A Panorama of Human Glitches Seen in the Musculoskeletal and Reproductive System with Professor Nathan Lents, PhD
Professor Nathan Lents studied biology at St. Louis University and then completed his PhD at St. Louis University’s school of medicine in Pharmacological and Physiological Sciences. PhDs need residencies, too, so he did his postdoctoral training in cancer genomics at NYU and loved New York so much that he stayed and is now a Professor at John Jay College in Manhattan and director of the honors program.
His book, Human Errors: A Panorama of Our Glitches, from Pointless Bones to Broken Genes, discusses the beauty of our flaws. We are not the well-oiled machines that we think we are. This is part three out of three of my interview with Professor Lents. For the orthopods, we discuss how the wrist and ankles developed in such a nonsensical way, and why standing upright causes problems from herniated discs to ACL tears. For the OBs, we discuss reproduction and why infant mortality is so high, our ability to procreate is so inefficient, and if we are already so inefficient, how menopause can actually be advantageous for natural selection.
He maintains the Human Evolution Blog and his podcast is called This World of Humans. He can be found at NathanLents.com
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Disclaimer: This is the transcript to the episode. This transcript was created by a talk to text application and the function of having this here is to improve the page search engine optimization. This transcript has not been proofread, so please listen to the episode and don’t read this. The information contained herein will inevitably contain inaccuracies that affect that quality of the information conveyed and the creator of this content will not be held liable for consequences of the use of the information herein.Professor Nathan lens studied biology at St. Louis University, and then completed his PhD at St. Louis University School of Medicine, in pharmacological and physiological sciences, PhDs need residences to. So he did his postdoctoral training in cancer genomics at NYU, and love New York so much that he stayed and is now a professor at john Jay College in Manhattan, and the director of the Honors Program, his book human errors, a panorama of our glitches from pointless bones to broken jeans discusses the beauty in our flaws. We are not the well oiled machines that we think we are. This is part three out of three of my interview with Professor lens for the orthopods out there, we discussed how the wrists and ankles developed in such a nonsensical way. I’ve heard him describe it as obnoxious and why standing upright causes problems from herniated discs to all the way to ACL tears. And for the OBS, we discuss reproduction, and why infant mortality is so high. Our ability to procreate is so inefficient. And if we’re already so inefficient, How menopause can actually be advantageous for natural selection. He maintains the human evolution blog and his podcast is called this world of humans. He can be found at Nathan lense.com.Welcome to the physicians guide to doctoring A Practical Guide for practicing physicians. Dr. Bradley Block interviews experts in and out of medicine to find out everything we should have been learning while we were memorizing Krebs cycle. The ideas expressed on this podcast are those of the interviewer and interviewee and do not represent those of their respective employers.And now, here’s Dr. Bradley Block.This episode is brought to you by Orange County bookkeepers, healthcare, accounting, and all in one accounting firm for small healthcare businesses and private medical practices. One thing that I’ve personally love about OCB accountants is that they are quickbook professionals with over 20 years experience focusing specifically on healthcare. They utilize a tailored approach individualized to your needs. They’re a full service bookkeeping firm specializing in accounting, payroll taxes, and financial planning. And for our listeners for limited time, they’re offering 25% off their services for the first three months. You can visit them at OCB med calm that’s OCB m Ed or call at 833-671-3873 or 949215 6200 and check out the show notes for more information. Okay, so we have equal inefficiencies in other other specialties. And I love your description of the human hand. So let’s talk about how evolution has has allowed orthopedic surgeons to thrive As a specialty,right? Well, I’m more thinking of the wrist. I mean, the wrist seems to me like a really funny arrangement because you have these bones, all these little bones in there, the carpals. And what function Do they really serve separate from one another, the fact that there are seven sort of crammed in there, you know, if you were to design a robot, for example, with a joint, something like our wrist, there’s no way that you would put all of these independent parts together, and they’re mostly fused to each other in the sense that they don’t move relative to one another. So what’s the point? The point is that there is an evolutionary legacy there, and that that arrangement in all of the limbs of our ancestors were it was very similar in terms of the numbers of bone and their relative positions to each other. But we would not design a joint like that today. And in fact, the similarity to our ankle and our wrist, despite them performing almost entirely different jobs, harkens back to that shared ancestral history because our four limit ancestors really did use all their limbs in very similar ways, but we don’t but yet we have that that sort of parallel anatomy and the wrist has weird constraints. I mean, if you try to like twist it around while well bending it, you know, it doesn’t really work nearly as