September 16, 2025 • 48 mins
When your car breaks down or your fridge goes on the fritz, you can order a replacement part and get things back up and running in no time. The same cannot always be said for another intricate machine: the human body. For centuries, scientists have grappled with making or transplanting suitable replacements for nearly every body part, from hearts to hair and from legs to lungs. We’ve come quite a long way in that quest, so that at times, it feels as though we’re living in a sci-fi novel, where skin cells are printed and we can grow a customized heart. Yet we still have further to go, thanks to our magnificent immune system, who proves to be quite a worthy opponent. Here to tell you all about the weird and wonderful world of regenerative medicine is the one and only Mary Roach, who joins us this week to chat about her latest book Replaceable You: Adventures in Human Anatomy. As with any Mary Roach production, this is the perfect combination of informative, fascinating, and fun. Tune in today!
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:44):
Hi, I'm Aaron Welsh and this is this Podcast will
Kill You. You're listening to the latest episode in our tp
w k Y book Club series, where I get to
interview authors of popular science and medicine books about their
latest work. We have featured some excellent books so far
this season and have a great lineup for the rest
(01:04):
of the year. If you'd like to sneak a peek
at the books that we'll be reading later this season,
as well as check out the ones we've already covered,
head over to our website This Podcast will Kill You
dot com. There under the extras tab you'll find a
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a bunch of podcast related lists, including one for this
book club series. I am always updating this list, so
(01:28):
check back in regularly to see what's coming up later
this season.
Speaker 2 (01:32):
As always, we love.
Speaker 1 (01:33):
Hearing from you all about these book club episodes as
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(01:55):
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Our human bodies are astoundingly complex, intricate machines that allow
us to interact with, exist within, and move about this world.
(02:20):
Even at this moment, whether you're driving home from work,
out for a walk, cross stitching on the couch, or
just sitting meditatively, your body is performing a whole host
of functions, some of which you might be aware of,
like listening to what I'm saying, pumping the brakes, or
picking up your dog's poop, and others that you don't
even realize are happening, like digesting lunch, maintaining balance, or
(02:44):
growing hair one micrometer at a time. When you think
about all the things that have to go right every
second of every day to keep us healthy and alive
and doing what we want to be doing, it's hard
not to be amazed at what our bodies are capable of.
In general, they do such a good job of keeping
(03:05):
as functional that When something happens that throws a figurative
wrench in our figurative machine slash body, we are often
left with only imperfect solutions. The human body is a
difficult thing to replace, but that hasn't kept people from
attempting to do so for centuries. From the earliest skin
grafts to three D bioprinting, scientists have made incredible strides
(03:29):
in developing suitable replacements for our various body parts, and
Mary Roach is here to tell you all about it.
The ever delightful Mary Roach joins me to discuss her
latest book, Replaceable You, Adventures in Human Anatomy, which takes
reader's body part by body part through the science of
regenerative medicine. You'll learn what's so special about a pig's heart,
(03:53):
why hair transplants work as well as they do, how
to choose an OSTOMEI bag, what it feels like in side,
in iron lung, and so much more. This journey is
alternatively funny, bizarre, revelatory, passionate, and inspirational. In other words,
it's a classic Mary Roach. By the end of the book,
(04:14):
you're left in awe of the scientists who have accomplished
so much to heal those in need, the brave patients
who have dared to put their lives in their hands,
and our bodies themselves, whose stubborn instinct to protect us
is often the thing holding us back from creating a
perfect replacement. I am beyond thrilled to get to chat
(04:35):
with Mary again, so let's take a quick break and
get started. Mary, it is so great to see you again.
(05:05):
Thanks for joining me today.
Speaker 3 (05:07):
My pleasure lovely to be back.
Speaker 1 (05:09):
I am thrilled to get to chat with you about
your newest book, Replaceable You, which takes readers on this
frolicking tour through replacement body parts and the challenges in
getting them to work the way we want them to.
Could you tell me about the journey from the seed
of an idea to how this book came to be, Like,
was there a certain place or body part where you started?
Speaker 3 (05:33):
Yes, in fact, there is. When I'm looking for a
book idea, I often call people from past books or
people who have sort of generalized knowledge, and I called
this one. I think partly because I was thinking about
fat like as a book topic, oh, fat like fat
as a substance. I didn't end up going there, but
(05:54):
I spoke to this woman, Leah Bellis, who works with
stem cells derived from fat, and we had this wide
ranging conversation and one thing she told me had nothing
to do with fat or stem cells. She mentioned this
surgeon who had created he'd created a replacement penis for
a man using his own metal finger, and I of
(06:17):
course pictured the finger moved as is from the man's
hand and just like stitched in place, able to move
and like you.
Speaker 2 (06:27):
Know hencile penis.
Speaker 3 (06:28):
Yeah, exactly like you could beckon with it. And of
course that's not the case. It was sort of used
as a natural kind of prosthetic implant. Anyways, I was like, wow,
I really need to see I need to visit this person.
I need to write about that. And so I then
started just thinking about replacement parts and prosthetics and ostomes
(06:53):
and hair transplants and of course bioprinting and stem cells,
and that's kind of where it's kind of how it happened.
It just it tends my books tend to happen. There's
one chapter and then there's another one, and then I think, well,
what could be the kind of topic the umbrella that
goes over all of this. So it's never me going yeah,
(07:16):
I'd like to do a wide ranging book on regenerative
medicine and prosthetics, which is not what the book really is,
but that's how it goes with me.
Speaker 1 (07:25):
I love that the theme emerges, which as you just
follow your curiosity from you know, prosthetic penises and beyond, like.
Speaker 3 (07:35):
Yeah, exactly, that could have been the title.
Speaker 2 (07:38):
Next time, the sequel.
Speaker 1 (07:40):
Yeah, you talked about how like you know, there's we
start now with three D bioprinting, which sounds like this
like sci fi thing, but in reality, the history of
replacement body parts goes back centuries, millennia even and I
know that you know, hindsight is twenty twenty, but it's
hard to understand and some of the decisions that certain
(08:02):
physicians have made throughout history when it comes to some
of these replacement body parts.
Speaker 2 (08:07):
And one that.
Speaker 1 (08:07):
Springs to mind is trying to grow a skin flap
through a human dog connection, which you talk about in
your book. But without these attempts, we would not be
quite where we are today. And I'm curious if you
can take me through some of the either the early
pioneers or some of the strangest, most outlandish stories of
(08:29):
early skin grafting. Or any other prosthetics that you came
across in your research.
Speaker 3 (08:34):
Sure, well, skin grafting is a good one. I mean
that goes back seventeen hundred eighteen hundreds, and physicians or
surgeons were initially there was a belief that when you
took a graft from someone else, and back then it
was animals mostly being used, that you needed to keep
(08:56):
it attached to a blood supply. It's you know, getting
settled in its new home. So there'd be it was
called a pedical flap, and it was it was, you know,
there'd be the piece that's going to be transferred and
then sort of a peninsula connecting it to its original owner.
And what that meant this going back to the eighteen
(09:18):
hundred's Charles Setio I believe his name was, I had this.
I remember reading about how he had used He described it.
Of course, it's in French an chien denois, and I'm thinking, well,
I don't know much about Danish dog breeds and I'm
picturing something small, but no, you meant the great Dane.
So this person had to lie with a great Dane
(09:42):
for a number of weeks while the you know, the
keeping the blood supply from the dog, but in fact
he terminated the project early because of the continual and
excessive movements of the dog. And I'm like, what did
you expect.
Speaker 1 (09:57):
It's amazing that the project got as far as it did,
like into actual execution and not just like in the
early stages, like what are we doing here?
Speaker 2 (10:04):
What are we doing?
Speaker 3 (10:05):
There's one there was one description of a similar surgery
using a pig, and a pig like a you know, livestock,
horses cows have this ability to move the skin, you know,
to discourage and make flies go away. They can kind
of twitch the skin. So the pig kept doing that,
you know, and instead of it being a fly that
it was trying to dislodge, it was an actual human.
(10:28):
So in the you know, there's a pig in the room,
it meant there was manure. It was quite a sort
of a circus. And at certain point surgeons realize it's
going to work pretty well even if you just you
don't keep it connected to it to the host. You
can take a patch and put it. It's kind of
a bio dressing. It isn't as though the person becomes
(10:49):
part dog or port frog or par chicken, especially with
a burn a big burn. The immune system is suppressed initially,
and that allows foreign graft to sit there and to
kind of take for a while, and eventually it'll slough off,
or the surgeons will remove it and put on a
graft from the from the patient themselves, which works. But
(11:13):
as a kind of a band aid of bio dressing.
They're called zoografts or zenographs. They do work. You know,
it protects it, it keeps it from drawing out. It
sounds really weird, but it did work fairly well. Chickens
frogs were used often.
Speaker 1 (11:28):
Let's take a quick break, and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(11:52):
been chatting with Mary Roach about her book Replaceable You
Adventures in Human Anatomy. Let's get back into things. Chickens frogs,
Why choose animals? I mean, I'm assuming access was one
of the things. But you know, how did we go
from chickens frogs to today where we're actually able to
use you know, autograph someone's for someone's own tissue and
(12:15):
will in the future people look back and go, I
can't believe you used the own tissue like we now
just print sheets of skin from someone's body.
Speaker 3 (12:24):
Yeah, yeah, yeah, And in fact, now you can do
something called a cultured epithelial autographed where you take the
person's cells and they're sent off site and they're grown
into a very very very thin layer of their own cells.
