Sawbones: Methylene Blue

Speaker 1 Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun.

Speaker 1 Can't you just have fun for an hour and not try to diagnose your mystery boil?

Speaker 1 We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth.
You're worth it.

Speaker 1 All right, tomorrow meetings about some books.

Speaker 1 One, two, one, two, three, four.

Speaker 1 We came across a pharmacy with its windows blasted out.

Speaker 1 Pushed on through the broken glass and had ourselves a lucky round. The medicines, the medicines, the escalat macabre

Speaker 2 Hello, everybody, and welcome to Sawbones, Marital Tour of Miss Guided Medicine. I'm your co-host, Justin McElroy.

Speaker 3 And I'm Sidney McElroy.

Speaker 2 Let's address the elephant in the room sick because I can't pretend that we're not on the same side of the table right now.

Speaker 3 That's true.

Speaker 3 We're not facing each other directly. I have to angle my body to sit down.

Speaker 2 In theater, of course, we know this is three-quarter.

Speaker 3 I'm cheating out. Cheating out.
I'm cheating out. Cheating out.

Speaker 2 Yeah, but we're all sitting on the same side of the table. I don't think it's going to change the energy that much.
At least I hope it's not.

Speaker 3 I was hoping it would bring more of a live show energy because we do this in a live show. Yes.

Speaker 3 And so,

Speaker 3 although generally that is accompanied by people cheering for us more loudly for me, I would just like to know usually more loudly for me.

Speaker 3 So I am missing that.

Speaker 2 Yes, I did. That was pretty good.
That was pretty good.

Speaker 3 We'll work on it.

Speaker 2 You can build up to it.

Speaker 2 Can't you get

Speaker 3 Can you get me a machine? Aren't there machines that do that?

Speaker 2 Applause machines?

Speaker 2 They have actually condensed a lot of those just onto phones.

Speaker 2 They're just buttons. It's just buttons.

Speaker 3 It's all you have a whole machine for white noise. I don't know why you wouldn't get a whole machine for applause.

Speaker 2 That's true.

Speaker 2 Me specifically, I think, could use that in my day-to-day life.

Speaker 3 I think you would make... more use of that than a white noise machine.

Speaker 2 I mean, around the house, I would love a little bit of extra support. I don't feel like I'm getting a lot of, you know, that reinforcement from you and the girls sometimes and the cats.

Speaker 2 I don't feel like me or the cats are getting enough positive reinforcement.

Speaker 3 Justin, I'm excited to talk about our topic this week because I encountered it in the wild. Ooh.

Speaker 3 And so sometimes something that's sort of pseudoscientific or

Speaker 3 not necessarily based in good science.

Speaker 3 not necessarily evidence-based will pop into my own Facebook feed through people that i know

Speaker 2 sydney you got to understand sydney is keeping the ai guessing sydney is keeping the algorithm guessing because they cannot get a beat on this lady because as much as she looks into pseudoscientific nonsense she's also looking into like

Speaker 2 real pills and stuff as a real pills and stuff

Speaker 2 i don't know

Speaker 3 That's the website we use. That's what they tell you when you start medical school.
They're like, you don't need to learn anything here. Just go to realpillsandstuff.net.

Speaker 2 Just because I'm a patient doesn't mean I should be patronized, Sydney. I'm sorry.

Speaker 3 I'm sorry.

Speaker 2 What are you talking about this week?

Speaker 2 What did you encounter in the wild?

Speaker 3 In the wild, I encountered methylene blue

Speaker 3 being used for, in the post that I saw, being suggested as a possible cancer treatment.

Speaker 2 Yes. Yes.

Speaker 3 I was outraged.

Speaker 3 I responded. I normally don't, I am that person.
I responded.

Speaker 3 I was outraged and I thought,

Speaker 3 why would a medical professional be recommending methylene blue in this way? What is, where did this even come from? And then we got an email from Priya.

Speaker 3 Thank you, Priya, who is also a fourth-year medical student. So good luck.
Good luck in your fourth year. You get lots of vacation that year.
Nice.

Speaker 2 Yeah.

Speaker 3 I mean, you're supposed to because you got to go interview and stuff. So it's a good year.

Speaker 3 You should choose family medicine. I'm not biased, but you should because everyone should.

Speaker 2 I don't think she is biased. Yeah, I am.

Speaker 3 It's great. You need to do everything.
Anyway, but Priya also asked about methylene blue as a new sort of wellness trend. And so then it clicked.

Speaker 3 Okay, this isn't just this one person that I happen to know on Facebook touting methylene blue. This is part of a larger

Speaker 2 fad.

Speaker 3 New cool thing.

Speaker 2 So what is methylene blue?

Speaker 3 Why are we talking about it in medical circles? What are the legitimate medical uses? And where do things get a little wonky?

Speaker 2 You're asking me that, and it's sending a real panic through my body, Sid, because I had not heard of this stuff until about two minutes ago. So I don't know.

Speaker 2 I hope you were not relying on me for this.

Speaker 3 I have them all. I have it all.

Speaker 2 I know it all.

Speaker 2 Okay. Normally over on that side of the table, I'm able to read you a little bit better, but like you're in my peripher now, and I don't know.
I'm flying blind.

Speaker 3 So tell me about it, Justin. So if you had to guess, wait, if you had to guess what methylene blue was, what would you guess it is?