well and the ankles even more rigid. But of course, that’s a good thing. We want a rigid ankle, and we have so much power that we can drive from our, our big toe and so forth. I mean, they really have evolved, well, they just didn’t fix every problem along the way. That’s sort of the theme ofYeah, if you were to design them de novo, you would not do it this way.Right? There’s no animal whose anatomy is perfectly designed for how it lives and you could in any engineer could have a field day redesigning the skeleton of almost any creature. But that’s not how evolution works. It doesn’t work with a floor plan, and it certainly doesn’t create new structures de novo, it really takes what’s there and makes tweaks and tugs and even the bones of our middle ear, you know, grew out of brinjal bones previously in our reptile ancestor, so we have to take something and retool it, we don’t really invent new structures. And what that means is you’re stuck With the constraints, because it’s not just that you stuck with what you have, every step of the way has to at least offer a non disadvantage. But really, every step really needs to be advantageous in order to get fully formed something in the future. So you can’t start evolving a structure in the hope that one day it will be useful. That’s just not how evolution works. So if we wanted to grow wings, for example, we’re not just going to sprout new structures out of our back, wouldn’t it be great because then we’d still have our four limbs when they finally got around to being finished. But that’s not how it works, right? You have to, you have to co OPT the anatomy that you already have. So the three times that wings have evolved in vertebrates, all three cases, they lost their four limbs in the process. So birds, pterosaurs, and bats, none of them really can grasp. They can’t, there’s so much functionality with their four limbs that they lost in the process of evolving those into wings. So evolution always just has to work with humanity. that you have. And slight advantage overcomes a slight disadvantage, hopefully. And that’s really, that’s how you get directionality to it.So it sounds like the wrists and ankles could have been done better, but they’re nonetheless still pretty efficient. Whereas walking upright, seems to be seems to have created a significant hurdle from us because it’s, it’s almost like a domino effect. Right? It doesn’t just affect your back.Right. I think the back I think our lower back is really the biggest problem with walking up right in terms of sort of incomplete evolution. If you look at the vertebral column of a chimpanzee, for example, or a gorilla, it has this sort of sloping slow sloping bend to it. It’s like a j looks like a capital J, but even a gentle sloping J. And when we wanted to sort of stiff in the back and walk more upright rather than straightening it out. We just introduced another curve. So we have an S shaped back. So we threw this curve into our lower back. And part of that was to accommodate how the organs were going. To attach and to make room, there’s some reasons why it did just straight now, but it did cause a tremendous new point of weakness. And the cartilage in his discs in between each vertebra can now slip out of place much more easily because of that, that bend. So if you can, if you can just picture like a stack of pancakes, but it’s curved, it’s really easy for the little discs of cartilage in between to slip out of place when they’re undergoing strain. And that’s what happened. That’s a herniated disc, a slip disc. And that does not happen in the other apes. It’s never been documented in a chimpanzee or a gorilla to have a slip disc, because their back is optimal for their posture. But our back is sort of, okay. It allowsus to stand upright, but it has a number of weaknesses. So this can alsoaffect our knees, right?Yeah, yeah. And I think one of the big problem with our knees is that if you look at how a gorilla or a chimpanzee walks, a lot of times, their legs are bowed and there’s slightly bent and that means That the muscles are doing a lot of work, even just in a resting state. And whereas when we stood upright, we’re now putting the burden of our weight on just two limbs instead of four. And just compensate so that the muscles aren’t doing all this work all the time we straightened our legs. So we stand with a straight leg posture much more often than the other age to, which means that our bones are bearing much more of the weight that our muscles and a lot of, you know, the anatomy evolved to accommodate this, but they’re at least one piece. Well, there’s two that I can think of, but one that definitely didn’t really fully optimize for this is the anterior cruciate ligament, which is right behind your kneecap, and it’s the primary not the only but the primary ligament that holds the upper and the lower leg together. And that’s the ACL as you know. And so anytime you change directions or your your your weight, your momentum changes quickly. If you straighten your leg when you do that, the ACL is bearing the full brunt of That change in momentum, the full force and it just simply isn’t up to the task. It is a very thin ligament compared to the job it’s supposed to do. And it’s not up for because it was in evolutionary lineage, it was that burden was shared by the muscles and four limbs and it was spread more evenly. And now we have this little ligament that’s doing all the work. And there’s no way to get it stronger, through exercise that you can’t like, go to the gym and work out your ACL. There’s just no way to do that. And so what you have to do is hope for the best and try to not let your legs lock when you when you change directions like that. But if you do, and the other problem, of