Speaker 1: How the extraordinaries. In a prior episode, we took a
Speaker 1: historic look at cholera, and just like before, you should
Speaker 1: keep in mind that cholera is a pretty awful disease,
Speaker 1: so we'll be discussing both disturbing symptoms and death. But
Speaker 1: today we're taking a more modern approach. We'll talk about
Speaker 1: what we've learned about how vibrio cholera goes about inducing
Speaker 1: catastrophic diarrhea, where these bacteria can be found when they're
Speaker 1: not wreaking havoc upon our intestines, and the methods we
Speaker 1: use to treat cholera. We'll also take a short foray
Speaker 1: through the colossally bad ideas we've had for treating cholera,
Speaker 1: because wow, we've tried out some really bad ideas. Welcome
Speaker 1: to Daniel and Kelly's Extraordinary Universe.
Speaker 2: Hi Daniel, I'm a particle physicist and I just installed
Speaker 2: bedezs and every toilet in my house.
Speaker 3: Hello.
Speaker 1: I'm Kelly Waiter Smith. I Uh, I feel like I
Speaker 1: didn't need to know that.
Speaker 2: Starting with the toilet and information at the very top.
Speaker 1: I don't feel like I needed to know that about your.
Speaker 2: Are we talking about diarrhea today?
Speaker 3: Sure?
Speaker 1: But that doesn't have to be connected to beidets. I
Speaker 1: encountered my first bidet when I lived in Davis, California,
Speaker 1: and I went to a sushi restaurant and I was like,
Speaker 1: what is this my Why do toilets need buttons? And
Speaker 1: then I was like, I pushed a button. I was like, whoa, whoa,
Speaker 1: And I don't know that I need a bidet in
Speaker 1: my house.
Speaker 2: I see, well, I just came back from two weeks
Speaker 2: in Japan and Korea, and so I experienced toilets with
Speaker 2: control panels, and I pressed that button and I went, whoa, whoa.
Speaker 1: I gotta say, this makes me wish we had we
Speaker 1: were releasing videos so that people can see the face
Speaker 1: that you made. Although maybe it's better we don't.
Speaker 2: No, yeah, exactly, everybody makes that face in private in
Speaker 2: the bidet, you know. And it turns out it's actually
Speaker 2: quite easy to turn your toilet into a bidet.
Speaker 1: Wow. Is the water heated or is it cold?
Speaker 2: Yes? Nice warm, toasty water, yes, exactly.
Speaker 1: Okay, So actually it was your trip to Asia that
Speaker 1: made you come home and add bidets to all your Okay, Yeah.
Speaker 2: I was like, wow, we are still using a very
Speaker 2: archaic form of this technology, it can be made much
Speaker 2: more pleasant. Why don't we do that? Oh my gosh,
Speaker 2: it's like eighty dollars, let's do it.
Speaker 1: Man. You know there are some people who are all like, man,
Speaker 1: it's a shame that cultures are homogenizing, and you're all like, no,
Speaker 1: this is great. We should be taking stuff from Asian cultures.
Speaker 1: We should be given stuff to them. They've got McDonald's.
Speaker 1: Why don't we have bidets?
Speaker 2: Yeah, I mean ask yourself this question. If you got
Speaker 2: peanut butter on a shag car, but would you just
Speaker 2: wipe it up with a piece of paper?
Speaker 1: No? No, I would.
Speaker 2: Well, Okay, there you go, there you go. I think
Speaker 2: we know the relevance of that example.
Speaker 1: Yes, we do. Thank you for choosing peanut butter and
Speaker 1: rooting peanut butter for me. I think it's time we
Speaker 1: move on, all.
Speaker 2: Right, and don't think about me next time you're having
Speaker 2: peanut butter.
Speaker 1: Thanks Daniel. Thanks all right. So in the last episode,
Speaker 1: we talked about the work that John Snow did to
Speaker 1: help us understand how cholera gets to people the fecal
Speaker 1: oral route passing through water into our mouths unfortunately, and
Speaker 1: today we're going to talk a little bit about the
Speaker 1: science that has been done in the one hundred plus
Speaker 1: years since to help us better understand what cholera is
Speaker 1: doing to our bodies and help us to treat people
Speaker 1: who have encountered the bacteria that causes cholera so that
Speaker 1: we can save their lives exactly.
Speaker 2: And so it's going to be a whole episode full
Speaker 2: of too much information.
Speaker 1: That is my specialty. Okay, So before we really dig in,
Speaker 1: I want to remind everybody that in the last Cholera
Speaker 1: episode I mentioned that we're actually in the middle of
Speaker 1: an ongoing cholera pandemic. And my sense is that most
Speaker 1: of us don't realize that because we're lucky enough to
Speaker 1: not have to hear about or deal with cholera on
Speaker 1: a daily basis. So I asked the extraordinaries, when did
Speaker 1: the most recent cholera pandemic, that is, the seventh cholera
Speaker 1: pandemic end? So let's go ahead and hear their answers.
Speaker 2: Cholera pandemic. I have no idea, Sorry, no answer, Kelly,
Speaker 2: I never heard of cholera pandemics. Please educate me on that.
Speaker 4: HI A bit of a guess, but I would reckon.
Speaker 4: The most recent cholera academic probably ended in the nineteen thirties,
Speaker 4: sometime after the end of the First World War. I
Speaker 4: don't remember any cholera event, so I'm going to say
Speaker 4: before I was born it ended nineteen sixty eight.
Speaker 3: If you asked like that, I would say it's ongoing.
Speaker 4: But I really don't have any idea.
Speaker 2: Just guessing here. In the nineteen twenties.
Speaker 3: Colera pandemic, and there's been several I have no idea
Speaker 3: when it ended, but I sure hope it was a
Speaker 3: while ago and that there are few possibilities of it
Speaker 3: coming back. But given the show, I'm a little bit concerned.
Speaker 2: Since there are still many parts in the world with
Speaker 2: questionable sanitization, I would guess like last year. Maybe my
Speaker 2: wild guess here is that the most recent cholera pandemic
Speaker 2: is still happening.
Speaker 4: I have no idea. I don't even know when it started.
Speaker 2: Maybe it hasn't ended yet.
Speaker 1: When did the most recent colera pandemic? And I don't know,
Speaker 1: but I think maybe it ended when they learned to
Speaker 1: treat the water that was causing a color.
Speaker 2: I don't know, but probably much more recently than one
Speaker 2: would guess maybe in the nineteen sixties.
