Your Friendly Neighborhood Hookworms

Introduction

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0:27Hey, I'm Latif Nasser. Hi, I'm Molly Webster, and this is Radio Lab. And what are we doing today, Molly? Okay, well, Latif, remember back in 2009, before you and I both worked at the show, there was an episode called Parasites. Oh my God, love that episode. It is really one of my favorites. And in that episode, we talk about this tiny, maybe creepy little worm called a hookworm. That's right. You remember it. Yeah, I mean, it hooked into my brain. The hookworm hooked into your brain.

0:58It's the story of that one guy, and then there's the final scene where he's walking through the... Oh, wait, okay, wait, wait, wait. You don't actually have to... Don't say what the final scene is, is because what we're going to do here is I'm going to play the hookworm's chunk of that episode. Oh, okay. And then I have an update, a 20-year-later hookworm and human medical update. VH1 behind the music, where is the hookworm now? Yes. Where is the hookworm and where is the human?

1:30Okay, great. This whole episode, it introduced this idea that this thing that we think is like the biggest, scariest, grossest pest of all time, maybe they're not as gross as you think. And now, 20 years later, people are saying, maybe they're really not as gross as you think. Love it. And there's just like all this cool new research about hookworms in the human body, and specifically one very important type of disease,

2:00autoimmune disorders. Ooh, that, as you know, is one I'm particularly interested in. But, well, yeah, I'm sold. I would like to hear more. Okay, great. So I'm going to play the original hookworm segment, just so we all know what's going on, and then we'll jump into an update in about 20 minutes. Okay, great. Wait, you're listening. Okay. All right. Okay. All right.

Hookworm History

2:25You're listening to Radiolab. Radiolab. From WNYC. See?

2:34Rewind. Hello, I'm Jad Abumrah. And I'm Robert Krillrich. This is Radiolab. Our topic today. Parasites. Parasites. Now, we've met them when they're nice, and we've met them when they're not so nice. I don't know that we've met any nice ones, really. Oh, we haven't? I thought that. Oh, the blood flukes. They were pretty nice. Yeah, they were nice. So, now the question is, let's just talk about scale. I mean, for the most part, they're irritating and little, and they seem kind of invisible and sort of offstage. Yeah.

3:04But when you back off a little bit and consider them, you know, in the effects that they have on the world. They're actually these powerful sculptors of monumental narrative. In other words, these are little guys telling very big stories. In fact, here's an example. Recently, I went to visit a guy named Dixon Despamier.

3:26But Columbia University, he's a parasitologist, and, well, he does a bunch of different things. Very good to meet you. And we ended up talking about, well, he told me this crazy story. Okay. Molly, jumping in here really quick. This next part of the story, which has to do with Rockefeller, think of it like those stories that has been told so many times. It starts to become like a tall tale. It's a living myth. So, the facts are a little blurry, but the idea is right.

3:56Here we go. The story I love telling the most is how we eradicated Hookworm.

4:01The story begins in 1908. John D. Rockefeller, Sr. Really rich guy is sitting in his New York office, and he's thinking, How can I make more money selling something to the South? Yeah, I've got all this money, got all these resources. I just need a new market. And in terms of new markets, the South was pretty much untapped. If only those damn Southerners. Just get off their butts and get going. The problem was, they weren't. They weren't getting off their butts. The farms were not operational. The economic engine was turned off.

4:32The economy was in the toilet, and so John D. Rockefeller wanted to know why. Why aren't they producing more? Yep. What's happened to their economic engine? So, he thought... I know. I'll form a commission. Yeah. So, he sent out a bunch of economists and sociologists and people like that on the original Rockefeller commission. They did everything a commission could possibly do to try to find out why these Southern gentlemen were not rising to the occasion. And they came back with the following conclusion. Well, we don't exactly know what's wrong, but we think that these people are sick from

5:05something because they don't behave like we do. What does that mean? They are slow. Not mentally. They're slow physically. They're pale. I'll give you an example. Remember the movie Deliverance? Sure. Okay. Remember that little guy that played the banjo?

5:22I remember the other scene that we all remember. Yeah. We're not going to talk about that. No, we're not. No, we're not. But if you can recall what that little banjo player looked like. A little wiry looking guy, but he looked old. Sickly pale. Yeah. Sickly pale and yet an adult. Well, wait a second. That is not a description of all Southerners. No. It's a description of one teeny corner in a... No, but what the commission did say about a lot of these Southern people that they encountered is that a lot of them, they just don't look right. They look weak. They look wan. They look kind of wan.

