WEBVTT - Listener Mail: Supernaut 0:00:02.960 --> 0:00:05.280 Welcome to Stuff to Blow Your Mind, a production of 0:00:05.360 --> 0:00:11.080 My Heart Radio. Hello, and welcome to Stuff to Blow 0:00:11.119 --> 0:00:14.160 Your Mind Listener Mail. I am Joe McCormick, and my 0:00:14.200 --> 0:00:17.040 regular co host Robert Lamb is off work the weekend 0:00:17.079 --> 0:00:20.480 recording this, So like last Monday, I'm gonna be recording 0:00:20.520 --> 0:00:24.400 another listener Mail episode, so low but never fear. Rob 0:00:24.440 --> 0:00:27.120 will be rejoining me and we'll have some fresh new 0:00:27.120 --> 0:00:31.600 episodes for you sometime later this week. But for today, 0:00:32.000 --> 0:00:34.159 I'm going to dive right into a few of the 0:00:34.200 --> 0:00:42.520 messages that you've sent in over the past cycle. Looks 0:00:42.560 --> 0:00:45.880 like this. First one comes from Chris. Chris says, hey, guys, 0:00:46.040 --> 0:00:48.920 love the show. Something that blew my mind recently has 0:00:48.960 --> 0:00:52.200 to do with evolution. Here it goes in the ancient 0:00:52.280 --> 0:00:57.080 timeline of life on Earth, sharks are older than trees. 0:00:57.760 --> 0:01:01.040 I always thought of plants as first. Knowing that sharks 0:01:01.040 --> 0:01:04.240 were swimming around for a hundred million years before there 0:01:04.280 --> 0:01:09.400 were even trees blew my mind. Thanks Chris, Chris. Yeah, 0:01:09.480 --> 0:01:12.080 I I love stuff like this. So to fill in 0:01:12.120 --> 0:01:15.479 some detail on this claim, I would say that this 0:01:15.560 --> 0:01:18.120 statement is true, though it depends a little bit on 0:01:18.200 --> 0:01:21.760 how strict your definitions of a shark are um there 0:01:21.800 --> 0:01:24.440 there's some debate, I guess, about what counts as evidence 0:01:24.480 --> 0:01:27.839 of the first shark. But for reference, I just looked 0:01:27.880 --> 0:01:31.720 up the timeline summarized by the Natural History Museum of London, 0:01:31.880 --> 0:01:35.640 and according to them, there are a few fossil scales 0:01:35.800 --> 0:01:39.800 that appear to come from shark like animals, dating all 0:01:39.840 --> 0:01:42.680 the way back to the Ordovician period, So that's four 0:01:42.760 --> 0:01:47.840 hundred and fifty million years ago, which is mind bogglingly old. 0:01:48.080 --> 0:01:52.360 The Ortivician is the first geologic period after the Cambrian, 0:01:52.480 --> 0:01:54.560 and if you remember, we've done episodes on this in 0:01:54.600 --> 0:01:58.480 the past, the Cambrian is when we first see the 0:01:58.560 --> 0:02:02.600 explosion in divers city of animal body plans, animal body 0:02:02.600 --> 0:02:06.040 plans with hard parts that leave fossil traces, and so 0:02:06.080 --> 0:02:09.080 this is the age of the triobytes, of course famously, 0:02:09.200 --> 0:02:14.359 but also these these amazing creatures like Anomala carress, this undulating, 0:02:14.560 --> 0:02:18.400 soft bodied predator with a ring shaped crusher mouth and 0:02:19.040 --> 0:02:23.360 little face tentacles that look like shrimp anomal a caress 0:02:23.360 --> 0:02:29.200 actually means anomalous shrimp or weird shrimp. And uh creatures 0:02:29.240 --> 0:02:33.440 like Hallucigenia, which is the wandering spike worm. Uh and 0:02:33.480 --> 0:02:36.000 so so that's the Cambrian. But then after that we 0:02:36.120 --> 0:02:38.720 enter the Ordovician period and there we yes, we do 0:02:38.800 --> 0:02:42.600 see evidence of scales, but not teeth. But the scales 0:02:42.720 --> 0:02:45.640 look like they may have belonged to some kind of 0:02:45.760 --> 0:02:51.040 ancestral shark or creature that that overtime became sharks. So 0:02:51.160 --> 0:02:53.440 that evidence is is a maybe. But then by the 0:02:53.440 --> 0:02:56.880 early Devonian period, about four and ten million years ago, 0:02:57.520 --> 0:03:01.480 there is clear fossil evidence of shark teeth from a 0:03:01.680 --> 0:03:07.080 fish called Dolotas problematicus, which was beginning to show some 0:03:07.120 --> 0:03:09.760 of the signs of shark like anatomy, such as in 0:03:09.800 --> 0:03:13.040 the teeth and the jaw. And there's another early shark 