Interview Interlude Playlist, Part 6: Mary Roach

we have, well, what is an unusual topic. We're gonna be talking about penile transplants, And we just wanted to say up front before we you know, dive into this episode that every time we've posted something about this subject, because there's been a lot of news about it lately, whether it's been to social media or we talked about it on like our live streams or something like that, it often kind of descends into these sort of like adolescent jokes, uh, And you know, we want to have

a sense of humor about this, but at the same time, like doing this research, it really became apparent to us like how traumatizing this is for a lot of people, and how important this proced JR. Is. There's some weird science to it, certainly, but there's a lot of people's

lives that are affected by this. Yeah, I mean we're talking about the loss of genitalia, the loss of a sex organ here, and that's that's a serious matter, and I think are our sort of conditioning is certainly in an American culture, in Western culture in general, Uh, are are conditioning to want to laugh, to want to make a joke about it? I mean, I guess a lot of that is coming from an area of just you know, you're uncomfortable. What can you do? What kind of what's

my response? I can make a joke and then I can fill that space bred of your anxiety or something. Yeah, And that's and that's understandable. You know, for the most part, I feel like everything is on the table when it comes to humor. But in in in researching this, in talking with our special guests today, it really became apparent that this unwillingness to seriously engage with with this issue has actually held back some of the advances that can

that that could help people who need it. Yeah. Absolutely, So that's a perfect segue into that. We were very lucky to be able to talk with Mary Roach for about half an hour about her upcoming book, Grunt. In particular, there are two chapters in that book that are about

penile transplant surgery for soldiers. Uh. This is a very real issue for American soldiers coming back from overseas in particular who have been damaged by i e. D. Explosions UH, and the military's UH wing of doctors are trying to figure out what to do with that, and Mary consulted with a lot of those. But then there's also like a good like ten year history now of the science of penile transplants for everything from these wounded soldiers to

cancer victims. And then also, as we'll talk about in South Africa, there is ritualistic circumcision that leads to penis is essentially falling off right and and and it's the situations where it's not full on penal transplant. I mean, we're still still dealing with with euro trauma. You're dealing

with plastic surgery to correct injuries to the genitals. UH. And that is and and some of that science actually is what was we end up discussing ends up stemming from gender reassignment surgeries and advancements that have been made in that area. Yeah, And so a little bit of clarification to about like the conversation and then the like sort of turn of events since we recorded the conversation. UH,

Mary's book was coming out soon. It should be out this week grant the Curious Science of Humans at War, and we actually interviewed Mary a couple of weeks ago in preparation for this, and since then, on May sixteenth, the first US UH penile transplant was achieved UH, and it was announced in the New York Times, I believe, UH and actually here at how stuff works. Our colleague Lauren Vogelbaum wrote an article and recorded a video about that.

By the time you're hearing this episode, that maybe like two or three week old news. But when we recorded the interview with Mary, it actually hadn't been announced here. So we were focusing primarily on the research and transplants that have been done in China and South Africa, as well as what Mary had experienced in her research with military medicine right, and some of the depending um advancements there,

like some of the procedures they're working up too. So yeah, just keep that timeline in mind as you listen to the interview, and you know, nothing's actually broken in the interview, just keep in mind when it was recorded. So we're gonna play the interview now, UH and let you hear our conversation with Mary about this fascinating topic. And then when we come back after that, Robert and I are going to go over the brief history and the science

of what's going on here with penile transplants. Well, first of all, thanks for taking the time out of your day to chat with us here. UM. We've we've really been in going uh reading Grunt and UH and in the past I've been a big fan of I think I've I've read all of your previous books, Stiff, Spook, Gulp, Packing for Mars. Uh. So anytime I'm Mary Roach book comes out, we get excited. There should be some kind of special I don't know, bracelet or metal or something

that you get if you've read all of them. Very few people have read all of them. Thank you, Thank you. With this particular book, I guess the place I want

to start is UM. I was particularly interested in the two chapters concerning euro trauma, genital reconstruction, surgery, and genital transplants, because I mean, there's the I mean, there's the morbidity and the squint, the squeamishness of the topic, but it ultimately provides some some you provide some powerful insights into the place where science and and to a certain extent, the war machine itself has to try and stitch everything

back together again, both physically and psychologically. Was this a challenging subject matter to undertake? It was, Yeah, for just the reasons that you've just mentioned. It's it's it's a sensitive topic. And I'm not known as a sensitive writer. Uh if you're familiar with my book, but it's, um, yeah, I think that because it is sensitive, people shy away from it. And I feel like it's important to talk about it, and so does the people who do the work.

Because somebody's sexual health and sex life and relationships are in the balance, and that's you know, that's important stuff. It's you know, I mean, it's important to get veterans, wounded warriors whatever you want to call them, you know, mobile and walking and able to take care of data day activities and be back on their feet. But sex is important too. And um, a substantial number of these men say injuries that do that do go up that high. I mean it's a it's a it's a fraction of them,

but still enough that it's it's important to talk about it. Hey, Mary, this is Christian Sega, the COEs to the show to piggyback off of what Robert was just saying, I'm particularly interested here in the cultural and identity connections that you remarked on regarding penis reconstruction. And i'd like to know, you know, from the research and from the people you talked to, how much of the repair part is actually psychological. In particular, I'm thinking of the example you gave of

men who are worried about having to sit down to urinate. Yeah, that's there is a cultural um. You know that what you're talking about is a euri thrust. To me, I believe I'm saying it right. Um, wherein if it's it's one option, if rebuilding the euretra isn't possible or doesn't work, you can take what remains of urethra and make an opening in the Paraneum. Okay, however you pronounce it. Uh? And then um, the the person would sit down to urinate, you know, as a as a woman does. And um,

