The stretched-open abdominal cavity of a human cadaver is not.
Justin Cottle’s hand, protected by a blue latex glove, reaches into the cavity, where he runs his index finger along the small intestine. Off camera, Cottle narrates, guiding users through the digestive system: “This may seem a little strange. Believe it or not, most people don’t know where the stomach is,” he says.
This situation is strange, and not only because the stomach is actually located behind the liver.
What’s strange is that this video is on TikTok. It has over 1.5 million likes. Only 50 percent of the people featured in this viral video are alive.
At the Institute of Human Anatomy, a privately owned cadaver lab based in Salt Lake City, Utah, Cottle is a lab director and the face of its TikTok channel, which has 4 million followers as of publishing. His video of the stomach has 20,100 comments and has been shared 49,400 times.
It’s 2020 and Tik Tok is everywhere. It was the seventh most-downloaded app of the 2010s, despite launching in September 2016, and claims 800 million active users a month. Those 800 million are all still alive — at least when they appear in their videos.
[See also: The lab's most-viewed cadaver videos on TikTok]
Over at the IOHA lab in Utah, anonymous human cadavers are the stars, and this has given the lab a social media following that’s exploded in recent months.
Jeremy Jones, the founder of the Institute of Human Anatomy, says that in September 2019, the Institute of Human Anatomy had a mere 292 Instagram followers. It had no YouTube videos. As of publication of this story, the lab has over 42,000 followers on Instagram and 221,000 subscribers on Youtube.
This newfound internet popularity, says Jones, is thanks to TikTok.
“Literally, it has gone from teaching thousands of students to millions. I mean, that's what it turned into with TikTok,” Jones tells me.
TikTok isn’t where you would usually go to find videos about science, let alone bite-sized lessons about the complexity of the human body. But in the wake of the coronavirus pandemic, the platform is serving up both frivolous escapism and serious public health information. A hand-washing video and song created by the Vietnam's National Institute of Occupational Safety created a "new TikTok craze," the BBC reported on March 9. The World Health Organization made a TikTok account in February 2020 in effort to ensure that its expert advice reached more people.
The rest of the scientific world has caught on to TikTok's serious streak. he IOHA have been cultivating a following on TikTok since September 2019, though it hasn't always been easy.
With each short video, Cottle and his colleagues have to match the light nature of TikTok (bulldogs on skateboards, etc.) and a respect for the dead these bodies demand. Their ability to strike the right tone has catapulted them from anonymity to a must-follow account, and revealed a new way to learn from death on the internet.
If the statistics prove anything, it’s that there’s undeniable interest in the dead, no matter if that interest is morbid, academic, or a little of both.
“It is literally something that we consider every single time we put a camera on anything,” says Jones.
“It was a human, like all of us.”
IOHA’s TikTok videos aren’t quite formulaic, but they do follow a pattern. They answer basic questions you might ponder in the doctor’s office or in the shower: “You ever wonder why tattoos are permanent?" or “Why do pregnant women need to pee so much?” A video on period cramps has nearly 500,000 likes. A video called “Ever have something go down the wrong tube?” has 2.6 million likes. Cottle, alongside his cadaver co-stars, answer those questions by diving into the human body — literally.
Collectively, their body of work deals with two far bigger questions:
- How do we really feel about using death to educate?
- Does that change when we’re doing it on social media?
Humans have been grappling with how to feel about dissection, both publicly and privately, for centuries. It has proved controversial, even after it became accepted that dissection was a crucial rite of passage for medical students. In 18th century England, the “1752 Murder Act” considered posthumous anatomical dissection an apt punishment for murderers. After they were hung, “the corpse of the convicted murderer was then sent for anatomization and dissection or handed over to the sheriff to be hung in chains (‘gibbeted’). In either case, the punishment inflicted on the criminal corpse was, by intention and in effect, highly visible,” writes Sarah Tarlow and Emma Battell Lowman in their 2018 academic paper, “Harnessing the Power of the Criminal Corpse.”
The idea that anatomical dissection was strange persisted even after it was no longer a legal punishment, as a 2015 review paper on the history of human cadavers observes.
“Till the first part of the 20th century, instances of voluntary body donation were very low as socio-cultural prejudice against human dissection remained high,” the authors write.
By the end of the 20th century, the public attitude toward dissection began to change. In 1968, the Uniform Anatomical Gift Act made donating your body to science a legal right. More than 50 years later, it is a right that more Americans appear to be exercising.
The federal government doesn’t track whole-body donations, but some estimates suggest that about 20,000 people donate their bodies to science each year. In 2016, the Associated Press reported that several American medical schools reported a rise in the number of bodies donated to their programs.
