Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Malaria

Episode Date: March 11, 2015

This week on Sawbones, Dr. Sydnee and Justin explain why an earthquake knocking trees into a lake was pretty miraculous in their history of malaria. Music: "Medicines" by The Taxpayers (http://thetaxpayers.net)

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books! One, two, one, two, three, four! We came across a pharmacy with a toy and that's lost it out. We pushed on through the broken glass and had ourselves a look around.

Some medicines, some medicines, the escalant macaque for the mouth. Wow! Hello everybody and welcome to Sobo and Seminal Tour of Miss medicine. I'm your co-host Justin McAroy and I'm Sydney McAroy Sydney I'm tired of something Tired of something I'm tired of something and I would like to broach the subject with you now Right now We you know what you and I really pick the best time to have these kind of disputes.

Well, that's kind of what I'm asking. That's kind of what I want to talk to you about. This is like our 80th episode, I think, somewhere around there, 80 episodes. Yeah. And in every episode, we try to come up with like a reason, like a conversation that we might have been having that would lead us into the topic of the subject

that we're discussing. Yeah, it's like a bit that we do. It's like a bit, and you know. And you're really messing this one up. Yeah, well, it's exhausting. We spent, dear friends, we spent the last three minutes trying to figure out how we might have a conversation. Three whole minutes of our precious time.

Three minutes. Now I would say upwards of four minutes discussing what conversation we would be having that would lead us into malaria. Friends. Now you've given it away. Now it's not a surprise. Now they know we're talking about malaria.

Well, that's my intro there. Now that's the conversation we had that led us into malaria friends. We talk about a lot of things here between the two of us and most of which are are Charlie centric, but you would be shocked the just a wide breadth of topics. Very rarely are we say, are we having any conversations that would take us into malaria? Just like a net, well, okay, more more so being married to you, I would say. I tried it, but those aren't so much conversations as like one-sided monologues.

Like I tell Justin things and he tries not to look like glazed over and. Sobbing. Bored. The podcast. Hey. Hey, I'm just kidding. So anyway, we're gonna talk about malaria.

If you have a big problem with us leaving out our bits, our classic bits. You can let us know. Otherwise, we'll spare you. I just imagine people at home like, at home like, yeah, I get it. I get what you guys are going for. But if you like that, if you like that,

I tell you, maybe you would try to guess. That would be me like, oh, they're gonna get into this. Yeah, if you liked that part of the show please Let us know but also like write a bunch of them for us Because I know it seems weird that those took effort but like they do Anyway, sorry Sydney the thing that this heart is like I don't I don't know the layer is real funny

Like that's the where we get into troubles. Like what are some good? What are some good? I was sitting my head here thinking like I was sitting like banging my head against table thinking what are some good malaria jokes? There are many good malaria jokes. No, I there aren't. I mean malaria is not I don't think it's funny.

I think it's a fun disease to talk about. Like people enjoy talking about malaria. It's interesting. I should say it's funny. I think it's a fun disease to talk about. Like people enjoy talking about malaria. It's interesting, I should say. It's got a long history. And it's a parasite, which we don't talk about a lot. And people always get a little... Remind me, what is a parasite? Well, it's a, some sort of small, well,

doesn't have to be small. In this case, we're talking about tiny little organisms that use something from your system, your nutrients to survive. They wheeze off your juice. Right. So they're not giving you anything, they're not providing you anything, they're just taking from you. And they don't have to be small. But usually when we're talking about parasitology and human parasites, we're talking about small things. Now they can be big, they're

big giant worms that can come out of your butt, but we're not talking about that today. And monkeys, monkeys might fly out of your butt, but we're not talking about that today. And monkeys. Monkeys might fly to your butt too. Nope. That's another concern. Nope. Not a concern. Did somebody suggest the topic? Yes. A lot of people have suggested malaria because like I said, a lot of people like to talk about malaria. Don, David, Leemon, Jean, Jose, Nicholas, all suggested the topic.