course, is that our athletes are getting larger and larger and larger. If you look at the average weight. Some of these linemen For example, I mean, they’re just massive individuals who are moving way faster than I ever could. And, you know, if they want to change direction quickly, that poor little ACL just snapsand there’s no way to fix it except for surgery. Evolution keeping our orthopedic surgeons in business.Oh, definitely. I mean, I’ve had I had surgery myself on my ankle when I was in high school. And it’s one of the things I think about a lot. But if I had been born just 150 years earlier, I’m not talking about Stone Age, I’m talking about 19th century I would have been crippled for life, I would never have walked. Normally again, I had a biomolecular fracture, it had had to be repaired. And simple surgery nowadays. You know, I was in a cat, I was young. So the cast was, I think about eight weeks, and full recovery, full range of motion. You know, I was playing soccer within six months, it’s totally fine. But I would never have walked again. Or at least not normally. Because of that my daughter broke her arm last week. She didn’t need surgery, but it needed to be set. And I just wonder her just just a few hundred years ago, if she would have been a cripple for life, I don’t know. Oh, yeah.But yeah, I mean, it’s and the amount that our knowledge has increased. Just, it’s incredible. It’s astronomical.Yeah, I think granted, you know, there’s so much that we’re down about the modern world, and we were talking about dying. And things like this. And we forget that the prehistoric world in some ways we would we were living in better harmonies with our body. But there was really nothing in the way of intervention whenYeah, if something if something went wrong. Like, yeah, we lived in harmony, fine. But as soon as something goes wrong thatyeah, I think about that with all birth all the time. They’re like, well, women were doing it naturally for millions of years when they were and 80% of the time it went, it went well.If you’re fine with the 20% mortality,yeah, that’s that would be good.Yeah. I don’t think women should give birth in hospitals because it’s required for every birth. I think it’s because the chance of going wrong is high enough that you would really be mad at yourself if you tried to do it at home and something went wrong.Yeah, it’s it’s nice to have that. Yeah, it goes smoothly most of the time. But when it doesn’t, and it tends to not when things go wrong, they go wrong fast. They go wrong fast. And a quick intervention can save your mom and baby Yes, yeah. So actually let’s let’s talk about that. If you have I’m not sure if you have time, but the OB GYN section of your book, which had a lot of great information in it. So the the inefficiency, let’s just before we get to childbirth, let’s talk about the inefficiency of human reproduction. Right. Yeah, we’re seeing that more and more in the modern world. Why is it so hard? Why do we Why do we have you know that? I feel like every family has a story of difficulty conceiving of miscarriage of stillbirth of like, there’s, there’s you either it’s either happened to you or you know, someone that that has happened to why are we so inefficient at reproduction. It’s remarkable for a lot of ways and people think this is silly to talk about as being inefficient reproducers considering it, there’s like 7 billion of us on the planet now, but can’t remember how recent that population boom really is. And in fact, we were thin on the ground for most of our existence, and in fact, our closest relatives all went extinct. So our success was by no means a foregone conclusion. But anyway, the efficiency is really still, it’s still not every step of the way. Yeah, you’reright, you’re right. But every step of the way, when it comes to reproduction, we have inefficiencies. And many of them, we don’t even share with our close relatives. So for example, we made sure very late compared to other animals. So we reach reproductive age several years later than the other African apes who have similar lifespans to us. And that creates a lot of inefficiency in terms of evolution, because it’s a lot more chances that you might not live long enough to reproduce. So just that in and of itself is strange and really calls out for an explanation and then how many people have trouble making gametes that are that are viable and successful is really high to now that that rake might not be so different from other animals. But the reasons behind it to me are remarkable. I mean, something like 40% of conception events failed to implant for some reason or another. And I think that 40% is probably an underestimate, but that’s that’s what we do. The best we can do 40% of, of successful sperm and egg union result in a failure to implant. Now a lot of those are chromosomal abnormalities. Others, we just don’t know why failure to implant itself could be the problem. We don’t really know. But there’s just a lot of embryos that just don’t take that aren’t successfully formed or or don’t get the signals out to stop ministration. In enough time, we don’t really know. And that’s why drugs can really tweak this up just a little bit when it comes to the implantation event itself. And that’s just about it. There’s no drugs that help with chromosomal abnormalities, for example. Um, the other thing that’s that’s sort of weird for us is that childbirth is so difficult in humans compared to other species. I mean, if you’ve ever been on a farm, I mean, most of these animals just sort of barely notice when they give birth. It’s it’s really, and and the infants kind of shake themselves off and they’re often on their way. There’s a video you can find on YouTube of a gorilla giving birth and she