Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Memorialization and Medical Ethics

Episode Date: September 14, 2018

This week on Sawbones, Dr. Sydnee and Justin discuss what we owe to people who do terrible things in the name of medical progress. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. Hello everybody and welcome to Saul Bones, a Marlotteur of Miss Guy,

the Medicine I'm your co-host, Justin McAroy. And I'm Sydney McAroy. I had a nice relaxing drive, Sid, this afternoon. I got my car back. You know, of course, as everyone knows, I think it's been hot topic. I got a flat tire on our way Avenue. Yes.

They fixed up at the dealership, my Honda Pilot, and then you know what I did after that? I just took nice drive around, celebrate having a car, or enjoy the privilege of having a motor vehicle. We take things for granted. With four tires that work. Four great tires that cost a lot of money, and I'm still kind of upset about the pothole. But anyway, where'd you go? I went down to campus, you know, living in the town that you went to college and it's kind of cool sometimes, could you get to drive around and see the young, the young ins, you know,

prom of their lives, party in, hoistin' bruises with the buds? Well, I was thinking more that they were about to embark on this college experience. I don't miss that part though. Some people enjoy the learning and the changing. I missed the part where you're changing and having responsibilities And as partying with my blood you and I had different college experiences. That is fair

I it took me I liked it so much. I hung out for five years in there So I guess maybe I liked it just a little bit more than you sure It's fun going through campus though, but our campus has actually been, there's been some controversy lately. That's true Justin. So one of, as is true in many college campuses, our halls are named for various individuals. There's like a corbally hall and a Harris hall who I assume are named for people. I don't. I'm a science hall. I don't know. There's the science building. Science building. Do your bit. Do your science building bit. You're just gonna make fun of me more for it.

I'll comment on what, just do your bit. I always say it's the science building. You know, it's named for Alexander F. Science, who of course was a journalist. And not a scientist. That's kind of a great idea. Anyway, it's called the science building because they haven't named it for me yet, right? Boom.

The Sydney building. The Sydney. Wait, how long? The microwave complex. Well, I was smurled when I went there and smurled. I'm not now. So either last name doesn't work. It's just the Sydney building. I think the important thing is you are not Confederate General Albert Galaton Jenkins. That's right. Jenkins Hall is named for a Confederate general who, I didn't know this when I went to school there. I would imagine many people didn't because you don't always know who the namesakes of these halls. But it has been written in the campus newspaper and I think a lot of people have made the

revelation now that this hall, Jenkins Hall, is named for a Confederate general, who owned a fairly large slave run plantation. You know, he owned slaves up green bottom up on the Ohio River here in West Virginia on the West Virginia side of it. And he was a really bad guy. A side from obviously being someone who owned slaves, he lived right on the river and across the river was Ohio, where people were free. He led hunts to track down escaped slaves. And he was a terrible person.

Bad dude. And for whatever reason, we named a hall after him on campus. And though it's currently undergoing renovations and refurbishments, and this would be a great moment, I think, for us to stand on the right side of history and rename it for someone who is deserving of or having really anything named after them. Or related to education,

because it's an education building. Yes, yeah. Not an education building in the sense that all buildings in the university are education buildings, literally. You teach teachers. Teach teachers. Yeah, so there are a lot of great figures

you could highlight not this guy. Not this guy. So in light of that, I started thinking about the fact that in medicine, there have been a lot of discoveries made by people who weren't great. And there's always the argument everybody exists in the time in which they live. But I call shenanigans on that sometimes. I think that we need to distinguish the stuff we've learned from the people who have obtained

that knowledge. And one figure that comes to mind in medical history that we have never done a show on, but that, we've actually gotten a lot of emails over time requesting this topic. And I've always shied away from it because it's not, oh, there's nothing funny about it. First of all, and secondly, it's a darker note

in medical history and not just this specific figure, but it highlights that there are lots of points like this in scientific discovery where vulnerable people were put at risk and experimented upon in order to obtain knowledge. But I still think we should talk about it. It's important to talk about it and learn from it despite that. So we're going to talk about J. Marion Sims. You may have heard his name because there was some controversy about a statue of J. Mary and Sims

uh in New York in Central Park actually. And it was actually removed back in April because of a lot of the things that that we're about to talk about. If you've heard about him from if you're a anyone in the medical world, you may have heard him referred to as the father of gynecology um for some of the discoveries that he's made. To get started into what he did and kind of what the whole issue is, we need to talk about vesico vaginal fistulas. Okay. Now let me take a swing, vaginal, that's easy.