Speaker 1: Okay, So as we sort of suspected not a lot
Speaker 1: of awareness that we're in the middle of a cholera
Speaker 1: pandemic because it's not really part of our lives if
Speaker 1: you happen to be living in a place, you know,
Speaker 1: like the United States, for example.
Speaker 2: So remind us Kelly, cholera. It's a virus, it's a bacteria,
Speaker 2: it's a pathogen. What is it?
Speaker 1: It is a bacteria. And so it is a bacteria
Speaker 1: that gets into the water. And for you to get cholera,
Speaker 1: you need to ingest a lot of it. So if
Speaker 1: you just sow, something like a million or maybe one
Speaker 1: hundred million need to be ingested for you to get sick,
Speaker 1: and Daniel.
Speaker 2: One hundred million, one hundred.
Speaker 1: Million, And so you might think, how would you accidentally
Speaker 1: ingest one hundred million cholera bacteria? Right?
Speaker 2: Is that like ten liters of cholera leased water.
Speaker 1: Now it turns out that in like a regular cup
Speaker 1: of water, you could have something like two hundred million
Speaker 1: cholera bacteria and you probably wouldn't detect them in there
Speaker 1: because they're pretty tiny and the glass like wouldn't look cloudy.
Speaker 1: So you probably wouldn't know, but if you.
Speaker 2: Put them under a microscope, you could probably see them.
Speaker 1: Or yeah, yeah, but you know, how often do you
Speaker 1: put your water under a microscope?
Speaker 2: Yeah? Never, never from now on? Always but never.
Speaker 1: All right, But so Daniel, like, you know, a million
Speaker 1: to one hundred million before you get sick. How do
Speaker 1: you think we know that?
Speaker 2: Because people tried it on themselves, not.
Speaker 1: Tried it on themselves, but tried it on prisoners. But
Speaker 1: the prisoners they signed consent forms. And so this was
Speaker 1: the experiment that I read was done on a prison
Speaker 1: population in Maryland, and they signed consent forms and they
Speaker 1: were told that they could stop the experiment at any time,
Speaker 1: and they were very carefully watched by physicians, and as
Speaker 1: soon as they started to show symptoms, they were you know,
Speaker 1: brought into an environment where they were treated very carefully
Speaker 1: and they were watched very carefully. This was done in
Speaker 1: the seventies.
Speaker 2: Wow, would that pass modern day i RB standards?
Speaker 1: So we actually do continue to infect people with cholera today,
Speaker 1: and we're going to talk about that later.
Speaker 2: Yeah, don't we know enough? We're still doing this to people.
Speaker 1: We are still doing this to people. Wow, hold your
Speaker 1: breath hold your cheeks. We're still gonna be talking about
Speaker 1: this later.
Speaker 2: So I just hope those poor people have access to
Speaker 2: a bidet. Yeah, yeah, so they can feel clean and
Speaker 2: fresh after.
Speaker 1: Work, I guess in that. Yeah, I'm behind bidets in
Speaker 1: that situation, all right, Yeah, yeah, you're getting me on
Speaker 1: the same page. I guess so. But another thing that
Speaker 1: we learned from these this prison population is that actually
Speaker 1: it turns out cholera is really susceptible to acid. So like,
Speaker 1: if your stomach is particularly acidic at the moment, the
Speaker 1: cholera bacteria are much more likely to die. So even
Speaker 1: if you ingest something like one hundred million bacteria and
Speaker 1: your stomach is having like a particularly acidic day, you
Speaker 1: might not get cholera.
Speaker 2: Wow. So cholera is a bacteria. You got ingested billions
Speaker 2: of them. A lot of them die in your stomach.
Speaker 2: Where do they end up setting up camp?
Speaker 1: The small intestine? And I'll note now that when we
Speaker 1: do experiments with people to try to study cholera, we
Speaker 1: give them something that makes their stomach a more basic environment.
Speaker 1: So maybe you'll take some like sodium bicarbonate along with
Speaker 1: your cholera bacteria. Wow, so you ingest a bunch of them,
Speaker 1: and then they go through your stomach. Some of them survive,
Speaker 1: and then they get to your small intestine. The color
Speaker 1: of bacteria have a flagella, and so this is like
Speaker 1: a really long whip like appendage, and they use that
Speaker 1: flagella to try to get through the mucus that lines
Speaker 1: your small intestine. And so they like run into your
Speaker 1: mucus and they start shaking their butts and they're trying
Speaker 1: to get through the mucus so that they can get
Speaker 1: to the cells that line your intestine.
Speaker 2: But I thought the flagellum is like a propeller. You
Speaker 2: have it at the back to push you somewhere, like
Speaker 2: you know, like the motor on a boat, but here
Speaker 2: they're sort of like backing in. They're using it like
Speaker 2: a drill.
Speaker 1: No no, so they sorry, they run in headfirst. Oh yeah,
Speaker 1: and then they're using it to try to like corkscrew
Speaker 1: their way in.
Speaker 2: Got it.
Speaker 1: Yeah, Okay, So they keep going until they hit the
Speaker 1: cells of your intestine. And once they hit those epithelial cells,
Speaker 1: they sort of like cement themselves down and they start
Speaker 1: to replicate. And so now they've got these little batches
Speaker 1: that are replicating and they start producing.
Speaker 2: A toxin, and so they somehow know where to go,
Speaker 2: like they are looking for this. They're not just swimming
Speaker 2: in all random directions and the ones that end up
Speaker 2: there set up camp. They're like all heading in that direction.
Speaker 1: They are all heading in that direction.
Speaker 2: Wow, that's a little creepy.
Speaker 1: It is creepy. Yeah, Bacteria and viruses and things that
Speaker 1: we might think of as not being very smart can
Speaker 1: do pretty smart things.
Speaker 2: They seem more like aware of the environment that I imagined.
Speaker 2: Very cool. So then they start to replicate.
Speaker 1: Yeah, so then they start to replicate, and while they're replicating,
Speaker 1: they start producing a toxin. And this toxin is what
Speaker 1: is massively the problem for cholera se. So this toxin
Speaker 1: finds a way of like binding with your intestinal cells
Speaker 1: and it gets taken up by your intestinal cells, and
Speaker 1: when it's inside your intestine cells, it messes with your
Speaker 1: cells and it starts to mess with your what we
Speaker 1: call asmotic balance. But essentially, the way your body makes
Speaker 1: sure that you are extracting water from the small intestine
Speaker 1: to go into your body is by having different concentrations
Speaker 1: of ions on either side of the inside of your
Speaker 1: intestine and in your body.
Speaker 2: So without getting too much into the chemistry, essentially you
Speaker 2: want the water passing through the small intestines to be
Speaker 2: less salty than the water in your body, so that
Speaker 2: it then comes into your body to balance the salinity. Right,
Speaker 2: isn't that the way it works?