Thanks, y'all. If you, by the way, people ask about this. If you'd like to suggest a topic, you can email solbons at maximumfund.org. So malaria comes from the Italian word for bad air, mal air. And that was because, and we'll talk about this more, but a lot of people thought for a long time that the way you got malaria was by inhaling something in the air. It was like, we've talked about before like the measma, teri of disease, like that it's

like there's some kind of illness that's floating around you and you might breathe it in accidentally and get sick, which sometimes is kind of right, but not with malaria. Right. No, not in this case. So like I said, it's caused by a parasite, which we don't talk about a lot, because, and I think it's because in the US, we don't get us, or we think we don't get as many parasites. But there are parasites in the US. Malaria used to be.

Really? You used to get malaria in the US. You used to get malaria everywhere. Malaria was a big deal and pretty much not every country on earth, but almost every country on earth for many years. But the change in kind of our sanitation and the big thing is whether or not you have a lot of standing water for the mosquitoes to to lay their eggs in. If you don't you don't have a lot of these mosquitoes and then you don't get a lot of malaria and, and then you don't get a lot of malaria, and so as kind of things changed in the US,

malaria got pushed further and further south, and now we see it mostly in Africa, although it still exists other places. So what does it do? So let's talk about malaria, the parasite, and what it does. Okay, so. Is it single-celled or is it like bigger than that?

It's a little teeny plasmodium. Okay. So, yes? Yes. Okay. So, yes? Yes. Okay. No? No. No, it's not.

Okay. No. No. I'm going to go with no. Official no. I don't know. I'm a doctor. Okay.

It's a plasmodium. I know all the names. I know what it does to you. Okay. So, there are several different flavors of malaria that people get. Depending on which. Make mine rock your road. Which plasma modium infects you. There's phalciperum, malaria, vi-vaxovalley. There's a couple of others. It's carried by a certain kind of mosquito as I've already alluded to, the

enophilies mosquito. So anywhere that you have enophilies mosquitoes, conceivably you could have malaria. It gets into your bloodstream when the mosquito bites you. So, that's why I said it's not really from inhaling toxic air. It's specifically from a mosquito bite. And then initially the parasite will go infect your liver cells. But from there it's released into your bloodstream and that's when you start really getting sick. And that's also when we tend to see and diagnose malaria.

And there's a lot of, like if you are the kind of person who likes to look at microscopy pictures. And who is that? Like of things you might see if you looked at blood under a microscope. You can see a lot of little shapes like ring forms and little banana shaped things that under the microscope

when somebody's blood who has malaria. Some forms can live in your liver for a long time. Like the Vivext and a Valley, they can have these little things called hypnizzoids, these little secret things like surprise. I don't know, timed. What am I thinking of? Timed minds. What? They're like, you know, like

timed. Time bombs? Yeah. Okay. Yeah. I'm saying, you know, time bomb. You know, time bombs. Don't worry that couldn't come up with. They were somehow managed to save the two components of you. I said mines. I was thinking like golden-eye. Like sure, sure, sure. Like instead of proximity mines. Well, they had remote mines, but that I don't think. mines. I was thinking like, golden-eye. Like, instead of proximity mines. Well, they had remote mines, but that, I don't think. I'm thinking of remote mines. Well, no, because you don't, they don't, they're just there. And then they just, let's go with time, Bob. Yeah.