Got that one. Fistulas are holes or conduits or tunnels. Yes. And then vesico is... Bladder. Bladder. I was just about to, I would've guessed bladder. You wouldn't have, but I'll give you that one.

So it's basically a tube or a tunnel between the bladder and the vagina? Yes. Not a tube, but like an abnormal connection between those two structures. Okay. They should not be connected directly. So vagina and the bladder should not be connected directly?

No. There is no window or hole or anything in between the two, right? They're two distinct organs. Fair enough. So an anything in between the two, right? There are two distinct organs, fair enough. So an abnormal connection between the two. There's also something called erectovaginal fistula, which is an abnormal connection between the rectum and the vagina. Same idea, these are not things that we have in our bodies naturally.

They are things that arise as the result of illnesses, you know, problems trauma, that kind of thing. There are lots of different reasons, but one of the primary reasons that these have occurred historically are results of a protracted, complicated labor. So the way that this happens is, let's say that someone is in labor, the baby has come down to the, we call the outlet of the pelvis. So that's where it comes, where you come out of the pelvis, right? The outlet, you can probably figure that out. And the baby's head gets stuck basically. This can be the result of the pelvic outlet, the pelvic itself being smaller or just shape differently, or the baby being large,

although a lot of times this has been the result of pregnancy at a young age, just when the pelvis is not fully formed yet. But basically the baby's head presses against all those tissues as the person continues to labor and it, and the baby doesn't come out, and as it's compressing all those tissues as the person continues to labor and it in the baby doesn't come out. And as it's compressing all those tissues down in the pelvis, you can actually get lack of blood flow.

I mean, you can do that if you press hard enough on your skin and it gets paler because you're depriving it of blood flow. We'll imagine that for a protracted period of time intense pressure. Eventually, the tissue can die. Some cell death, yeah. Yes. So you get some cell death and then holes can form there. And as those heal, you get some abnormal connections between various parts of the body. That is the general way that these have been formed. At least in this case, I'm not saying that this is the only way you can get one of these fischulas. There are other conditions, but this is what we're talking about. So, if the bladder and vagina are now connected, you can have urine that

continually leaks from the vagina, which can predispose you to infections, bladder infections, kidney infections, that kind of thing. And if there is a connection between the vagina and the rectum, stool can leak from the vagina, which again, it can predispose you to all kinds of infections. And beyond these medical complications, there's also some obvious quality of life complications here. Of course. You're constantly in continent.

That's a very uncomfortable way to have to go through life. And then depending on where we are in history, there are also a lot of social implications from this, societal implications. If you are continually having either of these problems, either of these incontinence issues, it may prevent you from participating in society. You may become kind of a pariah, you know. And it would certainly complicate if you desired, you know, to have more children further, you know, the ability to have children in the future and that kind of thing.

So it was a devastating complication for people. I think that's important to note. This was not a minor problem, not a, well, no big deal. We don't really need to bother to figure out how to fix it. Efforts to figure out how to fix it were certainly founded in the sense that this was a big complication. And we needed some sort of surgery to correct it that I think is fair to say.

And by the way, a lot of the research that we're going to talk about, a lot of the things that happened, all are in the 1800s, but we've known that these could form way back as far as 2050 BCE. We have found the mummified remains of someone who had a vesicovaginal fistula. And they even noted the connection between that and that the pelvis was very contracted and small. And so perhaps that was why the fistula formed. Maybe it was the result of a complicated childbirth and that exact process. We had made some attempts to try to fix these because this really is a surgical fix. There's no medicine, right?

This is a pure, there's a problem. It needs a surgery to fix it for many, many years in medical history. We don't have anesthesia and we don't have proper surgical instruments. And we don't even know how to do this without killing someone, right? So there aren't a lot of attempts to do anything for it other than surgery. There were some notes back in the 1600s of trying to sow things back together with swan quills. Oh, how festive.

