Mary Roach Explores the Future of Replacement Parts (Full Transcript)

[00:00:01] Speaker 1: You're a beautiful writer. It's substantive and yet so accessible and humorous. And I just, you know, the idea, I think sometimes there's the dichotomy between science and humor and you're like, screw that, man. I'm jumping right over that line and combining those two things. And I love it.

[00:00:17] Speaker 2: Yeah, absolutely. Absolutely. The thing that, yeah, I think that sadly the word science makes people run the other way when it comes to books. They think, oh, this is going to be a slog. You know, I did an event with Gina Collada, who's this wonderful reporter for the New York Times. She may be retiring or retired, but we did an event together and Gina said, I loved your book. I thought, you know, cause she was my conversation partner. She said, I thought it was going to be a real slog. But you're a science writer.

[00:00:53] Speaker 1: That's I think how a lot of people think about science books though, you know, it's like eating a broccoli, you know. Can you give us a little bit of background just on replacement parts, if you will? Like how long ago did this start? How did it begin for humans?

[00:01:09] Speaker 2: Interestingly, the earliest, with the exception of there's some prosthetic foot, you know, if you look up the history of prosthetics, there's some foot somebody found like a wooden foot. Okay. That may predate the noses, but in terms of a substantial number of replacements going on, noses were where it began because nasal mutilation was a form of punishment that sadly was used fairly commonly because it was not just a punishment, but also deterrent because your nose is in the middle of your face and everybody sees it. So the whole community would see and that would, you know, nobody wants their nose cut off. So that would be, yeah, it would serve as a deterrent. So it's amazing that so far back, you know, like 1500 BC, like that there were surgical procedures, you know, the taking the flap, you know, from the cheek or the forehead and keeping it attached in one part and then like, you know, swinging it down and letting the blood, you know, the capillaries grow in on the nose and then disconnect it up here or here. The fact that that was going on so long ago was kind of amazing. And then syphilis came along and there was another need for noses. So, because the, I guess, late stage syphilis, the cartilage of the nose can be affected. Anyway, that blew me away that that far back physicians were crafting new body parts, noses. And then they moved into, of course, the, you know, the metal or the celluloid plastic. I love the guy who had the nose suspended from glasses.

[00:02:49] Speaker 1: Yeah, right.

[00:02:50] Speaker 2: And with actually a mustache at the bottom, obviously would only work for men, but I was like, it was a medical Groucho Marx glasses. It was ingenious though. And I've seen the, you know, the photographs before and after, and it was, you know, it looked pretty, looked better anyway.

[00:03:09] Speaker 1: I mean, it is interesting that it goes that far back and also the surgical techniques, aside from actually using prosthetics, but when you used adjacent skin, it required some understanding of blood flow, because if you moved a flap down, so when you're starting to write about that, and again, in your book, it's so detailed, that's not your area of expertise. So, I've always been curious about you in particular, Mary, like how do you go about then? How do you sort of educate yourself when writing a section like that about skin flaps to replace noses, for example?

[00:03:42] Speaker 2: Sure. Sure. I typically, well, I try to do some background reading on my own before I show up. Most of my chapters, I'm going somewhere and spending time with a physician or a researcher in the lab, in the operating room, wherever it is. And I have no qualms about using those folks as kind of unpaid tutors. You know, I'm asking a lot of very basic questions and I'm very upfront with, look, this is, I know, going to seem really basic for you, the questions that I'm asking. But I love when somebody's explaining something to me as they're working on, say, a patient, or they're doing something, you know, in a stem cell lab, where what they're doing relates to what's being explained. And then I have a built-in narrative for people. So, it's, you know, I have things happening and a dialogue, and that's a bit of a narrative scaffold on which to hang this information, which can be a little dense, you know, for the reader. So, I'm very focused on where am I going to go and who am I going to talk to and what will they be doing as we're talking? And I rely on them to explain things for me. And it's incredibly generous of them. I'm not paying them for their time. These are incredibly busy people like you, and they're so generous. Scientists and surgeons and physicians are incredibly generous. And I think that they genuinely appreciate somebody taking an interest in what they do and wanting to share it with a population of people who've never really been in that setting or thought about that. Like, how does that work? And what actually, when people talk about induced pluripotent stem cells or bioprinting or amputation, what exactly is going on behind the scenes? What's that like? Where are we in the science? And what's it look like? You know, I want to kind of bring it to life. So, I'm not doing a heavy amount of reading of, you know, I will typically have five or six things I've printed off PubMed before I go somewhere. I'm not showing up as an utter and complete ignoramus, but close. I would say close.