“There's no objectifying it.”
Body donation is an admirable commitment to scientific discovery and education. The team at IOHA calls their cadavers “anatomical gifts.” In some medical schools, memorial services are held at the end of cadaver-based courses.
“At that point, you’re just a bag of skin and bones,” said the late Donald Truhe of South Dakota before he died and had his body donated to the South Dakota Sanford School of Medicine. “You might as well help medical students learn.”
That culture of respect is tangible to anyone who speaks to the team at IOHA. As they developed their TikTok videos, the cadaver researchers thought carefully about how to remain respectful, even though they have as short as 15 seconds to impart an educational lesson memorably.
Timothy Lahey, a physician and ethicist at the University of Vermont Medical Center, tells Inverse that respect is critical in cadaver-based research, especially when done publicly, like on TikTok. That high visibility can have a lasting effect on how people see body donation.
“You can imagine that if there was improper interaction with a cadaver and that got onto social media, someone who might have considered donating their body to science might not do so,” Lahey tells me.
“The manner of interaction has to be professional; it has to be seen not to endanger that social good.”
Jones, as well as the rest of the team at IOHA feel that pressure, especially because their content gets distributed to millions on TikTok in a matter of hours.
“We are very careful about what we show and how we show it,” Jones says. “You will never see any sort of disrespect or jokes or just posing with cadaver.
“There's no objectifying it.”
Still, IOHA can’t control everything. A cultural taboo around dead bodies lives on in the comments. In a sense, humor is perfectly natural. A medical student in a lab might make a dark joke to process an encounter with a cadaver, says Lahey, “And we allow them that,” he says, due to the heavy nature of a dissection.
But when dark jokes appear in a comment section, they stick around for everyone to see.
Occasionally, you’ll see comments that liken human tissue to “raw carne asada” (a comment with 498 likes as of writing). Of course, there’s a misplaced cannibal joke: “Maybe the cannibals had the right idea … he’s looking like a REAL snack,” quipped another user.
That’s exactly the attitude that the IOHA team wants people to abandon. “We want to move people away from that taboo of ‘oh that’s a ‘dead body’; shouldn't be seeing this,’” Jones adds.
That’s a high bar, given the long history of public attitudes toward human dissection. Occasionally, you’ll see that breakthrough moment in a short, character-limited comment on IOHA’s page.
“It hits different when you realize that it was a human, like all of us,” observed commenter denysminaiev.
(That comment, for the record, got 274 likes.)
An algorithmic taboo
The visceral reaction that some have toward dead bodies is entrenched in social media algorithms and the way we moderate content.
TikTok’s 2020 community guidelines bar depictions of dismembered human remains or gore in which an open wound or injury is the sole focus. The tone of those guidelines makes it clear that the policy is intended to avoid spreading messages of mutilation or violence.
The tone of the IOHA’s videos is different. But there’s no hiding from what actually appears on the screen.
Cottle knew their content might get flagged on TikTok, either by a person or by an algorithm.
So when he first set out to create videos at IOHA, he contacted the company to discuss how they could portray human cadavers online in the best way possible.
“I knew our content was going to be graphic,” says Cottle. “I made this little sample video, I sent it to them, and then they immediately contacted me back saying they would love to do it.”
TikTok eventually put Cottle in contact with content strategists, where they talked over what might be appropriate to show in a video. A few rules were evident from the get-go.
The cadavers were to remain anonymous (this is just best practice with cadavers, says Cottle). That means not showing faces, or identifying marks, like tattoos. The rest was a matter of Cottle’s discretion and experimentation. Hands seemed to pose problems, as did the way that embalming fluid interacts with blood.
The process was touch-and-go. An early video on the kidney (“tame” by cadaver standards, says Cottle) was immediately flagged. “It was really difficult to figure out what was going on,” he says. “I didn't know if there was a person doing it. I didn't know if it literally was just the straight-up algorithm.”
A spokesperson for TikTok tells Inverse that it employs a combination of algorithms and human workers to ensure that TikTok provides viewers with an enjoyable experience. But the company declined to provide details of why and how certain TikTok videos are removed.
“I mean, for the first few weeks, pretty much every single video we posted was getting flagged and taken down or suspended by the TikTok algorithms, and we had to work with them on a regular basis to get them back up,” says Jones, the IOHA co-founder.
“We would post one, and millions of people would look at it and then it would be down.”
Finally, the team arrived at a golden rule that united content and style.
