MrBallen’s Medical Mysteries - Ep. 50 | Elephant Man

Episode Date: September 17, 2024

When a routine medical study makes patients swell up like sausages, the doctors running it struggle to understand what went wrong. They have to act fast – because if they can’t figure it out soon, the so-called “elephant men” could die.Follow MrBallen's Medical Mysteries on Amazon Music or wherever you get your podcasts. New episodes publish for free every Tuesday. Prime members can binge episodes 49-56 early and ad-free on Amazon Music.Wondery+ subscribers can listen ad-free--join Wondery+ in the Wondery App or on Apple Podcasts.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Hey Prime members, you can binge episodes 49 to 56 right now and ad-free on Amazon Music. Download the app today. A doctor in his mid-40s strode into the intensive care unit, or ICU, preparing himself for the worst. He'd been eating dinner when the hospital called him. They told him six patients had just been admitted to the ICU in alarming condition. They were covered in sweat and barely conscious, their blood pressure and other vital signs were crashing, and they looked just bizarre. When the doctor stopped at the first patient's bed, he nearly gasped. The man lying there was

red and patchy, like every blood vessel in his body was inflamed. His face was so swollen that the skin was pulled tight, like the softest touch would rip it open. His lips were bulging and purple, and his fingers were like fat sausages, bright red from inflammation, and certainly they had to be very painful. Drool was also pooling at the corner of the man's mouth. The doctor asked the patient, you know, how are you doing? But the patient just looked up at him with hazy eyes, unable to focus. This was one of the sickest patients the doctor had ever seen, and he knew there were five more patients just like him. The doctor felt a rush of adrenaline as he sprang to action. He had no idea if it was even possible to save these grotesquely swollen men, but he had to try.

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Listen to The Best Idea Yet on the Wondery app or wherever you get your podcasts. From Ballin Studios and Wondery, I'm Mr. Ballin, and this is Mr. Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, our own bodies. If you liked today's story, please move into the apartment right above the follow button and start running on your treadmill at 5am. This episode is called Elephant Men. On the evening of Sunday, March 12, 2006, 23-year-old Rost Kahn bounded up the steps of Northwick Park Hospital in London, England. He was running late for the start of a clinical trial that promised to pay him £2,000

in exchange for just three days of work as basically a human guinea pig. But to a recent university graduate like Rost, this was incredible money. £2,000 would be more than enough for him to catch up on his many unpaid bills and put some away as savings. But if he missed the start of the trial, he was worried they wouldn't even let him in. So even though Rost hated running, he pushed himself to sprint the rest of the way up the stairs to the second floor, and then he jogged down the dingy beige hallway to the waiting room. Once inside, he found a group of men already seated around a conference table, each with a little packet of papers in front of him. A doctor in a white lab coat walked over to him, saying he must be Rost Kahn, their very last

volunteer. Rost nodded, his hands on his hips, trying to stop panting. He was just grateful he'd made it. Once Rost caught his breath, he sat down at the conference table and looked around and nodded a quick hello to the other men, and then he looked down at the packet of papers, as the doctor in the lab coat explained that for this trial, they'd be testing an experimental drug called TGN-1412. It was designed to strengthen the body's immune system so that it could fight off cancers like leukemia. If the drug worked, it might allow cancer patients to avoid the agony of long and painful chemotherapy treatments. And so far, TGN-1412 had been tested successfully in animals, and so now it was cleared for a human trial. The doctor proudly announced that this group of men

would be the first to be given the drug to see how the human body responded to the medicine. When Rust heard this, he sat up a little bit straighter. He'd done a few clinical trials before, and none of them had felt very important. But a drug that might cure leukemia could save countless lives, and so he thought it was really cool that he got to be a part of something that could potentially make medical history. The doctor told the men that tonight, the medical staff would take their vitals and give them all the same late-night snack. Then they would spend the night at the hospital. In the morning, they'd receive the drug, and for three days after that, they would be carefully monitored to see if they experienced any side effects from taking this drug.