[00:05:57] Speaker 1: Tell me about your friend, Judy.

[00:05:59] Speaker 2: Judy Berna. Yeah, Judy Berna. She's got this whole thing rolling in a way. She's a reader who wrote to me. So, this is one of those emails. Yes, it is. But it wasn't. Yes, it is. It's one of those easy mail. However, her idea was that I write about NFL referees, national football, professional football referees. I don't know. And she's read my books. I don't really know how she envisioned Mary Roach doing that, but she's a huge Seattle Seahawks fan. And she's fascinated by it. She's like, please write about it. It's really interesting. And so, I let her go on about that for a while. And this was an email exchange. And then she happened to, I guess she must have mentioned that she's an amputee. And I said, well, when I'm in that mode, I'm like, what's interesting in amputation? What's going on? And she said, actually, well, I'm an elective amputee. And I hadn't really heard that term. That is someone who their foot had a good blood supply. It was a healthy foot, but it was twisted. The nerves didn't work properly. She was born a spina bifida. So, her foot, she couldn't walk on it well. She couldn't run well. She just would see people with prosthetic lower limbs doing things she couldn't do, hiking and running. And she just thought, well, your hip wears out, you get it replaced. Why can't I replace my foot? And I thought that was interesting. That notion of wholeness is something to hold on to even when the wholeness itself becomes a disability.

[00:07:43] Speaker 1: Yeah, right. The surgeons are reluctant, I think understandably, to remove a healthy limb. But for her, it wasn't functioning. And I printed this out from her website. She said she spent almost 30 years hating, I spent almost 30 years hating my left foot, which grew crooked as a side effect of a case of spina bifida. I saw amputees doing things I could never even imagine like running and jumping. It made me jealous and honestly a bit mad. I thought that was really interesting.

[00:08:14] Speaker 2: I did too. I did too. That's where it started. And I said, what else is going on in this community? And she mentioned osseointegration, which is, she said, this is what everyone's... And that is rather than having a socket that your residual limb goes into, you would actually implant the prosthetic right into the bone, similar to a dental implant. You're screwing it into the bone and you have much better control. You have sensation of where you're walking through the bone, through the skeleton. So people are talking a lot about that in the amputee community, but there've just been a problem with infections getting into the bone. And so it's not quite there yet. But so those were the things she was telling me about. And then she said, well, why don't you come along? The Amputee Coalition has an annual conference and why don't you just come along and talk to people? And I did. And that was fascinating.

[00:09:13] Speaker 1: That was really the genesis of this book? That's where it started. I think in Judy's case, anyone who reads about her, I feel like you could sort of in your own head, get your mind wrapped around the idea that her left foot was not functioning well for her. And she saw what a functioning foot could do for her in terms of hiking, running, jumping, things like that. That makes sense. You get to this point in the book, I think it's around page 100. I made some notes. You say the better prosthetics become, the easier it will be to make a case for elective amputation. And I wanted to talk about that a little bit, because I think that's maybe what some of the surgeons who are reluctant to perform an amputation and what they would call a healthy limb, that's what they're sort of getting at. Is that, does this become a slippery slope? Do we start as prosthetics become better? I mean, look, the prosthetics could always potentially be better than your existing limb, hand, foot, whatever it might be. How do you think about that? Yeah.

[00:10:14] Speaker 2: You know, where I think about that is, well, that chapter for sure. But talking to surgeons about cat, about interocular lens replacement, you know, the procedure for cataracts has gotten so safe and so quick and reliable that there are folks who are simply very nearsighted, like me, you know, I'm like 2,800, who would like to just get, rather than getting, you know, that, what's it called? LASIK. LASIK, yeah. Rather than getting that, they want a lens, a new lens just put in. So, not so, their lenses are fine. They don't have cataracts. There's nothing wrong with the lens itself, but, you know, the shape of the cornea is such that, you know, they're very, they're very nearsighted and that you could pop in a new lens and people are asking for that. People are in their twenties and thirties. And I thought, let's not, let's not get surgery for, quite yet for that. And yeah, what is the end point of that?