is Eating, she’s continuing to care for other children. It’s It’s like she barely notices. It’s not a dramatic affair at all. And that’s nothing like what we know, human human mothers experience. And, of course, the obvious explanation is that our, our heads are massive. And so our cranium grew so much over the last, really the last million years, sorry, 2 million years. And it got to this point where we are born too early. That’s really what’s going on. So evolution is pulling on both ends of this road, because a big, big brain is great. It’s good for us. And it allows us to do all kinds of clever things. But it also makes it harder for childbirth. And so this sort of tug of war between the two, the compromise that was made was that we are born at least I would say, two or three months early.It’s interesting because we, you know, we’ve we’ve three kids, and they refer to the first three months of life as the fourth trimester.Exactly. That’s the best way to think of it. Yeah,we were not mixed. SinceYeah, but if we wait any longer, you know, maternal mortality would be unacceptably high for the species. So that’s sort of the compromise. And it’s not just the big brain. By the way, we also have a fairly narrow pelvis. And that’s because as we transition to upright rocking, we actually narrowed the bottom part of the pelvis in order to so that our legs can go straight down. Because if you watch a chimpanzee walk, for example, they can walk on two legs, but they sort of swing their legs outwards because their their legs go much more out and then down. Whereas our legs go straight down so that we can stride in a smooth way, our center of gravity does not bounce back and forth from the left and the right as we walk. It’s, it’s kind of remarkable. But to really accomplish that you need your legs to be close together. And so but that transition happened two to 3 million years before the expansion of the brain. Right? So those events were not connected. Evolution doesn’t think ahead. So by bringing our legs close together, it was great for walking, but it also put constraints on how big the head could get millions of years. Later. And so when that expansion finally happened, we were fully committed to upright walking. And now we had this big brain. So what was the compromise? We’re just born too early, and our infants are incredibly incapable. Again, if you look at other animals, the infants are much more independent, even in the other eight. Now, the other apes, the nurse, and the babies are, by no means independent. But they’re more successful than our infants are.Okay, so it’s not just my kids. No, no,not really. And, and I think you’ll find How old is your oldest three and a half? I think you’ll find he or she is still pretty dependent.Yes, yes. If we put him out in the wild, he’d be in trouble.Yeah. And and that’s, that’s sort of the theme of human biology in the sense that our bodies just really cannot make it on their own right. we survive through our cultural status, right? So we help each other we take care of one another, not just kin, but we we take care of one another. We pay people to take care of our kids when we can’t and we solve problems with our brains instead of our bodies and so So the result of that has been a lessening pressure on our bodies to navigate the world on their own. We really are. Our cultural evolution has taken over for biological evolution. And this goes back several million years. I don’t, I don’t just mean since farming. I mean, we’ve been taking care of each other for a very long time. And what that allows is the cultural drive to collect information to have skills that are taught not just learned, but taught. We’re the only species that really teaches everybody, every species learns, but we teach intentionally. And that’s been going on for a long time. And I think that the lesson of that is a happy one. So our bodies are kind of are kind of crappy. But the reason is because we don’t need them to be perfect anymore. We really, we really are solving our problems other ways. So that’s why I like to say the theme of my book is actually pretty happy. It’s pretty uplifting in the sense that aren’t you glad you don’t have to solve the problems with your bodies anymore? Well, I am. I mean, my ankles a perfect, perfect example. Right? This would have been a life altering injury and it’s just not anymore. cultural evolution provided us the tools to fix broken ankles, so that we don’t have to, to try to heal them through, you know, biological means no, we heal them through technological means and, and like my vision was terrible, absolutely terrible part of that is the way we live. Now. We can talk about that if you want, but I had like 2450, and I had these minus 4.5 lenses. But with the advance of this book, I paid a surgeon to shoot lasers in my eyes. And now I see perfectly so. And we just keep solving all of the deficits of our bodies by using our brains or other people’s brains. And I think that’s a good thing.So another thing that you that you discussed in that reproduction section section of your book is the C section. And I thought that was really interesting that the C section is is just much much older than I than I ever thought it was.Yeah, yeah. I think that people have been slicing into mothers in distress for a long time, and I think it’s So there were, you know, ancient Roman tales of it. And part of the there was, you know, of course lore about it and supernatural beliefs about this than the other and it became a public health policy around these fetuses and so forth. But I think there was a long been the recognition that particularly during breech delivery, which you can, you can feel you can you can tell when a baby’s in the breech position, that the