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Episode: Sawbones: Walking Pneumonia

Author: Justin McElroy, Dr. Sydnee McElroy
Duration: 00:39:07

Episode Shownotes

It’s nearly winter, which means the return of mycoplasma or “Walking Pneumonia” on this hemisphere. This week Dr. Sydnee and Justin talk about how this infection was discovered, the questionable way it was researched and how it differs from “typical” pneumonia.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/Harmony House: https://harmonyhousewv.com/

Full Transcript

00:00:00 Speaker_02
Sawbones 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.

00:00:15 Speaker_02
Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it.

00:00:59 Speaker_03
Hello everybody and welcome to Sawbones, a marital tour of misguided medicine. I'm your co-host, Justin McElroy.

00:01:10 Speaker_01
And I'm Sydney McElroy.

00:01:12 Speaker_03
Happy holidays.

00:01:14 Speaker_01
That's a weird- I hadn't wished you happy holidays. That's a weird energy.

00:01:16 Speaker_03
I realized I hadn't wished you happy holidays yet. Happy holidays, Sid.

00:01:20 Speaker_01
Happy holidays, Justin. Thank you.

00:01:21 Speaker_03
Honestly, I hadn't come up with an introduction, and then I looked at the name of the document you shared with me, and I don't know what I have- You don't know what it means.

00:01:30 Speaker_01
I got nothing. You don't know what it means. I got nothing. That's fair. That's fair. I got nothing.

00:01:34 Speaker_03
I got nothing, so I said, happy holidays, and just hoped that you would tie it together, because I got nothing.

00:01:38 Speaker_01
We're a little, this is timely, it's just a little behind.

00:01:42 Speaker_01
There's been an, I try to keep up with if there's like a new outbreak, infection, something rising, something whatever that I feel like would, oh wait, this is a good opportunity to talk about history and educate on a current thing.

00:01:56 Speaker_01
And we're a little, this is, so have you heard about the increasing cases of pneumonia in children?

00:02:03 Speaker_03
No, have you?

00:02:04 Speaker_01
Well, obviously, I'm doing a podcast about it.

00:02:07 Speaker_03
Yes, that is a very fair response.

00:02:09 Speaker_01
Also, I'm a physician, and also we're parents.

00:02:12 Speaker_03
I'm just trying to keep the conversation going. Sydney, it's a conversational style, okay? It's called asking questions. No, I don't know what that is. Have you heard of that?

00:02:23 Speaker_03
Increase I will say yes, and I will say I do think there is a little bit of benefit It's just another conversation Sydney. It's just I'm just keeping the conversation.

00:02:32 Speaker_01
This may be a lesson that kovat taught me We tried to jump out I think pretty early before COVID was COVID, and it was like, there's a coronavirus in China, and that was all anybody was saying.

00:02:46 Speaker_01
We tried to jump out pretty early on that, and we were not worried, and we were wrong.

00:02:51 Speaker_03
We weren't worried, and we were being too optimistic, and we were wrong about that.

00:02:54 Speaker_01
And we were wrong. And so maybe waiting a little bit, gathering some more information is a good idea. For instance, I am not talking about the new mystery illness in the Democratic Republic of Congo, because I don't know what it is.

00:03:06 Speaker_01
No one seems to know what it is yet. There's really not much to say about it yet.

00:03:10 Speaker_03
I don't feel like me weighing in with guesses would be... You just wanted to raise the specter of worrying about it without any sort of context.

00:03:17 Speaker_01
Well, I imagine many of our listeners are paying attention to that as well. And right now we don't know anything. And so I don't think me like theorizing on that would be helpful. But talking about pneumonia... I've never heard anything about it.

00:03:30 Speaker_01
How have you not heard about it?

00:03:32 Speaker_03
What have I heard about Sydney? I don't really hear about things.

00:03:35 Speaker_01
Like, everybody in my algorithm is talking about it.

00:03:37 Speaker_03
Yeah, okay, mine's mainly Arby's. So, okay, I don't hear about these things, but now I know, I just know that there's a mystery, Alyssa. My wife's not gonna tell you more about it.

00:03:46 Speaker_01
So, there is a lot of that. concern over this mystery illness. And all I'm saying is, I think at some point when we know more about it, it would be helpful to talk about that. And so this is the lesson I've learned.

00:03:58 Speaker_01
I'm learning from my past mistakes and I am growing as a person. I can talk about mycoplasma pneumonia

00:04:05 Speaker_01
and how it's on the rise, or has been on the rise for the last year, because I think we know more about it, we understand, and I can say something helpful and not just, you know, cultivate fear around an unknown.

00:04:19 Speaker_01
So if you have been paying attention for any of these reasons, or perhaps if you've been sick or somebody you know has been sick, which is quite possible, because it is pretty widespread.