And that's nice because you're not taking a graph from
another part of the body. You know. Frequently yeah, you know,
(12:47):
you'll take a graph from the thigh or the back,
you know, and and when it's somebody has a really
serious burn that's covering you know, sixty percent of the
body or something, you you don't have a lot of options,
not a lot of real estate to be taking those
grafts from so and you can wait for them to
heal and then reuse that space. I mean, it's quite
an undertaking. So some of these new newer developments like
(13:09):
the spray on skin where you kind of you know,
you take a graft and it's meshed and you kind
of fill in the spaces and the mesh with some
of the person's own cells sprayed on there.
Speaker 1 (13:22):
I love that, Like scaffolding build here, Yeah, this is
this is the real estate that you want to be, yeah,
taking it seems like the early days of replacement body
parts is peppered with the use of animals of all
different kinds and all different ways. And you talk in
your book about milk and how in the hospital you
(13:44):
might see like cows or goats or like, what tell
me about the use of goat's milk in a hospital
setting in the eighteen hundreds.
Speaker 3 (13:51):
Yeah, milk, goat's milk, cow's milk. There's some disagreement on
whose milk was best. It was a blood substitute. Basically.
It was because you know, early on before sodium citrate
was found to be something that could prevent clotting, clotting
was a real issue with transfusing blood from one person
(14:12):
or one animal to another. So somebody had this idea
of to try another miraculous bodily substance. So they tried milk.
Goat's milk, cow's milk. I mean, it was just a
lot of very excited journal articles going, this is going
to be this is going to be huge milk transfusions.
So we're going to apply to the hospital to get
(14:34):
funding for a cow that you know, that will keep
on the grounds. And very quickly medicine came to its
senses and realizes it's just basically It's similar to giving
someone saline to keep their blood volume up in the
case of a hemorrhage. If somebody's lost a lot of blood,
it prevents going at a shock, and so it's useful
in that way. There wasn't something inherent in milk, you know,
(14:57):
that made it this miraculous substance. But it wasn't an
entertaining period, and it was like eighteen seventy eight, there
was this flurry of milk transfusions.
Speaker 2 (15:08):
Milk transfusions, get them here. Did people not get sick
from this?
Speaker 3 (15:13):
Not an ideal sterile scenario?
Speaker 1 (15:17):
No, No, We talked about frog skin and dog skin
and chicken skin and all this, but then it goes
beyond skin graphs and zographs into organs transplanted from animals
as well, and sort of like with the frog skin graphs,
these are temporary solutions. But I was wondering if you
(15:37):
could tell me more about zeno transplantation or zo transplantation.
I guess with pig hearts, when do we use that?
How well does it work? How did we get the idea?
Just the full story?
Speaker 3 (15:50):
Sure, zeno transplantation. I mean, this work has been going
on about thirty years at least, and it is just
now over the past year year and a half are
actually being used in humans. So pig organs are the
ones that are being used. I mean, pig's hearts are similar,
especially a smaller, smaller size, kind of a good match
(16:14):
for the human heart. And by now there are fewer
than ten zeno transplantations into humans. There's one man, Tim Andrews,
as far as I know, is still alive. The rest
of them bought them about two months. This is a
pig organ it's a genetic edit so that some of
(16:34):
the surface proteins that tell the human immune system like
this is really foreign, get it out of here. So
there's these genetic edits to make this heart more like
a human heart, to try to fool the immune system
and to prevent hyperacute rejection, which is if you put
in a pig heart, like right away, the body's going
(16:56):
to attack it, it's going to start turning black. Is
knock a work. So they've managed to get around the
hyper acute rejection, but there are still rejection, you know,
longer term rejection issues. So it's not thought of at
this point. It's not a permanent like a human transplant
human heart or kidney transplantation. You're buying time in the
(17:17):
hope that you'll make your way up the list and
be able to get a human kidney or heart whatever
it is. So it's a stalling mechanism. It's a way
just to buy time for the person you know, who's
otherwise you know, could die. Unfortunately, that means the patients
that are getting these hearts are are not in tip
top shape and that may be contributing to to the
(17:39):
short survival time. Tim Andrews was in better shape than
some of the previous recipients. No one is quite sure,
you know, why is it only lasting two months? What
do we need to do next? How many more edits
are we going to do? Or is it something else
entirely that's going on. There's also concerns about zoom no
(18:00):
ses diseases that could go back and forth between the
animal and the person. I mean, it's amazing to think
that we can even get two months using something that
is that foreign. You know, it's a pig heart, so
you know in pig valves have been used before, but
that's that's not live cells, you know, that's a sort
(18:20):
of extra cellular material, so not quite the same I
visited a place in China where they're raising these pigs
and so they're super cle It's a super clean pig sty,
which to me was this lovely oxymoron. I'm like, what
do you mean it's a clean pig sty, But it is.
It's they're tested for forty bacteria, viruses, fungi. The whole
(18:42):
place gets disinfected every few days. The staff are not
allowed to leave. They work for three months in the facility,
and then they're swapped out with someone else. So very
very strict cleanliness and hygiene and sterile protocols for these pigs.
You know what I saw. I wasn't allowed to go in.
Of course. I I go all the way to China,
thinking well, I'm going to get in to see the pigs.
(19:03):
And they're like, of course you're not going in. You're
full of germs, you know. And then they're like, you
can see it from across the river. There there's the facility,
you know. And then we went over to a kind
of a control center where I could see them, the pigs,
that is, on a video screen in real time. There
they were the very clean pigs, still pooping on the floor.
(19:26):
I mean, they're pigs.
Speaker 2 (19:27):
Right, there's no gene.
Speaker 3 (19:29):
At it to make a pig use a toilet.
Speaker 1 (19:32):
Not yet, not yet, moving away now from animals for now,
I guess maybe we'll circle back at some point and
going on to prosthetic devices. And you had such a
great chapter about this where you kind of touched on
these different misconceptions that I think a lot of the
general public has, who maybe doesn't have experience with prosthetics
(19:53):
has in mind about these devices, and also just the
bias that there is for wholeness. And it's a really
difficult decision to make for amputation, especially when it's not
medically necessary, or when it's a parent that has to
make this decision or.
Speaker 2 (20:08):
Not for their child.
Speaker 3 (20:10):
Right.
Speaker 1 (20:10):
I was wondering what your sort of did your perspective
change or evolve as you worked on that chapter and
visited people and talked with, you know, individuals who have
different prosthetic or terminal devices.
Speaker 3 (20:23):
Yeah, that was a conversation. In fact, that was one
of the early conversations I had that sort of cemented
my decision to do this book. I heard from a
reader of mine who believed that I should do a
book on professional football referees. I don't know why she thought.
Speaker 2 (20:41):
It was a good fit for me in your real house.
Speaker 3 (20:46):
Yeah, so she's like, you should do this book. And anyway,
we corresponded by email and come to find out she
was an amputee below the knee amputee, but specifically she
had an elective amputation. In other words, she chose to
have a healthy foot amputated. It was a healthy foot
in that the tissue was fine, there was no gangrene
(21:08):
or anything, no reason, no obvious reason why a physician
or surgeon would say you should remove this foot. But
she had spina bifida and that she had like a
tumor on her spine that it caused this foot to
be twisted to not work well. She had had a
half dozen operations, never getting to the point where she
(21:28):
was improving, always getting worse. And she's described watching people
out hiking and watching people who had prosthetic limbs in
artificial foot who were able to walk or run or
hike and do things that she couldn't do. And they've
got a prosthesis and she has a natural foot, and
she just decided, I don't want this foot. I want
(21:51):
this gone. And it was very hard for her to
find a surgeon willing to do that, because you're talking
about removing healthy in quote, I mean it's healthy, it
is just not functional. For her, it was very hard
to find a surgeon willing to do that. She finally did,
she was so much happier. She can do all of
those things she would see other people doing. So there
(22:13):
is a bias for wholeness, that's part of it. But
it's also a surgeon. You know, no one's going to
call a surgeon to task for Let's try another operation,
Let's see if we can make this foot work, you know,
because cutting a foot off feels extreme final, there's no
going back. Also, the surgeon may or may not have
experience and amputations and may be concerned about you know,
(22:36):
what if there's phantom pain, what if I don't do
it right? You know. You need also to convince the
insurance people. That's another issue. So so it's it's a
tricky thing to take off your foot and as you
mentioned when when you ask the question, when it's a
parent trying to make that decision for a child, that's
(22:56):
really hard to do.
Speaker 1 (22:58):
Yeah, And I think that, like you said, the the
technology being varied for different limbs is part of the
equation too.
Speaker 3 (23:06):
Yes, absolutely, the feet and the legs are far better
bet than those. You know, it's sort of in its
infancy because a hand is that you get fingers and
you're doing very fine tuned work. When you're trying to
write or pick something up or whatever it is you're
doing with your hand and your fingers, that's a big
(23:28):
chore to get a prosthetic to do. Whereas walking is,
you know, it's not simple. A gait is not just
putting the foot on the floor. There's a lot going
on there. But compared to a hand, it's a much
more successful thing to replace.
Speaker 2 (23:43):
Let's take a quick break here.
Speaker 4 (23:45):
We'll be back before you know it.
Speaker 1 (24:02):
Welcome back everyone. I'm here chatting with the wonderful Mary
Roach about her book Replaceable You. Let's get into some
more questions. Speaking of difficult things to replace, breathing ventilators,
it's something that we have various forms of technology, including EVA,
which I want to ask you about because that was
(24:24):
something new that I learned. But I also wanted to
talk about your experience in the iron lung. Thanks to vaccines,
we don't see the iron lung wards these days, but
it was a whole community, like a whole culture, and
so it must have been really incredible to kind of
see this device and then experience it yourself.