Speaker 2 The truth of the matter is I was thinking, I figured it it was the stuff from Breaking Bad. I figured it was the stuff from Breaking Bad.

Speaker 3 You thought it was meth?

Speaker 2 He made blue meth. Notably, in Breaking Bad, he made blue meth.
So, like,

Speaker 2 I use my context clues. I don't know.

Speaker 3 Let me ask you a quick question about Breaking Bad. Did he make meth that was just blue, or did he color his meth blue so you would know it was his meth? Oh, no, no, no.

Speaker 3 Like as a hallmark of his meth.

Speaker 2 Walter White's stuff was just, it was just blue, but it was the the best stuff. Like he wouldn't use artificial dyes.

Speaker 2 Later on, I think some of the other guys in the drug fight started dying theirs blue to kind of like

Speaker 2 to compete. Just to

Speaker 2 some real world context.

Speaker 3 Yeah. Often.

Speaker 2 Mine was sorry. Mine was from Breaking Bad.

Speaker 2 Right.

Speaker 3 So not real world.

Speaker 2 But it's a fairly recent show. It's a television show.
It's fairly recent. It's a television show.

Speaker 3 In our community,

Speaker 3 the color of a certain product usually has nothing to do with what's in it. It's that the person who's selling it might add colorant so that you know, like, this is so-and-so's stuff.
Right.

Speaker 3 And so sometimes we will say, like, oh, watch out for the pink stuff. But it's not because there's something about it that makes it pink.

Speaker 3 It's that we know right now that wherever that's coming from has bad stuff in the stuff.

Speaker 2 Stay away from the pink stuff, but do try the gray stuff. It's delicious.
Don't believe me.

Speaker 3 But it can change. More recently, it was the purple stuff, so you never know.
Yeah. So the color is

Speaker 2 hot. I hate when my mom gets purple stuff and I just want sunny D, you know?

Speaker 2 Do you have any other color plus stuff? Because I would like to see how many others I can do.

Speaker 3 Well, there was the yellow stuff for a while, but most recently it's been pink and purple. I don't know.
I don't have anything for those.

Speaker 3 Anyway, so as you, I thought you might guess methylene blue is a dye because it's got blue in the name. Okay.
So it sounds like a dye. Yeah.
Do you know why? Because it is. It was a dye first.

Speaker 2 That was cool.

Speaker 3 It dyed things. It was synthesized.

Speaker 2 Blue Cantrell also has blue in her name. And she's not a color, notably.
She is a singer. So I don't know what your point is.
Okay.

Speaker 3 Well, it was a dye.

Speaker 3 It is a dye, but initially that's all it was. Synthesized in 1876 by German chemist Heinrich Caro.
It was a very pretty blue. It was used in textiles.

Speaker 2 We used to get

Speaker 2 to be so wild about. I know blue and purple, especially.
We're wild about this stuff because we don't get a lot of blue and purple in nature.

Speaker 2 And we've done some wild stuff to get blues and purples over the years.

Speaker 3 And we made this synthetic dye and we were all very excited. And the crossover point, because then, how did we end up using a dye as a legitimate medication? Because it is.
I mean, that's the thing.

Speaker 3 There are things we legitimately use methylene blue for. How did that happen? Okay, the crossover is probably

Speaker 3 the advent of staining techniques in the laboratory. So we realized as we developed microscopy, so we can use a microscope to look at small things,

Speaker 3 just getting the small thing onto a slide, that's not always enough because we're looking for certain structures and maybe we need to highlight different pieces.

Speaker 3 And so we started playing around with dyes to stain different parts of the specimen so that we could look at specific structures or features or just look at like a bacterial pathogen and not the tissue it was invading, that kind of thing.

Speaker 3 Does that make sense? Yeah. So we started putting

Speaker 3 stains and dyes on tissues and organisms in a laboratory setting because of that.

Speaker 2 And we noticed in the process of doing that that something was up?

Speaker 3 Well, we did because as we started using them to highlight specific tissues or pathogens, we noticed that they would selectively bind sometimes to just the pathogen.

Speaker 3 And so that was intriguing because if this is a substance that I can put in a human body and it's only going to attach itself to the invading organism, what does it do to the invading organism?

Speaker 3 You know, I'm looking under a microscope and maybe everything's already dead. But if I put it in a human body, will it kill the organism and leave the human body alone?

Speaker 3 Because then all of a sudden we got a medicine, right?

Speaker 2 Nope.

Speaker 3 Like medicine. Well, maybe.
Here you go. Maybe.
Maybe we got a medicine.

Speaker 3 And it's great because then we're, we're, one, we're going to turn it blue. And two, we're going to kill it.
Yeah. Which is the goal.

Speaker 2 Turn it blue, kill it.

Speaker 3 So that's probably the crossover crossover point and there was like a lot of interest at that time period when we're moving into like the late 1800s in these stains and dyes these synthetic substances using them as some sort of treatment for something so this and that is probably why it came to be we use them to stain things

Speaker 3 let's put them in

Speaker 3 them right let's put them in living humans um

Speaker 3 And this was, and it probably started with Koch of postulate fame, Koch's postulates. We've talked about on the show before.

Speaker 3 Paul Ehrlich was really the one that first started experimenting with different dyes and like how would they attack different microorganisms.