And that was it. Then they'd go home and would just need to come back for a few follow-up tests. The doctor beamed as he explained that once they knew how healthy people reacted to this drug, they could then test it on volunteers who actually had leukemia. Next, the doctor started reviewing a list of bullet points about how the drug was supposed to work, and as he did this, Ross sort of tuned it out and just began looking around the table at the seven other men sitting there, and most of them were in their 20s and 30s. But as he looked around, Ross noticed that all the eyes at the table were actually turning to

him now. It took a moment for him to realize that the doctor had actually asked Ross a question and was waiting for the answer. Sheepishly, he apologized and then asked the doctor to please repeat himself. The doctor cleared his voice and then he said again what Ross had not heard. He said there were risks involved in this trial, real risks. Test subjects could possibly break out in hives or even go into a life-threatening anaphylactic shock. The doctor then turned to Ross and asked if those risks gave him any second thoughts about joining this experiment. But Rost just kind of shrugged like it was no big deal because for him, at all the trials he had been at, doctors always sounded this way, talking

about the risks as being so bad, you know, are you sure you want to proceed? But honestly, Rost had already made up his mind. Besides, the trial had already been approved by the government and all the participants were already in a hospital, so if something went wrong, they were in the right place. So, Rost said, yep, no second thoughts. After Rost gave his approval, along with the other men at the table, the doctor began splitting the men into two groups of four. Rost was sent with three other men to a place the doctor called Trial Bay 1, while the other four participants headed to Trial Bay 2. Rost followed his group into a big white-walled room with four hospital beds. A desk and some cabinets had been shoved into the corner of the room, suggesting the room

was normally used as an office. But tonight, it would be Trial Bay 1, complete with patient privacy curtains hanging from the ceiling. Rost and the other patients settled into their hospital bed inside of their curtained cubicles and waited for their snacks. And then after that, around 10 p.m., the lights went out and Rost tried to get some sleep. The next morning, Rost woke up when a nurse called out good morning to the whole group and then flicked on the overhead lights. It was 7.30 a.m., which meant they had half an hour before the trial officially started. Rost stumbled out of bed and made his way on the overhead lights. It was 7.30am, which meant they had half an hour before

the trial officially started. Rost stumbled out of bed and made his way to the bathroom down the hall. He wanted to change out of his pajamas and into some sweatpants before the trial actually got started. And after changing, when he got back to the trial bay, all of the curtains were now pushed back so that the room was now one big open space again. The nurse then asked Rost to please climb back into his bed, and then she explained that she was about to hook him up to a heart rate monitor. That way, nurses and trial leaders could monitor any cardiac symptoms while he was on this medication. While the nurse taped wires to Rost's chest,

a man entered the room and introduced himself as Dr. Daniel Bradford. He explained that he was the lead doctor on the trial, and that the dose of TGN-1412 they'd be receiving was scaled back dramatically from the highest dose they tried during animal testing. This way the men would only get a tiny fraction of the animal dose. Dr. Bradford said that each of them would get an injection in their arms. One volunteer would be injected every 10 minutes until they had all been infused. However, only six of the eight volunteers would actually receive the experimental drug. The other two volunteers would just be receiving a placebo,

like sugar water, just for comparison purposes. Nobody, not even Dr. Bradford himself, would know who received the drug and who didn't. Rost knew this was completely normal in medical research, and it reminded him that these researchers were very serious. When the clock finally struck 8 a.m. and it was time to start, Rost watched as a nurse gave the first infusion to the patient in the bed that was next to Rost, a man whose name was David. David had told Rost the night before that he was getting married in a few months, and like everyone else in the trial, he'd signed up to make some quick cash. He wanted to pay off his credit card debt before starting this brand new life with his

fiancée. The nurse slid an IV needle into David's arm and then hooked the IV tube up to a small machine. She turned it on, and then a clear liquid began flowing out of the machine and down the tube into David's arm. She told David to relax until the bag of fluid was empty, and then she looked across the bed to Rost and told him that she'd start his infusion in precisely 10 minutes at 8.10 a.m. As Rost waited for his turn, he grabbed a book off the bedside table and flipped through the pages, but he couldn't concentrate enough to actually read.

He kept stealing glances at David to see if, you know, maybe David was negatively reacting, but Rost was pleased to see David looked perfectly calm. At 8.10 a.m., the nurse came to Rost's bedside, and for some reason, Rost's stomach began fluttering with nerves. He told himself everything was fine and tried to look nonchalant as the nurse wiped the inside of his elbow with antiseptic and then stuck him with the IV needle. Rost began looking around the room to distract himself. The liquid drug felt cool as it flowed into his forearm and up into his shoulder.

