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Speaker 1: Hello, friends, We're talking about parasites again today. These parasites

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Speaker 1: can have some pretty nasty impacts on human bodies, and

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Speaker 1: I just wanted to give you all a heads up

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Speaker 1: in case you or your kiddos are a bit squeamish

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Speaker 1: about such things. I study parasites for a living, so

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Speaker 1: I am a long past having a reasonable handle on

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Speaker 1: what a decent person would consider disgusting. Sorry about that, Okay,

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Speaker 1: on with the show. In eighteen ninety eight, a German

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Speaker 1: parasitologist named Arthur Loss was trying to figure out exactly

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Speaker 1: how this particular kind of parasite infects people, as was

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Speaker 1: fairly common at the time. The method he was using

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Speaker 1: to try to figure out this parasite's complicated life cycle

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Speaker 1: was by trying to infect himself in various ways. During

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Speaker 1: this self experimentation, he discovered something surprising. He was already

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Speaker 1: infected by a different parasite species. How did you make

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Speaker 1: this discovery? Well, it's kind of a gross story. You see.

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Speaker 1: He knew that the parasite he was initially studying lives

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Speaker 1: in our guts and produces eggs that get out of

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Speaker 1: the body by traveling out in our bowel movements. So

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Speaker 1: when he was checking his turns for parasite eggs, he

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Speaker 1: found the eggs from this other species. The kind of

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Speaker 1: parasite he discovered he was infected with is commonly called

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Speaker 1: a hookworm, and this was another species of parasite for

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Speaker 1: which back in eighteen ninety eight we had figured out

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Speaker 1: how it manages to infect people in the first place.

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Speaker 1: So Low starts thinking back on behaviors he had engaged

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Speaker 1: in recently to get a good guess for how he

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Speaker 1: got infected with this parasite. His best guess was that

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Speaker 1: maybe it accidentally happened during an experiment that he was

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Speaker 1: doing on hookworms and guinea pigs where he accidentally spilled

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Speaker 1: some of the hookworms on his hand. He remembered afterwards

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Speaker 1: that he started scratching like crazy and that it was uncomfortable,

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Speaker 1: and he thought, well, maybe the parasites get through your skin.

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Speaker 1: No stranger to self experimentation. Los subsequently dropped some more

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Speaker 1: juvenile hookworms on his hand and his skin started to

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Speaker 1: burn and get red. Then he tried to like scrape

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Speaker 1: his skin a little bit to see if he could

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Speaker 1: get the worms off there, and he noticed that there

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Speaker 1: were far fewer worms on that scrape than he had

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Speaker 1: initially put on his hand, so he suspected, Okay, they're

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Speaker 1: actually disappearing into my skin. So he's feeling pretty good

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Speaker 1: about his hypothesis now that the parasites get in by

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Speaker 1: burrowing through your skin. But how could he know for sure? Well,

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Speaker 1: Los finds himself a volunteer, a young man who was

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Speaker 1: in need of a leg amputation, graciously agreed to help

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Speaker 1: out with science. In the process, Los put some of

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Speaker 1: the juvenile hookworms on the leg of the patient prior

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Speaker 1: to the procedure. Following the imputation, Los was able to

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Speaker 1: recover the parasites that had indeed burrowed through the skin

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Speaker 1: and were working their way through the leg. So now

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Speaker 1: he knew that hookworms infect people by getting their eggs

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Speaker 1: into the environment with our poop, and then the juvenile

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Speaker 1: worms hatch out and go off in search of things

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Speaker 1: like bare feet. Knowing how a parasite affects you gives

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Speaker 1: you some tools to help combat the parasites. Flash forward

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Speaker 1: about ten years and John D. Rockefeller is using his

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Speaker 1: oil money to create a commission to do battle with

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Speaker 1: this parasite in the American South. Today, we're making some progress,

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Speaker 1: but we still have a long way to go. Improved

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Speaker 1: sanitation systems have made this parasite rare in the United States,

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Speaker 1: but globally this parasite and a few other species that

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Speaker 1: will also talk about in this episode. Improve sanitation systems

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Speaker 1: have made this parasite rare in the United States, but

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Speaker 1: hookworms and some other parasites that you find in the

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Speaker 1: soil are still a problem in other parts of the world.

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Speaker 1: This parasite infects about one and a half billion people worldwide,

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Speaker 1: or about twenty five percent of the global population, though

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Speaker 1: the infections are mainly happening in Asia and Africa. Today,

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Speaker 1: we'll talk more about these parasites and how public health

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Speaker 1: officials are currently trying to do battle with this ancient

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Speaker 1: scourge of humanity. To Daniel and Kelly's extraordinarily warmy universe.

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Speaker 2: Hi, I'm Daniel. I'm a particle physicist, and I contain multitudes.

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Speaker 1: Hi. I'm Kelly Wiener Smith. I study parasites for a living,

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Speaker 1: and I agree Daniel does contain multitudes. I do too.

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Speaker 1: We all do. You're never alone.

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Speaker 2: There's a side of me that's fascinated by biology, and

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Speaker 2: then the side that thinks it's totally griss.

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Speaker 1: You know, I let both of those sides coexist inside myself.

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Speaker 1: It's okay to be grossed out by something but still

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Speaker 1: think it's fascinating.

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Speaker 2: You're a quantum superposition of biological fascination.

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Speaker 1: I don't think they have to be diametrically opposed, like

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Speaker 1: the cat's alive the cat is dead. I think it

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Speaker 1: can be both awesome and disgusting. They're not mutually exclusive states.

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Speaker 2: You never have that moment where you're like looking at something,

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Speaker 2: You're like, Wow, this is fascinating, and then all of

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Speaker 2: a sudden you get the ick, like, WHOA, I can't

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Speaker 2: touch this thing anymore. I have to put it down.

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Speaker 1: No, but there was a moment in a talk. It

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Speaker 1: was an anthropology talk that grossed me out. There was

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Speaker 1: a table of monkey brains. It was that a food market,

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Speaker 1: and even though I had just spent like literally the

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Speaker 1: last couple months looking at fish brains and thought that

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Speaker 1: I was like totally immune to brain related disgustingness, the

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Speaker 1: room started to spin and I had to put my

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Speaker 1: head down because looking at the monkey brains was making

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Speaker 1: me sick, and I was so embarrassed. I was like,

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Speaker 1: I should be okay, but what about you. What was

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Speaker 1: the moment where disgust just sort of overwhelmed you. I

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Speaker 1: imagine that being married to Katrina, there's gotta be a

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Speaker 1: lot of like hope related moments.

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Speaker 2: Well, you know, there are times when I expected to

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Speaker 2: be grossed out, Like, for example, when my daughter was

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Speaker 2: born by sea section, and they told me you have

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Speaker 2: to sit behind the curtain, you can't watch, and I

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Speaker 2: was like, oh no, I'm looking at this. And I

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Speaker 2: stood up and I peeked over the curtain and I

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Speaker 2: was totally fine, like, ow, that's my wife and they're

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Speaker 2: cutting her open, and that's my daughter, and it's pretty goofy.

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Speaker 2: But it was just so amazing. Yeah, I didn't fainter,

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Speaker 2: cost trouble or anything. Missed that moment, and then you know,

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Speaker 2: much more simply, there's the time when I like, open

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Speaker 2: the freezer in our house, I'm like, what's in this

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Speaker 2: paper bag? Uh? Oh no, that's not what I expected.

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Speaker 1: It's a sample that's pretty gross. You know. It's funny

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Speaker 1: I didn't get a C section, but my husband couldn't

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Speaker 1: even look on the other side of the curtain over

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Speaker 1: the legs because he was just like, no, no, this

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Speaker 1: is all too gross. And they went to lift the

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Speaker 1: umbilical cord up, like do you want to cut the

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Speaker 1: And before they even got it up over the blanket,

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Speaker 1: he was like, no, no, just hand me the dry

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Speaker 1: clean baby, please. I don't need to know any of

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Speaker 1: this stuff. And he did a good job providing support

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Speaker 1: from the safe side of the blanket.

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Speaker 2: Well. Biology is messy and squishy, but that's how life works, right, reproduction, propagation,

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Speaker 2: all of that stuff. And something that I've had to

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Speaker 2: come to terms with, especially being married to Katrina and

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Speaker 2: learning more about microbes, is that inside all of us,

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Speaker 2: it is a whole ecosystem. It's not just human cells

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Speaker 2: that make you work. You are filled with all sorts

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Speaker 2: of bacteria and other stuff, some of which are vital

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Speaker 2: to the operation of your guts and some of which

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Speaker 2: are doing you harm. And the line between them can

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Speaker 2: be a little bit fuzzy, isn't that right?

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Speaker 1: Yeah, it really can. So the parasites that we're going

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Speaker 1: to be talking about today, there's some evidence that when

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Speaker 1: you have just a few of them, they help suppress inflammation,

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Speaker 1: or the presence of these parasites suppresses inflammation, and maybe

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Speaker 1: even having some of these parasites reduces your risk of

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Speaker 1: allergies or some autoimmune diseases. So yeah, that's not necessarily

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Speaker 1: yes or no dichotomy sort of here. It sometimes it's

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Speaker 1: a gradient. It's complicated.

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Speaker 2: Yeah, it's not something we can understand from first principles

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Speaker 2: because the body is a huge complex Rube Goldberg machine, right,

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Speaker 2: and you can't look at it and say, if I

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Speaker 2: pulled this one thing out, everything would be better or worse,

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Speaker 2: Like it would be different, and it's not always clear

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Speaker 2: whether it's better or worse. So is it even clear

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Speaker 2: what a parasite? I mean, if we're going to talk

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Speaker 2: about parasites in humans that date back thousands of years,

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Speaker 2: you know, maybe they're just part of how we evolved.

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Speaker 1: Yeah, so parasites definitely are part of how our species evolved,

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Speaker 1: that they've been with us, you know, from the beginning.

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Speaker 1: But then the question is do they do more harm

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Speaker 1: than good? And I think the answer really depends on

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Speaker 1: context and even can depend on the person how their

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Speaker 1: immune system responds to these parasites. And so I think

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Speaker 1: it's never a yes or no. Although with the parasites

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Speaker 1: we're gonna talk about today, when you have a lot

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Speaker 1: of them, that is always bad. There is zero debate

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Speaker 1: about whether or not it's bad to have a lot

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Speaker 1: of these parasites. It is, and unlike tricinella, which we

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Speaker 1: talked about last week, where there's been a lot of

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Speaker 1: progress made around the world, but particularly in places like

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Speaker 1: the United States, for controlling the transmission of this parasite

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Speaker 1: and making sure pretty much no one gets it. These

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Speaker 1: soil transmitted nematodes. And I think Daniel's gonna tell me

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Speaker 1: that's too much jargon. So we're gonna call them dirt worms.

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Speaker 2: Oh I love it, dirt worms, thank you.

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Speaker 1: Yes, these nematodes, which are these like long, thin, cylindrical parasites,

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Speaker 1: we're gonna call them dirt worms because they're a wormy shape.