And then they explode out of your liver later on after you think you've already gotten over the malaria and you get sick again. You spread them to another person, only you like them, a mosquito bites you and then bite somebody else. So you tend to see the kind of outbreaks of it in areas, but it's not person to person so much as mosquito to person. The symptoms of malaria, the classic are these cyclical fevers. And this is why, as I'll talk about, we think we've had malaria around for a really long time,

is because there aren't a lot of illnesses that have this kind of pattern of like you get this really high fever, you get really sick, and then it starts to abate, you feel better, almost to the point where you seem like you're totally fine, and then you go through the cycle again. And that's been written about all through antiquity, and so that's why we think malaria's been around so long. You also get a riger, so these really awful chills and shakes. You get anemic, you get headaches. You feel really, really lousy when you have malaria. And then there are like really severe complications

that can happen, not to everybody, but especially if you get the falsiparum variety, you can get fluid in your lungs, like pulmonary dima. Your spleen can get really big, it can even rupture, you can go into renal failure, which kidney failure, you can go into shock, it's really bad for pregnant women to get malaria, there are lots of complications. So malaria can be something that just makes you feel really rotten or it can turn into a really big deal.

What changes that? Like what determines what, it just the different, as you said, varietals of malaria? Part of it is that, which one is more likely to cause problems, but just like felsiprom is classically what we think of as the worst,

but just because you get felsiprom doesn't mean you're gonna get that sick. It depends one on, there are more complications, sometimes the more times you have malaria. Man, that's rotten. I know, I know. I didn't mean to laugh,

it's just like, ugh, like to me, the idea of getting a malaria is so like, just so unfathomable, like it breaks my heart to think that there are people who get it like uh... again it again with this for a lot of people really is like that like on other times infection like that the in certain parts of the world people get malaria that

often you know and it can cause if you're it's not treated appropriately and you're not getting an address and it can cause chronic problems from that or just sometimes it's you you know, either your first time getting malaria or who knows, and you have one of these catastrophic complications. Certainly, people who are already sick would be more likely to have these problems, but it's part of it is just bad luck as well. We have found evidence that the parasite, the plasmodium that causes malaria, has been around for 30 million years. And we found it in mosquitoes trapped in amber.

Which I think is- Along with some dinosaur DNA. I knew you were gonna go down this room. Dinosaur. As soon as I found this information, and I thought, now we're gonna have a Jurassic Park conversation. The bad thing is, we thought it was just malaria malaria but then we crossed it with a DNA of a frog and that's why malaria is so bad today.

Because it's the cross that with, because it's frog malaria and it's reproducing as actually. If it was frog malaria, it probably wouldn't infect humans probably. I mean that might not be so bad. Dinosaur. There was suggested that maybe some dinosaurs got malaria. Oh, really? Yeah. That is because, I mean, there's been evidence that it was in reptiles, so yeah, maybe.

So this is not one of our new diseases that we've talked about before. This is an old one. No. We likely first got it, as it evolved over time from chimpanzees and, depending on what strain and gorillas who passed it on to humans, like again, from mosquitoes. And malaria is interesting because it's probably evolved

alongside us, with us adapted to us and we have adapted to malaria. And it's actually shaped some of the other chronic blood disorders that we see. For instance, sickle selenemia, thalassemia, there's another called G6PD deficiency. These people are less likely to be infected by malaria. And so there's a thought that when you, the reason that we still see these blood disorders, the reason that, you know, when they arose, you weren't selected against evolutionarily. Do you understand what I'm saying?

Yeah. Is because they provided a selective advantage because you were less likely to get malaria if you had them. Right. That makes sense. So that's why that's part of why we see the prevalence of these diseases. In addition to our evolutionary history, malaria has changed the course of history in a lot of like our social and political history.

Sort of like, well, what do we talk about last time? The... Siflas have it. Siflas have it. And it impacted that way. To work at Losis has had that impact. But malaria certainly, because at times, if there would be an outbreak in certain parts of the world, it would destroy whole city states.

