Speaker 1: Hi, I'm Aaron Welsh and this is this Podcast Will
Speaker 1: Kill You. Welcome to our very first tp w k
Speaker 1: Y book Club episode of the season. In these episodes,
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Speaker 1: medicine books about their latest work, and I get it
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Speaker 1: miss an episode. All right, let's get to the real
Speaker 1: reason we're here. John Green's Everything Is Tuberculosis. I know
Speaker 1: that many of you out there, like me, have been
Speaker 1: eagerly awaiting this book's publication, and let me tell you
Speaker 1: that it is well worth the wait, and its arrival
Speaker 1: could not have come at a better time, as tuberculosis
Speaker 1: cases surge across the globe amidst massive funding cuts to
Speaker 1: global health programs such as USAID. In Everything Is Tuberculosis, Green,
Speaker 1: award winning, internationally best selling author, famous YouTuber, and excellent
Speaker 1: science communicator, takes a panoramic view of this fascinating and
Speaker 1: deadly disease, linking its biology and history with the perception
Speaker 1: and prevalence of tuberculosis today. For many of US, tuberculosis
Speaker 1: may conjure up Charles Dickens or long abandoned sanatoriums in
Speaker 1: Upstate New York. But as Green describes, tuberculosis is far
Speaker 1: from a disease relegated to the past. Despite the fact
Speaker 1: that curative treatments for this disease have existed for decades,
Speaker 1: hence those sanatoriums being abandoned, tuberculosis remains a significant contributor
Speaker 1: to morbidity and mortality around the world. This is a
Speaker 1: disease caused by a microorganism, Mycobacterium tuberculosis, but it's also
Speaker 1: so much more than that. Over the centuries, people have
Speaker 1: ascribed various meanings to tuberculosis, each of which carries the
Speaker 1: significant burden of othering. It has been used to romanticize
Speaker 1: and stigmatize. It has changed the course of history in
Speaker 1: untold ways, and it stands today as a deadly consequence
Speaker 1: of how the global health care decisions that are driven
Speaker 1: by profit lead to unnecessary death and suffering for millions
Speaker 1: of people around the world. Through his heartfelt and incisive writing,
Speaker 1: Green demonstrates the human cost of tuberculosis and how intervention
Speaker 1: is not only possible but necessary. It was an absolutely
Speaker 1: surreal delight to get to chat with John, and I
Speaker 1: am very excited to share our conversation with you all,
Speaker 1: So let's get right to it after this short break. John,
Speaker 1: thank you so much for joining me today. I really
Speaker 1: can't tell you what a thrill it is to get
Speaker 1: to chat with you.
Speaker 2: Oh well, thank you, Erin. It's great to be here.
Speaker 2: I'm a fan of the pod.
Speaker 1: That is so thrilling. That absolutely made my day. So
Speaker 1: usually I start off these book club episodes by asking
Speaker 1: someone how did you get the idea for this book
Speaker 1: or how did this book come to be? But today,
Speaker 1: with you, I'd love to begin by asking about Henry.
Speaker 1: Can you tell me how meeting Henry started you on
Speaker 1: this journey that led to this book.
Speaker 2: Sure, in twenty nineteen, I had no idea that tuberculosis
Speaker 2: is the world's deadliest infectious disease. I would have been
Speaker 2: stunned to hear that. I was visiting Sierra Leone with
Speaker 2: my wife, where we work with Partners in health on
Speaker 2: maternal mortality infant mortality in the Cono region, and on
Speaker 2: the last day of the trip, some of the doctors
Speaker 2: we were traveling with asked if we could go to
Speaker 2: a tuberculosis hospital, and I was like, tuberculosis hospital, that's
Speaker 2: still a thing, right. I hadn't listened to enough of
Speaker 2: the pod, so when we got to the hospital, I
Speaker 2: was immediately grabbed, like physically grabbed by the shirt by
Speaker 2: a boy whose name was Henry, which is also my
Speaker 2: son's name. And this boy appeared to be about the
Speaker 2: same age as my son, who was nine at the time,
Speaker 2: and this boy started walking me around the hospital. Most
Speaker 2: sier Leonians are multi lingual, but Henry spoke particularly good
Speaker 2: English for a young child, and so I was able
Speaker 2: to kind of talk with him and enjoy the conversation
Speaker 2: with him. And he took me to the lab where
Speaker 2: he showed me a microscope and told me to look
Speaker 2: for TB bacteria in the microscope. He took me around
Speaker 2: the wards, he took me to the kitchen where the
Speaker 2: food was being made, and then eventually we made our
Speaker 2: way back to the entrance of the hospital where the
Speaker 2: doctors were meeting, and one of the nurses sort of
Speaker 2: lovingly showed him away, and I was like, whose kid
Speaker 2: is that? Is that like a doctor's kid, and they
Speaker 2: were like, no, that's one of the patients we're really
Speaker 2: worried about. And it turned out he wasn't nine years old,
Speaker 2: he was seventeen. He'd just been so emaciated, stunted by
Speaker 2: mountnourishment and then emaciated, further emaciated by tuberculosis. And it
Speaker 2: was really through meeting Henry and knowing Henry that I
Speaker 2: came to be interested in tuberculosis. I came home after
Speaker 2: that trip and just started reading voraciously about the disease,
Speaker 2: trying to understand how there'd been this massive hole in
Speaker 2: my understanding of the world around me.