It's a very elegant solution. And I mean, that literally elegant and not like, not like it would work. Not like it would work, but it's like very fronciful. Well, and it's, and it's very interesting Not like it would work. But it's like vendor's principle. Well, and it's and and that it's very interesting Probably not very helpful and again a lot of the subtitles solvents interesting not very helpful And a lot of these things would have been even if even if a inappropriate surgical procedure had been Created this is these are all

Again done in difficult to reach places without anesthesia. So, it all would have been very hard to do. So, J. Marion Sims is a physician working in the mid-1800s. He had gotten his medical degree as it were at the time and started practicing in Montgomery, Alabama. Now, the practice he set up there was specifically to cater to the wealthy plantation owners in that region at the time. And not to the owners and their families so much as the people that they owned, the people who were enslaved. And this, I want to be very clear, this sounds like an altruistic effort that I'm describing.

It's an outreach. No, no, this is not, I want to take care of vulnerable people who are not getting appropriate medical care. This is, this is motivated economically. There was a lot of money to be made in helping a plantation owner keep their labor healthy. To keep the people that they had, I don't want to say working for them because that implies that there's payment. And obviously there was not. But to keep the people that they had enslaved to keep them healthy and to keep them

bearing more children, right? There was a there was a huge economic, um, you know, motivation there. And so this is why he set up this practice. He is, it is not an outreach to reach vulnerable people. That is just, that is the important takeaway here. So he's there. Is someone who is viewing these people as property and treating them for people who, in turn,

view them as property. Exactly. Keep their quote unquote property functioning properly. Yes, so they can continue to make money. Right. So he, and this was unusual, you wouldn't, you wouldn't have seen a lot of people in his practice, he wouldn't have a lot of business

typically because most of, and this was true actually for the whole country at the time, most medicine was done at home, right? You got sick and there were a lot of full remedies and you just kind of figured things out. You didn't always go to the doctor. So you would only have been brought to see him if you were pretty sick.

Or if you were unable to perform a function that you're only rated you to perform. And impeded your, of course. So this started when he was asked to examine a woman who had fallen off a horse and had a lot of pelvic pain as a result. He basically had to invent what was pretty much the first speculum to do so,

the first kind of of the modern iteration of speculums to do so. And he examined her and he found that she had a vesicovaginal fistula. And he decided that he needed to come up with a way to fix these. They were a major medical problem. This was something that needed to come up with a way to fix these. They were a major medical problem. This was something that needed to fix. It also would be a great way for him to kind of make a name for himself.

He didn't, and I should know, he didn't have any experience necessarily with gynecology or gynecologic surgeries or anything up to this point. He just decided that this was the thing he was going to pursue. Now in order to do a medical procedure, you obviously have to this point. He just decided that this was the thing he was going to pursue. Now, in order to do a medical procedure, you obviously have to practice it. And to practice it, you need, I mean, throughout history, we've used animals, but he wanted willing patients. And the way that he obtained patients that he could do this procedure on is that he had some plantation owners in the community who had slaves who had this condition. He, I don't want to say bought them. There was no money exchange, but he took ownership of them in order to perform these experiments and do these surgeries to perfect his technique. The deal was, and there are three women

that we're going to talk about in particular, but the deal was that he would take ownership of them and be able to do whatever surgeries he wanted to do and in exchange the, in an attempt to fix these problems and in exchange the slave owners would pay taxes on them and provide some clothes and So this is the deal that was set out for the experiments that we're going to talk about That's gonna be after the break and do you want to warn you that Sydney has briefed me on some of this and it will not be

necessarily a pleasant listen, but Think it's worthwhile, but do you want to give you a warning now if that is not something that you would Enjoy hearing I'll give you a warning now? If that is not something that you would enjoy hearing, I'll give you a close notes. Bad dude. Very bad, very bad dude is the short version. And if you want to hear the longer version and the discussion about this, we will do that right after we go to the billing department.

The medicines, the medicines that ask you let my God for the mouth. Well said. All right, so as we set up, Jamie Arian Sims is going to start working on perfecting some sort of surgical technique to repair vescovaginal fistulas. He had three women that we know their names that he did most of his procedures on. There were certainly other people involved,

but these are the three that we're gonna mainly gonna talk about, and Arca, Betsy, and Lucy. And they all had these fistulas to start with, so certainly they did need them repaired. But he had no idea really how to do this and it should be noted did not have, did not use anesthesia. He would do these procedures, his attempts in front of a crowd of doctors

so that they could see what he was doing as well. And it would take a long time because there was no accepted method at the time for fixing these, right? So you were figuring it out as you went. He performed the surgery 30 times over four years on Antarctica before getting it right. During one of the procedures that he was attempting on Lucy, he used a sponge placed over the urethra to absorb urine. Kind of in surgery today, we would put a catheter in someone used a sponge placed over the urethra to absorb urine.