0:03:13.120 --> 0:03:15.760 from the Devonian that I was reading about that I 0:03:15.760 --> 0:03:19.000 think we don't know much about, but it's called Leonotas 0:03:19.400 --> 0:03:23.000 l e O n O d u s. And the 0:03:23.000 --> 0:03:25.440 the only thing that I could really find about this 0:03:25.480 --> 0:03:27.440 one had to do with its teeth. If you get 0:03:27.440 --> 0:03:29.880 a chance, you should look up the teeth of the 0:03:29.960 --> 0:03:34.200 Leonoda shark. These creatures were about four million years old, 0:03:34.760 --> 0:03:38.960 and its teeth are not the serrated triangles or or 0:03:39.000 --> 0:03:41.400 the murder spikes you might think of in in shark 0:03:41.480 --> 0:03:45.080 mouth today. These look like well they look like the 0:03:45.080 --> 0:03:47.400 devil horns. They look like somebody in a metal show 0:03:47.520 --> 0:03:50.080 they go, they throw up the devil horns. They're these 0:03:50.120 --> 0:03:54.040 little y shaped forks, which makes me wonder what kind 0:03:54.040 --> 0:03:56.480 of prey this animal was eating. What do you bite 0:03:56.520 --> 0:04:00.120 with a bunch of little spiky, y shaped forks? I 0:04:00.160 --> 0:04:03.720 don't know. But meanwhile, the evolution of trees is also 0:04:03.760 --> 0:04:07.200 an interesting subject. I think the first things we would 0:04:07.240 --> 0:04:11.800 identify as trees, meaning tall vascular plants on dry land 0:04:12.280 --> 0:04:15.240 with woody stems. These show up I think in the 0:04:15.280 --> 0:04:18.599 mid to late Devonian period, so maybe around three hundred 0:04:18.839 --> 0:04:21.760 ninety to three hundred and eighty million years ago, somewhere 0:04:21.760 --> 0:04:26.800 in that range. And in fact, the proliferation of land plants, 0:04:26.800 --> 0:04:30.599 including trees during the mid to late Devonian is one 0:04:30.880 --> 0:04:35.799 of the hypothesized causes of the big mass extinction event 0:04:35.839 --> 0:04:38.440 that happened at the end of the Devonian period. Now, 0:04:38.440 --> 0:04:40.320 of course, this is not a settled issue. There are 0:04:40.320 --> 0:04:43.560 a bunch of different ideas about what could have caused it. Uh, 0:04:43.640 --> 0:04:46.760 you know, you have the regular culprits, things like US 0:04:46.839 --> 0:04:51.320 impacts from space or a massive volcanic eruptions. Um. But 0:04:51.440 --> 0:04:54.200 at least one idea that has been advanced is that 0:04:54.279 --> 0:04:58.080 as the continents were covered in plants and forests during 0:04:58.120 --> 0:05:02.240 the Devonian and as as the land turn green, suddenly 0:05:02.279 --> 0:05:06.120 a large amount of the carbon in the atmosphere was removed. 0:05:06.640 --> 0:05:10.719 Because remember this really weird fact. Plants the parts of 0:05:10.880 --> 0:05:14.680 plants that is not water, that is mostly built out 0:05:14.720 --> 0:05:19.120 of atoms that were originally in the air. So carbon, 0:05:19.560 --> 0:05:22.880 the carbon in wood in a tree trunk comes from 0:05:23.040 --> 0:05:26.760 atmospheric c O two that plants ingest and then they 0:05:26.920 --> 0:05:31.120 use the energy from sunlight to power the chemical reaction 0:05:31.760 --> 0:05:34.719 uh we know as photosynthesis, So it reacts CEO two 0:05:34.720 --> 0:05:39.640 with water to produce carbohydrates and oxygen as a byproduct. 0:05:39.760 --> 0:05:43.160 So you have the proliferation of forests that might have 0:05:43.560 --> 0:05:46.799 removed a bunch of carbon from the atmosphere to cause 0:05:46.839 --> 0:05:51.000 a sort of anti greenhouse effect leading to deadly rapid cooling. 