Speaker 1: Yep, that's exactly right. But then after this toxin gets
Speaker 1: taken up by your body, that changes, and now your
Speaker 1: intestine is saltier and the water in your body starts
Speaker 1: getting dumped into your intestine and you start losing massive
Speaker 1: amounts of water from your body, like we talked about
Speaker 1: in the last episode.
Speaker 2: And is this good somehow for the cholorobacteria. Are they
Speaker 2: doing this in order to affect something which is positive
Speaker 2: for them, or so that you'll have massive diarrhea which
Speaker 2: spreads them or is this just like a random accidental
Speaker 2: byproduct that they don't even care about.
Speaker 1: So once you start losing this massive amounts of water,
Speaker 1: the bacteria that have been replicating like crazy release themselves
Speaker 1: from the outside of the cells and they get back
Speaker 1: into the environments. And so in this way they managed
Speaker 1: to get back out so they can go off and
Speaker 1: infect someone else I see.
Speaker 2: So it's definitely a part of their cycle. It's not
Speaker 2: just an incidental thing.
Speaker 1: It is easy to imagine how it could benefit the bacteria.
Speaker 1: So I do think it seems to be a beneficial.
Speaker 2: Thing that makes me feel better somehow, because if our
Speaker 2: suffering and death was just like, well, we don't even
Speaker 2: really care and we're accidentally doing this thing that kills you,
Speaker 2: that would feel more tragic somehow.
Speaker 1: Yeah, I guess, So I guess if no one's benefiting
Speaker 1: from it, but I guess I don't. Maybe. But Okay,
Speaker 1: so here's something that kind of blew my mind. And
Speaker 1: maybe you already know this, given who you're married to,
Speaker 1: and maybe I've just given away the punchline by saying that.
Speaker 1: But these genes that produce the toxin, I want to
Speaker 1: guess where they came from Mars Mars.
Speaker 2: Wait wait, no, eight, there was a Katrina related clue here,
Speaker 2: So it's gotta be a virus. Is it a virus?
Speaker 1: It's a bacteria phage. Yeah, that's right, that's where well,
Speaker 1: and you probably read the outline. So it looks like
Speaker 1: there were two different bacteria phages that infected Vibrio cholera.
Speaker 1: At some point. One of those bacteria phages I believe
Speaker 1: gave the bacteria the ability to cling to the outside
Speaker 1: of the intestinal cells so that they could like form
Speaker 1: those mats and start replicating, and the other one gives
Speaker 1: them the ability to make these toxins. And so without
Speaker 1: this bacteria phage, Vibrio cholera would not be this like
Speaker 1: human scourge that And did you catch that? I said
Speaker 1: scourge right? I didn't say it right in the smallpox episode,
Speaker 1: but I learn when the listeners write in lots of
Speaker 1: emails about how I'm not pronouncing things right.
Speaker 2: Gold star for Kelly makes everyone. But that's amazing that
Speaker 2: this is virus power and it's like virus engineered. But
Speaker 2: for those of you who don't remember, a lot of DNA,
Speaker 2: including human DNA, is affected by viruses. Viral infections in
Speaker 2: years past have altered our DNA, and some of our
Speaker 2: essential functions come from DNA that essentially was injected into
Speaker 2: the record by viruses, and that's true also for bacteria.
Speaker 2: It's incredible.
Speaker 1: It is incredible. But okay, so I feel like this
Speaker 1: begs the question what was Vibrio cholera doing before these
Speaker 1: viruses came along? And it turns out that this question
Speaker 1: is really important for trying to figure out how you
Speaker 1: can control cholera around the world, and it's also important
Speaker 1: for trying to understand what colera is doing when it's
Speaker 1: not in our body right. And so the answer is
Speaker 1: that Vibrio cholera is a bacteria that you find in
Speaker 1: aquatic ecosystems like all over the world. This is just
Speaker 1: an aquatic bacteria that you find living on zoplankton, like copapods,
Speaker 1: you find it living on like aquatic plants. This is
Speaker 1: just an aquatic bacteria that is totally happy outside of
Speaker 1: our bodies, living in aquatic ecosystems. You find it in
Speaker 1: the Gulf Coast, you can find it in Lake Erie,
Speaker 1: you can find it in the Ganges. It's just a
Speaker 1: happy bacteria out there that every once in a while
Speaker 1: ends up in a human body. So it looks like
Speaker 1: there's lots of different strains of this bacteria. Some strains
Speaker 1: don't have these toxin genes, so if you swallowed one
Speaker 1: hundred million of them, nothing would happen. Other strains cause
Speaker 1: some like tummy issues, but nothing on the level of
Speaker 1: like cholera. But some of them cause pandemic cholera. And
Speaker 1: so like there's lots of different Wow kinds of Fibrio
Speaker 1: cholera that differ in how bad they are for us,
Speaker 1: but you know they're out in our waterways.
Speaker 2: So these were basically weaponized by these viruses. So the
Speaker 2: story isn't this cholera infects you and uses you to
Speaker 2: make more of it. It's this virus took over this
Speaker 2: bacteria and instructed this bacteria to infect you to make
Speaker 2: more of the bacteria, which in effect is making more
Speaker 2: of the original virus DNA.
Speaker 1: Yeah, I mean that sounds a bit more directed than
Speaker 1: it probably, you know, actually.
Speaker 2: Was I just wanted to make it sound like a
Speaker 2: conspiracy theory so we can climb up the podcast charts.
Speaker 1: Oh not, yes, okay, that I agree. That is exactly
Speaker 1: what happened, Daniel. This bacteria phage was out to get us,
Speaker 1: and through Vibrio cholera, it has achieved its goal.
Speaker 2: Probably was engineered by the CIA, wasn't it.
Speaker 1: Yeah? No, I know, right, like, yeah, the exploding cigars
Speaker 1: for Castro didn't work, and so they were like, let's
Speaker 1: go after a Vibrio cholera.
Speaker 2: So no, I don't think a CIA is pulling the strings.
Speaker 2: I think it probably is. Virus viruses control the world.
Speaker 1: Yeah, yeah, well, so I think we don't really understand
Speaker 1: what the bacteria phage was doing with this toxin before
Speaker 1: it got into the bacteria or you know, so we
Speaker 1: don't really understand all of the steps and why they happened.
Speaker 1: But we're you know, we're working on trying to understand that.
Speaker 1: But it does appear that, yes, this bacteria phage is
Speaker 1: what essentially gave cholera the ability to be this whole
Speaker 1: scourge upon humanity. And here we are, all.