He actually shivered a bit, trying his best not to move. And then finally, he leaned back against the pillows on his hospital bed. The injection was over. At 8.20am, so right after Ross' injection ended, the nurse began administering the drug to the volunteer on Ross' other side. Ross couldn't remember this man's name. All he knew is that he was an actor who had recently come back from Los Angeles, California on a vacation, and the nurse had just finished hooking up the IV when David, the first patient to receive the infusion, called out to her. David draped one

arm across his eyes and told the nurse he had a migraine. The nurse told David she'd be right back and then she walked out of the trial bay, and then a minute later she came back with just a cold towel and laid it across David's forehead and then apologized to him. She told him that they couldn't give him any kind of pain reliever since it might affect the drug trial. Rost felt terrible for David, who just groaned and pressed the towel against his eyelids. And as Rost stared at David, Rost just hoped he wouldn't develop a migraine too. And so far he felt fine. But the more he began to think about it, the more convinced he became that a migraine was actually forming. Rost began to feel panic rise in his chest. But a few minutes went by and his head actually felt basically fine.

At least that's what he kept telling himself. 25 more minutes ticked by and at that point, all four of the volunteers in Rost's trial bay were hooked up to their ivs rost still felt fine but david's migraine seemed to be getting much much worse ross could see that david was sweating now his skin had turned reddish and david said he felt like he was burning up suddenly david sat up just long enough to rip his shirt off and then he collapsed back onto his bed complaining about stabbing pain in his head. At this point, Rost was finding it impossible to distract himself. Around the room, everyone except for David seemed to be doing fine, but in his gut, Rost felt like something was wrong here. At 8.50am, Dr. Bradford sat inside of Trial Bay 2, so not the trial bay that Rost was a part of,

and the doctor sat next to volunteer number 6. And as he inserted an IV into the volunteer's arm, the nurse from Trial Bay 1 strode into the room and asked to speak with Dr. Bradford in private. The doctor stepped into the hallway with her and was surprised to hear that three of the volunteers in Bay 1 were experiencing migraines and pain in their lower backs. Two of them were also running high temperatures and had begun vomiting. The third volunteer was wracked with chills and was shaking so badly it almost looked like he had hypothermia. Dr. Bradford immediately rushed past the nurse and hurried down the hallway to see what was going on in trial bay one. The drug, TGN-1412, had tested so well in animals that he had complete confidence that today's trial would go smoothly.

But when Dr. Bradford burst into Bay One, he found a truly chaotic scene. David was writhing around in his bed, his body drenched in sweat. Meanwhile, two other volunteers were slumped over vomiting into yellow biohazard bags. Like David, they were red and flushed and dripping with sweat. Then the smell of urine hit Dr. Bradford, and he realized the bedsheets around the room were wet with more than just sweat. Suddenly, the volunteer in bed number three sprang up and screamed that he wanted to go home. Before Dr. Bradford realized what was happening, the man tore the IV from his arm and made a dash for the door.

Horrified, Dr. Bradford went running after him. The doctor finally caught up with the patient halfway for the door. Horrified, Dr. Bradford went running after him. The doctor finally caught up with the patient halfway down the hall. Dr. Bradford coaxed the man back into his bed, explaining that at this point, they couldn't let him leave for safety reasons. The patient would be putting his own health at risk, and besides, he seemed too weak to even make it out the front door of the building. Dr. Bradford looked around, totally stunned at trial bay one. Vomit and urine were everywhere, and he could barely hear himself think over all the shouting. He'd been involved in over 300 clinical trials over the years,

and he'd even volunteered himself in several clinical trials back when he was in med school. And in all that time, he had never seen this level of chaos and misery. But Dr. Bradford could not dwell on that now. Two of the patients in the ward had bright red faces and he could hear their monitor alarms chirping. The two volunteers were going into shock, which meant their organs weren't getting enough blood. If Dr. Bradford didn't act fast, they could have permanent organ damage or they could even die. The nurses started pulling the curtain dividers around the beds to give the men and the medical team some privacy. Dr. Bradford immediately began ordering drugs that would help stabilize the patients.

As he worked, he glanced up and his eyes settled on volunteer number two. His name was Rost Khan, one of their youngest volunteers. And unlike just about all the other volunteers, Rost seemed totally fine, although he had a terrified look on his face. Three hours later, Rost still sat on his hospital bed, feeling absolutely horrified. The last thing he'd seen as the curtains were drawn around David was the stricken look on his face. Then, Rost had been forced to just listen for three hours, as David and the other volunteers cried and screamed and vomited, filling the air with this awful smell. It sounded like they were fighting for their lives. Rost felt invisible as he heard nurses racing around the room, tending to the other three

volunteers. He could hear similar screams coming from Trial Bay 2 next door as well. And all this time, Rost was thinking any second he was going to get sick like everybody else. Then, Rost heard footsteps approaching his bed. A nurse pulled back the curtains, and for the first time since that morning, he was able to see beyond his tiny cubicle. The other patients were still hidden behind their own privacy curtains, but he could see bodily fluids on the floor and walls, which explained the smell that would not go away.