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Speaker 1: These are still a problem in some parts of the

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Speaker 1: United States, in particular areas that are poor and don't

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Speaker 1: have good sanitation, and they are a problem in Africa

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Speaker 1: and Asia. It's thought that about twenty five percent of

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Speaker 1: the world's population is infected with at least one of

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Speaker 1: these worms, and a lot of people are infected with

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Speaker 1: a lot more than that.

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Speaker 2: I guess some of the questions we'll be asking today

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Speaker 2: is how long we've been doing battle or evolutionarily dancing

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Speaker 2: with these dirt worms, whether they hurt or help us,

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Speaker 2: and what we can do about them in the future.

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Speaker 1: Right, Yeah, So let's just jump right in. So you know,

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Speaker 1: you asked, like, how long have we been doing battle

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Speaker 1: with these parasites and the answer is a really long time.

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Speaker 1: So there's some evidence from the ancient Nile Valley. So

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Speaker 1: like when the ancient Egyptians were, you know, ruling the

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Speaker 1: world or whatever, they were infected by some of these worms.

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Speaker 1: And the way that we figure it out is again

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Speaker 1: creepy but wonderful, like both those things together. So we

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Speaker 1: study what are called coprolites, which is essentially like poop fossils.

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Speaker 2: Poop fossils, oop fossils.

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Speaker 1: Yes, I have such a big grin on my face,

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Speaker 1: and so they are like parasite eggs that you can

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Speaker 1: still like dig out of these poop fossils. In some

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Speaker 1: cases you can extract a little bit of DNA from

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Speaker 1: them to confirm. But the eggs from the different kinds

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Speaker 1: of dirt worms that we're gonna be talking about today

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Speaker 1: are pretty distinctive.

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Speaker 2: Let's go back to what these things are. Are these

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Speaker 2: things we find like in the guts of mummies or

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Speaker 2: in ancient toilets, or where are we finding these poof fossils?

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Speaker 2: How do we know that they're poof fossils and not

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Speaker 2: just lumps of dirt?

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Speaker 1: Well, all of the above. So sometimes we'll find like

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Speaker 1: a latrine, and so like it's kind of clear from

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Speaker 1: what's happening around the samples the specimens that it was

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Speaker 1: like a latrine, and so there'll be a bunch of

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Speaker 1: poop in one place. Sometimes you'll find a mummy, and

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Speaker 1: if you dig around in the mummies intestines, some of

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Speaker 1: the parasite eggs that we're passing through the body of

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Speaker 1: that mummy are still there. You can look there, or

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Speaker 1: if you've got like a body that's sort of decomposed,

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Speaker 1: you can dig around in the dirt around where they're

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Speaker 1: like belly and their bells were, and sometimes you can

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Speaker 1: still find parasite eggs that have been preserved in that area.

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Speaker 2: Preserved how like if you put them in water, they

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Speaker 2: would like swiggle back into worms like tartar grades, or

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Speaker 2: they're like fossils of these eggs. Because fossilization is some

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Speaker 2: process we are replacing it with minerals, right, So what

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Speaker 2: it actually is preserved here.

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Speaker 1: Yeah, it's mineralization, so they're definitely not coming back to life.

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Speaker 1: Mineralized parasites sometimes with a little bit of DNA still present,

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Speaker 1: but like you really have to worry about contamination. It's

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Speaker 1: hard to do the DNA stuff, but we can be

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Speaker 1: pretty sure.

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Speaker 2: You know, some of these ancient kings really wanted to

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Speaker 2: be remembered in the future, and I wonder how they

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Speaker 2: would feel about, you know, this is what they've passed

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Speaker 2: down to later generations.

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Speaker 1: If you managed to get in one of those pyramids

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Speaker 1: and you really didn't want anyone to disturb you, you're

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Speaker 1: probably not super happy if this is happening. But yeah,

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Speaker 1: that's the uncomfortable history of science.

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Speaker 2: Speaking of the history of science, we know a lot

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Speaker 2: about ancient Egyptian culture, and we have their hieroglyphics. Is

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Speaker 2: there any evidence in their writing that they understood what

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Speaker 2: was going on in their guts? Like, were there ancient

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Speaker 2: Egyptian parasitologists.

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Speaker 1: I don't think there were ancient Egyptian parasitologists. There are

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Speaker 1: some writings, I think in Chinese texts where it's interpreted

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Speaker 1: that they were talking about some of these worms, but

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Speaker 1: we don't know for sure, so you know, the description

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Speaker 1: would just be like there was a wormy thing, and

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Speaker 1: you're like, well, that could be a lot of things,

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Speaker 1: because we're infected by a lot of wormy things, especially

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Speaker 1: a long time ago. There's some guesses that like ancient

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Speaker 1: Chinese texts were talking about roundworms, so these very long,

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Speaker 1: like pencil sized worms. But I'm not an expert in

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Speaker 1: this topic, and I'm under the impression that the best

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Speaker 1: we can do is, oh, that's probably right ascharis for example,

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Speaker 1: But we don't know for sure.

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Speaker 2: So then how far back do these fossils go, Like

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Speaker 2: how long have we been living with these worms?

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Speaker 1: The review paper that I was reading talked about copper

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Speaker 1: lightes so fossilized poop that had evidence of parasites from

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Speaker 1: Krueger Cave in South Africa that was twelve thousand years

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Speaker 1: before present, so twelve thousand years ago.

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Speaker 2: Wow.

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Speaker 1: And that mummy Utzi, how do you say, do you

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Speaker 1: know the name of that mummy? The one that was

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Speaker 1: found in the Alps near Italy and Australia, and I

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Speaker 1: think it had like a arrowhead.

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Speaker 2: Let's see the iceman.

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Speaker 1: Yeah, yeah, the iceman. The iceman had whipworm and is intestine.

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Speaker 1: Oh wow, this has been a problem for a lot

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Speaker 1: of people for a long time.

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Speaker 2: Do you think it's possible that we had worms before

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Speaker 2: we were humans, Like, had they evolved with us from

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Speaker 2: our ancestors or was there a time when we were

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Speaker 2: first infected and before that our ancestors were a worm

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Speaker 2: free somehow? What do you think is more likely?

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Speaker 1: Yeah, I think our ancestors had these worms, and the

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Speaker 1: worms probably speciated with us. I can't say that I've

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Speaker 1: actually looked up the phylogeny of the nematodes and the

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Speaker 1: ascarids and the parasites we're talking about today, but folks

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Speaker 1: have done this kind of work, and there are a

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Speaker 1: lot of parasites that our ancestors had, and the parasites

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Speaker 1: speciated along with our ancestors and us, and so you

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Speaker 1: ended up with like two sort of human e species

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Speaker 1: and two you know, parasites to infect both of them.

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Speaker 2: Wow. I think that goes a long way to making

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Speaker 2: the argument that it's part of being human is to

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Speaker 2: have worms, because we've always had them, right, Like, literally

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Speaker 2: the first humans had worms. So it's maybe what it

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Speaker 2: means to be human is to be a little bit wormy.

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Speaker 1: I think what it is to be alive is to

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Speaker 1: be a little bit wormy or to be a little

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Speaker 1: bit infected. I think you know just about any wild

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Speaker 1: animal that you go pick up in nature, if you

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Speaker 1: dissect it, it's got probably a nematod, maybe a treematod.

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Speaker 1: It's probably got some lice. Parasites are ubiquitous.

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Speaker 2: So what fraction of our listeners hearing this right now

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Speaker 2: do you think have worms inside them?

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Speaker 1: Really depends on where they're listening from. I think you

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Speaker 1: and I probably don't have worms. I might have toxoplasmosis

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Speaker 1: because I have barncats and I regularly interact with their

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Speaker 1: feces while I'm cleaning stuff up. But I think you know,

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Speaker 1: if you cook your food well and you live in

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Speaker 1: a pretty sanitary environment, you can escape a lot of

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Speaker 1: this stuff.

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Speaker 2: All right, So we've been living with worms forever. It's

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Speaker 2: part of being human, part of being alive, part of

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Speaker 2: existing in this wonderful, squishy world. Tell us about how

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Speaker 2: these things live, like, did they just hang out in

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Speaker 2: your guts? Is there some whole process where they go

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Speaker 2: in and out of you? Do they move from person

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Speaker 2: to person? What's the whole life cycle of these crazy worms.

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Speaker 1: Yeah, so for this set of worms and for a

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Speaker 1: bunch of other parasites also, they live in our guts

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Speaker 1: and they produce eggs that pass with our feces into

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Speaker 1: the environment, so they're not multiplying inside of us. Each

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Speaker 1: parasite that we have in us we accidentally independently, like

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Speaker 1: consumed from the environment, and then their eggs go with

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Speaker 1: our feces out into the environment, where if we don't

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Speaker 1: take good care of our feces and we don't have

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Speaker 1: good sanitary procedures, then they can go off and infect

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Speaker 1: other people.

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Speaker 2: Oh so, if you have worms, you can get rid

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Speaker 2: of them by just stop eating worms.

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Speaker 1: Well, I mean the worms that you have in you

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Speaker 1: can survive for a while.

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Speaker 2: Oh I see.

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Speaker 1: I think the three that we're talking about today have

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Speaker 1: an average lifespan of about a year, but some of

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Speaker 1: them can live much longer than that. So if you

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Speaker 1: stop accidentally ingesting parasites and you can go a year

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Speaker 1: without reinfecting yourself, then you can get rid of these parasites.

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Speaker 1: But a problem is that there's lots of places in

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Speaker 1: the world where sanitation is not very good, and so

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Speaker 1: you know, humans will defecate out into the environment, and

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Speaker 1: then the feces will sort of dry, and the parasites,

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Speaker 1: you know, by getting on people's feet who are walking

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Speaker 1: around in the like latrine area, they'll spread out into

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Speaker 1: the environment. The way the dirt worms work, and there's

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Speaker 1: something like four different species of these dirt worms, is

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Speaker 1: that the eggs get in the environment, and then the

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Speaker 1: eggs after like waiting a short period of time, if

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Speaker 1: they get into you because you like maybe you were

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Speaker 1: gardening in an area where there was night soil, so like,

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Speaker 1: those feces may have actually been placed on top of

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Speaker 1: your plants as a way to fertilize them, and so

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Speaker 1: if you don't wash them well enough or wash your hands,

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Speaker 1: you could accidentally ingest the eggs and get infected that way.

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Speaker 2: Did you just use night soil as a euphemism for poop?

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Speaker 1: Uh? No, that's a great question. No. Night soil is

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Speaker 1: the like technical term for the use of human and

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Speaker 1: livestock waste as fertilizer. This is actually pretty common in China,

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Speaker 1: which is one of the reasons why China has problems

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Speaker 1: with some of these parasites. Oh, you can treat the

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Speaker 1: night soil and kill the parasites in it before you

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Speaker 1: use it, but that doesn't always happen, and so that

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Speaker 1: spreads the parasite like crazy.