Speaker 3 And we know he knew you'll see these really pretty cross sections. If you ever look up like methylene dye as a stain, they would do like cross sections of like

Speaker 2 sorry, say again.

Speaker 3 If you ever look up methylene blue as like a stain, like a laboratory stain or a tissue stain, you'll see these beautiful cross sections of like the human brain with specific pieces of it dyed blue.

Speaker 2 Okay, cool.

Speaker 3 If that kind of thing you find beautiful, yeah,

Speaker 2 I feel like if I was the kind of person that finds that beautiful, I probably already would have searched for images of methylene blue, but I don't know. Maybe I just missed out.
Well, I did.

Speaker 3 Do you want me to? I mean, I have they're saved. I could pull them up.
I don't have them pulled up, but I could.

Speaker 2 Let's save it and I'll put it on the big screen upstairs and we can really get into the details and stuff because I got a lot more pixels up there. We can really get into it.

Speaker 3 He noticed that you could do this even in like living human tissues. And so the thought was like, ooh, okay, so this is, you know, this is safe for the most part, inert.

Speaker 3 I mean, it's not, we'll get into that. It's not completely without risk, but like, it's a safer substance to put in a human body.

Speaker 3 And it binds specifically, we figured out, to the parasite that causes malaria.

Speaker 3 And so as early as 1891, we started proposing that maybe methylene blue could be used to treat malaria because when we put it in a human body, it attaches itself to the malaria parasite, parasite the plasmodium but it doesn't harm human tissues

Speaker 3 so great so there were some studies done in the late 1800s to look specifically at hey could we instead of the other medications we have for malaria it would this be a safer less side-effecty kind of route right

Speaker 3 and basically what they found is it's not as good does it work yeah maybe a little it's kind of is it pretty it's pretty it's pretty it's pretty and it kind of works but it's not not.

Speaker 3 So a lot of times, if we're trying to a pretty and kind of works is better than crystals.

Speaker 2 That's only half of it.

Speaker 3 I mean, honestly, like, I think this lesson and the fact that they latched onto this so quickly.

Speaker 3 I mean, we're talking again at the, we're still developing how we go about, you know, making therapeutics. And the idea of a synthetic drug is still pretty new.

Speaker 3 Something that you just made in a lab and then put in a human. That's still, I mean, this is probably the first one.

Speaker 2 And it's blue, which we still are using for medicines to communicate that they're futuristic.

Speaker 2 Like I still think when you see like a little blue vial in a movie, it's like, oh, that's, don't drop that because we're all dead.

Speaker 3 Exactly, exactly. And so they, but they looked at this and they did the studies and they compared it to quinine, which was the treatment of the time.

Speaker 3 That was what most people would have received for malaria. And what they found is that it was not as good.
It was what you're looking for is what called non-inferior.

Speaker 3 You're testing a new drug. Is it not inferior to the existing drug? That's the study you want to do.

Speaker 2 And quinine is naturally occurring, right? Or are we refining that?

Speaker 3 Well, no, we got it out of the bark of the Syncona tree. So yeah, it was, yeah.

Speaker 3 But we,

Speaker 3 what we found is that methylene blue was not as effective. And so it did not supplant.
quinine as the primary treatment.

Speaker 3 And I think that that, the fact that that was latched onto so quickly is informative because I find stuff today that people will be like, hey, if you take, you know,

Speaker 3 red rice yeast is a great example. People will say you should take that instead of a statin medication to lower your cholesterol.
Well, it doesn't work as well.

Speaker 3 And if you take really high doses of it, it can have the same side effects as statins do. So it doesn't, the fact that it's natural doesn't help.

Speaker 2 Yeah. Does that make sense? That's a bias.
Right. It's a bias to think that something is natural and thereby it is more effective.

Speaker 3 So in this case, they did the study and they found, yeah, it doesn't work better. That's, and this also wasn't natural.
So maybe that was the bias too. Also, it can kind of turn things blue.

Speaker 3 So like your pea was blue if you took it. Sometimes the whites of your eyes, the sclera would turn blue.

Speaker 2 That, okay. Pea is blue when you took it is huge.
For me, I think that would be so exciting. You know how excited I get about asparagus and what a rewarding system that is for me.

Speaker 2 And I wish more foods kind of rewarded you. Not a reward necessarily, but like I noticed, I see you.
You know what I mean? Like, it makes me feel like my body sees the, the, what I'm doing for it.

Speaker 2 And the fact that it's like, I could make my pee blue, I feel like that would be my body saying, like, thank you for this medicine. It's working as intended.

Speaker 3 I think, I think, actually, what you're hitting on is why, as we get to the end of the episode, you're going to see a resurgence in methylene blue.

Speaker 3 I do think people want to see the effect it's having. That's right.

Speaker 2 It's weird that we haven't had it. We should look into asparagus.

Speaker 2 Because I do wonder if people have harnessed the power of asparagus in a refined form where you take these pills and all of a sudden your urine is just like off the chart stinking.

Speaker 2 Unbelievable.

Speaker 2 The impact.

Speaker 3 I was going to say you're the only person I know personally who wants to eat something to make their peace stinky, but Cooper, our daughter, has said the exact same thing.

Speaker 2 She also told us that she wanted butter chicken this morning to load up on fart power, which we did provide to her and her sister. who are both of them are going to be on a bus today.