Armies were decimated by malaria at various points in different wars and history. Specifically, when we talk about the civil war, there were as many people sick and bed with malaria as there were fighting and being injured in the war. It's depressed economies every time there would be a big outbreak of malaria. It was very hard on the economic situation. And there were theories that there were parts of countries that were uninhabited, especially coastal lands, for decades because people knew that it had something to do with water and they didn't know what specifically, so they stayed away from bodies of water. So there were areas that it was thought, and nobody lives there, and it's probably because of malaria. We tend to think of it, like I kind of said, we tend to think of it as like a tropical disease now, but it was everywhere for a long time. But like I said, you need

some, you need standing water. That's one of the big things that you, when you're trying to address the malaria problem to eliminate sources of standing water, can be a big help. And we've seen malaria kind of recede from, at least from the U.S. and, you know, the UK and Europe. There is evidence that the ancient Egyptians had malaria. Yeah, I would think so if the dinosaurs hadn't. We found DNA evidence in mummies. And there's also evidence that they at least had some idea

that they didn't want to be around mosquitoes. Oh, really? Yes. The pharaohs and the phro used to use bednets, Cleopatra slept with a bednet. And I mean, maybe they just don't like getting bitten by mosquitoes. But still, I mean, that's, yeah.

But I mean, if you do that every single night, you have to begin to wander like, I don't know. Do you know, do you know something? Do you suspect something? Well, yeah, but like at the same time, who would have nights where like, maybe I'd like to get bit by mosquitoes tonight? Like, I mean, I think that once you decided

you would rather not be a bit by mosquitoes, that's probably a life decision you're gonna live with. Maybe you just fall asleep first and you're like, oh, I don't wanna wake back up and get my bed net out. Who would have been that out? I think if you're Cleopatra, odds are pretty good. You're not hanging up here in bed net, but like maybe? I don't know.

It's kind of, I mean like, you know how how every night you get in bed and try not to brush your teeth, and then I have to convince you to get back out of bed and brush your teeth. Yeah, yeah, yeah, yeah, yeah, I remember that. Maybe it's like that. Same principle. The, the builders of the pyramids were given a lot of garlic, and that's thought that it was an attempt to protect them from malaria. Hmm.

Again, not sure that there was, that they knew any connection between what was going to give them malaria, just that somehow garlic would kind of like the strong smells, fight strong smells, push away the bad air. Sure. Like I said, these cyclical fevers are really what make us think that this has existed so long because hypocrite's wrote about this, that there was an illness and that you would have these horrible, horrible high temperatures and then you would get better and then it would come again and then it could be deadly. We think this is malaria. We're pretty sure that ancient Chinese physicians wrote about this as well

and also wrote about the fact that patients who would get these high fevers tended to have large spleens often. So again, more evidence that we think this probably is malaria. large splings often. So again, more evidence that we think this probably is malaria. The Romans called it the Roman fever. We think that when they reference that, they're talking about malaria, which I think is a little conceited. Yeah, it's very showy. And also dinosaur fevers better. Dinosaur fevers would be, if they had like, A, called it with dinosaurs and B called it dinosaur fever. I would be slightly less concerned about catching malaria, I think. If it was called dinosaur fever. Yeah, because I, honestly, there was a period,

but when I was like five or six, where I did have dinosaur fever a lot. I think a lot of little kids go through that phase. Like a dinosaur fever phase. Not malaria to be clear. I'm just really into dinosaurs. The Pope Gregory IV actually in response to the Roman fever being more prevalent and warmer times of the year actually moved all Saints day from May to November and in part it was because of malaria. All Saints day in November first, all hellos.

It's not what I know about, is that a Catholic thing? It's the day after Halloween, all Saints day. Oh, okay. I know about all Saints, the girl group. Is that the same thing? Not at all. Okay. I thought Halloween is nice and bad.

I think it's a nice day. I think it's a nice that all Saints has a day in their honor though. They made only a minor impact on the music landscape, but I'm glad that we're still remembering their contribution. Nothing like All Spice Day. I expected more from that one. Yeah. No, but it's a day after. All Spice Day.

