The Hype and Reality of Medical Breakthroughs w/ Mary Roach, Author, Replaceable You

Welcome back to Health Care Rounds, where we give you smart conversations with the people moving Health care forward. I'm John Marchica, CEO of Darwin Research Group. A quick reminder, if you have a question or comment for me, please send it to Health care rounds at darwinresearch.com. And if you're not receiving our weekly newsletter, you can subscribe also at darwinresearch.com. So today is something new for the show. Um, for years, this podcast has brought you conversations with people running health systems and shaping how Health care is delivered and paid for, leading companies trying to change it, and that's not going anywhere. But some of the sharpest thinking about medicine comes from outside the industry, from writers and reporters who spend years reporting on the human side of Health care, so the patients, the scientists, the surgeons, and the s- strange, fascinating history behind all of it. And so what we're launching today is a new series on "Health care Rounds," and every so often, I'll sit down with one of the best writers in science and medicine working today, and I can't think of a better person to kick it off. My guest has written about cadavers, digestion, sex, war, and what happens when wild animals break the law. Her new book is about the centuries-long effort to replace the parts of the human body that fail, from brass noses to gene-edited pig kidneys. And to report it, she went into burn units and transplant labs, a pig facility in China, and a cataract camp in rural Mongolia. She climbed into a working iron lung and even came to Scottsdale, my backyard, for an ostomy 5K. She's the author of "Stiff," "Gulp,""Grunt," "Fuzz," and now "Replaceable Adventures in Human Anatomy." Mary Roach, welcome to "Health care Rounds." Thank you. It's a pleasure to be here. Well, you're our first guest in the series, so no pressure. Um, um, but my, my, my listeners know the, the sort of the ins and outs of the Health care system, but really most of them, including myself, get to see what you saw in this book. So I guess maybe the way to think about our conversation today is you're, you're our field correspondent. How does that sound? I like it. All right. So from, from what I've read, and this was the third, um, and wait, I should be accurate. The third "Replaceable You" I've listened to, so And I did that because I thought maybe, oh, I can get a copy of a book from you at some point for the hard copy. But it's really, it's, it's different when you're listening to it than, um, than when you read it. I don't know which is better. Um, but in any event, the pattern that I see is you start with a question that you couldn't stop thinking about. So what was the sort of the inspiration or the one question that started "Replaceable You"? Well, it's never really it's never really a clean origin story for me. Uh, this book How did this book happen? Well, I had this idea, um, I had a folder labeled "Bits and Pieces," and I was looking through that 'cause I'm, you know, it, t- for me to find a, a topic for a book is always the hardest part. And, uh, in that folder were some random things, and one of them, uh, had to do with, uh, fat. And I was thinking like fat as an, as an entity, you know, and, and like looking at different bits and pieces of the body was th- th- but that's the stuff that was in that folder. And I contacted this woman who runs this fat lab, uh, and we had this conversation. Had to-- Uh, you know, she works with adipose-derived stem cells. And, uh, and so I was sort of talking to her about stem cells and what people are doing with them. But then the conversation kinda went off the rails and she mentioned, and I don't remember how this came up, but she mentioned this, she came across a paper by a surgeon in former Soviet Georgia who had, uh, rebuilt a man's penis using his middle finger. And I, of course, like pictured the f- the finger like being installed as is, like a working finger that could kinda like beckon and like-- I was like, "What?" So that kind of like sealed the deal for me, like, "I gotta go to Georgia. I gotta talk to this surgeon." I don't know, meet the guy with the-- But of course, the, the finger w- is, was just supplying rigidity. It was, uh, there was skin around it. I mean, it looked, it, we-- the, the final product was quite convincing. You would never know there's a finger in there except if you maybe saw the guy's hand and he's missing, you know, he's missing a finger. So, um, I didn't really have a burning question. It's just, you know, this, I, I start down a path and, and sometimes I keep going, and that's what happened with this one. Yeah. Yeah. I think sometimes you just, you, you take the reader right up, right up to the edge of this discomfort. You know? I mean, it, it's- Yes, this is my way. It's like, really? Do I have to be reading this about vaginas?'Cause I don't know that I'm allowed to read this chapter, um- … or listen to it, um, and the finger. Um, but really, you know, you, you got me with the noses. And, you know, just thinking about, I don't know if it was the vanity or, you know, what was going on in the 17th. Was it Tycho Brahe? Was that the, the, the guy? Yeah. I think the, the one with the, the nose. And, and I think I'd read something about that before, but contextually, you know, kind of opening up the, the, the book that way just really got me thinking, "Wow, are we this just like uber vain like species?" You know, like- Well, uh, I-- Well, yes, we are. But the, but the thing with the noses was, you know, the- Th- this was the, kind of the original plastic surgery, and, uh, you know, dating back thousands of years. And the reason is that nasal mutilation was this, um, punishment that was carried out specifically, um, not just to punish somebody, but as a deterrent, because the whole population would see this person with a, you know, a hole in the middle of their face, and it's this f- nobody wants that. You know, it's this very disturbing thing that was done to people. So the, you know, the original uses of it, and then, and for syphilis later, were not, you know, it wasn't vanity, it was just restoring somebody's sense of themself and their self-respect and dignity. It was just a way to, you know, get, uh, make them feel comfortable going back out in public, uh, again. So, uh, I thought that was, that was fascinating. Just, I mean, that's, there's been a demand for noses before anything else. Yeah. And the, and the shaming part of that, you know, that was new for me. I didn't, I didn't realize that that was… And you could think about, I mean, there are horrible things that we used to do to people back in the day, um, and that's, that's, uh, pretty atrocious. You know, I'm, I'm thinking about the other story. I've got a few stories I wanted you to talk about, but the, um that the surgeons didn't want to remove this foot that the patient, and said it was healthy. And I thought, oh, I'm not gonna-- I'm just gonna tee it up for that, but it, it was very revealing on a number of different levels. Can you tell us that story, Mary? Yeah, that was another thing that, uh, got me rolling on this book. Um, I had heard from a, a reader who, uh, wrote to me because she, she thought I should write a book about professional football referees and, and that's a very odd match for me. Uh, I'm-- I don't watch football. I don't care about referees. But anyway, we corresponded, and I, uh, I always like to ask people about themselves, 'cause when I meet a