Speaker 2 (24:48):
Oh it was.
Speaker 3 (24:49):
It was the one that I spent time in as
a functional Emerson iron lung from that era, from the
polio era before there was the vaccine, when like you mentioned,
they were huge wards rose even sometimes stacked iron lungs,
and there were a few of them still around and
I found somebody I was interviewing mentioned that, and I said,
(25:11):
do you know anybody who is still using one? And
there were a couple of people, and she put me
in touch with this man whose wife had recently died,
and I wrote to him and said, you know, I'm
really curious about this. Could I come and spend the
night in your wife's iron lung? Which is like a
cold email, like hello, you don't know me. As it
(25:34):
turned out, he did know me from having read one
of my books. So that was helpful because I think
otherwise you feel like you're really weird. Go away, yes man, Yes,
yeah creepy. So yeah, it does sound kind of creepy,
like I want to spend the night in you iron love.
So anyways, his name was Mark, and Mark said yes.
So I went out and I didn't know what to expect.
(25:57):
I imagined it being a little simpler than it was,
Like I wanted to eat a meal in there, and
that was frowned upon because that can be very dangerous
because if you have a machine, and I should back
up and just say, an iron lung is different from
a ventilator in a hospital that is a positive pressure ventilator,
you know, the thing that we're all used to seeing
(26:17):
where you're it's kind of inflating your lungs like a
party balloon, which is very different negative pressure ventilation. That's
how we breathe. So you have muscles to pull apart
your rib cage and pull down your diaphragm, and that
lowers the pressure inside the lungs. It pulls air in
and then when the muscles let go, it squeezes it out.
So it's a very gentle and natural thing that is
(26:40):
mimicked by these machines. They create a vacuum in this
sealed tube that you are inside, and that opens up
the chest, pulls in air and then it goes back out.
That means you're inside there, but your head is outside,
so it isn't quite as claustrophobic as you would think.
It is a very strange experience to have a machine
(27:03):
decide when you will inhale and when you will exhale.
And so if you're trying to eat, say you had
shoot some food and you were about to swallow it,
and the machine decided that's when you're going to inhale,
that could be a serious choking hazard, or you could
get you could get food inside your lungs, which could
cause pneumonia, you get bacteria in there. So they're like, no,
(27:24):
you won't be you won't be eating dinner in the
iron lung. Now that would take some coordination and practice,
so we're not going to do that anyway. So I'd
had this idea that I would spend the night in
the iron lung, and Mark had brought in a couple assistants.
It's kind of a you know, it's kind of an undertaking.
Kind of looks like a hot water heater lying on
(27:46):
its side, okay, but with a sort of like an MRI.
You know, where this bed rolls out. So you get
on the bed and then they roll you in, but
then you've got to get your head out this opening yeah,
so you get your head out the opening and then
the next needs to be really tight to keep because
it has to be a sealed right to create the vacuum.
(28:06):
It's a little hard to explain without seeing it, but
it's got to be. It's got to be a seal.
So that's like not a comfortable way to sleep, you know,
and to have that tight and I'm like, I think
this is too tight, and they're going, no, it's not
quite tight enough. Great, you know, and mark It said, oh,
it's really relaxing. You'll be asleep in no time. So
I lasted about nine minutes in the iron lung. So
(28:31):
because the collar is so tight, you have this weird
simultaneous sense of like breathing deeply and as though you
were really relaxed, but at the same time it feels
like somebody's choking you. So it's it's a strange place
to be. You've got to stay on your back. It's
a big ordeal to change position. I don't sleep on
(28:52):
my back, so it's it was not a for me,
not very conducive to sleeping, but for someone you know,
and I've read memoirs of people who'd spent a lot
of time in an iron lung, and I expected a
description of panic, claustrophobia, anguish, but the description of being
put into an iron lung across the board. People would
describe this tremendous relief and relaxation to be able suddenly
(29:18):
to breathe calmly and deeply when they'd been struggling to
get enough oxygen to live, a very different experience than
a ventilator that's pushing air down into the lungs.
Speaker 1 (29:32):
We've covered a little bit of hospital ventilators are the
ones that we think of today as ventilators. We've covered
a little bit of iron lung.
Speaker 2 (29:38):
Tell me about EVA.
Speaker 3 (29:41):
Yes, EVA stands for enteral ventilation via anus. You're basically
using the rectum as a third long kind of which
is amazing. Okay, so you're there's this stuff per fluo carbon,
if I'm saying it right, it holds oxygen. Well, so
you put perfluor rocarbon into the rectum and the body
(30:04):
absorbs oxygen that way. I mean you can feed people
via the rectum. People can absorb things through the mucose
of the rectum, including oxygen. You can also do this
by blowing it through. I spoke to a doctor Bartlett
at the Extra Corporeal Life Support Laboratory said, yeah, we
(30:25):
tried that. You can sort of blow it through via
the stomach and that way this carbon dioxide comes out
the anus and I'm like, so sort of constantly farting.
He goes, yeah, not very.
Speaker 1 (30:33):
Attractive, just like one continuously.
Speaker 3 (30:36):
One continuous part. But you know, EVA is amazing. You know,
the applications are quite specific. If you've got a premature infant,
one of the things that is precarious with them is
they're breathing. The lungs aren't developed enough to support breathing.
So but if you put them on a positive pressure ventilator,
(30:56):
it's it's a very delicate tissue, the lining of the lungs,
and you can damage the lungs. So if you could
supplement with getting oxygen in through the butt, you know,
that could be great. Or if it's a situation, a
combat situation where you don't have a ventilator available, you
don't have the equipment necessary just to get some oxygen
(31:17):
in there, so sort of a supplement the anus is
happy to provide.
Speaker 1 (31:24):
There's really no other way to put it, is there.
I want to keep us moving through these different replacement
body parts, because there is so much technology and history
with each and every one of them. And one of
the ones that has a surprisingly long story is ostomes,
which are these surgically created openings on someone's abdomen that
(31:47):
allow waste to come out. And along with this long
history of ostomes also of course comes with this long
history of stigma and also these myths that just abound
when it comes to ostomese, you know, with like Napoleon
and so on and so forth. Can you give me
just like a little tour through the history of ostomese?
Speaker 3 (32:07):
Sure? Well, this is going to go back to the
seventeen hundreds. As long as people have been stabbing each other,
there's been kind of natural instances where an opening from
the intestines will appear in the skin. It'll like the
body will heal in a way that the lips of
the intestine. I like that. This was one of the surgeons.
The lips of the intestine will kind of fuse to
(32:30):
the cut the opening, and they'll have this natural kind
of artificial anus, if you will. And so in seventeen
fifty seven there was this surgeon that's basically why not
take a hint from nature. What if we were to
do this in cases where somebody has a blockage, whether
it's a tumor or whatever is going on, and that
(32:51):
it's this blockage. They've tried all manner of the usual
suspects and breaking up the blockage and it's not working,
and they haven't released anything in days or weeks, and
they're about to die because it's going to break, it's
gonna pop soon. So they would create an opening to
let stuff come out. The opening is called a stoma,
(33:14):
and today that is still done, not so much for blockages,
although for that as well, but with very serious cases
of inflammatory bowel disease crones or colitis things get really bad.
You can put an opening and a pouch.
Speaker 1 (33:33):
And there are so many variations on ostome bags on
ways to collect the waste. How does one go about
choosing a bag?
Speaker 3 (33:41):
Well, I can tell you that because I went to
the a five K fundraiser of the United Ostome Associations
of America and one of the things they do, if
you're not an ostimate, which I am not, they recommend
that you choose one and to wear as an empathy pouch.
It just you know, join the crew. And I didn't
(34:04):
realize I didn't read the email very well. When the
guy mentioned to me that I would choose an empathy pouch.
It's supposed to be full, you know, of liquid, but
I just put an empty one on there. I'm like,
this isn't bad. But anyway, depending on where your stoma is,
that determines what kind of pouch you might wear. There's
(34:25):
some that are have to be changed more often because
the material is more liquid higher up a small intestine,
further down it's more solid. There's various options, big or smaller,
two part, one part, just depending on what you need.
Then there's you can sort of fart with them. There's
venting if I just like poke a little whole little
(34:45):
venting device because you don't want to have a blowout
as they call it. So there are like a thousand
different pouches and systems for oustumates. And it was, you know,
there was a really fun event. Everybody was. You know,
this woman when I was using my empathy pouch, I
just sort of grabbed this one. She goes, oh, that's
a really large pouch. That's just very unsexy. Let me
(35:06):
show you my pouch. See this, This is like, you know,
and I changed it three or four times a day,
and you know, everybody's had this kind of what are
you wearing red carpet buzz? You know, it was fabulous.
It was just very fun. And the more we can
talk about these things, the less there's a stigma. There's
been a lot of good progress made, I think via
TikTok and people with ostomies just saying hey, this is
(35:28):
how it works. Here's my pouch, here's how I changed,
here's you know, just sort of saying here you go this.
Speaker 1 (35:34):
So far, we've mostly touched on things that are medically
necessary replacement body parts. We're talking about skin grafts, organ transplants, prothesis,
et cetera. But then there's cosmetic surgery. We've come a
long way. It's obviously a huge industry these days, talking
about things like early hair transplants, early breast implants.