5:53Wan. Wan. They were wan. Pale. Lethargic. It's interesting. Wan or wan? Wan. You choose. So the thought was that maybe these Southerners had some kind of laziness disease. This is really what a lot of folks thought. But one member on the committee suggested to Rockefeller, you know what?

Anemia Discovery

6:07Perhaps these people are anemic. Anemic. They're anemic, do you say? Yeah. They're anemic. It sounds like a medical problem then. Maybe they're not lazy after all. Maybe they're anemic and maybe they're just weak. Next thing you know, Rockefeller puts together another commission... ...to find out what the basis for the anemia was. And not only did they find anemia, but they found a correlation of the anemia with soil types. That's bizarre. Sandy loamy soils? Anemia. Hard-packed clay soils?

6:38Hmm. No anemia. Sandy loamy soils? Good farmland. Hard-packed clay soils? Not such good farmland. So all the rich farmers were anemic and all the poor farmers were doing okay. And this seemed to be a clue. The incidence of anemia was linked somehow to the soil. Maybe, bum-bum-bum. Yes. Something was in the soil. That's correct. So somehow they hit upon this idea of looking for hookworm.

7:04The hookworm. The hookworm.

7:09So they thought, all right, let's run some tests. And when they did, big time, they discovered hookworm big time.

7:17So the anemia is due to hookworm. Now the question became, how are these Southerners getting the hookworm and giving it to one another? And a pretty good place to start to look for an answer was their feces. Because if these hookworms are in you, they're going to come out of you when you go to the bathroom. So they asked these Southerners, when you guys defecate, where do you do it? Most of them said something like this. And I defecate over there. You see that tree over there? That's where I defecate. So I defecate over there, but I live over here.

7:48Okay. So then the investigators asked the next question. When you go to that tree and do it, do you wear any shoes? Most of them said no. Barefoot, just like everybody else. Because it's comfortable.

8:01So clearly these worms are in the feces that are landing near the tree. They are somehow getting into people's feet the next time they come to use the tree. But no one intentionally steps in their own, you know, no one does that. Which meant... Oh my goodness, oh my goodness, it can crawl.

8:20Right, so let's find out how far it can crawl. So what they did, these researchers, is they built a sandbox. And then they took some hookworm-infested stool... ...and put it right in the middle. Then every day, we'll sample from the stool sample out in the sand in all directions and find larvae and find out how far they can travel. How's that sound? So now we have larvae in the stool, and they begin to crawl away from the stool, seeking a victim. On day one, they crawled an entire foot. In all directions.

8:51But they weren't at two feet. On day two, my God, they're at two feet. At day three... They're at three feet! I can't believe this! They're crawling a long way! Day four, they crawled to four feet. What about day five? I'm allowed to ask that. And what about day five? Five feet? No. No. Four feet. That's it.

9:24So how in the world could you deal with this problem when these worms can crawl... They can crawl four feet. It doesn't matter where you defecate. They're going to crawl away from that. And within a four-foot radius of that stool sample, you're going to get hookworm. Unless you do something radical that's never been done before. They devised a scheme for burying the stool sample into the ground six feet deep.

9:54Because if the worms can only make it four feet, well then that's two feet past the point where they die. We call that the outhouse.

10:05And in fact, Rockefeller got his wish. The South did rise again. That sounds too easy to me though. You're telling me that an understanding of hookworm, which created the outhouse, removed the quote, southern laziness disease and they did rise? It did. And you bring that all back to the hookworm? I do. Really? No, I bring it back to sanitation. Now to be fair, you can find plenty of other reasons why the South rose again. Air conditioning and highways and universities and stuff like that. So the hookworm had some help. But what is clear is that when we as a country began to distance ourselves from our own excrement, to put it bluntly, when we stopped walking around in our own s***, there were all of these unintended consequences.

10:46Salmonella disappeared, eostholytica disappeared, shigella disappeared, cholera disappeared, giardia disappeared, cryptosporidium, anything that's associated with parasites in feces disappeared. Every time we built outhouses and people used them religiously, guess what? Their kids could stay in school longer. They could learn more. They got to head faster. Dixon Desvamieh is a professor of public health and environmental health sciences and microbiology at Columbia University.