Cottle speaks informatively, in a casual tone, but not he’s flippant. He’s upbeat yet all business as he walks viewers through the very organs and tissues that can cause tennis elbow and or period cramps. As for the visuals: “We tried to not show anything overly human,” says Cottle.
“But what if people were able to get a hold of bodies 100 years earlier, or 200 years earlier, and start to do dissections?”
This professional but approachable tone helps IOHA maintain an atmosphere of respect, and it also helps them make their videos better from an educational standpoint, says Christine Greenhow, a professor at the University of Michigan who studies social media and education.
Greenhow watched one of the videos on the bones of the human skull and called it a “great teaser.”
“I thought it was really engaging,” she tells Inverse. “You’re really looking at real bones and real cadavers, and the speaker is pointing out real structures in the anatomy.”
Working with TikTok — and nailing down the style of the videos — was worth the effort, says Jonathan Bennion, an anatomist and IOHA co-founder. He sees overcoming TikTok’s moderation policies as merely another hurdle in the history of anatomical study.
History’s anatomists faced cultural attitudes or religious skepticism toward dissection. IOHA’s 21st century anatomists had to grapple with the inner workings of TikTok itself. Getting past the algorithms, Bennion says, will now expose more people to the visceral intricacies of human biology than ever before.
“When people finally started doing dissections, there were a lot of barriers for these early anatomists. It was hard to actually get bodies because of the taboo,” Bennion adds. It’s true. Read about the Burke and Hare murders of 1828 in Edinburgh, Scotland.
“But what if people were able to get a hold of bodies 100 years earlier, or 200 years earlier, and start to do dissections? How much further along would we be anatomically or medically now, in 2020?”
“We cannot tell you how many DMs we have.”
There are virtual cadavers and apps that can show the human body in intimate detail. But nothing compares to the real thing, says Bennion. That’s why he thinks these videos have such appeal.
“There's nothing like the actual real brain, the actual real kidney, or the heart,” he tells me. “It’s kind of indescribable in a way that will sound cheesy.”
Not everyone gets to have that experience with a real heart or a real kidney. That’s partially due to self-selection. (If you’re not into bodies, you’re just not into them.) It’s also due to the pure cost of cadaver-based courses.
In 2011 and 2012, the State of Virginia Anatomical Board estimated that a full human cadaver cost about $1,500, and that’s without the required cadaver equipment (steel humidors to keep bodies fresh), which can cost between $4,000 and $8,000.
IOHA’s TikTok videos are one way to allow anyone with an internet connection to see a real human cadaver, which rarely happens unless you’re pursuing higher education.
“What I loved about these videos was that you’re taking real materials that teachers wouldn’t have access to because they’re too costly, and helping students see what they look like, and that’s great,” Greenhow says.
Jones tells Inverse if you include comments on the videos, IOHA gets “tens of thousands” of inquiries from fans asking how they might pursue a career in science. If you count Facebook and Instagram messages, he says they get about 20-30 every day that are “clearly triggered by the social platform activity.”
“I can't tell you how many comments I read, where people go, I'm going back to school,” Cottle says. “We have people asking, ‘How do I do what you do? How do I get into this?’”
If you’ve never seen one, how could you ever know if you’re captivated by a kidney or inspired by an intestine? Now you can see one for free on TikTok, which levels the playing field.
If these videos can help users start a conversation with Cottle or with each other, they become more effective learning tools than the average textbook photo, Greenhow explains. However, the real power of these viral TikTok videos seems to be that they give users a sense of identity and community that can bolster them through tough times.
It’s a place where you can unabashedly show how much you’re into human bodies and be applauded for it by millions of like-minded people. The IOHA TikTok account makes it cool to be an anatomy nerd.
“Let’s say I get on social media and post something related to my interest in air and space,” says Greenhow. “If other people see that post and retweet it or share it, all of the sudden I get a lot of recognition and activity around this interest.
“What’s happening is that I’m out there signaling my interest, and that interest is being magnified through my social media network. That can sustain my interest and build it over time.”
Some comments seem to indicate that the interest is indeed being sparked.
There are students self-identifying as anatomy enthusiasts: “I’m a future DPT student and I love this page!” writes one. Others pose questions: “Why does everyone’s voice sound different?” asks another beneath a video about the larynx.
The hope is that when times get tough, anatomy students might be able to scroll through a TikTok feed and remind themselves what drew them there in the first place. When that happens, Cottle and his deceased co-stars will still be there.
“It's very far-reaching,” Cottle says of the TikTok experiment. “It's very impactful.”
[See also: The lab's most-viewed cadaver videos on TikTok]