacement organ. Yeah.
Speaker 1: So Uh. In the cases of organs that are super sensitive,
Speaker 1: like your heart, your lungs, and other sensitive organs, transplantation
Speaker 1: is actually like the last resort, Like that's the last
Speaker 1: thing that they wanted to But here's the process of
Speaker 1: how this works. And it's essentially the same for penile transplants. Uh.
Speaker 1: A patient finds a willing donor. Uh. Usually it's a
Speaker 1: friend or a family member, but what they're looking for
Speaker 1: is a match, somebody that can go directly into surgery. Uh.
Speaker 1: And a small number of the transplants come from general donors,
Speaker 1: of course, people who who you know, have filled out
Speaker 1: their organ donor cards or whatnot. But many of these
Speaker 1: have to come from dead donors, and oftentimes we're actually
Speaker 1: talking about brain dead donors, not physically dead donors. That's
Speaker 1: kind of the I guess, the ideal if you want
Speaker 1: to say, a situation, because the body is preserved with life,
Speaker 1: but there is no more mental capacity in the creature exactly.
Speaker 1: And it's incredibly complex going through the process of getting
Speaker 1: permission to get an organ from somebody who's technically still
Speaker 1: alive but who's brain dead legally. So it's so complex
Speaker 1: in fact, like we don't have time to go into
Speaker 1: it on this episode. And also, uh, you know, give
Speaker 1: you the interview that we did with Mary, but if
Speaker 1: you really want to know more about it, I recommend
Speaker 1: going and checking out the article that's at how stuff
Speaker 1: works dot com about organ transplants in general. There's some
Speaker 1: good information there. The actual transplantation itself involves a huge
Speaker 1: team of surgeons. Obviously there's a hospital involved, and they
Speaker 1: all have to assess the patient's attitude, their psychological condition,
Speaker 1: and especially their history with drugs, cigarette and alcohol use
Speaker 1: because that can complicate things as well. Compatibility in particular
Speaker 1: requires everything from your physical tissues and blood samples being
Speaker 1: able to match to how long the recipient has actually
Speaker 1: been waiting for this, right, So when it's a go,
Speaker 1: you move quickly. Uh, you really hurry the patient into surgery,
Speaker 1: and then a whole another team goes and gets the
Speaker 1: organ from the donor. Now here's a disturbing little tidbit.
Speaker 1: Note that you can stash away overseas. Organs often come
Speaker 1: from executed prisoners, most notably in China, and there's an
Speaker 1: indication that because there are people paying for these organs,
Speaker 1: actually accelerated the execution schedules in these countries in order
Speaker 1: to meet demand. So that's pretty disturbing. Post operation recovery
Speaker 1: usually involves a lot of medication and a lot of
Speaker 1: follow up hospital visits to make sure that everything is
Speaker 1: healed correctly. This is gonna pretty much last for the
Speaker 1: rest of your life. Um, and the reason why is
Speaker 1: because your immune system is going to see this new
Speaker 1: organ as foreign cells and it's going to try to
Speaker 1: attack it. So to minimize this, like I said before,
Speaker 1: you try to match the blood and tissue types. But
Speaker 1: also the body is just naturally going to reject it
Speaker 1: unless you have like an identical twin hanging around and
Speaker 1: they're willing to give up their organs to you. So
Speaker 1: there's three kinds of rejection. Uh, there's hyperacute rejection and
Speaker 1: this is when like the blood type just doesn't match
Speaker 1: up at all, the antibodies react and really like this
Speaker 1: is the worst case scenario, because the recipient is going
Speaker 1: to die on the operating table. Acute reaction uh A
Speaker 1: rejection rather is what we see most often, and this
Speaker 1: is when you have a normal immune response. It starts
Speaker 1: a few days after the transplant UH and basically our
Speaker 1: immune system UH it needs to be suppressed by medications
Speaker 1: so that we can go ahead with the transplant. The
Speaker 1: unfortunate side effect is it makes us susceptible to infection
Speaker 1: and disease. Right, So sometimes they're they're trying at this
Speaker 1: new thing where they sometimes also take bone marrow transplants
Speaker 1: to produce white blood cells inside the recipient's body, hoping
Speaker 1: that their immune system will sort of be tricked into
Speaker 1: recognizing the new organ. The last kind of of rejection
Speaker 1: is a chronic rejection, and this is a gradual thing
Speaker 1: that that lasts over the course of months or years.