[00:11:24] Speaker 1: Not to belabor this point, but why not though? Because, you know, some, so my parents went through this recently, cataract surgery. And I remember the doctor said something, and my parents are in their eighties now, but they had this done about 10 years ago. And the doctor said, oh, these lenses, they last like a hundred years. And I'm like, hey, buddy, I understand your patient population. Like, I mean, they're 70 years old. I mean, I love my parents. I want them around forever, but we were building a hundred year lenses for people who are getting these procedures in their seventies.

[00:11:53] Speaker 2: Well, it's so interesting when you talk about joint replacement. It used to be you would wait, they wouldn't do it until you were in your sixties or seventies because the joint, they have the joints not going to last that long. You don't want to do it twice. Right. So, but now you see people getting it done in their forties or fifties because, you know, because it's, because it's so much better and that, and that's great. That's great. Um, but the, yeah, the prosthetic, yeah. The other thing with, with, you know, the, with Judy's case and with people in her situation, there are people have done studies where they look at, okay, if you, if you do limb salvage surgery, in other words, you say, no, we're just going to keep going in and trying to fix this foot, trying to rearrange things, trying to do it surgically. And you compare the outcome and the functionality with lower limb prosthesis, you know, amputation and giving an artificial limb, the best results are with a prosthetic. I mean, time and again, and there are, there are tools, you know, there's one called the mangled extremity severity scale.

[00:13:03] Speaker 1: I've not heard that one.

[00:13:04] Speaker 2: That's an acronym, a very, are they aware of that acronym?

[00:13:09] Speaker 1: Wait, what is it again? Mangled?

[00:13:11] Speaker 2: Mangled extremity severity score. So if you have a mangled, You have a mess, right? You got a mess. So you, so you, you know, there's tools where you can.

[00:13:21] Speaker 1: Somebody's chuckling to themselves right now. I'm sure. Yeah.

[00:13:25] Speaker 2: Yeah. Um, so there, yeah, there are, there are tools to help physician surgeons make that decision. And, um, uh, it, it's, but I, I, like you said, I can understand a surgeon's hesitation. I mean, what if the patient ends up with some kind of phantom limb pain? Um, and also insurance, you have to make the case for insurance. Uh, so that might not be easy to do. And it's just, you know, nobody's going to fault you. There was one prosthetist who was saying, nobody's going to fault you for trying to go back in and make corrections one at a time and try to fix it that way. But if you cut it off, it's a pretty final thing to do. And if things go poorly from a liability standpoint, perhaps that's worrisome.

[00:14:11] Speaker 1: Do you think, I mean, so if you, you know, I think as a surgeon myself, I think one of the things it's always in the back of our mind, if you're doing anything that would be remotely considered elective, not really my area, but, but you know, plastic surgeons, for example, anything that's remotely elective, you think, God forbid, something goes wrong. This person was living a perfectly fine life. And now something has gone terribly wrong. It's always in the back of the mind, even though the chances of that happening are very remote, you know, anesthesia is probably the biggest risk of a lot of these procedures. Certainly people can develop things like phantom limb pain and things like that. Where do you think we go with this as these prosthetics become better hips and knees and the guy who says, Hey, I'm 40 years old. I can get a, I can get new hips. Uh, they'll last me 70 years. It's certainly my lifespan. Um, do you think that that's going to become something that's more common and done more at a younger age?

[00:15:08] Speaker 2: Yes. I think that it already is. Uh, I think, and I think, I mean, I spoke to this guy, Paul Stoodley, uh, an expert in biofilms and bacteria growing on things in the body. And he painted a pretty scary picture of, of that process whereby, you know, say you have an artificial hip, you know, an implant and bacteria set up housekeeping and they set up, you know, biofilm. So they're kind of impenetrable. They have this kind of fortress that they're in, and then they can send out little, little scouts to go elsewhere. And there's persister cells. And it was this incredibly alarming scenario that he shared with me. And, and, and I said something to him about, um, would you ever knowing all that, you know, about infection and, and even though it's a low rate, but that the scenarios that you've presented to me, would you ever get an artificial hip? And he said, Oh, I have an artificial hip. The guy was barely 50. He's like, I got an artificial hip. Not only that it's metal on metal, which, you know, there'd been a lot of problems. He says, those are much better now. And you know, I run marathons, I run marathons and I wanted to keep running marathons. And so I'm like, wow, that's a great advertisement for artificial hips right there.

