Speaker 1: Hi, I'm Aaron Welsh and this is this Podcast will
Speaker 1: Kill You. You're listening to the latest episode in our tp
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Speaker 1: Our human bodies are astoundingly complex, intricate machines that allow
Speaker 1: us to interact with, exist within, and move about this world.
Speaker 1: Even at this moment, whether you're driving home from work,
Speaker 1: out for a walk, cross stitching on the couch, or
Speaker 1: just sitting meditatively, your body is performing a whole host
Speaker 1: of functions, some of which you might be aware of,
Speaker 1: like listening to what I'm saying, pumping the brakes, or
Speaker 1: picking up your dog's poop, and others that you don't
Speaker 1: even realize are happening, like digesting lunch, maintaining balance, or
Speaker 1: growing hair one micrometer at a time. When you think
Speaker 1: about all the things that have to go right every
Speaker 1: second of every day to keep us healthy and alive
Speaker 1: and doing what we want to be doing, it's hard
Speaker 1: not to be amazed at what our bodies are capable of.
Speaker 1: In general, they do such a good job of keeping
Speaker 1: as functional that When something happens that throws a figurative
Speaker 1: wrench in our figurative machine slash body, we are often
Speaker 1: left with only imperfect solutions. The human body is a
Speaker 1: difficult thing to replace, but that hasn't kept people from
Speaker 1: attempting to do so for centuries. From the earliest skin
Speaker 1: grafts to three D bioprinting, scientists have made incredible strides
Speaker 1: in developing suitable replacements for our various body parts, and
Speaker 1: Mary Roach is here to tell you all about it.
Speaker 1: The ever delightful Mary Roach joins me to discuss her
Speaker 1: latest book, Replaceable You, Adventures in Human Anatomy, which takes
Speaker 1: reader's body part by body part through the science of
Speaker 1: regenerative medicine. You'll learn what's so special about a pig's heart,
Speaker 1: why hair transplants work as well as they do, how
Speaker 1: to choose an OSTOMEI bag, what it feels like in side,
Speaker 1: in iron lung, and so much more. This journey is
Speaker 1: alternatively funny, bizarre, revelatory, passionate, and inspirational. In other words,
Speaker 1: it's a classic Mary Roach. By the end of the book,
Speaker 1: you're left in awe of the scientists who have accomplished
Speaker 1: so much to heal those in need, the brave patients
Speaker 1: who have dared to put their lives in their hands,
Speaker 1: and our bodies themselves, whose stubborn instinct to protect us
Speaker 1: is often the thing holding us back from creating a
Speaker 1: perfect replacement. I am beyond thrilled to get to chat
Speaker 1: with Mary again, so let's take a quick break and
Speaker 1: get started. Mary, it is so great to see you again.
Speaker 1: Thanks for joining me today.
Speaker 3: My pleasure lovely to be back.
Speaker 1: I am thrilled to get to chat with you about
Speaker 1: your newest book, Replaceable You, which takes readers on this
Speaker 1: frolicking tour through replacement body parts and the challenges in
Speaker 1: getting them to work the way we want them to.
Speaker 1: Could you tell me about the journey from the seed
Speaker 1: of an idea to how this book came to be, Like,
Speaker 1: was there a certain place or body part where you started?
Speaker 3: Yes, in fact, there is. When I'm looking for a
Speaker 3: book idea, I often call people from past books or
Speaker 3: people who have sort of generalized knowledge, and I called
Speaker 3: this one. I think partly because I was thinking about
Speaker 3: fat like as a book topic, oh, fat like fat
Speaker 3: as a substance. I didn't end up going there, but
Speaker 3: I spoke to this woman, Leah Bellis, who works with
Speaker 3: stem cells derived from fat, and we had this wide
Speaker 3: ranging conversation and one thing she told me had nothing
Speaker 3: to do with fat or stem cells. She mentioned this
Speaker 3: surgeon who had created he'd created a replacement penis for
Speaker 3: a man using his own metal finger, and I of
Speaker 3: course pictured the finger moved as is from the man's
Speaker 3: hand and just like stitched in place, able to move
Speaker 3: and like you.
Speaker 2: Know hencile penis.
Speaker 3: Yeah, exactly like you could beckon with it. And of
Speaker 3: course that's not the case. It was sort of used
Speaker 3: as a natural kind of prosthetic implant. Anyways, I was like, wow,
Speaker 3: I really need to see I need to visit this person.
Speaker 3: I need to write about that. And so I then
Speaker 3: started just thinking about replacement parts and prosthetics and ostomes
Speaker 3: and hair transplants and of course bioprinting and stem cells,
Speaker 3: and that's kind of where it's kind of how it happened.
Speaker 3: It just it tends my books tend to happen. There's
Speaker 3: one chapter and then there's another one, and then I think, well,
Speaker 3: what could be the kind of topic the umbrella that
Speaker 3: goes over all of this. So it's never me going yeah,
Speaker 3: I'd like to do a wide ranging book on regenerative
Speaker 3: medicine and prosthetics, which is not what the book really is,
Speaker 3: but that's how it goes with me.
Speaker 1: I love that the theme emerges, which as you just
Speaker 1: follow your curiosity from you know, prosthetic penises and beyond, like.
Speaker 3: Yeah, exactly, that could have been the title.
Speaker 2: Next time, the sequel.
Speaker 1: Yeah, you talked about how like you know, there's we
Speaker 1: start now with three D bioprinting, which sounds like this
Speaker 1: like sci fi thing, but in reality, the history of
Speaker 1: replacement body parts goes back centuries, millennia even and I
Speaker 1: know that you know, hindsight is twenty twenty, but it's
Speaker 1: hard to understand and some of the decisions that certain
Speaker 1: physicians have made throughout history when it comes to some
Speaker 1: of these replacement body parts.