Speaker 2 (35:57):
You know, what did.
Speaker 1 (35:58):
These things look like, how did people begin and how
much was maybe the person who was receiving the transplant
not necessarily like thought of their experience in terms of,
for instance, what a breast implant was made of.
Speaker 3 (36:12):
Oh yeah, I wish I had the book right in
front of me to just read you the list of
all the stuff that was injected into women's Should we
read that list? It's kind of an astounding.
Speaker 2 (36:23):
Let's read it.
Speaker 3 (36:24):
That's right, right, right, yeah, hold on, let me get
the book. Okay. The filler would need to be thick
enough to pass as breast tissue, yet thin enough to
pass through the opening of a syringe. This is before aspirators,
before the arrival. Yeah. In the early nineteen eighties of
the liposuction aspirator, the substances injected were not typically fat.
They were it truly seemed whatever fat like substance. Some
(36:46):
enterprising plastic surgeons gaze happened to land on. Some took
their inspiration in the kitchen olive oil, vegetable oil, some
in the barnyard goat's milk, cow collagen, pig collagen, or
the forest beeswax, tree resin derivatives. Others in the supply
rooms of industry paraffin, petroleum, jelly, various glues and polymers.
(37:09):
They were sticking anything in there.
Speaker 1 (37:12):
Love that goat smoke makes a second mention there, it's good. Yeah.
Someone's gonna keep trying until they find use medically for
goat smell. Yeah, yeah, yeah, I think The other thing too,
is was hair transplants, which I know you tried to
see if your hair could grow and then be transplanted.
Speaker 2 (37:31):
How did that end up all shaking out?
Speaker 3 (37:33):
Yeah? Yeah. I wanted to demonstrate for myself a concept
called donor dominance, and this is what makes hair transplants possible.
So you take hair from a man who's losing hair
on the top. That's where you lose hair on the top,
male pattern baldness. You don't lose it. They don't lose
it on the sides in the back. So you can
take a certain percentage of these follicles and move them
(37:56):
up top, and they'll retain the characteristics of their homeland,
so they won't be hair that responds to testosterone falls out.
So you take a couple thousand hairs from back here
and from the sides, and you put it up top,
and because of donor dominance, it won't fall out, won't
be hair that falls out. And so I was at
a hair transplant clinic because of another chapter that had
(38:20):
to do with growing follicles from stem cells. So while
I was there, I said, will you can you transplant
a couple of hairs from the back of my head
to my leg because I wanted by the time I
went on book tour, I wanted to have a couple
of long, luxuriant hair screwing on my legs so i'd
have this demons that I could show people. Look, this
(38:41):
is donor dominance. These hairs came from the back of
my head. Unfortunately they didn't take The legs get a
lot less blood than the head. The scalp gets a
very robust blood supply. On the calf not so much.
So I'm sad to say I don't have long, luxuriant
(39:02):
leg hair growing from the spot where they transplanted a
couple follicles.
Speaker 2 (39:09):
Devastating.
Speaker 3 (39:09):
Yeah, I know, I know, I really, you know, but
it's kind of amazing how well it does work, to
the extent that there's something called pubic alopecia, which can
be traumatic for some women, whether they lose their they
don't have pubic care, they've lost their pubic care. And
you can take head hair, but the thing is you
(39:30):
then every two months have to trim it, Oh.
Speaker 2 (39:32):
My gosh, because it just will keep growing because of length.
Speaker 3 (39:35):
It's head hair.
Speaker 2 (39:37):
Yeah, amazing.
Speaker 3 (39:39):
The opposite shore, you could take pubic care, and this
has been done transplant it. If you're going bald, you
could use chest hair, armpit hair, pubic hare, but it's
rarely done. The surgeon who did the largest study on
it pointed out pubic care. That is that it is
difficult to style difficult styles.
Speaker 2 (40:03):
That's amazing.
Speaker 1 (40:04):
I feel like with a hair transplant, you know and
donor dominance with whatever various things people are injecting into
breast tissue. But also beyond that. Throughout the rest of
the book, where you talk about you know, z know, transplantation,
you talk about skin graphs, the thing that really stands
in the way is not a will. It's not a
(40:27):
lack of skill, it's not knowledge, but it's our immune
system that seems to be like this kind of unexpected
antagonist that prevents us from achieving all that we want
to and replacing whatever body part we you know, have
our mindset on. What are people working on to solve
the issue of rejection while also not destroying our immune system?
Speaker 3 (40:50):
Yeah, that is that is the challenge. The immune system
is very very good at recognizing something foreign, and that's
been a real problem with some of these With hand transplants,
face transplants, these are composite tissue allow transplants. In other words,
they're not just one kind of you know, a liver
(41:12):
is fairly uniform, but this is, you know, a hand,
there's there's muscle, there's tender there's skin, there's there's all
these various components. There's just a lot going on to
upset the immune system and to create a reaction, an
immune reaction and a rejection. So and that's been in issues.
There there are folks who've had a face transplant and
(41:32):
now it's breaking down. It's not working as well, it's
not supple it's whatever's going on in addition to rejection
episodes and all the issues of immunosuppression. They're going to
need a second face or hands, or there's folks who
are having hands removed just because the immunosuppression that's necessary
to keep the body from rejecting it. It's too problematic.
(41:55):
So you know what could be done. There was some
work being done with taking some of the donors marrow
which has components of the immune system, so you would
sort of donate that along with the part being donated.
I don't you know, but you know that was going on.
This was back when I reported grunt, which you know,
(42:16):
around twenty sixteen, I think they were just doing a
lot of these, you know, composite tissue transplants the hands,
the arms, the faces, and it's kind of they've backed
off of it just it's been very problematic. Even with
that marrow I don't remember the name exactly of the technique,
but where you take a little bit of marrow from
the donor. There's hope that in the future you could genetically,
(42:42):
I'm not sure how, but you would get the organ
itself to secrete an immunosuppressive protein, so it would have
you'd have localized immunosuppression, so you wouldn't have to tamp
down the whole body immune system. You could just get
the organ to do it itself. That you know is
in the future. In terms of stem cells, you know,
(43:05):
right now, there are treatments where you can take somebody's blood,
you can regress it to its very early state where
it's called plury potency, and then instruct it to become
a kind of cell, say a dopamine producing neuron, you know,
for somebody with Parkinson's. But that's a bespoke process, so
(43:27):
it's you've got to take it's time consuming and very expensive.
It has to be the person's own cells, otherwise the
body will destroy them. But if you could create what's
called stealth cells where they evade the immune system, then
you could just buy plury potent cells off the shelf
kind of and instruct them to become what you want.
(43:48):
So so that would be terrific, But that's not You're
talking about cells that may replicate and do what they
want that evade the immune system. So that's a scary thing.
The f is rightfully concerned about that. So you know,
those are two directions things are going, but not quite
there yet.
Speaker 1 (44:08):
Yeah, yeah, I mean, and hopefully there will be more
progress made in so many of these fronts. I mean,
it is amazing how fast pace some of this research is.
And even though the headlines might be overhyping and overstating
where things are, but I do feel like it is.
It's a really promising area of research. And that's one
(44:29):
thing that I really appreciated about your book, and how
all of these areas we've made progress in and progress
in one area also means progress in all of these
other areas as well.
Speaker 3 (44:39):
Yes, And that's why cuts to the NIH and the
NSF cuts to laboratory funding is so damaging looking like
down the line in terms of just the pipeline of
innovators and engineers and work that needs to go on
to keep things moving forward. You know, it's bad enough
just to of what it's doing to patients and to
(45:02):
projects that are underway, but going forward, you know, all
the progress that we've made, all of that depends on
government funding. So that's been you know, I have an
epilogue in the book because the book was I was
going to the you know, into production just as the
DOGE cuts were happening, and we so we added an
epilogue about that. And it's really sad. Yeah.
Speaker 1 (45:28):
Yeah, the costs when calculated, the costs will be I mean,
and when we can actually calculate is a big question,
but it'll be incomprehensible.
Speaker 3 (45:35):
I feel like, yeah.
Speaker 5 (45:36):
But well yeah, well, sorry to end on a bot
a sad note, but it you know, aside from the
necessary reflection on the state of funding today and science
science funding today, it has been such a joy chatting
with you as always.
Speaker 1 (45:54):
Thank you so much for taking the time to chat
about your book.
Speaker 3 (45:58):
Oh my pleasure. Always in joy being on the podcast
Thanks so much, Jaron.
Speaker 1 (46:21):
A big thank you again to Mary Roach for taking
the time to chat with me. It is just so
surreal to get to talk with one of my sycom heroes.
If you enjoyed today's episode and would like to learn more,
check out our website this podcast will kill You dot com.
We're all post a link to where you can find
Replaceable You Adventures in Human Anatomy, as well as a
(46:41):
link to Mary's website where you can find her other
incredible work. And don't forget you can check out our
website for all sorts of other cool things, including but
not limited to, transcripts, quarantine and placeiver rita recipes, show
notes and references for all of our episodes, links to
merch our, bookshop dot org, affiliate account, our Goodreads list,
a first hand account, form, and music by Bloodmobile.
Speaker 2 (47:04):
Speaking of which, thank you to.
Speaker 1 (47:06):
Bloodmobile for providing the music for this episode and all
of our episodes. Thank you to Leana Squialacci and Tom
Briifogel for our audio mixing, and thanks to you listeners
for listening. I hope you liked this episode and our
loving being part of the TPWKY book Club. A special
thank you as always to our fantastic patrons. We appreciate
(47:28):
your support so very much. Well, until next time, keep
washing those hands.