Kind of in surgery today, we would put a catheter in someone so that their bladder just remained empty during the procedure. Right, we might do that. Sometimes that happens during a surgery. That's an accepted practice. Instead, he used a sponge, so urine would not get in the way, but the problem with that is that it introduced bacteria and Lucy got a terrible infection became septic and almost died as a result of this. Oh my gosh. It should be noted

So he he did these procedures many many many times. He Eventually came up with a surgical procedure that worked and eventually came up with a surgical procedure that worked. And there's been a lot of debate about the fact that, as I said, he did not use anesthesia. At the time that he was doing these procedures, anesthesia was not used all the time. We actually just did an episode on ether, right? And we talked about how it wasn't until about 1846 that everybody was using ether. These were done in 1845, and so many have argued that he wasn't using anesthesia

simply because it wasn't done, right? It wasn't a common practice. And I think it's fair to say that it was not used by everyone, but as we have noted, it had been used previously. ETHER had been used as early as 1842. So this wasn't, and he was not operating in a vacuum. There was knowledge that ETHER could be used. There was knowledge that there were attempts made to anesthetize patients while they were

having procedures done. How much of it he knew, I don't know, I can't go back and say, but anesthesia was being used by some people at this point in history, not by everyone. He did go on to perform these procedures on other patients who were not enslaved. He didn't use anesthesia on all of them, although eventually he was routinely using anesthesia. And there again has been debate about is that because it was just following the accepted like procedures at the time, eventually anesthesia became the norm. And so that's why he wasn't and then was. There's also been some conversation

that Sims made some comments. He documented comments that he didn't think the procedure was very painful anyway. The guy the guy didn't demand. Right. The man didn't think that. Now this is wrong. It would be a very painful procedure to undergo without anesthesia. I don't know if I need to say that. I may be a white dude, but even I know that would be definitely the truth. Um, there, I always think because as we're getting into kind of the conversation about this, there have been surprisingly a lot of published opinions in his defense. From like the 1800s?

No, like more recent. And that really kind of took me back because I thought this was a pretty clear cut case. Whatever you think about that time period in history, there were obviously people who knew that it was wrong to own other humans. Right. So it wasn't accepted by everyone that this was okay. It wasn't like we just discovered that people who are not white are also human beings. This is not new information. I'm sorry, it's not like, sorry, I don't want to get into the whole like, was slavery good or'm sorry. It's not like Sorry, I don't want to get him to the whole like Was slavery good or bad thing? It's 2018 apparently we have to have those conversations

But like it was bad and like some people knew it was bad and some people pretended like it wasn't Yeah, yes, everyone knew it was bad Everyone knew it was bad. They participated or not Some people just really wanted some money. Like I, okay. So. I'm not gonna litigate the Civil War again. No, well, I don't think, I just don't think it's fair to say, well, you gotta consider the time someone lived in.

I think we say that a lot on the show when we're saying, well, they used mercury because they thought mercury was an appropriate treatment, but at the time, everybody was using mercury. So, I mean, I think like that kind of thing thing we can look back and say, well, it was the time period. We can forgive that. I think that owning people is wrong and we've always known that, right?

Whether or not you decided to do it, we knew it was wrong. Right. So I don't think we forgive that. And we also, he was called into question, these procedures, experiments that he was doing were called into question by other physicians in his day. There were other people in his time who were saying, whoa, whoa, whoa, what are you doing? No, you can't keep doing that. That's not okay. That's not okay. That's your harming someone. You are first doing

harm. You're violating, I mean, the Hippocratic Oath didn't know. Right. Not even in the 1840s. Yeah, and it's, I think it's important to note that like, we're not just talking about slave ownership. We're talking about somebody who, like, dehumanized and tortured, I would argue, tortured people in the name of medical science because they didn't

believe that they were on the same level of humanity as they were. Yes, and to add to that, he was of the opinion that black people did not feel pain the way that white people did. So I think whether or not you can argue the anesthesia question all you want, but even if it had been readily available, what have you used it? I don't know. And again, the fact that he sometimes didn't use anesthesia on women, I don't think, later on white women, I don't think that that excuses anything because women's pain has always been under appreciated by male physicians. Like even today women are much less likely to be taken seriously with pain complaints than men. So just because he was sexist doesn't mean he was also racist, of course he was.