Speaker 2: And one that.
Speaker 1: Springs to mind is trying to grow a skin flap
Speaker 1: through a human dog connection, which you talk about in
Speaker 1: your book. But without these attempts, we would not be
Speaker 1: quite where we are today. And I'm curious if you
Speaker 1: can take me through some of the either the early
Speaker 1: pioneers or some of the strangest, most outlandish stories of
Speaker 1: early skin grafting. Or any other prosthetics that you came
Speaker 1: across in your research.
Speaker 3: Sure, well, skin grafting is a good one. I mean
Speaker 3: that goes back seventeen hundred eighteen hundreds, and physicians or
Speaker 3: surgeons were initially there was a belief that when you
Speaker 3: took a graft from someone else, and back then it
Speaker 3: was animals mostly being used, that you needed to keep
Speaker 3: it attached to a blood supply. It's you know, getting
Speaker 3: settled in its new home. So there'd be it was
Speaker 3: called a pedical flap, and it was it was, you know,
Speaker 3: there'd be the piece that's going to be transferred and
Speaker 3: then sort of a peninsula connecting it to its original owner.
Speaker 3: And what that meant this going back to the eighteen
Speaker 3: hundred's Charles Setio I believe his name was, I had this.
Speaker 3: I remember reading about how he had used He described it.
Speaker 3: Of course, it's in French an chien denois, and I'm thinking, well,
Speaker 3: I don't know much about Danish dog breeds and I'm
Speaker 3: picturing something small, but no, you meant the great Dane.
Speaker 3: So this person had to lie with a great Dane
Speaker 3: for a number of weeks while the you know, the
Speaker 3: keeping the blood supply from the dog, but in fact
Speaker 3: he terminated the project early because of the continual and
Speaker 3: excessive movements of the dog. And I'm like, what did
Speaker 3: you expect.
Speaker 1: It's amazing that the project got as far as it did,
Speaker 1: like into actual execution and not just like in the
Speaker 1: early stages, like what are we doing here?
Speaker 2: What are we doing?
Speaker 3: There's one there was one description of a similar surgery
Speaker 3: using a pig, and a pig like a you know, livestock,
Speaker 3: horses cows have this ability to move the skin, you know,
Speaker 3: to discourage and make flies go away. They can kind
Speaker 3: of twitch the skin. So the pig kept doing that,
Speaker 3: you know, and instead of it being a fly that
Speaker 3: it was trying to dislodge, it was an actual human.
Speaker 3: So in the you know, there's a pig in the room,
Speaker 3: it meant there was manure. It was quite a sort
Speaker 3: of a circus. And at certain point surgeons realize it's
Speaker 3: going to work pretty well even if you just you
Speaker 3: don't keep it connected to it to the host. You
Speaker 3: can take a patch and put it. It's kind of
Speaker 3: a bio dressing. It isn't as though the person becomes
Speaker 3: part dog or port frog or par chicken, especially with
Speaker 3: a burn a big burn. The immune system is suppressed initially,
Speaker 3: and that allows foreign graft to sit there and to
Speaker 3: kind of take for a while, and eventually it'll slough off,
Speaker 3: or the surgeons will remove it and put on a
Speaker 3: graft from the from the patient themselves, which works. But
Speaker 3: as a kind of a band aid of bio dressing.
Speaker 3: They're called zoografts or zenographs. They do work. You know,
Speaker 3: it protects it, it keeps it from drawing out. It
Speaker 3: sounds really weird, but it did work fairly well. Chickens
Speaker 3: frogs were used often.
Speaker 1: Let's take a quick break, and when we get back,
Speaker 1: there's still so much to discuss. Welcome back everyone. I've
Speaker 1: been chatting with Mary Roach about her book Replaceable You
Speaker 1: Adventures in Human Anatomy. Let's get back into things. Chickens frogs,
Speaker 1: Why choose animals? I mean, I'm assuming access was one
Speaker 1: of the things. But you know, how did we go
Speaker 1: from chickens frogs to today where we're actually able to
Speaker 1: use you know, autograph someone's for someone's own tissue and
Speaker 1: will in the future people look back and go, I
Speaker 1: can't believe you used the own tissue like we now
Speaker 1: just print sheets of skin from someone's body.
Speaker 3: Yeah, yeah, yeah, And in fact, now you can do
Speaker 3: something called a cultured epithelial autographed where you take the
Speaker 3: person's cells and they're sent off site and they're grown
Speaker 3: into a very very very thin layer of their own cells.
Speaker 3: And that's nice because you're not taking a graph from
Speaker 3: another part of the body. You know. Frequently yeah, you know,
Speaker 3: you'll take a graph from the thigh or the back,
Speaker 3: you know, and and when it's somebody has a really
Speaker 3: serious burn that's covering you know, sixty percent of the
Speaker 3: body or something, you you don't have a lot of options,
Speaker 3: not a lot of real estate to be taking those
Speaker 3: grafts from so and you can wait for them to
Speaker 3: heal and then reuse that space. I mean, it's quite
Speaker 3: an undertaking. So some of these new newer developments like
Speaker 3: the spray on skin where you kind of you know,
Speaker 3: you take a graft and it's meshed and you kind
Speaker 3: of fill in the spaces and the mesh with some
Speaker 3: of the person's own cells sprayed on there.
Speaker 1: I love that, Like scaffolding build here, Yeah, this is
Speaker 1: this is the real estate that you want to be, yeah,
Speaker 1: taking it seems like the early days of replacement body
Speaker 1: parts is peppered with the use of animals of all
Speaker 1: different kinds and all different ways. And you talk in
Speaker 1: your book about milk and how in the hospital you
Speaker 1: might see like cows or goats or like, what tell
Speaker 1: me about the use of goat's milk in a hospital
Speaker 1: setting in the eighteen hundreds.