Speaker 1: You may not find out until many years after the
Speaker 1: transplant that the you know, that didn't actually hold in.
Speaker 1: One note that I'd like to point out here too,
Speaker 1: is that these immunosuppressive drugs that we give the patients,
Speaker 1: they also have adverse effects over a long term, including
Speaker 1: cancer and kidney damage. So in some situations, the benefits
Speaker 1: may not outweigh the risks involved here. So let's get
Speaker 1: to penises, shall we. Until recently, and like I'm talking
Speaker 1: like ten years recently, Uh, the only treatment for men
Speaker 1: was to construct a penis from the flesh of their
Speaker 1: thigh or forearm skin and basically plastic surgery reconstruction. Yeah.
Speaker 1: And so you take that skin, you add a penile
Speaker 1: prosthetic and it's got malleable or inflatable rods in it
Speaker 1: that make it semi rigid. Then you add a saline
Speaker 1: pump to this that fills it up, right, like acting
Speaker 1: like the um the blood filling up the tissue of penis.
Speaker 1: And this has been around since the seventies is practice. Uh.
Speaker 1: This is a direct quote from one of the articles
Speaker 1: that we researched for this about this procedure. It said
Speaker 1: the aesthetics were crude and the penetration is awkward. Now,
Speaker 1: that can be said about most people's first that first
Speaker 1: experience is sexually true too. Yeah, so we do have
Speaker 1: a sense of human yeah. Yeah, And you know, and
Speaker 1: I think it's also worth noting that it's it's look
Speaker 1: at imagining this scenario here, and certainly you can look
Speaker 1: up images and more, you know, technical documents on all this.
Speaker 1: It's easy to say, well, that sounds crude, and certainly
Speaker 1: that's no that that's no replacement for the tissue situation,
Speaker 1: but that is still pretty remarkable that that we were
Speaker 1: able to accomplish this. This is a still surgical feat. Yeah,
Speaker 1: it gets back to what we were talking about in
Speaker 1: our Cyborgs episode, like the things that we're able to accomplish,
Speaker 1: like what makes us human, what makes us the machine,
Speaker 1: the cyborg nature of humanity. So I don't want to
Speaker 1: slite procedure at all, because that is an amazing feat. Uh.
Speaker 1: And then here's the other thing that made uh any
Speaker 1: kind of penile transplants really difficult and still does uh.
Speaker 1: So I talked earlier about how just getting organs in
Speaker 1: general is difficult, right, getting a penis downer is even
Speaker 1: more difficult. The organ banks that accept other internal organs
Speaker 1: they don't even have like a field on their form
Speaker 1: for penises, right uh, And so they don't usually request these.
Speaker 1: It has to be done separately. In fact, in South Africa,
Speaker 1: families often flat out refuse. And this is going to
Speaker 1: be important because the first penile transplant was in South Africa.
Speaker 1: But there's such an emotional cultural gravity to a request
Speaker 1: like that that most people just say no, I will
Speaker 1: not give you, you you know, my my dead family members
Speaker 1: penis uh. And in in the case of the people
Speaker 1: who did the first penile transplant in South Africa, they
Speaker 1: actually had to come up with a way to work
Speaker 1: around it, where they started constructing faux penises for the
Speaker 1: dead uh from the donor's skin to preserve their dignity
Speaker 1: in their graves and subsequently still be able to use
Speaker 1: the penis and give it to a living recipient. Huh. Wow,
Speaker 1: that is that is that is crazy, you know. In
Speaker 1: um In Grunt Mary wrote his book, she points out
Speaker 1: that the cadavers that were being used in some of
Speaker 1: the not even actual transfort procedures, but essentially rehearsals for
Speaker 1: an upcoming transplant procedure. Like those are situations where somebody's
Speaker 1: body was donated to science and they're you know, they're
Speaker 1: not about to you know, necessarily share the exact details
Speaker 1: of how that body was used totally, you know, in
Speaker 1: part because of the complexities of our our psychological um
Speaker 1: attachments to these various parts. Yeah, who wants to know
Speaker 1: about like how their loved one was carved up and
Speaker 1: maybe mistakes were made on them or whatever, but the
Speaker 1: benefit is that it led to the successes that we're
Speaker 1: going to talk about next and some of the failures.