0:05:51.800 --> 0:05:54.240 But again, there are other possible explanations for the for 0:05:54.279 --> 0:05:58.200 the late Devonian extinctions, so we don't really know for sure. However, 0:05:59.160 --> 0:06:01.680 one last cool thing to notice when you put sharks 0:06:01.720 --> 0:06:03.960 and trees side by side, so it does look like 0:06:04.000 --> 0:06:07.480 the sharks came first. But the other thing to notice 0:06:07.520 --> 0:06:10.560 is that they both appear to have had a sort 0:06:10.560 --> 0:06:15.239 of flourishing age of diversification and dominance in the period 0:06:15.360 --> 0:06:19.160 right after the Devonian, which is known as the Carboniferous 0:06:19.160 --> 0:06:23.240 So the Carboniferous period lasted from roughly three hundred and 0:06:23.279 --> 0:06:26.880 sixty to about three hundred million years ago, and it 0:06:27.040 --> 0:06:30.040 is named after the fact that this is the geologic 0:06:30.120 --> 0:06:33.719 strata that we first find packed with lots of coal. 0:06:34.000 --> 0:06:38.320 Carboniferous means coal carrying or full of coal, and coal 0:06:38.520 --> 0:06:41.640 is of course a form of fossil carbon that came 0:06:41.760 --> 0:06:46.720 largely from dead plant matter, including trees, especially trees that 0:06:47.320 --> 0:06:51.440 grew in low lying wetlands and swamps. So in these 0:06:51.560 --> 0:06:54.800 vast uh you know, continents full of low lying wetlands 0:06:54.880 --> 0:06:58.760 and wet forests and swamps, you'd have plants dying they 0:06:58.760 --> 0:07:02.880 fall down there there, or carbon content it's fossilized into coal, 0:07:03.040 --> 0:07:05.880 and then of course in the industrial revolution we we 0:07:05.960 --> 0:07:08.440 dig that up and that that turns into the energy 0:07:08.520 --> 0:07:13.640 that powers the development of modern civilization. But the Carboniferous 0:07:13.680 --> 0:07:17.000 period is also sometimes called the Golden Age of sharks. 0:07:17.200 --> 0:07:19.880 That same article I was looking at by the by 0:07:19.880 --> 0:07:22.800 the London Natural History Museum referred to it as the 0:07:22.800 --> 0:07:27.240 Golden Age of sharks. There's a great question why did 0:07:27.280 --> 0:07:30.760 sharks thrive in this period? Why this great diversification of sharks? 0:07:30.800 --> 0:07:33.880 And that's not known for sure. But one idea that 0:07:33.960 --> 0:07:38.080 I was reading at a great website called Elasmo research 0:07:38.200 --> 0:07:41.520 dot org. That's a shark science website that I think 0:07:41.600 --> 0:07:45.080 is mostly or entirely authored by a marine biologist named 0:07:45.080 --> 0:07:47.960 our Aiden Martin. I was reading on that site the 0:07:48.040 --> 0:07:52.480 idea that possibly sharks thrived in this period because at 0:07:52.520 --> 0:07:56.080 the at the Late Devonian extinction, another group of marine 0:07:56.080 --> 0:08:01.480 predators called the plaquaderms were wiped out. The plaqueoderms, if 0:08:01.520 --> 0:08:04.080 you've never seen pictures of them, you should definitely look 0:08:04.120 --> 0:08:08.239 them up there. They're great. They were armored fishes fish 0:08:08.440 --> 0:08:12.000 fish you would see with like plates around their head 0:08:12.080 --> 0:08:15.840 and sort of plate like jaws and mouths. Uh So, 0:08:15.960 --> 0:08:19.240 one good one to look up is called dunk Leosteus 0:08:19.400 --> 0:08:22.640 d U N K l e O S t e 0:08:22.800 --> 0:08:26.360 U S. Dunk Leosteus. And if you can find an 0:08:26.360 --> 0:08:29.040 image with a human for scale, or even better, if 0:08:29.040 --> 0:08:32.120 you can stand next to an arrangement of their armored 0:08:32.160 --> 0:08:35.719 head plates in a museum. It's a nightmare. You know. 0:08:35.760 --> 0:08:38.360 I would much rather face down a great white shark 0:08:38.480 --> 0:08:40.800 or I don't know, maybe even a megalodon. Is something 0:08:40.840 --> 0:08:45.679 about it's it's it's terrifying and awesome. But but the 0:08:45.720 --> 0:08:49.280 idea is that maybe with the competition of these plaqueoderms 0:08:49.400 --> 0:08:51.240 gone because they were wiped out at the end of 0:08:51.240 --> 0:08:54.880 the Devonian, maybe then sharks could expand and fill new 0:08:54.960 --> 0:08:58.640 niches and diversify. So anyway, thanks for kicking this off, Chris, 0:08:58.679 --> 0:09:01.240 but I wanted to give you an another one. So, yes, 0:09:01.280 --> 0:09:04.200 it appears sharks are older than trees. But did you 0:09:04.240 --> 0:09:09.320 know that mammals are older than bees. As with the 0:09:09.360 --> 0:09:13.160 previous case, there's some debate about where where you should start, 0:09:13.240 --> 0:09:15.880 you know what, at what point on the lineage you 0:09:15.920 --> 0:09:18.880 should say, okay, now these are