Hi, I'm Aaron Welsh and this is this Podcast will
Kill You. You're listening to the latest episode in our tp
w k Y book Club series, where I get to
interview authors of popular science and medicine books about their
latest work. We have featured some excellent books so far
this season and have a great lineup for the rest
(01:04):
of the year. If you'd like to sneak a peek
at the books that we'll be reading later this season,
as well as check out the ones we've already covered,
head over to our website This Podcast will Kill You
dot com. There under the extras tab you'll find a
link to our bookshop dot Org affiliate page, which has
a bunch of podcast related lists, including one for this
book club series. I am always updating this list, so
(01:28):
check back in regularly to see what's coming up later
this season.
Speaker 2 (01:32):
As always, we love.
Speaker 1 (01:33):
Hearing from you all about these book club episodes as
well as our regular episodes, so if you have anything
you'd like to share, reach out through the contact us
form on our website. Some of you have sent in
some great book recommendations, which I always appreciate. Two last
things before moving on to this week's book, and that
is to please, rate, review, and subscribe if you haven't already.
(01:55):
It really does help us out, and you can now
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on YouTube. Make sure you're subscribed to exactly Right Media's
YouTube channel so you never miss a new episode drop.
Our human bodies are astoundingly complex, intricate machines that allow
us to interact with, exist within, and move about this world.
(02:20):
Even at this moment, whether you're driving home from work,
out for a walk, cross stitching on the couch, or
just sitting meditatively, your body is performing a whole host
of functions, some of which you might be aware of,
like listening to what I'm saying, pumping the brakes, or
picking up your dog's poop, and others that you don't
even realize are happening, like digesting lunch, maintaining balance, or
(02:44):
growing hair one micrometer at a time. When you think
about all the things that have to go right every
second of every day to keep us healthy and alive
and doing what we want to be doing, it's hard
not to be amazed at what our bodies are capable of.
In general, they do such a good job of keeping
(03:05):
as functional that When something happens that throws a figurative
wrench in our figurative machine slash body, we are often
left with only imperfect solutions. The human body is a
difficult thing to replace, but that hasn't kept people from
attempting to do so for centuries. From the earliest skin
grafts to three D bioprinting, scientists have made incredible strides
(03:29):
in developing suitable replacements for our various body parts, and
Mary Roach is here to tell you all about it.
The ever delightful Mary Roach joins me to discuss her
latest book, Replaceable You, Adventures in Human Anatomy, which takes
reader's body part by body part through the science of
regenerative medicine. You'll learn what's so special about a pig's heart,
(03:53):
why hair transplants work as well as they do, how
to choose an OSTOMEI bag, what it feels like in side,
in iron lung, and so much more. This journey is
alternatively funny, bizarre, revelatory, passionate, and inspirational. In other words,
it's a classic Mary Roach. By the end of the book,
(04:14):
you're left in awe of the scientists who have accomplished
so much to heal those in need, the brave patients
who have dared to put their lives in their hands,
and our bodies themselves, whose stubborn instinct to protect us
is often the thing holding us back from creating a
perfect replacement. I am beyond thrilled to get to chat
(04:35):
with Mary again, so let's take a quick break and
get started. Mary, it is so great to see you again.
(05:05):
Thanks for joining me today.
Speaker 3 (05:07):
My pleasure lovely to be back.
Speaker 1 (05:09):
I am thrilled to get to chat with you about
your newest book, Replaceable You, which takes readers on this
frolicking tour through replacement body parts and the challenges in
getting them to work the way we want them to.
Could you tell me about the journey from the seed
of an idea to how this book came to be, Like,
was there a certain place or body part where you started?
Speaker 3 (05:33):
Yes, in fact, there is. When I'm looking for a
book idea, I often call people from past books or
people who have sort of generalized knowledge, and I called
this one. I think partly because I was thinking about
fat like as a book topic, oh, fat like fat
as a substance. I didn't end up going there, but
(05:54):
I spoke to this woman, Leah Bellis, who works with
stem cells derived from fat, and we had this wide
ranging conversation and one thing she told me had nothing
to do with fat or stem cells. She mentioned this
surgeon who had created he'd created a replacement penis for
a man using his own metal finger, and I of
(06:17):
course pictured the finger moved as is from the man's
hand and just like stitched in place, able to move
and like you.
Speaker 2 (06:27):
Know hencile penis.
Speaker 3 (06:28):
Yeah, exactly like you could beckon with it. And of
course that's not the case. It was sort of used
as a natural kind of prosthetic implant. Anyways, I was like, wow,
I really need to see I need to visit this person.
I need to write about that. And so I then
started just thinking about replacement parts and prosthetics and ostomes
(06:53):
and hair transplants and of course bioprinting and stem cells,
and that's kind of where it's kind of how it happened.
It just it tends my books tend to happen. There's
one chapter and then there's another one, and then I think, well,
what could be the kind of topic the umbrella that
goes over all of this. So it's never me going yeah,
(07:16):
I'd like to do a wide ranging book on regenerative
medicine and prosthetics, which is not what the book really is,
but that's how it goes with me.
Speaker 1 (07:25):
I love that the theme emerges, which as you just
follow your curiosity from you know, prosthetic penises and beyond, like.
Speaker 3 (07:35):
Yeah, exactly, that could have been the title.
Speaker 2 (07:38):
Next time, the sequel.
Speaker 1 (07:40):
Yeah, you talked about how like you know, there's we
start now with three D bioprinting, which sounds like this
like sci fi thing, but in reality, the history of
replacement body parts goes back centuries, millennia even and I
know that you know, hindsight is twenty twenty, but it's
hard to understand and some of the decisions that certain
(08:02):
physicians have made throughout history when it comes to some
of these replacement body parts.
Speaker 2 (08:07):
And one that.
Speaker 1 (08:07):
Springs to mind is trying to grow a skin flap
through a human dog connection, which you talk about in
your book. But without these attempts, we would not be
quite where we are today. And I'm curious if you
can take me through some of the either the early
pioneers or some of the strangest, most outlandish stories of
(08:29):
early skin grafting. Or any other prosthetics that you came
across in your research.
Speaker 3 (08:34):
Sure, well, skin grafting is a good one. I mean
that goes back seventeen hundred eighteen hundreds, and physicians or
surgeons were initially there was a belief that when you
took a graft from someone else, and back then it
was animals mostly being used, that you needed to keep
(08:56):
it attached to a blood supply. It's you know, getting
settled in its new home. So there'd be it was
called a pedical flap, and it was it was, you know,
there'd be the piece that's going to be transferred and
then sort of a peninsula connecting it to its original owner.
And what that meant this going back to the eighteen
(09:18):
hundred's Charles Setio I believe his name was, I had this.
I remember reading about how he had used He described it.
Of course, it's in French an chien denois, and I'm thinking, well,
I don't know much about Danish dog breeds and I'm
picturing something small, but no, you meant the great Dane.
So this person had to lie with a great Dane
(09:42):
for a number of weeks while the you know, the
keeping the blood supply from the dog, but in fact
he terminated the project early because of the continual and
excessive movements of the dog. And I'm like, what did
you expect.
Speaker 1 (09:57):
It's amazing that the project got as far as it did,
like into actual execution and not just like in the
early stages, like what are we doing here?
Speaker 2 (10:04):
What are we doing?
Speaker 3 (10:05):
There's one there was one description of a similar surgery
using a pig, and a pig like a you know, livestock,
horses cows have this ability to move the skin, you know,
to discourage and make flies go away. They can kind
of twitch the skin. So the pig kept doing that,
you know, and instead of it being a fly that
it was trying to dislodge, it was an actual human.
(10:28):
So in the you know, there's a pig in the room,
it meant there was manure. It was quite a sort
of a circus. And at certain point surgeons realize it's
going to work pretty well even if you just you
don't keep it connected to it to the host. You
can take a patch and put it. It's kind of
a bio dressing. It isn't as though the person becomes
(10:49):
part dog or port frog or par chicken, especially with
a burn a big burn. The immune system is suppressed initially,
and that allows foreign graft to sit there and to
kind of take for a while, and eventually it'll slough off,
or the surgeons will remove it and put on a
graft from the from the patient themselves, which works. But
(11:13):
as a kind of a band aid of bio dressing.
They're called zoografts or zenographs. They do work. You know,
it protects it, it keeps it from drawing out. It
sounds really weird, but it did work fairly well. Chickens
frogs were used often.
Speaker 1 (11:28):
Let's take a quick break, and when we get back,
there's still so much to discuss. Welcome back everyone. I've
(11:52):
been chatting with Mary Roach about her book Replaceable You
Adventures in Human Anatomy. Let's get back into things. Chickens frogs,
Why choose animals? I mean, I'm assuming access was one
of the things. But you know, how did we go
from chickens frogs to today where we're actually able to
use you know, autograph someone's for someone's own tissue and
(12:15):
will in the future people look back and go, I
can't believe you used the own tissue like we now
just print sheets of skin from someone's body.
Speaker 3 (12:24):
Yeah, yeah, yeah, And in fact, now you can do
something called a cultured epithelial autographed where you take the
person's cells and they're sent off site and they're grown
into a very very very thin layer of their own cells.