Speaker 1: So let's go back to a case that Mary Roach
Speaker 1: discussed in the interview. This was a two thousand six
Speaker 1: guang Show General Hospital in Guango, China. You had a
Speaker 1: forty four year old man and who had lost his
Speaker 1: penis and they quote an unfortunate traumatic accident. That's about
Speaker 1: all we know. One of the is is we've already
Speaker 1: touched on in the interview this case, there's there's some
Speaker 1: material that is that is not as directly related to
Speaker 1: the reader. There's maybe some of that might be lost
Speaker 1: in translation, some of it's just maybe not provided. Um. Yeah,
Speaker 1: there are a lot of things about this particular case,
Speaker 1: and it's been ten years that are still vague to
Speaker 1: this day. And when we talked to Mary, we sort
Speaker 1: of mentioned that, right Like I remember saying to her,
Speaker 1: you know what, what was actually up with that? And
Speaker 1: she said, as far as she could tell, it was necrosis.
Speaker 1: But we'll get there. So the lead surgeon on this
Speaker 1: one was one doctor who Wai Lee and so from
Speaker 1: what we know, the parents of a brain dead man
Speaker 1: in his twenties agreed to donate their son's penis to
Speaker 1: this man who was damaged in this unfortunate traumatic accident. Now,
Speaker 1: the way that they did it in this Chinese procedure
Speaker 1: was they warmed up the donor's penis with an infrared
Speaker 1: lamp post operation, and this was supposed to increase the
Speaker 1: metabolic requirements of the organ instead of increasing the blood supply. Now,
Speaker 1: other doctors that have been interviewed about this particular procedure,
Speaker 1: they have said things along the lines of they think
Speaker 1: that what happened here and why it didn't work out
Speaker 1: was there was inadequate psychological workup. So like with a
Speaker 1: lot of the procedures that we talked about on this
Speaker 1: show that are semi experimental, like say, uh, using m
Speaker 1: D M A to help with PTSD, right, it requires
Speaker 1: therapy as well. It's psychological and physical and not like
Speaker 1: just you're doing not doing body work in a car here, Yeah, exactly. Um. Now,
Speaker 1: in the particular case for the biological surgery here with
Speaker 1: this Chinese case, they could only use the local nerve
Speaker 1: structures because the donor's blood vessels had actually been obliterated. Uh.
Speaker 1: And they re routed a blood vessel from his lower
Speaker 1: abdomen to his paraneum to connect it to this new penis.
Speaker 1: Then they connected the blood vessels and dorsal nerves, and
Speaker 1: then the urethra for urination and the corpus cavernossum for erections. Now,
Speaker 1: according to the Guardian, they thought okay, everything was a success.
Speaker 1: After about ten days he had a rich blood supply
Speaker 1: and could urinate normally. But then the recipient and his
Speaker 1: wife came back in two weeks after the surgery and
Speaker 1: requested that it be removed. And as we talked about
Speaker 1: with Mary, nobody really knows the answer here, but we
Speaker 1: think that it's likely due to psychological issues surrounding the
Speaker 1: necrotian necrosis of the tissue involved. Yeah, I mean, of
Speaker 1: course you can't help, but wonder, like to what extent
Speaker 1: was this, how much of this was a failed reattachment surgery? Uh?
Speaker 1: And then to what to what extent is it more
Speaker 1: silent psychological? Like is it is the is the version
Speaker 1: that everyone gets is it leaning one way or another
Speaker 1: that they decided to lean away from from blaming the science?