I asked. When I was in the operating room, I asked both the surgeons. They're like, how but how much of a big deal is this? And one of them said, well, you know, when you're talking about you've lost one part of one leg, and you know part of one hand, and you know, this is not a big deal. The other surgeon looked at me and said it's huge. So

there's a difference of opinion there. But um, yeah, obviously it's I think it's And then she went on to say that she'd been at a neurological conference in Europe. It was a World urology conference, and it was very cultural. They were, she said, the Italian surgeons are like, are you kidding me? No, you know that that seemed to be, you know, an affront to masculinity. Other cultures were, you know, it was less. It seemed like less of a big deal. So, um,

you know, as a woman, it's hard for me. That's an interesting thing. You know. There's sometimes, you know, every now and then that men who are like, yeah, I sit down the toilet because you know it keeps the carpet cleaner, where my wife likes me too, And and then there's other men are like, you sit down on the toilet to peace. So I think it's both cultural

and personal. It's an interesting topic. So they're incorporating therapy into this then as well, I would assume, um, therapy is this is an area of sex, sexual health and intimacy counseling is is an area that I think the government would do well to dedicate more funding too. At the time I was at Walter Ree, there was not

a full time staff person doing just that. You know, there's a sense that, um that that you know, we only have so much money to go around and this, you know, sex is it's LIFETI this is this lifestyle. You know that this is not going to be a

priority for our taxpayer of dollars. And there are people at Walter Root who work with these patients who feel like this is really important, Like, yeah, it's important that they walk, but it's also important that they be able to have a sexual relationship that isn't fraught and that you know, and that and that once you know, once you come out of these operations and you know, there's just a lot of things to adjust to and and you know, how do you use this thing now that

it's been reconstructed or you know, whatever has been done. I mean, and it's not just with reconstruction and transplants. It's also, um there's a lot of heavy medication that goes on, especially in the early months after an injury. There's nerves stabilizers and antidepressants and pain meds, all of which can affect um a man's ability to get an erection or to keep an erection. And that's you know,

that's that's also should be part of the council. And there are people there who do it, but there there need to be more of them. Yeah. So I'm going to jump ahead a little bit here because that you connected right to another thing I wanted to ask about, which is this idea that that sex isn't as valued financially as walking, for instance. And so I'm curious from your experience researching this book, do you think the fear of just sex talk in general is preventing us from

making strides in health sciences. Yes, I think the part of part of it. I mean the woman that I um that I spoke to, Christine Delorier, who runs the Wall to Read. It's a sexual health and Intimacy working group and it's something she does on her own time. There's about fifty people who get together and share resources and who've been working in this area. And that was what she said to me. She said, this isn't just a budget issue. This is the government not wanting to

embrace sex, and and not just out of prudishness. I think just as it's out of a sense of you know, we we spend taxpair dollars and you know the way that taxpayers want us to and and that sex is perceived. It's certainly, certainly certain segments of the population. You know, that's that's not perceived as a worthy expense. You know that that is uh um, yeah, it's it's it's considered

lower priority. And yeah, I think it is. It is in some way tied in with kind of a not a prudishness, but you know it to be spending taxpayer dollars promoting sexual pleasure, you know, it's it's it's treacherous grounds in terms of getting negative media attention or what

have you. But it's also you know, I should also say the number of I mean, if you look at the number of veterans whose injuries have left them in need of surgery or infertile or what have you, it's a small percentage because most I mean most of the injuries in the lower part of the body. It's the foot and the calf and below the need higher up you go to the less frequent. These injuries are so

something like three genital ural euro genital. However you want to um term it injuries for something like a hundred and fifty thousand amputations or sorry, sorry, so I know I think it was it's three D genital eurological patients very eighteen thousand limb amputees. So it's it's a it's a lower priority in that sense, and you know that's when you're looking at a budget and where to spend the money. That's also part of it. So it's not just squeamishness regarding sex. But I do I do think

that probably places a factor. Yes, But as you you point the point out in the book, and this I thought was the really important factors. Just we are our medical technology has has reached the point where more soldiers are surviving the sort of injuries that would in previous uh decades would have just killed them out right, but now just surviving with more grievous grievous injuries. Correct, Yeah,

that's right, Yeah, exactly. The I E. D s have gotten larger, so the injuries are going higher up the limb and to the extent where they're affecting the genitals, and that used to be a fatal and you know that size of an explosion you used to be a fatal injury for the most part. That if you if you're hitting the level of someone's hips, you're also going to be damaging organs and so so that's a a very serious injury. And yes, these patients are now surviving

more than they used to. But not only are the injuries, the explosions are getting bigger, but also the ability to keep these folks alive has it ANSWD a lot. So yeah, there's there's there are more people surviving to need this kind of surgery and counseling. So, Mary, I'm curious in the conversations you had with medical professionals about this, how much did they acknowledge the contributions of fallow plastic from

the transgender community as contributing to their work. UM that one the very first conversation I had was someone at UM. It was a meeting I had It uses the Uniform Uniform Services, University of Health Sciences, and that first person that I spoke to, UH, that's what he said, some of the you know that these are techniques that are stemming from work from transgender work. I mean that it

makes perfect sense. I mean that is what has pushed the advances in rebuilding building a penis from various other pieces of anatomy. That's where the demand has been, you know, I mean it started out with war injuries way way back, but the very early on one of the first you know, I think one of the first cosmetic surgeons who started. I think you're doing rebuilding noses, etcetera. I think one of those, um was a was the very first transgender surgery.

You spent a lot of time with Dr Richard J. Read It at John Hopkins discussing the continued efforts to conduct the first successful penis transplant in the United States. Um, you know, where are we currently in that process? Yeah,

right now as of a lot of last week. I checked in with him, and there's a recipient that's been identified who uh And they're trying to find a suitable match because it's a it's a you know, in addition to all the other things that you look for with an organ with organ transplant, in this case, there's skin color. And I mean that's the case is similar to it, you know, like a hand transplant or a face transplant. But anyway, they're they're they're trying to identify a donor.