[00:16:22] Speaker 1: The thing is that these, uh, these prosthetics are in many ways, they're not just replacing what already exists. I mean, these prosthetics are getting smart. They're incorporating microprocessors as you write about, they, they, they have these sensors to adapt. I remember Amy Mullins who, who was born without her, her, um, lower extremities below the knee. And, and she was a triathlete, is a triathlete. And, and, you know, I remember talking to her years ago, her prosthetics, it was a point of controversy because her prosthetics were probably actually helping her perform better on the racetrack. Where is that?

[00:17:00] Speaker 2: That's a thing. Well, you know, it was interesting. I spoke to Ezra Freck, who just won gold in the Paralympics in the high jump and in one of the sprints. And, um, I mentioned Oscar Pistorius and, and the notion of techno doping, which is what you're just, you're talking about the idea that, um, a bionic, you know, an artificial limb could be, could bestow an advantage in, in athletics. And he said, first of all, cause I said, oh, you mean Oscar Pistorius, the guy who won the medal, he goes, first of all, he didn't win.

[00:17:36] Speaker 1: He didn't win because he was techno doping, you're saying?

[00:17:38] Speaker 2: The saying is, well, that if it, if it can, if it conferred an advantage, you know, having an artificial limb, we would have seen more than one person. We would have seen people winning. There's been no one. Uh, so Oscar Pistorius was an extraordinary athlete who, you know, who managed to still be able to compete. So, so, you know, he finds it, he doesn't like when people accuse him of techno doping because it's extraordinary. He's the, he actually made it, he's on a division one track team along with able-bodied athletes, which is the first time ever. So if it, if it conferred an advantage, you'd think we'd be seeing more people. It's just, it's so rare.

[00:18:22] Speaker 1: Is it that we haven't seen it yet because the technology is still developing? I mean, is that the future?

[00:18:28] Speaker 2: Conceivably, yeah. If you, I suppose if you, as particularly with, if, you know, if osseointegration reached a point where the issue with the infections was resolved, I mean, uh, I mean, I, I met someone at that conference who says I walk 10 miles a day. I'm like, under any circumstances, that's great. You know, but, uh, so to have it integrated into the skeleton that way, uh, would be extraordinary, you know, cause you're dealing with a socket based system, you know, that's, it's extraordinary that, I mean, that must be painful just, I mean, cause you're, you know, just those folks, they get like blistering and rubbing and ingrown hairs and perspiration. I mean, it's a, it's not a comfortable thing to have this limb kind of just, it's, you know, held on by compressing the residual limb and it's not a, not a comfortable thing. I can't imagine, uh, sprinting and doing, you know, any kind of athletics with that system, you know, at an Olympic level. But when osseointegration becomes the norm, I could imagine, yeah, that, that, that, that would confer an advantage. There was one, one woman said, um, uh, uh, was talking about, I don't know if it was her son or who it was. She said when he's got his basketball legs on, like he had, he had legs that made him tall enough to play basketball. Okay. That guy, he's doing better at basketball because he's got basketball legs and, you know, plus, you know, plus he gets more dates cause he's taller. So, so yeah, I mean, it definitely there.

[00:20:02] Speaker 1: And, and people like Hugh Herr who, who out of MIT who, you know, he's a climber, a mountain climber. His prosthetics allow him to do things.

[00:20:10] Speaker 2: There's a, they call them terminal devices, which is a terrible term, terminal devices. But there, uh, you, you can have a closet full of attachments for whatever sport, you know, whether it's kayaking or ping pong or, you know, uh, for a hand or a foot, uh, there are, uh, there's somebody making a device. There's an origami attachment that you can use. There's, there is a prosthetist who, who made a mop foot for his wife, which I'm sure you'd prefer not to be, uh, not to have that get around, but still married or before I, before I ask you about gene editing, cause I thought that was really interesting.