Speaker 2: Right, So I ingest like a cup of fluid with
Speaker 2: like one hundred million collar bacteria in it, and then
Speaker 2: they colonize my lower intestine. They make lots more of themselves?
Speaker 2: How many come out the other end? Like I'm a
Speaker 2: color of factory. Now, how big a multiplier am I?
Speaker 1: You could produce like a trillion cholera bacteria with a
Speaker 1: tea with a t yep, and you can release something
Speaker 1: like twenty liters of fluid with about of cholera. I know,
Speaker 1: just an incredible about flu Yes, flu Well, I mean
Speaker 1: you're vomiting also, so the.
Speaker 2: Fluid smelling rice filled fluid, right.
Speaker 1: Yep, yep, it's pretty unpleasant. And so you know, so
Speaker 1: you can see how this is a great route for
Speaker 1: cholera to reproduce itself and get back into the environment
Speaker 1: in large quantities.
Speaker 2: Wow, if I'm doing my math right, one hundred million
Speaker 2: to a tillion, that's a factor of ten thousand. So
Speaker 2: every individual can ten thousand x the cholera population.
Speaker 1: Yeah, but you know, if you have good sanitation and
Speaker 1: all of those fluids from either end end up in
Speaker 1: a good sanitation facility and they get treated appropriately, then
Speaker 1: it's a dead end. And so sanitation makes a huge
Speaker 1: difference here, so to me, like you know, good sewer
Speaker 1: systems are one of the most amazing things that humanity
Speaker 1: has ever done. And you might understand now why I
Speaker 1: don't get invited to a lot of parties, but I'm
Speaker 1: very excited about sewers.
Speaker 2: And so why do people die of cholera? The toxin itself?
Speaker 2: Does it do more than just make you put out
Speaker 2: twenty leaders or is it dumping twenty leaders of fluid?
Speaker 2: It kills you.
Speaker 1: It's dumping twenty leaders of fluid that kills you. That's
Speaker 1: all it's got to do. At that point, your blood
Speaker 1: becomes super thick, your organs shut down because you just
Speaker 1: can't get oxygen and stuff to all the places it
Speaker 1: needs to go, and you go into a coma and
Speaker 1: die usually.
Speaker 2: Yeah.
Speaker 1: Wow, all right, so now we know what the color
Speaker 1: of bacteria are doing. Let's take a break, and when
Speaker 1: we get back, let's start with the history of treatments
Speaker 1: and begin with some of the less good treatments we've
Speaker 1: tried throughout the history of time.
Speaker 2: All right, we're back, and we were talking about cholera,
Speaker 2: a disease that makes people produce twenty liters of fluid
Speaker 2: out the north and the south ends of the body
Speaker 2: on average.
Speaker 1: Ish.
Speaker 2: Yeah, and we've done a deep dive on the pandemics
Speaker 2: and now we understand the biochemistry of cholera, how it
Speaker 2: affects you. So let's talk about the good side of it,
Speaker 2: developing treatments. How did we start to make this better?
Speaker 1: Well, I'm going to start on the bad side of
Speaker 1: treatments first. So, well, I was reading about the history
Speaker 1: of cholera. There was this book that kept coming up
Speaker 1: and it was Cholera It Causes Symptoms, Pathology Treatment by
Speaker 1: Robert's Bartholow. And Bartholow was a physician in the United
Speaker 1: States who was a physician through two cholera pandemics, and
Speaker 1: people thought of him as an expert, and so I
Speaker 1: was like, okay, well let's read what the expert was
Speaker 1: saying in eighteen ninety three. And so when I got
Speaker 1: to the treatment section, I found myself saying out loud
Speaker 1: many times, oh.
Speaker 2: No, oh no, didn't. It wouldn't.
Speaker 1: So okay, So here's bad idea number one. Okay, okay,
Speaker 1: so quick background they knew at this point. So this
Speaker 1: is eighteen ninety three. So Roberts totally believed the cholera
Speaker 1: was caused by vibrio cholera. He knows that it's a
Speaker 1: bacteria that you're drinking it, it's in your gut. He's
Speaker 1: on board with that.
Speaker 2: You had the germ theory already.
Speaker 1: He had the germ theory already. Not everybody was on
Speaker 1: board with it at the time, but Bartholow was. So
Speaker 1: he's like, all right, so here's the idea. You've got
Speaker 1: these bacteria in your gut and they're gonna give you cholera.
Speaker 1: If you are early in a case of cholera and
Speaker 1: you just got it, maybe the solution, and hear me out,
Speaker 1: is to give someone diarrhea. What to wash out the bacteria.
Speaker 2: Oh, and it's like no.
Speaker 1: But if twenty liters of fluids washing through your intestines
Speaker 1: doesn't get rid of the bacteria. Yeah, And so the
Speaker 1: idea was, if you start the diarrhea early, you'll flush
Speaker 1: the bacteria out before the collar it can get worse.
Speaker 1: And so you'd give people castor oil to induce diarrhea
Speaker 1: and then you'd try to stop the diarrhea later on.
Speaker 1: And needless to say, this just started dehydrating people before
Speaker 1: the collar had a chance to dehydrate them further. So
Speaker 1: this not a good idea.
Speaker 2: Yeah, this is like there's a leak in the water tank,
Speaker 2: so let's blow a hole in the water tank.
Speaker 1: Yes, exactly right. And the word that they use for
Speaker 1: the diarrhea inducing medications were eliminates, and which I had
Speaker 1: never heard before, and so I that made me chuckle
Speaker 1: a little before I went back to feeling awful for
Speaker 1: the people who were being induced to have diarrhea before
Speaker 1: they were subsequently killed by diarrhea.
Speaker 2: And you know, in the defense of these folks, like
Speaker 2: there are some successful treatments which on the surface sound insane.
Speaker 1: Yeah, yep, yeah, you know.
Speaker 2: Like drilling holes in people's skulls can sometimes relieve headaches.
Speaker 1: Relieve the pressure. Yeah, yeah, yeah, yeah, you know totally.
Speaker 2: So science is bizarre. If you don't have a fully
Speaker 2: working model of how the body works, it's basically a
Speaker 2: Rube Goldberg machine and we're just mashing on the levers.
Speaker 2: You never really know what's going to work.
Speaker 1: That's right. Well, and then in the past, we've given
Speaker 1: people malaria to cure late stage syphilis.
Speaker 2: Yeah exactly, and it worked, and.
Speaker 1: It worked in some cases. Other cases it killed them.
Speaker 1: But yes, we have done crazy things that have worked
Speaker 1: in the past. So you know, you try stiff in.