And I'm not sure how much of it is. Much of it is is also the discomfort that the family might have that I don't know. I don't know why things are white, why it's been slow to happen, because as you, as you point out in the book, the first procedure of this sort took place in Guangzho, China,

back in two thousand six. H Yes, And of course that, as you point out, that did not exactly that was not a successful surgery in the in the long run, the this this early attempt at it, though, does that do you think that speaks to anything culturally about a more you know, a more openness to engage with the sexual questions involved here, or is it just uh, you know, more eagerness to h to carry out the endeavor. I mean, probably more the latter. I think probably um more eagerness

to plunge ahead and be the first. And you know, in this case, it was they claimed it was a psychological issue, but two weeks later that removed it, after having transplanted it there, they removed it, and they cited a severe psychological problem, but they didn't elaborate at all. And I wasn't able to get in touch with They didn't respond to emails, so I don't know. I don't know exactly there was some necrosis, there was some and

the and they didn't attach all of the same. And I believe that the cavernosal artery, there's a there's an artery that the U S. Surgeons are planning to hook

up that. I believe that they didn't, so that what there was in the China operation, But a lot of it is speculation because there hasn't been a lot of open communication between the Chinese surgeons in the in the U S. I mean, I wasn't able to get a lot of details about that procedure, only what is in the paper, which is that the there was some psychological distress and it was removed and it looked like the U. S. Surgeons told me that from looking at the photographs, that

looked like there was some necrosis, some tissue that was not being receiving blood and getting oxygenated, and that that um may have contributed as well. But you're asking why did they go ahead so quickly? And I think that just maybe a yeah, I desire to go ahead and give it a whirl and be a little less perhaps a little less cautious, and a little less inclined to

work out all the details. I don't know, I'm not sure. Well, I hesitate to call this a lighter note, but Robert and I were both very interested in how a rectile tissue can be constructed from the sinuses and also from mouth tissue. Can you speak to that a little bit more? Like? Why is it so good for reconstructive penile surgery? Uh, cheek, Yeah, but for rebuilding a euresra or part of a urethra. And this is, of course a tube that is transporting liquid um. The the inside of the cheek is good

because it's it's used to moisture. It doesn't doesn't steriorate in moisture, it doesn't break down, it's it's it's evolved to be wet all the time. And if you just use skin, uh, you can end up with um infection and fistulas, which is when infection kind of eats through, uh to the outside, and you have sort of a tube going off where you don't want it to the other thing. Uh. You want you want a patch of tissue that for the penis or the eis. You don't

want hair growing on it. For there three, you don't want hair because there's minerals and urine which can collect and build up on the strands of hair, and that can cause problems. You get little calcls, little stones basically. Uh So, the cheek is advantageous in two ways. It's it's used to moisture and it's hairless. You know, the um for rebuilding a penis they tend to use. You know, the underside of the arm doesn't have hair. Also, that behind the ear is another little strip there that is

a little careless stretch. Um. And in that case, just you don't want a penis probably right. I mean can't I can't speak. Yeah, So anyway, that's that's why those particular um patches of tissue are selected. Yet in reading you some of your past books, I've often found this pattern where they'll be like a section of one book and then uh in retrospect, you can I sort of look back and see like, oh, that's maybe where she

got the idea for the following book. Um So, so I had to ask, when did you decide that Grunt was your next book? And if we look back into previous books, is there a particular chapter in a previous book that that basically gave birth to this volume. No, you have to look into the pages of Smithsonian magazine and you even then would never be because it was a story I had to do with the world. But

as chili peppers which are grown in Naga land in India. UH. And while I was reporting that Piezz, somebody told me that the Indian Defense Ministry had basically weaponized this chili pepper and made a kind of tear gas or mace with this uh, with a nature's own tear gas. So I felt like I needed to report on that. I went over to the neighboring state of Asam, India, and they went to this lab and while I was there, I just there were a number of projects going on

that struck me as kind of fascinating and esoteric. There was a leach repellent project going on, and I remember that was the moment where I thought, oh, military science, there's this whole world out there of things that uh, I have nothing to do with building better weapons. There's there's just there's it's a whole world of the kind

of stuff I like to report on. There's a lot of biology and um human related science that goes on in the name of keeping people alive, which is I also liked that it was as kind of counterintuitive for a military book. It's not really about so much of what you see is about the technology of weaponry and bombs and high tech lasers and drones, et cetera, so that the human side of it seemed just it seemed to fit in it. But anyway, it didn't grow out of anything in any of the earlier books. It was

from a story I was doing in between books. Yeah, that's interesting for us because we just maybe a month or two ago, did an episode on the history of the weaponization of animals for military purposes. So it was really nice to see in your book, like the flip side to it where it was more of the like healing function that all this you know, d G research goes towards. Did you cover the I saw something about about owls. Did you cover that one where the coast

Guard wanted to use an owl? No? No, look for uh yeah, that was anyway, but that's not weaponization. That was more like almost more like a cadaver rescue dog. It was. We've talked about going back anyway doing a second episode where we talked about the use of animals and more like spying, surveillance, you know, other other uses aside from just killing people. I think the craziest one we got into was the bat bomb. Did you ever

hear about that during World War Two? Yeah? I did. Yeah, I almost put it in the book, but I thought I had to remind myself that a little off topics. Yeah, were amazing, It's totally insane. So how does science and sort of generally speaking, and you know, I know your experience, how does science that orbits military endeavors, you know, not necessarily the weaponized stuff, but the stuff you've covered in this book, How does that How does it differ from

other areas of science and scientific research and inquiry. Um, It's well, it's an interesting mix because they're there. There's a whole world of kind of science that gets funded through DARPA, which is very um it's with an eye to the future. And then like, for example, there'd be

UM and I didn't. I didn't do cover a lot of darper stuff, but I was fascinated by it because it was it would be so idea of like, you know, well, how can we with a what's a way to make you know soldiers, you know, more effective and better at what they do. Wouldn't it be great if they were away where they could not be sleep to provide so they could be they could sleep but have what kind of one eye open, like be partially looking out for things um and but still sleep and not get sleep deprived.