And that's nice because you're not taking a graph from
another part of the body. You know. Frequently yeah, you know,
(12:47):
you'll take a graph from the thigh or the back,
you know, and and when it's somebody has a really
serious burn that's covering you know, sixty percent of the
body or something, you you don't have a lot of options,
not a lot of real estate to be taking those
grafts from so and you can wait for them to
heal and then reuse that space. I mean, it's quite
an undertaking. So some of these new newer developments like
(13:09):
the spray on skin where you kind of you know,
you take a graft and it's meshed and you kind
of fill in the spaces and the mesh with some
of the person's own cells sprayed on there.
Speaker 1 (13:22):
I love that, Like scaffolding build here, Yeah, this is
this is the real estate that you want to be, yeah,
taking it seems like the early days of replacement body
parts is peppered with the use of animals of all
different kinds and all different ways. And you talk in
your book about milk and how in the hospital you
(13:44):
might see like cows or goats or like, what tell
me about the use of goat's milk in a hospital
setting in the eighteen hundreds.
Speaker 3 (13:51):
Yeah, milk, goat's milk, cow's milk. There's some disagreement on
whose milk was best. It was a blood substitute. Basically.
It was because you know, early on before sodium citrate
was found to be something that could prevent clotting, clotting
was a real issue with transfusing blood from one person
(14:12):
or one animal to another. So somebody had this idea
of to try another miraculous bodily substance. So they tried milk.
Goat's milk, cow's milk. I mean, it was just a
lot of very excited journal articles going, this is going
to be this is going to be huge milk transfusions.
So we're going to apply to the hospital to get
(14:34):
funding for a cow that you know, that will keep
on the grounds. And very quickly medicine came to its
senses and realizes it's just basically It's similar to giving
someone saline to keep their blood volume up in the
case of a hemorrhage. If somebody's lost a lot of blood,
it prevents going at a shock, and so it's useful
in that way. There wasn't something inherent in milk, you know,
(14:57):
that made it this miraculous substance. But it wasn't an
entertaining period, and it was like eighteen seventy eight, there
was this flurry of milk transfusions.
Speaker 2 (15:08):
Milk transfusions, get them here. Did people not get sick
from this?
Speaker 3 (15:13):
Not an ideal sterile scenario?
Speaker 1 (15:17):
No, No, We talked about frog skin and dog skin
and chicken skin and all this, but then it goes
beyond skin graphs and zographs into organs transplanted from animals
as well, and sort of like with the frog skin graphs,
these are temporary solutions. But I was wondering if you
(15:37):
could tell me more about zeno transplantation or zo transplantation.
I guess with pig hearts, when do we use that?
How well does it work? How did we get the idea?
Just the full story?
Speaker 3 (15:50):
Sure, zeno transplantation. I mean, this work has been going
on about thirty years at least, and it is just
now over the past year year and a half are
actually being used in humans. So pig organs are the
ones that are being used. I mean, pig's hearts are similar,
especially a smaller, smaller size, kind of a good match
(16:14):
for the human heart. And by now there are fewer
than ten zeno transplantations into humans. There's one man, Tim Andrews,
as far as I know, is still alive. The rest
of them bought them about two months. This is a
pig organ it's a genetic edit so that some of
(16:34):
the surface proteins that tell the human immune system like
this is really foreign, get it out of here. So
there's these genetic edits to make this heart more like
a human heart, to try to fool the immune system
and to prevent hyperacute rejection, which is if you put
in a pig heart, like right away, the body's going
(16:56):
to attack it, it's going to start turning black. Is
knock a work. So they've managed to get around the
hyper acute rejection, but there are still rejection, you know,
longer term rejection issues. So it's not thought of at
this point. It's not a permanent like a human transplant
human heart or kidney transplantation. You're buying time in the
(17:17):
hope that you'll make your way up the list and
be able to get a human kidney or heart whatever
it is. So it's a stalling mechanism. It's a way
just to buy time for the person you know, who's
otherwise you know, could die. Unfortunately, that means the patients
that are getting these hearts are are not in tip
top shape and that may be contributing to to the
(17:39):
short survival time. Tim Andrews was in better shape than
some of the previous recipients. No one is quite sure,
you know, why is it only lasting two months? What
do we need to do next? How many more edits
are we going to do? Or is it something else
entirely that's going on. There's also concerns about zoom no
(18:00):
ses diseases that could go back and forth between the
animal and the person. I mean, it's amazing to think
that we can even get two months using something that
is that foreign. You know, it's a pig heart, so
you know in pig valves have been used before, but
that's that's not live cells, you know, that's a sort
(18:20):
of extra cellular material, so not quite the same I
visited a place in China where they're raising these pigs
and so they're super cle It's a super clean pig sty,
which to me was this lovely oxymoron. I'm like, what
do you mean it's a clean pig sty, But it is.
It's they're tested for forty bacteria, viruses, fungi. The whole
(18:42):
place gets disinfected every few days. The staff are not
allowed to leave. They work for three months in the facility,
and then they're swapped out with someone else. So very
very strict cleanliness and hygiene and sterile protocols for these pigs.
You know what I saw. I wasn't allowed to go in.
Of course. I I go all the way to China,
thinking well, I'm going to get in to see the pigs.
(19:03):
And they're like, of course you're not going in. You're
full of germs, you know. And then they're like, you
can see it from across the river. There there's the facility,
you know. And then we went over to a kind
of a control center where I could see them, the pigs,
that is, on a video screen in real time. There
they were the very clean pigs, still pooping on the floor.
(19:26):
I mean, they're pigs.
Speaker 2 (19:27):
Right, there's no gene.
Speaker 3 (19:29):
At it to make a pig use a toilet.
Speaker 1 (19:32):
Not yet, not yet, moving away now from animals for now,
I guess maybe we'll circle back at some point and
going on to prosthetic devices. And you had such a
great chapter about this where you kind of touched on
these different misconceptions that I think a lot of the
general public has, who maybe doesn't have experience with prosthetics
(19:53):
has in mind about these devices, and also just the
bias that there is for wholeness. And it's a really
difficult decision to make for amputation, especially when it's not
medically necessary, or when it's a parent that has to
make this decision or.
Speaker 2 (20:08):
Not for their child.
Speaker 3 (20:10):
Right.
Speaker 1 (20:10):
I was wondering what your sort of did your perspective
change or evolve as you worked on that chapter and
visited people and talked with, you know, individuals who have
different prosthetic or terminal devices.
Speaker 3 (20:23):
Yeah, that was a conversation. In fact, that was one
of the early conversations I had that sort of cemented
my decision to do this book. I heard from a
reader of mine who believed that I should do a
book on professional football referees. I don't know why she thought.
Speaker 2 (20:41):
It was a good fit for me in your real house.
Speaker 3 (20:46):
Yeah, so she's like, you should do this book. And anyway,
we corresponded by email and come to find out she
was an amputee below the knee amputee, but specifically she
had an elective amputation. In other words, she chose to
have a healthy foot amputated. It was a healthy foot
in that the tissue was fine, there was no gangrene
(21:08):
or anything, no reason, no obvious reason why a physician
or surgeon would say you should remove this foot. But
she had spina bifida and that she had like a
tumor on her spine that it caused this foot to
be twisted to not work well. She had had a
half dozen operations, never getting to the point where she
(21:28):
was improving, always getting worse. And she's described watching people
out hiking and watching people who had prosthetic limbs in
artificial foot who were able to walk or run or
hike and do things that she couldn't do. And they've
got a prosthesis and she has a natural foot, and
she just decided, I don't want this foot. I want
(21:51):
this gone. And it was very hard for her to
find a surgeon willing to do that, because you're talking
about removing healthy in quote, I mean it's healthy, it
is just not functional. For her, it was very hard
to find a surgeon willing to do that. She finally did,
she was so much happier. She can do all of
those things she would see other people doing. So there
(22:13):
is a bias for wholeness, that's part of it. But
it's also a surgeon. You know, no one's going to
call a surgeon to task for Let's try another operation,
Let's see if we can make this foot work, you know,
because cutting a foot off feels extreme final, there's no
going back. Also, the surgeon may or may not have
experience and amputations and may be concerned about you know,
(22:36):
what if there's phantom pain, what if I don't do
it right? You know. You need also to convince the
insurance people. That's another issue. So so it's it's a
tricky thing to take off your foot and as you
mentioned when when you ask the question, when it's a
parent trying to make that decision for a child, that's
(22:56):
really hard to do.
Speaker 1 (22:58):
Yeah, And I think that, like you said, the the
technology being varied for different limbs is part of the
equation too.
Speaker 3 (23:06):
Yes, absolutely, the feet and the legs are far better
bet than those. You know, it's sort of in its
infancy because a hand is that you get fingers and
you're doing very fine tuned work. When you're trying to
write or pick something up or whatever it is you're
doing with your hand and your fingers, that's a big
(23:28):
chore to get a prosthetic to do. Whereas walking is,
you know, it's not simple. A gait is not just
putting the foot on the floor. There's a lot going
on there. But compared to a hand, it's a much
more successful thing to replace.
Speaker 2 (23:43):
Let's take a quick break here.
Speaker 4 (23:45):
We'll be back before you know it.
Speaker 1 (24:02):
Welcome back everyone. I'm here chatting with the wonderful Mary
Roach about her book Replaceable You. Let's get into some
more questions. Speaking of difficult things to replace, breathing ventilators,
it's something that we have various forms of technology, including EVA,
which I want to ask you about because that was
(24:24):
something new that I learned. But I also wanted to
talk about your experience in the iron lung. Thanks to vaccines,
we don't see the iron lung wards these days, but
it was a whole community, like a whole culture, and
so it must have been really incredible to kind of
see this device and then experience it yourself.