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Speaker 2: And how big are these eggs? Like they must be

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Speaker 2: very small, otherwise you would notice them and avoid eating them. Right,

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Speaker 2: we're not talking chicken eggs here obviously, Like we're talking microscopic.

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Speaker 1: Yeah, microscopic. You can't see them with the naked eye.

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Speaker 1: You got to put them under a microscope to see them.

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Speaker 2: Oh wow. So they're like under your fingernails and stuff.

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Speaker 1: Yeap, like pinworms. So the dirt worms are round worms,

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Speaker 1: which are you know, round, and they get pretty big,

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Speaker 1: like I dissected one in class, Like they're big enough

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Speaker 1: that you can dissect them. They're like pencils, like they

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Speaker 1: can be about a foot long, and they're thick. And

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Speaker 1: after you see them, you are like, I'm not eating

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Speaker 1: spaghetti for a really long time, Like I.

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Speaker 2: Just put see you got the ick?

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Speaker 1: I did get the ick? Yeah? No, asparants give me

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Speaker 1: the egg. Roundworms are super inchy. And then there's whipworms

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Speaker 1: and they're called that because like they have tails that

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Speaker 1: kind of look like whips, but they're much much smaller.

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Speaker 1: You know, a big one is like fifty millimeters and

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Speaker 1: then there's hookworms. And so hookworms they get into you

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Speaker 1: in a totally different way. So they get to pop

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Speaker 1: it into the environment, and then their eggs hatch and

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Speaker 1: they release these tiny little juvenile stages, and the juvenile

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Speaker 1: stages they go up on the grass and stuff, and

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Speaker 1: as you walk past, they get on your skin and

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Speaker 1: then they burrow into you. Yeah, and it often itches

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Speaker 1: and is uncomfortable.

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Speaker 2: Get big timech over here, I know.

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Speaker 1: I'm sorry, I'm sorry. But they take the wildest journey

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Speaker 1: to get to your gut. And I'm gonna tell you

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Speaker 1: all about it when we get back from the break.

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Speaker 1: So hookworm goes on this crazy journey once it gets

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Speaker 1: into your body. All right, So it burrows in like

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Speaker 1: you know, you're walking around, it's a beautiful morning, there's

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Speaker 1: dew on the grass. But accidentally you encounter a hookworm

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Speaker 1: and it burrows in, you know, between your toes or something,

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Speaker 1: and it ends up in your circulatory system.

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Speaker 2: Can it dig in anywhere? Does it have to find

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Speaker 2: some soft spot between your toes?

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Speaker 1: It can dig in anywhere? Oh wow, yeah nasty. And

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Speaker 1: so it goes into your circulatory system and it rides

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Speaker 1: it till it gets to your lungs, and then it

397
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Speaker 1: goes out of the circulatory system into your lungs into

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Speaker 1: your lungs. Well, it gets worse, I think it gets worse.

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Speaker 1: And so then it crawls up your lungs and it

400
00:19:27,560 --> 00:19:30,760
Speaker 1: crawls up and it gets into like sput them. And

401
00:19:30,800 --> 00:19:33,800
Speaker 1: so when you like kind of cough, you cough up

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Speaker 1: the parasites. And then when you swallow that again it

403
00:19:36,920 --> 00:19:38,120
Speaker 1: goes into your stomach.

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00:19:38,359 --> 00:19:41,360
Speaker 2: You cough up the worms into your mouth, so now

405
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Speaker 2: you like have warmy mouth.

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Speaker 1: I know this is really rise.

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Speaker 2: We are tilting far from curiosity towards icky again.

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Speaker 1: I feel like those things are connected. But I've got

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Speaker 1: a friend named Jimmy Burnout who got purposefully infected for

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Speaker 1: a vaccine trial, and you know, like I wanted to,

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Speaker 1: you know, like when you spit up, can you feel

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Speaker 1: the worms in your mouth? And he's like, no, no,

413
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Speaker 1: like they're really small. I think it was on his

414
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Speaker 1: mind every time. He was like, eh, you know, he

415
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Speaker 1: probably thought to himself like, oh, those are worms, but

416
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Speaker 1: he said it wasn't like obvious. So anyway you swallow them,

417
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Speaker 1: they get into your gut. But hookworms cause trouble because

418
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Speaker 1: they eat your blood. So they have these like hooky mouths,

419
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Speaker 1: and they use those hooks to like cut into the

420
00:20:23,600 --> 00:20:27,040
Speaker 1: sides of your intestine and they suck blood out that way,

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Speaker 1: and then they'll move on to a different site. And

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Speaker 1: so often you will end up with like a lot

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Speaker 1: of blood in stool, blood in poop if you have

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Speaker 1: too many of these, because they've just opened up a

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Speaker 1: bunch of wounds in order to get at your blood.

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Speaker 2: So why did they go into your intestine to eat

427
00:20:41,600 --> 00:20:44,199
Speaker 2: your blood If they started out in your circulatory system,

428
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Speaker 2: why aren't they just like happy floating in blood.

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Speaker 1: So I think that it has to do with the

430
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Speaker 1: ease of getting your eggs back out into the environment.

431
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Speaker 1: You make eggs and you just release them into the intestine,

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Speaker 1: your body will just you know, with the rest of

433
00:20:56,760 --> 00:20:58,440
Speaker 1: your food and with the rest of your bowel movement,

434
00:20:58,480 --> 00:21:00,399
Speaker 1: just move it back out into the environment, and that

435
00:21:00,440 --> 00:21:02,560
Speaker 1: way their eggs can get back out inside of the world.

436
00:21:03,000 --> 00:21:06,240
Speaker 1: The real question to me is there's this other parasite

437
00:21:06,240 --> 00:21:09,880
Speaker 1: called roundworm's ask Chris. These are the ones that are

438
00:21:09,880 --> 00:21:13,760
Speaker 1: like pencil shaped. You eat them accidentally.

439
00:21:13,400 --> 00:21:14,679
Speaker 2: With a nice tomato sauce.

440
00:21:15,160 --> 00:21:18,320
Speaker 1: Maybe who knows, if you didn't wash your hands before

441
00:21:18,320 --> 00:21:21,560
Speaker 1: preparing the tomato sauce. Maybe, but then they go like

442
00:21:21,680 --> 00:21:24,320
Speaker 1: into your digestive tract. But then they burrow out of

443
00:21:24,359 --> 00:21:27,439
Speaker 1: your stomach and into your bloodstream and do the same

444
00:21:28,080 --> 00:21:30,639
Speaker 1: lung spit up, get back to your gut thing. And

445
00:21:30,720 --> 00:21:33,560
Speaker 1: so I wrote an expert who works on hookworm vaccines

446
00:21:34,040 --> 00:21:36,240
Speaker 1: and who studies this stuff, and his name's John Hawden,

447
00:21:36,280 --> 00:21:38,800
Speaker 1: and I was like, John, why does Askris go on

448
00:21:38,800 --> 00:21:41,160
Speaker 1: that long journey when it had already gotten to where

449
00:21:41,240 --> 00:21:43,959
Speaker 1: it wanted to be? And he pretty much was like,

450
00:21:44,359 --> 00:21:47,119
Speaker 1: we don't know. One of the hypotheses is that it

451
00:21:47,240 --> 00:21:50,800
Speaker 1: evolved from an ancestor that already made that journey and

452
00:21:50,840 --> 00:21:53,520
Speaker 1: so just sort of like evolution left that step in.

453
00:21:53,600 --> 00:21:56,879
Speaker 1: Whether that makes sense or not, there's another argument that

454
00:21:56,920 --> 00:21:59,000
Speaker 1: they need some extra time to develop, and going through

455
00:21:59,000 --> 00:22:01,880
Speaker 1: this journey gives them a little bit more development time. It's

456
00:22:01,920 --> 00:22:03,639
Speaker 1: not clear to me why they can't just stay in

457
00:22:03,680 --> 00:22:06,200
Speaker 1: the gut and finish their development there. But maybe, like

458
00:22:06,600 --> 00:22:09,280
Speaker 1: you know, you get intestinal cells slough off, you got

459
00:22:09,320 --> 00:22:12,600
Speaker 1: some risk of being pooped out accidentally, And so the

460
00:22:12,640 --> 00:22:14,680
Speaker 1: answer is, we don't really know, but it could be

461
00:22:14,800 --> 00:22:16,960
Speaker 1: like a relic of what some ancestor used to do

462
00:22:17,080 --> 00:22:18,639
Speaker 1: that kind of stuck with this parasite.

463
00:22:18,720 --> 00:22:20,960
Speaker 2: Maybe it's the friends they make along the way, you know.

464
00:22:21,080 --> 00:22:22,960
Speaker 1: That's right, that's right. They wanted to hang out with

465
00:22:23,000 --> 00:22:25,840
Speaker 1: the other lungworms for a while, and you'd hate to

466
00:22:25,880 --> 00:22:26,760
Speaker 1: lose your buddies.

467
00:22:27,080 --> 00:22:29,000
Speaker 2: How long have we known this kind of stuff? Like

468
00:22:29,119 --> 00:22:32,120
Speaker 2: we know that people have been having worms forever, When

469
00:22:32,160 --> 00:22:34,439
Speaker 2: did we first start to understand this stuff? When is

470
00:22:34,440 --> 00:22:37,760
Speaker 2: the science of worminess really kick off?

471
00:22:38,200 --> 00:22:40,320
Speaker 1: Well, so for hookworms, which I know the most about,

472
00:22:40,440 --> 00:22:44,240
Speaker 1: around eighteen forty there was a doctor Debinni who was

473
00:22:44,359 --> 00:22:47,399
Speaker 1: doing dissection of a cadaver like a post mortem examination,

474
00:22:47,600 --> 00:22:50,119
Speaker 1: and he found hookworms and wrote about it. So he

475
00:22:50,240 --> 00:22:51,800
Speaker 1: was one of the first ones to be like, oh,

476
00:22:51,880 --> 00:22:53,920
Speaker 1: like this might be something we should look into more.

477
00:22:54,359 --> 00:22:58,800
Speaker 1: And then in eighteen fifty four, Wilheim Greysinger, sorry about

478
00:22:58,800 --> 00:23:02,040
Speaker 1: the mispronunciations everyday, did a post mortem on a soldier

479
00:23:02,119 --> 00:23:03,960
Speaker 1: and this guy had a lot of worms. And this

480
00:23:04,080 --> 00:23:05,920
Speaker 1: was the first time that somebody was like, you know what,

481
00:23:06,520 --> 00:23:09,359
Speaker 1: this worm could be bad enough that maybe this is

482
00:23:09,400 --> 00:23:11,400
Speaker 1: part of why the soldier died. Because the soldier had

483
00:23:11,440 --> 00:23:14,680
Speaker 1: like really awful diarrhea. So that was the first instance

484
00:23:14,720 --> 00:23:17,080
Speaker 1: that we know of where somebody was like, not only

485
00:23:17,080 --> 00:23:19,040
Speaker 1: are these worms in there, but they could be the

486
00:23:19,080 --> 00:23:19,960
Speaker 1: cause of a problem.