stranger either on an airplane or wherever or through email, I'm curious about what they do, because you never know if there's gonna be a book idea there. And she said she was an amputee, specifically an elective amputee, and I'd never heard that term, and I asked her to tell me about it, and she told this story of how she'd been born with spina bifida. Her, her foot grew in twisted, and so she couldn't, she couldn't walk or run the way she wanted to be able to. And for years, she would see people with a prosthetic lower, you know, lower pr- lower leg prosthesis, and, and they were running and jumping and getting along fine, and she's like: "Why can't I do that? Why, you know, why can't I cut off this leg?" This foot, basically, you know, from the mid-calf down. And no one-- For years, she couldn't find a surgeon to do that for her, because they'd say: "Well, it's, it's a viable leg. It has a blood supply. I'm not gonna remove it." And she's like: "But I don't-- It doesn't work. I don't want it." Uh, and, uh, there's various reasons why a, a surgeon would decline to do that. Um, you know- Ethical reasons maybe, or, you know- Well, yeah, well, like y-y-yeah, like what if the patient developed phantom limb pain afterwards, or what if in the future there became a better technique and, and they could have saved the limb, you know? Uh, and there's-- And plus, you know, you have to, to get insurance to cover it. You'd need to, you know, justify removing it. Or the surgeon just may not do a lot of amputations and feel comfortable doing that. So, you know, I understand that. Um- But by the same token, it was, you know, like she would s- she'd say, you know, "Your hip wears out, you replace it." You know, I have a non-functioning foot. It's viable. It has a blood supply, but it doesn't serve me, so, uh, take it, take it off. I mean, she did finally find, uh, someone willing to do that, and she was, you know, much happier. Sure. Yeah, and it, it, it reminds me of the, you know, jumping to the story with the, the, you know, the high-tech arm or hand- Mm-hmm and the raspberry. Can you talk a little bit about that? Oh, yeah. Yeah. Uh, you know, I went to the am, um, the Amputee Coalition National Conference with her, the woman with the lower limb amputation. Uh, and We walked around there. It's a huge space. Uh, it's got a wonderful vibe. There's a lot of people with prosthetic lower legs, not so much, um, arms. Uh, not-- There weren't, there was only-- I only saw one booth with one of those, you know, bionic individually articulating fingers, that kind of thing that you s- there's a lot of hype on the media, in the media about it. Uh, and they are kinda cool, but the reality, you know, she-- when we walked by, she looked at this poster of this, you know, this limb holding a raspberry, which is of course a very delicate berry. And she, she said, "Uh, yeah. Are you gonna spend like 30 seconds, uh, adjusting?" Like, no, you're gonna reach over with your other hand and pick it up and eat it. You know, she's like… And, um, and in fact, the majority of people with, uh, an arm amputation or limb difference, they might have been born that way, uh, don't use a prosthetic like that. They're, um, they're heavy. The battery life is fairly short. They're kind of exhausting to use, and they're very, very expensive, and insurance doesn't cover it. And the other thing is that people who are missing a hand are really good at doing things with the other hand and like their knee or their head or the wall. You know, they're just very, they get used to- They've adapted. They've adapted really well, and they're-- Or even those, you know, the shoulder-mounted, the harness that, that, that, that they use, the, um, with, uh, just a, a grasper. Those folks are able to, to pick things up and move and like gesture. I remember seeing a guy at, adjusting his COVID mask. It was just like second nature the way he was able to move those. So, um, some people u-use those, and so it isn't always the case. You know, this one woman who's written, uh, Brit Young, who's written a lot about that, who's tried that out, that she had a… I forget the company. And she said, "I'm more disabled with it than without it," which was interesting. Yeah. Yeah. Uh, was there any through line? I mean, I know we're talking about appendages, uh, and I was gonna say, what's the connective tissue? Use a bad, uh, pun, you know, between the two. But was there any through line in, in those stories? The one where, you know, desperately trying to get something done that was in the way, right? And people not wanting to do it. And then on the flip side, you've got all of this investment in technology to make this super cool but highly impractical, right? At least at this stage of development, right? At this stage, yeah. At this stage, highly impractical. Was there any kind of through line that you saw in doing that reporting in those stories, or am I-- Is it just appendages? Well, I think, I think each appendage is different. Um, you know, they all have their own challenges and reasons why things tend to kinda move forward In lurches rather than sort of a straight line of progression and development. Um, I, I don't know if there's really a-- Well, talking about the, talking about, you know, what, what Health care providers think people want versus what they can actually use, it's not so much the Health care provider. I mean, I think prosthetists know all of this and are, you know, the people who, uh, need to get a pros- prosthesis made, uh, work with prosthetists, and I think they're very aware. I mean, I've talked to quite a few of them. They're very aware of that, um, the, the challenges that face somebody who actually wants an amputation. Um, and they are good advocates for them. Um, so I don't, I don't know that it's-- I think there's a disconnect between the pr- presentation of some of this new technology in terms of how it's presented in press releases and, you know, universities and biotech companies. They may sort of put the word out when they're still in the fundraising stage and try, you know, trying to generate excitement and kind of overstating th- th- you know, th- it's all like, "This is what we hope we're gonna do, and we're confident we can do it," but who knows? You know, these companies come and go, and they're trying to-- They're in a fundraising round, and so they, they put out material that, you know, t- turns out to be, um, a lot of hype. And, and that, when somebody sees it, like Judy Berna, the woman with, uh, that I, uh, profiled and spent time with, she said, "I cannot tell you the number of times somebody m- well-meaning emails me something going, 'Look at this. It's a 3D-printed leg that costs 20 bucks, and it's perfectly fitted to you, and you don't ever need to go to a prosthetist.'" And she's like, "Yeah, right. You know, I appreciate it, but please stop sending me this stuff." That's just never gonna be the reality. There's just a lot of hype out there that isn't helpful for patients. You know, uh, I think it's, um, you know, it just builds up false hope.'Cause this stuff is, it, it is happening and it's exciting, but all this stuff happens really slowly. I mean, the first hip transplant was, what, 1938? H- sorry, hip replacement, 1938. Um, xenotransplantation, um, that is, you know, genetically editing a pig so that their organs can be used for a human, that's been-- they've been working on that 30 years. So, um, that sense of the brave new world has arrived and everything's out there for you, and they're printing organs in