Across the room, somebody in a lab coat was tying up a yellow biohazard bag and rushing it out of the room. The nurse took the IV out of Rost's arm and removed the wires from his chest and told him he was safe. She said he should go grab some food in a neighboring conference room and someone would be in shortly to explain what was happening. Rost was very shaken, but hearing the nurse tell him that everything was okay made relief flood over him so quickly that he almost felt lightheaded. But mostly what Rost felt is he was just so eager to get out of this foul-smelling room. Slowly, Rost got out of the bed and moved out the door and down the hallway to the conference room next door.

There were some nice sandwiches on the table, which seemed to indicate that there had been a really nice catering order that had been arranged right before all this mayhem broke out in the trial base because it had been totally untouched. But Rost was not hungry. He was just too rattled by what had just happened. So he just stood there, waiting for what seemed like forever. At first, he could still hear the blood-curdling wails coming from the other volunteers, but as he waited, the horrible sounds died down. Finally, around 12.30pm, a nurse entered the conference room and told Rost to collect his things. He was being sent home. He nodded and followed her back to the trial bay. But to his surprise, all of the patients were now gone. The bay was deathly quiet. Rost felt very

uneasy as he collected his wallet and book from the nightstand. He just kept looking around the room, wondering where the volunteers had been taken, and whether they would even be okay. In a quiet suburb, a community is shattered by the death of a beloved wife and mother. But this tragic loss of life quickly turns into something even darker. Her husband had tried to hire a hitman on the dark web to kill her. And she wasn't the only target. Because buried in the depths of the internet is The Kill List, a cache of chilling documents containing names, photos, addresses, and specific instructions for people's murders.

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Join Wondery Plus in the Wondery app, Apple Podcasts, or Spotify. Around 8.30 p.m. that evening, Dr. Ganesh Sundararangam entered the intensive care unit at Northwick Park, even though it was supposed to be his night off. In the middle of having dinner with his wife that night, he'd gotten a call from Dr. Bradford that they needed his help tonight treating some critically ill patients. And then he'd been shocked as Dr. Bradford explained that six volunteers

from that day's clinical trial were in the intensive care unit, all in truly desperate shape. Dr. Bradford explained that they were the first people ever to receive the drug TGN-1412, so nobody knew why the patients were having such strong reactions. Dr. Bradford was basically dealing with an unknown illness, and the volunteers were falling apart quickly. He didn't have much time to put this puzzle together, so he had called Dr. Suntharalingam for help. Dr. Suntharalingam stopped at the ICU bed nearest the door.

A volunteer from the drug trial named David, so the man sitting next to Rost, was hooked up to a ventilator to help him breathe. David's body was swollen, his blood pressure was very low, and it was clear that his lungs were failing. He was one of the sickest patients that Dr. Suntharalingam had ever seen and he knew that he would soon see five other men in a similar condition. Dr. Suntharalingam ordered a full battery of tests right away and when the blood work came back, he could see that all six patients were going into kidney failure which could be fatal. Now obviously this was a massive problem on its own but it was a particularly big issue for this hospital, because this hospital didn't have enough dialysis machines to do the kidney's work for all six of these volunteers. Dr. Suntharalingam began calling around to different hospitals asking for spare machines, and when he talked to them, he told them to please hurry.

Then, Dr. Suntharalingam and his staff got to work trying to stabilize the patient's blood pressure. In all six cases, he could see that they were suffering from some kind of blood poisoning that was causing their blood pressures to drop. If it continued, all of them were at risk of more vital organs shutting down. For a moment, the doctor wondered if the trial drug was somehow contaminated. That was the only explanation he could think of that would cause blood poisoning in all six volunteers. Dr. Sun Thurlingham looked out the ICU window and saw blue and white ambulance lights zooming up the street. Then he heard commotion in the halls, and he knew that hospital staff were racing dialysis machines up to the ICU. Dr. Suntharalingam knew he needed to get out of the way, which gave

him the perfect chance to race down to Dr. Bradford's office. He needed to see every last bit of paperwork they had on this drug, TGN-1412. 30 minutes later, Dr. Sun Thurlingham stood outside the ICU. He and Dr. Bradford had poured over the paperwork for TGN-1412 until they found a potential diagnosis. They saw that there was an extremely small risk that this drug could trigger an immune reaction known as a cytokine storm. Cytokine storm is extremely dangerous, leading to inflammation, high body temperature, organ failure, and rapid deterioration of healthy body tissues. It is absolutely a life-threatening condition.