Speaker 1: Yeah, it is. You know, there's this statistic that you
Speaker 1: say early on in your book about one hundred and
Speaker 1: fifty million people having died since we've had a cure
Speaker 1: for tuberculosis, and that's just been like circulating and echoing
Speaker 1: in my head over and over again, and I pull
Speaker 1: people aside and I'm like, did you know this? And
Speaker 1: I feel like it is so it's such a stark
Speaker 1: statistic because it really cuts to this core question of
Speaker 1: like how did we allow this to happen? And later
Speaker 1: in our conversation, I do want to touch on more
Speaker 1: of like the details of that, but like, broadly speaking,
Speaker 1: can you kind of take me through what are some
Speaker 1: of the major drivers in allowing that number to grow
Speaker 1: every single year?
Speaker 2: Yeah, I think the biggest driver is choice, human choice.
Speaker 2: We have chosen to live in a world with tuberculosis.
Speaker 2: We've chosen to live in a world where in countries
Speaker 2: like Germany or the US or Australia, TB is very rare,
Speaker 2: and in countries like sier Leone or even middle income
Speaker 2: countries like India and the Philippines, TV is very common.
Speaker 2: And some of that is because TV is difficult to cure.
Speaker 2: You know, it takes four to six months of daily
Speaker 2: antibiotics with the newest regimens it used to take even longer,
Speaker 2: and so it's it's a hard disease to cure. But
Speaker 2: my brother had Hodgkin lymphoma a couple of years ago,
Speaker 2: which is also a hard disease to cure, but curable,
Speaker 2: and there was no question as to whether or not
Speaker 2: he would receive treatment, or whether or not we would
Speaker 2: do a good job of getting him treatment. Doctor Peter Mugeny,
Speaker 2: this great Ugandan physician, said in two thousand of HIV drugs,
Speaker 2: which were still not getting to where they were most
Speaker 2: needed at the time, he said, where the drugs, the
Speaker 2: drugs are where the disease is not, and where is
Speaker 2: the disease the disease is where the drugs are not.
Speaker 2: And that's very much still the case with tuberculosis.
Speaker 1: Yeah, absolutely, And you know, I want to kind of
Speaker 1: circle back to the current present and then the potential
Speaker 1: future in a bit, but let's take a step back
Speaker 1: and look at the deep history of tuberculosis. I mean,
Speaker 1: this is a disease that has been with humans for millennia,
Speaker 1: and yet, as with many other infectious diseases, it is
Speaker 1: rarely acknowledged outside of you know, specific disease history books,
Speaker 1: you know on influenza or on cholera, as like this
Speaker 1: major force that is shaping historical events. I've wondered this
Speaker 1: so much, like why is that? Why do we not
Speaker 1: consider the role of an infectious disease in shaping history?
Speaker 2: Well, I think it's a great mystery. But in the book,
Speaker 2: I argue that one of the reasons we do is
Speaker 2: that we're so biased toward human agency. We love a
Speaker 2: story where humans are in control, and we love a
Speaker 2: story where humans make choices rather than have those choices
Speaker 2: made for them by micro organisms or viruses. Like that's
Speaker 2: an uncomfortable thing to live with. So I speculate in
Speaker 2: the book that maybe the reason we continue to spread
Speaker 2: the rumor that Alexander the Great died by poisoning when
Speaker 2: he almost certainly died of malaria or typhoid, is that
Speaker 2: we just don't want to reckon with a world where
Speaker 2: where the most powerful person on earth can be killed
Speaker 2: by a tiny bacteria or virus.