487
00:23:20,240 --> 00:23:22,639
Speaker 2: And do you think the earlier discovery of worms in

488
00:23:22,680 --> 00:23:24,920
Speaker 2: the body was a surprise or is this something people

489
00:23:24,960 --> 00:23:27,439
Speaker 2: were sort of genuinely aware of, like, yeah, people have

490
00:23:27,520 --> 00:23:29,720
Speaker 2: worms in them, or it was like, oh my god,

491
00:23:29,760 --> 00:23:31,440
Speaker 2: there are worms in people's bodies.

492
00:23:31,680 --> 00:23:33,640
Speaker 1: I think we knew about it before then. I think

493
00:23:33,640 --> 00:23:36,359
Speaker 1: the ancient Greeks knew about some of these worms. I

494
00:23:36,400 --> 00:23:38,600
Speaker 1: don't actually know how well substantiated this is, And at

495
00:23:38,640 --> 00:23:40,560
Speaker 1: some point I'd love to have a whole episode on

496
00:23:40,600 --> 00:23:43,280
Speaker 1: guinea worms. But you know how doctors have that staff

497
00:23:43,320 --> 00:23:45,840
Speaker 1: with like the two snakes that sort of wrap around it,

498
00:23:45,880 --> 00:23:49,119
Speaker 1: and that's like this ancient symbol. There's some evidence that

499
00:23:49,119 --> 00:23:52,040
Speaker 1: that was the guinea worm parasite, because the way you

500
00:23:52,160 --> 00:23:55,040
Speaker 1: eradicate that parasite is you wrap it around a stick

501
00:23:55,080 --> 00:23:57,440
Speaker 1: and you sort of slowly extract it from people because

502
00:23:57,440 --> 00:24:00,399
Speaker 1: it sticks its head out of your ankle. Oh that nasty,

503
00:24:00,400 --> 00:24:03,119
Speaker 1: But actually that's another success story. We're like close to

504
00:24:03,200 --> 00:24:06,520
Speaker 1: eradicating that one. That one's pretty interesting. They're all pretty interesting.

505
00:24:06,560 --> 00:24:09,080
Speaker 2: Really, and we want to eradicate them because some of

506
00:24:09,119 --> 00:24:11,880
Speaker 2: them obviously cause harm or you have too many of them.

507
00:24:12,200 --> 00:24:14,040
Speaker 2: I mean, somebody like a train it might say like, hey,

508
00:24:14,040 --> 00:24:16,280
Speaker 2: why are we calling these things pathogens? They're just part

509
00:24:16,320 --> 00:24:17,560
Speaker 2: of the human life cycle.

510
00:24:17,880 --> 00:24:20,800
Speaker 1: Hmm. The personal line in the sand that I use

511
00:24:21,280 --> 00:24:24,040
Speaker 1: is if it happened to my daughter, how would I

512
00:24:24,080 --> 00:24:26,399
Speaker 1: feel about it? Or mysef if it happened to my children.

513
00:24:26,760 --> 00:24:30,000
Speaker 1: If you told me, hey, your kids each have a

514
00:24:30,119 --> 00:24:33,000
Speaker 1: hookworm in their gut, I'd be like, all right, that's fine.

515
00:24:33,080 --> 00:24:33,359
Speaker 2: Oh.

516
00:24:33,440 --> 00:24:35,560
Speaker 1: I wouldn't be like you need to put in anti helmethics.

517
00:24:35,560 --> 00:24:37,680
Speaker 1: Anti helmethics being the drugs that you use to kill

518
00:24:37,720 --> 00:24:40,480
Speaker 1: these parasites. But if somebody was like, your kids have

519
00:24:41,200 --> 00:24:43,959
Speaker 1: two hundred hookworms in their guts, I'd be like, all right,

520
00:24:44,320 --> 00:24:45,919
Speaker 1: right now, we got to do something about it.

521
00:24:47,400 --> 00:24:49,639
Speaker 2: Well, where's the line there? Between one and two hundred

522
00:24:49,920 --> 00:24:52,080
Speaker 2: fifty hookworms? Is okay? Five is okay?

523
00:24:52,520 --> 00:24:53,919
Speaker 1: So first of all, the way that you figure out

524
00:24:53,960 --> 00:24:56,719
Speaker 1: how many they have, you can't like call up and

525
00:24:56,760 --> 00:24:59,520
Speaker 1: be like, hey, gut, how many hookworms are in there?

526
00:25:00,000 --> 00:25:01,840
Speaker 1: And what you usually do is you look to see

527
00:25:02,160 --> 00:25:04,719
Speaker 1: how many eggs are in one gram of feces and

528
00:25:04,720 --> 00:25:08,240
Speaker 1: that's how you do the county at the roundworms literally

529
00:25:08,240 --> 00:25:10,959
Speaker 1: make two hundred thousand eggs a day. Just incredible numbers

530
00:25:10,960 --> 00:25:13,960
Speaker 1: of eggs a day. Both hookworm and whipworm can make

531
00:25:14,080 --> 00:25:17,040
Speaker 1: up to like ten thousand eggs a day. So I

532
00:25:17,040 --> 00:25:20,119
Speaker 1: would trust a doctor. If a doctor said, like, your

533
00:25:20,200 --> 00:25:22,040
Speaker 1: kids are almost certainly not going to get infected by

534
00:25:22,040 --> 00:25:25,320
Speaker 1: any more of these because you've confirmed that, like you know,

535
00:25:25,359 --> 00:25:28,040
Speaker 1: the latrine that was broken in your community has been

536
00:25:28,080 --> 00:25:31,440
Speaker 1: fixed and they have very light infections, I'd be like, well,

537
00:25:31,440 --> 00:25:33,840
Speaker 1: maybe that's fine. But if they were like there's blood

538
00:25:33,880 --> 00:25:36,480
Speaker 1: in your kid's stool. You've got so many hookworms that

539
00:25:36,520 --> 00:25:39,000
Speaker 1: they're like losing blood, then yeah, we should do something

540
00:25:39,040 --> 00:25:39,399
Speaker 1: about it.

541
00:25:39,640 --> 00:25:42,120
Speaker 2: And you think there are cultural differences around the world,

542
00:25:42,240 --> 00:25:45,000
Speaker 2: like in some countries they're like, no big deal hookworms.

543
00:25:45,000 --> 00:25:47,160
Speaker 2: In other countries they're like, you must kill every worm

544
00:25:47,160 --> 00:25:50,040
Speaker 2: inside the body. Or do you think medical practices are

545
00:25:50,040 --> 00:25:51,280
Speaker 2: pretty constant around the world.

546
00:25:51,720 --> 00:25:53,600
Speaker 1: I don't know, But what I can say is that

547
00:25:53,680 --> 00:25:56,600
Speaker 1: the World Health Organization, their goal isn't to get rid

548
00:25:56,640 --> 00:26:00,600
Speaker 1: of the parasite entirely. They're focused particularly on trying to

549
00:26:00,640 --> 00:26:04,000
Speaker 1: make sure that people with heavy infections they get treated.

550
00:26:04,040 --> 00:26:05,520
Speaker 1: I mean, they would love for the parasite to be

551
00:26:05,520 --> 00:26:08,000
Speaker 1: eradicated entirely. And we're going to get to this, but

552
00:26:08,280 --> 00:26:10,960
Speaker 1: part of the difficulty there is that you have to

553
00:26:11,000 --> 00:26:13,439
Speaker 1: completely upgrade the sanitation system to get rid of these

554
00:26:13,480 --> 00:26:18,400
Speaker 1: parasites more or less entirely. But having low intensity infections,

555
00:26:18,400 --> 00:26:20,560
Speaker 1: so just a couple of worms is not a problem.

556
00:26:20,600 --> 00:26:23,840
Speaker 1: And again maybe there's some evidence that it reduces inflammation.

557
00:26:24,320 --> 00:26:26,760
Speaker 1: But if you have a lot of askris, they're like

558
00:26:26,800 --> 00:26:30,119
Speaker 1: pretty big parasites, and so sometimes they end up in

559
00:26:30,160 --> 00:26:32,760
Speaker 1: like the same part of your gut and they literally

560
00:26:32,800 --> 00:26:35,560
Speaker 1: cause it compaction and nothing else can get through, and

561
00:26:35,640 --> 00:26:37,880
Speaker 1: so in that case you have to get a surgery

562
00:26:37,920 --> 00:26:38,800
Speaker 1: to get them removed.

563
00:26:39,000 --> 00:26:39,359
Speaker 2: Wow.

564
00:26:39,640 --> 00:26:41,600
Speaker 1: Sometimes the photos of these things end up in your

565
00:26:41,600 --> 00:26:44,280
Speaker 1: parasitology textbooks and I'm like, that's the ick that I

566
00:26:44,320 --> 00:26:48,240
Speaker 1: didn't need to see. But it's important. Hookworm causes a lot.

567
00:26:48,160 --> 00:26:50,359
Speaker 2: Of blood loss because they're drinking your blood.

568
00:26:50,400 --> 00:26:52,680
Speaker 1: Because they're drinking your blood, and then they also leave

569
00:26:52,960 --> 00:26:55,240
Speaker 1: gaping wounds when they move to another spot and you

570
00:26:55,359 --> 00:26:55,960
Speaker 1: keep bleeding.

571
00:26:56,200 --> 00:26:58,040
Speaker 2: That's not very considerate. You know, there are a lot

572
00:26:58,040 --> 00:27:00,639
Speaker 2: of animals that sip our blood. But mosquitos at the

573
00:27:00,760 --> 00:27:02,760
Speaker 2: very least don't leave you like dripping blood.

574
00:27:02,880 --> 00:27:06,879
Speaker 1: Mm hmm. They're totally jerks. I agree whipworm. If you

575
00:27:06,880 --> 00:27:09,600
Speaker 1: have really high infections, they get kind of pushed to

576
00:27:09,640 --> 00:27:11,760
Speaker 1: areas that they'd rather not be, which is like farther

577
00:27:11,840 --> 00:27:14,720
Speaker 1: down in the bowel, and they cause troubles with some

578
00:27:14,880 --> 00:27:17,200
Speaker 1: kids who end up just constantly feeling like they need

579
00:27:17,240 --> 00:27:18,919
Speaker 1: to have a bowel movement because they've got all these

580
00:27:18,960 --> 00:27:23,240
Speaker 1: parasites in there. And sometimes that causes prolapsed anus, which

581
00:27:23,280 --> 00:27:26,480
Speaker 1: is really I just can't imagine if one of that

582
00:27:26,520 --> 00:27:28,200
Speaker 1: happened to one of my kids. It would be so upsetting.

583
00:27:28,280 --> 00:27:29,879
Speaker 1: So then you need a surgery again to kind of

584
00:27:29,920 --> 00:27:33,200
Speaker 1: like put everything back in. But another problem that's less

585
00:27:33,240 --> 00:27:35,160
Speaker 1: gross to talk about is if you have a lot

586
00:27:35,160 --> 00:27:38,440
Speaker 1: of these parasites, there's concerns that they cause declines in

587
00:27:38,560 --> 00:27:42,480
Speaker 1: physical growth and cognitive development. And partly that's because you're

588
00:27:42,600 --> 00:27:44,879
Speaker 1: just you don't have the energy. The parasites are sucking

589
00:27:44,920 --> 00:27:47,880
Speaker 1: your blood. Some of them like maybe take particular vitamins out.