11:39Can they make longer titles at that university? He literally wrote the book on parasites. The book is called Parasitic Diseases. You know it very well. It's soon to be a major motion picture, but now in its fourth edition. In its fourth edition. And while we're on the subject of hookworms and the glorious campaign to deworm America, because this has been a very carefully crafted and intentionally fair program, you have heard the case against hookworms. Now, let's turn the coin and say something nice about hookworms.

Hookworm Benefits

12:11And to begin that discussion, let's go to our reporter, Patrick Walters. So, Pat, are you there? Yeah, I'm here, Robert. So, tell us a little bit about this fellow. What's his name exactly? His name is Jasper Lawrence. That's right, Jasper Lawrence. So, where is he from? He actually grew up in England. He grew up in this little farm in the southwest corner of England. And it's important to know, I think, before hearing any part of his story, that Jasper has had allergies for pretty much his whole life. On really bad days, my eyes would swell up so much from pollen or airborne allergens that they would feel like they were swelling shut.

12:45I could feel my eyes squeaking in my sockets. It was an enormously uncomfortable feeling. But it was nothing debilitating. They were just allergies. So, you know, he's just like most other people who have allergies, just learn to deal with it. You know, you live with it. But what changed for me in my late 20s, early 30s was my asthma. And at that time, I was living in Santa Cruz. I was relatively recently married. We had three cats that had been grandfathered in with the relationship. And I started a landscaping business. I really didn't want to work for someone else.

13:16Like someone with allergies, starting a landscaping business. That seems kind of unexpected. Stupid is actually the word for it. And within six months or a year, he starts to notice this really weird barking cough. Was there anything particular that brought this on? No, it was just sitting and breathing. Cats certainly didn't help. Right. And during that period, my asthma got much worse very, very quickly. By the time it was 1996, 1997, I was seeing specialists having skin allergen tests and cycling through emergency inhalers, trying Singular and all these other drugs that were coming on the market.

13:58I was being hospitalized at least a couple of times a year. I mean, I looked terrible. I had dark eyes and pale, waxy skin. I had that allergic look. It was a really bad time. And he decides in the summer of 2004 to take a vacation. You made this visit to England. Yeah. I took my two daughters back to see my aunt, who had raised me. Very early in the visit, I was sitting at her kitchen table, and she asked me if I'd seen a BBC documentary about parasites and their connection with things like asthma and allergies and multiple sclerosis.

14:33And, of course, I hadn't, but I went upstairs and got on the Internet after lunch, and I stayed on the Internet until perhaps 2 in the morning.

14:45I didn't stop. And he's reading and reading. The work of all these researchers. One study after the next. Japan, epidemiological studies in Africa, animal models, multiple sclerosis. There's this enormous weight of evidence that, in the developing world, people don't really have asthma or allergies. And what he discovers is that behind all of this, to his shock, is hookworms. Hookworm?

15:15Yeah, hookworms. Yeah, I learned that asthma was 50% less likely in someone who had a hookworm infection. So this sort of just, like, hits you. Oh, yeah. What did you think when you read that? Oh, I immediately was determined to obtain a hookworm. Immediately. I couldn't wait. So hookworms are these very tiny worms the size of a little hare. But if you take a microscope and you zoom way in, they have this big circular mouth brimming full of pointy teeth.

15:49Very scary to look at. They have these toothy mouths so that they can burrow up through your feet, ride through your blood, and eventually end up down in your gut and start chewing on the inside of your intestines. This guy wants hookworms in his intestines? Absolutely. And so you just Google it? Yeah, hookworms for sale. I mean, you know, someone's got to be selling them. But, uh... Not nothing. I contacted every laboratory supply company in the world and parasitology research centers, and they all said the same thing.

16:22No. Various flavors of no. And so I came to the conclusion that I was going to have to go to the tropics. So, fast forward a little. Jasper is in Cameroon along the coast. Quite literally and figuratively the armpit of Africa. He's 200 miles north of the equator. It's extremely hot. He finds a guy to drive him around. And so he and his driver would go to a village. He'd get out of the car. Walk up to these villagers and ask them if they could see the latrine. Just an open area of ground, usually with bushes so people can have a little bit of privacy.

16:58And I would go over to the area, remove my shoes, and start walking. The first time I did that, I almost couldn't do it. It was... It must have been 110 degrees that day. 100% humidity.

17:14And the stench and the noise from the insects... It was so repulsive and so disgusting.