And and so they were looking at animals, marine mammals and also some birds that have UM one that are awakened with and in one hemisphere and a sleep in the other. Like there are there are geese and ducks that can you know, they have sleep in a group in the one on the perimeter, will sleep but also be watching out for predators. And so there's there's some um biologists or zoologists who have gotten funded by DARPA

to just to study unique hemispheric sleep. So that and you'll you'll look at this paper and they'll think why is DARPA funding Like oh okay, they're looking forward to the future, like how can we make this kind of invincible modulated soldier, Like what what could we do to the sight soldier to make him or her more efficient, more awake, uh, just less of a human and more

of a fighting machine. So there's that very strange world which I didn't spend much time and I just sort of would come across the papers and go, WHOA really surgically installed gils? Really? So that's that's sort of futuristic

surreal stuff. And then there's, um, there's just a tremendous amount of work that kind of goes on under the a R. That's just you know, like the Naval Submarine Medical Research Lab, which is just you know, looking at sleep deprivation and you know, air levels and and and the you know, the various things that people deal with when they're out on a submarine, and um, how to sort of make that existence better, more efficient, healthier, etcetera.

So but there's like that work goes on and has gone on and just is not it's kind of um invisible. I mean it's not that it just doesn't get a lot of attention, and it's you know, it's it's heartening to me to see that that's there and that the people that are doing it are very committed and dedicated and caring. You know, the reasons ultimate reasons some of

this work is being done. You know, when you get right down to it's like how to make soldiers better at what they do and keep them alive so they can keep being soldiers, which is less sort of heartwarming, but take it down to the level of the actual scientists, and they're really caring people who are very dedicated to the lives of men and women who are serving the military. And that's so so it was anyway, I don't know

if I answered your question. No, No, that's that's exactly what I was wondering, just sort of the the difference, you know, what what the energy of the research is like as opposed to like non military research. Uh so, yes,

I think that's that That answers the question perfectly. I can only imagine you're getting a lot of interview questions about the euro trauma and the pianot transplant sections of the books as we ask you and I and again I want to stress that I thought you handled it just perfectly with you know, utilizing the the expected Mary wrote voice, but also you know, handling some potentially delicate

subject matter. But can you tell our our listeners and readers about something that you explored in the book that's getting less coverage that maybe you wish more interviewers we're asking you about. Well, I'm actually you know the book. Since I'm talking, I'm talking to you a month before the book is out, so you are really among the first folks that I've spoken to. I've done um, I've done some q and as, and to be honest, this is the first time where I've talked in much detail

about it, probably because there just haven't been many interviews yet. UM. But UM. And it'll be interesting to see whether this is something that people focus on or whether they'd rather leave it alone because it is you know, it is sensitive and it's UM there's a level of discomfort with the conversation and with I guess how listeners, readers, whatever, will react to it. And so I think I don't know whether that will be discussed. I would think it

would be discussed a lot, but we'll see. Um, it's hard to imagine it coming up like the late night talk shows. Yeah, depending on who's um, yeah, well or or I was thinking more like you know CBS Sunday morning or the morning mainstream TV, you know, while people are having their breakfast. Yeah, we really gravitated for that section. It just I think it felt like it fit the voice of the show. The whole book did. But this in particular. We were like, that is something we can

make a whole episode around. Oh yeah, I agree, I mean I think. I mean, there's two chapters in the book, and I had originally planned one, and um, then I heard about the transplant that the the folks at Johns Hopkins working towards, and then I obviously wanted to cover that. I mean partly because I'm Mary Roach and that's the kind of thing I covered, but also just how could it how could I not want to cover that. It's it's just really interesting because it's it's it's it's Tara

incognito for for the transplant. You know, the face face first face transplantment tremendously compelling to people because it's, you know, we've we've left behind the world of organs are they're hidden. You don't really look at somebody and you think, okay, they've got a new liver. That's great, But that doesn't have to say there's not a psychological component that's as kind of immediately fascinating. Yeah, I feel like a lot of this research to just like strays right alongside like

some borderline science fiction pop culture stuff too. You know, like when we're talking about these sleep experiments. Thinking about Robert and I have done episodes in the past about like people speculating about all these myths about theoretical Russian military sleep experiments, you know, and then like, of course, you know, you just mentioned the face transplant thing, and it brings to mind that with that nineties movie Face

Off where they swap face. Yeah, you know, and it's it's this is exac Yeah, and people have been thinking thing about it in sort of silly terms for a while,

but this has some very serious real world applications. Yeah, and the fact that the immuno suppressive regiments have have made tremendous strides, And so now you can do something like faith transplant, which because it wasn't because it wasn't matter life and death, people sort of shied away from it because the burden of the drugs that you take to suppress the immune system so it doesn't reject the tissue um that that seemed, you know, it was questionably ethical.