590
00:27:48,280 --> 00:27:50,840
Speaker 1: So a big reason that we want to treat for

591
00:27:50,880 --> 00:27:54,240
Speaker 1: these parasites is because having heavy infections when you're young

592
00:27:54,320 --> 00:27:57,000
Speaker 1: can have implications for the rest of your life. And

593
00:27:57,440 --> 00:27:59,800
Speaker 1: kids tend to get these infections more than adults, which

594
00:27:59,840 --> 00:28:02,920
Speaker 1: is surprising. It's amazing to me that we ever teach

595
00:28:03,000 --> 00:28:05,879
Speaker 1: kids to wash their hands regularly, because it's so hard

596
00:28:06,320 --> 00:28:08,640
Speaker 1: to get kids to wash their hands. But that's why

597
00:28:08,680 --> 00:28:09,800
Speaker 1: a lot of kids get infected.

598
00:28:10,040 --> 00:28:13,800
Speaker 2: Well, I just heard from Katrina Real Time Consulting that

599
00:28:13,880 --> 00:28:16,560
Speaker 2: there are some things that infect us in the US,

600
00:28:16,600 --> 00:28:18,600
Speaker 2: and in the US, if they find it in you,

601
00:28:18,960 --> 00:28:22,080
Speaker 2: they will prescribe medicines to try to remove it, whereas

602
00:28:22,080 --> 00:28:24,359
Speaker 2: in other countries, like in Ecuador, they're like, yeah, no

603
00:28:24,440 --> 00:28:28,200
Speaker 2: big deal. So, for example, blastocystis some you carry it

604
00:28:28,200 --> 00:28:30,960
Speaker 2: which infects the body, and in some countries they're like, yeah,

605
00:28:31,040 --> 00:28:33,360
Speaker 2: no big deal. But in the US we're like, yeah,

606
00:28:33,359 --> 00:28:35,600
Speaker 2: I gotta get rid of it. And it's not clear

607
00:28:35,640 --> 00:28:37,600
Speaker 2: whether it like does more harm than good. It's like

608
00:28:37,640 --> 00:28:38,680
Speaker 2: on this fuzzy edge.

609
00:28:38,800 --> 00:28:41,560
Speaker 1: Oh interesting, did you just answer an email. I'm so

610
00:28:41,640 --> 00:28:43,600
Speaker 1: glad we have Katrina as a consultant for the show.

611
00:28:43,960 --> 00:28:47,640
Speaker 1: So we know that these parasites at high intensities are bad,

612
00:28:47,880 --> 00:28:49,960
Speaker 1: and so you don't want your kids infected with them,

613
00:28:50,280 --> 00:28:52,000
Speaker 1: and so should we talk a little bit about the

614
00:28:52,040 --> 00:28:55,040
Speaker 1: history of trying to do battle with these worms. Yeah,

615
00:28:55,480 --> 00:28:58,040
Speaker 1: as you remember from the intro, around nineteen hundred is

616
00:28:58,080 --> 00:29:01,200
Speaker 1: when that German parasitologist was self infecting himself and the

617
00:29:01,240 --> 00:29:03,440
Speaker 1: patient at the hospital and figuring out the life cycle

618
00:29:03,480 --> 00:29:08,120
Speaker 1: for hookworm. About ten years after that, John D. Rockefeller,

619
00:29:08,160 --> 00:29:10,000
Speaker 1: this you know, super rich guy with all of the

620
00:29:10,040 --> 00:29:13,160
Speaker 1: oil money. He decides that he wants his foundation to

621
00:29:13,400 --> 00:29:16,080
Speaker 1: try to eradicate hookworm from the American South. So this

622
00:29:16,200 --> 00:29:18,800
Speaker 1: was a big problem in the American South because it's warm,

623
00:29:18,880 --> 00:29:21,160
Speaker 1: it's moist, these are great conditions for the eggs to

624
00:29:21,240 --> 00:29:24,320
Speaker 1: last for a really long time in the environment. So

625
00:29:24,360 --> 00:29:28,440
Speaker 1: he creates the Rocket Feller Sanitary Commission. And even though

626
00:29:28,440 --> 00:29:30,760
Speaker 1: they said they were going to eradicate hookworm, their goal

627
00:29:30,800 --> 00:29:32,960
Speaker 1: right from the beginning was to just control it and

628
00:29:33,000 --> 00:29:35,520
Speaker 1: make it a little bit less bad. But part of

629
00:29:35,600 --> 00:29:38,920
Speaker 1: how they advertised why this was important was they were

630
00:29:39,040 --> 00:29:43,800
Speaker 1: essentially blaming hookworm for this myth of Southern laziness. So

631
00:29:43,840 --> 00:29:46,680
Speaker 1: the parasite like makes you lethargic, it makes you sort

632
00:29:46,680 --> 00:29:48,640
Speaker 1: of not want to move, not want to eat, like

633
00:29:48,720 --> 00:29:50,440
Speaker 1: you just feel miserable. If you've got a bunch of

634
00:29:50,440 --> 00:29:53,240
Speaker 1: worms in your gut, and so they referred to hookworm

635
00:29:53,280 --> 00:29:57,680
Speaker 1: as the germ of laziness. And so through this system

636
00:29:57,720 --> 00:30:00,880
Speaker 1: of like education and treat and they tried to get

637
00:30:00,880 --> 00:30:02,800
Speaker 1: a handle on it. So they made a bunch of

638
00:30:02,880 --> 00:30:06,040
Speaker 1: videos about the hookworm life cycle, and I spent way

639
00:30:06,080 --> 00:30:09,000
Speaker 1: too many hours watching these videos the other day. And

640
00:30:09,040 --> 00:30:11,680
Speaker 1: then they had some treatments at the time, but the

641
00:30:11,720 --> 00:30:15,200
Speaker 1: treatments were like also a little bit toxic, and so

642
00:30:15,240 --> 00:30:17,800
Speaker 1: there were some people who died when they took the treatment,

643
00:30:17,920 --> 00:30:21,440
Speaker 1: which is clearly less than ideal. Yeah, but the plan

644
00:30:21,520 --> 00:30:23,120
Speaker 1: at the time was to get people to go to

645
00:30:23,240 --> 00:30:25,640
Speaker 1: like doctors get their stool checked to see if they

646
00:30:25,680 --> 00:30:29,080
Speaker 1: had eggs, and if so, you'd get a treatment followed

647
00:30:29,120 --> 00:30:31,840
Speaker 1: with drinking a bunch of like epsom salts and water,

648
00:30:31,880 --> 00:30:34,480
Speaker 1: which would sort of clear out your bowels, let's say,

649
00:30:34,520 --> 00:30:36,600
Speaker 1: and the parasites would sort of pass out and you'd

650
00:30:36,640 --> 00:30:39,840
Speaker 1: see them pretty gross. But the problem is that without

651
00:30:40,000 --> 00:30:45,040
Speaker 1: actually upgrading the sanitation system, people just kept getting infected again.

652
00:30:45,480 --> 00:30:48,440
Speaker 1: And so there were some studies that tried to find

653
00:30:48,640 --> 00:30:52,920
Speaker 1: an effect of this sanitary commission, and the results are

654
00:30:53,000 --> 00:30:55,680
Speaker 1: kind of mixed. When some people analyzed the data, they'd say, like,

655
00:30:55,760 --> 00:30:59,000
Speaker 1: you know, people were getting more time in school because

656
00:30:59,040 --> 00:31:00,560
Speaker 1: like sometimes you feel so I mean, you don't go

657
00:31:00,600 --> 00:31:02,280
Speaker 1: to school, And so they were like, you know, saying

658
00:31:02,320 --> 00:31:05,760
Speaker 1: the prevalence was lower. But then there's other studies that

659
00:31:06,080 --> 00:31:09,400
Speaker 1: looked at improvements in the South over time and found

660
00:31:09,440 --> 00:31:12,280
Speaker 1: things like how many days you went to school each

661
00:31:12,320 --> 00:31:15,640
Speaker 1: year had been improving over time already, and so maybe

662
00:31:15,680 --> 00:31:17,920
Speaker 1: it had nothing to do with huckworm eradication. It could

663
00:31:17,920 --> 00:31:19,479
Speaker 1: have just been that the South was getting better at

664
00:31:19,480 --> 00:31:22,600
Speaker 1: sanitation over time and this commission did nothing beneficial.

665
00:31:22,760 --> 00:31:25,400
Speaker 2: And do you know the scientific context, like this is

666
00:31:25,440 --> 00:31:28,080
Speaker 2: a whim of a zillionaire essentially deciding we're going to

667
00:31:28,120 --> 00:31:31,480
Speaker 2: do this medical program. Is that what the medical establishment

668
00:31:31,560 --> 00:31:35,479
Speaker 2: or the scientific community would have wanted anyway, Like if

669
00:31:35,480 --> 00:31:37,440
Speaker 2: they've just given them the money, is it sort of

670
00:31:37,480 --> 00:31:39,600
Speaker 2: like best practices or was it just sort of like

671
00:31:39,920 --> 00:31:40,680
Speaker 2: off in the weeds.

672
00:31:41,000 --> 00:31:44,160
Speaker 1: Yes, we are essentially having some of the same debates today.

673
00:31:44,280 --> 00:31:47,000
Speaker 1: So it was like a reasonable first effort, and that

674
00:31:47,040 --> 00:31:51,240
Speaker 1: the debates are, you know, is it worth trading without

675
00:31:51,280 --> 00:31:54,000
Speaker 1: improving sanitation? Like what kind of improvements can you make

676
00:31:54,040 --> 00:31:56,880
Speaker 1: if you're not actually solving the root problem, which is

677
00:31:56,920 --> 00:31:59,800
Speaker 1: that you need to tackle these sanitation problems and so

678
00:32:00,000 --> 00:32:03,640
Speaker 1: so there are a bunch of organizations that were sort

679
00:32:03,640 --> 00:32:08,600
Speaker 1: of inspired by these early Rockefeller efforts, and a parasitologist

680
00:32:08,800 --> 00:32:11,760
Speaker 1: named u Styles was one of the first ones who

681
00:32:11,800 --> 00:32:13,560
Speaker 1: was like really beating the drum for we need to

682
00:32:13,560 --> 00:32:16,160
Speaker 1: tackle hookworm in the South, and he ended up working

683
00:32:16,200 --> 00:32:18,560
Speaker 1: with them on a bunch of this stuff. Yes, I

684
00:32:18,560 --> 00:32:20,800
Speaker 1: think that there were probably engaging in practices that were

685
00:32:20,800 --> 00:32:23,920
Speaker 1: fairly scientifically sound at the time, but there is some

686
00:32:24,000 --> 00:32:26,640
Speaker 1: debate about whether or not they were balancing the risks

687
00:32:26,720 --> 00:32:30,320
Speaker 1: of the medication against the benefits well enough for the

688
00:32:30,360 --> 00:32:33,920
Speaker 1: people who died, and they ended up extending their reach

689
00:32:34,000 --> 00:32:37,360
Speaker 1: into some other countries. And there's also debates about the

690
00:32:37,440 --> 00:32:40,200
Speaker 1: relative impacts of like what their medication did in terms

691
00:32:40,240 --> 00:32:43,360
Speaker 1: of killing people versus helping people. So it's not all rosy,

692
00:32:43,360 --> 00:32:46,280
Speaker 1: which is perhaps exactly what you'd expect about this time

693
00:32:46,320 --> 00:32:49,240
Speaker 1: in American history. Let's take a break now, So at

694
00:32:49,240 --> 00:32:52,440
Speaker 1: this point we understand the life cycle of these parasites.