Speaker 3: Yeah, milk, goat's milk, cow's milk. There's some disagreement on
Speaker 3: whose milk was best. It was a blood substitute. Basically.
Speaker 3: It was because you know, early on before sodium citrate
Speaker 3: was found to be something that could prevent clotting, clotting
Speaker 3: was a real issue with transfusing blood from one person
Speaker 3: or one animal to another. So somebody had this idea
Speaker 3: of to try another miraculous bodily substance. So they tried milk.
Speaker 3: Goat's milk, cow's milk. I mean, it was just a
Speaker 3: lot of very excited journal articles going, this is going
Speaker 3: to be this is going to be huge milk transfusions.
Speaker 3: So we're going to apply to the hospital to get
Speaker 3: funding for a cow that you know, that will keep
Speaker 3: on the grounds. And very quickly medicine came to its
Speaker 3: senses and realizes it's just basically It's similar to giving
Speaker 3: someone saline to keep their blood volume up in the
Speaker 3: case of a hemorrhage. If somebody's lost a lot of blood,
Speaker 3: it prevents going at a shock, and so it's useful
Speaker 3: in that way. There wasn't something inherent in milk, you know,
Speaker 3: that made it this miraculous substance. But it wasn't an
Speaker 3: entertaining period, and it was like eighteen seventy eight, there
Speaker 3: was this flurry of milk transfusions.
Speaker 2: Milk transfusions, get them here. Did people not get sick
Speaker 2: from this?
Speaker 3: Not an ideal sterile scenario?
Speaker 1: No, No, We talked about frog skin and dog skin
Speaker 1: and chicken skin and all this, but then it goes
Speaker 1: beyond skin graphs and zographs into organs transplanted from animals
Speaker 1: as well, and sort of like with the frog skin graphs,
Speaker 1: these are temporary solutions. But I was wondering if you
Speaker 1: could tell me more about zeno transplantation or zo transplantation.
Speaker 1: I guess with pig hearts, when do we use that?
Speaker 1: How well does it work? How did we get the idea?
Speaker 1: Just the full story?
Speaker 3: Sure, zeno transplantation. I mean, this work has been going
Speaker 3: on about thirty years at least, and it is just
Speaker 3: now over the past year year and a half are
Speaker 3: actually being used in humans. So pig organs are the
Speaker 3: ones that are being used. I mean, pig's hearts are similar,
Speaker 3: especially a smaller, smaller size, kind of a good match
Speaker 3: for the human heart. And by now there are fewer
Speaker 3: than ten zeno transplantations into humans. There's one man, Tim Andrews,
Speaker 3: as far as I know, is still alive. The rest
Speaker 3: of them bought them about two months. This is a
Speaker 3: pig organ it's a genetic edit so that some of
Speaker 3: the surface proteins that tell the human immune system like
Speaker 3: this is really foreign, get it out of here. So
Speaker 3: there's these genetic edits to make this heart more like
Speaker 3: a human heart, to try to fool the immune system
Speaker 3: and to prevent hyperacute rejection, which is if you put
Speaker 3: in a pig heart, like right away, the body's going
Speaker 3: to attack it, it's going to start turning black. Is
Speaker 3: knock a work. So they've managed to get around the
Speaker 3: hyper acute rejection, but there are still rejection, you know,
Speaker 3: longer term rejection issues. So it's not thought of at
Speaker 3: this point. It's not a permanent like a human transplant
Speaker 3: human heart or kidney transplantation. You're buying time in the
Speaker 3: hope that you'll make your way up the list and
Speaker 3: be able to get a human kidney or heart whatever
Speaker 3: it is. So it's a stalling mechanism. It's a way
Speaker 3: just to buy time for the person you know, who's
Speaker 3: otherwise you know, could die. Unfortunately, that means the patients
Speaker 3: that are getting these hearts are are not in tip
Speaker 3: top shape and that may be contributing to to the
Speaker 3: short survival time. Tim Andrews was in better shape than
Speaker 3: some of the previous recipients. No one is quite sure,
Speaker 3: you know, why is it only lasting two months? What
Speaker 3: do we need to do next? How many more edits
Speaker 3: are we going to do? Or is it something else
Speaker 3: entirely that's going on. There's also concerns about zoom no
Speaker 3: ses diseases that could go back and forth between the
Speaker 3: animal and the person. I mean, it's amazing to think
Speaker 3: that we can even get two months using something that
Speaker 3: is that foreign. You know, it's a pig heart, so
Speaker 3: you know in pig valves have been used before, but
Speaker 3: that's that's not live cells, you know, that's a sort
Speaker 3: of extra cellular material, so not quite the same I
Speaker 3: visited a place in China where they're raising these pigs
Speaker 3: and so they're super cle It's a super clean pig sty,
Speaker 3: which to me was this lovely oxymoron. I'm like, what
Speaker 3: do you mean it's a clean pig sty, But it is.
Speaker 3: It's they're tested for forty bacteria, viruses, fungi. The whole
Speaker 3: place gets disinfected every few days. The staff are not
Speaker 3: allowed to leave. They work for three months in the facility,
Speaker 3: and then they're swapped out with someone else. So very
Speaker 3: very strict cleanliness and hygiene and sterile protocols for these pigs.
Speaker 3: You know what I saw. I wasn't allowed to go in.
Speaker 3: Of course. I I go all the way to China,
Speaker 3: thinking well, I'm going to get in to see the pigs.