Speaker 2 Listen,

Speaker 3 I would rather eat butter chicken than eggs and bacon. So

Speaker 2 it's it's like I don't understand butter chicken at 645 a.m. though.
I like legitimately don't get it sends me for a loop. I feel like I'm in a David Lynch movie every time I open a container.

Speaker 2 I'm like okay

Speaker 2 sure.

Speaker 2 I love butter chicken. I love chicken tikka salad.
It is like it would be like

Speaker 2 It would be like waking up at 4 a.m. and putting on a tuxedo and going into a swimming pool.
It's madness.

Speaker 3 They're sitting there with their paper towels as napkins tucked into their shirts so they don't get butter chicken on their school clothes it's like what

Speaker 2 so cute anyway anyway so you don't care about our kids yeah they do

Speaker 3 they do so in 1932 we found some more uses so now that we knew methylene blue could do something then it you know kind of opens the door for what else could we do in the human body with methylene blue

Speaker 3 And I mean, that's true for a lot of things. If we find something

Speaker 3 that kills germs and doesn't kill humans, we're going to keep playing with it and see what else it does.

Speaker 3 Right? So, we found Dr. Matilda Brooks, a cellular biologist at UC Berkeley in 1932, found some other uses for methylene blue.
I do want to note, I think it's really interesting.

Speaker 3 I was reading about Dr. Brooks.
Her and her husband were hired at UC Berkeley at the same time to both do research together in the same lab. So, they were researching together.

Speaker 3 She was technically working as a research assistant to him him because they had an anti-nepotism policy. Oh.

Speaker 3 So they couldn't both, basically she didn't get paid. She wouldn't get paid for her work.
Even after he passed away, she couldn't be paid for the work she was doing researching in the lab.

Speaker 3 But she continued to do her research and work in the lab.

Speaker 3 Eventually, they gave her.

Speaker 2 Sorry, guys. It sounds like another bad one for us.
We did it again, guys.

Speaker 3 Dagnabbit. Well, it's just, it's wild.

Speaker 3 I mean, they wouldn't they wouldn't pay she was working they wouldn't pay her we gotta stop with this stuff history come on she was also a cellular biologist like she had the credentials to work there in the lab after he passed away and then of course she couldn't live off of his salary i mean you know that the rationale at the time would have been like well he's getting paid what do you need money for lady probably said like that this is my favorite hey little lady hey little lady what do you need money for your husband's got money i can't do that character because i think it will make you mad at me even though it's just a fun character character.

Speaker 3 She was given a $500 a year stipend moving forward. Basically, like, I mean, I suppose you still have to eat or

Speaker 3 whatever.

Speaker 3 They would not like reimburse her for... travel or expenses associated with doing her job and presenting her research and findings.

Speaker 3 So a lot of it she did on either her own dime or she would write and get her own grants to continue her research.

Speaker 2 Ah, man. I don't know, Sid.

Speaker 2 That's pretty rough. Guys, man, history, guys, again, dang it.

Speaker 3 It is not.

Speaker 2 I could really use a W, history, guys. Come on.

Speaker 3 No, but listen,

Speaker 3 this is the best we can do. I cannot go back in time and give Dr.
Brooks a fair salary, right? I can't do that. I don't have a time machine because we'd know.
We would know if time travel exists.

Speaker 2 Because they will pay you to be my co-researcher in my time machine project.

Speaker 2 I'm doing it all on my own.

Speaker 3 This is where we would reveal that I don't get paid for any of this. I'm Justin's assistant.
We have an anti-Nepotism policy here.

Speaker 2 Actually, I'm the only one in the McLaren family organization that does get paid. Literally,

Speaker 2 no one else gets paid. Everybody else is an enthusiastic volunteer learning my trade.

Speaker 3 That's not true. I don't want you to think that's true.

Speaker 2 Every night when we go to bed, Cidi puts her head on her shoulder, on my shoulder. She says, I've learned so much from you today.

Speaker 3 Thank you so much.

Speaker 2 Thank you so much.

Speaker 3 For the podcast training.

Speaker 2 No, I don't have a trade. So

Speaker 3 Dr. Brooks proposed that because methylene, oh, no, I didn't get to finish my thought.
I'm so sorry. So we cannot go back in time and pay her a fair wage.
However,

Speaker 3 we can recognize her on this podcast. It is not the same.
It is not fair. It is all I have to offer, though.

Speaker 3 It is the only thing I can do, which is to recognize her contributions and her hard work and say her name. It is the only thing I can do.
So I can do that.

Speaker 2 And I will say it is not as good as that, at that recognition at the time. It is better.
All they had back then were newspapers, dusty old newspapers.

Speaker 2 This is electronic, and literally 6 billion people can get at it. Like, it's better.
This credit is eternal, digital, eternal.

Speaker 2 And I think it's actually better than getting in some weird old newspaper at the time.

Speaker 3 Yes, I do think the attention is better. I would say that if I were to pull out my Ouija board and ask Dr.
Brooks, she would prefer a paycheck.

Speaker 2 Can I ask, do you want a Ouija board or do you want a time machine? Because it seems redundant to have your Ouija board if you, if the time machine is already functional.

Speaker 3 I think we've got to explore all avenues in science. Let's try everything.
So anyway, she proposed methylene blue is what we call a redox dye.