00:04:29 Speaker_03
Would you say it is fair, a fair assumption for me, if I see a healthcare story, to not click on it with the assumption that my wife will know what is happening? Do you think that's a fair assumption?

00:04:41 Speaker_03
I probably do pay a little less attention to medical stuff than your average person, because I assume that my SIDGAR rhythm will bring it to my attention if I need. So you know about that.

00:04:53 Speaker_01
And I guess that is bearing out right now.

00:04:56 Speaker_03
Yes, that's true.

00:04:57 Speaker_01
So Justin, you've probably heard of walking pneumonia.

00:05:00 Speaker_03
And the boogie woogie flu.

00:05:03 Speaker_01
Most people have heard the term, the colloquial term, walking pneumonia.

00:05:07 Speaker_03
I've heard that colloquial. Do you know why? Like, what is that? I would assume it's because you're like sick, but still good enough to walk. Like you have pneumonia, but you still feel okay enough to go to your job.

00:05:17 Speaker_01
That is, that's kind of, yes, that is where the term comes from. Now this is obviously not true for everyone who, who contracts this illness. There are some people who get quite sick, but yes, a lot of people who were not walking before.

00:05:29 Speaker_03
So you wouldn't assume that that would be affected by the pneumonia.

00:05:32 Speaker_01
No, not in any way. So the idea is that for a lot of people who contract this, it will either be a bronchitis, an upper respiratory infection, or a pneumonia that isn't as severe as other pneumonias.

00:05:44 Speaker_01
In the medical world, we often call it atypical pneumonia, and we'll get into the history of that.

00:05:49 Speaker_03
Atypical being one word.

00:05:50 Speaker_01
Yes. Yes. Atypical, as opposed to typical. Right. Yes. Yes. Okay. There is an increase this year There is nothing to be alarmed about. This isn't a new illness. It's a known illness and we know how to treat it and we know how to prevent it and we know how to.

00:06:11 Speaker_01
manage it, and we kind of know why there's an increase, and we also kind of saw that coming. So I feel like this is all comforting, right? This is all comforting information when we know things. Okay, so let's talk about walking pneumonia first.

00:06:25 Speaker_01
And to understand why it's a little different than other, why do we have a whole other name for this pneumonia? Why is it different? Why do we care?

00:06:33 Speaker_01
There's a couple reasons, and I think that it starts off with the difference between a virus and a bacteria. Do you know?

00:06:40 Speaker_03
allow me to guess yes no not guess can i i wow that was so mean uh bacteria is a very small microscopic living organism okay a virus is also very small these two things you can't even believe it virus is much smaller than bacteria though yes generally yes and virus uh is

00:07:02 Speaker_03
Not dead and not alive, like Nosferatu, it wanders the earth, hovering between twilight and dawn. Not quite alive, not quite dead. The virus is a terrifying predator.

00:07:14 Speaker_01
This is true. I will give you that. I think that's, that was the thing that drew me to viruses in the beginning, because before I became a family physician, I wanted to study infectious diseases.

00:07:29 Speaker_01
And then before I wanted to go to medical school, I just wanted to do it in a lab. and not have to deal with humans, just microscopes. And I think what drew me to it is that viruses exist in this sort of living and non-living space.

00:07:43 Speaker_01
And why is it important for us to know? Well, both can cause a pneumonia. We treat them differently. And exactly like you said, Justin, bacteria are free-living organisms. They can live outside of us. Viruses need us or some host in which to exist.

00:07:58 Speaker_01
They cannot just exist. If you spill a virus on a surface, which I know is a weird visual because they're very tiny, you wouldn't see it, but there's a virus on a surface, it's not going to exist very long.

00:08:08 Speaker_01
It can last there for a determined period of time before it's gone. It cannot reproduce or thrive in the way the bacteria can.

00:08:16 Speaker_03
Nevermind, I'm just gonna sound really stupid. Could you get enough virus together that you could see it?

00:08:24 Speaker_01
So you can, not without some sort of instrument, not with the naked eye. Okay, got it.

00:08:29 Speaker_03
But they do, they can form- But we couldn't get enough viral particles together that we could see them?

00:08:35 Speaker_01
I mean, they're so small.

00:08:36 Speaker_03
Yeah, but I mean a lot.

00:08:39 Speaker_01
I mean, I did not look at how many viral particles would you have to put together before you could see them with the naked eye.

00:08:45 Speaker_01
They can form sort of crystal-like structures when you just sort of like stick them all together, which is kind of like some of them. They're all different, and we're finding new ones all the time, by the way.

00:08:56 Speaker_03
We are great.

00:08:57 Speaker_01
Excellent. Because for a long time, we couldn't tell all this stuff.

00:09:00 Speaker_01
All this thing that I'm telling you, like bacteria is a living, it's a single cell organism, and viruses are like these collections of genetic material inside proteins, and they're kind of alive and kind of not. We didn't know all that.