I mean, both can exist. Right. And to add to all this, he also did an experimental procedure on newborns. And again, these were because he was catering to the plantation owners. These would have been babies born of their enslaved populations. He noticed a high rate of neonatal tetanus, what was called trismis nacensium. And this was probably, by the way, the real reason this was happening was usually because of infections of the umbilical stump. So where the umbilical cord was cut,

if because you are living in conditions that do not allow things to be sanitary, right? A lot of these people weren't, I mean, the slaves were not being housed be sanitary, right? A lot of these people weren't, I mean, this, the slaves were not being housed in sanitary conditions. These babies were exposed to unsanitary conditions and they could have a higher rate of this neonatal tetanus occurring. This is why it was happening. He thought it had something to do with differences in the skulls between various races. And so in an attempt to fix this, he started trying to pry open and widen the skull bones of newborns.

What was essentially like an all-used for shoe making? This procedure, if you want to call it that, had a hundred percent mortality rate. And he blamed it on not his procedure, not the fact that people were living in unsanitary conditions that they had no control over. But in this is a quote, the sloth and ignorance of their mothers and the black midwives who attended them. So I think, I mean, I don't say this to belabor the point.

I just, there have been a lot of modern arguments that we can still celebrate this man. And my modern argument would be that we absolutely cannot. There we go. All right. I agree with Sidney after much consideration. Just to finish off his story, he eventually did get around to his goal, which was operating on rich white women. That's what he was aiming for with his experiments.

He did do it. And while he did these other procedures that would work to fix a Vesco vaginal fissula, he also did things like remove ovaries to cure hysteria. We've done that one. We hit that one in the past. Check out our history episode. I think it's pretty early on in Talbons, but that's not real. No, that's not real. And by the way, these were done at the request of whatever the male guardian was. So a father, a brother, a husband, whatever. If they, let's say Justin you brought me in for improper sexual behavior, he would also at your

request perform a removal of the clitoris. So he also would keep patients in the hospital for a long time on opium after the surgery so that he could do more surgeries on them. I don't think I think this was an experimentation not for fun. I don't mean to insin surgeries on them. I don't think this was an experimentation, not for fun. I don't mean to insinuate that, but I don't know that that's any better. He did some good stuff that he is noted for, but I don't think that you memorialize someone who does all this. I think that we have this information.

He had a procedure that fixed a Vesco vaginal fistula that has been documented. We can learn that and not celebrate his memory. Those two things can happen. Right. I mean, there's a difference. There's a lot of stuff that we talk about on this podcast that we've learned and we don't celebrate the people

who obtained the information. And as I said, this happened, there was a controversy about this recently because of the Statue in Central Park, and it was removed in April and moved to Greenwood Cemetery, I believe, where he is buried. There are other memorials to him, other places, where I think you could still have this debate. Should they be? And some of them have been removed, some of them haven't. And there is precedent for this in medical history. One thing that came to mind as I was hearing this story, because I'd never heard of Sims

in medical school. Nobody taught me about him to their credit. That's something. Yeah. Nobody taught me about this guy. I know about fishulas, I know about the surgery, but nobody ever taught me about him. But, I mean, not to get off topic, like nobody ever taught you about him,

but that is like part of the problem, right? Like if you have to learn these lessons too. Yes. That's true, that's a good point. That's a good point. That's true, that's a good point. That's a good point. That's a good point.

With people who made the decision, took it upon themselves as human beings to say, this knowledge is worth someone else's suffering. Yeah. Like, you know what I mean? Like it's people have made this decision throughout medical history. And again, that you can't excuse it by by basing it. Well, at this point in history, the Hippocratic oath says, first do know harm.

And that's pretty frickin' old. That's ancient. Yes. It's hypocrite's. Human beings have inherently known. It has been ethically wrong to harm another person for the benefit of someone else. For a very long time.

We don't, this is not new information. So he's not excused from this because it was the 1840s and other people owned humans too. You don't, you don't just write it off. Um, and, and another example that, that came to mind that I did learn about in medical school is someone named Hans writer, who was a Nazi. And he experimented on prisoners at book and walled. And for a long time, we named a certain kind of arthritis that we call reactive arthritis. After him, when I was taught this in medical school, I was taught that this is something called Riders Syndrome.

And I was not taught the name Hans Rider or anything about him. I just, I mean, there are a lot of epinems. You're taught a lot of names, and they don't, they, I mean, I was never tell you who they're named for. And I remember I was taught writer syndrome and then I was being quizzed and during one of my rotations by a doctor about something, what do you think this could be?