Speaker 1: Let's take a quick break, and when we get back,
Speaker 1: there's still so much to discuss. Welcome back everyone. I've
Speaker 1: been chatting with John Green about his latest book, Everything
Speaker 1: Is Tuberculosis. Let's get back into things. I mean, especially
Speaker 1: when you're when examining wars and the history of wars,
Speaker 1: like generals aren't acting in isolation, and neither are the
Speaker 1: diseases that are spreading throughout the entire military or through
Speaker 1: war torn regions. You can't look at these diseases or
Speaker 1: these factors leading to disease individually, which is a point
Speaker 1: that you bring up in your book, that we can't
Speaker 1: look even at tuberculosis through these narrow lenses. That being said,
Speaker 1: I'd love to ask you about a few specific influences
Speaker 1: that tuberculosis has had throughout history, especially on the granting
Speaker 1: of statehood and early twentieth century global politics.
Speaker 2: Sure, I mean it's very unlikely New Mexico would have
Speaker 2: become a state, or at least become a state when
Speaker 2: it did, without tuberculos, because New Mexico had all the
Speaker 2: institutions needed for statehood, and it wanted statehood, but Congress
Speaker 2: repeatedly rejected it because it had such a large Spanish
Speaker 2: speaking population, for just reasons of outright racism, and also
Speaker 2: because it had a large population of indigenous people. And
Speaker 2: so New Mexico realized that in order to become a state,
Speaker 2: it needed to attract more white residents. And the way
Speaker 2: that it did that was making itself sort of a
Speaker 2: advertising itself as a great place for people with consumption
Speaker 2: to come and recover. Had the dry air, it had
Speaker 2: the sunshine, and at the time we believed that sunshine
Speaker 2: and dry air would sort of heal the wet lungs
Speaker 2: of consumption. And so by I think by nineteen hundred,
Speaker 2: about ten percent of all people living in New Mexico
Speaker 2: were tuberculosis patients, and there were enough of them that
Speaker 2: Congress eventually acknowledged that New Mexico should become a state
Speaker 2: in accordance with its desires, and that's how, or one
Speaker 2: of the reasons why New Mexico became a state in
Speaker 2: the first place. Then you have something like World War One.
Speaker 2: You know, I think you're so right that every war
Speaker 2: is shaped by disease. The Franco Prussian War was shaped
Speaker 2: in part by the fact that one side had access
Speaker 2: to antiseptics and the other side didn't, and so, you know,
Speaker 2: injuries that were utterly unsurvivable five years earlier were suddenly survivable.
Speaker 2: But with TB in particular, I'm fascinated by the role
Speaker 2: that TV played in World War One because all three
Speaker 2: of the assassins who sort of semi succeeded in killing
Speaker 2: the Archduke Frans Ferdinand, knew that they were dying of consumption.
Speaker 2: They were all quite sick, and they knew that they
Speaker 2: were dying, and they wanted to die for a great cause,
Speaker 2: as young people often do. And they thought this great
Speaker 2: cause was the nationalism of their community being able to
Speaker 2: be a nation independent of the Austro Hungarian Empire. And
Speaker 2: that's why they assassinated the Archduke Franz Ferdinand. All three
Speaker 2: of those boys, they were nineteen, and I think all
Speaker 2: three of them were nineteen died within a couple of
Speaker 2: years of tuberculosis after assassinating the Archduke.
Speaker 1: That is wild to think about that this disease could
Speaker 1: have such far reaching consequences, and I'd love to hear
Speaker 1: more about one of these consequences slightly less extreme than
Speaker 1: a World war maybe, And that is why we may
Speaker 1: have tuberculosis to think or blame, depending on who you
Speaker 1: ask for the cowboy hat.
Speaker 2: Oh yeah, no, that's an interesting one. So this young
Speaker 2: hat maker was living in New Jersey, his name was John,
Speaker 2: and he got TB and was told that his only
Speaker 2: chance of survival was to head west, which young people
Speaker 2: were often told, especially young men who got consumption, and
Speaker 2: so he headed west. He only made it as far
Speaker 2: as Saint Joseph's, Missouri, which might be the most humid,
Speaker 2: least dry airplace I've ever been and personally, but nonetheless
Speaker 2: that's where he ended up. And while he was there
Speaker 2: he recovered. So about twenty five percent of people, for
Speaker 2: reasons we still don't really understand, recover spontaneously from tuberculosis.