695
00:32:52,480 --> 00:32:56,440
Speaker 1: There have been some efforts to try to eradicate these parasites,

696
00:32:56,480 --> 00:32:59,400
Speaker 1: but they've been met with sort of limited success. Where

697
00:32:59,440 --> 00:33:01,280
Speaker 1: are we now? What have we tried in the one

698
00:33:01,400 --> 00:33:05,320
Speaker 1: hundred plus year since the Rockefeller Sanitary Commission. You'll get

699
00:33:05,360 --> 00:33:19,560
Speaker 1: your answer after the break.

700
00:33:23,200 --> 00:33:25,320
Speaker 2: All right, we are back and we are battling the

701
00:33:25,400 --> 00:33:28,480
Speaker 2: ick today on the podcast we are learning all about

702
00:33:28,480 --> 00:33:31,200
Speaker 2: the worms in you, the worms in me, the worms

703
00:33:31,200 --> 00:33:33,360
Speaker 2: that are in all of us and make us who

704
00:33:33,400 --> 00:33:36,560
Speaker 2: we are. So tell us, Kelly, how far have we

705
00:33:36,600 --> 00:33:40,040
Speaker 2: come in battling these worms or have we just given

706
00:33:40,120 --> 00:33:42,320
Speaker 2: up and accepted that it's a wormy world?

707
00:33:42,360 --> 00:33:46,080
Speaker 1: We will not give up. The Rockefeller Sanitary Commission, you know,

708
00:33:46,160 --> 00:33:48,760
Speaker 1: met with mixed success, but eventually they ended up backing

709
00:33:48,760 --> 00:33:51,240
Speaker 1: out because they were like, look, we can't improve sanitation.

710
00:33:51,400 --> 00:33:54,040
Speaker 1: If you can't improve sanitation, you really can't solve the

711
00:33:54,080 --> 00:33:57,680
Speaker 1: root problem. But around the nineteen fifties nineteen sixties, sanitation

712
00:33:57,880 --> 00:34:01,479
Speaker 1: in the South improved on its own, and the percent

713
00:34:01,520 --> 00:34:04,960
Speaker 1: of the population that's infected by this parasite went way down,

714
00:34:05,080 --> 00:34:08,680
Speaker 1: and as medical care got better and various parts of

715
00:34:08,719 --> 00:34:11,840
Speaker 1: the country got lifted out of poverty, things got way better.

716
00:34:11,920 --> 00:34:14,760
Speaker 1: We do still have the parasite though in some areas

717
00:34:14,800 --> 00:34:18,680
Speaker 1: of like rural Alabama, where sanitation has broken down and

718
00:34:18,680 --> 00:34:22,120
Speaker 1: people are getting infected by these parasites again, but in general,

719
00:34:22,160 --> 00:34:25,160
Speaker 1: in most parts of the United States, just simply the

720
00:34:25,200 --> 00:34:29,120
Speaker 1: act of like going through development and improving sanitation eventually

721
00:34:29,320 --> 00:34:31,040
Speaker 1: saved a bunch of people from these parasites.

722
00:34:31,400 --> 00:34:33,760
Speaker 2: And do we get flare ups when there's a natural disaster,

723
00:34:33,960 --> 00:34:36,880
Speaker 2: you know, floods and hurricanes and stuff that interfere with sanitation.

724
00:34:37,320 --> 00:34:39,719
Speaker 1: I think in the United States that's pretty rare. But

725
00:34:39,840 --> 00:34:42,120
Speaker 1: around the world I can imagine that those kinds of

726
00:34:42,160 --> 00:34:44,799
Speaker 1: problems would make this stuff much worse. But this has

727
00:34:44,880 --> 00:34:49,400
Speaker 1: remained a serious problem in Asia and Africa. In Asia,

728
00:34:49,520 --> 00:34:52,680
Speaker 1: night soil sort of makes it difficult, but in Africa

729
00:34:52,760 --> 00:34:55,200
Speaker 1: you have, you know, sanitation issues, and so the World

730
00:34:55,239 --> 00:35:00,120
Speaker 1: Health Organization has become interested in trying to reduce the

731
00:35:00,160 --> 00:35:02,560
Speaker 1: prevalence of this parasite, like the percent of the population

732
00:35:02,600 --> 00:35:05,719
Speaker 1: that's infected. But you know, even more importantly, you want

733
00:35:05,760 --> 00:35:09,040
Speaker 1: to reduce the incidents of people who have lots of

734
00:35:09,080 --> 00:35:10,960
Speaker 1: these parasites, because those are the people who are the

735
00:35:10,960 --> 00:35:13,600
Speaker 1: most likely to like, really experience some problems. In the

736
00:35:13,680 --> 00:35:17,960
Speaker 1: nineteen seventies, some drugs that were developed for livestock turned

737
00:35:17,960 --> 00:35:20,799
Speaker 1: out they could be used for parasites to treat these infections,

738
00:35:21,160 --> 00:35:25,040
Speaker 1: and that's albendazol and me bendazol. They're way less toxic

739
00:35:25,120 --> 00:35:28,960
Speaker 1: than prior medications, and so like that's good news. But

740
00:35:29,239 --> 00:35:31,359
Speaker 1: for a while, we like had those medications, but we

741
00:35:31,360 --> 00:35:33,480
Speaker 1: weren't really doing anything with them. But then in the

742
00:35:33,480 --> 00:35:36,439
Speaker 1: twenty tens, the ball really got rolling. The World Health

743
00:35:36,520 --> 00:35:40,120
Speaker 1: Organization started up a program and amazingly, so, like I

744
00:35:40,200 --> 00:35:44,120
Speaker 1: usually love to hate pharmaceutical companies because medications are so expensive,

745
00:35:44,239 --> 00:35:47,799
Speaker 1: but they've donated like literally billions of doses of these

746
00:35:47,840 --> 00:35:52,120
Speaker 1: medications to help the World Health Organization do battle with

747
00:35:52,200 --> 00:35:53,640
Speaker 1: these dirt worms.

748
00:35:53,440 --> 00:35:55,760
Speaker 2: Just out of the goodness of their pharmaceutical hearts.

749
00:35:55,920 --> 00:35:57,600
Speaker 1: I mean, I'm sure it was a pr move too.

750
00:35:58,239 --> 00:36:00,800
Speaker 1: So one of the problems with treating people in areas

751
00:36:00,840 --> 00:36:03,319
Speaker 1: where there's not a lot of money is that, you know,

752
00:36:03,480 --> 00:36:07,160
Speaker 1: pharmaceutical companies can't really make a profit by giving them medications,

753
00:36:07,200 --> 00:36:10,880
Speaker 1: and so surprisingly often there are pharmaceutical companies who are

754
00:36:10,880 --> 00:36:13,440
Speaker 1: willing to donate in cases like this, and so here

755
00:36:13,600 --> 00:36:15,839
Speaker 1: you get these huge donations. Maybe I'm being two nice.

756
00:36:15,840 --> 00:36:17,239
Speaker 1: I don't know if it happens often, but in this

757
00:36:17,320 --> 00:36:19,799
Speaker 1: case it happened. So now you've got all of these

758
00:36:19,840 --> 00:36:21,399
Speaker 1: doses of drugs and you've got to try to figure

759
00:36:21,400 --> 00:36:23,800
Speaker 1: out what to do. And it turns out that, you know,

760
00:36:23,840 --> 00:36:27,200
Speaker 1: the Rockefeller Sanitary Commission, they would test people before giving

761
00:36:27,200 --> 00:36:30,400
Speaker 1: them medications, which involved like taking a sample of feces,

762
00:36:30,480 --> 00:36:32,600
Speaker 1: putting it under a microscope looking for the signs of

763
00:36:32,600 --> 00:36:36,000
Speaker 1: the eggs. But that takes a long time, and time

764
00:36:36,160 --> 00:36:38,120
Speaker 1: is money because you need to hire people to do that,

765
00:36:38,200 --> 00:36:40,480
Speaker 1: you need to get the microscopes in, and so it

766
00:36:40,560 --> 00:36:43,920
Speaker 1: was decided that actually it would be prohibitively expensive to

767
00:36:44,080 --> 00:36:47,880
Speaker 1: treat based on already having an infection. So instead, what

768
00:36:47,920 --> 00:36:50,800
Speaker 1: they decided to do was bring these drugs into countries

769
00:36:50,840 --> 00:36:53,480
Speaker 1: that had a pretty high percent of the population that

770
00:36:53,640 --> 00:36:56,680
Speaker 1: was carrying the worm, and then they would go to schools,

771
00:36:57,080 --> 00:37:00,880
Speaker 1: and because kids usually have the heaviest infections, they would

772
00:37:00,920 --> 00:37:03,239
Speaker 1: dole out the medication at the school. So there'd be

773
00:37:03,280 --> 00:37:05,720
Speaker 1: a day where like the teacher would pass these pills

774
00:37:05,719 --> 00:37:08,280
Speaker 1: out to the students and they would take the medication,

775
00:37:08,840 --> 00:37:10,680
Speaker 1: and in that way they were trying to treat the

776
00:37:10,840 --> 00:37:13,719
Speaker 1: entire population. I think there was also some efforts to

777
00:37:13,719 --> 00:37:15,400
Speaker 1: give it to moms when they would come in for

778
00:37:15,560 --> 00:37:18,280
Speaker 1: like maternal care checks, so if they were pregnant or lactating,

779
00:37:18,400 --> 00:37:21,200
Speaker 1: because both of these are stages where you need your

780
00:37:21,320 --> 00:37:23,680
Speaker 1: energy and if you don't have it, it could cause

781
00:37:23,719 --> 00:37:24,640
Speaker 1: long term impacts.

782
00:37:25,000 --> 00:37:27,160
Speaker 2: And was there any resistance to this? You know, there's

783
00:37:27,200 --> 00:37:31,200
Speaker 2: like classic resistance to vaccination in some portions of society,

784
00:37:31,760 --> 00:37:36,480
Speaker 2: where people against this somehow, or everybody happily accepting these drugs.

785
00:37:36,719 --> 00:37:39,080
Speaker 1: It can't be the case that everyone happily accepted the drug.