What was the joke? All Spice. It's a spice. All Saints, all Spice. I thought you're going for a spice girl's thing Because we have all saints okay, no, I was talking about the seasonings sure, yeah Anyway, no, it's the day after how all Hallows Eve is Halloween and the next day is it's must be the day of the Hallows of the Saints the holy people not only the day after Halloween is the day that I have diarrhea from eating too much candy So that's not I didn't know it was a holiday. Well, I

It's also a day where we celebrate all the saints when I was younger I dressed up as one of the same don't do that we all did we all had to do that in mine I don't know what to tell you Sydney. Okay, anyway, we don't do that. We didn't do that when I was little We did our saints so there's some belief that maybe part of the reason we moved all science data. November is because of malaria. The Romans also believe that it came from the air and specifically swamp air. So one of the solutions was move away from the swamps. Don't be close to the swamps, which again, is that a bad idea? Yeah. if you're looking for a place where mosquitoes are.

It's nice that they figured out the water thing. Did they know it was from mosquitoes or did it? It was just the water. Nope, just something to do with the swamp air. Huh. Throughout Shakespeare's time, Shakespeare wrote about malaria quite a bit, like seven or eight of his plays.

He mentions malaria. At this point, it would have been called March fever or the Tertian Agu. The Agu is a name we hear a lot for malaria. At this point, it would have been called marsh fever or the tertian agu. The agu is a name we hear a lot for malaria. And as I kind of mentioned, it just ravaged different wars in our history, specifically the Revolutionary War and the Civil War, a lot of people had malaria.

Congress actually during the Revolutionary War bought a synconobark, which is we're going to talk about was one of the old and current treatments for malaria from South America during the Revolutionary War in an attempt to combat malaria. I know about Sincona bark from the signature of all things. Yeah. And then World War I and World War II,

there were certainly many people sick with malaria, although not as many people were dying from malaria at this point. The bigger point is that it made a lot of, a lot of soldiers sick, and that was obviously a huge impact on many, many different battles in the war. By the 1890s, we figured out

that it was spread by a parasite, we'd isolated the parasite. It was actually two medical students helped in this effort finding the parasite, like reproducing inside mosquitoes and figuring out what was going on. And then of course that it was spread by mosquitoes, we figured out after that. Excellent. I should mention, we just randomly mention single-trible things. That's a great novel by our friend Elizabeth Gilbert. If you like our show, you will probably like seeing terrible things. I think you absolutely is a wonderful book.

I would highly recommend it. Sydney, I just did that little plug for Liz Gilbert's book, and now I'm got the urge to promote more things. Can you help me out? Yeah, let me show you the way to the billing department. Let's go. The medicines, the medicines that I've skilled in my car before the mouth.

So why don't we talk about some treatments for malaria? Yeah. Yeah, we've kind of gone over the history. Let's start digging out of this, this, this, well. Okay. So first of all, what's interesting about the history of malaria treatments is that we kind of got it right a couple times without really intending to. Hey, go us.

As far back when we go into the ancient Chinese writings about malaria, you find them recommending a certain herb, the Artemisia herb. What is so interesting about that is that that is the basis of some of the treatments we still use today for malaria. So this was not wrong. I don't know if soaking it in cold water and then eating it raw would work, but I know that they were on the right track.

And what I love the most is the recommendation of using this herb is from a book called Emergency Prescriptions, kept in one sleeve. That's a great title. I bet that was flying off the shelves. I don't recommend to my patients to keep any prescriptions in their sleeve, but I'm gonna start. I guess. Your sleeves look really baggy. Well, I've been feeling under the weather lately. I've got some emergency in here. I've got some cough drops. I've got some brambleberry essence.

Be careful what you carry in your sleeves though. Yeah. It's a crazy world out there now. Lot of sleeve thieves. You have to be careful. People are said, you notice somebody I in your sleeves, you just head on down the road. They're up to no good. They're, they're after your blood pressure medication. Your bark, depending on whatever or the bark you have in your sleeve.