00:09:13 Speaker_01
We needed a better way to visualize them than we initially had, because our original microscopes are just light microscopes. We're shining light on it, we're magnifying it, we're looking very closely. That's it. And you can't see a virus that way.

00:09:26 Speaker_01
Right. We didn't know all that yet. We have better microscopes now. We can figure that out.

00:09:31 Speaker_01
But what is cool, I think, is that if you look at the history of microbiology, and especially when you get into, like, the study of things that are infectious, things that can make us sick, the pathogens, because there's lots of stuff out there that's small that doesn't make you sick.

00:09:45 Speaker_04
Yeah.

00:09:46 Speaker_01
But when it gets to the things that affect humans, we knew that things existed and we characterized them and we called them names before we could ever see them.

00:09:57 Speaker_03
Like the Roman gods.

00:10:02 Speaker_00
Why is that? What of all analogies?

00:10:08 Speaker_03
It just seems that we're looking for ways to explain what's happening in the world around us. It's a similar thing. It's a human impulse to want to try to understand things that we don't, right? So we create narratives.

00:10:27 Speaker_03
This narrative happened to be weirdly close to the truth, I guess, right?

00:10:31 Speaker_01
No, okay. See, I think these are two very different, but I mean, I think important and valuable human impulses, one, to create a narrative to explain a phenomenon, and two, to scientifically study, to experiment and seek a truth. Yes.

00:10:50 Speaker_01
I think those are both valuable.

00:10:51 Speaker_03
Me too.

00:10:52 Speaker_01
And they both have their place. Yes. One of them in medical science and the other one in lots of media and other things we enjoy, right? Yes, right. Sure.

00:11:02 Speaker_01
So once we kind of understood, because for a long time when we've talked about this on the show, we didn't know why disease happened.

00:11:08 Speaker_01
So there were the humoral theories, there were miasmas, there's lots of- Big clouds of disease, free roaming clouds of disease. Demons, punishment by Roman gods, perhaps.

00:11:18 Speaker_03
The poor. Yes, being poor. Just being poor, being near the poor. Yes. Drinking the same water as the poor, actually.

00:11:26 Speaker_01
Any of these things, yeah. Being a woman, you know. So, once we knew that germ theory of disease was established.

00:11:34 Speaker_03
I was nodding, thoroughly.

00:11:35 Speaker_01
I know.

00:11:35 Speaker_03
I didn't say yes out loud, but I was nodding, folks at home, and drinking from my iced coffee, but I absolutely agree with my wife's sentiments.

00:11:46 Speaker_01
And then we established Koch's postulates, meaning like, you can take the way we know that an agent, first of all, we know that things cause disease, they're contagious things, bacteria, viruses, fungus, parasites, whatever, that cause disease.

00:11:58 Speaker_01
And in order to figure out, is the constellation of symptoms, the thing that's wrong with you, is it because of this tiny thing, we have to find it in you, take it out of you, put it in something else, and see the same thing.

00:12:14 Speaker_01
And there's other things. We have to also find it in everybody who has it, and we have to be able to grow it and see it. So there's a bit of it. We figured this out while using instruments. But the point is, we figured all that out.

00:12:28 Speaker_01
The way we would do this is sometimes we would take infectious material from people, so like tissue or spit or something gross, and we would pass it through a filter. Okay, to look to see if the thing that caused the disease is filterable.

00:12:46 Speaker_01
So right now what we're focused on is size. We don't really understand... That's right. We're trying to figure out.

00:12:54 Speaker_03
It's just the mesh is too big, like the colander is too big, right? We don't have a sieve, we have a colander.

00:13:00 Speaker_01
So we've got a filter, and we're passing material through the filter. And what we started to figure out is that some things were caused by filterable agents, and some things were caused by unfilterable. agents, right?

00:13:12 Speaker_01
And that was sort of our initial understanding of viruses and bacteria. Bacteria, generally speaking, are bigger. Now, the study of virology has evolved, and there are bigger viruses than we initially thought.

00:13:25 Speaker_01
But the point is, generally speaking, if it passes through the filter, it's a virus. If it doesn't, it's a bacteria. Again, this is a massive generalization. But this was our early understanding of what caused different diseases.

00:13:39 Speaker_01
Did it pass through the filter or not? Toxins also pass through the filter, so this would cause problems. By the way, initial filters that we used, the first ones were diatomaceous earth. Do you know what that's made of?

00:13:54 Speaker_01
Because I didn't know until I researched this.

00:13:57 Speaker_03
What?

00:13:59 Speaker_01
Do you know what diatoms are?

00:14:01 Speaker_03
No.

00:14:02 Speaker_01
They're kind of like algae.

00:14:03 Speaker_03
Yeah.