Speaker 1: And you know what kind of how was it portrayed
Speaker 1: in the media, and like you said earlier, how much
Speaker 1: is lost in translation when we bring it over to
Speaker 1: English speaking media. So there's a lot of confusion around
Speaker 1: this case. But from what we know, uh, it was
Speaker 1: considered a quote failure because the man asked it to
Speaker 1: be removed, right, And we shouldn't discount that the psychological
Speaker 1: issues at all, because psychological issues involving transplants are not
Speaker 1: unheard of. The world's first hand transplant recipient a New
Speaker 1: Zealander by the name of Clint Hallam. He stopped taking
Speaker 1: his immune suppression drugs, uh, you know, by choice, and
Speaker 1: then later requested that the hand be amputated. So and
Speaker 1: and this is often brought up as an example of well,
Speaker 1: they essentially they essentially tackled the problem like like like
Speaker 1: auto work, and they didn't they didn't take into account that, uys,
Speaker 1: you have to have all of this additional psychological support
Speaker 1: as well. Yeah, this is incredibly gruesome stuff when you
Speaker 1: get down to the nitty gritty of it too, Like
Speaker 1: this is the kind of stuff that would make up
Speaker 1: like a Tales from the ript style story or something
Speaker 1: like that, like like he has a dead man's hand
Speaker 1: and uh, you know what I mean, Like it lends
Speaker 1: itself very well to to paranoid thinking, to doubt, and
Speaker 1: and I can't help but wonder two Like in the
Speaker 1: especially these earlier cases, to what extent was the were
Speaker 1: they straight straight with expectations for the recipient? They're like, hey,
Speaker 1: this is this You aren't going to be this is
Speaker 1: not going to be a you know, a one to
Speaker 1: three fixed scenario. Right, It's not like you and as
Speaker 1: we'll talk about, you don't just walk out of there
Speaker 1: and you've got a fully functioning penis. It takes like weeks,
Speaker 1: two months to years to try to get everything working properly.
Speaker 1: And in fact, in the South African case, they were
Speaker 1: surprised at how quickly things became functional. Well, let's look
Speaker 1: at that. The South African case. This is a two
Speaker 1: thousand fifteen and we're taking this is taking place at
Speaker 1: the Tigerberg Hospital in Cape Town, South Africa. Twenty one
Speaker 1: year old penile amputee who ust to his penis in
Speaker 1: a botched circumcision. And this is apparently pretty common. Dozens,
Speaker 1: some say hundreds of boys are maimed or die each
Speaker 1: year during traditional initiation ceremony. So these are not. These
Speaker 1: are not infant circumcisions. These are coming out of a circumcisions. Yeah,
Speaker 1: he was eighteen when this happened. And these ritual circumcisions
Speaker 1: are basically the way that it goes is they're so
Speaker 1: tightly wrapped that it causes necrosis in the penis, but
Speaker 1: you know, without it even being detached, So his penis
Speaker 1: had to be amputated. Uh. This is particularly common in
Speaker 1: South Africa's I believe this is Zosa speaking region. It's
Speaker 1: x h o s a. I'm not quite sure how
Speaker 1: to pronounce that, but let's say it's Zosa uh speaking
Speaker 1: region of the Eastern Cape. Uh. And it's so it's
Speaker 1: a rite of passage for young men. They actually attend
Speaker 1: circumcisions school and they're instructed in family values and sexual
Speaker 1: education there. Uh. There's also high prices that are charged
Speaker 1: for this procedure. So basically they take the penis, they
Speaker 1: wrap it at its base to stem the flow of
Speaker 1: blood up to the foreskin. Right, some men actually die
Speaker 1: because they won't go to a hospital because they're they're
Speaker 1: afraid of being ostracized after revealing that their gangarinus penis
Speaker 1: has fallen off. So there's such a strong psychological cultural
Speaker 1: connection to this thing that it's leading to people dying.