Do you put somebody you should you put someone through the risks and inconveniences and problems of this very heavy immuno suppressive regiment just for a faith was not a matter of life and death. And now that they know with marrow infusion and other advances and immun suppression. Now it's it's that's kind of falling away, and it's, um, they're they're transplanting whole arms, They're transplanting faces and you know, now penises and probably at some point legs, although legs

are problematic for various reasons. Uh, and and because um there's they're also at the same time making great strives with prosthetics. With prosthetic Yeah, so, um, you definitely want to You're a leg transplant is not going to be the best option for a very long time, I think so. But then yeah, this is the guy and Eleeve is talking about a whole body transplant or what is sort of commonly talked about in the press as a head transplant, but really the head is the person. The transplantation is

the whole body of the brain dead person. So and there's some guy in Italy. I don't know how much of that is bluster and how much of that is real, but he's talking about, oh, yeah, I've got a patient and I'm ready to go, which I can't even imagine because that, um, there's so many unknowns with that and so many potential problems. I don't know, and I haven't spoken to him, But anyway, this whole Frankenstein science fiction realm is rapidly coming to be not science fiction, and

it's it's fascinating now. In all of your books, I've I always enjoyed the footnotes so much because there's always they're always these little little nuggets of a fascination that kind of spring off from the main material. And and in this one there were several great ones, but that the rabbit eye transplant by one Dr H. Bradford, that one really floored me. Were you able to learn much

about this? Just it was in the paper? You know, I couldn't interview him, he's long gone, But that was so like there were so many things that fascinating me about that. First of all the fact that rabbit eyes are very similar to human eyes. If you go on the internet, you can sort of verify this, and I don't really recommend that because when you do the search, this weird thing comes up about a guy who was selling a box of rabbit heads um anyway purposes. I

don't know why. They seemed like he was offering a pretty good deal on those, right, But no, and I was like, well, somebody transplanting eyeballs, why would you want these rabbit heads? What are you doing with them? But and he was like, make me an offer that. But anyway, see this is what happens when I got on these tangents. But the UM, Yeah, but there was some It was

some guy who he was. He was a sailor I think where he was anyway, he worked on ships and he um for some reason that was there saying well, Lett, for that reason, we you know, a glass eye won't work. I guess it was an occupational issue. So they wanted to do something that wouldn't break when you were hitting your in the face or something. And then I thought, well, you have pirates have eye patches, so maybe there's a there is a high level of ocular injury on ships.

I don't know why. Anyway, that was what the reason they gave for why they were going to do this. UM. And of course I should point out to listeners, Um, the eye this is just it was cosmetic. It wasn't gonna be hooked up and you would be able to the person couldn't see because there's never been a successful eye transplant because hooking up the eye it's a much more complicated. It's insteadily hooking up a telephone cable. You know,

I'm talking about the nerves here. You're hooking up, you know, a complicated computer system, and the body doesn't know how to regrow and reattach and make it all work again. So the there hasn't been an eye transplant other than this cosmetic eighteen what was it ninete early nineteen hundreds. I don't have the date handed yeah, yeah, yeah, So other than the guy who tried to do it for

transparent reasons, yeah, there hasn't. There's there's not any but nobody else's transplanting eyes rabbit or pop or otherwise or otherwise. All right, well, you know those were our main questions for you here today. Uh again, thank you for taking time out of your day to chat with us. UH greatly enjoyed the book, and we certainly encourage all of

our listeners to go and pick it up. Um when this episode comes out, it should be available and all the physical and digital um ways that one normally acquires a a good book. Well, thanks thanks so much for having me on this program. Thanks once again to Mary Roach. Again. The book is Grunt the Curious science of Humans at War. Thanks to Mary for coming on the show and chatting with us. We're gonna take a quick break and when we come back, Christian and I are going to discuss

the topic further. So, well, let's back up a little bit. We've had myths and legends of penis loss and probably replacement as well, to go back pretty far. It's the sort of thing that's likely lost in the midst of history. I mean, the myths of are full of castration and um penectomy accounts with a with a primordial castration of the god urine Us being one of the big ones.

And I've I've read various the European tales that have involved which is, stealing men's penises, sometimes hiding them away in trees, and then uh, sometimes the men are able to steal the penises back and they are somehow magically

reattached the body. So and this is probably like a legend that is deeply seated in psychological fear of you know, as we're gonna talk about that, there's like a real deep psychological cultural connection to your genitals, of course, but um, yeah, something like that seems like, you know, it's sort of pre lorraina Bobbitt style, like fear of the woman's stealing

uh manliness. Yeah, and even then there has there's like a sense of humor and uneasiness, unwillingness to like confront the horror or in terror of it and therefore wrapping it then in the in something a little more whimsical. And then as far as just simply as far as just simply reattaching a penis that has been uh cut from the body. UH penis reattachment surgery has been around

for a little while. Um. In fact, Dr Surasak Moon Sumbat of Thailand actually became something of an expert in it uh during the nineties due to an upswing in such attacks on philandering men um by their wives um and transplanting you know, one's own member back is challenging enough, especially if said member has been fed to a duck, which was apparently the practice at the time. I wonder why, in particular a duck as rather than any other animal.

That's something we should look into, that would I would be curious to see what the sort of cultural implications of that or just the ducks are around. Maybe they're just plentiful. Yeah, Well, if you out there. No, let let us know about that. Yeah, I mean, maybe it's a worse fate than a fish. I'm not sure, but

certainly it's one thing too. It's complicated enough involving microsurgery to to to put one penis back onto an individual, but then to transplant another's member, that's a more complicated scenario. So before we get into the like real nitty gritty specifics about how these penile transplants work, I think it's worth doing just like a brief overview of organ transplantation in general, because a lot of the same stuff applies here.

So uh. To start with, researchers originally had success in early twenty century with transplanting organs in animals but not in humans, and that they were basically they had a lot of failures. They could not make it work until the nineteen fifties when the first kidney transplants started to work out. And this is important because it was saving

lives in these instances. These are organs that people need to live, right, kidneys, hearts, uh, And so they need these transplants and oftentimes even today still don't get them because of the availability. And that's something that we're going to talk about as well, but um genitals were kind of off the table. Nobody had been able to pull that one off. Uh. And the problem here is that the demand for organs, with all of the diseases that are affecting us as human beings, way outweighs the supply

of the actual organs. There's just not enough. UM donors can wait for years. Sometimes they die while they're waiting. Uh. And we're talking about thousands of people here. This isn't

pano transfers, which just organ transplants in general. Uh. And even though here in the US, people in general favor organ donation, right, Like if you walk up to most people in the street and ask them, I'm sure they would say, yeah, sure, I would you know, after I pass away, get my organs a science or something like that, right, or or to somebody who needs them. But actually only a small percentage of people do this. They actually go