Speaker 3: And they're like, of course you're not going in. You're
Speaker 3: full of germs, you know. And then they're like, you
Speaker 3: can see it from across the river. There there's the facility,
Speaker 3: you know. And then we went over to a kind
Speaker 3: of a control center where I could see them, the pigs,
Speaker 3: that is, on a video screen in real time. There
Speaker 3: they were the very clean pigs, still pooping on the floor.
Speaker 3: I mean, they're pigs.
Speaker 2: Right, there's no gene.
Speaker 3: At it to make a pig use a toilet.
Speaker 1: Not yet, not yet, moving away now from animals for now,
Speaker 1: I guess maybe we'll circle back at some point and
Speaker 1: going on to prosthetic devices. And you had such a
Speaker 1: great chapter about this where you kind of touched on
Speaker 1: these different misconceptions that I think a lot of the
Speaker 1: general public has, who maybe doesn't have experience with prosthetics
Speaker 1: has in mind about these devices, and also just the
Speaker 1: bias that there is for wholeness. And it's a really
Speaker 1: difficult decision to make for amputation, especially when it's not
Speaker 1: medically necessary, or when it's a parent that has to
Speaker 1: make this decision or.
Speaker 2: Not for their child.
Speaker 3: Right.
Speaker 1: I was wondering what your sort of did your perspective
Speaker 1: change or evolve as you worked on that chapter and
Speaker 1: visited people and talked with, you know, individuals who have
Speaker 1: different prosthetic or terminal devices.
Speaker 3: Yeah, that was a conversation. In fact, that was one
Speaker 3: of the early conversations I had that sort of cemented
Speaker 3: my decision to do this book. I heard from a
Speaker 3: reader of mine who believed that I should do a
Speaker 3: book on professional football referees. I don't know why she thought.
Speaker 2: It was a good fit for me in your real house.
Speaker 3: Yeah, so she's like, you should do this book. And anyway,
Speaker 3: we corresponded by email and come to find out she
Speaker 3: was an amputee below the knee amputee, but specifically she
Speaker 3: had an elective amputation. In other words, she chose to
Speaker 3: have a healthy foot amputated. It was a healthy foot
Speaker 3: in that the tissue was fine, there was no gangrene
Speaker 3: or anything, no reason, no obvious reason why a physician
Speaker 3: or surgeon would say you should remove this foot. But
Speaker 3: she had spina bifida and that she had like a
Speaker 3: tumor on her spine that it caused this foot to
Speaker 3: be twisted to not work well. She had had a
Speaker 3: half dozen operations, never getting to the point where she
Speaker 3: was improving, always getting worse. And she's described watching people
Speaker 3: out hiking and watching people who had prosthetic limbs in
Speaker 3: artificial foot who were able to walk or run or
Speaker 3: hike and do things that she couldn't do. And they've
Speaker 3: got a prosthesis and she has a natural foot, and
Speaker 3: she just decided, I don't want this foot. I want
Speaker 3: this gone. And it was very hard for her to
Speaker 3: find a surgeon willing to do that, because you're talking
Speaker 3: about removing healthy in quote, I mean it's healthy, it
Speaker 3: is just not functional. For her, it was very hard
Speaker 3: to find a surgeon willing to do that. She finally did,
Speaker 3: she was so much happier. She can do all of
Speaker 3: those things she would see other people doing. So there
Speaker 3: is a bias for wholeness, that's part of it. But
Speaker 3: it's also a surgeon. You know, no one's going to
Speaker 3: call a surgeon to task for Let's try another operation,
Speaker 3: Let's see if we can make this foot work, you know,
Speaker 3: because cutting a foot off feels extreme final, there's no
Speaker 3: going back. Also, the surgeon may or may not have
Speaker 3: experience and amputations and may be concerned about you know,
Speaker 3: what if there's phantom pain, what if I don't do
Speaker 3: it right? You know. You need also to convince the
Speaker 3: insurance people. That's another issue. So so it's it's a
Speaker 3: tricky thing to take off your foot and as you
Speaker 3: mentioned when when you ask the question, when it's a
Speaker 3: parent trying to make that decision for a child, that's
Speaker 3: really hard to do.
Speaker 1: Yeah, And I think that, like you said, the the
Speaker 1: technology being varied for different limbs is part of the
Speaker 1: equation too.
Speaker 3: Yes, absolutely, the feet and the legs are far better
Speaker 3: bet than those. You know, it's sort of in its
Speaker 3: infancy because a hand is that you get fingers and
Speaker 3: you're doing very fine tuned work. When you're trying to
Speaker 3: write or pick something up or whatever it is you're
Speaker 3: doing with your hand and your fingers, that's a big
Speaker 3: chore to get a prosthetic to do. Whereas walking is,
Speaker 3: you know, it's not simple. A gait is not just
Speaker 3: putting the foot on the floor. There's a lot going
Speaker 3: on there. But compared to a hand, it's a much
Speaker 3: more successful thing to replace.
Speaker 2: Let's take a quick break here.
Speaker 4: We'll be back before you know it.
Speaker 1: Welcome back everyone. I'm here chatting with the wonderful Mary
Speaker 1: Roach about her book Replaceable You. Let's get into some
Speaker 1: more questions. Speaking of difficult things to replace, breathing ventilators,
Speaker 1: it's something that we have various forms of technology, including EVA,
Speaker 1: which I want to ask you about because that was
Speaker 1: something new that I learned. But I also wanted to
Speaker 1: talk about your experience in the iron lung. Thanks to vaccines,
Speaker 1: we don't see the iron lung wards these days, but
Speaker 1: it was a whole community, like a whole culture, and
Speaker 1: so it must have been really incredible to kind of
Speaker 1: see this device and then experience it yourself.
Speaker 2: Oh it was.