Speaker 3 What that means is that in an oxidized state, it is blue and then when it is reduced it turns colorless that Those are helpful when we are doing experiments in a lab, chemical reactions in a lab, to see what happened.

Speaker 3 Does that make sense? Like, if you put it in there and it changes color, you know what just happened. Yeah.
And if it doesn't, you know it didn't happen. Okay.

Speaker 3 So it was already being used in this way. What that means is that it can gain and lose electrons.
That's key to understanding what she was doing moving forward.

Speaker 3 This compound can take an electron on or give an electron away. Okay.
Okay.

Speaker 3 Cyanide.

Speaker 3 The poison.

Speaker 2 The apple seeds. It's in that.

Speaker 3 But this, but we're not talking about apples. We're talking about cyanide.
Just some trivia.

Speaker 2 I want to go from solving.

Speaker 3 From a very simplified perspective, the way it works, you know what mitochondria are.

Speaker 2 Pat, Dad. The generators of the cell.
Powerhouse. Powerhouse of the cell.
Okay.

Speaker 3 So cyanide, very simply, turns off the ability of mitochondria to make ATP, which is the, that's the stuff that makes things go. It's like the energy, right?

Speaker 3 It turns that off, and eventually it will starve your cells of oxygen and you'll die. That's how cyanide works.

Speaker 3 What she discovered is that methylene blue can bypass what cyanide is blocking, the point in the chain that cyanide creates a block. Methylene blue can get around that block.

Speaker 2 Whoa, anti-cyanide? Yes.

Speaker 3 It can be a treatment for cyanide poisoning.

Speaker 2 This is going to go in my James Bond novel, unlicensed James Bond novel. Think about it.
It's like they get him with cyanide and he's like, actually, I have this blue cufflink. And he's like,

Speaker 2 and he drinks his blue cufflink, and he's fine. I mean, that, yes.

Speaker 3 I mean, because what it goes around the

Speaker 2 joke, that was just sick. Yeah.
I mean, I don't know. No, it would be.

Speaker 3 Probably

Speaker 3 somewhere someone has put this in a spy thing.

Speaker 2 That's everything all this new again. That's not going to keep me from doing it.

Speaker 3 So she spoke, by the way, she spoke of her findings and this proposed mechanism, like here's a treatment for cyanide poisoning at the Society for Experimental Biology and Medicine in April of 1932.

Speaker 3 I think it's important to note that in December of that year, Dr. J.C.

Speaker 3 Geiger, a man, had an article published in JAMA, the Journal of the American Medical Association, titled, Methylene Blue as Antidote for Cyanide and Carbon Monoxide Poisoning. Dr.
Brooks responded

Speaker 3 with a letter to the editor, to JAMA,

Speaker 3 noting that when Dr. Geiger wrote this article, he talked about how he had heard from some other people about how maybe this would work.

Speaker 3 and some some there was another guy another scientist who told him about some research he'd done to suggest this and this is how he arrived at these conclusions the other guy that he referenced was at her talk in april of that year pass this information on to this dude and then he published all the findings she was not credited except for in her letter to the editor where she said i'm the one who told him these these moments where you're yelling at men i think would be so a lot more impactful now that we do have the camera if they were like you really got to to just like send him out there to like, there's all the men.

Speaker 2 There's one man here, you know, and he's been getting it for 13 years on Sawbones. And I'm saying, what I'm saying is like, let's just send that

Speaker 2 there.

Speaker 2 That's all, there's one man here and all the other ones are out there.

Speaker 3 It just figures, right? She like, she's not getting paid for her work. Right.
Got a $500 a year stipend.

Speaker 3 She went to this conference to speak and she probably paid for her own transportation, her own hotel. She probably had to pay for her own like, I mean, we didn't have PowerPoint yet.

Speaker 3 So, like, poster board

Speaker 2 or whatever.

Speaker 2 You know, she's still feeling of us being on the same team right now. It's us versus them.

Speaker 3 She told everybody, like,

Speaker 3 I have some evidence that methylene blue can be an antidote for cyanide poisoning. Isn't this exciting? And there was a guy in the audience who was like, I'm going to tell my buddy about this.

Speaker 3 And he went and told his buddy about it. And then his buddy was like, I'm going to publish a whole article about it in JAMA and get all the credit.

Speaker 2 Not now. Look who just said it right.

Speaker 2 I guess it takes a good man with a podcast to stop a bad man with a medical journal.

Speaker 2 And we'll just

Speaker 2 freeze it right there. And if we could

Speaker 2 crop on me where it's like, fixed it, you know, that's good.

Speaker 3 I'm done talking about the injustices for Dr.

Speaker 2 Bros

Speaker 3 for this half of the show.

Speaker 3 Let's take a break and then

Speaker 3 we can just talk about medicine. medicine.

Speaker 2 Okay, let's go to the building department.

Speaker 3 Let's go.

Speaker 2 The medicines, the medicines that escalate my cards before the mouth.

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Speaker 3 That was in a film.

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Speaker 3 Can I say I will? I did really love the interaction. Like he published the article in JAMA.
She sent a letter to the editor where she was like, this was my thing.

Speaker 3 And like, I presented it at this conference. Like, there's a record of me knowing it first.
And he did respond immediately below it. There's like like author's response because they do that.

Speaker 3 They have like the people who write who are like, I don't know about this. And then the author gets to be like, well, here's what I was thinking.