through the procedure of filling out the paperwork for it. Uh. Uh. This is how serious it is. Sixteen potential recipients die every single day from something that's totally curable if they had transplants. Uh. And then we're also obviously looking into artificial organs. You're hearing a lot about this lately, not just in bioengineering, but then also with like the advent of three D printing, what people can do with that, right, the creation of the necessary scaffold thing and then the

growing of tissue over that to create a suitable replacement organ. Yeah. So Uh. In the cases of organs that are super sensitive, like your heart, your lungs, and other sensitive organs, transplantation is actually like the last resort, Like that's the last thing that they wanted to But here's the process of how this works. And it's essentially the same for penile transplants. Uh. A patient finds a willing donor. Uh. Usually it's a friend or a family member, but what they're looking for

is a match, somebody that can go directly into surgery. Uh. And a small number of the transplants come from general donors, of course, people who who you know, have filled out their organ donor cards or whatnot. But many of these have to come from dead donors, and oftentimes we're actually

talking about brain dead donors, not physically dead donors. That's kind of the I guess, the ideal if you want to say, a situation, because the body is preserved with life, but there is no more mental capacity in the creature exactly. And it's incredibly complex going through the process of getting permission to get an organ from somebody who's technically still alive but who's brain dead legally. So it's so complex in fact, like we don't have time to go into

it on this episode. And also, uh, you know, give you the interview that we did with Mary, but if you really want to know more about it, I recommend going and checking out the article that's at how stuff works dot com about organ transplants in general. There's some good information there. The actual transplantation itself involves a huge

team of surgeons. Obviously there's a hospital involved, and they all have to assess the patient's attitude, their psychological condition, and especially their history with drugs, cigarette and alcohol use because that can complicate things as well. Compatibility in particular requires everything from your physical tissues and blood samples being able to match to how long the recipient has actually been waiting for this, right, So when it's a go,

you move quickly. Uh, you really hurry the patient into surgery, and then a whole another team goes and gets the organ from the donor. Now here's a disturbing little tidbit. Note that you can stash away overseas. Organs often come from executed prisoners, most notably in China, and there's an indication that because there are people paying for these organs, actually accelerated the execution schedules in these countries in order

to meet demand. So that's pretty disturbing. Post operation recovery usually involves a lot of medication and a lot of follow up hospital visits to make sure that everything is healed correctly. This is gonna pretty much last for the rest of your life. Um, and the reason why is because your immune system is going to see this new organ as foreign cells and it's going to try to attack it. So to minimize this, like I said before,

you try to match the blood and tissue types. But also the body is just naturally going to reject it unless you have like an identical twin hanging around and they're willing to give up their organs to you. So there's three kinds of rejection. Uh, there's hyperacute rejection and this is when like the blood type just doesn't match up at all, the antibodies react and really like this is the worst case scenario, because the recipient is going

to die on the operating table. Acute reaction uh A rejection rather is what we see most often, and this is when you have a normal immune response. It starts a few days after the transplant UH and basically our immune system UH it needs to be suppressed by medications so that we can go ahead with the transplant. The unfortunate side effect is it makes us susceptible to infection

and disease. Right, So sometimes they're they're trying at this new thing where they sometimes also take bone marrow transplants to produce white blood cells inside the recipient's body, hoping that their immune system will sort of be tricked into recognizing the new organ. The last kind of of rejection is a chronic rejection, and this is a gradual thing that that lasts over the course of months or years.

You may not find out until many years after the transplant that the you know, that didn't actually hold in. One note that I'd like to point out here too, is that these immunosuppressive drugs that we give the patients, they also have adverse effects over a long term, including cancer and kidney damage. So in some situations, the benefits may not outweigh the risks involved here. So let's get

to penises, shall we. Until recently, and like I'm talking like ten years recently, Uh, the only treatment for men was to construct a penis from the flesh of their thigh or forearm skin and basically plastic surgery reconstruction. Yeah. And so you take that skin, you add a penile prosthetic and it's got malleable or inflatable rods in it that make it semi rigid. Then you add a saline pump to this that fills it up, right, like acting like the um the blood filling up the tissue of penis.

And this has been around since the seventies is practice. Uh. This is a direct quote from one of the articles that we researched for this about this procedure. It said the aesthetics were crude and the penetration is awkward. Now, that can be said about most people's first that first experience is sexually true too. Yeah, so we do have

a sense of human yeah. Yeah, And you know, and I think it's also worth noting that it's it's look at imagining this scenario here, and certainly you can look up images and more, you know, technical documents on all this. It's easy to say, well, that sounds crude, and certainly that's no that that's no replacement for the tissue situation, but that is still pretty remarkable that that we were

able to accomplish this. This is a still surgical feat. Yeah, it gets back to what we were talking about in our Cyborgs episode, like the things that we're able to accomplish, like what makes us human, what makes us the machine, the cyborg nature of humanity. So I don't want to slite procedure at all, because that is an amazing feat. Uh. And then here's the other thing that made uh any kind of penile transplants really difficult and still does uh.

So I talked earlier about how just getting organs in general is difficult, right, getting a penis downer is even more difficult. The organ banks that accept other internal organs they don't even have like a field on their form for penises, right uh, And so they don't usually request these. It has to be done separately. In fact, in South Africa, families often flat out refuse. And this is going to be important because the first penile transplant was in South Africa.