Speaker 3: It was the one that I spent time in as
Speaker 3: a functional Emerson iron lung from that era, from the
Speaker 3: polio era before there was the vaccine, when like you mentioned,
Speaker 3: they were huge wards rose even sometimes stacked iron lungs,
Speaker 3: and there were a few of them still around and
Speaker 3: I found somebody I was interviewing mentioned that, and I said,
Speaker 3: do you know anybody who is still using one? And
Speaker 3: there were a couple of people, and she put me
Speaker 3: in touch with this man whose wife had recently died,
Speaker 3: and I wrote to him and said, you know, I'm
Speaker 3: really curious about this. Could I come and spend the
Speaker 3: night in your wife's iron lung? Which is like a
Speaker 3: cold email, like hello, you don't know me. As it
Speaker 3: turned out, he did know me from having read one
Speaker 3: of my books. So that was helpful because I think
Speaker 3: otherwise you feel like you're really weird. Go away, yes man, Yes,
Speaker 3: yeah creepy. So yeah, it does sound kind of creepy,
Speaker 3: like I want to spend the night in you iron love.
Speaker 3: So anyways, his name was Mark, and Mark said yes.
Speaker 3: So I went out and I didn't know what to expect.
Speaker 3: I imagined it being a little simpler than it was,
Speaker 3: Like I wanted to eat a meal in there, and
Speaker 3: that was frowned upon because that can be very dangerous
Speaker 3: because if you have a machine, and I should back
Speaker 3: up and just say, an iron lung is different from
Speaker 3: a ventilator in a hospital that is a positive pressure ventilator,
Speaker 3: you know, the thing that we're all used to seeing
Speaker 3: where you're it's kind of inflating your lungs like a
Speaker 3: party balloon, which is very different negative pressure ventilation. That's
Speaker 3: how we breathe. So you have muscles to pull apart
Speaker 3: your rib cage and pull down your diaphragm, and that
Speaker 3: lowers the pressure inside the lungs. It pulls air in
Speaker 3: and then when the muscles let go, it squeezes it out.
Speaker 3: So it's a very gentle and natural thing that is
Speaker 3: mimicked by these machines. They create a vacuum in this
Speaker 3: sealed tube that you are inside, and that opens up
Speaker 3: the chest, pulls in air and then it goes back out.
Speaker 3: That means you're inside there, but your head is outside,
Speaker 3: so it isn't quite as claustrophobic as you would think.
Speaker 3: It is a very strange experience to have a machine
Speaker 3: decide when you will inhale and when you will exhale.
Speaker 3: And so if you're trying to eat, say you had
Speaker 3: shoot some food and you were about to swallow it,
Speaker 3: and the machine decided that's when you're going to inhale,
Speaker 3: that could be a serious choking hazard, or you could
Speaker 3: get you could get food inside your lungs, which could
Speaker 3: cause pneumonia, you get bacteria in there. So they're like, no,
Speaker 3: you won't be you won't be eating dinner in the
Speaker 3: iron lung. Now that would take some coordination and practice,
Speaker 3: so we're not going to do that anyway. So I'd
Speaker 3: had this idea that I would spend the night in
Speaker 3: the iron lung, and Mark had brought in a couple assistants.
Speaker 3: It's kind of a you know, it's kind of an undertaking.
Speaker 3: Kind of looks like a hot water heater lying on
Speaker 3: its side, okay, but with a sort of like an MRI.
Speaker 3: You know, where this bed rolls out. So you get
Speaker 3: on the bed and then they roll you in, but
Speaker 3: then you've got to get your head out this opening yeah,
Speaker 3: so you get your head out the opening and then
Speaker 3: the next needs to be really tight to keep because
Speaker 3: it has to be a sealed right to create the vacuum.
Speaker 3: It's a little hard to explain without seeing it, but
Speaker 3: it's got to be. It's got to be a seal.
Speaker 3: So that's like not a comfortable way to sleep, you know,
Speaker 3: and to have that tight and I'm like, I think
Speaker 3: this is too tight, and they're going, no, it's not
Speaker 3: quite tight enough. Great, you know, and mark It said, oh,
Speaker 3: it's really relaxing. You'll be asleep in no time. So
Speaker 3: I lasted about nine minutes in the iron lung. So
Speaker 3: because the collar is so tight, you have this weird
Speaker 3: simultaneous sense of like breathing deeply and as though you
Speaker 3: were really relaxed, but at the same time it feels
Speaker 3: like somebody's choking you. So it's it's a strange place
Speaker 3: to be. You've got to stay on your back. It's
Speaker 3: a big ordeal to change position. I don't sleep on
Speaker 3: my back, so it's it was not a for me,
Speaker 3: not very conducive to sleeping, but for someone you know,
Speaker 3: and I've read memoirs of people who'd spent a lot
Speaker 3: of time in an iron lung, and I expected a
Speaker 3: description of panic, claustrophobia, anguish, but the description of being
Speaker 3: put into an iron lung across the board. People would
Speaker 3: describe this tremendous relief and relaxation to be able suddenly
Speaker 3: to breathe calmly and deeply when they'd been struggling to
Speaker 3: get enough oxygen to live, a very different experience than
Speaker 3: a ventilator that's pushing air down into the lungs.
Speaker 1: We've covered a little bit of hospital ventilators are the
Speaker 1: ones that we think of today as ventilators. We've covered
Speaker 1: a little bit of iron lung.
Speaker 2: Tell me about EVA.