00:14:04 Speaker_01
A very tiny algae.

00:14:05 Speaker_03
Yeah.

00:14:06 Speaker_01
Diatomaceous earth.

00:14:07 Speaker_03
Yeah.

00:14:09 Speaker_01
Is the fossilized remains of diatoms.

00:14:15 Speaker_03
which are?

00:14:16 Speaker_01
It has accumulated, it's kind of algae. They have accumulated over millions of years. It's largely, it's almost like glass. It's largely like silica is what's in this substance.

00:14:26 Speaker_01
But it is why, you can look up, if you want to look up an electron microscope picture of diatomaceous earth, it is a wild thing to see.

00:14:35 Speaker_03
Okay, but- I just didn't know this. Diatomaceous earth is also, you know, the other thing that's very interesting about that.

00:14:43 Speaker_05
What?

00:14:44 Speaker_03
What do you think of for diatomaceous earth these days? What are you using your diatomaceous earth for around the house?

00:14:51 Speaker_01
I don't use it for anything, but there are some people in the shelter who try to use it to keep bugs away.

00:14:57 Speaker_03
you know what you actually do use it for every day to put your dishes on. We use a diet to make earth drying for dishes. I put dishes on it because it's extremely hydrophobic.

00:15:11 Speaker_01
It's the fossilized remains of algae.

00:15:14 Speaker_03
That's so cool. And now it's cool. I put my Disney on ice cups on it and helps them dry. Amazing. Thank you, Algie. I just stepped out of you from the shower to the floor and didn't slip side around.

00:15:26 Speaker_03
Even millions of years later, you're still doing me a solid. Thanks, Algie.

00:15:32 Speaker_01
I mean, I think it's pretty cool. I didn't know this. And maybe everybody listening already knew this about diatomaceous earth. But eventually we switched to porcelain filters. Porcelain filters work better.

00:15:40 Speaker_01
So in case you're curious, those are the kind of filters. And then we have other ways of separating it out now. But this is our early understanding. And what was confusing about this bacteria is that it's really tiny.

00:15:54 Speaker_01
It's a very tiny filterable bacteria, and so it was originally thought to be a virus, probably. We couldn't see it, we couldn't find it, but it passed through a filter. What is it? And so it took us a while to find out about mycoplasma.

00:16:08 Speaker_01
It took longer, for instance, than like streptococcus can cause pneumonia, a certain kind of strep bacteria can cause pneumonia. We figured that out earlier.

00:16:16 Speaker_01
It took us longer to discover mycoplasma because it's just this little teeny, it's like the smallest living, free-living thing are in the mycoplasma world of bacteria.

00:16:28 Speaker_01
The way that we initially encountered it, there were other kinds of mycoplasma that cause diseases in other creatures, but in humans in the 1930s in the US, there were these cases of an atypical pneumonia and the way they distinguished at the time, the way they would call it either typical or atypical.

00:16:46 Speaker_01
was based on its responsiveness to a certain kind of antibiotic. At the time we didn't have, this is pre-penicillin, so all we have are the sulfonamides. Penicillin would come along within the next 10 years or so.

00:17:00 Speaker_01
But we could treat a lot of pneumonia patients with sulfonamides. We couldn't treat this kind of pneumonia with this antibiotic. So we called it an atypical pneumonia. It's atypical. All the other pneumonias respond to this. This one doesn't seem to.

00:17:14 Speaker_01
It's different. It looked pretty similar.

00:17:17 Speaker_03
Why is it still a pneumonia? You know what I mean? Why are we so sure that it was the same thing, that it wasn't something else?

00:17:23 Speaker_01
Infection of the lungs.

00:17:24 Speaker_01
Pneumonia just means infection of the lungs, and so you can get a viral pneumonia, bacterial pneumonia, fungal pneumonia, right, and you can do, by this point we have x-rays, so you can see that, you got the clinical picture, so you've got cough, fever, chills, you're weak, you're tired, you're sore throat, headache, you know, the whole thing, you look like you have pneumonia, your lungs sound like you have pneumonia, the x-ray looks like pneumonia, but you're not getting better the way

00:17:49 Speaker_01
We expect you to. So we know there's something else. It's small. We think it's a virus at first in the 30s and 40s because it passes through what was the best filter at the time.

00:17:58 Speaker_01
The seats filter was the best one to remove bacteria and it wasn't removing this. So we didn't think it was bacteria at first.

00:18:05 Speaker_01
And then eventually, Eaton was the scientist who was able to take whatever was growing, whatever they were taking out of people with this illness and put it in cotton rats. and then hamsters, and then chicken embryos.

00:18:21 Speaker_01
And all of those things got sick, or he grew more of it, but he still hadn't proved it in humans. So for a while, actually, it was called the Eaton agent.