And I said, well, could it be writer syndrome? And he said, that's what I was looking for, but don't call it that, call it reactive arthritis. We don't use that term anymore. And I said, well, why not? And he said, well, he was a bad guy. I don't think he really, I don't think the physician really knew either.

I think he just knew why I'm not an email person. I got an email person. He just tried to send you anymore. So then I looked it up and he was a Nazi. And we knew, I mean, we knew he was a Nazi because we captured him, the allies captured him. So this wasn't a secret. We knew he was a Nazi. He, uh,

even after he was captured, it was continued to be known as it's called writer syndrome. And it wasn't until the 70s that a group of doctors got together and said, you know what, maybe we stop using this Nazi's name for this. Maybe we call it reactive arthritis because that's what it is. It's more descriptive. And also he was kind of wrong about what caused it So he wasn't even right about it. So Annie's to Nazi. So let's just get rid of his name and even though that happened in the 70s When I was in medical school in the 2000 right I was still taught this name and there is my point is there is a way to Take the it we can't just forget the information we have I'm not saying that we should throw out a surgical procedure because, I mean, if it works,

you have to build on that, you have to use a thing that works. You can't do something bad to somebody because you don't want to use the procedure that works because it was obtained this way. But we can learn about this, learn about how wrong it was. It helps us understand the framework we have, the ethical framework we have for experiments now, why you have to get approval from a review board before you can just do something because things have to meet certain ethical guidelines. And it's not because, oh, this is hard and we just have to do our paperwork and we don't want to get sued. It's because people have violated them all throughout human history.

And if we don't hold everyone to the same standards, they'll do it again. And vulnerable populations are always at risk at the time. These were people who were enslaved in the American South. But even now, there are vulnerable populations who are at risk for this. I mean, I think prisoners are a good example, and I think a lot of indigent populations and people who are differently abled. I think you could even make a kit of certainly minorities and I think you could make a case that immigrants for sure

and to some extent women still, as we know, whose complaints aren't taken as seriously. Children, I think, are another good example, but anyway, that's why I think it's important to talk about that we know how we obtain this information, we can still use the information and also not celebrate the people who obtained it in such horrific ways. And this, of course, leads me to, we need to do an episode about Henrietta Lacks at some point, who is a subject of an excellent book, and we will cover on this show as well. I know a lot of people are going to say, you didn't talk about Henrietta Lacks, that's because she needs her

whole episode about that story. Soon, coming soon, sneak previews. Yes. And hey, if you want to call our email, Marshall University, speaking of things that could be named other things. Yeah, I think it's about time. Especially if you're a grader. I don't know, whatever. Yeah, if you went to Marshall University, I don't know how many people who listened to our show dead, but if you did, this would be a great thing to call

and make your voice heard because it's unacceptable. There's no reason that Jenkins Hall should be named that anymore. Yes There are a lot of people we could celebrate and he's not one of them. I Think after weighing all of it Justin McRoy Hall is the name that we've all sort of said along we kept coming back to and I think that I could probably make this call right now Justin McAroy Hall for

Education and Reflection and growth spiritual and mental and Also podcasting Put that at the end because there's people will be like oh, I get it now. I understand. I love you But I don't think that at the end, because there's people who'll be like, oh, I get it now, I understand. I love you, but I don't think that's the best. Okay, well maybe I should come up with it. You know what you should do. You should buy them a microphone for their studio to the radio, and then it can be the Justin Macro Memorial

microphone. Wait, what? I die in the process. Someone now. That's terrible, Sydney. Thanks so much for listening to our podcast. If you want to rate us a review of some iTunes, that's great. I have a new show out called The Empty Bowl.

And it's for people who have anxiety or anxious and like cereal. It's just one, a little bit of serenity. It's a meditative podcast about cereal. It's called The Empty Bowl. I can find it on iTunes, wherever find podcasts are sold. If you want to go check that out. It's not for sale. It's free, obviously. Thanks to taxpayers for using their song medicines. This is the intro and outro program. Thanks to you. We hope you have learned a little something today. We have a book coming out. Oh, we have a book coming out bit.ly-forod-slash-the-sobones-book.

Go pre-order that now and we uh... we think you really like it and that is going to do it for us so until next week i'm just a macrory i'm sitting back right and as always don't do a whole in your head Alright! Maximumfund.org Comedy and Culture, Artistone Listener Supported you