Speaker 3: Yes, EVA stands for enteral ventilation via anus. You're basically
Speaker 3: using the rectum as a third long kind of which
Speaker 3: is amazing. Okay, so you're there's this stuff per fluo carbon,
Speaker 3: if I'm saying it right, it holds oxygen. Well, so
Speaker 3: you put perfluor rocarbon into the rectum and the body
Speaker 3: absorbs oxygen that way. I mean you can feed people
Speaker 3: via the rectum. People can absorb things through the mucose
Speaker 3: of the rectum, including oxygen. You can also do this
Speaker 3: by blowing it through. I spoke to a doctor Bartlett
Speaker 3: at the Extra Corporeal Life Support Laboratory said, yeah, we
Speaker 3: tried that. You can sort of blow it through via
Speaker 3: the stomach and that way this carbon dioxide comes out
Speaker 3: the anus and I'm like, so sort of constantly farting.
Speaker 3: He goes, yeah, not very.
Speaker 1: Attractive, just like one continuously.
Speaker 3: One continuous part. But you know, EVA is amazing. You know,
Speaker 3: the applications are quite specific. If you've got a premature infant,
Speaker 3: one of the things that is precarious with them is
Speaker 3: they're breathing. The lungs aren't developed enough to support breathing.
Speaker 3: So but if you put them on a positive pressure ventilator,
Speaker 3: it's it's a very delicate tissue, the lining of the lungs,
Speaker 3: and you can damage the lungs. So if you could
Speaker 3: supplement with getting oxygen in through the butt, you know,
Speaker 3: that could be great. Or if it's a situation, a
Speaker 3: combat situation where you don't have a ventilator available, you
Speaker 3: don't have the equipment necessary just to get some oxygen
Speaker 3: in there, so sort of a supplement the anus is
Speaker 3: happy to provide.
Speaker 1: There's really no other way to put it, is there.
Speaker 1: I want to keep us moving through these different replacement
Speaker 1: body parts, because there is so much technology and history
Speaker 1: with each and every one of them. And one of
Speaker 1: the ones that has a surprisingly long story is ostomes,
Speaker 1: which are these surgically created openings on someone's abdomen that
Speaker 1: allow waste to come out. And along with this long
Speaker 1: history of ostomes also of course comes with this long
Speaker 1: history of stigma and also these myths that just abound
Speaker 1: when it comes to ostomese, you know, with like Napoleon
Speaker 1: and so on and so forth. Can you give me
Speaker 1: just like a little tour through the history of ostomese?
Speaker 3: Sure? Well, this is going to go back to the
Speaker 3: seventeen hundreds. As long as people have been stabbing each other,
Speaker 3: there's been kind of natural instances where an opening from
Speaker 3: the intestines will appear in the skin. It'll like the
Speaker 3: body will heal in a way that the lips of
Speaker 3: the intestine. I like that. This was one of the surgeons.
Speaker 3: The lips of the intestine will kind of fuse to
Speaker 3: the cut the opening, and they'll have this natural kind
Speaker 3: of artificial anus, if you will. And so in seventeen
Speaker 3: fifty seven there was this surgeon that's basically why not
Speaker 3: take a hint from nature. What if we were to
Speaker 3: do this in cases where somebody has a blockage, whether
Speaker 3: it's a tumor or whatever is going on, and that
Speaker 3: it's this blockage. They've tried all manner of the usual
Speaker 3: suspects and breaking up the blockage and it's not working,
Speaker 3: and they haven't released anything in days or weeks, and
Speaker 3: they're about to die because it's going to break, it's
Speaker 3: gonna pop soon. So they would create an opening to
Speaker 3: let stuff come out. The opening is called a stoma,
Speaker 3: and today that is still done, not so much for blockages,
Speaker 3: although for that as well, but with very serious cases
Speaker 3: of inflammatory bowel disease crones or colitis things get really bad.
Speaker 3: You can put an opening and a pouch.
Speaker 1: And there are so many variations on ostome bags on
Speaker 1: ways to collect the waste. How does one go about
Speaker 1: choosing a bag?
Speaker 3: Well, I can tell you that because I went to
Speaker 3: the a five K fundraiser of the United Ostome Associations
Speaker 3: of America and one of the things they do, if
Speaker 3: you're not an ostimate, which I am not, they recommend
Speaker 3: that you choose one and to wear as an empathy pouch.
Speaker 3: It just you know, join the crew. And I didn't
Speaker 3: realize I didn't read the email very well. When the
Speaker 3: guy mentioned to me that I would choose an empathy pouch.
Speaker 3: It's supposed to be full, you know, of liquid, but
Speaker 3: I just put an empty one on there. I'm like,
Speaker 3: this isn't bad. But anyway, depending on where your stoma is,
Speaker 3: that determines what kind of pouch you might wear. There's
Speaker 3: some that are have to be changed more often because
Speaker 3: the material is more liquid higher up a small intestine,
Speaker 3: further down it's more solid. There's various options, big or smaller,
Speaker 3: two part, one part, just depending on what you need.
Speaker 3: Then there's you can sort of fart with them. There's
Speaker 3: venting if I just like poke a little whole little
Speaker 3: venting device because you don't want to have a blowout
Speaker 3: as they call it. So there are like a thousand
Speaker 3: different pouches and systems for oustumates. And it was, you know,
Speaker 3: there was a really fun event. Everybody was. You know,
Speaker 3: this woman when I was using my empathy pouch, I
Speaker 3: just sort of grabbed this one. She goes, oh, that's
Speaker 3: a really large pouch. That's just very unsexy. Let me
Speaker 3: show you my pouch. See this, This is like, you know,
Speaker 3: and I changed it three or four times a day,
Speaker 3: and you know, everybody's had this kind of what are
Speaker 3: you wearing red carpet buzz? You know, it was fabulous.
Speaker 3: It was just very fun. And the more we can
Speaker 3: talk about these things, the less there's a stigma. There's
Speaker 3: been a lot of good progress made, I think via
Speaker 3: TikTok and people with ostomies just saying hey, this is
Speaker 3: how it works. Here's my pouch, here's how I changed,
Speaker 3: here's you know, just sort of saying here you go this.