mammals, because of course 0:09:18.920 --> 0:09:20.920 mammals are part of a lineage going back to the 0:09:20.920 --> 0:09:23.920 synapsids that lived even before the dinosaurs, you know, the 0:09:23.960 --> 0:09:27.480 dimetrodon So again you could debate about the where the 0:09:27.520 --> 0:09:30.760 best place to put their beginning is. But small furry 0:09:30.840 --> 0:09:34.640 sort of rodent ish critters that we would probably recognize 0:09:34.679 --> 0:09:37.800 as mammals existed during the reign of dinosaurs, with a 0:09:37.880 --> 0:09:41.120 number of fossils from the Jurassic Period between about a 0:09:41.200 --> 0:09:44.280 hundred and fifty and two hundred million years ago. Meanwhile, 0:09:44.440 --> 0:09:47.120 bees pop up later I think closer to a hundred 0:09:47.160 --> 0:09:56.160 and thirty million years ago. Anyway, thank you, Chris. Okay, 0:09:56.200 --> 0:09:59.839 this next message comes from Steven and it's in Risk 0:10:00.000 --> 0:10:03.720 wants to the series we did on thirst. Steven says, 0:10:03.920 --> 0:10:07.760 Dear Joe and Rob. As a recent microbiology graduate, I 0:10:07.800 --> 0:10:11.160 was delighted when you started talking about rabies, the horse 0:10:11.200 --> 0:10:15.200 hair worm and their relationships with their hosts thirst, and 0:10:15.200 --> 0:10:17.240 I remember that this was in the context of us 0:10:17.280 --> 0:10:22.320 talking about ways that UH disease causing pathogens and parasites 0:10:22.400 --> 0:10:25.880 will alter the host behavior in order to help themselves 0:10:26.360 --> 0:10:29.240 spread or reach another part of their their life cycle. 0:10:29.360 --> 0:10:31.880 So in the same way that a respiratory infection will 0:10:31.920 --> 0:10:34.480 make you cough and sneeze and spit more of the 0:10:34.920 --> 0:10:38.440 germs onto other people to to to spread it around faster, 0:10:39.200 --> 0:10:44.400 the rabies virus causes a series of behavioral modifications that 0:10:44.400 --> 0:10:47.600 that help it spread through bite. So you get bitten 0:10:47.600 --> 0:10:50.960 by an animal with rabies um and the the infected 0:10:51.000 --> 0:10:53.559 saliva put some of the virus into your muscle tissue, 0:10:53.600 --> 0:10:56.840 it spreads to the nervous system. Uh that that is 0:10:56.920 --> 0:10:59.559 facilitated by the fact that rabies tends to cause a 0:10:59.640 --> 0:11:05.480 kind of confusion, irritability aggression in its later stages, and 0:11:05.720 --> 0:11:08.720 that it makes it hard for the host to swallow, 0:11:08.880 --> 0:11:12.840 so it can't the The person or animal that's infected 0:11:13.200 --> 0:11:16.960 has difficulty or even finds it impossible to drink water, 0:11:17.760 --> 0:11:20.560 un thus can't wash all this infectious saliva out of 0:11:20.559 --> 0:11:24.760 its mouth, so each bite is supercharged as a vector 0:11:24.960 --> 0:11:28.440 of new infection. But Steven goes on to say, I 0:11:28.440 --> 0:11:30.760 thought I would add to the conversation with another interesting 0:11:30.760 --> 0:11:35.080 parasite that hijacks our need for water. The guinea worm 0:11:35.320 --> 0:11:38.240 is a parasitic worm whose life cycle depends on close 0:11:38.280 --> 0:11:42.520 proximity to water. As larvae, they spend their developmental years 0:11:42.520 --> 0:11:46.000 in the stomachs of aquatic copa pods that try to 0:11:46.080 --> 0:11:49.840 eat them. It isn't until they're consumed by larger animals 0:11:49.920 --> 0:11:52.960 e g. Humans that they can bust through our stomach 0:11:53.040 --> 0:11:57.440 lining and develop into adulthood while taking residents just under 0:11:57.480 --> 0:12:01.240 our skin. However, once the alt worm has set up 0:12:01.280 --> 0:12:04.560 camp under our skin. How does it get larvae back 0:12:04.640 --> 0:12:07.839 out into the world to begin the cycle again? If 0:12:07.840 --> 0:12:10.600 I remember correctly, the best cure for this disease is 0:12:10.600 --> 0:12:13.320 a simple stick with a notch at the end. The 0:12:13.360 --> 0:12:16.600 worm's tail is inserted in the notch and spooled out 0:12:16.679 --> 0:12:19.360 of the patient, much like a noodle being twirled into 0:12:19.360 --> 0:12:22.319 a fork. Of course, one can use a coffee filter 0:12:22.440 --> 0:12:26.119 to remove copa pods from drinking water, preventing infection altogether. 