[00:20:49] Speaker 1: Um, when I read this chapter, I still wasn't entirely sure where you came down on these smart prosthetics and page, I think around a hundred again, you say about smart prosthetics that incorporate microprocessors and sensors to adapt a prosthetic to an individual wearer's gait, but there are trade-offs. Trade-offs being, I think you may have just talked about, but what are the trade-offs you were referring to?

[00:21:13] Speaker 2: Sure. Well, uh, um, one of those limbs with a microprocessor, you have got a battery, like having an electric car, you got to be thinking about where am I going to plug in and charge? Um, we're going to charge it. Um, is it waterproof? It, they're heavier. They're heavier than, um, a traditional limb insurance isn't going to cover it likely, but it's, you know, I have very different feelings, uh, lower limb prosthetics versus some of those arm and hand prosthetics. And that's just because the hand is so much more complicated and the benefits are so much smaller compared to the, um, upper leg. You know, those are, those are amazing. And I think any, anybody getting a prosthetic lower leg is going to probably want one of those with a microprocessor. Judy didn't because Judy is like, I banged my leg around getting in and out of the car. I felt like I was going to damage it. I felt like it was going to break. Uh, and I, cause she tried one of Hugh Harris. Um, she was a beta tester, one of his, uh, lower leg prosthetics. She just didn't feel comfortable with it. It was also out of her price range. Uh, but, but, but, you know, a hand has the individually, five individually moving fingers. So to be able to move it fluidly, however you want, rather than go through a bunch of set grips, you know, there are grips that you choose, you know, on the arms that are available now, including one for holding a credit card, which I thought was appropriate. Um, like there's, those are, you know, they're heavy. They, they, they're not, you don't move as fluidly yet. You know, Judy had this comment. We walked by a display that showed one of those sort of bionic looking hands holding a raspberry. And she said, are you going to, she laughed and said, are you going to spend 15 seconds manipulating that grip? No, you're going to reach over with the other hand and pick it up and eat it.

[00:23:10] Speaker 1: That's funny. That's right. Right. And, and, and should we all live long enough as you write in the book, we will likely have some sort of disability. Um, and the question I think almost becomes at what point do you define disability? If you're not a hundred percent, is that a disability, you know, and, and that might dictate when people choose to get these replacement parts.

[00:23:32] Speaker 2: Oh yeah, no. I mean, I have, I'm just talking to Ezra Freck about the word disability and to call him disabled. Look at what he can do versus what I can do. I'm not an athlete. I'm, I'm barely in shape, you know, and, and I, plus, you know, I, I get up in the morning and I, cause I'm extremely nearsighted. So if I didn't have contact lenses, that prosthetic that I put in every morning, I would be utterly disabled. I couldn't do anything that I do.

[00:24:03] Speaker 1: Would you get those, those implantable lenses now that they do for cataracts? Would you just do that to, to avoid having to put in contact? No, no.

[00:24:10] Speaker 2: Cause I don't know because what's not there yet is accommodation. You know, the ability of the eye to, to change focus from near to far. I mean, they're, they're getting there, but that, that, that fluid shift of from far away to very close, that amazing thing that the eye does automatically, that's, that's not there yet. The lenses are great. Yeah, but no, no, no, I wouldn't, I wouldn't do it because I've, I'm used to wearing contacts.

[00:24:39] Speaker 1: No, I, I, I, I, I just think it's so fascinating. This is a, maybe I'm perseverating on this point, but when I watched my parents go through this, first of all, they wore glasses or contacts most of their adult life. Then all of a sudden they're not. And I, it like everything about them changed. I mean, first of all, their vision changed, but I think how they looked even changed. It looked younger, you know, they seemed younger to me. And now they did this in their seventies, which is, you know, I think it seems like the right age based on their, their eyesight and everything at that point. And obviously their cataracts, but I'm in my fifties now. And I think, and I wear contacts and I do think to myself, they're making these lenses, they're going to get better. They're going to be able to accommodate. So I could actually look at a bird watching like you like to do, and then also read a book with good accommodation without ever having to put on reading glasses or anything. It is an operation. It does have the attendant risks of surgery. And yet, man, and I wouldn't qualify for it from my insurance because I don't have cataracts, but wow, isn't that something? It is something. Why did you not get LASIK? You know, so it's, it's my risk tolerance for those types of things is probably lower than other people's. I, what I worried about the most was that I'm a surgeon and a lot of times my operations I'm performing under a microscope and with the microscope, it's not so much the vision as it is the potential halos and sort of light streaks that come across that. And if I, if I started to get halos while I'm operating, that, that worried me. And I realized that the risk of that was low, but people had talked to me about having LASIK and then driving and then having the, the other side's headlights by almost blinding them. And, and I just didn't want that.