Speaker 2: One of the things that made it such a difficult
Speaker 2: disease to deal with societally was its unpredictable and is
Speaker 2: its unpredictable course? And so John recovered and as he
Speaker 2: recovered this hat, this young hat maker noticed that the
Speaker 2: hats in the West weren't very good. There were the
Speaker 2: kind of coonskin caps that were bug infested and gross,
Speaker 2: and then there were straw hats that folk from Mexico
Speaker 2: and Texas had brought up to Missouri, but those didn't
Speaker 2: hold up particularly well in the rain. And so eventually
Speaker 2: John B. Stetson invented what we now know is the
Speaker 2: stetson or the cowboy hat.
Speaker 1: It's amazing that that final reveal of like and then
Speaker 1: Stetson was his last name. Yeah, it's really good. Also,
Speaker 1: it's just it's so funny that like, it was just
Speaker 1: all of these different factors combining. I mean, it's what
Speaker 1: I love about history and how we can make these
Speaker 1: different connections. But yeah, so humans have long given different
Speaker 1: meanings to disease in part to you know, make sense
Speaker 1: of the world, to answer why me or why them?
Speaker 1: And that meaning seems like it varies a lot depending
Speaker 1: on how the disease is transmitted, who's affected, or what
Speaker 1: the disease looks like like on the outside, something like
Speaker 1: plague compared to tuberculosis, for instance, And for a long
Speaker 1: period of time, tuberculosis, as you discussed, was romanticized. Why
Speaker 1: was such a devastating disease seen this way?
Speaker 2: Well, I think you make a really good point that
Speaker 2: part of it is the outward appearance of the disease,
Speaker 2: right like Mycobacterium, tuberculosis is very closely related to the
Speaker 2: bacteria that causes leprosy, and leprosy, of course, is perceived
Speaker 2: very differently because it's seen as a disfiguring disease rather
Speaker 2: than as an ennobling one, although at times leprosy has
Speaker 2: also been seen as ennobling because of its connection to Jesus,
Speaker 2: at least in the Christian world. But with TV, everybody
Speaker 2: started to get it. In the late eighteenth century in England,
Speaker 2: about a third of all people who died died of tuberculosis.
Speaker 2: About a third of all death was caused by TV.
Speaker 1: It's a staggering statistic.
Speaker 2: Staggering, I mean, it was completely overwhelming. One writer referred
Speaker 2: to it as the frightful tuberculization of humanity and it
Speaker 2: was terrifying. Yeah, And so how do you make sense
Speaker 2: of a disease that, as Charles Dickens put it, wealth
Speaker 2: never warded off. A disease that you can't easily stigmatize,
Speaker 2: a disease that doesn't just affect poor people or marginalized people.
Speaker 2: I mean, the richest guy of the nineteenth century died
Speaker 2: of tuberculosis. How do you make sense of that disease?
Speaker 2: And I think one of the ways we made sense
Speaker 2: of it was through stigma, and another way we made
Speaker 2: sense of it was through romanticization. And it's easy to
Speaker 2: think of those things as opposites. One dehumanizes someone, one
Speaker 2: argues that someone is sort of like more more than human,
Speaker 2: more beautiful than is possible if you're a regular human.
Speaker 2: But they're really alternate ways of othering the sick, you know,
Speaker 2: just kind of creating a world where the sick exists
Speaker 2: that isn't the so called normal world or the healthy
Speaker 2: world or whatever. And the romanticization of tuberculosis was so
Speaker 2: intense in Northern Europe and the United States that it's
Speaker 2: really hard to overstate. It was really really weird. Looking
Speaker 2: back on it, it feels weird to us. Men were said
Speaker 2: to become geniuses because they had tuberculosis. I think I
Speaker 2: write in the book about when Shelley found out that
Speaker 2: Keats had tuberculosis. He was like, well, you know, this
Speaker 2: is a disease that affects people who write good verses
Speaker 2: as you have done, which I think is especially funny
Speaker 2: or sad or whatever it is, because Shelley also had tuberculosis,
Speaker 2: and so he was kind of like patting himself on
Speaker 2: the back, even if he was complimenting Shohn Keiths. But
Speaker 2: also like for women, it was seen as this disease
Speaker 2: that made you really beautiful, you know, it made you
Speaker 2: very pale, and whiteness of the skin was really kind
Speaker 2: of worshiped at the time. It gave you rosy cheeks,
Speaker 2: and so people would use rouge to try to affect
Speaker 2: the same outcome as tuberculosis. It gave you big sunken eyes,
Speaker 2: and so people would apply belladonna to their eyelids to
Speaker 2: make their pupils look appropriately tubercular. And I think all
Speaker 2: of this was an attempt to make sense of the crisis,
Speaker 2: an attempt to just deal in some way with the
Speaker 2: fact that an overwhelming number of people were dying young.