Speaker 2 And then the next person gets like one more little one. And then the last person gets one picture where they're like,

Speaker 2 or

Speaker 3 they just get a meme.

Speaker 2 Just to get one emoji at the end.

Speaker 3 So the author did respond and said, it has come to my attention that she blah, blah, blah. And I would like to give her recognition.

Speaker 3 And I would like to alter my thing to say that she came up with this. What's

Speaker 3 he like very quickly was like, sorry, sorry, sorry, oops, sorry.

Speaker 2 But that's the thing about systemic, right? It's like he probably didn't know. And then he gets to be like, oh, that was my mess up.
But you don't think about like,

Speaker 2 why did it happen in the first place, man? It's not an isolated thing. I don't

Speaker 3 listen. I don't, I'm not going to sit here and say he probably didn't know.
I don't know. 50-50.

Speaker 2 I'm just saying, I'm saying he might have known.

Speaker 3 He might have known.

Speaker 2 And maybe he didn't. I bet.
Can I say, can I actually?

Speaker 3 He probably did.

Speaker 2 Can I revise what I said earlier? He definitely knew now.

Speaker 2 He definitely knew now. That's where I'm at.

Speaker 3 He definitely knew.

Speaker 3 You have to actually

Speaker 3 happens to this day. I'm not going to sit here and put people on blast that are alive and live in our world right now, but like this happens to this day.

Speaker 2 So, yeah. Anyway, I thought the first half, because at the end of the first half, you were like, medicine.

Speaker 2 And I, can I say, I'm so relieved to hear that that was wrong and that we're still

Speaker 3 because

Speaker 3 we have discovered, unlocked this property of methylene blue as something that can give and take electrons away, it opened the door for it to be used for other medical conditions.

Speaker 3 And this is where you get to the primary use of methylene blue in medicine as a legitimate medication that is still indicated and used to this day is for a condition called met hemoglobinemia.

Speaker 3 Okay, this can either be something that you inherit, you know, that you just have, or it can be something that happens to you when you take certain medications.

Speaker 3 But basically, the iron, you know, there's iron in your hemoglobin, in the heme, there's iron in there. It gets an extra oxygen, and this inhibits its ability to transport oxygen.
Okay.

Speaker 3 And the result of this can be some minor symptoms like some headache and dizziness onto shortness of breath. You can become lacking oxygen, like cyanotic, turn blue, hypoxic.
You can have seizures.

Speaker 3 You can have abnormal heart rhythm. So it can be very serious.
So it's important to address this condition.

Speaker 3 Methylene blue, because it can give and take electrons away, is a really helpful medication to give somebody with met hemoglobinemia.

Speaker 3 We also give them oxygen, that's kind of like the standard first thing, like put some oxygen on them to get oxygen in their body.

Speaker 3 Then you can give them methylene blue, and it'll help reverse what's going on with the iron, and it can turn back into the hemoglobin we know and love that can transport oxygen to your body cells.

Speaker 3 Good. So,

Speaker 3 as when I went through medical school, and to this day, as far as I know, methylene blue is used in medicine primarily in one way to treat met hemoglobinemia.

Speaker 3 I will say you could use it to reverse a cyanide poisoning. There are other things you can do, but you could do that.

Speaker 3 You could also, there's been some resurgence in interest of treatment for malaria with methylene blue as like an adjunct, as an added-on treatment to other treatments that exist.

Speaker 3 Yes, there's been, I was reading some

Speaker 3 really recent research about that.

Speaker 2 I almost joked earlier that they should have just mixed them up together. And I almost said that, and you would have thought that was so smart if I had said it, but dag nabbit.
Okay, I'll just keep.

Speaker 2 It's a good reminder. I need to just say these thoughts as soon as they come into my head and not second guess myself ever.
I just need to get it out there, no matter what crosses up there.

Speaker 3 The seed of a lot of scientific thought is just stuff like that.

Speaker 3 What if we mixed it together? I mean, that really is the base. Now, we don't stop there.
Good science never stops there.

Speaker 2 But some of our brightest scientific minds do. In a sense, some of the biggest scientific minds are the ones that just have the guts to ask the questions and then don't follow up.

Speaker 2 They say, like, what if we mix them together? And then I'm like, I will leave you all to it. You know what I mean? Like, I, I, what if we mix them together and then I just back out of the room.

Speaker 3 It depends on what your metric of success is, Justin, because I would say that while our leading scientific minds don't do that,

Speaker 3 there are a lot of influencers and very successful,

Speaker 3 I don't know, YouTubers, podcasters, whateverers, who that's exactly what they're doing.

Speaker 2 On the grand spectrum of the human experiment, I'd love to pretend I'm more the former, but let's be honest.

Speaker 3 So I think it's important to know as we said, legitimate medical uses, methylene blue is a real medicine, not debating this.

Speaker 3 There are some side effects and danger, risks to using it. And I shouldn't say danger.
There are risks.

Speaker 3 Let's say any medication, right? You go over the risks, the benefits, the alternatives, and the side effects. So

Speaker 3 because of the way that methylene blue functions in your body,

Speaker 3 it can actually interact with certain other meds, specifically antidepressants. So medications that increase your serotonin level by preventing it from being taken back up,

Speaker 3 selective serotonin reuptake inhibitors, SSRIs, a lot of the most popular antidepressants are those.