labs, and you c- you know, that, there's-- That is frustrating, I think, for patients sometimes. Yeah. Or for the, the, the users. And I, I just have to say One of the-- I mean, I learned so much from this book. But one of the areas that just really piqued my curiosity was that prosthetists? Prosthe-- I can't say the word. Prosthetist. But the people who work with… Prosthetists. Okay. Prosthetist. Um, that so much goes into the ongoing adjustment. Um, you know, people gain a little light weight, they lose a little weight. Um, and I just had, hadn't even thought about that. It's like you stick it on and, and- Yeah… no, it's, it's, it doesn't work that way. And these people are, are really seem like dedicated, um, clinicians, artists, however you wanna describe their unique world. But the, but the other piece I was thinking about that I literally did laugh out loud was, um, the, the physician talking about, I think it was in the, the fat section, talking about the marketing copy and the way that they, that they label these, you know, like the, the dri- the drills or the things that go in to cut, the different types of tools. And, and I was like, you know, yeah. I mean, I, parts of my life I've kind of thought of myself in that marketing world and, and it is true, and people think like that, yeah. Well, what's really gonna capture- Yeah. Yeah … the doctor's, the surgeon's attention? Let's call this the, the stabber. Yeah. I wish I-- Exactly. Yeah. I ca- I-- the stabber. I can't, I can't remember. There was a couple of examples in the, in the brochures. I was like, "Is that really what you wanna call this tool?" The penetrator. The penetrator, right. Oh, now, now they're gonna wanna buy this. Um- Yeah. But so the, I mean, the doctors see the hype too, so it's not just the patients, uh, 'cause they're trying to get attention. Yes. Yeah, absolutely. That's, uh, how you get-- I mean, you need to get your, whether it's a, you know, like some of those, um- Bio dressings, some of those, you know, materials for burns that are very expensive and, you know, in many cases are not any better than a piece of cadaver skin. But there's a lot of hype. There's like, we've measured these biomarkers and it's hehehe and it's healing fan- healing faster. And I remember seeing-- There was a piece in "The New York Times" about they put… Oh God, what was it? It wasn't from a foreskin or a placenta. Was it placenta? I can't remember. Some, you know, reproductive related, I don't know if it was embryo, foreskin, whatever the hell it was. But they're like, they put it on her face and it healed really quickly. And I wrote to the surgeon who I'd followed around at Mass General. I'm like, what do you make of this? And he said, you know what? The head has a great blood supply, and, and she had a second-degree burn on her face. It's gonna heal pretty quickly with anything on there. So, you know, it's a, it's a, um… But, you know, they're trying-- You're trying to get-- You've spent a, a lot of money on this, developing this product, whether it's a drug or a bio dressing or a, you know, prosthetic. Um, y- y- and you need to get it to patients, and the way to do that is through physicians. And that's so, you know, you Take them on a junket or whatever you're gonna do. But, you know, I, I feel for them'cause y- y- if you don't do that, nobody's gonna know about your product. But, um, you know, and it's up to the physician to kind of make the distinction between what is hype and what is not. And so anyway, it's interesting system. Yeah. Yeah. Um, and I think, you know, in the broader world of Health care, people making decisions, procurement decisions or treatment decisions, um, especially nowadays, I think there's more attention paid to not so much, you know, what does the insurance company say, but is there really incremental, you know, better value? And I, and I, and I got my career started a- about a million years ago in the drug world, and where, you know, you'd see these, like, sales aids that would compare, well, our drug has, you know, 5% explosive- Yeah … uh, vomiting versus- … the competitor's that has 10%. Yeah. You know? Or, you know, just this- Right … minutia around certain side effects, and that's the way that people sold, and not- Yep so much anymore. Now people are looking for, you know, bigger breakthroughs in biologics and things like that. They don't- Yeah. But back in the day it was, you know, what kind of little thing can we- Yeah. Yeah… hone in on and just really, you way? Yeah. Well, it's like any advertising. I mean, I took an advertising copywriting class years ago, and there was all these things that, you know, like, uh, a unique selling proposition, like cold brewed, you know, or the fan jet airline. Like, who cares? It's like they all have a fan jet. Or like, but they, they… Or I don't know if they all have a fan jet, but does that make it any better? But it made it s- you know, special. It sort of stood apart. It had this special quality that only that beer had or whatever, regardless of whether it made it taste any better or whatever. And yeah, there was that, and there was just all these kind of ways to get attention. But that's how you survive in the business world. So, you know, I, I get it. So ch- wanted to shift gears a little bit because I didn't We're doing fine on time, but I wanted to make sure, I think it's really important that you talk about, um, the super clean pig facility. I was absolutely fascinated with this, and I thought it was a really important part of the book addressing, you know, kind of developments of what's going on in China. And by the way, I also think that it, that it's cool that you're a responsible reporter and you actually, you know, you go-- I mean, I know you do some, some Zoom and, right, um, virtual meetings, but you actually get on a plane and you go see wherever you can. You're like the intrepid reporter, and I appreciate that. Um, I certainly don't have the, the- Well, I- … the wherewithal to do that. But just, just tell, tell us about that. Well, I enjoy, I, I enjoy traveling. Okay. Well, so there, there's that. But, but see, there's that. But in this case, um, there's a couple reasons I went to China for the-- This was the xenotransplantation chapter. In other words, genetically editing pigs so that their organs are not so reactive and they don't have this instant rejection that would otherwise happen. Um, and there are two companies, at least here in the United States, eGenesis and United Therapeutics, um, that both, that, that have pig farms, essentially pigs in, in, um, hyper-clean, it's a hyper-clean, sterile pigsty, which appealed to me as a concept, pigsty and hyper-clean. Right. Right. How do you get that? Um, yeah. Yeah, yeah, yeah. So, but, but I-- And both of them were like, "No." Mm. In the end, uh, they either ghosted me or said, "No, you can't come here." So, um, I, I contacted someone in China, and it turns out I think China is a, a good place to set that chapter because China has no culture of organ donation. It isn't, it's, it, it's considered, the way it was explained to me by the researcher in Chengdu, uh, is that it's considered disrespectful to one's ancestors to, uh, mess with the organs that you were given. And so they don't, they just don't do it in China. Um- And so there's a huge demand, and if you could, uh, edit pigs to the point where those organs could be used long term, that would be a tremendous boon. So that's, you know, that's why I went to Chengdu. And also I was just cur- I was like,"What is this hyper-clean, pathogen-free