Speaker 1: Uh So yeah, so South Africa seems like an ideal
Speaker 1: place to to start getting a prep team ready to
Speaker 1: go for the first penile transplant. Uh. And the lead
Speaker 1: surgeon here was one Professor Andre von der Murwi. So
Speaker 1: when the recipient recovered, he actually had to come back
Speaker 1: in UH and drain a hematoma and repair a small
Speaker 1: fistilla in the urethra. And now here's the thing. They
Speaker 1: expected that it was going to take two years for
Speaker 1: him to be fully functional. It only took three and
Speaker 1: a half months. Uh. And the surgery itself, it took
Speaker 1: four years of clinical and ethical therapeutic preparation. They had
Speaker 1: to work with cadavers and practice. As we talked about earlier,
Speaker 1: it was really difficult to find penile donors. As we
Speaker 1: talked about earlier, they were trying to overcome this by
Speaker 1: doing the whole procedure that I talked about where they
Speaker 1: build these fake penises. So this team is not only
Speaker 1: trying to come up with a way to help these uh,
Speaker 1: these victims of this botched ritual circumcision, but then they
Speaker 1: also have to come up with a way to somehow
Speaker 1: please the families of the donors. Uh. And as of
Speaker 1: the last time this was reported, the hospital had nine
Speaker 1: more candidates in weight. But the good news is the
Speaker 1: recipient the patient. Last June it was reported that his
Speaker 1: girlfriend was pregnant, so fully functioning penis apparently. I wonder
Speaker 1: if this case of it also helped that the recipient
Speaker 1: was so young, just by virtue of, you know, the
Speaker 1: cause of the act, whereas in the recent case, the
Speaker 1: American case, he was he was far not not he's
Speaker 1: not old, but he was older than this guy's sixty
Speaker 1: were years old, right, all right, So let's get to
Speaker 1: this most recent case when we're looking at May eighth
Speaker 1: through eighth and the ninth, two thousand, sixteen weeks, just
Speaker 1: weeks ago at took place at Massachuset's Massachusetts General Hospital
Speaker 1: in Boston. Thomas Manning, a sixty four year old bank
Speaker 1: carrier from Halifax, Massachusetts. Penis was removed because of cancer.
Speaker 1: Now this is you know, most recent, and the New
Speaker 1: York Times and then also The Atlantic did really great
Speaker 1: write ups on this. So a lot of our information
Speaker 1: is from here. Man. I wish we could get married
Speaker 1: on the phone again and talk about this. I'm sure
Speaker 1: she was pretty interested in it as well. Uh. It
Speaker 1: took thirty healthcare workers in total to perform this operation.
Speaker 1: There were three years of preparation again, all the practicing
Speaker 1: on cadavers. Now, Manning only found out about the fact
Speaker 1: that he had this rare cancer after he had an
Speaker 1: accident at work. When he went into the doctor, they said, WHOA,
Speaker 1: there's this this, you know, abnormal growth on your penis,
Speaker 1: and they realized that it was. It was so cancerous
Speaker 1: that it had to be amputated. Now. It only took
Speaker 1: him two weeks though, to find a donor who matched
Speaker 1: his blood and tissue type, so that works out pretty well. Now.
Speaker 1: The surgery here in the US is estimated costs somewhere
Speaker 1: between fifty thousand and seventy five thousand dollars, but the
Speaker 1: hospitals involved are paying for the procedures while the doctors
Speaker 1: are donating their time. So everything, as far as we
Speaker 1: know with this is so far, so good. Right. In
Speaker 1: their official statement, they said that the penis has regular
Speaker 1: blood flow, no signs of infection or rejection. They hope
Speaker 1: that in a few weeks he'll achieve normal urination, so
Speaker 1: probably around right now. I would imagine they say they
Speaker 1: already have another patient waiting. This guy his penis was
Speaker 1: destroyed by burns in a car accident. Ultimately, their goal
Speaker 1: is to help combat veterans, like we talked about with
Speaker 1: Mary and Uh, other cancer patients and accident victims. They're
Speaker 1: in fact hoping to train their techniques to military surgeons.
Speaker 1: Because this is, like we talked about with Mary, so
Speaker 1: common with i D victims. Yes, I mean all this
Speaker 1: is very much taking on the front lines of the
Speaker 1: of the surgical frontier. Um, That's why doctors are donating
Speaker 1: their times, That's why hospitals are are are are paying
Speaker 1: the bills here and then then hopefully as these techniques
Speaker 1: are are perfected, yeah, they will be passed down and
Speaker 1: and others can start utilizing that these techniques around the world. Now,
Speaker 1: there's one thing that I want to add to this.
Speaker 1: We talked a little bit about it with Mary Uh.