Now, the two doctors began to suspect that the volunteers were suffering cytokine storms right before their eyes. Luckily, there was a treatment for this condition, however, it was very risky. In fact, it presented the doctors with a life-or-death decision. And that's because the doctors were not 100% sure what was making these volunteers sick. It was possible they were suffering from cytokine storms, but they could also be suffering from blood poisoning due to contaminated drugs. And the treatments for those two conditions are almost exact opposites. If these men, these volunteers, had a cytokine storm, they would need a high dose of strong drugs to shut down

their immune systems. But if this was a blood infection, well, those strong drugs, the immunosuppressant drugs, those would kill them because their immune systems would now not be able to fight the poison. And there was no way for Dr. Sundaralingam to know for certain which condition was sickening the patients. He just had to make an educated guess

and hope that he chose the right course of treatment. However, before making that guess, Dr. Suntharalingam took out his phone and began calling every colleague he trusted, and he walked them through the case, getting as many opinions as possible, because of course, there was just no room for error here. If he didn't choose the correct treatment, there was a strong chance all the patients would die. He listened carefully to the advice of his colleagues, and then he knew it was time. It was now after midnight, and the nursing staff was really struggling to keep the patient stable much longer. Dr. Sunturlingam made his decision and ordered the treatment.

Around 3.30 a.m. that morning, March 13th, Katrina Oakley's heart was racing as she climbed the hospital steps to the ICU. An hour earlier, her phone had woken her up. She'd purposely left the phone on loud in case her fiancé David called her from the hospital where he was taking part in a clinical trial. He told her he would be totally safe, but she had still been worried. Except the call that had just woken her up was not a call from David. It was from a nurse asking her to come to the hospital right away. Something had gone wrong during the trial. Within minutes, Katrina had been running out the door. Just outside of the ICU, a nurse met Katrina and warned her that David might look a little

different. He was being treated for something called a cytokine storm, which meant he was on a lot of drugs to suppress his immune system. And as a result, those drugs had caused some serious swelling. Katrina swallowed hard, doing her best to stay calm, but feeling very overwhelmed and confused. She had a million questions about David's condition and how any of this could have happened in the first place, but first, she just wanted to see David. She followed the nurse inside of the ICU to David's bedside. And right away, she saw her fiancé's face was so swollen,

his eyes were like these little tiny slits, and his cheeks were so puffed up, his head looked like a beach ball. His stomach was also so huge and distended that at first, she thought he was resting his hands on his belly under the blankets. But he wasn't. His hands were by his side, and those too were very puffy. Plus, David's skin now had a yellow tint. Katrina took one of David's hands, and as she did, he turned to look at her, but his eyes were totally glazed over, like he couldn't really see her. Katrina had to fight the impulse to scream. She couldn't understand how something like this could happen to the perfectly healthy young man

she had kissed goodbye just the day before. Just after dawn, Dr. Bradford drove into the Northwick Hospital parking lot and found news cameras waiting outside. Dr. Bradford hustled past them into the hospital and flipped on the television he kept in his office. Every channel was now talking about the catastrophic medical trial, calling the sick volunteers the elephant men because of how they had all swollen up like balloons. Dr. Bradford ran up the stairs to the ICU, where a nurse told him that five of the six patients were still in bad shape, but they were stable. However, the sixth patient was continuing to get worse, and in fact, he could die. And later that morning, Dr. Bradford learned that Scotland

Yard was now investigating for any signs of foul play in this trial. But no matter how bad Dr. Bradford felt about this, and no matter what actually made these men sick, there really actually was not much Dr. Bradford could do for the patients now. Dr. Sunthorlingham was the intensive care specialist, not Dr. Bradford. So Dr. Bradford just went home, and for the next two days, he was glued to the news, checking repeatedly on the condition of the men. And finally, on the third morning, Dr. Bradford learned that all six patients almost miraculously had improved overnight. And for the time being, it seemed like they could recover. And so that morning, Dr. Bradford decided to go into the hospital. But when he arrived at his office, he found that the office itself had been sealed off by police. An officer with Scotland Yard