00:18:29 Speaker_01
Mycoplasma was known as the Eaton agent because Eaton was the closest to figuring out what this thing was.

00:18:36 Speaker_01
But the final thing we needed to do in order to prove that Mycoplasma was causing these different cases of pneumonia was to put it in some humans and see them get sick. Ethically dicey, right?

00:18:50 Speaker_03
A little bit.

00:18:51 Speaker_01
We're going to do it anyway.

00:18:52 Speaker_03
Oh, you and me?

00:18:53 Speaker_01
Well, not us, but humans. OK. But first, we've got to go to the billing department. OK, let's go.

00:19:11 Speaker_03
Well, it sounds like we're in store for another one of humanity's classic cutups. Sid, I'm so excited. What do we get into this time?

00:19:18 Speaker_01
So, as I was reading through the history of the discovery of mycoplasma, and at first, Justin, I gotta be honest, I'm researching this, because I feel like it's an important thing for us to talk about, and I'm not finding something fascinating to latch on to, or like something weird.

00:19:33 Speaker_01
And then I started reading about when we finally, and we have done this, there is an ethical way. to go about actually taking something that we believe causes disease and intentionally inoculating, making people sick with it.

00:19:50 Speaker_01
There is an ethical way to go about that. We have established that in society. Obviously, we have also done it in many unethical ways.

00:19:56 Speaker_03
Super duper.

00:19:57 Speaker_01
But there is a there's a path for that. And so this is not unprecedented. But that's what I was looking for were what I what I kept finding referenced in different articles as the Pinehurst trials. What were the Pinehurst trials?

00:20:09 Speaker_01
I wanted to know because this was the moment where we actually got volunteer subjects to put this eaten agent in and see if they got sick and prove definitively that this was the cause of this atypical pneumonia.

00:20:25 Speaker_01
So back during 1944 and 1945, which there may be some other major world events you might remember, well not remember personally, but probably have learned about.

00:20:35 Speaker_03
World War II.

00:20:36 Speaker_01
Exactly. During World War II, specifically, atypical pneumonia was actually causing quite a problem for the U.S. Army and probably a lot of other people, but specifically for the U.S. Army. A lot of people were getting sick.

00:20:50 Speaker_01
And again, even though for most people who get walking pneumonia, they're not going to die, you're sick for a while. I had it back in college, and it was like two miserable weeks.

00:21:02 Speaker_01
I was still able to go to class and do the stuff I had to do, but it felt awful. And if you're in the military, I imagine that's a much bigger deal that you feel that bad.

00:21:11 Speaker_01
So they wanted to do a study through the military to figure out what is causing this pneumonia definitively and can we do something about it. So they created the Commission on Acute Respiratory Diseases as a way to study this.

00:21:27 Speaker_01
And then during the summers of 44 and 45, they got four groups of 40 men to come to the Holly Inn This is in the this is near Fort Bragg in North Carolina to do this study. Now, how did they find this was where I finally pieced together.

00:21:48 Speaker_01
Where did they get these guys? Justin, they were conscientious objectors.

00:21:53 Speaker_03
What?

00:21:56 Speaker_01
These were people who were conscientious objectors to the war and had been jailed because you can't do that. Right. There's a draft. Yes. And so instead of going to jail, they were sent to be subjects in this experiment. Now, they volunteered.

00:22:19 Speaker_01
I'm not suggesting that they were coerced, except in the sense that- They definitely were. I don't mean, well, no, I mean, they were coerced, but I mean, I'm not saying like, they did agree to it.

00:22:33 Speaker_03
Yeah. I mean, yeah, I understand. I think we all understand the distinction that you're making.

00:22:39 Speaker_01
Well, I just, I want to paint the right picture. I don't want to paint a picture of people being forced, you know, I mean, because you're going to give somebody a bacteria. You're going to put an infectious agent in somebody's body.

00:22:51 Speaker_01
I don't I think I just want to paint the right picture. Right.

00:22:55 Speaker_03
So anyway, this is one of many bad outcomes that was available to them. But there were other bad outcomes that they could also have experienced had they not chosen this bad outcome.

00:23:05 Speaker_01
And the reason they were called the Pinehurst Trials is because they were all in the Pinehurst area around Fort Bragg because there were so many people there because, you know, World War II was happening.

00:23:14 Speaker_01
So anyway, so basically they took these guys to this hotel and put them there and then they would take material, infectious material from patients who had this pneumonia.

00:23:28 Speaker_01
So take washings of their airways, of their throat, swabs from the back of their throat, take material and then put it in these. It ended up being 12 subjects and wait and see if they got pneumonia.

00:23:43 Speaker_01
And they would hang out in this hotel waiting to see if they got pneumonia and then to monitor the course of their disease. And of course, they were provided with medical services and support. They weren't just observed.