Speaker 1: So far, we've mostly touched on things that are medically
Speaker 1: necessary replacement body parts. We're talking about skin grafts, organ transplants, prothesis,
Speaker 1: et cetera. But then there's cosmetic surgery. We've come a
Speaker 1: long way. It's obviously a huge industry these days, talking
Speaker 1: about things like early hair transplants, early breast implants.
Speaker 2: You know, what did.
Speaker 1: These things look like, how did people begin and how
Speaker 1: much was maybe the person who was receiving the transplant
Speaker 1: not necessarily like thought of their experience in terms of,
Speaker 1: for instance, what a breast implant was made of.
Speaker 3: Oh yeah, I wish I had the book right in
Speaker 3: front of me to just read you the list of
Speaker 3: all the stuff that was injected into women's Should we
Speaker 3: read that list? It's kind of an astounding.
Speaker 2: Let's read it.
Speaker 3: That's right, right, right, yeah, hold on, let me get
Speaker 3: the book. Okay. The filler would need to be thick
Speaker 3: enough to pass as breast tissue, yet thin enough to
Speaker 3: pass through the opening of a syringe. This is before aspirators,
Speaker 3: before the arrival. Yeah. In the early nineteen eighties of
Speaker 3: the liposuction aspirator, the substances injected were not typically fat.
Speaker 3: They were it truly seemed whatever fat like substance. Some
Speaker 3: enterprising plastic surgeons gaze happened to land on. Some took
Speaker 3: their inspiration in the kitchen olive oil, vegetable oil, some
Speaker 3: in the barnyard goat's milk, cow collagen, pig collagen, or
Speaker 3: the forest beeswax, tree resin derivatives. Others in the supply
Speaker 3: rooms of industry paraffin, petroleum, jelly, various glues and polymers.
Speaker 3: They were sticking anything in there.
Speaker 1: Love that goat smoke makes a second mention there, it's good. Yeah.
Speaker 1: Someone's gonna keep trying until they find use medically for
Speaker 1: goat smell. Yeah, yeah, yeah, I think The other thing too,
Speaker 1: is was hair transplants, which I know you tried to
Speaker 1: see if your hair could grow and then be transplanted.
Speaker 2: How did that end up all shaking out?
Speaker 3: Yeah? Yeah. I wanted to demonstrate for myself a concept
Speaker 3: called donor dominance, and this is what makes hair transplants possible.
Speaker 3: So you take hair from a man who's losing hair
Speaker 3: on the top. That's where you lose hair on the top,
Speaker 3: male pattern baldness. You don't lose it. They don't lose
Speaker 3: it on the sides in the back. So you can
Speaker 3: take a certain percentage of these follicles and move them
Speaker 3: up top, and they'll retain the characteristics of their homeland,
Speaker 3: so they won't be hair that responds to testosterone falls out.
Speaker 3: So you take a couple thousand hairs from back here
Speaker 3: and from the sides, and you put it up top,
Speaker 3: and because of donor dominance, it won't fall out, won't
Speaker 3: be hair that falls out. And so I was at
Speaker 3: a hair transplant clinic because of another chapter that had
Speaker 3: to do with growing follicles from stem cells. So while
Speaker 3: I was there, I said, will you can you transplant
Speaker 3: a couple of hairs from the back of my head
Speaker 3: to my leg because I wanted by the time I
Speaker 3: went on book tour, I wanted to have a couple
Speaker 3: of long, luxuriant hair screwing on my legs so i'd
Speaker 3: have this demons that I could show people. Look, this
Speaker 3: is donor dominance. These hairs came from the back of
Speaker 3: my head. Unfortunately they didn't take The legs get a
Speaker 3: lot less blood than the head. The scalp gets a
Speaker 3: very robust blood supply. On the calf not so much.
Speaker 3: So I'm sad to say I don't have long, luxuriant
Speaker 3: leg hair growing from the spot where they transplanted a
Speaker 3: couple follicles.
Speaker 2: Devastating.
Speaker 3: Yeah, I know, I know, I really, you know, but
Speaker 3: it's kind of amazing how well it does work, to
Speaker 3: the extent that there's something called pubic alopecia, which can
Speaker 3: be traumatic for some women, whether they lose their they
Speaker 3: don't have pubic care, they've lost their pubic care. And
Speaker 3: you can take head hair, but the thing is you
Speaker 3: then every two months have to trim it, Oh.
Speaker 2: My gosh, because it just will keep growing because of length.
Speaker 3: It's head hair.
Speaker 2: Yeah, amazing.
Speaker 3: The opposite shore, you could take pubic care, and this
Speaker 3: has been done transplant it. If you're going bald, you
Speaker 3: could use chest hair, armpit hair, pubic hare, but it's
Speaker 3: rarely done. The surgeon who did the largest study on
Speaker 3: it pointed out pubic care. That is that it is
Speaker 3: difficult to style difficult styles.
Speaker 2: That's amazing.
Speaker 1: I feel like with a hair transplant, you know and
Speaker 1: donor dominance with whatever various things people are injecting into
Speaker 1: breast tissue. But also beyond that. Throughout the rest of
Speaker 1: the book, where you talk about you know, z know, transplantation,
Speaker 1: you talk about skin graphs, the thing that really stands
Speaker 1: in the way is not a will. It's not a
Speaker 1: lack of skill, it's not knowledge, but it's our immune
Speaker 1: system that seems to be like this kind of unexpected
Speaker 1: antagonist that prevents us from achieving all that we want
Speaker 1: to and replacing whatever body part we you know, have
Speaker 1: our mindset on. What are people working on to solve
Speaker 1: the issue of rejection while also not destroying our immune system?