0:12:26.960 --> 0:12:30.599 Thanks for making such an informative and entertaining podcast. Sincerely, 0:12:30.640 --> 0:12:36.080 Stephen PS. Rob is right. Rabies is effectively one fatal 0:12:36.120 --> 0:12:40.240 if not vaccinated against before symptoms come on. However, there 0:12:40.360 --> 0:12:43.760 is one case of rabies being cured by a procedure 0:12:43.800 --> 0:12:47.880 called the Milwaukee Protocol. It seemed to have been a fluke, though, 0:12:47.960 --> 0:12:50.280 but it's an interesting enough topic to read about when 0:12:50.320 --> 0:12:53.720 you get the time. Well, Stephen, thank you for the message. 0:12:53.720 --> 0:12:57.360 Actually did look into this into the Milwaukee Protocol, and 0:12:57.400 --> 0:13:02.320 I found an explanation in a paper called Failure of 0:13:02.360 --> 0:13:05.560 the Milwaukee Protocol and a Child with Rabies, published in 0:13:05.559 --> 0:13:10.080 Clinical Infectious Diseases in two thousand eleven by Angela Arum Burrow. 0:13:10.440 --> 0:13:15.839 At all. So this paper is looking at rabies encephalitis, 0:13:16.280 --> 0:13:19.160 and this is the phase of Raby's infection where the 0:13:19.280 --> 0:13:23.000 virus has reached the central nervous system. Now, remember the 0:13:23.080 --> 0:13:27.319 normal courses that you're probably bitten by an infected animals, 0:13:27.400 --> 0:13:29.760 say somewhere in the body, maybe on the hand, and 0:13:29.800 --> 0:13:33.360 then viral particles from the saliva of that animal get 0:13:33.400 --> 0:13:37.280 into your muscle tissue, they infect nerve cells, and then 0:13:37.280 --> 0:13:40.800 they climb gradually up the nerve pathways until they finally 0:13:40.840 --> 0:13:43.400 reached the spinal cord in the brain. Now, remember that 0:13:43.480 --> 0:13:47.479 Rabies typically has a long incubation period. There can potentially 0:13:47.480 --> 0:13:51.760 be months between the initial exposure and the onset of 0:13:51.840 --> 0:13:57.040 symptoms with encephalitis. Rabies encephalitis may in fact be one 0:13:57.080 --> 0:13:59.960 of the worst and most deadly diseases you could imagine, 0:14:00.040 --> 0:14:03.760 and but it is pretty much entirely preventable if you 0:14:03.800 --> 0:14:08.080 seek treatment immediately after you get bitten or otherwise exposed. 0:14:08.640 --> 0:14:11.680 And the treatment is referred to in the literature as 0:14:11.840 --> 0:14:16.120 post exposure prophylaxis or PEP. And in fact, we've got 0:14:16.160 --> 0:14:18.840 some more listener mail coming up in a bit with 0:14:19.200 --> 0:14:22.920 direct experience with PEP. But anyway, the authors of this 0:14:22.960 --> 0:14:26.800 paper from two thousand eleven right that before two thousand four, 0:14:27.520 --> 0:14:31.640 there were only five documented cases of anyone ever surviving 0:14:31.760 --> 0:14:35.480 rabies and sephalitis, and all five of them were people 0:14:35.560 --> 0:14:39.240 who received some form of PEP, though they ended up 0:14:39.280 --> 0:14:44.360 reaching the encephalitis phase because the prophylaxis was maybe incomplete 0:14:44.440 --> 0:14:47.680 or late. But in the year two thousand four, some 0:14:47.800 --> 0:14:51.880 doctors reported the first ever survival of rabies and sephalitis 0:14:51.960 --> 0:14:55.560 without any PEP. This was in a child who had 0:14:55.560 --> 0:14:58.640 received what they called the Milwaukee Protocol, which is a 0:14:58.640 --> 0:15:02.520 combination h that they describe the following way. They say, 0:15:02.560 --> 0:15:09.080 it's quote therapeutic coma, anti viral therapy, cerebral vaseo spasm management, 0:15:09.160 --> 0:15:13.640 and avoidance of immunization. Now, unfortunately, it looks to me 0:15:13.800 --> 0:15:17.040 like attempts to reproduce this outcome in other patients have 0:15:17.120 --> 0:15:19.960 all failed, including in the case documented in this two 0:15:20.040 --> 0:15:23.480 thousand eleven paper. They tried the Milwaukee protocol, it didn't work. 0:15:23.640 --> 0:15:27.400 So it's possible that, as Stephen says, the time it 