[00:26:35] Speaker 2: Yeah. Yeah. Same here. And because I'm extremely nearsighted, I have a higher risk of something not going well. I mean, it's riskier for me because I'm a extreme myopia patient. So, so yeah, I never wanted to get LASIK. I reported on it back in the late eighties when I was over in Moscow for Dr. Fyodorov, who came up with RK, the original, you know, cut little slits.

[00:27:02] Speaker 1: Radial keratotomy.

[00:27:03] Speaker 2: Yeah. He had a conveyor belt operating room. It was fascinating, but LASIK was just getting going. But at that point, even though I would definitely have benefited, I, the risks seemed, you know, not, not worth it. Yeah.

[00:27:17] Speaker 1: I think that's always going to be part of the conversation is what, what are the risks and what is your tolerance for those risks, you know, and am I okay? And at the same time, you may look at other people who, who get a replacement of some sort and think, wow, look, look at that. No need for eyeglasses, faster runner, stronger arms, whatever, you know, the whole Steve Austin, bionic man sort of, you know, sensibility.

[00:27:40] Speaker 2: We will be there. We're not there yet.

[00:27:42] Speaker 1: Not there yet. But when we get there, you anticipate that more people would probably just get replacement parts or at least get them earlier in life.

[00:27:51] Speaker 2: Yes. I think people, people are very accepting and enthusiastic about surgery in ways that maybe because I see it and I read about it a lot, and I have more of an awareness of the very uncommon possibilities that, you know, the infection or the things or something with the anesthesia. And I, I am always impressed at how willing people are to embrace a surgical option. I have a friend who's got, I don't know what's wrong with his back, but he's had three different procedures. Like, yeah, I think I'm going to get, I'm going to try it again. I'm like, you are? You're going to get that again? You know, I mean, they're going to fuse something else. I think we're going to try that, you know, like, oh, yeah, yeah. Okay. People, I mean, and that's a testament to how good surgeons and surgery are that, you know, people, and it's like books, people.

[00:28:46] Speaker 1: Maybe not so good.

[00:28:47] Speaker 2: Yeah. Maybe you want to slow down a little bit, but it's like, it's like books, your neighbor and your friends, if they had it done and you see that they, they're moving much better, they're in less pain. You're like, I want to do that too. You know, so I think, I think you're going to see it more and more and more. And, and yes, I think that we will reach a point where people will be having it done sooner. And when it's less medically necessary.

[00:29:12] Speaker 1: Let's, let's travel to China with you for a second. And I will preface by saying I'm very, I got very interested in xeno transplantation and especially genetically modified pigs. One of the things, one of the headlines for me immediately was that there was these companies like United Therapeutics, Martine Rothblatt, who it's, it's somewhere between 10 and 60 gene edits to these, these gigantic genomes and 10 to 60 gene edits. And you can essentially make a pig organ compatible with a human. I mean, it's still the human still requires anti-rejection drugs, so it's not completely compatible, but it's as good as a human transplant in terms of the overall, the genes. Why, why did you go to China? What were you trying to find there?

[00:29:59] Speaker 2: Well, two reasons. The main reason is that both United Therapeutics and eGenesis, while they were initially very lovely to speak to, and we had a nice conversation with this, I think the CEO of eGenesis. And I was interested in the pathogen free facilities. I was interested in the pigs because I love that juxtaposition of hog farming with cutting edge surgical and genetics techniques. I, yeah, a completely pathogen free pigsty, super clean. That's the, that's a technical term, super clean. So it's a super clean pig and pigsty. The reason being that one of the concerns, if you're talking about taking an organ from a pig is that it may have a virus that would affect the patient or that might, you know, end up creating problems for large numbers of, you know, if it spreads. So I wanted to go to one of the facilities where they raised the pigs. I wanted to meet the pigs. And both companies said no, which isn't all that surprising. Biotech companies are pretty closed to outsiders, particularly outsiders writing books, walking around with cameras and tape recorders. So I went on PubMed and sort of looked around to see who else is doing this work. And there was somebody in China who had been working on this for 30 years, you know, transplantation. It seemed like it hit the press about five years ago, but it's been in progress for 30 years. And they were quite open to my coming there and going to the facility. The other thing that occurred to me as this was going on was that China was a really good place to set this chapter because culturally there's no tradition of organ donation. People don't donate organs.