But there's such an emotional cultural gravity to a request like that that most people just say no, I will not give you, you you know, my my dead family members penis uh. And in in the case of the people who did the first penile transplant in South Africa, they actually had to come up with a way to work around it, where they started constructing faux penises for the dead uh from the donor's skin to preserve their dignity in their graves and subsequently still be able to use

the penis and give it to a living recipient. Huh. Wow, that is that is that is crazy, you know. In um In Grunt Mary wrote his book, she points out that the cadavers that were being used in some of the not even actual transfort procedures, but essentially rehearsals for

an upcoming transplant procedure. Like those are situations where somebody's body was donated to science and they're you know, they're not about to you know, necessarily share the exact details of how that body was used totally, you know, in part because of the complexities of our our psychological um

attachments to these various parts. Yeah, who wants to know about like how their loved one was carved up and maybe mistakes were made on them or whatever, but the benefit is that it led to the successes that we're going to talk about next and some of the failures. So let's go back to a case that Mary Roach discussed in the interview. This was a two thousand six guang Show General Hospital in Guango, China. You had a forty four year old man and who had lost his

penis and they quote an unfortunate traumatic accident. That's about all we know. One of the is is we've already touched on in the interview this case, there's there's some material that is that is not as directly related to the reader. There's maybe some of that might be lost in translation, some of it's just maybe not provided. Um. Yeah, there are a lot of things about this particular case, and it's been ten years that are still vague to

this day. And when we talked to Mary, we sort of mentioned that, right Like I remember saying to her, you know what, what was actually up with that? And she said, as far as she could tell, it was necrosis. But we'll get there. So the lead surgeon on this one was one doctor who Wai Lee and so from what we know, the parents of a brain dead man in his twenties agreed to donate their son's penis to

this man who was damaged in this unfortunate traumatic accident. Now, the way that they did it in this Chinese procedure was they warmed up the donor's penis with an infrared lamp post operation, and this was supposed to increase the metabolic requirements of the organ instead of increasing the blood supply. Now, other doctors that have been interviewed about this particular procedure, they have said things along the lines of they think that what happened here and why it didn't work out

was there was inadequate psychological workup. So like with a lot of the procedures that we talked about on this show that are semi experimental, like say, uh, using m D M A to help with PTSD, right, it requires therapy as well. It's psychological and physical and not like just you're doing not doing body work in a car here, Yeah, exactly. Um. Now, in the particular case for the biological surgery here with this Chinese case, they could only use the local nerve

structures because the donor's blood vessels had actually been obliterated. Uh. And they re routed a blood vessel from his lower abdomen to his paraneum to connect it to this new penis. Then they connected the blood vessels and dorsal nerves, and then the urethra for urination and the corpus cavernossum for erections. Now, according to the Guardian, they thought okay, everything was a success. After about ten days he had a rich blood supply

and could urinate normally. But then the recipient and his wife came back in two weeks after the surgery and requested that it be removed. And as we talked about with Mary, nobody really knows the answer here, but we think that it's likely due to psychological issues surrounding the necrotian necrosis of the tissue involved. Yeah, I mean, of course you can't help, but wonder, like to what extent was this, how much of this was a failed reattachment surgery? Uh?

And then to what to what extent is it more silent psychological? Like is it is the is the version that everyone gets is it leaning one way or another that they decided to lean away from from blaming the science? And you know what kind of how was it portrayed in the media, and like you said earlier, how much is lost in translation when we bring it over to English speaking media. So there's a lot of confusion around

this case. But from what we know, uh, it was considered a quote failure because the man asked it to be removed, right, And we shouldn't discount that the psychological issues at all, because psychological issues involving transplants are not unheard of. The world's first hand transplant recipient a New Zealander by the name of Clint Hallam. He stopped taking his immune suppression drugs, uh, you know, by choice, and

then later requested that the hand be amputated. So and and this is often brought up as an example of well, they essentially they essentially tackled the problem like like like auto work, and they didn't they didn't take into account that, uys, you have to have all of this additional psychological support

as well. Yeah, this is incredibly gruesome stuff when you get down to the nitty gritty of it too, Like this is the kind of stuff that would make up like a Tales from the ript style story or something like that, like like he has a dead man's hand and uh, you know what I mean, Like it lends itself very well to to paranoid thinking, to doubt, and and I can't help but wonder two Like in the especially these earlier cases, to what extent was the were

they straight straight with expectations for the recipient? They're like, hey, this is this You aren't going to be this is not going to be a you know, a one to three fixed scenario. Right, It's not like you and as we'll talk about, you don't just walk out of there and you've got a fully functioning penis. It takes like weeks, two months to years to try to get everything working properly. And in fact, in the South African case, they were

surprised at how quickly things became functional. Well, let's look at that. The South African case. This is a two thousand fifteen and we're taking this is taking place at the Tigerberg Hospital in Cape Town, South Africa. Twenty one year old penile amputee who ust to his penis in a botched circumcision. And this is apparently pretty common. Dozens, some say hundreds of boys are maimed or die each year during traditional initiation ceremony. So these are not. These

are not infant circumcisions. These are coming out of a circumcisions. Yeah, he was eighteen when this happened. And these ritual circumcisions are basically the way that it goes is they're so tightly wrapped that it causes necrosis in the penis, but you know, without it even being detached, So his penis had to be amputated. Uh. This is particularly common in