pigsty look like?" And it turns out, well, it looks like a pigsty. There's a bunch of pigs, you know, and they're still peeing and pooping on the floor and, uh, but, but they are, uh, tested, uh, regularly for, was it 40 viruses, uh, bacteria, fungi. Uh, the people who work there come in and stay three months and then rotate out. So they're, like, they're, they, they aren't allowed out in the world. I wasn't allowed in except there's big video monitors that are showing them all. So, um, so basically I flew all the way to China and wasn't allowed in the pigsty. But, um, it was pretty, yeah, pretty in- it's pretty interesting. It's a pretty interesting place, and I was just, just, you know, curious, um, where things are at with that, and how do you keep a pigsty sterile? S- did, did you get the sense that-- That was interesting, you talk about those two companies where you tried to get in. Um, obviously you have a, you know, a, a reputation, a good reputation. So do you think it's, was it like secrecy or you think, is, is that like, um, the- Um- … the biotech world here, maybe they're a little bit more reticent to share what they're doing versus the in, in China, they wanted to kinda show off what they were doing? I think so. I th- well, I think, um, there were two th- you know, the United Therapeutics was, uh, originally very, uh, you know, we had a long conversation. They, they know my work and they were very uh, positive initially and then just said, "You know, we're not at a pha- we're not at a phase where we are ready to talk about this." And I think that, um, like, b-because at that point, the, the longest anybody had survived with a pig organ, either a heart or a kidney, was a c- you know, three or four months. And so they just felt like he, the, the, the guy that I spoke to said,"I feel like, you know, the stuff that's going on now is a little distracting from the long-term goal. We're not there." A few months, a few months. Okay, if you could push it out to eight months, which is now I think the current record, now you're talking about a span of time that some, you know, somebody could get the pig heart, and then when it starts to fail, maybe they've made their way up the list so they qualify for a human heart. So it's a bridge, uh, technology, which, you know, the-- it's very cool, but they, they were, they just felt like we were not, we're not ready to be talking about that. And the other one, um, eGenesis, I don't know. We, we had a great conversation and then they ghosted me. I, I don't know why. They, I don't know what… Uh, I think my sense-- This is the first book where I've really dealt with biotech companies a lot, and, uh, my sense is that they are just very cautious in terms of, um, yeah, secrecy. And, you know, I'm fine signing an NDA or whatever, but they're just like, they're, they're just like, "No, there's-- What's in it for us at this point?" I don't know. I, um… Their, they, their model of dealing with the media, and I guess I'm part of that, though I don't like to think of myself as the media. Yeah, me either. Yeah. Uh, I think that, um, their way of doing things is, "Okay, we have something to announce. Here's a press kit, here's video, here's the social," what do they call it?"Assets. Uh, and here's what, that's what you get." You don't get to come and hang out, which is how I've always done my job. Just spend a few days, just hang around, see what's going on, talk to people, um, learn by osmosis. So that-- And they're like, that makes them, uh, seems to make them uncomfortable. I got a lot of unreturned email on this book. Yeah. It's, um- It's probably the area of Health care where I have the, the most, uh, experience and maybe, let's say, the longest standing relationships. And we're on, I don't know what episode number this is, 200 and something. So we've been doing this since 2018. Um, I always like to point that out'cause I don't wanna be thrown in with, like, the latest podcasters and content creators or whatever the latest terms are. We've been doing this for a long time, and I've yet to have a pharma person who is in their existing job talk to me. And I know a million of these people. In fact, I just the other day had a conversation with somebody about this and said, "You know, I'd love to have you on, on the podcast and talk." And he kinda laughed. He's like, "Yeah, that would never, that would never happen." And I, I think it's, it's a-- there's a couple of reasons behind it, but one of the biggest is their, their compliance. They're afraid that they're gonna say something that's gonna get them in trouble. Yes. It's not like they're leaking secrets, but pharma has a history of, you know, all of a sudden a lawsuit because some rep said something to a doctor- Yes that they shouldn't have. So they're paranoid. Yes, paranoid. And- Yeah, that's a good word. Yeah… and, but it's too bad because I think uh, interesting interviews. Um- I, yeah. I, I am kinda surprised at the degree to which that is, seems to be true. I mean, I, I wrote a book that had to do with military science, and for that book, I, you know, I went to Camp Lemonnier in Djibouti, where Special Forces are dealing with Middle East terrorists. I got onto a ballistic missile submarine out in the middle of the Atlantic while it was out at sea. You know, I wasn't allowed to know where we were, uh, and I wasn't allowed access to certain parts 'cause I don't have security clearance, but The fact that the Department of Defense was okay with Mary Roach hanging out on a submarine in the middle of the Atlantic, a nu-- a, a ballistic missile sub for four days, um, they're okay with it. And like these companies, these biotech companies are like: "No, you can't ever set foot in our lab or our building." There was just th-this level of… I guess it's just how it's done. So when I f- you know, I f- I did finally found, find someone who said,"Yeah, you can come down here a couple times and we'll explain how we do this." You know, all I'm looking to do is like, I wanna understand, you know, what's an induced pluripotent stem cell? How do you do that? How do you take a blood cell, return it to its pluripotency, and then instruct it to become something else? How the hell does that work? What are you guys doing? You know, that's all I want. I don't wanna look into, you know, share trade secrets or spy for another company or anything. But, um, so it, it was kind of a eye-opener 'cause I, you know, I'm not, I'm not used to dealing with i- and I've never dealt with pharma. I think I just know like off the bat that's that's not worth my while to try to, uh, get in there. It is, it is the way it is. So if, if any of you pharma people are listening- … um, please come on the show, 'cause it always i-inevitably when I, when I do have the, that particular topic, it's like somebody in between their roles, you know, at a new company or something along those lines. But, uh, um, so a couple- Yeah of more pieces that I wanted to get to. One is you stayed up all night with a tissue recovery team. I did. Can you t- can you talk about that experience and what that was? What was that like? Yeah. That was, that was so illuminating. Um, I, you know, when I wrote my first book, "Stiff," I thought about doing-- I thought about writing about tissue recovery. I, I have a chapter on, on organ recovery. Uh, but the f- I, uh, the folks in the tissue recovery world were, um, maybe paranoid, a little bit wary. D- just didn't, didn't respond to my overtures, let's say. So I kind of forgot about it for a while. But then for this