[00:31:52] Speaker 1: Yeah, I saw that. I mean, 6,000 registered organ donors in a country that has, you know, a billion and a half people. That was surprising to me.

[00:32:00] Speaker 2: Yeah, it's nothing. It's nothing.

[00:32:02] Speaker 1: And why is that, do you think?

[00:32:04] Speaker 2: Well, it was explained to me by Yi Wang, who is the researcher who showed me around, that it was a religious thing. It's a belief that your body and everything in it was a gift from your ancestors. And so for you to mutilate it in any way, change it, you know, take parts out and mess with them would be disrespectful to your ancestors. That was how she put it. And also I think because, you know, the organs that they do have come from death row prisoners, people who've been executed, it has the stigma of a punishment. It isn't something that's, there is no tradition of organ donation as an actor of altruism. So it just, it seems, you know, it was just talking to them about, you know, transplantation, about chimerism, which is a whole other thing. You know, I thought, God, wouldn't it be simpler if you just did a bit of a, you know, this is China. You could just say, okay, it's your patriotic duty to donate, to be an organ donor. It seemed like it should be a pretty simple fix. But that's not happening.

[00:33:17] Speaker 1: Mary, you're a very influential person, but changing an entire government, that's challenging. Just in the interest of time, so Xenotrans, we have an organ shortage problem. I think maybe a hundred thousand people waiting for an organ at any given time. A lot of people die waiting. So there, I think everyone agrees there's a need and there's not enough donors, even in the United States, aside from, you know, the religious implications in China, for example, there's just not enough donors. Where do you think, when you think about the future, will it be things like 3D printed organs that will help fill that gap more so, or do you think Xenotransplantation is going to sort of be the thing that fills the gap? Or a combination?

[00:33:58] Speaker 2: Probably a combination. I think Xenotransplantation is further along. It's got a ways to go. The longest, Tim Andrews just had, he had a kidney and that was removed a few weeks ago. He made it what, nine, 10 months?

[00:34:14] Speaker 1: Something like that. He was the longest.

[00:34:16] Speaker 2: Yeah, he was the longest. And even though nine to 10 months doesn't sound like much, if that bought somebody enough time to make their way up the list and be eligible for a human organ, that would be a boon.

[00:34:30] Speaker 1: So like a bridge?

[00:34:31] Speaker 2: A bridge. Yeah, exactly. Like those mechanical hearts, they were kind of viewed as a bridge, like keep the person alive until they can get a human organ. I mean, but like you said, the gene edits have created a pig organ that the body doesn't see as a pig. It's seeing it almost as a human organ. They've edited it to the point where the immune system is more accepting. And they'll continue to tweak that and they'll figure out. It isn't clear to me exactly what still isn't there yet. And there's been some virus issues as well, even though the pigs are in those very fancy hyper hygienic...

[00:35:15] Speaker 1: Well, it's probably why they were so reluctant to allow you to come in there. Because I think pathogens and infection risk is probably the biggest concern. And then if someone has an infection after Mary Roach visited, it's like, well, did Mary... I mean, it wouldn't be your fault, but the implication would be there. To a conference we had, we had a conference called Life Itself. And I'd love for you to come sometime when we do this, but she brought a 3D printer with her and basically was showing us how this was done. And they were trying to 3D print lungs. And to give context, a 3D print a lung, you're talking close to a trillion voxels. So this isn't just like putting a dot on a piece of paper. It's oriented a very specific way, these cells, and obviously they all have to function as tiny blood vessels, as airways, all that sort of stuff. Fascinating. And she said, I said, how long does it take to do this, to print one of these lungs? And she said, you know, about nine or 10 months. And I said, that seems like a really long time. And she goes, how long did it take to print your lungs?