Speaker 2 (24:48):
Oh it was.
Speaker 3 (24:49):
It was the one that I spent time in as
a functional Emerson iron lung from that era, from the
polio era before there was the vaccine, when like you mentioned,
they were huge wards rose even sometimes stacked iron lungs,
and there were a few of them still around and
I found somebody I was interviewing mentioned that, and I said,
(25:11):
do you know anybody who is still using one? And
there were a couple of people, and she put me
in touch with this man whose wife had recently died,
and I wrote to him and said, you know, I'm
really curious about this. Could I come and spend the
night in your wife's iron lung? Which is like a
cold email, like hello, you don't know me. As it
(25:34):
turned out, he did know me from having read one
of my books. So that was helpful because I think
otherwise you feel like you're really weird. Go away, yes man, Yes,
yeah creepy. So yeah, it does sound kind of creepy,
like I want to spend the night in you iron love.
So anyways, his name was Mark, and Mark said yes.
So I went out and I didn't know what to expect.
(25:57):
I imagined it being a little simpler than it was,
Like I wanted to eat a meal in there, and
that was frowned upon because that can be very dangerous
because if you have a machine, and I should back
up and just say, an iron lung is different from
a ventilator in a hospital that is a positive pressure ventilator,
you know, the thing that we're all used to seeing
(26:17):
where you're it's kind of inflating your lungs like a
party balloon, which is very different negative pressure ventilation. That's
how we breathe. So you have muscles to pull apart
your rib cage and pull down your diaphragm, and that
lowers the pressure inside the lungs. It pulls air in
and then when the muscles let go, it squeezes it out.
So it's a very gentle and natural thing that is
(26:40):
mimicked by these machines. They create a vacuum in this
sealed tube that you are inside, and that opens up
the chest, pulls in air and then it goes back out.
That means you're inside there, but your head is outside,
so it isn't quite as claustrophobic as you would think.
It is a very strange experience to have a machine
(27:03):
decide when you will inhale and when you will exhale.
And so if you're trying to eat, say you had
shoot some food and you were about to swallow it,
and the machine decided that's when you're going to inhale,
that could be a serious choking hazard, or you could
get you could get food inside your lungs, which could
cause pneumonia, you get bacteria in there. So they're like, no,
(27:24):
you won't be you won't be eating dinner in the
iron lung. Now that would take some coordination and practice,
so we're not going to do that anyway. So I'd
had this idea that I would spend the night in
the iron lung, and Mark had brought in a couple assistants.
It's kind of a you know, it's kind of an undertaking.
Kind of looks like a hot water heater lying on
(27:46):
its side, okay, but with a sort of like an MRI.
You know, where this bed rolls out. So you get
on the bed and then they roll you in, but
then you've got to get your head out this opening yeah,
so you get your head out the opening and then
the next needs to be really tight to keep because
it has to be a sealed right to create the vacuum.
(28:06):
It's a little hard to explain without seeing it, but
it's got to be. It's got to be a seal.
So that's like not a comfortable way to sleep, you know,
and to have that tight and I'm like, I think
this is too tight, and they're going, no, it's not
quite tight enough. Great, you know, and mark It said, oh,
it's really relaxing. You'll be asleep in no time. So
I lasted about nine minutes in the iron lung. So
(28:31):
because the collar is so tight, you have this weird
simultaneous sense of like breathing deeply and as though you
were really relaxed, but at the same time it feels
like somebody's choking you. So it's it's a strange place
to be. You've got to stay on your back. It's
a big ordeal to change position. I don't sleep on
(28:52):
my back, so it's it was not a for me,
not very conducive to sleeping, but for someone you know,
and I've read memoirs of people who'd spent a lot
of time in an iron lung, and I expected a
description of panic, claustrophobia, anguish, but the description of being
put into an iron lung across the board. People would
describe this tremendous relief and relaxation to be able suddenly
(29:18):
to breathe calmly and deeply when they'd been struggling to
get enough oxygen to live, a very different experience than
a ventilator that's pushing air down into the lungs.
Speaker 1 (29:32):
We've covered a little bit of hospital ventilators are the
ones that we think of today as ventilators. We've covered
a little bit of iron lung.
Speaker 2 (29:38):
Tell me about EVA.
Speaker 3 (29:41):
Yes, EVA stands for enteral ventilation via anus. You're basically
using the rectum as a third long kind of which
is amazing. Okay, so you're there's this stuff per fluo carbon,
if I'm saying it right, it holds oxygen. Well, so
you put perfluor rocarbon into the rectum and the body
(30:04):
absorbs oxygen that way. I mean you can feed people
via the rectum. People can absorb things through the mucose
of the rectum, including oxygen. You can also do this
by blowing it through. I spoke to a doctor Bartlett
at the Extra Corporeal Life Support Laboratory said, yeah, we
(30:25):
tried that. You can sort of blow it through via
the stomach and that way this carbon dioxide comes out
the anus and I'm like, so sort of constantly farting.
He goes, yeah, not very.
Speaker 1 (30:33):
Attractive, just like one continuously.
Speaker 3 (30:36):
One continuous part. But you know, EVA is amazing. You know,
the applications are quite specific. If you've got a premature infant,
one of the things that is precarious with them is
they're breathing. The lungs aren't developed enough to support breathing.
So but if you put them on a positive pressure ventilator,
(30:56):
it's it's a very delicate tissue, the lining of the lungs,
and you can damage the lungs. So if you could
supplement with getting oxygen in through the butt, you know,
that could be great. Or if it's a situation, a
combat situation where you don't have a ventilator available, you
don't have the equipment necessary just to get some oxygen
(31:17):
in there, so sort of a supplement the anus is
happy to provide.
Speaker 1 (31:24):
There's really no other way to put it, is there.
I want to keep us moving through these different replacement
body parts, because there is so much technology and history
with each and every one of them. And one of
the ones that has a surprisingly long story is ostomes,
which are these surgically created openings on someone's abdomen that
(31:47):
allow waste to come out. And along with this long
history of ostomes also of course comes with this long
history of stigma and also these myths that just abound
when it comes to ostomese, you know, with like Napoleon
and so on and so forth. Can you give me
just like a little tour through the history of ostomese?
Speaker 3 (32:07):
Sure? Well, this is going to go back to the
seventeen hundreds. As long as people have been stabbing each other,
there's been kind of natural instances where an opening from
the intestines will appear in the skin. It'll like the
body will heal in a way that the lips of
the intestine. I like that. This was one of the surgeons.
The lips of the intestine will kind of fuse to
(32:30):
the cut the opening, and they'll have this natural kind
of artificial anus, if you will. And so in seventeen
fifty seven there was this surgeon that's basically why not
take a hint from nature. What if we were to
do this in cases where somebody has a blockage, whether
it's a tumor or whatever is going on, and that
(32:51):
it's this blockage. They've tried all manner of the usual
suspects and breaking up the blockage and it's not working,
and they haven't released anything in days or weeks, and
they're about to die because it's going to break, it's
gonna pop soon. So they would create an opening to
let stuff come out. The opening is called a stoma,
(33:14):
and today that is still done, not so much for blockages,
although for that as well, but with very serious cases
of inflammatory bowel disease crones or colitis things get really bad.
You can put an opening and a pouch.
Speaker 1 (33:33):
And there are so many variations on ostome bags on
ways to collect the waste. How does one go about
choosing a bag?
Speaker 3 (33:41):
Well, I can tell you that because I went to
the a five K fundraiser of the United Ostome Associations
of America and one of the things they do, if
you're not an ostimate, which I am not, they recommend
that you choose one and to wear as an empathy pouch.
It just you know, join the crew. And I didn't
(34:04):
realize I didn't read the email very well. When the
guy mentioned to me that I would choose an empathy pouch.
It's supposed to be full, you know, of liquid, but
I just put an empty one on there. I'm like,
this isn't bad. But anyway, depending on where your stoma is,
that determines what kind of pouch you might wear. There's
(34:25):
some that are have to be changed more often because
the material is more liquid higher up a small intestine,
further down it's more solid. There's various options, big or smaller,
two part, one part, just depending on what you need.
Then there's you can sort of fart with them. There's
venting if I just like poke a little whole little
(34:45):
venting device because you don't want to have a blowout
as they call it. So there are like a thousand
different pouches and systems for oustumates. And it was, you know,
there was a really fun event. Everybody was. You know,
this woman when I was using my empathy pouch, I
just sort of grabbed this one. She goes, oh, that's
a really large pouch. That's just very unsexy. Let me
(35:06):
show you my pouch. See this, This is like, you know,
and I changed it three or four times a day,
and you know, everybody's had this kind of what are
you wearing red carpet buzz? You know, it was fabulous.
It was just very fun. And the more we can
talk about these things, the less there's a stigma. There's
been a lot of good progress made, I think via
TikTok and people with ostomies just saying hey, this is
(35:28):
how it works. Here's my pouch, here's how I changed,
here's you know, just sort of saying here you go this.
Speaker 1 (35:34):
So far, we've mostly touched on things that are medically
necessary replacement body parts. We're talking about skin grafts, organ transplants, prothesis,
et cetera. But then there's cosmetic surgery. We've come a
long way. It's obviously a huge industry these days, talking
about things like early hair transplants, early breast implants.
Speaker 2 (35:57):
You know, what did.
Speaker 1 (35:58):
These things look like, how did people begin and how
much was maybe the person who was receiving the transplant
not necessarily like thought of their experience in terms of,
for instance, what a breast implant was made of.