Speaker 1: The words like tubercular and tuberculized, tubercular, what is it tuberculization.
Speaker 1: It's what other infectious diseases have so many derivative words
Speaker 1: developed from them. It's remarkable. And you know, I think
Speaker 1: this again, these statistics that you bring up one third
Speaker 1: of everyone you know dying of tuberculos or who died
Speaker 1: died of tuberculosis. This is so it's so fascinating because
Speaker 1: in contrast with other infectious diseases during that time, you know,
Speaker 1: in the pre antibiotic, pre an acceptive, pre vaccine era,
Speaker 1: they the spread was so different too, you know, plague
Speaker 1: tour through a community caller, a tour through a community, typhus,
Speaker 1: all these things, and to some degree or another, maybe
Speaker 1: they weren't quite as what does Dick and say, they
Speaker 1: weren't quite as wealth never warded off. But at the
Speaker 1: same time, like, how do you think that that played
Speaker 1: a role the way that tuberculosis spread so insidiously in
Speaker 1: a way.
Speaker 2: Yeah, and this is a really I think that's a
Speaker 2: really important point. Tuberculosis was almost universally in Northern Europe
Speaker 2: believed to be inherited, and so it was seen as
Speaker 2: a hereditary disease that ran in families, and that as
Speaker 2: such also came with certain other personality traits the way
Speaker 2: that those are also passed down in families, and one
Speaker 2: of those personality traits, this was called spez tysika, I
Speaker 2: think the burular spirit. And one of these personality traits
Speaker 2: was that you were very sensitive, if you're a very
Speaker 2: deep thinker, you were attuned to the suffering in the world,
Speaker 2: and you were also quite quite beautiful and wispy. This
Speaker 2: idea that as the body shrank, the spirit grew was
Speaker 2: very powerful at the time. But because it was seen
Speaker 2: as hereditary, as opposed to a disease like cholera or
Speaker 2: typhus or plague that would just tear through a community,
Speaker 2: and even if it wasn't quite understood to be infectious,
Speaker 2: it was certainly understood to be something weird and not inherited.
Speaker 2: That changed the way that consumption was imagined in the
Speaker 2: eighteenth and nineteenth centuries, which is why it was such
Speaker 2: a big deal when Robert Coch discovered that tuberculosis was
Speaker 2: in fact caused by a bacteria like cholera, like anthrax,
Speaker 2: like the other diseases that were coming to be understood
Speaker 2: as infectious.
Speaker 1: I want to kind of get into that switch of
Speaker 1: what that medicalization of tuberculosis meant. But before I want
Speaker 1: to ask how we can see the effects of tuberculosis
Speaker 1: in the art and literature of the day. I know
Speaker 1: we've mentioned Dickens a couple of times, but it's everywhere
Speaker 1: else and Shelley and yeah.
Speaker 2: It's everywherewhere. It's everywhere, and not just in Western art.
Speaker 2: It's also I write a lot about the Japanese and
Speaker 2: Indian artists and poets who lived with tuberculosis. But in
Speaker 2: Northern Europe in the nineteenth century, because there was this
Speaker 2: romanticization of tuberculosis, there was also a romanticization that affected
Speaker 2: art and poetry. You see paintings by Toulouse Latrek, for instance,
Speaker 2: of a woman applying rice powder to her face and
Speaker 2: she's very pale. The great actor Eliza Poe, who was
Speaker 2: Edgar Allan Poe's mother, looked stereotypically tubercular and was sort
Speaker 2: of worshiped for her beauty. And you see it a
Speaker 2: lot in poetry. I mean, Keats writes about youth growing specter,
Speaker 2: thin and dying, which is of course precisely what happened
Speaker 2: to him when he was just twenty five years old.
Speaker 2: And so I think from poetry to visual art to theater.