success rate of just a regular vaginal delivery was so low, that it was worth the risk of opening up her abdomen, knowing that she probably wasn’t going to make it but the baby could, and the baby probably would, in that case, and then with the mother, you so we’re up and hope for the best. But I mean, it’s called the Syrian for a reason. It really does. I don’t think that Julius Caesar was delivered that way, but it does go back to Roman times. And it’s also been documented in other cultures as well, because it’s not rocket science in the sense that you sense through your feeling you through your hands, excuse me, your tactile senses that this baby is not in the right position and every other time that happened, you know, it’s been unsuccessful and we lose both what, you know, what else do we have? What else can we do with the tools around but get a sharp stone and do our best, then that learning and teaching in that institutional memory? Exactly. You have the knowledge and it passes on and but the idea that a woman would die in childbirth was also not altogether, you know, unusual. That would have been, you know, just part of the expectations that at a certain number of women don’t survive. And so well, she might not make it anyway, we might be able to save the baby let slicer open and hope for the best. And so I think that that practice, I think it’s overdone. Now, I think you’d probably agree that we probably do a little, little too many of them. I also am not a big fan of induction, but we can that might be a conversation for another day. But the point here is that it is an ancient practice and it’s worked and it’s been in response to the fact that we have this huge head.Yeah, I’d rather not just lacking any expertise in in that area. I definitely am not going to criticize my ob GYN colleagues with with regards to the frequency of the C section or induction because they’re they’re definitely working with much, much more information much more than institutional memory.But you and I have aware that our the infant mortality rates in the United States are the highest in the industrialized world. I mean, we’re Yeah, yeah. And so it’s some combination of factors. And I don’t blame the doctors at all. I actually blame a lot of the legal culture around health care in this country for a fair number of for amount of it. But I do agree with you in the sense that we don’t have the information we need to really know what’s going on there.Well, there’s also, you know, there, it’s higher in some populations than others. So it’s much higher in African American women, then it is in white women. So there there, there are a lot of factors at play here.Then, yeah, I mean, the tragedy in this country is that that we do treat populations differently. And some of that provides for a natural experiment. But the problem is, there’s so many confounding variables, and unfortunately, in this country, race and wealth are so tied, that you can’t know You know what’s at play in those cases? I mean, you really have to bear down in the data to separate socioeconomic status from race. And, and but we do have the natural experiment of if we just consider wealthier populations and compare them to say, Canada and other UK with otherwise culturally similar populations. And we just don’t see the rate of infant mortality that we see in the United States. So something’s going on.Yeah, I definitely don’t disagree with that. There. Were there were two more parts. Before I let you go. There were two more parts of the book that I think bear mentioning and and when we were talking earlier about the inefficiency of human reproduction, and one part that plays into that is hidden estrus? Yeah, right. I don’t know when my wife is. And neither. Neither she so I mean, we have an app now. Right? Yeah. So that can that can be pre app. Right? You just, you know, yeah. Well, there’s no you had to just you had to just keep trying, even though that adds the inefficiency. So what would be the advantage?Well, it’s a great, it’s a great conversation because we really are unusual in our hidden population. I mean, if you when a chimpanzee is in heat, you know, it is visibly conspicuous. She knows, everybody knows. And that’s how it is with with other mammals is population is advertised and in humans it is hidden even from the woman herself. And there’s a lot of theories about this but the one that I think holds the most water is that it represented this transition to this group living communal living. And it was a trick that women’s bodies played on themselves in men to create a family to to get a man for, for example, to stick around and to protect his investment and to no BS be assured of his paternity and it was also her way to make sure that she got parental investment out of him. So they were both sort of playing. It’s sort of this battle of the sexes and a lot of people would say That the the concealed population was sort of the first step in that in creating a nuclear family where the reproductive interests were there only aligned if you’re if no one’s Sure. And so you had a lot of sex you had a frequently, that was the only way. And it was essentially mate guarding in a sense, but it was made guarding in a way that the female has a lot more agency over the process. And I think that’s where hidden estrus came from is this idea of keeping men interested in sticking around and and protecting their reproductive investment and then also from the female point of view, getting some parental investment out of dad, by allowing him to ensure that it’s his biological offspring that he’d be investing into. So it was them sort of finding a way to align their reproductive interests, and I say finding away meaning none of this was intentional or