Speaker 3 (36:12):
Oh yeah, I wish I had the book right in
front of me to just read you the list of
all the stuff that was injected into women's Should we
read that list? It's kind of an astounding.
Speaker 2 (36:23):
Let's read it.
Speaker 3 (36:24):
That's right, right, right, yeah, hold on, let me get
the book. Okay. The filler would need to be thick
enough to pass as breast tissue, yet thin enough to
pass through the opening of a syringe. This is before aspirators,
before the arrival. Yeah. In the early nineteen eighties of
the liposuction aspirator, the substances injected were not typically fat.
They were it truly seemed whatever fat like substance. Some
(36:46):
enterprising plastic surgeons gaze happened to land on. Some took
their inspiration in the kitchen olive oil, vegetable oil, some
in the barnyard goat's milk, cow collagen, pig collagen, or
the forest beeswax, tree resin derivatives. Others in the supply
rooms of industry paraffin, petroleum, jelly, various glues and polymers.
(37:09):
They were sticking anything in there.
Speaker 1 (37:12):
Love that goat smoke makes a second mention there, it's good. Yeah.
Someone's gonna keep trying until they find use medically for
goat smell. Yeah, yeah, yeah, I think The other thing too,
is was hair transplants, which I know you tried to
see if your hair could grow and then be transplanted.
Speaker 2 (37:31):
How did that end up all shaking out?
Speaker 3 (37:33):
Yeah? Yeah. I wanted to demonstrate for myself a concept
called donor dominance, and this is what makes hair transplants possible.
So you take hair from a man who's losing hair
on the top. That's where you lose hair on the top,
male pattern baldness. You don't lose it. They don't lose
it on the sides in the back. So you can
take a certain percentage of these follicles and move them
(37:56):
up top, and they'll retain the characteristics of their homeland,
so they won't be hair that responds to testosterone falls out.
So you take a couple thousand hairs from back here
and from the sides, and you put it up top,
and because of donor dominance, it won't fall out, won't
be hair that falls out. And so I was at
a hair transplant clinic because of another chapter that had
(38:20):
to do with growing follicles from stem cells. So while
I was there, I said, will you can you transplant
a couple of hairs from the back of my head
to my leg because I wanted by the time I
went on book tour, I wanted to have a couple
of long, luxuriant hair screwing on my legs so i'd
have this demons that I could show people. Look, this
(38:41):
is donor dominance. These hairs came from the back of
my head. Unfortunately they didn't take The legs get a
lot less blood than the head. The scalp gets a
very robust blood supply. On the calf not so much.
So I'm sad to say I don't have long, luxuriant
(39:02):
leg hair growing from the spot where they transplanted a
couple follicles.
Speaker 2 (39:09):
Devastating.
Speaker 3 (39:09):
Yeah, I know, I know, I really, you know, but
it's kind of amazing how well it does work, to
the extent that there's something called pubic alopecia, which can
be traumatic for some women, whether they lose their they
don't have pubic care, they've lost their pubic care. And
you can take head hair, but the thing is you
(39:30):
then every two months have to trim it, Oh.
Speaker 2 (39:32):
My gosh, because it just will keep growing because of length.
Speaker 3 (39:35):
It's head hair.
Speaker 2 (39:37):
Yeah, amazing.
Speaker 3 (39:39):
The opposite shore, you could take pubic care, and this
has been done transplant it. If you're going bald, you
could use chest hair, armpit hair, pubic hare, but it's
rarely done. The surgeon who did the largest study on
it pointed out pubic care. That is that it is
difficult to style difficult styles.
Speaker 2 (40:03):
That's amazing.
Speaker 1 (40:04):
I feel like with a hair transplant, you know and
donor dominance with whatever various things people are injecting into
breast tissue. But also beyond that. Throughout the rest of
the book, where you talk about you know, z know, transplantation,
you talk about skin graphs, the thing that really stands
in the way is not a will. It's not a
(40:27):
lack of skill, it's not knowledge, but it's our immune
system that seems to be like this kind of unexpected
antagonist that prevents us from achieving all that we want
to and replacing whatever body part we you know, have
our mindset on. What are people working on to solve
the issue of rejection while also not destroying our immune system?
Speaker 3 (40:50):
Yeah, that is that is the challenge. The immune system
is very very good at recognizing something foreign, and that's
been a real problem with some of these With hand transplants,
face transplants, these are composite tissue allow transplants. In other words,
they're not just one kind of you know, a liver
(41:12):
is fairly uniform, but this is, you know, a hand,
there's there's muscle, there's tender there's skin, there's there's all
these various components. There's just a lot going on to
upset the immune system and to create a reaction, an
immune reaction and a rejection. So and that's been in issues.
There there are folks who've had a face transplant and
(41:32):
now it's breaking down. It's not working as well, it's
not supple it's whatever's going on in addition to rejection
episodes and all the issues of immunosuppression. They're going to
need a second face or hands, or there's folks who
are having hands removed just because the immunosuppression that's necessary
to keep the body from rejecting it. It's too problematic.
(41:55):
So you know what could be done. There was some
work being done with taking some of the donors marrow
which has components of the immune system, so you would
sort of donate that along with the part being donated.
I don't you know, but you know that was going on.
This was back when I reported grunt, which you know,
(42:16):
around twenty sixteen, I think they were just doing a
lot of these, you know, composite tissue transplants the hands,
the arms, the faces, and it's kind of they've backed
off of it just it's been very problematic. Even with
that marrow I don't remember the name exactly of the technique,
but where you take a little bit of marrow from
the donor. There's hope that in the future you could genetically,
(42:42):
I'm not sure how, but you would get the organ
itself to secrete an immunosuppressive protein, so it would have
you'd have localized immunosuppression, so you wouldn't have to tamp
down the whole body immune system. You could just get
the organ to do it itself. That you know is
in the future. In terms of stem cells, you know,
(43:05):
right now, there are treatments where you can take somebody's blood,
you can regress it to its very early state where
it's called plury potency, and then instruct it to become
a kind of cell, say a dopamine producing neuron, you know,
for somebody with Parkinson's. But that's a bespoke process, so
(43:27):
it's you've got to take it's time consuming and very expensive.
It has to be the person's own cells, otherwise the
body will destroy them. But if you could create what's
called stealth cells where they evade the immune system, then
you could just buy plury potent cells off the shelf
kind of and instruct them to become what you want.
(43:48):
So so that would be terrific, But that's not You're
talking about cells that may replicate and do what they
want that evade the immune system. So that's a scary thing.
The f is rightfully concerned about that. So you know,
those are two directions things are going, but not quite
there yet.
Speaker 1 (44:08):
Yeah, yeah, I mean, and hopefully there will be more
progress made in so many of these fronts. I mean,
it is amazing how fast pace some of this research is.
And even though the headlines might be overhyping and overstating
where things are, but I do feel like it is.
It's a really promising area of research. And that's one
(44:29):
thing that I really appreciated about your book, and how
all of these areas we've made progress in and progress
in one area also means progress in all of these
other areas as well.
Speaker 3 (44:39):
Yes, And that's why cuts to the NIH and the
NSF cuts to laboratory funding is so damaging looking like
down the line in terms of just the pipeline of
innovators and engineers and work that needs to go on
to keep things moving forward. You know, it's bad enough
just to of what it's doing to patients and to
(45:02):
projects that are underway, but going forward, you know, all
the progress that we've made, all of that depends on
government funding. So that's been you know, I have an
epilogue in the book because the book was I was
going to the you know, into production just as the
DOGE cuts were happening, and we so we added an
epilogue about that. And it's really sad. Yeah.
Speaker 1 (45:28):
Yeah, the costs when calculated, the costs will be I mean,
and when we can actually calculate is a big question,
but it'll be incomprehensible.
Speaker 3 (45:35):
I feel like, yeah.
Speaker 5 (45:36):
But well yeah, well, sorry to end on a bot
a sad note, but it you know, aside from the
necessary reflection on the state of funding today and science
science funding today, it has been such a joy chatting
with you as always.
Speaker 1 (45:54):
Thank you so much for taking the time to chat
about your book.
Speaker 3 (45:58):
Oh my pleasure. Always in joy being on the podcast
Thanks so much, Jaron.
Speaker 1 (46:21):
A big thank you again to Mary Roach for taking
the time to chat with me. It is just so
surreal to get to talk with one of my sycom heroes.
If you enjoyed today's episode and would like to learn more,
check out our website this podcast will kill You dot com.
We're all post a link to where you can find
Replaceable You Adventures in Human Anatomy, as well as a
(46:41):
link to Mary's website where you can find her other
incredible work. And don't forget you can check out our
website for all sorts of other cool things, including but
not limited to, transcripts, quarantine and placeiver rita recipes, show
notes and references for all of our episodes, links to
merch our, bookshop dot org, affiliate account, our Goodreads list,
a first hand account, form, and music by Bloodmobile.
Speaker 2 (47:04):
Speaking of which, thank you to.
Speaker 1 (47:06):
Bloodmobile for providing the music for this episode and all
of our episodes. Thank you to Leana Squialacci and Tom
Briifogel for our audio mixing, and thanks to you listeners
for listening. I hope you liked this episode and our
loving being part of the TPWKY book Club. A special
thank you as always to our fantastic patrons. We appreciate
(47:28):
your support so very much. Well, until next time, keep
washing those hands.
Hosts And Creators
Erin Welsh
Erin Allmann Updyke
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