Speaker 2: The defense of bad idea number one, make them poop more.
Speaker 1: That's right.
Speaker 2: I can't believe I ended up on that side of
Speaker 2: this conversation.
Speaker 1: Oh, you know, it's good that defending outside the box
Speaker 1: thinking they're something.
Speaker 2: I just I'm always fascinated on these historical journeys, trying
Speaker 2: to get in the minds of the people there, because
Speaker 2: it's easy to judge them given our level of knowledge
Speaker 2: and our understanding and our mode of thinking. But it's
Speaker 2: another thing to try to get yourself in their heads
Speaker 2: and wonder, like, what did they know? What's this reasonable?
Speaker 2: Given what they understood, would I really have done something different?
Speaker 1: Yeah? Yeah, Well, so you know what, let's jump to
Speaker 1: what I had listed as bad idea number three because
Speaker 1: I feel like it kind of goes with the argument
Speaker 1: you're making right now. So okay, So bad idea number
Speaker 1: three was sort of built on this idea that if
Speaker 1: you made someone's stomach more acidic y, you could fight
Speaker 1: the cholera. And I don't know that they actually understood
Speaker 1: at the time that stomach acidity did kill cholera bacteria,
Speaker 1: but they were onto something and so sounds reasonable, yes,
Speaker 1: and so they would give people various acidic solutions and
Speaker 1: have them drink it, and you know, it did turn it.
Speaker 1: We did discover later on through controlled experiments that acidic
Speaker 1: stomachs were good for killing bacteria, and so that that
Speaker 1: was a reasonable treatment. But then some prodigy decided, what
Speaker 1: if we instead injected the acid under someone's skin. And
Speaker 1: I'm not sure what the thought was there, because I get,
Speaker 1: you know, going after the bacteria in the intestine. But
Speaker 1: it turns out injecting sulfuric acid under the skin quote
Speaker 1: caused colossal gangreen.
Speaker 2: Wow.
Speaker 1: Yes, so that's that's essentially when the tissues die.
Speaker 2: How many people did they inject this in before they
Speaker 2: decided maybe this isn't a go to treatment.
Speaker 1: I don't think it was a lot. I hope it
Speaker 1: wasn't a lot, but it was some. So that's not great.
Speaker 2: Yeah, yeah, because gangreen does not seem like a fun
Speaker 2: thing to have.
Speaker 1: On top of cholera, right right, yeah, right, yeah, So okay,
Speaker 1: that there's a idea. All right, So the last bad
Speaker 1: idea before we get to the good ideas. The last
Speaker 1: bad idea is what was called tero lysis or no enteroclysis,
Speaker 1: And the idea here is that maybe it would be
Speaker 1: helpful if you rinsed off the intestines from the inside
Speaker 1: with a chemical. And so they took a long tube
Speaker 1: that was connected to a bag with a solution of tannins,
Speaker 1: which are like some chemicals that plants make, and they
Speaker 1: inserted the tube up the rear end as far as
Speaker 1: it would go, and then they squeezed the bag to
Speaker 1: try to rinse the inside of the intestines off with
Speaker 1: these chemicals to try to essentially dislodge the bacteria and
Speaker 1: sort of kill them.
Speaker 2: So this is a tannin anema. Basically, this is.
Speaker 1: A tannin anima. I guess I'm going to admit now
Speaker 1: that I am not super familiar with how enemas are conducted.
Speaker 1: I am not aware of them being attached to like
Speaker 1: a hose. I thought it was more of I won't
Speaker 1: go into too much detail anyway, this sound I don't.
Speaker 2: Think it's that complicated, Kelly. I think you're maintaining an
Speaker 2: ignorance untentionally.
Speaker 1: I thought it was just just stuck a like pouch
Speaker 1: up there and then that's done. Isn't that? Isn't that
Speaker 1: the end? There's no like tube and you won't rinse
Speaker 1: the inside. That's enemas. Aren't that complicated? Are they? Have?
Speaker 2: You have I answer your questions? Never?
Speaker 3: Fine?
Speaker 1: Never fine? Okay? Point is point is they used to
Speaker 1: rinse out people's intestines while they were suffering from uh cholera.
Speaker 2: Why tannins though, Like I understand, the idea is to
Speaker 2: rinse it out, maybe do something to reduce the bacteria.
Speaker 2: But they have a theory that tannins we're going to
Speaker 2: impact the bacteria.
Speaker 1: So I have recently started keeping this amazing to me
Speaker 1: timeline of medical advances, and it wasn't until nineteen twenty
Speaker 1: eight that Alexander Fleming discovers penicillin. Yeah, and so this
Speaker 1: is around eighteen ninety three, and so we didn't really
Speaker 1: have antibiotics at that point, and so I don't know,
Speaker 1: I'm guessing tannin's were just they were like, I don't know,
Speaker 1: those things like kill stuff, and they're just kind of
Speaker 1: they seem like the kind of thing that might make
Speaker 1: an intestine inhospitable. So I'm not really sure what the
Speaker 1: thinking was for tannins.
Speaker 2: I mean, because if they're just guessing, you think maybe
Speaker 2: they would try a few things. They're like, oh, let's
Speaker 2: put in some cayenne pepper or something.
Speaker 1: There was more than one thing that they were trying.
Speaker 1: Tannic acid is those are tannins, right, tannic acid dear,
Speaker 1: Neither one of us know they were putting stuff in
Speaker 1: people's intestines, raising it out. So anyway, bad answer?
Speaker 2: Did that make things worse or have no effect?
Speaker 1: So Barthelow, the author of this book, seemed pretty convinced
Speaker 1: that this was a good method. But here's the thing.
Speaker 1: If you are dying from cholera, you probably don't want
Speaker 1: to sit through this procedure, especially when it turns out
Speaker 1: that what works is very simple. It is rehydration. And
Speaker 1: Bartholow notes that there's this guy named Latta who in
Speaker 1: eighteen thirty one was saying, hey, y'all, if you just
Speaker 1: use this intravenous infusion of fluids that have some like
Speaker 1: electrolytes in them, they seem to survive. And Bartholow is like, yeah, okay,
Speaker 1: So if you give them a bunch of fluids intravenously
Speaker 1: or you just make them drink it, if they're able to,
Speaker 1: they perk up and they seem like they're in such
Speaker 1: a good mood. But it's temporary because then they get
Speaker 1: diarrhea and they throw up, and then they don't feel
Speaker 1: good again, and it just kind of feels like you
Speaker 1: have to keep doing this over and over again, and
Speaker 1: that's frustrating, and so they abandoned this technique until like
Speaker 1: nineteen fifteen when this new physic, when this physician named
Speaker 1: Rogers is like, hey, y'all, actually this rehydration thing, like
Speaker 1: this is the thing that works. All of those fluids
Speaker 1: that they're losing, you just need to put them back.