17:33How many villages, latrines do you think you visited? Between 30 and 40.

17:40Jasper spent two weeks there, walking around in village latrines, and then he flew home. I got back from Africa in early February. So I was looking at allergy season coming up. And the day I realized that I no longer had allergies, it was such a good day. I got into my car, and I started driving. And I had the window down. You know, I felt the breeze blowing across my face. In the past, what that meant was that very quickly my eyes would be itching uncontrollably.

18:12Snot and phlegm was going to be pouring out of every orifice in my face. And it didn't happen.

18:19It didn't happen.

18:22I just started screaming in the car. I was so, so happy. And I haven't had an asthma attack since I went to Africa.

18:38I no longer have allergies.

18:45The vast majority of the benefit that I've experienced has come from hookworm. What is the hookworm doing? Do you know? Well, so the immune system that we learned about in elementary school is all about, like, these attack cells that go after foreign invaders and destroy them. Right. And that's a big, important part of the immune system. But if the immune system were allowed to attack and destroy things unchecked, it could kill you. And there are lots of diseases where the primary symptoms are caused by the immune system attacking the body that it's really designed to protect.

19:16Allergies and asthma are just two of these. Some of the more serious ones are, like, type 1 diabetes, multiple sclerosis, Crohn's disease, in which the immune system actually starts attacking the inside of the intestines. There are, like, 80 of these diseases. 80 of them. And so what scientists have found in lots and lots of mouse studies, and in some human studies to this point, too, is that once the hookworms get inside the gut and the immune system actually starts attacking somehow, hookworms actually stimulate these cells,

19:47which just quiet things down and tell the attack cells to stop attacking.

19:58So these are like lullaby cells? Exactly. What lots and lots of scientists think, Joel Weinstock, Joel Weinstock, Tufts Medical Center, and dozens of others, is that over thousands and thousands of years, hookworms almost developed in tandem with the human immune system. Co-evolution. Parasites living within your body. Your immune system changes. So you got to a point where the hookworms could survive safely. The worm gets a home. There's food coming down the food pipe. And in return,

20:28the human immune system gains some kind of positive regulatory advantage. So that if you had this glitch where your immune system started attacking your own body, the presence of the hookworms would keep things controlled. That's the gift. You do something for the worm, the worm does something for you. So then, by that logic, what we in the West, in the richer countries, have done stupidly

21:00is we have cleaned ourselves up too much, and we don't have enough wormies in us. Yeah, this is called... They call it the hygiene hypothesis. The hygiene hypothesis. That we're not dirty enough. Too clean. We function like rainforests. We're ecosystems. And we've entirely eliminated a class of organism that co-evolved with us and our genetic predecessors for millions of years. Now, I don't want to leave the impression that hygiene is bad for you. People can't go back to living in filth, kids playing in sewage by the riverbank,

21:31but in improving our hygiene, we are also excluding organisms that may be important for making us well. So then what does Jasper do about all this? He decides to start a business selling hookworm to people. What? You can call him up, and he will literally FedEx a dose of hookworms to your door. How... Sorry to break in for a second. Pat. Hi, Jad. Where does he get the hookworm from? This is weird. Jasper gets the hookworm from himself. Could you describe how you go about getting hookworm from your stool

22:07into one of your patients? Well, it's a very easy organism to work with. It just gets up and it walks out of it. So it doesn't take an enormous amount of work to separate it from the feces. And then having done that, I repeatedly wash them in solutions of antibiotics to make sure that anything that could live on them is killed. People contact us. We'll have them complete a questionnaire, submit a recent blood test. Then we'll ship them a dose and all the materials and equipment and the instructions necessary to infect themselves.

22:37To me, is this a safe thing to do? Jasper has done tons and tons of research, but he's not a doctor. The treatment is not approved by the FDA. That's what I wonder, is there any serious sort of double-blind study trying to figure out whether some safe delivery of hookworm might make sense? Yes. So one of the guys who was sort of a pioneer in this hookworm research is David Pritchard. I'm Professor David Pritchard. Immunologist and parasitologist. At the University of Nottingham where I study parasites

23:09and the wound healing properties of maggots. So we've now got two safety trials under our belts, but we've yet to conduct the trials to show the therapeutic benefit results from infection with worms. So Pritchard infected himself pretty much just to make sure that it was safe. What we did was 10 of us in the lab took worms at different doses. We were either given 10, 25, 50, or 100 worms, and then we had to report on the symptoms. And on the back of that study, we determined that 10 worms were tolerated.