There was an early understanding. We kind of talked about that people knew that water had something to do with it and swamps. So rice patties came under fire in China. And so there were some recommendations like, Oh, I bet those things are just like rife with mosquitoes. Yeah, and so there were some thoughts like, maybe we should stop doing this,

but of course that was a huge economic problem. So it wasn't stopped, but there was debate, like what do we do? Because we need, that rice was a big, you know, still, I imagine a big feature of the economy and yeah. So there was some question as to whether that should be stopped. Similarly, draining swamps was something that we suggested at various times, at various places in history. Like, I don't know if we drain all the swamps, will people start getting, stop getting sick? I don't know that a lot of good comes from swamps, like from a human being point of view.

It's like, they're people in Florida right now who are losing their mind. You say, well, no, what they're thinking is like, you know what, Justin, that offended me, but then I realized like the only thing that happens in swamps is alligators are there and sometimes people have bodies there. Those are the two things that happens in swamps and those sweet air boats, but I don't know where you get those.

Okay, I will tell you that I went to many school trips when I was younger and lived in my cross Georgia to the Okie-Fonokie swamp. And it was very cool. One guy's like, yeah, Okie-Fonokie represent. I loved going to the Okie-Kie's Wamp because you saw all the colors you wrote in a bow and then there were these leaves that you would like, they would pull off plants and row together and soap, there would be soap would happen from the leaves.

I loved going to those. That sounds fun. I don't know, that sounds fun. So be careful when you did swamp. Sorry swamps. I used to like sawdems, but that shows when you do swamps. Sorry swamps. I used to like, so I was like, but that shows how late I swam.

In the middle ages, they tried all kinds of weird bad ideas for treating malaria. As we did for everything, right? Yeah, middle ages really bad. We tried blood-duty. We didn't get much worse in the middle ages. This is our apex of like,

not knowing what we're doing, cross with our willingness to just do whatever. Just do something. I don't know. Cut yourself, drill a hole in your head, which we tell you not to, like every time. But people did that. Amputate a limb.

It's like they're not even listening to our podcast. Try some witchcraft, take some Beladana, that won't help. I saw it out of a rock. Like what are you guys doing? No, let's work out your nativity chart with astrology and then tell you what, what plan is causing your malaria. I don't know how that fixes it. Middle ages was really bad. At least before that, we're like, I don't know, honey.

Figure it out or something or don't. I don't know, we don't know anything. The most interesting and Justin, you probably know part of this because you read the signature of all things. The first is the story of the synconetry. So it's funny because if you read about how did we figure out this synconetry, which has also been called the fever tree because it cures feverish, the way that we figured

out, how do we ever think this bark might help us against this horrible disease? The story is that there was an earthquake that caused a bunch of synconatries to fall into a lake and that the water in the lake was really bitter after that, flavored by the syncona. And nobody wanted to drink it, except there was one guy who was really sick, and so he had a fever, he was really thirsty, so he drank it because what is he? He needed water. He was very thirsty and he got better and that's how we figured out that Sincona bark that story is just wild enough to make total sense. It's interesting. I don't have a better thought as to how we would have ever thought to To get tree bark and I don't know how we figure out any of this stuff, right? There's gotta be some story like that for all of these things, right? Yeah, some just random happenstance.

You're making metal springs for weapons and one of them gets knocked off of a shelf. You see it very pleasingly coil off the shelf on the floor and you think, that's a toy, slinky, born. And this is on the same level, I think, is the slinky. Basically. It's kind of like Sean Connery and Medicine Man.

You know, it was the ants. Mm-hmm. Sorry, spoilers. Spoolers from medicine! Stay tuned, or spoiling, remanting the stone necks. There were miners also took this when they had to go into like, called damp mines, because it would stop, they thought it stopped shivering which is probably a reference to the fact that it stopped the rigors that are associated with malaria.

It was used by the native, the people native to Peru and then the Spanish missionaries found it when they came to Peru and started noticing that people would use this local tree bark to treat this awful fever that everybody got and it worked and so they started exporting it all over the world. And it does work because it has the alkaloid quinine in it, which quinine is still used to treat malaria two day. So that's pretty cool. That is cool. Yeah.