Speaker 3 So a lot of people are on these medications. I'm saying they're very common medications.

Speaker 3 Methylene blue can interact with those because it also can increase your serotonin levels and you can develop something called serotonin syndrome.

Speaker 3 So it's not a good idea to take it if you're on other medications without talking to a healthcare provider. So there are some risks to it.

Speaker 3 Also, as strange as this sounds, methylene blue can cause met hemoglobinemia in somebody who doesn't have it if taken at the wrong dose and too much and all that kind of stuff, right?

Speaker 3 And so anyway, there are some risks to it. It is not completely benign.
It's not one of those things that it's like, I don't know, just do it if you want to. What's the harm, right? It's not.

Speaker 3 There are real harms if you shouldn't be taking it. Back in 2015, there was a study that came out, which looked at methylene blue as a potential treatment for progeria, which is a rapid aging disease.

Speaker 2 I think it's,

Speaker 2 I know that it's not technically Jack disease, but I do want to clarify that in the past, I have referred to it as Jack disease to explain what it is, but not to make light of it. Right, exactly.

Speaker 2 Because Jack disease is not real.

Speaker 2 And neither is Benjamin buttonitis.

Speaker 3 No, Benjamin Button, that is not real.

Speaker 2 Progeria is real.

Speaker 3 Yes, and this is a a specific kind of progeria that they were looking at.

Speaker 3 Basically, the idea is that through certain effects on mitochondria, because we know methylene blue can do that because of the cyanide history, that maybe we would be able to slow the progression of progeria by giving somebody methylene blue.

Speaker 3 So there was a study published in 2015. It showed that...

Speaker 3 There were some effects on the mitochondria. And these weren't, this was not in people.
This was in a lab. So in vitro, not in vivo.
That's in life.

Speaker 3 There was some suggestion, like, well, this could be something. Maybe there's something here.

Speaker 3 We should do some more research on this to see if methylene blue or compounds like it, because there are other things that can give and take electrons away. It's not the only compound.

Speaker 3 Maybe this could be something in this very specific condition.

Speaker 2 Maybe, maybe, maybe.

Speaker 3 And that's all it takes for wellness influencers to run with something. So the next, I think the next step step in this story was there's a fitness influencer named Ben Greenfield.

Speaker 3 And he told his Instagram followers that methylene blue is a potent cognitive enhancer.

Speaker 3 And what I think what really you talked about how you can see the effects of it and that people like that.

Speaker 3 I think that's exactly why this over other things maybe caught on very quickly is because he would give himself methylene blue and it would make his tongue blue.

Speaker 3 And so he posted a picture of himself with his tongue out blue. Yeah.
And then encouraged other people to take methylene blue and post pictures of yourself on your methylene blue.

Speaker 3 So you take it and then you

Speaker 3 post a cute little picture with your blue tongue, which like you could also just get one of those really great blue raspberry

Speaker 2 blow pops. Those are great.
Yeah.

Speaker 3 Those are much better

Speaker 3 than methylene blue. Yeah.

Speaker 2 And they'll go full blue. Full blue tongue.
Full blue. And you got a nice little, if you got bubble puppy, you got a nice little piece of bubblegum with you to look forward to.
Come on.

Speaker 3 But he touted, so you should do this, not just for the cognitive benefits, but it enhances mitochondrial function. So he's, this is sort of, it's based in an idea.

Speaker 3 It's not true, but like it's, you know what I mean? Like

Speaker 3 it's related to the truth. It's truth adjacent.

Speaker 3 That it provides neuroprotective effects against brain inflammation, increases memory and cognitive function, enhances the effects of light and oxygen therapies, and much more.

Speaker 2 I feel nootropics

Speaker 2 that he's referencing here, as I understand it, is the idea that you can add chemicals to make your brain work better. Right.
Or substances that are going to make your brain work better.

Speaker 3 Yeah, it's like a limitless pill.

Speaker 2 It's like a limitless pill.

Speaker 2 I think

Speaker 2 that I, I think it is weird to me that more people have not wised up to this.

Speaker 2 If you look at the vast number of people who believe that they are into nootropics,

Speaker 2 it is certifiably provable that nootropics do not work.

Speaker 2 Look at the people who say their brains are functioning better on nootropics, okay?

Speaker 2 And then see if their brains are functioning better. It's not a Venn diagram.
It's Mr. Magoo, okay?

Speaker 2 Nootropics, the end.

Speaker 3 The problem is that a lot of rich people say that, and we have this bias in our society to equate the ability to accumulate wealth with intelligence. Yes.
And those, there is

Speaker 3 all over the board, all over the board there. Yeah.
Now, you might be wondering, where are people getting methylene blue? Because I've just referenced, it's a prescription medication.

Speaker 2 Yeah. So they don't have the special cufflings I mentioned earlier.

Speaker 3 So where are they getting it? Well, it is also used as an antifungal dye that cleans fish tanks. So you can buy it to clean your fish tank.

Speaker 3 And then you could take it.

Speaker 2 Don't. I feel like I would look for more natural alternatives even to clean my fish tank.

Speaker 2 That doesn't even feel, that doesn't even make me feel good for stovetop stuffing to have to deal with methylene blue.

Speaker 3 Yeah. No, but that's, that is where, I mean, that was the idea is like, it's really easy to purchase.