00:23:55 Speaker_01
But they were very intentionally given pneumonia. They did, by the way, did not receive any pay for this. And they did have to sign a waiver that said, and if anything goes wrong,

00:24:10 Speaker_03
We're not, yeah.

00:24:10 Speaker_01
Yeah, the US Army is not responsible for any of this. So there's a fascinating story to this, I found. Sorry. Yeah, go ahead.

00:24:20 Speaker_03
I would like to hear your fascinating story, and if the question will be answered later, let me know. I know that for testing that we do now, there is a board that has to, right, there's like standards that people have to adhere to.

00:24:38 Speaker_03
and there's like approvals and like a process that you have to go through, right? This is, do I have this correct?

00:24:44 Speaker_01
I don't know the name of the- Yes, the Institutional Review Board.

00:24:47 Speaker_03
Right, okay. Do you know the extent to which that sort of process exists within the military? Like is the military adhere to those standards? Are they super military or are they, you know, like we have things like the Geneva Convention, right?

00:25:07 Speaker_03
ostensibly people adhere to because there are tenets that we uphold. Is there a similar thing for, obviously, for research?

00:25:16 Speaker_01
This is a good, in terms of timing, this is a good question. Well, first of all, the Institutional Review Board, the IRB guidelines around any kind of human research apply to everybody now. now in this time period.

00:25:33 Speaker_01
So military or otherwise, you can't do this without IRB approval, period.

00:25:39 Speaker_03
In 2024? In 2024.

00:25:39 Speaker_01
Okay. That was not established until 1974. Okay. So at this time, we're in 1944 and 1945. The precursor, by the way, to the IRB, and I don't mean direct precursor.

00:25:54 Speaker_01
I mean, the set of guidelines that we were supposed to follow prior to the IRB in 1974 were actually established in 1945. It's the Nuremberg Code. And it was in response to a lot of unethical

00:26:09 Speaker_01
Of course, you know, I don't even want to use the word research that was being done at during World War Two. And it was certainly not in response to this Pinehurst trial. But I think you could point to this as.

00:26:24 Speaker_01
Another example of, while it's hard, definitely they were coerced in the sense they had two bad options and they were choosing the lesser of two evils. They did, it was very brave that they signed up to become infected with something.

00:26:42 Speaker_03
Sure, yeah.

00:26:43 Speaker_01
And contribute to, so I don't wanna say, I mean, I don't wanna undermine the significance of their contribution.

00:26:48 Speaker_01
I mean, that's why we're I mean, there are people and they their stories deserve to be told and they did this and they got sick and they did get better.

00:26:55 Speaker_03
I mean, I also don't think said that it's you know, I think that sometimes something that I have been guilty of, I think that it's OK for us to just say what happened, you know, like like we don't need to. I think I feel an instinct to try to like.

00:27:11 Speaker_03
A lot of times on Sawbones, I try to pass judgment on something that's pretty complicated and that I don't fully understand, but I think it's okay to not say, you know what I mean? Like, I don't know.

00:27:24 Speaker_03
There's a lot, it's a very complicated thing and it's hard to just do kind of a drive-by judgment on everybody involved in the situation.

00:27:31 Speaker_01
I know. And I think that this is beyond the scope of our show to discuss all of the different kind of ethics, personal ethics people were following throughout this whole story. I mean, because we are talking about World War II.

00:27:45 Speaker_01
And so I think a conscientious objector in the setting of World War II is a

00:27:50 Speaker_03
It's hugely complex.

00:27:50 Speaker_01
That's a huge, right? I'm not going to sit here and tell you definitively this is where history has weighed in on any of this. I mean, certainly not me. I don't have that moral authority.

00:28:01 Speaker_03
It did happen.

00:28:01 Speaker_01
It did happen. No, but I read it was really hard to find a good history of this exact event. the Pinehurst trials are mentioned multiple times in different articles about the history of mycoplasma. So it's not hard to find that they existed.

00:28:17 Speaker_01
But to get into like, who were these men? And how were they chosen as subjects? Will they? This is how, and how did this come to be? That was actually kind of hard to find. I finally found this article that was in the

00:28:34 Speaker_01
It was in the news and record in Greensboro, and it was called Lonely Valor, Some Objectors Served as Medical Pigs. And this is from 1995. Guinea pigs, I assume they mean. Guinea pigs is what they mean. They mean guinea pigs. But it's an article.

00:28:49 Speaker_01
Column inches were hard to come by in those days. Right. It is an article about the history of the conscientious objectors who were coerced into participating in this

00:29:00 Speaker_01
experiment and and the the sacrifice that they made in terms of allowing themselves to be sick was something that we didn't have all the tools to know how to treat at the time we didn't know how to how to cure it and There's a whole history of that they wrote poems while they were stuck there looking out the window at people outside Enjoying the summer weather and they're in isolation for two months waiting to see if they get pneumonia Anyway, it was a definitive moment in proving that this was the causative agent the poems also

00:29:30 Speaker_03
Nothing rhymes with ammonia, so you can imagine it's tough.