Speaker 1: And then everybody's okay, and Daniel, you have a story
Speaker 1: about this, right.
Speaker 2: Yeah, key to this rehydration technique is getting the like
Speaker 2: salt and sugar balance of the rehydration correct, so the
Speaker 2: things are actually absorbed and you don't end up like
Speaker 2: stealing more fluids. And what works best is a particular
Speaker 2: mix not just like salty water. We're also having some
Speaker 2: sugar in there. And a guy I know here, Jonas Schultz,
Speaker 2: who's a particle physicist, his brother Stanley Schultz, is the
Speaker 2: guy who figured out like exactly the right balance of
Speaker 2: salt and sugar and the chemistry for why that works.
Speaker 2: And so now we understand exactly like how to sweeten
Speaker 2: and salty that water so that when you rehydrate people
Speaker 2: they absorb and keep as much of that water as possible.
Speaker 1: That's amazing and so like. Whereas previously cholera was pretty
Speaker 1: darn fatal, these days, if you use the appropriate rehydration technique,
Speaker 1: we expect that you only lose about one percent of
Speaker 1: patients who come in with cholera. You lose, of course,
Speaker 1: ideally you lose no one, but the one percent that
Speaker 1: you lose tend to be people who had some other
Speaker 1: issues going on and the cholera just sort of was
Speaker 1: more than their body could take. But for most people,
Speaker 1: if you can get the fluids back, they survive.
Speaker 2: So that's why I asked earlier, like what is it
Speaker 2: that kills you? And if it's just really the loss
Speaker 2: of fluids, then yeah, it seems very straightforward to say, well,
Speaker 2: let's just prevent you from losing those fluids or replace
Speaker 2: them as they exit. But then the other question, of course,
Speaker 2: is like how long do you have to do this for?
Speaker 2: Does the body eventually kill the bacteria without any external assistance,
Speaker 2: without penicillin, if you can just sort of survive long
Speaker 2: enough for it to do that.
Speaker 1: Yes, that is the case. Every once in a while
Speaker 1: they will give people antibiotics to try to speed the
Speaker 1: process up, but in a lot of cases they don't
Speaker 1: even give people antibiotics, and eventually your body clears it
Speaker 1: out and you will be fine.
Speaker 2: And that's fascinating because then everybody gets what they want, right,
Speaker 2: Like the cholera still got to do their thing and
Speaker 2: make more cholera and exit your body in twenty liters
Speaker 2: of discusting fluid. Do you survive?
Speaker 1: Yeah? I don't think the World Health Organization is like
Speaker 1: making their recommendations based on trying to make everyone happy,
Speaker 1: including the one trillion cholera that we're produced by an infection,
Speaker 1: and I don't think the cholera are happy if they
Speaker 1: end up in like a modern sanitation system. But yeah, so,
Speaker 1: I mean, the World Health Organization says you need water,
Speaker 1: sanitation and hygiene. The acronym there is wash with the
Speaker 1: water providing the W and the A loving it. And
Speaker 1: you know, if you have these things, you can usually
Speaker 1: keep cholera out of your population. And then with this
Speaker 1: oral rehydration solution, you can treat anyone who does happen
Speaker 1: to get cholera.
Speaker 2: And so these days, if you have any get cholera,
Speaker 2: it's still the go to treatment is basically just an
Speaker 2: infusion of fluids.
Speaker 1: Yeah, an infusion of fluids. Sometimes you'll get antibiotics, but yes,
Speaker 1: just trying to replace those fluids is what happens.
Speaker 2: But it has to be quick, right because color can
Speaker 2: kill you in like twelve hours.
Speaker 1: Yes, yeah, yeah, you want to get to a hospital immediately.
Speaker 3: Yeah.
Speaker 2: It's amazing sing when like minutes or hours matter for
Speaker 2: outcomes in these medical decisions.
Speaker 1: Yeah, scary, it is.
Speaker 2: All right, let's take a break and when we come back,
Speaker 2: we'll learn about how we're going to prevent people from
Speaker 2: getting cholera in the first place. All right, we're back,
Speaker 2: and now we're going to talk about something which is
Speaker 2: unfortunately controversial these days vaccines.
Speaker 1: Yes, yes, unfortunately controversial and also in this case a
Speaker 1: little bit hard to study. So it turns out that
Speaker 1: cholera is one of those diseases that acts differently in
Speaker 1: humans than it does in a lot of animals. So
Speaker 1: it's been hard to have animal models because, for example,
Speaker 1: if you give cholera to an animal like a rabbit,
Speaker 1: they don't produce the massive quantities of diarrhea that humans produce.
Speaker 1: And so if you are testing out a vaccine on
Speaker 1: a rabbit, for example, you don't necessarily get the information
Speaker 1: that you want from studying a rabbit that you would
Speaker 1: get from studying a human, for example, because it's just
Speaker 1: not doing the same thing.
Speaker 2: To rabbits, even proportionally.
Speaker 1: Even proportionally, that's right.
Speaker 2: And do we understand what's going on in the rabbit
Speaker 2: small intestine that makes it respond differently.
Speaker 1: We've done some research to understand a bit about why
Speaker 1: it differs in rabbits versus why it differs in humans.
Speaker 1: To be honest, I didn't dig into that part too much,
Speaker 1: but at the end of the day, rabbits don't tell
Speaker 1: us everything we need. We've learned some great stuff from
Speaker 1: rodents that's been super helpful, but not everything we need
Speaker 1: will be able to come from rabbits. And another thing
Speaker 1: that's difficult, so we had talked about in the prior
Speaker 1: segment the fact that vibrio cholera has a lot of
Speaker 1: different strains that act differently, the strains that cause pandemics.
Speaker 1: There is a lot of them. So you know how
Speaker 1: every season you go and you get the flu vaccine
Speaker 1: because there's a different strain of the flu that's going around.
Speaker 1: Cholera isn't really that different. It doesn't have a different
Speaker 1: strain every year, but there are something like five or
Speaker 1: six different pandemic strains, and you do need to keep
Speaker 1: an eye on it over time, because every once in
Speaker 1: a while, a new pandemic strain will sort of pop up,
Speaker 1: and now you need to worry about trying to include
Speaker 1: that strain in the vaccines. And if you're vaccinated against,
Speaker 1: you know, one of the six strains that might protect
Speaker 1: you against a subset of the other strains, but not
Speaker 1: all of them. And so when you're creating a vaccine,
Speaker 1: you need to have multiple strains in there. And this
Speaker 1: isn't totally foreign. Like when I went to go get
Speaker 1: the flu shot this year, I think there were three
Speaker 1: different flu strains in that flu shot to protect me against,
Speaker 1: you know, the most likely strains that I'll encounter this year.