Speaker 3 It's sort of like everybody was going after ivermectin by like getting it for your horse or whatever and then taking it for yourself.

Speaker 3 Please don't do that either. But it's the same idea.
Like, we'll just, I mean, we can cheat the system. Buy it to clean your fish tank and then take it in your human body.

Speaker 3 So anyway, a lot of influencers and people who push pseudo medicine and pseudoscience started following in this, you know, I mean, this is great. Like it's really easy to tell people.

Speaker 3 It's kind of like we've talked about laxatives, things that make you poop and diuretics, things that make you pee, have always been popular

Speaker 3 in

Speaker 3 medicine that isn't really evidence-based. And the reason is that if it's working or not is objective.
Did it work? Well, yeah, I was in the bathroom for an hour, so it worked.

Speaker 3 Did it do any of the things it was supposed to? I don't know, but I was in the bathroom for an hour, so it did something. Yeah.

Speaker 3 So I think, like you said, methylene blue, you can see the blue on your tongue. If you take enough, it might turn your pea blue.
You could get blue eyes. So like you can see that it's working.

Speaker 3 And now it's being pushed. There are all kinds of supplements you can buy online with methylene blue in it that

Speaker 3 are anti-aging, that will increase your energy and stamina.

Speaker 3 Or as I saw on my own personal Facebook feed, another physician saying, if you have nothing else to lose, why not try it?

Speaker 3 In reference to using methylene blue as a treatment for stage four breast cancer,

Speaker 3 along with the eye drug, which I think must have been ivermectin, but

Speaker 3 I do want to note that

Speaker 3 one, I think these things take on interest because they're, you can see them and they're Instagrammable and whatever.

Speaker 3 Two, for most people, taking methylene blue isn't going to harm them. That isn't me saying you should, because for some people, it can absolutely do harm.
But for most people, it won't do harm.

Speaker 3 And so you're going to take it and it may be placebo effect, maybe you feel better or whatever, but it's not going to hurt you. And so you're going to think it's good, right?

Speaker 3 So for those reasons, it catches on. But then that specific point, if you have nothing else to lose, why not try it, is one of the most dangerous statements a person can make.

Speaker 3 And if somebody says that to you, a red flag. needs to go up in your head about everything else they've told you because we have lots of handrails put on the things we do in medicine.

Speaker 3 There are tons of checkpoints in our studies, especially when it involves humans, alive human bodies that we're putting substances in, that check us to make sure we are not taking advantage of people who are desperate, of people who know that their condition doesn't have an effective treatment or cure at this point, and who will try anything.

Speaker 3 That is exactly why we have guardrails on the science that we do in humans to prevent charlatans from taking advantage of people who are desperate.

Speaker 3 So if somebody says to you, go ahead, take it, you got nothing else to lose,

Speaker 3 that is that no scientist says that. No one who is operating out of a place of evidence and good faith will say that to you.

Speaker 3 The people online who are selling you supplements, they'll say that every day because all they want to do is sell you a supplement and they don't care what happens to you.

Speaker 3 All of this is added to the claim that supposedly earlier this year, there was a picture taken of RFK Jr. on Air Force One about to have a drink, and he was adding drops of a blue liquid to his drink.

Speaker 3 And everybody went wild. RFK likes methylene blue.
It must be the real thing. I don't know.
I don't know.

Speaker 2 It was Mio Berry pomegranate, though. I guarantee it.
I know that stuff anywhere.

Speaker 3 Also, predictably, Joe Rogan really loves. this stuff.
Nootropics.

Speaker 2 Yeah.

Speaker 3 So it's just like a lot of the cure-alls.

Speaker 3 It's easy to get and and sell and see that you're, you know, I mean, it's blue. So you know, you're getting the thing.

Speaker 3 You can see that it's happening.

Speaker 3 At this point, other than it's legitimate evidence-based uses that we have researched and found to be true in medical science, that you could be prescribed it or given to it by a healthcare provider for.

Speaker 3 Other than those things,

Speaker 3 we have no evidence to suggest that you should just be taking methylene blue. And we definitely have reasons to suggest that it could potentially harm you.
So

Speaker 3 please don't do this.

Speaker 2 That's going to do it for us for this week on Sawbones. I want to say thanks to the taxpayers for the use of their song Medicines as the intro and outro of our program.

Speaker 2 Thanks to our editor, Rachel, and thanks to you. Hey, one last quick thing.

Speaker 2 We do lots of different kinds of episodes of Sawbones, and we have tried lots of different kinds, and we like doing all of them. We're curious sort of what you guys think,

Speaker 2 the folks out there in the listening world. If you'd like to weigh in, we'd love to hear from you.
There's a link in the description of this episode.

Speaker 2 So if you would go check that link, there's a survey there. If you would click it and take that survey, gosh, I'd sure appreciate it.
Thank you so much. It's, you know what? It's science.

Speaker 2 You guys like science, right? You think about it. You could be part of a spearman.
Basically, we really appreciate it. That is going to do it for us for this week.

Speaker 2 Until next time, my name is Justin McElle.

Speaker 3 I'm Sydney McElroy.

Speaker 2 And as always, don't drill a hole in your hand.

Speaker 2 Maximum Fun, a worker-owned network of artist-owned shows, supported directly by you.