0:15:27.760 --> 0:15:29.760 looked like it worked in two thousand four, was some 0:15:29.840 --> 0:15:32.120 kind of outlier or some kind of fluke and and 0:15:32.160 --> 0:15:35.920 not a demonstration of any underlying usefulness in the therapy 0:15:36.200 --> 0:15:39.200 um and I've actually seen at least one more recent 0:15:39.240 --> 0:15:50.880 paper just discouraging its use altogether. We've got another message 0:15:51.360 --> 0:15:55.120 from Nate concerning treatment for rabies, and it goes like this, 0:15:55.840 --> 0:15:58.160 Robert and Joe love the show. I was listening to 0:15:58.200 --> 0:16:01.160 your episodes on Thurst and thought i'd share my experience 0:16:01.200 --> 0:16:05.600 with the rabies vaccine. Back in I had contact with 0:16:05.640 --> 0:16:08.800 a bat that found its way into my condo. I 0:16:08.840 --> 0:16:11.160 got it out of my place and wasn't too worried 0:16:11.200 --> 0:16:14.760 about it until my friend described how terrible rabies really is. 0:16:15.240 --> 0:16:17.760 I'm relatively certain that I wasn't bitten, but I went 0:16:17.800 --> 0:16:20.640 to the doctor anyway. The doctor decided to give me 0:16:20.680 --> 0:16:23.760 the vaccine to be cautious. The vaccine consisted of one 0:16:23.800 --> 0:16:26.480 shot in each arm and one shot in each thigh, 0:16:26.920 --> 0:16:29.800 followed by three more follow up visits with one shot 0:16:29.800 --> 0:16:32.640 in the arm. The first few days after the initial dose, 0:16:32.680 --> 0:16:35.440 I started to feel some flu like symptoms. Flu like 0:16:35.520 --> 0:16:38.640 symptoms also happened to be the early signs of rabies. 0:16:39.000 --> 0:16:41.760 At that time, I wasn't aware that vaccine side effects 0:16:41.800 --> 0:16:45.080 are relatively common, so that resulted in a pretty stressful 0:16:45.080 --> 0:16:48.280 couple of days. However, after the side effects went away, 0:16:48.640 --> 0:16:52.040 everything was good. Then my bill arrived for the vaccine. 0:16:52.200 --> 0:16:55.320 The pre insurance cost listed on the bill was thirty 0:16:55.440 --> 0:16:59.720 seven thousand dollars. It was so unbelievable that seven shots 0:16:59.760 --> 0:17:03.240 could be listed anywhere near that price. Luckily, my insurance 0:17:03.280 --> 0:17:06.119 covered most of it, but I still ended up paying 0:17:06.119 --> 0:17:09.800 about sevent dollars for the vaccines. I'm sure this pales 0:17:09.840 --> 0:17:13.280 in comparison with some other drugs, such as treatments for 0:17:13.400 --> 0:17:16.200 cancer and HIV and so forth, but it was pretty 0:17:16.200 --> 0:17:19.920 mind blowing how expensive it was. It's not the wildest story, 0:17:19.960 --> 0:17:22.480 but just thought i'd share. You guys have a great show. 0:17:22.520 --> 0:17:26.840 Thanks for all the entertainment over the last few years. Nate, Well, Nate, 0:17:27.119 --> 0:17:28.960 I'm I'm glad to hear you all right now. I'm 0:17:29.040 --> 0:17:31.240 I'm very glad in any case, that you didn't get 0:17:31.320 --> 0:17:34.359 rabies and cephalitis and uh. And obviously it's good that 0:17:34.359 --> 0:17:37.880 you had health insurance, but that that is an astonishing bill. 0:17:38.680 --> 0:17:41.679 I actually looked into this topic a bit, and I 0:17:41.800 --> 0:17:45.720 found an article exploring exactly this question, like why is 0:17:45.840 --> 0:17:49.760 rabies prophylaxis so expensive and why does the cost of 0:17:49.800 --> 0:17:53.399 it very so much so. This was an article called 0:17:53.480 --> 0:17:56.440 why a simple life saving raby shot can cost ten 0:17:56.520 --> 0:18:01.080 thousand dollars in America published in vox In by the 0:18:01.200 --> 0:18:04.000 healthcare reporter Sarah Cliff. I think she's at the New 0:18:04.080 --> 0:18:06.320 York Times now, but I've read a number of her 0:18:06.400 --> 0:18:09.240 articles about health healthcare in the US and uh and 0:18:09.280 --> 0:18:13.000 they're good. But in this article, so the background is 0:18:13.040 --> 0:18:15.359 that apparently there are just a lot of cases in 0:18:15.400 --> 0:18:19.600 the US where people end up in medical debt after 0:18:19.680 --> 0:18:23.399 a possible rabies exposure. And the