And so that this bark was sent, Jezwit bark was the same name or you know fever tree, all kinds of the same thing was sent all over the world to treat malaria because it was a big problem. It's interesting because there's one of the other big treatments you read about is Warburg's tincture, which was created in 1834 by a German doctor, which also contained quinine. So it kind of took over for a while as the big treatment for malaria, but I mean it had quinine in it as well. So we're still using quinine.

But it was used hugely by the British and Austrian empires. Also, this is in tonic water, quinine. Oh yeah. Just as a side note. So. Because you were drinking a lot when you're pregnant for your leg, restless leg. Yes.

I was tonic water. That's unrelated to the layer. Yes, quinine has been used for leg cramps and restless leg and that kind of thing. Although, if you're considering that, talk to your doctor, be very careful. Not so, I mean tonic water, you'd have to drink a whole lot of it

to cause yourself problems. But there are a lot of supplements over the counter on a side note that have quinine in them and you can get too much and it's called synchonism because of the tree and you can get poison. So be careful. Good to know. Once we figured out the parasite, as I mentioned in the 1890s, throughout the 1900s, we developed all kinds of new medications and I won't go through all the medications we have today for malaria, but we have quite a few. The biggest problem though is as we have developed new medications, the malaria parasite is

wily and it becomes resistant to them almost as soon as we make them. So that's why if you're traveling somewhere in the world, the first question you should ask your doctor is, do they have malaria there and what medication can I use to prevent it when I go there because it's different everywhere you go in the world. And moving on to today, malaria is still a huge problem. Like I said, we don't think of it that way. I think here because we don't see it in the US. I know for me it was something that we talked about in medical school. I was interested in it because I had an interest in international medicine. But then I didn't see it until I went to Malawi. And then we had a case here, which is weird. But anyway, there's still like 225 million cases each year.

800,000 people still die of malaria. And there are, there are about a hundred different countries worldwide where it's still in dimic, largely in Africa. It's a huge cause of childhood death as well. And like I said, there are many drugs, but there's still much resistance to them. Bed nets are one of the biggest solutions to this. So simple, but effective. Just don't get bitten by mosquitoes. And this is important if you're going to travel anywhere in the world, go talk to your doctor, especially if you have somebody

who does like a travel clinic, like I offer, where you can ask about what meds you might need. And you can go donate, go donate some bed nets to help people who are still suffering from this. You could nothing but nets.net. You can buy some nets and help people out there. Because it's really that simple. I mean, the idea is historically of draining swamps and Cleopatra sleeping under a net, probably was more effective at fighting malaria than just about anything else we could do.

So go do that and then feel a little better about the problem because you're helping to combat it. Thank you to the maximumfund.org network for having us as a part of their family. We've got a lot of great programs that you can go listen to and we would recommend you do that right this second. We got the Max Fund drive coming up so you're going to have some a lot of chances to support the network and get some cool stuff in return. So that's pretty grievey.

Thank you to the taxpayers for our theme song, medicines. Mm-hmm. And thank you to people tweeting about the show. We're at solbones on Twitter. So you can, uh, you can tweet about us and be like, uh, pony, Lana Kay, Maelan Carlson, we are Goose, Foxy Love, Kelly Wardell, Amy, KLM, David Cooper, Mundissius, Ames, Meg Dan and Glinn over, it came to my play date, Adrian Mechha, Mechia, I think Mechia, that sounds right, Adrian Mechia, Dylan Sennott. I think Mecha. That sounds right.

Adrian Mecha. Dylan Snot. So many others. Thank you so much for tweeting about the show. You can follow us on Twitter if you would like to do so. And thanks to you for listening. Thanks to you, Sydney, for being here. Really appreciate you.

Thank you, Justin, for inviting me to your office. Her podcast. Until next time, probably on a Tuesday or Wednesday. I'm just a macro. I'm Sydney Macro. I always don't drill a hole in your head. All right Alright! Maximumfund.org Comedy and culture, artist owned. Listener supported.