Speaker 1: In the press release about this US penile transplant, they
Speaker 1: specifically said this will not be offered to transgender people
Speaker 1: for now. Now, I want to just touch on this
Speaker 1: a little bit because as we were reading Mary's book,
Speaker 1: obviously it was apparent that um, the science behind gender
Speaker 1: reassignment surgery has been used as sort of like a
Speaker 1: building block to get to where we are with these
Speaker 1: penile transplants. When I was twenty one, I read Kate
Speaker 1: Bornstein's Gender Outlaw and it it specifically describes the female
Speaker 1: to male gender reassignment surgery, and I immediately thought, when
Speaker 1: we were doing this research, well, it's it's clear that
Speaker 1: you know, there's a foundation there. Uh, and it seems
Speaker 1: to be the secret that no one's really talking about,
Speaker 1: I mean clearly in China and South Africa. Uh. And
Speaker 1: then in this most recent US case, it's it's it's
Speaker 1: not in the public press releases, right. But I think
Speaker 1: that it's fair to say that these medical teams uh
Speaker 1: did get some help at least or some some foundational
Speaker 1: work from the efforts that were done there. Yeah. Yeah,
Speaker 1: because the field of gender reassignment surgery definitely had an
Speaker 1: impact on our ability to treat eurotrauma wounds to the
Speaker 1: general area, and of course all this ends up playing
Speaker 1: directly and our ability to to graft a donor repeat
Speaker 1: it's not due recipient. Yeah, but I do agree with
Speaker 1: you it seems weird that that these contributions have not
Speaker 1: been highlighted more. Um, and there's just continued unwillingness perhaps
Speaker 1: to discuss, um sure, who should who should who should
Speaker 1: be open, who should be able to receive these procedures. Yeah,
Speaker 1: and given the controversy right now, especially like it's a
Speaker 1: hot button issue with transgender rights and bathrooms in North Carolina,
Speaker 1: you know, they these hospitals, they want to retain their funding.
Speaker 1: I get it, like it's a it's a pr move,
Speaker 1: but I think you know, for us covering this, it's
Speaker 1: only fair to be honest and say, you know, it
Speaker 1: seems like, uh, there was some foundational work there. Now
Speaker 1: there's also another topic that we don't have time for today,
Speaker 1: but maybe we'll be able to come back to in
Speaker 1: the future, which is the fact that there are actually
Speaker 1: artificially grown genitals that are being used and prepared for
Speaker 1: potential transplantation, both penises and vaginas. The vaginas actually successful,
Speaker 1: uh and have have been so for years. Um, But
Speaker 1: we don't really have time to dive into the science
Speaker 1: on that today. So if this is you know, something
Speaker 1: that's interesting to you listeners and you want to hear
Speaker 1: more about it, let us know and Robert and I
Speaker 1: can come back and maybe we'll do something on artificially
Speaker 1: grown organs and transling grown genitals. Who doesn't want to
Speaker 1: hear an episode on that. Yeah. Also, we're gonna be
Speaker 1: talking futuristically, so I feel like maybe that we'll be
Speaker 1: able to actually work in a little more humor as
Speaker 1: we distance it from some of the you know, the
Speaker 1: real life and often grim circumstances that require these procedures
Speaker 1: to begin with. Yeah, especially, man, let me tell you
Speaker 1: what they do to rabbits for this next time, next time,
Speaker 1: next time on Stuff to Blow Your Mind, the things
Speaker 1: they do to rabbits. All right, well, hey, in the meantime,
Speaker 1: check out the landing page for this episode on Stuff
Speaker 1: to Blow your Mind dot com. That's what you find,
Speaker 1: links out to some of the articles we mentioned here,
Speaker 1: links out to Mary's book, and you also find all
Speaker 1: the podcast episodes. You'll find blog post links to our
Speaker 1: social media accounts such as Facebook and Twitter. We are
Speaker 1: blow the Mind on both of those. We're also on Tumbler.
Speaker 1: We're also on Instagram. Yeah, and if you want to
Speaker 1: write us directly and tell us what you know about
Speaker 1: penile transplants or artificially grown organs or whatever, write us
Speaker 1: at blow the mind at how stuff works dot com.
Speaker 1: For more on miss in thousands of other topics is
Speaker 1: how stuff works dot com. Love,