book, I thought,"You know, I need to revisit that." And, um, I think it helps that now I have more of a, you know, p- I'm a known entity. Uh, and also I had contacts in that world, uh, from working on "Stiff." So I, uh, was able to find somebody at an org- uh, OPO, organ procurement organization, uh, in, uh, in Pittsburgh, CORE, they're called, uh, Center for Organ Recovery and Education. And they're like, "Okay, you can come out here." And I followed, um, I followed an individual from the time that they, uh, got consent from the family through when they arrived at the facility, all the way through the whole process of recovery, and then, you know, putting the body-- whoops, putting the, uh, essentially putting the person sort of back together. Uh, and, and it was incredibly interesting. It was, uh, uh, because I'm like, how do you, how do you remove bone, muscle, skin, ligaments, a- and then be able to put someone back together in a way that they look pretty much the way they looked like when they came in, except for some stitching? Uh, and, and so it was this incredible process, and just, y- you know, an amazing gift. And, uh, I know there's been, you know, stuff in the press about OPOs and some of the less reputable, um, operations. But, um, you know, this, this group seemed to me to be, um, you know, doing it right. And I th- I think, you know, because there'd been a lot of bad press in the, the past year or so, I think that was why p- uh, un- uh, it was, it would've-- it was hard to get people to s- to, uh, say, "Sure, come on down and hang out." Uh, but you know, I made the, I made the point of, you know, i- if the only thing that's ever in the press is when things are done wrong, why not showcase the process when it's done right, and h- you know, and how important it is? And it, you know, peop- uh, it's im- you know, a lot of people depend on these products, these, these ligaments and pieces of bone and skin for burns. I mean, they're incredibly helpful for people, and it's, and it's a really a great gift and, um, it's important to put that word out there. And I, you know, and I've t- I described how it's done. You know, I, I, I f- I mean, it is a, a quite a, a gory thing to see. Um, and I describe it, but not in any kind of sensationalistic way. I mean, I do think, um, you know, if you, if you hide something completely from the public, I think that people's image in their head is worse than the reality, you know? I think so. I think there's value in saying, "This is, this is how it's done. It's, you know, it's like major surgery, and then they put you back together." But, you know, people are fine with surgery, you know, cutting open somebody's chest cavity or, you know. I mean, there's pretty invasive things done to save lives, and this is just one more. So, um, it was one of my favorite chapters to do. Yeah. Can you take us to the operating room in Mongolia and, and what you saw? Sure, yeah. Um, I traveled with this group, Orbis. Um, Orbis has the Flying Eye Hospital, which is, um, a former FedEx jet plane that has, uh, a whole operating room on it. Um, and I initially thought, "Oh, this is-- They fly into a rural area, and they w- give cataract operations to people." But they, they-- what they actually do is train local surgeons and equip them to-- so that when they leave, these people can continue to save sight. Uh, so which is a, you know, a, a, a, in terms of the greater good, that's the way to do it, if you train local surgeons so they can operate and, and replace people's lenses rather than like, "Okay, we showed up and we did 50 cataract surgeries, and then we moved on." You know, that, that's great, but how much better to actually train and, and equip, you know, uh, these facilities. And so they were doing, um, they weren't doing phaco, which is, uh, uh, the current way that it's done. Um, they were doing a simpler, a simpler inc- you know, bigger incision, uh, and Uh, it, it was amazing 'cause they could d- they could do this with basically the patient was on like a wooden table with a, you know, some padding on it. Um, I think the only thing plugged into the wall was the, um, microscope, the, you know, the thing that the, the eyepiece that enables them, that magnifies what they're seeing. Uh, that was ki- and the light, I guess. Uh, so, so it was, it was done simply and inexpensively, but the patient was, you know, there it was a single, they weren't, they weren't getting multifocal. They were getting a single distance lens. But, um, a lot of these patients had put the surgery off for so long that they were almost blind, you know, that the lens was so opaque. So the next day, you know, when the bandages came off, they were just, you know, looking around like, well, one of them said, "It's like HDTV." Like, ah, the clouds part, right? Yeah. Yeah. Yeah, exactly. It was kind of inspiring. It was inspiring. Not kind of inspiring, it was. Uh, so that was a, um, kind of a treat to go along on that trip. Well, I, I, I, I brought that up because, you know, a lot of what, um, we talk about on, on this show is sort of value, right? Value for value in medicine. There's a, there's a term that is used in this world called value-based care that I think at this point most people agree is a terrible, um, moniker to use, at least people, people in, in my industry. But the bigger picture of sort of- High tech versus good enough. You know? The w- the, it just, it struck me as being this intersection of one of those examples of where you can spend a ton of money and, as you said, maybe do 50 procedures and then go on to the next and 50 proce- but, but no, it's the teaching and then it's doing the right kind of care in the right location. Um, it was a nice intersection of the world that, that I live in and certainly the, the clients and the people who listen to this and, and a real world example out there of, of, of doing it right. Yeah. And the other thing that they talked about there was, um When you do, when you do an operation and you do it well and you save someone's sight, um, now they're gonna talk about it as a good experience and spread the word. I mean, they, there was a lot of, um, hesitation and fear among the sort of the nomad population who, you know, they'd heard about somebody who went and had it done years ago, and it was-- I, I mean, I don't know that they were doing couching, which was, you know, that thing where you'd like push the lens completely down out of the range of sight. Yeah. But, but they, you know, the, the-- whatever was being done, the results weren't good, and so people avoided this, this procedure. So if you can, you know, sh- have people come in and, you know, treat, you know, train surgeons so there's a larger group of people who are benefiting and their experience is good and they're sharing the word, I mean, and then they're gonna encourage other people to have it done. There was one guy who was like, he was fine getting heart surgery, but he'd been putting off cataract surgery 'cause he was really worried.'Cause it, you know, it, it for whatever reason, it, it had a, a bad reputation there. So, you know, if you just sort of look at things through the lens of the greatest good, um, that kind of procedure on a wooden table in a room with one outlet was amazing. So I, I can't believe I'm gonna ask you this question. I know you're the only person I can ask it of or to. What is it like inside an iron lung? Oh, yeah. I'm glad you asked 'cause I love to talk about this. Um, I-- yeah. Well, I had this idea that, um… Oh, okay. I got-- First of all, I