786
00:37:39,600 --> 00:37:42,960
Speaker 1: That's a great question. I didn't come across stories like

787
00:37:43,040 --> 00:37:45,560
Speaker 1: that when I was doing the research for this episode.

788
00:37:45,719 --> 00:37:49,239
Speaker 1: Doctor Henderson wrote a great book about the eradication of smallpox.

789
00:37:49,560 --> 00:37:52,120
Speaker 1: He was in charge of the World Health Organization's effort

790
00:37:52,160 --> 00:37:55,040
Speaker 1: to eradicate smallpox, if I remember correctly, And there was

791
00:37:55,160 --> 00:37:57,600
Speaker 1: a lot of that, a lot of like people who

792
00:37:57,640 --> 00:37:59,719
Speaker 1: didn't want to get the vaccine, and so then there

793
00:37:59,760 --> 00:38:02,920
Speaker 1: was a lot of engaging with community members to convince

794
00:38:02,920 --> 00:38:04,880
Speaker 1: the community members that this would be better for the

795
00:38:04,880 --> 00:38:08,359
Speaker 1: community overall. And so a lot of like trust that

796
00:38:08,400 --> 00:38:11,960
Speaker 1: needed to be built between medical practitioners and the communities

797
00:38:11,960 --> 00:38:14,200
Speaker 1: that they were working with. And again that totally makes sense, right.

798
00:38:14,239 --> 00:38:16,880
Speaker 1: The Rockefeller Sanitary Commission that we were talking about. Some

799
00:38:17,000 --> 00:38:19,960
Speaker 1: kids died from the medications, and so like asking questions

800
00:38:20,360 --> 00:38:22,920
Speaker 1: was reasonable. But I think in general this program is

801
00:38:22,920 --> 00:38:25,000
Speaker 1: thought to have been pretty successful in terms of like

802
00:38:25,040 --> 00:38:28,799
Speaker 1: getting medications into kiddos that probably needed it.

803
00:38:29,239 --> 00:38:32,840
Speaker 2: And is it analogous to vaccines where it's helpful to

804
00:38:32,920 --> 00:38:35,359
Speaker 2: the whole population for an individual to take it, because

805
00:38:35,400 --> 00:38:37,279
Speaker 2: then you're just reducing the number of worms that are

806
00:38:37,320 --> 00:38:39,719
Speaker 2: like in the whole ecosystem the same way that like

807
00:38:39,760 --> 00:38:42,400
Speaker 2: taking a vaccine reduces the prevalence of the disease, so

808
00:38:42,440 --> 00:38:45,680
Speaker 2: that folks who for whom the vaccine doesn't work, you're

809
00:38:45,719 --> 00:38:46,640
Speaker 2: also protecting them.

810
00:38:46,920 --> 00:38:48,520
Speaker 1: Yeah, so that was a big part of the hope

811
00:38:48,560 --> 00:38:51,560
Speaker 1: was that you know, by targeting the people who have

812
00:38:51,680 --> 00:38:54,600
Speaker 1: the most parasites, those would also be the people who

813
00:38:54,600 --> 00:38:56,800
Speaker 1: would be producing the most eggs and putting those eggs

814
00:38:56,800 --> 00:38:59,600
Speaker 1: back into the environment. So by reducing their wormburden, you

815
00:38:59,600 --> 00:39:02,480
Speaker 1: should read reduce the risk for everybody else. But a

816
00:39:02,640 --> 00:39:05,799
Speaker 1: problem is that it's really expensive and difficult to do

817
00:39:05,840 --> 00:39:08,000
Speaker 1: the follow up monitoring to make sure that that kind

818
00:39:08,000 --> 00:39:10,640
Speaker 1: of stuff is happening, and so often these drugs will

819
00:39:10,640 --> 00:39:13,640
Speaker 1: get passed out, but then the subsequent monitoring won't happen.

820
00:39:14,239 --> 00:39:16,240
Speaker 1: And the studies that have been done to look for

821
00:39:16,440 --> 00:39:20,279
Speaker 1: like do you get improvements in growth and you know,

822
00:39:20,400 --> 00:39:24,160
Speaker 1: cognitive abilities in communities where you give out these medications.

823
00:39:24,480 --> 00:39:27,280
Speaker 1: You know, again often that's not done. Are those assays,

824
00:39:27,320 --> 00:39:30,640
Speaker 1: those tests that data collection is not happening, And then

825
00:39:30,680 --> 00:39:33,439
Speaker 1: in the areas where it is happening, some studies find

826
00:39:33,440 --> 00:39:36,239
Speaker 1: in effect and others don't. And that's not too surprising

827
00:39:36,280 --> 00:39:39,000
Speaker 1: because you know, as we've said, having a few worms

828
00:39:39,120 --> 00:39:41,680
Speaker 1: is not a big deal, but having a lot of

829
00:39:41,719 --> 00:39:44,120
Speaker 1: worms is. So you might expect that the people who

830
00:39:44,160 --> 00:39:46,480
Speaker 1: are getting the benefit would be the small subset of

831
00:39:46,480 --> 00:39:49,359
Speaker 1: the population who had a heavy worm burden that got

832
00:39:49,400 --> 00:39:52,479
Speaker 1: significantly knocked down by this medication. So if you're looking

833
00:39:52,520 --> 00:39:55,120
Speaker 1: at a whole population, it might be hard to target

834
00:39:55,239 --> 00:39:56,560
Speaker 1: and see those improvements.

835
00:39:57,760 --> 00:40:00,920
Speaker 2: Well, it's always fascinating and difficult to balance the individual

836
00:40:01,040 --> 00:40:04,160
Speaker 2: choices with the public health recommendations, right, And the folks

837
00:40:04,160 --> 00:40:05,960
Speaker 2: who work on this have such a difficult job. I

838
00:40:06,040 --> 00:40:07,239
Speaker 2: really have a lot of respect for that.

839
00:40:07,280 --> 00:40:09,680
Speaker 1: Oh my gosh, yeah, no me also and their job,

840
00:40:09,760 --> 00:40:12,120
Speaker 1: like it's difficult because so you go out there once

841
00:40:12,320 --> 00:40:15,000
Speaker 1: and first of all these medications don't always kill all

842
00:40:15,040 --> 00:40:17,600
Speaker 1: the parasites. I was reading a review paper that said

843
00:40:17,600 --> 00:40:20,400
Speaker 1: that often like it knocks down ninety percent of the parasites,

844
00:40:20,400 --> 00:40:22,759
Speaker 1: but some of the parasites still live, and so you

845
00:40:22,840 --> 00:40:25,400
Speaker 1: need to keep going out there and giving the medication

846
00:40:25,440 --> 00:40:27,480
Speaker 1: to people over and over again. So it kills some

847
00:40:27,560 --> 00:40:29,879
Speaker 1: of the worms that they have, but it doesn't at

848
00:40:29,880 --> 00:40:32,480
Speaker 1: all stop them from getting infected by worms again in

849
00:40:32,520 --> 00:40:34,640
Speaker 1: the future. Oh yeah, So are you going to go

850
00:40:34,680 --> 00:40:37,359
Speaker 1: out there every year for the rest of eternity and

851
00:40:37,400 --> 00:40:41,400
Speaker 1: give medication to these communities. That doesn't seem like a

852
00:40:41,480 --> 00:40:45,160
Speaker 1: feasible long term solution. So these programs are often also

853
00:40:45,239 --> 00:40:48,520
Speaker 1: pushing like better sanitation and other ways to kind of

854
00:40:48,520 --> 00:40:51,000
Speaker 1: try to break the cycle of these diseases, and there

855
00:40:51,000 --> 00:40:53,719
Speaker 1: has been pretty good success, Like, for example, Kenya was

856
00:40:53,760 --> 00:40:56,520
Speaker 1: really serious about giving out the medications and doing monitoring

857
00:40:56,920 --> 00:40:58,680
Speaker 1: and they're thought to have had a lot of success

858
00:40:58,680 --> 00:41:01,759
Speaker 1: with the program. Hand in South Korea also gave out

859
00:41:01,800 --> 00:41:05,360
Speaker 1: the drugs at school, but they also screened everybody, provided

860
00:41:05,440 --> 00:41:08,800
Speaker 1: education about how you get the parasites. They started treating

861
00:41:08,840 --> 00:41:12,680
Speaker 1: their night soil, so treating the human and livestock waste

862
00:41:12,960 --> 00:41:15,160
Speaker 1: before it got put on plants so the parasites would

863
00:41:15,160 --> 00:41:18,680
Speaker 1: be killed first. That even started like putting legislation into

864
00:41:18,680 --> 00:41:21,360
Speaker 1: place to try to make some of these like improvements permanent.

865
00:41:21,760 --> 00:41:25,120
Speaker 1: And they've been really successful at controlling the parasites. Okay,

866
00:41:25,200 --> 00:41:27,560
Speaker 1: so what do we do next? So there's some areas

867
00:41:27,560 --> 00:41:30,759
Speaker 1: where it's mostly been controlled, but there's other areas where

868
00:41:30,760 --> 00:41:32,000
Speaker 1: I think you're just not really going to be able

869
00:41:32,000 --> 00:41:34,680
Speaker 1: to control the problem until we have better sanitation. And

870
00:41:34,719 --> 00:41:39,320
Speaker 1: so as countries develop and their sanitation systems improve, probably

871
00:41:39,320 --> 00:41:41,000
Speaker 1: a lot of these problems will go away, sort of

872
00:41:41,040 --> 00:41:44,120
Speaker 1: like we saw in the American South. There's also some

873
00:41:44,320 --> 00:41:47,160
Speaker 1: effort to work on vaccines for some of these parasites.

874
00:41:47,440 --> 00:41:49,520
Speaker 1: We're going to do a whole episode on why vaccine

875
00:41:49,520 --> 00:41:52,200
Speaker 1: development and parasites is difficult, And I'm not going to

876
00:41:52,239 --> 00:41:54,239
Speaker 1: get into it much now because frankly, I don't know

877
00:41:54,280 --> 00:41:57,319
Speaker 1: the answer and I'll need to research that. But there

878
00:41:57,320 --> 00:41:59,839
Speaker 1: are some vaccines that are being trialed right now, and

879
00:42:00,000 --> 00:42:03,000
Speaker 1: even if those vaccines aren't completely successful, some combination of

880
00:42:03,080 --> 00:42:07,000
Speaker 1: vaccines plus medication might like put a break in transmission

881
00:42:07,080 --> 00:42:10,760
Speaker 1: and allow communities to sort of eradicate the parasite. We hope.

882
00:42:11,000 --> 00:42:14,000
Speaker 2: How do vaccines work for a worm? I mean, I

883
00:42:14,120 --> 00:42:17,319
Speaker 2: get the general picture for like a microbe, but does

884
00:42:17,320 --> 00:42:20,560
Speaker 2: your immune system learn to combat these particular worms or what?