Speaker 2: Tuberculosis played a huge role in shaping the both what
Speaker 2: we sort of thought of as beautiful but also what
Speaker 2: we thought of as very fragile. You know, at the time,
Speaker 2: we really associated beauty with a kind of fragility, of fleetingness,
Speaker 2: you know, that the idea that maybe you won't be
Speaker 2: in the world for very long, but you'll be very
Speaker 2: beautiful while you're here. Victor Hugo, I remember his friends
Speaker 2: would joke with him that he would become a great
Speaker 2: novelist if only he got tuberculosis. That's how much it
Speaker 2: was believed that this disease made you a great artist.
Speaker 1: The name consumption comes from the fact that, like it
Speaker 1: is a consuming disease, so how it's just it's fascinating
Speaker 1: to think about how that connection was made. How can
Speaker 1: you produce novels or plays or pieces of art while
Speaker 1: you are being consumed from the inside.
Speaker 2: I think that's exactly right. I mean, look, this romanticization
Speaker 2: of consumption, like the romanticization of mental illness today, or
Speaker 2: the romanticization of whatever diseases we romanticize or stigmatize, like
Speaker 2: it's all hooey. That's really important to note that, like
Speaker 2: dying of tuberculosis is horrible and really painful, and it's
Speaker 2: not nearly as romantic as it was made out to be.
Speaker 1: Yeah, this ever present threat of death from tuberculosis and
Speaker 1: everything else that was happening during in many industrialized regions
Speaker 1: of the world during the seventeen hundreds eighteen hundreds. I
Speaker 1: was thinking about this in the context of how people
Speaker 1: related to their own mortality at any stage, or the
Speaker 1: mortality of their friends and family. What did that And
Speaker 1: I know that tuberculosis is one part of this, but
Speaker 1: what did that look like and how did that sort
Speaker 1: of lead to people creating these concepts or perceptions of
Speaker 1: what an ideal death should be.
Speaker 2: Yeah, I think tb was and remains really hard because
Speaker 2: it it was called the robber of youth. It killed
Speaker 2: people in the one time of life when you were
Speaker 2: supposed to be relatively insulated from death and dying. Right
Speaker 2: like half of all people at the time were dying
Speaker 2: before the age of five, and then of course lots
Speaker 2: of people were dying over the age of fifty five.
Speaker 2: But between the ages of say ten and forty five,
Speaker 2: you were supposed to be relatively healthy. You were supposed
Speaker 2: to be in the prime of life, and consumption often
Speaker 2: killed people in that prime of life, which made it
Speaker 2: really hard to make sense of and I think especially
Speaker 2: devastating for families. And so I'm convinced that when we
Speaker 2: do not have an answer, we find one, we make
Speaker 2: one up. And I remember my dad had cancer twice
Speaker 2: when I was a little kid in the nineteen eighties,
Speaker 2: and people would tell my dad that it was commonly
Speaker 2: believed at the time that cancer came from bottling up
Speaker 2: your feelings. I mean, people told my dad that, you
Speaker 2: know that he got cancer because he hadn't been expressive
Speaker 2: enough about his own emotions. And that's us trying to
Speaker 2: find an explanation for the unexplainable. And I think that
Speaker 2: happened a lot with consumption in the eighteenth and nineteenth century.
Speaker 1: Let's take a quick break here. We'll be back before
Speaker 1: you know it. Welcome back, everyone. I'm here chatting with
Speaker 1: the incredible John Green about his book Everything Is Tuberculosis.
Speaker 1: Let's get into some more questions. People have never dealt
Speaker 1: with uncertainty or been able to sit with uncertainty. Even
Speaker 1: if we know the mechanism of disease and how the
Speaker 1: path of physiology, it's still there's still plenty of room
Speaker 1: for blame and stigma and shame. And so you touched
Speaker 1: on this a bit with a conflation of tuberculosis and whiteness.
Speaker 1: How was the prevailing assumption of tuberculosis as like a
Speaker 1: white man's disease shaped by colonialism and white supremacy.