[00:36:15] Speaker 2: And I said, yeah, good point.

[00:36:17] Speaker 1: Yeah, that's about right. Gestation is about nine or 10 months.

[00:36:20] Speaker 2: Yeah, exactly. Yeah. I mean, I spent time in a bioprinting lab at Carnegie Mellon and just, we were focusing on just muscle cells, muscles, you know, and they were talking about how you have to, when you're printing them the cells, I mean, it's kind of a long cell. You've got to align it depending on the function of the muscle. So the, the, with a heart, you print them kind of in a helix because the heart kind of twists as it pumps, as it squeezes. Right. And for the deltoid muscle, we have a bit of a, like a fan shape. So how you align these cells as you print them, plus then, you know, how are you going to feed these cells? You know, you're going to, you're going to, is the body going to grow in those, that blood supply, or you're going to have to, at some point, print it? What about nerves? It's so, but, but just an incredible, I mean, this woman showed me a, you know, she had printed a single ventricle for a mouse and it was working. And it can either, you can either be like, it's just a ventricle. It didn't have valves. So it's like the blood squirting out either end. It's not terribly helpful for the mouse. The mouse kept its own heart, but still it's a ventricle that was printed on a printer, an extrusion printer. And it works and it, and it pumps, you know, that's amazing. I asked the guy, Adam Feinberg, who runs the lab, I said, how long before we are printing whole organs that can be implanted into a body? Functional organs. Functional organs. And he said, we're kind of at the Wright brothers stage.

[00:37:53] Speaker 1: Oh, that's interesting.

[00:37:54] Speaker 2: Which is both really exciting. I mean, the Wright brothers, when that happened, that was world changing and exciting, but still a ways to go before we have planes flying back and forth across the country.

[00:38:05] Speaker 1: But proof of concept is there though. I guess that's, that's what the Wright brothers sort of, I mean, things develop pretty quickly after that.

[00:38:12] Speaker 2: Exactly. We're, yeah, we've, we've had that, you know, the major breakthrough is there and, and as same with as, you know, transplantation, I think it's, and for that matter, you know, a bionic hand that it's, it's a matter of, of tweaking and improving, you know, it's like anything like AI. Well, it's happening faster with AI, but it's, it, the breakthrough concept is there. It's, it's a matter of time.

[00:38:36] Speaker 1: These are just wildly fascinating scientific developments. I think everyone gets excited about these things. And, and if not just for the gee whiz quality, the idea that it could have really objective, measurable impact on human life. I do want to ask you, you know, the books, I love your books and you, you take on topics that, I mean, like at times when I'm reading it, I'd laugh and I'm like, ah, at the same time, whether it be a finger, that's going to be a penis or how the elementary canal works and gulp, or even some of the topics in the, this book, have there ever been topics that you say, look too much, even for me, too much, even for Mary Roach, I'm not going to do it. I mean, you, you, you've had an ultrasound while you were having sex. I mean, by the way, kudos to your husband for that. He really, sacrificed I'm sure for that.

[00:39:30] Speaker 2: I know he's such a good sport. Oh my God, I can't believe I did that to him. Oh my God. And yet, thank you for getting it right. It was ultrasound, not an MRI. People go, oh, you had sex in an MRI tube. I'm like, that would have been fine. There's some privacy in an MRI tube. Oh my God. But has there ever been anything too much for Mary Roach, even for me? No. The short answer is no.

[00:39:54] Speaker 1: Love it. I love it. It's, it's, I just, I feel, I feel lucky every time I get to talk to you. Thanks for joining us.

[00:40:00] Speaker 2: Oh, thank you so much. I feel lucky too. I so enjoy this conversation and I'm a big fan and I'm, and I love all that you do and bringing, you know, bringing medicine to, to people and getting them to talk and think about it is, it's so important.

[00:40:15] Speaker 1: I'm going to work on my humor a little bit sometimes. No, no, you leave that to me. No, no. Okay. All right.

[00:40:20] Speaker 2: Because if you're, no, no, we can't have you being super, super funny. You don't cut into my turf, but you are funny.

[00:40:27] Speaker 1: Mary Roach, thank you for joining us. Really appreciate it.

[00:40:31] Speaker 2: Thank you, Sanjay. I loved it.