885
00:42:20,840 --> 00:42:23,040
Speaker 1: Yeah, that's the hope. But so one of the difficulties

886
00:42:23,120 --> 00:42:26,560
Speaker 1: is that humans, when you get a hookworm infection and

887
00:42:26,560 --> 00:42:29,600
Speaker 1: then you clear the infection, if our immune system remembered it,

888
00:42:29,640 --> 00:42:32,240
Speaker 1: you'd expect us to be, you know, kind of immune

889
00:42:32,280 --> 00:42:34,560
Speaker 1: to the parasite the next time around. But our immune systems,

890
00:42:34,600 --> 00:42:37,319
Speaker 1: for whatever reason, don't seem to remember it, and so

891
00:42:37,400 --> 00:42:41,200
Speaker 1: we don't have a memory in our immune system for

892
00:42:41,760 --> 00:42:44,040
Speaker 1: something like hookworms the same way we do for like

893
00:42:44,080 --> 00:42:46,880
Speaker 1: the flu virus or the bacteria that cause a cold.

894
00:42:47,400 --> 00:42:50,000
Speaker 1: I don't totally understand why that's the case, but it

895
00:42:50,080 --> 00:42:53,080
Speaker 1: probably complicates the creation of a vaccine. But if you

896
00:42:53,080 --> 00:42:55,880
Speaker 1: could get your immune system to remember, maybe by regularly

897
00:42:55,880 --> 00:42:59,040
Speaker 1: giving people vaccines, like very regular reminders, and you couple

898
00:42:59,080 --> 00:43:01,200
Speaker 1: that with medication to killed a few parasites, you do

899
00:43:01,320 --> 00:43:04,799
Speaker 1: get maybe that's a viable solution going forward. But I

900
00:43:04,840 --> 00:43:08,360
Speaker 1: think in general, sanitation is just like having a public

901
00:43:08,440 --> 00:43:10,920
Speaker 1: sanitation system. That's sort of like getting a handle on

902
00:43:10,960 --> 00:43:14,160
Speaker 1: all of this is the clearest way. There's some other proposals,

903
00:43:14,320 --> 00:43:17,719
Speaker 1: like there's a containment system called biogas, and you put

904
00:43:17,719 --> 00:43:20,840
Speaker 1: your livestock waste and your human waste into this container

905
00:43:21,360 --> 00:43:25,239
Speaker 1: and it releases like methane and some other gases that

906
00:43:25,280 --> 00:43:27,280
Speaker 1: can then be piped into the house for like cooking

907
00:43:27,320 --> 00:43:31,680
Speaker 1: and heating, like propane. And I wrote somebody who works

908
00:43:31,719 --> 00:43:35,000
Speaker 1: on this and said, does it smell like human feces,

909
00:43:35,080 --> 00:43:37,279
Speaker 1: because I wouldn't want that piped into my house, and

910
00:43:37,320 --> 00:43:40,799
Speaker 1: he said, no, it doesn't stink. It's methane. And then additionally,

911
00:43:40,840 --> 00:43:44,520
Speaker 1: you get this anaerobic environment inside of the thing with

912
00:43:44,560 --> 00:43:47,920
Speaker 1: all of the waste anaerobic meaning meaning no oxygen, and

913
00:43:47,960 --> 00:43:50,480
Speaker 1: that kills the parasites and so then you can subsequently

914
00:43:50,600 --> 00:43:54,040
Speaker 1: use that human waste as night soil and it's safe.

915
00:43:54,160 --> 00:43:57,759
Speaker 2: But there's something beautiful about cooking your food with farts.

916
00:43:57,400 --> 00:44:00,840
Speaker 1: Basically, yeah, I mean, you know, if I lived in

917
00:44:00,840 --> 00:44:04,439
Speaker 1: an area where I couldn't afford heat and you could

918
00:44:04,480 --> 00:44:08,879
Speaker 1: heat up farts to keep warm and it didn't stay,

919
00:44:08,920 --> 00:44:12,600
Speaker 1: I would do it because I like being warm anyway.

920
00:44:12,640 --> 00:44:14,759
Speaker 1: So there's a number of different proposals for how to

921
00:44:14,760 --> 00:44:17,240
Speaker 1: do it, you know, keeping people from encountering these parasites

922
00:44:17,239 --> 00:44:19,319
Speaker 1: in the first place is a clear way to do it.

923
00:44:19,360 --> 00:44:22,040
Speaker 1: But it's just hard to get sanitation systems running in

924
00:44:22,080 --> 00:44:23,680
Speaker 1: a bunch of different places. So what is the big

925
00:44:23,680 --> 00:44:25,759
Speaker 1: take home here? The big take home is that once

926
00:44:25,800 --> 00:44:29,279
Speaker 1: we understood how these life cycles worked, that did give

927
00:44:29,400 --> 00:44:34,600
Speaker 1: us a clear path forward for tackling these infections. But

928
00:44:34,680 --> 00:44:38,719
Speaker 1: it's not actually always easy to implement the strategies that

929
00:44:38,760 --> 00:44:41,239
Speaker 1: you know would kill these parasites because there's just lots

930
00:44:41,239 --> 00:44:44,279
Speaker 1: of stuff going on and life is complicated. So this

931
00:44:44,320 --> 00:44:46,840
Speaker 1: is another parasite that is still with us and infecting

932
00:44:46,840 --> 00:44:50,040
Speaker 1: about twenty five percent of our population. But hopefully one

933
00:44:50,080 --> 00:44:51,600
Speaker 1: day we'll be able to get a handle on it.

934
00:44:51,760 --> 00:44:54,480
Speaker 1: We've had some success so far. Hopefully we'll be able

935
00:44:54,520 --> 00:44:56,560
Speaker 1: to reduce human suffering in the near future.

936
00:44:57,160 --> 00:44:59,719
Speaker 2: Well, so, my last question for you is we've come

937
00:44:59,719 --> 00:45:02,080
Speaker 2: a lot long way in understanding what's going on inside

938
00:45:02,120 --> 00:45:05,160
Speaker 2: the body and discovering these critters living inside of us.

939
00:45:05,440 --> 00:45:07,880
Speaker 2: Do you think there are still big discoveries left to

940
00:45:07,880 --> 00:45:11,400
Speaker 2: be made in terms of like what's living inside humans

941
00:45:11,680 --> 00:45:14,719
Speaker 2: or we mostly understand it because we've like sequenced our

942
00:45:14,760 --> 00:45:17,120
Speaker 2: poop and sequenced our saliva, and we know sort of

943
00:45:17,200 --> 00:45:18,640
Speaker 2: what critters are in there.

944
00:45:18,880 --> 00:45:21,560
Speaker 1: I've been going through old issues of the Journal of Parasitology.

945
00:45:22,040 --> 00:45:25,279
Speaker 1: I'm going to answer your question eventually, I promise. And

946
00:45:25,320 --> 00:45:29,280
Speaker 1: they used to have at the end of each issue

947
00:45:29,400 --> 00:45:31,600
Speaker 1: a list of the new parasites of humans that had

948
00:45:31,600 --> 00:45:34,320
Speaker 1: been identified, and there were a lot. There used to

949
00:45:34,360 --> 00:45:36,040
Speaker 1: be a lot on those pages, but at some point

950
00:45:36,080 --> 00:45:40,319
Speaker 1: they dropped that offering entirely, like new issues don't have that,

951
00:45:41,000 --> 00:45:43,360
Speaker 1: and I don't know if that's because it's just not

952
00:45:43,440 --> 00:45:45,760
Speaker 1: worth keeping a list anymore because you can just find

953
00:45:45,800 --> 00:45:49,360
Speaker 1: lists online so easily. We do still find parasites occasionally

954
00:45:49,360 --> 00:45:52,719
Speaker 1: infecting people. Usually they're sort of rare infections, but you know,

955
00:45:52,760 --> 00:45:54,919
Speaker 1: we get a lot of zonotic infections, so which means

956
00:45:54,920 --> 00:45:58,200
Speaker 1: they are parasites and pathogens that jump from wild populations

957
00:45:58,480 --> 00:46:02,000
Speaker 1: to human populations as we sort of encroach upon the

958
00:46:02,040 --> 00:46:05,440
Speaker 1: habitats of wild animals. So it wouldn't surprise me if

959
00:46:05,480 --> 00:46:08,200
Speaker 1: more parasites and pathogens will be jumping into people the

960
00:46:08,280 --> 00:46:11,040
Speaker 1: more we encroach into the habitats of wild animals. I'm

961
00:46:11,040 --> 00:46:12,800
Speaker 1: sure there's more that we'll have to learn.

962
00:46:13,040 --> 00:46:16,680
Speaker 2: And when aliens come, maybe some of their parasites will

963
00:46:16,680 --> 00:46:18,719
Speaker 2: take up home in our bodies. You know, I had

964
00:46:18,719 --> 00:46:20,319
Speaker 2: to bring it back to aliens eventually.

965
00:46:20,040 --> 00:46:22,319
Speaker 1: We can hope. Oh wait, yeah, how do we We

966
00:46:22,360 --> 00:46:26,040
Speaker 1: haven't touched on cannibalism yet today, but anyway, missed opportunities.

967
00:46:26,120 --> 00:46:28,320
Speaker 1: But yes, the alien parasites. I would love to study

968
00:46:28,320 --> 00:46:29,240
Speaker 1: some alien parasit.

969
00:46:31,600 --> 00:46:33,520
Speaker 2: Well, I'm just so amazed at how much we still

970
00:46:33,560 --> 00:46:35,680
Speaker 2: have left to learn about the workings of our own

971
00:46:35,760 --> 00:46:38,440
Speaker 2: body and the balances between these things, and how much

972
00:46:38,520 --> 00:46:41,880
Speaker 2: these things are helping and hurting and our ancient history

973
00:46:42,000 --> 00:46:43,880
Speaker 2: with these crazy ichy worms.

974
00:46:44,160 --> 00:46:48,000
Speaker 1: Yeah, but crazy, icky, fascinating words. Yes, they're very interesting.

975
00:46:48,080 --> 00:46:50,320
Speaker 1: But yes, I would like to see no humans suffering

976
00:46:50,360 --> 00:46:51,719
Speaker 1: from heavy infections ever.

977
00:46:51,800 --> 00:46:55,560
Speaker 2: Again. Well, I hope it hasn't been too much suffering

978
00:46:55,600 --> 00:46:59,560
Speaker 2: for you to hear about this crazy biological mystery and

979
00:46:59,640 --> 00:47:02,399
Speaker 2: you haven't had too much I while you're driving work

980
00:47:02,520 --> 00:47:05,319
Speaker 2: or eating your lunch, we appreciate you coming along for

981
00:47:05,360 --> 00:47:08,600
Speaker 2: the ride.

982
00:47:12,840 --> 00:47:16,680
Speaker 1: Daniel and Kelly's Extraordinary Universe is produced by IHEARTRADI. We

983
00:47:16,719 --> 00:47:19,120
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984
00:47:19,280 --> 00:47:22,040
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985
00:47:22,239 --> 00:47:23,920
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986
00:47:24,040 --> 00:47:27,000
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987
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989
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990
00:47:34,239 --> 00:47:37,360
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991
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992
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995
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