Speaker 3: Yeah, that is that is the challenge. The immune system
Speaker 3: is very very good at recognizing something foreign, and that's
Speaker 3: been a real problem with some of these With hand transplants,
Speaker 3: face transplants, these are composite tissue allow transplants. In other words,
Speaker 3: they're not just one kind of you know, a liver
Speaker 3: is fairly uniform, but this is, you know, a hand,
Speaker 3: there's there's muscle, there's tender there's skin, there's there's all
Speaker 3: these various components. There's just a lot going on to
Speaker 3: upset the immune system and to create a reaction, an
Speaker 3: immune reaction and a rejection. So and that's been in issues.
Speaker 3: There there are folks who've had a face transplant and
Speaker 3: now it's breaking down. It's not working as well, it's
Speaker 3: not supple it's whatever's going on in addition to rejection
Speaker 3: episodes and all the issues of immunosuppression. They're going to
Speaker 3: need a second face or hands, or there's folks who
Speaker 3: are having hands removed just because the immunosuppression that's necessary
Speaker 3: to keep the body from rejecting it. It's too problematic.
Speaker 3: So you know what could be done. There was some
Speaker 3: work being done with taking some of the donors marrow
Speaker 3: which has components of the immune system, so you would
Speaker 3: sort of donate that along with the part being donated.
Speaker 3: I don't you know, but you know that was going on.
Speaker 3: This was back when I reported grunt, which you know,
Speaker 3: around twenty sixteen, I think they were just doing a
Speaker 3: lot of these, you know, composite tissue transplants the hands,
Speaker 3: the arms, the faces, and it's kind of they've backed
Speaker 3: off of it just it's been very problematic. Even with
Speaker 3: that marrow I don't remember the name exactly of the technique,
Speaker 3: but where you take a little bit of marrow from
Speaker 3: the donor. There's hope that in the future you could genetically,
Speaker 3: I'm not sure how, but you would get the organ
Speaker 3: itself to secrete an immunosuppressive protein, so it would have
Speaker 3: you'd have localized immunosuppression, so you wouldn't have to tamp
Speaker 3: down the whole body immune system. You could just get
Speaker 3: the organ to do it itself. That you know is
Speaker 3: in the future. In terms of stem cells, you know,
Speaker 3: right now, there are treatments where you can take somebody's blood,
Speaker 3: you can regress it to its very early state where
Speaker 3: it's called plury potency, and then instruct it to become
Speaker 3: a kind of cell, say a dopamine producing neuron, you know,
Speaker 3: for somebody with Parkinson's. But that's a bespoke process, so
Speaker 3: it's you've got to take it's time consuming and very expensive.
Speaker 3: It has to be the person's own cells, otherwise the
Speaker 3: body will destroy them. But if you could create what's
Speaker 3: called stealth cells where they evade the immune system, then
Speaker 3: you could just buy plury potent cells off the shelf
Speaker 3: kind of and instruct them to become what you want.
Speaker 3: So so that would be terrific, But that's not You're
Speaker 3: talking about cells that may replicate and do what they
Speaker 3: want that evade the immune system. So that's a scary thing.
Speaker 3: The f is rightfully concerned about that. So you know,
Speaker 3: those are two directions things are going, but not quite
Speaker 3: there yet.
Speaker 1: Yeah, yeah, I mean, and hopefully there will be more
Speaker 1: progress made in so many of these fronts. I mean,
Speaker 1: it is amazing how fast pace some of this research is.
Speaker 1: And even though the headlines might be overhyping and overstating
Speaker 1: where things are, but I do feel like it is.
Speaker 1: It's a really promising area of research. And that's one
Speaker 1: thing that I really appreciated about your book, and how
Speaker 1: all of these areas we've made progress in and progress
Speaker 1: in one area also means progress in all of these
Speaker 1: other areas as well.
Speaker 3: Yes, And that's why cuts to the NIH and the
Speaker 3: NSF cuts to laboratory funding is so damaging looking like
Speaker 3: down the line in terms of just the pipeline of
Speaker 3: innovators and engineers and work that needs to go on
Speaker 3: to keep things moving forward. You know, it's bad enough
Speaker 3: just to of what it's doing to patients and to
Speaker 3: projects that are underway, but going forward, you know, all
Speaker 3: the progress that we've made, all of that depends on
Speaker 3: government funding. So that's been you know, I have an
Speaker 3: epilogue in the book because the book was I was
Speaker 3: going to the you know, into production just as the
Speaker 3: DOGE cuts were happening, and we so we added an
Speaker 3: epilogue about that. And it's really sad. Yeah.
Speaker 1: Yeah, the costs when calculated, the costs will be I mean,
Speaker 1: and when we can actually calculate is a big question,
Speaker 1: but it'll be incomprehensible.
Speaker 3: I feel like, yeah.
Speaker 5: But well yeah, well, sorry to end on a bot
Speaker 5: a sad note, but it you know, aside from the
Speaker 5: necessary reflection on the state of funding today and science
Speaker 5: science funding today, it has been such a joy chatting
Speaker 5: with you as always.
Speaker 1: Thank you so much for taking the time to chat
Speaker 1: about your book.
Speaker 3: Oh my pleasure. Always in joy being on the podcast
Speaker 3: Thanks so much, Jaron.
Speaker 1: A big thank you again to Mary Roach for taking
Speaker 1: the time to chat with me. It is just so
Speaker 1: surreal to get to talk with one of my sycom heroes.
Speaker 1: If you enjoyed today's episode and would like to learn more,
Speaker 1: check out our website this podcast will kill You dot com.
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Speaker 1: Replaceable You Adventures in Human Anatomy, as well as a
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