article starts with the 0:18:23.400 --> 0:18:25.920 story of a college student who literally had a bat 0:18:26.040 --> 0:18:29.240 fly into her mouth while she was trying to shoot 0:18:29.280 --> 0:18:32.159 it out of her apartment. Uh. So she goes to 0:18:32.160 --> 0:18:35.920 an urgent care and there they describes what happened. They 0:18:35.960 --> 0:18:38.760 refer her to an emergency room for treatment. This was 0:18:38.800 --> 0:18:41.640 somewhere in New Hampshire. And then in the end, the 0:18:41.720 --> 0:18:44.399 bills she got for the full treatment was over six 0:18:44.440 --> 0:18:48.280 thousand dollars. And somehow this is on the low end 0:18:48.560 --> 0:18:51.159 of the cost range for for rabies p EP in 0:18:51.160 --> 0:18:54.840 the United States. The article claims that many bills are 0:18:54.840 --> 0:18:57.320 in the range of ten thousand dollars which of course 0:18:57.400 --> 0:19:01.520 is enormous, but obviously nowhere near your UH pre insurance 0:19:01.600 --> 0:19:04.239 bill of thirty seven thousands. So I really don't know 0:19:05.200 --> 0:19:08.200 what makes the difference in your case, especially since US 0:19:08.240 --> 0:19:12.679 healthcare costs are often rather opaque UM. But according to Cliff, 0:19:13.400 --> 0:19:16.399 the main itemized cost of these treatments is usually a 0:19:16.480 --> 0:19:21.480 drug called immunoglobulin, which is designed to slow the spread 0:19:21.560 --> 0:19:24.840 of the rabies virus in its progression towards the central 0:19:24.840 --> 0:19:27.760 nervous system, which gives the body time to learn from 0:19:27.760 --> 0:19:32.560 the vaccine and fight the infection. And UH immunoglobulin is 0:19:32.680 --> 0:19:36.240 allegedly expensive to produce because it has to be manufactured 0:19:36.320 --> 0:19:39.520 using human blood, which has to be pre screened for disease. 0:19:39.560 --> 0:19:42.479 So I guess it's a complicated process. But there are 0:19:42.480 --> 0:19:45.879 other major expenses for rabies treatment, sometimes because you have 0:19:45.960 --> 0:19:49.040 to go for multiple follow up visits and so there 0:19:49.040 --> 0:19:51.960 can be these hospital facility fees which get charged to 0:19:52.040 --> 0:19:54.359 people for showing up in the emergency room or at 0:19:54.359 --> 0:19:57.520 the clinic multiple times. But based on what this article 0:19:57.600 --> 0:19:59.800 describes it, it just seems like, you know, it's a 0:19:59.800 --> 0:20:01.879 say situation where the patient is kind of in a bind, 0:20:02.000 --> 0:20:05.000 like if you have potentially been exposed to rabies, you 0:20:05.160 --> 0:20:08.520 have to get the treatment. You really need these vaccines 0:20:08.560 --> 0:20:12.480 because they're extremely effective and untreated rabies is basically a 0:20:12.560 --> 0:20:15.920 hundred percent fatal, so you can't afford to just roll 0:20:16.000 --> 0:20:18.520 the dice and hope you won't get it. Uh. So 0:20:18.800 --> 0:20:21.159 it seems like drug manufacturers here have a lot of 0:20:21.240 --> 0:20:24.240 leeway in what they can charge and still sell plenty 0:20:24.240 --> 0:20:26.879 of the drugs. So apparently the same drug can have 0:20:27.040 --> 0:20:30.520 wildly different prices depending on where you get it. Cliffs 0:20:30.600 --> 0:20:34.640 article compares costs of identical rabies drugs in the US 0:20:34.720 --> 0:20:37.240 and other countries, and the ones in the US are 0:20:37.800 --> 0:20:40.800 sometimes like six times more than what the same drug 0:20:40.880 --> 0:20:43.760 costs in the UK. Though obviously in the UK, uh, 0:20:44.000 --> 0:20:46.399 there's another difference, which is the government will cover the 0:20:46.440 --> 0:20:49.840 direct cost to the drug rather than the patient. Um. 0:20:49.880 --> 0:20:51.879 But anyway, to come back on this, though, that is 0:20:51.920 --> 0:20:54.520 a pretty unpleasant state of affairs that you can end 0:20:54.600 --> 0:20:56.760 up with like a ten thousand dollar bill there. Uh, 0:20:57.000 --> 0:21:00.240 you shouldn't let that discourage you from seeking treatment if 0:21:00.240 --> 0:21:02.840 you think you might have been exposed to rabies, because again, 0:21:02.960 --> 0:21:06.760 untreated rabies always ends in death, and it's a horrible death. 