00:29:36 Speaker_01
After we figured that out in the 40s, by the 50s, we started to be able to figure out how to grow this thing. It took a while. It was the 50s and 60s before we were able to fully grow it. Some things are harder to grow than others.

00:29:49 Speaker_01
And that's why we were able to test for some things a lot earlier than we were able to test for others. And it was another like 20 years before we finally said like, yep, the Eaton agent is mycoplasma. It is a bacteria. It is this small.

00:30:02 Speaker_01
And it led to this whole, in the 70s, this whole field of mycoplasmology arose from this because this was kind of a whole little subset of bacteria that nobody had really understood yet because they were so small.

00:30:18 Speaker_01
they had all been mis-identified as viruses. And so it led to the International Organization of Mycoplasmology and the first International Congress of Mycoplasmology in the 70s.

00:30:32 Speaker_01
There's some great pictures from this of a lot of, they're all guys, I think, in fancy robes and hats at their first Mycoplasmology conference, which, and by the way, it still exists today.

00:30:42 Speaker_01
I think the next one is in Poland in 2026 will be the next Congress of Mycoplasmology. Because it is a very unique subset of living organisms. Yeah.

00:30:53 Speaker_03
It's gonna be a killer one this year. I heard Chaperone's closing it out. It's gonna be like two days of just like madness.

00:31:01 Speaker_01
Yeah. They used to call everything in this group Mycoplasma. Now they've expanded it to other names, other genuses.

00:31:08 Speaker_03
You get a better hotel rate if you expand the conference to a lot more.

00:31:12 Speaker_01
But they're all called mollicutes.

00:31:14 Speaker_03
That is mollicute.

00:31:15 Speaker_01
They're mollicutes. They're mollicutes. Anyway, so what do you need to know about walking pneumonia after all this strange and challenging history that we have covered?

00:31:27 Speaker_01
So for most of us, you are going to get what we call a tracheobronchitis, meaning an infection in your airways, but not necessarily in the lung tissue itself. Once it gets to lung tissue, that's when you have a pneumonia.

00:31:41 Speaker_01
And some people will develop a pneumonia. So some people get a bad bronchitis. That's mycoplasma. Other people get sick enough, it continues on, and they actually have a pneumonia.

00:31:51 Speaker_01
cough, fevers, chills, body aches, sore throat, headache, the usual stuff. There are some severe complications that are more rare that can happen to some people. But for the most part, this is what we're talking about.

00:32:02 Speaker_01
And again, for most of us, you can, quote, walk around with it. So it is walking pneumonia. What has been interesting, oh, and treatment. The treatment is something you may be very familiar with.

00:32:15 Speaker_01
For most of us, we will receive azithromycin or what you may call

00:32:20 Speaker_03
A Z-Pak.

00:32:21 Speaker_01
A Z-Pak, yes. A Z-Pak is dosed to treat walking pneumonia or atypical pneumonia or mycoplasma pneumonia, whatever you prefer to call it.

00:32:29 Speaker_01
There are some backups if you're allergic to that or for some reason you can't take it, you can take a fluoroquinolone like Levaquin, you can take doxycycline, my favorite antibiotic, depending on...

00:32:38 Speaker_01
age and pregnancy and all other factors that we, all the things we consider with antibiotics. So it is something that we know how to treat now.

00:32:46 Speaker_01
That explains why initially it didn't respond to, it doesn't have a cell wall, so it didn't respond to the old antibiotics, or not old, the older, as in they came along first, antibiotics that we used to use for pneumonia wouldn't work on this. So

00:33:00 Speaker_01
That's why we had to wait till we had macrolides, which that's what azithromycin, that's what class it is in. So what's different this year is, one, we're seeing more cases than last year. And two, we're seeing it in younger children than usual.

00:33:17 Speaker_01
Anybody can get it. But the peak is usually school age, adolescent, moving kind of up into young adult. It's all those years where you're crammed in schools together, right? I got mine when I was living in a college dorm. Makes total sense.

00:33:30 Speaker_01
But this year we're seeing it in kids younger than five. So pre-school, not preschool, you know what I mean, prior to school age children. And that is a little more unique. Now, why would that be happening? Well, there are several reasons.

00:33:42 Speaker_01
And I actually, as I was researching, why is there a rise now? I found an article from last year sort of predicting that this was going to happen.

00:33:53 Speaker_03
Why?

00:33:53 Speaker_01
For one, we saw a suppression in rates of all respiratory viruses during COVID. Right. Why?

00:34:00 Speaker_03
Masking, social distancing, etc. All the mitigation techniques we used. The mitigation mitigated.