was, I got fascinated by, uh, iron lungs, the, from the polio era. Well, the, that back then. Hopefully we're not in the polio era again. Um, but the, uh, w- when enough people had paralytic polio that there were tank farms, there were rows in these facilities, rows and rows of old Emerson iron lungs, um, with people who, uh, couldn't otherwise breathe. And I was like, "Why?" And I just had this sense of like, that must be so horrifying, claustrophobic, awful. What a horrible thing. And I read, and I read a couple of memoirs about people who'd spent time in an iron lung, uh, you know, 24/7 for a while before they recovered enough ability to, you know, move their diaphragm and rib cage. And all of them There was this moment they describe when they went into the iron lung, 'cause, you know, of course they were getting to the point where they couldn't breathe, and then, you know, within a matter of a couple days, it was becoming an emer- an emergency. So they get there and they're put in this machine, and the thing within a-- that I didn't realize, an iron lung works in a different way than a, the kind of ventilator that's in an ICU now, which is positive pressure, you know, kind of inflating your lungs like a balloon. Um, the iron lung works… It breathes the way you do. You know, it's, it's, it, you know, pulls the air out and so that it's vacuum and your lungs expand and, you know, the ribcage opens up and then you let it go and it goes back out, which is how we breathe. So it's a very natural feeling and, um, I was just curious, what is that like? And I found, uh, a guy whose wife had been, until recently, uh, using an iron lung at night. She had had polio and she had… Nah, she could get out during the day, but then at the end of the day, she got back into the, and slept in the iron lung. And she had passed away and, but he still had the iron lung, and I wrote to him and said, "Can I, can I come sleep in your iron lung?" Which is kind of a weird thing to say to a stranger. Um, uh, fortunately, he was familiar with my books, so he was like, "Okay, this is, this is what Mary Roach does." So I did-- I went out there to, I think it was Kansas City, and I didn't make it the whole night, um, for a few reasons. One, um, while it is a very natural way to breathe, you don't control when you inhale and when you exhale, so it's very strange. You'll try to talk someone, to somebody, and, uh, if you're trying to speak when it's having you inhale, it just cuts you off. You'll be like, "So," because, you know, you can't… You, you speak on the exhale. You can't speak on the inhale. It doesn't, you know, that doesn't work. So, um, and I thought I would eat a meal while I was in there, and they're like,"No, no, no, no," because it's gonna-- Like if you're thinking you're gonna swallow and it decides you're gonna inhale at that point, you're gonna inhale your food and that can be a medical emergency. So no, you're not gonna be having a picnic in the iron lung. And then the other thing is that it, you need to have a tight seal, so the thing around your neck, uh, is quite tight, uh, which is not conducive to sleep. And, um, also, the guy had on his wall one of those bird clocks that every hour a different bird squ- So I'm like, "This is… I'm not gonna, I'm not gonna get any sleep in here." So I think I made it, I made it like eight minutes, if that. Yeah. But it was, it was fa- it was fascinating. It was fascinating. And it was, it was just-- And the fact that, you know, you can, you can be awake, you can eat. I mean, it's something you have to practice, but, you know, if you're intubated with a positive pressure ventilator, you know, you're, y-you can't talk, you can't swallow, uh, you're often sedated so that you don't breathe, try to breathe against the machine. Uh, it, you know, and y- things start to happen if you're in there for a while. It's… So an iron lung is kind of an amazing device. It's simple, you know, it's just sort of this diaphragm going in and out and, and it's, it's like, it's a lung, you know? It's a great big iron lung. Yeah. Uh, for me, and I think this is, you know, giving you a little praise here, Mary. Um, for, for me, it, it, it was one of the places, and this happens actually more frequently than I thought in the book, where you really kind of get to the humanity and, like, the person and the Post-it notes and, you know, still kind of like dealing with this, his wife's passing and not knowing what… I mean, it was just, like, kind of crushing to read that. Uh, but also it's another piece where it's, it's, it's the way you write, it's disarming because on the one hand you're, you're kinda laughing 'cause you have this sense of humor and, uh, describing difficult things sometimes. And then you get this picture of-- or the guy running around or, you know, in the, in the, in the, in the vehicle or in, in China, you know, and him describing the… Like, you get this, this snapshot really of who people really are in very vulnerable moments, and it's a talent. It's striking. And that was one of, that was one of the pieces in, that I took pause, you know? Oh, thank you. And I, I don't, um, I don't know when those things are gonna come up. You know, I went into this chapter thinking, "Well, I'm writing about positive versus negative pressure ventilation." You know, these two very different things and, and how do you deal with somebody, how do you help someone whose muscles are failing and they can't move their diaphragm or their ribcage? What do we do? Well, they're, and these two very different ways of approaching it, and people who are, you know, trying to come up with wearable negative pressure lungs. Anyway, that's where my head was, and then I get there and there's this guy, Mark, who's like, "Well, you know, I think a week went by without my breaking down sobbing." You know, just- Talking, I mean, he just, he's v- you know, still very much grieving over his wife and wanted to tell her story. And so, you know, you have to make room for that. You don't have to, but I think I want to, and I think it, you know, would be a shame to leave that out 'cause it is, it is a very human story. Uh, um- And we're all humans. Yeah. Yeah. And I, I think your perspective, which leads me to kinda getting towards the end of our conversation here, Mary, and, uh, I've enjoyed all of this. This has been great, and I, I hope people do go out and find "Replaceable You." I mean, it's wonderful. I mean, it's a wonderful, wonderful book. Um, but since this is the start of a writer series, I get to ask you a few writer questions- Okey-doke … if you don't mind. Absolutely. Um, this is more for my curiosity, but, um, 'cause I'm a big reader. Um, the first question, so there's only a few, but I thought about these. And I'm wondering, what is it about a subject that you're willing to give, like, three, four years of your life to? To just embed the stories that you've already told that are laced throughout everything that you do, all of your work. Now- What it, what makes it worth it, and how do you stick to it? Uh, I… Well, f- first of all, I love the reporting. I love going… Uh, it, it's such a gift to be able to, uh, step into these worlds that I know nothing about, whether it's a pathogen-free pigsty or somebody's personal iron lung or a conference of amputees. It's a, it's a, a world, a completely new world to me, and I've always liked traveling, but this-- So it's in a, it's similar in that it's just, it's a key to a universe I would never otherwise get to explore, and it's fascinating, and that always pulls me forward. And I always pick a broad enough topic that I can fit, you know, fairly… I mean, there's a, they're almost, my chapters are covering things that are, they're all related to the topic, but the topic's so broad that there's not, you know, there's not a whole lot of overlap between pig organs and iron lungs, except for the replaceable bit part of it. So, um, it, it's, there's a lot to explore, and I give myself wide latitude to put things in that, you know, that don't… Like I, I have a book about human-wildlife conflict, and w- I, one of the things, I went to Vatican City because they're having a problem with gulls. But you don't need to go to the Vatican to report a book on human-wildlife conflict, but I was like, "The Vatican. It must be so weird there. I'm gonna go." Yeah."What's it like?" 