South Africa's I believe this is Zosa speaking region. It's x h o s a. I'm not quite sure how to pronounce that, but let's say it's Zosa uh speaking region of the Eastern Cape. Uh. And it's so it's a rite of passage for young men. They actually attend circumcisions school and they're instructed in family values and sexual education there. Uh. There's also high prices that are charged for this procedure. So basically they take the penis, they wrap it at its base to stem the flow of

blood up to the foreskin. Right, some men actually die because they won't go to a hospital because they're they're afraid of being ostracized after revealing that their gangarinus penis has fallen off. So there's such a strong psychological cultural connection to this thing that it's leading to people dying. Uh So yeah, so South Africa seems like an ideal place to to start getting a prep team ready to go for the first penile transplant. Uh. And the lead

surgeon here was one Professor Andre von der Murwi. So when the recipient recovered, he actually had to come back in UH and drain a hematoma and repair a small fistilla in the urethra. And now here's the thing. They expected that it was going to take two years for him to be fully functional. It only took three and a half months. Uh. And the surgery itself, it took four years of clinical and ethical therapeutic preparation. They had to work with cadavers and practice. As we talked about earlier,

it was really difficult to find penile donors. As we talked about earlier, they were trying to overcome this by doing the whole procedure that I talked about where they build these fake penises. So this team is not only trying to come up with a way to help these uh, these victims of this botched ritual circumcision, but then they also have to come up with a way to somehow please the families of the donors. Uh. And as of the last time this was reported, the hospital had nine

more candidates in weight. But the good news is the recipient the patient. Last June it was reported that his

girlfriend was pregnant, so fully functioning penis apparently. I wonder if this case of it also helped that the recipient was so young, just by virtue of, you know, the cause of the act, whereas in the recent case, the American case, he was he was far not not he's not old, but he was older than this guy's sixty were years old, right, all right, So let's get to this most recent case when we're looking at May eighth through eighth and the ninth, two thousand, sixteen weeks, just

weeks ago at took place at Massachuset's Massachusetts General Hospital in Boston. Thomas Manning, a sixty four year old bank carrier from Halifax, Massachusetts. Penis was removed because of cancer. Now this is you know, most recent, and the New York Times and then also The Atlantic did really great write ups on this. So a lot of our information is from here. Man. I wish we could get married on the phone again and talk about this. I'm sure

she was pretty interested in it as well. Uh. It took thirty healthcare workers in total to perform this operation. There were three years of preparation again, all the practicing on cadavers. Now, Manning only found out about the fact that he had this rare cancer after he had an accident at work. When he went into the doctor, they said, WHOA, there's this this, you know, abnormal growth on your penis, and they realized that it was. It was so cancerous

that it had to be amputated. Now. It only took him two weeks though, to find a donor who matched his blood and tissue type, so that works out pretty well. Now. The surgery here in the US is estimated costs somewhere between fifty thousand and seventy five thousand dollars, but the hospitals involved are paying for the procedures while the doctors are donating their time. So everything, as far as we

know with this is so far, so good. Right. In their official statement, they said that the penis has regular blood flow, no signs of infection or rejection. They hope that in a few weeks he'll achieve normal urination, so probably around right now. I would imagine they say they already have another patient waiting. This guy his penis was destroyed by burns in a car accident. Ultimately, their goal is to help combat veterans, like we talked about with

Mary and Uh, other cancer patients and accident victims. They're in fact hoping to train their techniques to military surgeons. Because this is, like we talked about with Mary, so common with i D victims. Yes, I mean all this is very much taking on the front lines of the

of the surgical frontier. Um, That's why doctors are donating their times, That's why hospitals are are are are paying the bills here and then then hopefully as these techniques are are perfected, yeah, they will be passed down and and others can start utilizing that these techniques around the world. Now, there's one thing that I want to add to this. We talked a little bit about it with Mary Uh.

In the press release about this US penile transplant, they specifically said this will not be offered to transgender people for now. Now, I want to just touch on this a little bit because as we were reading Mary's book, obviously it was apparent that um, the science behind gender reassignment surgery has been used as sort of like a building block to get to where we are with these

penile transplants. When I was twenty one, I read Kate Bornstein's Gender Outlaw and it it specifically describes the female to male gender reassignment surgery, and I immediately thought, when we were doing this research, well, it's it's clear that you know, there's a foundation there. Uh, and it seems to be the secret that no one's really talking about, I mean clearly in China and South Africa. Uh. And then in this most recent US case, it's it's it's

not in the public press releases, right. But I think that it's fair to say that these medical teams uh did get some help at least or some some foundational work from the efforts that were done there. Yeah. Yeah, because the field of gender reassignment surgery definitely had an impact on our ability to treat eurotrauma wounds to the general area, and of course all this ends up playing directly and our ability to to graft a donor repeat

it's not due recipient. Yeah, but I do agree with you it seems weird that that these contributions have not been highlighted more. Um, and there's just continued unwillingness perhaps to discuss, um sure, who should who should who should

be open, who should be able to receive these procedures. Yeah, and given the controversy right now, especially like it's a hot button issue with transgender rights and bathrooms in North Carolina, you know, they these hospitals, they want to retain their funding. I get it, like it's a it's a pr move, but I think you know, for us covering this, it's only fair to be honest and say, you know, it

seems like, uh, there was some foundational work there. Now there's also another topic that we don't have time for today, but maybe we'll be able to come back to in the future, which is the fact that there are actually artificially grown genitals that are being used and prepared for potential transplantation, both penises and vaginas. The vaginas actually successful, uh and have have been so for years. Um, But we don't really have time to dive into the science

on that today. So if this is you know, something that's interesting to you listeners and you want to hear more about it, let us know and Robert and I can come back and maybe we'll do something on artificially grown organs and transling grown genitals. Who doesn't want to

hear an episode on that. Yeah. Also, we're gonna be talking futuristically, so I feel like maybe that we'll be able to actually work in a little more humor as we distance it from some of the you know, the real life and often grim circumstances that require these procedures to begin with. Yeah, especially, man, let me tell you what they do to rabbits for this next time, next time, next time on Stuff to Blow Your Mind, the things

they do to rabbits. All right, well, hey, in the meantime, check out the landing page for this episode on Stuff to Blow your Mind dot com. That's what you find, links out to some of the articles we mentioned here, links out to Mary's book, and you also find all the podcast episodes. You'll find blog post links to our social media accounts such as Facebook and Twitter. We are blow the Mind on both of those. We're also on Tumbler.

We're also on Instagram. Yeah, and if you want to write us directly and tell us what you know about penile transplants or artificially grown organs or whatever, write us at blow the mind at how stuff works dot com. For more on miss in thousands of other topics is how stuff works dot com. Love,