00:34:08 Speaker_01
The mitigation mitigated everything. And so we saw lower rates of a lot of other respiratory illnesses.

00:34:13 Speaker_03
That's why in many countries they take those precautions and keep people from getting sick.

00:34:19 Speaker_01
And so it was natural that we saw that and mycoplasma was among the respiratory illnesses that we saw decreased numbers of. It was one of the last to come back.

00:34:30 Speaker_01
It was one of the, in terms of as we saw the rise of all these other viruses, I think you remember RSV, we were having the same conversation about last year. So this was one of the last ones to sort of rebound, but that's part of it.

00:34:42 Speaker_01
We kind of figured it would rebound as everybody finally, you know, stopped engaging in those mitigation techniques. Not that everybody has, there are still some people doing that, but I think in a mass sense. Not in the scale needed to mitigate.

00:34:58 Speaker_01
public health-wise, not personally. And the other thing is that there is a three to five-year cycle, naturally, with mycoplasma, where we see bigger surges and then years where there's less.

00:35:10 Speaker_01
And so we have fewer people exposed for a few years, then now all of a sudden more people get it, and we've got younger people who had not been exposed previously are now getting exposed. It all kind of makes sense as to why this is happening.

00:35:22 Speaker_01
There's also some testing differences that are interesting. Mycoplasma used to be a lot harder to test for. Now, I know at all the facilities I work at, it's on the standard respiratory virus panel.

00:35:33 Speaker_01
So it's not a virus, but it is on a respiratory virus panel, which I always think is interesting. Yeah. And initially, a lot of us were ordering- Well, I did too, Syd. It is interesting. Yeah.

00:35:45 Speaker_01
Initially, when COVID started, we were all ordering a COVID test, and then COVID got added to our respiratory viral panel. So instead of ordering a COVID test, if someone suspected COVID, they would just order the panel.

00:35:58 Speaker_01
And we can all debate whether economically that's a good idea or not, but the point is it's happening. I wonder if that's also why we're picking up more mycoplasma. So we're testing more. That could be it too.

00:36:08 Speaker_01
But all of these things contribute to the fact that we are seeing an increase in cases. We kind of knew this would happen. So I don't think it's something to worry about in that sense.

00:36:18 Speaker_01
What I would do is engage in the same sort of strategies that help us prevent illness of any kind of respiratory droplet illness.

00:36:28 Speaker_01
So it is transmitted that way, respiratory droplets, coughing, sneezing, not washing your hands, getting that infectious material on other people.

00:36:39 Speaker_01
washing your hands, covering your mouth, staying home when you're sick, not sharing beverages with people who are ill, wearing a mask if you're going out in public if you're sick or if you are somebody who's particularly concerned about getting a respiratory illness, keeping your kids home when they're sick, staying home from work when you're sick.

00:36:57 Speaker_01
I mean, staying home when you're sick is a really big part of all of this. And then it is a time of year where, especially if you're somebody who is especially vulnerable to these kinds of illnesses, to avoiding crowds whenever you possibly can.

00:37:09 Speaker_01
Obviously, that is something we can only do to whatever extent we can. But that is what's going on. If you do contract, and I'm not suggesting that if you get a cough and a fever, you should immediately run to the doctor every time.

00:37:23 Speaker_01
Certainly not everybody always needs to do that. You know your own health history better, maybe you do, but not everybody always needs to.

00:37:31 Speaker_01
But if you are sicker than, you know, you'd expect with a common cold, right, than you'd expect with a runny nose, cough kind of thing, certainly go get checked out. If your young child is ill, certainly go get checked out.

00:37:44 Speaker_01
If you, again, have some sort of other coexisting condition that makes you more vulnerable, go get checked out.

00:37:50 Speaker_01
If something is lasting longer than you expect it to, we usually expect a virus to last like 7 to 10 days and then you're pretty much better.

00:37:56 Speaker_01
If you're still sick, I always tell people, if it's going on a week and you're just as sick as you were in the beginning, you need to get checked out or certainly if you're getting worse.

00:38:05 Speaker_01
And you might see that your doctor is a little quicker to prescribe something like a Z-Pak because we know there are increased rates of this right now. So if you're concerned, go get checked out. There is a test for it.

00:38:17 Speaker_01
And also, a lot of it is clinical picture. We can just tell, you know, based on your exam and your history.

00:38:23 Speaker_03
Yeah. Thank you so much for listening to our podcast. We hope you have enjoyed yourself. Thanks to the taxpayers for using their song medicines as the intro and outro of our program. Thanks to you for listening. That's going to do it for us.

00:38:34 Speaker_03
Until next time. My name is Justin McElroy.

00:38:36 Speaker_01
I'm Sydney McElroy.

00:38:37 Speaker_03
And as always, don't drill a hole in your love.

00:38:59 Speaker_00
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