Speaker 1: And so we do do a of different strains in
Speaker 1: the cholera vaccines, and interestingly that we also try to
Speaker 1: include subunits of the toxin that cholera produces because our
Speaker 1: body also produces like antibodies to stop the toxin from
Speaker 1: binding to our intestines.
Speaker 2: Wow, fascinating, And so how do we go about making
Speaker 2: this vaccine? Like do we inject it in humans and
Speaker 2: look at the antibodies and then use those antibodies somehow?
Speaker 2: Is it just those antibodies? How does this vaccine work?
Speaker 1: Yeah, So the way that we test these vaccines is
Speaker 1: different than the way we test a lot of other vaccines.
Speaker 1: So I think that the way that I most often
Speaker 1: think of how we test vaccines is that we give
Speaker 1: the vaccine to a large population of volunteers, and then
Speaker 1: we track those volunteers as they go about their lives,
Speaker 1: and then after like three or four months or some
Speaker 1: maybe half a year or something some amount of time,
Speaker 1: we ask them to report back and say, you know,
Speaker 1: for example, you got the COVID vaccine six months later,
Speaker 1: can you let us know did you get COVID or not?
Speaker 1: And then we look and we say, okay, for the
Speaker 1: people who got the placebo, what percent of them got COVID?
Speaker 1: And the people who got the actual COVID vaccine, what
Speaker 1: percent of them got COVID? And you hope the percent
Speaker 1: that got the actual vaccine is lower than the percent
Speaker 1: that got the place ebo, which is, you know, maybe
Speaker 1: like a solution of saline and not actually the vaccine.
Speaker 1: What we do with something like cholera often is we
Speaker 1: we know that cholera is the kind of thing where
Speaker 1: if you have somebody in a medical setting and they
Speaker 1: are healthy to begin with, if you treat them, you
Speaker 1: can make sure that they will survive, and so you
Speaker 1: can do a much faster trial if you essentially give
Speaker 1: people the vaccine, give some people a placebo, you know,
Speaker 1: like a solution of saline, and then you give everybody
Speaker 1: a hundred million cholera bacteria, because then you can control
Speaker 1: how strong of a dose everybody's getting and what strains
Speaker 1: of cholera they're being exposed to, and so that tends
Speaker 1: to be what we do. And so what what we'll
Speaker 1: do is we'll try to pick strains of cholera that
Speaker 1: we think are the most likely to be a problem
Speaker 1: in a particular region at a particular time. We will
Speaker 1: kill them. So usually what we're doing is like oral
Speaker 1: vaccines of killed cholera cells, and then we will set
Speaker 1: up a facility where people will volunteer. First, we'll do
Speaker 1: tests to make sure that everybody's healthy, and then they
Speaker 1: will either get the vaccine or a placebo, and then
Speaker 1: they'll get exposed to the kind of cholera that we
Speaker 1: think they're going to encounter. You know, in the areas
Speaker 1: that we're worried about, are these prisoners, Uh No, I don't.
Speaker 1: I haven't seen. The prisoner experiment was from the seventies.
Speaker 1: I think these days they're probably you know, college kids
Speaker 1: who are who are volunteering.
Speaker 2: We'd need a few hundred bucks and have a day
Speaker 2: to spend over the toilet. But I'm wondering you're saying
Speaker 2: we do this for cholera because we're confident that anybody
Speaker 2: who gets it they will recover, And so it's not
Speaker 2: really dangerous to give people the disease, and therefore it's
Speaker 2: a very useful way to directly study whether the vaccine
Speaker 2: saves them or prevents the disease. So is that only
Speaker 2: true for diseases where we're very confident that we can
Speaker 2: save people. That's why we don't do this for the flu.
Speaker 2: We don't give people the flu vaccine and then intentionally
Speaker 2: inject them with the flu because as a higher mortality rate.
Speaker 1: We're careful with things like respiratory illnesses. I do think
Speaker 1: we've done some challenge trials on influenza, but on very
Speaker 1: healthy volunteers. I'm sure that this was implied in what
Speaker 1: you said. But like you know, we for cholera, we
Speaker 1: only know we can save people because they are like
Speaker 1: already in a hospital. Like you know, you wouldn't yeah, yeah,
Speaker 1: you wouldn't test this out Like in the field where
Speaker 1: somebody got cholera, you'd have to drive them two hours
Speaker 1: to a hospital or something.
Speaker 2: Call us if you feel anything, right, are already in
Speaker 2: the Yeah, we're right.
Speaker 1: These are under conditions that are very controlled, and you
Speaker 1: know you could very quickly get them to safety.
Speaker 2: But is the mortality zero?
Speaker 1: There was one instance where somebody had a cardiac thing
Speaker 1: happen and this was over I think thirty years of
Speaker 1: experiments where these controlled studies challenge studies have been done,
Speaker 1: and I'm pulling this number from my head, and that
Speaker 1: might have been from challenge studies. So these kinds of
Speaker 1: trials are called challenge trials, and that might have been
Speaker 1: for all challenge trials, including studies that weren't just cholera,
Speaker 1: because this has been done on other diseases too. So
Speaker 1: this technique has very high success because folks are really
Speaker 1: cautious when they do it, But we have still had
Speaker 1: quite a bit of difficulty when we go to use
Speaker 1: colera vaccines in the field. So just because you have
Speaker 1: tested a colera vaccine I don't know, for example, in London,
Speaker 1: doesn't necessarily mean that when you go to use the
Speaker 1: color vaccine in children in India, you know, in an
Speaker 1: area where cholera pops up quite a bit, it doesn't
Speaker 1: mean that immune systems are going to do the same thing.
Speaker 1: So you know, for example, maybe if you're I don't know,
Speaker 1: a teenager in India, you have encountered the cholera bacteria
Speaker 1: before and so your immune system might respond differently whereas
Speaker 1: like a college kid in London has probably never encountered
Speaker 1: the color of bacteria before. Additionally, they have different microbiomes
Speaker 1: and I've seen papers indicate that that could matter. And
Speaker 1: kids in India probably have some different intestinal parasites than
Speaker 1: kids in London and that could impact how bodies respond
Speaker 1: to things like vaccines. And so we're finding that sometimes
Speaker 1: in challenge trials, what you see doesn't always match what
Speaker 1: you see in the field when you're giving it to
Speaker 1: two communities. So challenge trials still seem useful, but we
Speaker 1: don't always see exactly what we expect.