23:40But Pritchard, when he did this proof-of-safety study, actually gave himself 50 hookworms. Oh. Which put him out of commission for a while. Well, I felt pretty bad. I mean, pain in the gut, really. You know, you could feel them because they are biting on your tissues. I mean, if you have too many hookworms, they can cause things like diarrhea. And the most serious side effect, and the side effect that makes them sort of a public health enemy, is that they can give you anemia. Yeah.

24:08So if you have too many, you lose quite a bit of blood to these parasites? Well, you know, if you take too many hookworms, which you're not going to if you come to us, the worst thing you're going to get is anemia. But it's not like you wake up one morning and you're drained of blood. Very slow to develop, and it's very easy to deal with. Jasper's kind of just gone for it. You know, it's a very sort of, like, cowboy move. To the scientific community, I think they believe that I'm premature. It's not FDA approved. In offering this to the public. You don't know what it is. You don't know its purity. It's not safe. But I've talked to several clients who had really severe allergies and asthma.

24:42They say they've just achieved these great results. And Jasper also says he's seen success with a few multiple sclerosis patients and several Crohn's disease patients, too. Like, how many people do you think that you have infected? That's about 85 right now. How is business? Business is adequate. But I honestly don't know why I don't wake up in the morning with my front garden 20 deep, with people with ulcerative colitis, Crohn's disease, allergies. I just don't know why I'm not completely buried.

25:14The way he sees it, people are scared. Well, they're the people who are coming from a point of view of what they learned in kindergarten about clean drinking water and sewers. To them, worms and parasites are so repulsive that there's nothing good to be said about them. But I can make you better. It's simple. It's cheap. I mean, for God's sake, these organisms fall out my rear end every day a half a million at a time. The raw material is human excrement, for God's sake. All people have to do is open their minds.

25:46Are you really that scared of a little worm? Okay, okay, okay, okay. So, okay. So, that's it. So, so, wait, but, okay. Yeah, maybe the, maybe the question is, Latif, you have talked about this on the show. You have an autoimmune disorder. Yes. Crohn's disease. Crohn's disease, yeah.

Personal Story

26:12Okay, you've heard this piece. Are you scared of a little worm? I mean, I am intrigued. I am, I don't know whether to be scared. If there are clinical trials that can help tell me whether to be scared or not of this worm, that's what I want to know. All right. Well, then I am going to tell you about a clinical trial and then you can tell me what you think. Okay. But after the break. All right. Oh, after the break. All right, after the break, let's do it. After the break, a clinical trial. I'm ready. I'm excited. Okay. Great. Radio Lab is supported by Capital One.

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29:08Hi, Lulu here, and this episode is sponsored by BetterHelp. May is Mental Health Awareness Month, and as someone who reports on mental health, who likes talking to people about their mental health and what they look to in science, in the natural world, in faith, in friendship, wherever it may be, to help guide them through the rough patches of life, I just wanted to take a moment to say what seems to help people turn corners, find relief, get out of ruts, and even flourish is having someone with you.

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30:24Latif, we are back from break.

Clinical Trials

30:26Yeah.

Clinical Trials

30:26And we left you at are you scared of a little worm? And I was like, maybe, maybe, I don't know. Let's do some actual clinical trials. And that is what, like, okay, so that episode was done in 2009. Right. And so I want to fast forward to today. There have been a number of clinical trials. Okay, so what happened? Okay, so, hi. Hey, how are you? I'm good. I talked to this researcher, Dr. Paul Jackerman. Paul Jackerman. Senior Research Fellow at the Australian Institute of Tropical Health and Medicine.

30:58And he's basically trying to do, like, the next iteration of... Jasper. ...of, like, Jasper, but, like, with actual scientific studies and stuff. Okay, yeah. Yeah, trying to understand the potential beneficial effects of worms in people. So one of the things that he's been studying is... Treating people who are at risk of type 2 diabetes with hookworms. Hmm. So type 2 diabetes, that's the diabetes you typically get later in life? Yeah. What made you pick diabetes? It sort of came on the back of research which started in the 2010s

31:29where people went into regions of the world where parasitic worms are really common. And what they found is that there's a correlation between something like type 2 diabetes and the presence or lack of worms. Huh. Yeah, so basically... What Paul and his team did is basically they took people who are at risk for type 2 diabetes and they gave them hookworms. How do they give it to them? How do they take them? Do you, like, slurp it down like a little piece of spaghetti? No. You know, people think where they're going to enroll they're going to have to swallow a worm or swallow worm eggs, etc.