0:21:06.840 --> 0:21:08.679 So if you think it's possible, you've got to get 0:21:08.720 --> 0:21:11.120 to a doctor as soon as you can. But anyway, 0:21:11.200 --> 0:21:13.639 this whole story reminded me of something else I was 0:21:13.680 --> 0:21:17.560 reading about recently, which is a totally different but complementary 0:21:17.560 --> 0:21:23.199 approach to fighting the impact of rabies on on on 0:21:23.280 --> 0:21:28.080 human society. And this intervention is attempting to intervene before 0:21:28.240 --> 0:21:34.800 infection occurs by vaccinating wild animals against rabies. So in 0:21:34.840 --> 0:21:37.960 the United States, most people who are exposed to the 0:21:38.040 --> 0:21:41.439 rabies virus apparently get it from domestic animals like cats 0:21:41.480 --> 0:21:45.239 and dogs, which in turn get infected through encounters with 0:21:45.320 --> 0:21:49.960 wild animals like raccoons, skunks, bats, coyotes, and foxes. So 0:21:50.000 --> 0:21:53.240 at any given time, the vast majority of disease carriers 0:21:53.320 --> 0:21:57.600 are not humans or domestic animals, but wild animals um 0:21:57.720 --> 0:21:59.760 And so if you could cut down on the rates 0:21:59.760 --> 0:22:03.960 of an infection among wild animals, that would downstream cut 0:22:04.000 --> 0:22:07.360 down on the rates of infection and exposure among domestic 0:22:07.400 --> 0:22:10.160 animals and humans. So I was reading about a series 0:22:10.200 --> 0:22:13.600 of programs by the U. S Department of Agriculture, Animal 0:22:13.680 --> 0:22:17.320 and Plant Health Inspection Service Wildlife Services. That's a lot 0:22:17.359 --> 0:22:22.480 of words to essentially seed the wilderness with bait containing 0:22:22.760 --> 0:22:26.800 oral rabies vaccine UH and note that this type of 0:22:26.840 --> 0:22:29.720 vaccine is not nearly as expensive as the UH the 0:22:29.720 --> 0:22:33.679 full human p EP course. But to read from the U. 0:22:33.760 --> 0:22:37.960 S d A website on this program, quote oral rabies 0:22:38.040 --> 0:22:42.000 vaccination or o r V bait is distributed to wildlife 0:22:42.000 --> 0:22:45.280 in targeted areas. This edible bait consists of a satchet 0:22:45.960 --> 0:22:51.800 or plastic packet containing the raboral VRG rabies vaccine. To 0:22:51.880 --> 0:22:55.080 make the bait attractive to wildlife, the sachets containing the 0:22:55.160 --> 0:22:59.359 vaccine are sprinkled with fishmeal coating, or encased inside hard 0:22:59.400 --> 0:23:02.480 fish meal polymer blocks about the size of a matchbox. 0:23:03.119 --> 0:23:06.719 Each year, w S I guess it's Wildlife Services and 0:23:06.760 --> 0:23:11.280 cooperators distribute about six point five million bits in selected 0:23:11.320 --> 0:23:15.280 states to create a zone where raccoon rabies can be contained. 0:23:15.920 --> 0:23:18.400 And I think they've been doing programs like this since 0:23:18.440 --> 0:23:21.560 the nineties. They claim that for every dollar spent on 0:23:21.640 --> 0:23:24.560 the wild r V program, and estimate of somewhere between 0:23:24.640 --> 0:23:28.400 four dollars and thirteen dollars are saved in costs associated 0:23:28.440 --> 0:23:31.880 with rabies transmission into into humans and domestic animals down 0:23:31.880 --> 0:23:39.879 the line, So that sounds like a great intervention. Okay. 0:23:39.920 --> 0:23:42.720 One last response to our episodes on thirst. This one 0:23:42.800 --> 0:23:46.600 comes from Kenny. Kenny says, Hi, Rob and Joe. I 0:23:46.640 --> 0:23:49.800 really enjoyed the first two episodes on thirst. I particularly 0:23:49.880 --> 0:23:52.639 like the discussion around the neural and endocrine systems the 0:23:52.680 --> 0:23:56.680 body uses to maintain the osmolarity of our blood. Since 0:23:56.720 --> 0:23:58.800 you only had time to touch on this, I thought 0:23:58.800 --> 0:24:01.000 I would write in about the mechanism by which the 0:24:01.080 --> 0:24:05.639 kidneys helped to regulate blood volume and osmotic concentration. I 0:24:05.640 --> 0:24:07.720 know it's an odd thing to find mind blowing, but 0:24:07.760 --> 0:24:10.240