'Cause I was raised Catholic, and I was like, "It's just, just, wanna, I wanna go there." And, and then it's becomes this challenge, like, "How do I get in there?" And so it's just, it's just really fun for me. And then if the reporting goes well, you know, if it's a place where, you know, I've just learned a lot and found all these things that I wanna share with readers, the writing is so fun. It's just really f- it's just fun and, you know, to write a book is, you know, you're given a lot of freedom. You just sort of say, "Oh," they, you sign the contract, and they turn you loose for two, three years, and then hopefully they like what you turn in, and that's such a privilege. It's really… I mean, it's a little scary sometimes, but… Well, that, that kind of leads to my second question, writer's question, which I, when we, when we talked before, I think I asked you this same exact question, and I thought about it. I think this is a little, maybe it's an introspective question because as I said, I'm a big reader. I have been since I was a little kid. I started reading early. I always had a book in my hand or in my pocket. You know, I'm, I was one of those nerdy types, and to this day I, and I read a ton. And so I wonder, since I found you couple years ago, I'm trying to think of which was the first… Yeah, "Fuzz" was the first one that I read, that, that I read and that I ran across. Um- Who is your audience? And I, I'm not, and I'm asking you this 'cause I'm, I'm not asking in the way of, you know, are you writing for a specific audience. I know the book process. I know, you know, with an agent and a publ- all that stuff, there's gotta be a market. So d- do you, do you have a sense of who reads your stuff? Well, I do, because every time I put a book out, I go out on book tour. I, I do a, you know, dozen events or so. And, um, I, I would say it's a pretty even mix of men and women, and I would say it's a mix of ages also. It's really just kinda curious, quirky, smart people. They're just like, they're all… I mean, I love them. I don't know, every people who… Maybe it's a s- the people who come to my events are a specific subsection. Uh, some of them are scientists, some of them are in Health care, some of them have nothing to do with any of that. Um, they're often delightfully nerdy, but not necessarily. Uh, they like to laugh and they like to learn, I guess is, uh, you know, they're kind of… Like, I have this sense of it being kinda like, did you ever see "Being John Malkovich" the movie? Yeah, of course. Of course. There's that scene where he's looking at a restaurant and everybody in the restaurant is John Malkovich. So I feel like they're all like, it's kinda like a bunch of Mary Roach types, I guess. I, that's, I don't know. So I don't, I don't know that there's a… It's not a demographic that you could identify, you know, like women 18 to 35 or, you know, it's not, it's, it, it really is a kind of a age-wise and gender-wise broad spectrum, as far as I can tell. Hopefully it's a, it's a love of, a love of reading, um, reading good stuff. That too. Yes. Yeah. And I, and I thought about it, uh, you know, your stuff, ugh, I, I hate to do this to you, Mary, because I'm sure as a, as an author, as a writer, you never wanna hear this kind of stuff, but I'm gonna do it anyway. Y- you remind me a, a bit of Bill Bryson in the sense that- … um, he's one of my favorites. Me too. And I- Me too … and I, I've, I've, I've re- I've given and, and/or recommended "A Short History of Nearly Everything," "A Walk in the Woods" to I don't know how many people. Yes. And he has a gift like you have a gift. Um, and I think the connection is, I wanna hear what you, your sense of this, but you're able to make people laugh, but you're not a David Sedaris type. You know, you're not a humorist. You m- you, you can make people laugh with sometimes very difficult material to understand or uncomfortable, I mentioned this earlier, uncomfortable information in some place. You led this off talking about a finger, using a finger as a penis, so thank you for that. Uh-huh. It's still- No problem … it's still on my mind. Um- Is, is it a… So is that a, a tool that you use or do you think it's kind of a natural, like, extension of your personality and that's just kinda where you go to and the way that you, you interact with people? I think it's the latter. Um, I am pretty guileless when it comes to like, how should I write in order to reach the broadest audience? And I'm not doing that. I'm just like, this is sort of how I see the world. It's what I'm drawn to, first of all, and then the things that I zero in on and the things that either excite me or amuse me, uh, that's what, that's what I'm working with. Uh, but I mean, the Bill Bryson is one of my f- favorite nonfiction authors. I tried to get a blurb from him for like five books in a row bec- I was like his stalker, I would like say. I found out his address in England and I'd send him a book. Yeah. He finally wrote back one day, um, with a lovely note and a book, but no blurb But, um, yeah, he, he's, he-- S- similarly, he's very good at explaining things, and he's very f- he's got a wit and a point of view that's, um…"Thunderbolt Kid," that's just one of my favorite memoirs, "Life and Times of a Thunderbolt Kid." Oh my God, he make, you know, he had a happy '50s childhood. What are you gonna do with that, you know? But he, but he had enough reporting about what that era was like and what was going on, and there was enough detail in it. It was just ch- utterly charming, and you still learned something. Yeah. So, so it's not, um, I, I think I'm just being myself, uh, on the page. And, and I was lucky enough to have an editor from the beginning who didn't uh, try to rein that in, uh, which I thoroughly expected her to go like, "Oh, this is a little bit over the top," or, "I don't know about this humor with the…" You know, she's like, "Okay, we're gonna put it out there, see what happens." Well, that's, you know, when I… Eventually, I think what inspired me to, to reach out to you was I, I, I was probably the last person on earth to see your TED Talk- … um, which is, which is, which is wonderful.'Cause I, I'd, I'd read your stuff, and then I came across this on a top 10 list, and I was laughing hysterically, and I thought you would say the latter. I was glad that you did because it just, it feels like you're, in a very good way, you're just kinda talking. And, and the footnotes. The footnotes- Yeah … is where, like, a lot of the gold is. I love that. I know. I- I know, and I'm always afraid that people are gonna, like me, skip the footnotes. That should have, like, a warning, like, "Do not skip these footnotes.""This is the best stuff." Uh. Well, it's true with, like, uh, David