explained that the trial bays and his office were now part of a crime scene and off-limits until the investigation was over. All Dr. Bradford could do was yet again go back home and wait, as Scotland Yard and British health inspectors conducted their investigation into the trial. But Dr. Bradford didn't really care about the implications of this investigation. All he was focused on was that the patients would pull through, that's all he wanted. And not even for his own sake, but just because he couldn't bear the thought of these volunteers dying because of his clinical trial. It was horrible. Thankfully, Dr. Suntharalingam had made the right call. The TGN 1412 clinical trial volunteers had all developed cytokine storms, and the immunosuppressive drugs had saved their lives. But while Dr. Bradford was obviously thrilled to learn that

all six patients would likely pull through, he still had no idea what could have triggered such a rare response to this drug. It would take them months, but the health inspectors would eventually discover why this had happened. It would turn out Dr. Bradford and his team were missing some crucial information because even though this drug had been successfully tested on animals, those animals weren't capable of experiencing cytokine storms. So even though there was some preliminary clinical research showing that TGN-1412 might trigger cytokine storms in humans, it just had not been on Dr. Bradford's radar. And in the end, it actually was not really the drug that triggered this response, it was just how quickly the drug had been administered. The volunteers had received their entire dose of the drug in just six minutes, which actually was

10 times faster than it should have been given. And because Dr. Bradford and his team scheduled each patient's infusion just 10 minutes apart, the staff didn't have enough time to check each patient for immediate side effects before infusing the next patient. Had the drug been administered more slowly, it almost certainly would have been less of a shock to the system and the cytokine storm likely would not have been triggered. On the morning of Tuesday, March 20th, about nine days after the start of this trial, four of the six trial patients had improved enough to be transferred out of the ICU. But their immune systems were so depleted that they had to stay in the hospital for another two weeks. David Oakley made a full recovery in time for his wedding to Katrina. However, one volunteer named Ryan developed pneumonia, septicemia, and dry gangrene. As a result of the gangrene, his fingertips fell off and part of his foot had to be amputated. As for Rost, he never got sick

for one reason. He was the only person in his group to receive the placebo dose rather than the actual drug. As he watched the story of the Elephant Man unfold on national news, he knew he'd truly dodged a bullet. Eventually, David and some of the other trial volunteers who had gotten sick decided to file a lawsuit against Parexol, the company running the trial, and in 2009, they received an out-of-court settlement. In the wake of this failed medical trial, medical regulators made 22 recommendations to improve the safety of clinical trials, and these standards now apply throughout Europe. Hey, Prime members, you can listen to new episodes of Mr. Ballin's Medical Mysteries

early and ad-free on Amazon Music. Download the app today. And also, Wondery Plus subscribers can listen to Mr. Ballin's Medical Mysteries ad-free. Join Wondery Plus today. Before you go, tell us about yourself by completing a short survey at listenersurvey.com. From Ballin Studios and Wondery, this is Mr. Ballin's Medical Mysteries, hosted by me, Mr. Ballin. A quick note about our stories. We use aliases sometimes because we don't know the names of the real people in the story. And also, in most cases, we can't know exactly what was said, but everything is based on a lot of research. And a reminder, the content in this episode

is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This episode was written by Aaron Lan. Our editor is Heather Dundas. Sound design is by Andre Pluss. Our managing producer is Sophia Martins. And our coordinating producer is Taylor Sn Evan Allen. Our coordinating producer is Metub Zare. Executive producers are myself, Mr. Ballin, and Nick Witters. For Wondery, our head of sound is Marcelino Villapondo. Senior producers are Laura Donna Pallavoda

and Dave Schilling. Senior managing producer is Ryan Lohr. Our executive producers are Aaron O'Flaherty and Marshall Louis for Wondery. In the Pacific Ocean, halfway between Peru and New Zealand, lies a tiny volcanic island. It's a little-known British territory called Pitcairn, and it harboured a deep, dark scandal. There wouldn't be a girl on Pitcairn once they reached the age of 10 that would still have urged it. It just happens to all of us. I'm journalist Luke Jones, and for almost two years, I've been investigating a shocking story

that has left deep scars on generations of women and girls from Pitcairn. When there's nobody watching, nobody going to report it, people will get away with what they can get away with. In the Pitcairn Trials, I'll be uncovering a story of abuse and the fight for justice that has brought a unique, lonely Pacific island to the brink of extinction. Listen to the Pitcairn Trials exclusively on Wondery Plus. Join Wondery Plus in the Wondery app, Apple Podcasts or Spotify.