32:00So... It's actually much worse or... Okay. I don't know, it could be much better than that. Basically, in order to do our research... The first step of the process is they have folks who work in their lab... these what's called worm farms... Volunteers... Who've consented to have a small number of worms... Living inside of them. Oh, wow. Yes, exactly. The only way, you can't culture them, you can't just get them and freeze them. Really? Yeah, so that's one of the limitations about working with these worms. You actually have to maintain...

32:32We call them worm farms. Is there, like, hazard pay for that? Like, what? Do they get a bonus? No, I think they're just very generous volunteers. Brave and dedicated volunteers. And so that if we want to do our research, we say, hey, generous volunteer... Can you give me a sample of your stool? Okay. Because what happens in these people, in the worm farms, is the hookworms inside of them will mate... And they can produce, the females can produce tens of thousands of eggs every day,

33:03which are released eventually in the poo. Huh. And so they poop. We get the poo sample. Add charcoal to it. Which reduces the smell. And then we spread it onto the petri dish. They leave the petri dish in sort of, like, kind of a humid, tropical environment. Okay. It sits there for a week. And over the course of that week... These tiny hookworm eggs start to hatch. And emerging from them are these... Microscopic. Teeny, tiny baby worms. Barely visible to the naked eye. And very quickly, Paul and his team

33:35hit them... with, like, a strong disinfectant. To clean them. Then we can basically look down the microscope. We just, one by one, pick the wriggly worms, put them into a little tube. And then, what they do is they put the worms on a Band-Aid, essentially. Uh-huh. And they take that Band-Aid and they put it on the skin of the patients that are enrolled in the clinical trial. Oh, but not even on a cut. Just anywhere on the skin. Just anywhere on the skin. And then we sort of sit with them for about five minutes because participants

34:05start to get this tingling sensation. Because what happens is these baby worms on the Band-Aid start to release an enzyme. Which degrade tissue. Which basically melts your skin so that they can start to burn into your skin. And as they enter your skin, then your skin just closes up behind them. The tunnel closes and then the worm makes their way down through your skin into the lymphatics.

34:35Your lymphatic system. So, if you think of the inside of your body as a water park, as one does, the lymphatic system is like the lazy river. Sure, yeah, yeah, yeah. So these baby hookworms go through the skin cells, fall into this like little lymphatic river, then they float along through your lymph system. I kind of maybe picture them with, I don't know, cozies of non-alcoholic beer because they are babies on their little tube. That's funny. And they're floating downstream.

35:05Uh-huh. They float along and they get to what is known as your lymphatic duct, which is kind of right by your collarbone. And once they get there, they get shot out of the lymphstream into your bloodstream. And once they're going into the blood, they're cruising around like on a water slide. They go from your collarbone towards the center of your chest where they catch this huge slide that sends them into your heart and then your heart shoots them out

35:36onto another big slide. That slide starts splitting and branching and splitting and branching and as it does, the slide is getting smaller and smaller and smaller until these little baby worms get stuck. They get trapped inside a super tiny blood vessel. Because they're too big. Yeah, they're too big for the blood vessel so they get stuck there. Their journey ends. But Paul says that's their cue to again release an enzyme that starts to melt away the walls of the blood vessel. Whoa.

36:06Just enough. They can wriggle their way through and then pop out on the other side of this blood vessel and into your lungs. And then what they do is they crawl up through the lung all the airways like a rock climber up your trachea so they're almost in your throat and then unknowingly one day you will cough which will dislodge these worms

36:36from your trachea up into this little free space in your throat where I like to think that they will do a backward somersault and then after you cough you usually swallow. So yeah you'll swallow them. You swallow the worms. Oh my god. At which point they will shoot down your esophagus into your stomach. Oh my god. And then why wouldn't you just oh but it's like why wouldn't you just feed it to people then? Like why do this whole crazy Well because this whole process from skin to gut takes about two to three weeks and during that process

37:07the worm is maturing. Got it. And so it's actually developing in such a way that it can survive in your stomach. I see. So it's like this is how it develops. Exactly. So it's a really fascinating life cycle.