Foster Wallace, right? I mean, he's the f- he's the f- he was- He's the guy … the f- the footnote guy, and, um- Yeah … and I, and I'm, yeah, still finally, I'm like 300 something pages into"Infinite Jest" for the third time. I j- I love his writing, but I just, I can't seem to get through it. I've tried to reframe it in my head as like, this is a bunch of short stories and… But I'm thinking about my audience, and you'd mentioned in your book tours you see Health care people and doctors. Did, d- do you ever… Or rephrase this. What would you want Health care people, if anything, you might just say, "Oh, it's part of my audience." Would you want doctors or Health care administrator type people, would you want them to take anything specific away from this book? Which is, as I said, a delight. And while it's not really implicit in, in the book, I guess what I'd like to say to them is just to express some gratitude, because I think that people, whether it's books or Health care, people tend to dwell on w- thing- when things go wrong, you know? It's a, it's a, like, the, the conversation is all about, "We need to fix this," and, "We need to fix that," and, you know, it's like so much goes right, and there's so much good done for people, um, by Health care providers and the people who come up with drugs and devices. And, and so, y- you know, it's like somebody wrote a humor piece about Being on an airplane and the Wi-Fi went out, you know? And it's like, and the guy's like, "You know what?" It's like you're, you're able to send email most of the time on a plane. Like, be grateful. Shut up, you know? So, uh, I guess just, you know, like I was saying before about OPOs, there's been a lot of stuff in the press about things going on in that world that aren't great, and it's like, but let's stop and say, "Hey," when things do go well, which they usually do, let's acknowledge that and, and say thanks. Yeah. Well, thank you for that. And, and along with that, I said it was gonna be the easiest, maybe it's the hardest. What, what's, um- Okay, I'm ready… what's-- You can't, you can't say your own, but for Health care people, what's one book recommendation that you think Health care people should read this book? Can't say your own. Oh, no, no, no. Um, I'm gonna say, well, you know, there's one that I, I'm ashamed to admit I haven't read it, but my husband loved it, and it seems like it, it seems like a book that anyone in Health care should read, which is "Being Mortal," Atul Gawande. Um, yeah, uh, and shame on me for not having read it. But that, that seems Like, that'd be a good one to read. Um, I don't read, I don't read a ton of-- This is like, I shouldn't even admit this. I don't read a ton of science and health books. I write them, but I don't read them. Um, I'm trying to think. You know, there's some wonderful hi- uh, history, histories like the, um, uh, Lindsey Fitzharris writes, uh, she wrote a profile of Sir Harold Gillies or Gillies, the guy who pioneered a lot of the facial reconstruction after World War I, I think it was. Uh, uh, she also wrote about, um, I'm forgetting his name, that famous surgeon in the 18- the guy kinda like pioneered surgery. Uh, like, it's embarrassing. I can't remember his name. It's called the… What is it called?"The Butchering Art." Uh, it's a history of surgery. That's a good one. It's-- Atul Gawande is on the list. Do you hear that, Dr. Gawande? Um, I know you've been on Preet, you've been on other podcasts. It's time for you. Um, we would love to have you on here to talk about any one of your books. He's another… You know, it's interesting, um, there are some physicians out there that, whether it's kinda like their love, and they're really talented writers. He's one of them. Um- Yeah… uh, uh, Mukerj- Siddhartha Mukherjee- Yeah Oh my gosh, I can't believe- Yeah … I'm, I'm, I'm- "Emperor of Maladies"… " Emperor of All Maladies." Right. Which is amazing. You know, so some of them-- And I'm actually the nerd that, you know, I have, I, I read this. And I, I don't, I'm not a doctor. I don't have any medical background, but sometimes the essays that doctors put in "New England Journal" are Phenomenal Yeah. Yeah. The- You know what? There's a, there's a collection of essays, I think Jonathan Reisman is the author of-- Now, of course, I can't remember the, the book, but I mean, the, it's, it's got a beautiful cover of, like, a torso, and there's sort of flowers written in. But it, there-- He's a, he's a physician, and he's writing about different elements of the human body in a really smart, beautiful, original way. That's a good one, and I don't have the title for you. Uh, there's another book. Okay, I had to interview this guy, um, Harris, Richard Harris, I think his name is, and he wrote this book, um, uh, it's called the, it's called "Rigor Mortis," which is not a, it's not about dead bodies. It's about, uh, it's about sort of the thing that some not great things that are happening in the world of journals, uh, in terms of replication of s- of studies and the push. There's sort of a people trying to just have breakthroughs and not replicate things. Um, a lot of, you know, d- the different ways that bias creeps in. Just sort of a critique of the world of, um, medical journals and studies, and a really… And there's a lot of, fair amount of statistics in there. But, uh, I just felt like it's, it would be an important book for any science journalist or, or even a Health care professional to read. Just, just an eye-opener of, you know… And then, you know, the peer review process. I mean, it's such a time sink to be, like, to try to peer review a story. They're not paid to do it, and so they don't necessarily-- You know, people might not spend as much time as they should on it, and just, just, like, all these things that are going on in that world that need to be addressed. Uh, I thought that was a really good book, really an eye-opener, and he's very smart. He's an NPR reporter, Richard Harris. Yeah. Hmm. Well- That's a good one. And, and now I just made the link. Now I know who you're talking about. Um- Yeah. Not the actor. No, I, I know. Yeah, I, I know. No, I, I know who you're talking about. And, uh, and maybe there's, here's an idea. Maybe I do, uh, this really old idea,'cause I know people have been doing this for a while, but, like, a, like, a book club or something on our website where, uh, book recommendations. And you've given- Yeah … some good ones. I'd, I'd probably put "Being Mortal" at the, at least in terms of the ones that affected me, at the, at the top of that list. But, so Mary, this is awesome. I really appreciate your taking the time, kicking off this new series. I enjoyed it. I'm sure that our listeners will too. Um, and I don't know how we're gonna do this, but for-- I hope we keep in touch. Oh, it-- Thank you so much. This was really fun. I really enjoyed it and, um, would love to keep in touch. Um, Mary, thanks for, for joining us. Oh, my pleasure. It was really fun. And thank you for joining us on Health care Rounds. If you enjoyed this episode, please forward it to a friend and rate, review, subscribe on your favorite podcast platform. Positive reviews, of course, help people find the show. And remember, if you have a question for me you'd like me to answer or something relevant to this conversation with Mary, please send it to Health care rounds @darwinresearch.com. And if you're not receiving our take, Darwin Research Group's weekly newsletter, you can subscribe at darwinresearch.com. I'm John Marchica, and we'll see you next round.