conscious. Yes, sir. Yeah, and it corresponds well with menopause as well. So from the best we can tell menopause kind of came about sort of right around the same time and what menopause does Is it stops reproduction before the end of the lifespan, which is very unusual. all mammals, with a couple of exceptions, reproduce all the way through their lifespan, a female can can reproduce in, you know, all the way. Yeah. And humans can’t they stop at some point. And that was always unusual. You will see this presented in a weird way. Like, why is she still alive if she’s not reproductively capable, which is, besides being horribly misogynistic, it’s also framing it backwards. It’s not that she continues to live after she runs out of eggs or whatever, it’s that she purposely shuts down reproduction even though she has like lots of life left.Why did she stop white right, he’s able to reproduce not why she’s still alive.And thankfully, we’ve now discovered an inch into two species of whales, the pilot whales and the killer whales. And which, why I say this is great is that we can allow we can study them, and we can see how it works in those species. And we can extrapolate so the idea is, what it what it reduces is what we call intergenerational conflict. So when mothers and grandmothers are both reproducing at the same time, their children and it will be siblings versus aunts and all that start competing with each other for attention, for resources and for investment. And so to have, from a grandmother’s point of view, there’s nothing to be gained by continuing to have more children that will just simply compete with her for her children and her children’s children for limited resources. So instead, her better reproductive strategy is actually to stop reproducing herself and invest all of her resources in her children and her children’s children so that they can compete against other grandmother’s children. So it’s sometimes called the grandmother hypothesis. But it’s not just about conflict parties is what a lot of people miss about this. It’s not just about Oh, grandma’s can spoil their children and their grandchild, they could do that anyway. But the reason the real thing that they’re trying to avoid is intergenerational conflict, because for her it becomes a zero sum game to have her children outcompete her grandchildren or vice versa. You know, either way, but she’s so if she could Invest in their success another way, and it frees her up to do that. And remember, it doesn’t matter these grandmothers also have are older by definition. So they have more cultural wisdom, they have more cultural knowledge to share. They are a commodity a precious resource, and so that what they are passing on to their children isn’t necessarily food, literally food, it’s the knowledge of where to find food, how to prepare food and all of that. So it is valuable.It doesn’t make sense for her to have a two year old when her daughter or son has a two year old because then those two year olds are going to be competing with each other and that’s what she said, is a zero sum game. So it’s better for her to give more advantage to her grandchild two year old than to have her you know next.That’s right. That’s right. And the powerful evidence for this has been found in these killer whales. So if you look at pods of killer whales, for the most part, they are families and they are led by older menopausal females because they know where the seals are. they’ve they’ve fished those routes, for jet for decades and they have all the wisdom and the knowledge and that’s that’s a good lesson for us. You know we should be we should be electing grandmothers to our, to our highest office in the land, although we had a chance to do that we had an opportunity. But it just shows that that actually care for elders really is a cultural phenomenon that was born out of their value, their wisdom, they’re not they just know more because they’ve been around. And it’s not just women, women seem to be more generous with their wisdom and knowledge. But we we have fossil evidence of older men really, really old men going all the way to humble Erectus that could not possibly have been physically fit. They must have been a burden on the group physically, but they were kept around and they were aided people chew their food for them and so forth, because they knew things. And that was valuable to the group. So that’s another I think uplifting story in my book is that freeing us from just our bodies being well, it also allows us to live longer, in a happy way in a productive way. You can contribute long after Your body has seen its best days and that’s that’s what that’s what being human is fantastic.Well I really appreciate you coming on the show a second time. My pleasure I love a human errors a panorama of our glitches from pointless bones to broken genes. really a fantastic read. I really recommend it to all physicians. Well, everybody, but certainly physicians because it really gives us a lot of great perspective like what we talked about today on on how we ended up where we are and and when you’re doing especially if you’re doing a surgery, right everything just kind of makes a bit more sense when when you’re looking at through this lens. So I really appreciate your taking your time.Thanks for the kind words is my pleasure.That was Dr. Bradley Block at the physicians guide to doctoring. He can be found at physicians guide to doctoring calm, or wherever you get your podcasts. If you have a question for previous guests, or have an idea for a future episode, send a comment on the webpage. Also, please be sure to leave a five star review on your preferred podcast bye form. We’ll see you next time on the physicians guide to doctoring.Transcribed by https://otter.ai