Speaker 2: And who takes this vaccine. Is it only for people
Speaker 2: who are living in cholera endemic regions and people traveling
Speaker 2: there or is everybody get it? Have I been vaccinated
Speaker 2: against cholera?
Speaker 1: Well, it depends have you traveled to an area where
Speaker 1: cholera is endemic?
Speaker 2: I don't think so. I've ever been to India.
Speaker 1: Well, you know, it's also in South America and Africa.
Speaker 2: I've been to South America and I definitely got some
Speaker 2: vaccines for that.
Speaker 1: So maybe maybe I've gotten the yellow fever vaccine before,
Speaker 1: but I think but I don't think I've ever gotten
Speaker 1: the color of vaccine. Most people have probably haven't gotten
Speaker 1: the color of vaccine. If you traveled to an area
Speaker 1: where cholera is endemic, you might have gotten the vaccine,
Speaker 1: and challenge trials were used to develop the traveler's version
Speaker 1: of the colera vaccine. And if you live in an
Speaker 1: area where cholera is common, you and your kids may
Speaker 1: have had the color of vaccine. And actually, if any
Speaker 1: of our listeners want to write in and let us
Speaker 1: know if they got the color of vaccine, I'd be
Speaker 1: interested in hearing about that. But you need to get
Speaker 1: the color of vaccine pretty often. So even if you
Speaker 1: get cholera in real life, the immunity that your body
Speaker 1: provides doesn't last for a lifetime. Like if you get
Speaker 1: cholera and it's like a mild case, your immunity might
Speaker 1: last for like three years. I've read one source that
Speaker 1: said a really bad case of cholera can give you
Speaker 1: immunity for ten years. But after that, your immune system
Speaker 1: kind of forgets what colera looks like, which seems like
Speaker 1: a bad plan. And so you need to get immunized regularly.
Speaker 1: And if your immune system only remembers an actual case
Speaker 1: of cholera for three to ten years. Probably that's the
Speaker 1: best we can do with a vaccine, which means you
Speaker 1: need to get vaccinated regularly, which is hard because a
Speaker 1: lot of areas where cholera is endemic are areas where
Speaker 1: you don't have good sanitation, and those are also areas
Speaker 1: where it's probably hard to get vaccines, especially if for
Speaker 1: the vaccines need to be refrigerated, and so there are
Speaker 1: areas where it's hard to get vaccines to people regularly,
Speaker 1: and so we don't currently have vaccines that we feel
Speaker 1: like amazing about. Research on cholera vaccines continues because we
Speaker 1: would like to have even better cholera vaccines.
Speaker 2: And is there a campaign to eradicate cholera like we
Speaker 2: did for smallpox or is that impossible because cholera is
Speaker 2: happy to live in the environment even if we got
Speaker 2: it out of all of the people.
Speaker 1: I think that the goal is to reduce cholera. I
Speaker 1: don't think it would be reasonable to try to eradicate
Speaker 1: cholera entirely because it can live in the environments without us,
Speaker 1: Like I just I don't see how you would how
Speaker 1: you would do that, And.
Speaker 2: Because it's out in the environment and there's viruses out there.
Speaker 2: There must be constantly new versions of it, and it's mutating,
Speaker 2: and there's gazillion's uncountable number of these things floating in
Speaker 2: every lake, one mutation away from being the next pandemic.
Speaker 1: Yes, right, yeah, And you know, even if we had
Speaker 1: a perfect vaccine tomorrow, the week after that, you could
Speaker 1: have horizontal gene transfer and you know, the genes for
Speaker 1: the toxin could be passed to a new strain of cholera,
Speaker 1: and that's the next pandemic. So you need constant surveillance
Speaker 1: to try to understand this stuff, which is why it's
Speaker 1: really important that we fund organizations like the World Health Organization,
Speaker 1: which the United States pulled out of.
Speaker 2: And so who does this research? I mean, doesn't sound
Speaker 2: like there's a lot of money in cholera vaccines since
Speaker 2: the places where color is endemic tend to be poorer countries.
Speaker 2: You don't have a whole lot of cholera happening to
Speaker 2: like US senators for example. And so who is funding
Speaker 2: this research?
Speaker 1: If anybody, cholera research is funded by you know, the
Speaker 1: World Health Organization wants there to be cholera vaccines. There's
Speaker 1: money from government organizations like the National Institute of Health.
Speaker 1: There's I think there's US companies that make color of
Speaker 1: vaccines to sell to you know, tourists in the US
Speaker 1: who want to go and you know, there's lots of
Speaker 1: people living in areas where color is endemics. So if
Speaker 1: you could sell the vaccine, you know, you can probably
Speaker 1: make some money, although you probably can't sell it for
Speaker 1: too much. There's philanthropic organizations and government organizations funding this
Speaker 1: kind of research.
Speaker 2: Yeah, not everyth happens from a profit mode of y'all.
Speaker 1: Yes, that's right. This research is super important. The seventh
Speaker 1: cholera pandemic, as we said in the last episode, is
Speaker 1: still happening right now. The next cholera pandemic could start
Speaker 1: at any time. Cholera pandemics can overlap. If a new
Speaker 1: strain pops up and starts spreading around the world, seven
Speaker 1: and eight could be happening at the same time.
Speaker 2: And I'm grateful that there's continued funding for research into
Speaker 2: technological developments in advanced bidets. As I traveled around Japan,
Speaker 2: I discovered, ooh, some of these have music. Ooh, this
Speaker 2: one has a strong deodorizer button you can press. What
Speaker 2: does that do?
Speaker 1: Okay? All right? I'm grateful for good sanitation systems, and
Speaker 1: i am grateful to organizations that are trying to bring
Speaker 1: good sanitation systems to communities that don't have them yet,
Speaker 1: because that you know, vaccines are great, but sanitation systems
Speaker 1: that keep people from getting poop in their water, yes,
Speaker 1: is probably a better long term solution.
Speaker 2: You're so much more wholesome than i am, Kelly.
Speaker 1: I'm glad that the day is bringing you so much joy.
Speaker 2: Hey, it's the small pleasures in life, that's right. Anyway,
Speaker 2: Today it's been a great pleasure learning about colera. Thank you,
Speaker 2: Kelly for this deep dive into the experience of calera,
Speaker 2: how we treated it, and how we continue.
Speaker 1: To Thanks for listening. Daniel and Kelly's Extraordinary Universe is
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