Speaker 2: Profoundly, profoundly, it was really believed by white doctors that
Speaker 2: consumption was impossible among people of color. And this was
Speaker 2: partly because consumption was so romanticized that it was believed
Speaker 2: to be a disease of the great intellects, and a
Speaker 2: disease of the very beautiful, and a disease of paleness,
Speaker 2: and all of this stuff, and all these ideas that
Speaker 2: we had in Europe and the United States around whiteness
Speaker 2: penetrated our understanding of disease as well. And so, you know,
Speaker 2: Frank Ryan writes very movingly about how tuberculosis in black
Speaker 2: and brown people was considered to be a different disease,
Speaker 2: a disease that was not even given a name, which speaks,
Speaker 2: i think, both to healthcare access and to the total
Speaker 2: racism of the medical establishment at the time. And so
Speaker 2: until TB became understood as an infectious disease. It was
Speaker 2: generally believed to be rare or impossible among people of color.
Speaker 1: And then how did the discovery of microbacteria tuberculosis sort
Speaker 1: of changed that both that aspect but also overall what
Speaker 1: tuberculos is, you know, the romanticization and sort of now
Speaker 1: this new othering of this disease.
Speaker 2: Yeah, it changed everything. Once we understood that TV was infectious,
Speaker 2: Suddenly it became a disease that was no longer romanticized
Speaker 2: and was heavily stigmatized, associated with poverty, associated with poor
Speaker 2: working conditions, crowded living conditions, and especially associated with people
Speaker 2: of color. So whereas before white supremacy had held that
Speaker 2: only white people could get this disease of civilization, now
Speaker 2: white supremacy held that disproportionately this disease would affect quote
Speaker 2: unquote less civilized people, and that had devastating consequences for
Speaker 2: the way that the medical establishment treated people with TV,
Speaker 2: for the way the medical establishment understood TV and people
Speaker 2: of color. And even today there's still a huge disproportionate
Speaker 2: bias toward people of color when it comes to the
Speaker 2: burden of tuberculosis, even in rich countries, but all throughout
Speaker 2: the world.
Speaker 1: Yeah, I was thinking about this transitional period and tuberculosis
Speaker 1: had such an impact, as we've talked about on art
Speaker 1: and literature and all these different aspects of life. When
Speaker 1: that medicalization happened, how did that, like, how quickly did
Speaker 1: that disappear from that culture of tuberculosis.
Speaker 2: It disappeared pretty quickly, But it disappeared as quickly as
Speaker 2: people started to really agree that the disease was infectious,
Speaker 2: that it wasn't hereditary. So it took a couple decades.
Speaker 2: A number of people kind of held onto the idea
Speaker 2: that the disease was hereditary and therefore that this idea
Speaker 2: of the tubercular personality still should hold sway. But as
Speaker 2: it became clearer and clearer and the evidence mounted that
Speaker 2: this is actually an infectious disease, that started to melt away.
Speaker 2: And you can almost see it in the language, like
Speaker 2: before eighteen eighty two, consumption is almost always referred to
Speaker 2: as consumption, and after eighteen eighty two, it's almost always
Speaker 2: referred to as tuberculosis. So you see the medicalization of
Speaker 2: it even in the language that we use to describe
Speaker 2: the illness, almost as if they're two different illnesses. Because
Speaker 2: they're imagined so differently.
Speaker 1: Yeah, it is. It is sort of like, yeah, this
Speaker 1: romantic disease to this horror that is tuberculosis.
Speaker 2: And there is something inherently horrific about infectious disease, right, Like,
Speaker 2: there's something terrifying about the idea that we can survive
Speaker 2: lions and bears and tigers and make all of them
Speaker 2: irrelevant to our safety, but we can't survive these tiny
Speaker 2: micro organisms that spread through the air. I mean that
Speaker 2: is the stuff of a literal horror movie.
Speaker 1: Yep, yeah, absolutely no, it's that period of seeing finally
Speaker 1: these things and making a connection is fascinating to think
Speaker 1: about how we perceived a cause of disease. But so
Speaker 1: this medicalization, this discovery of the fact that tuberculosis was
Speaker 1: caused by bacterium, this led to a lot of stigma,
Speaker 1: and that stigma is in large part still present today
Speaker 1: very much. And so can you talk a little bit
Speaker 1: about that. You know, what happens when someone is diagnosed.
Speaker 1: How might friends or family or the community broadly respond
Speaker 1: to someone's diagnosis with tuberculosis.
Speaker 2: Yeah, so in a different age, in a different time,
Speaker 2: someone like Henry would have been really lifted up for
Speaker 2: having TB right, I mean, he writes poetry. He's a
Speaker 2: very engaged, sensitive kid, and he embodied that idea of
Speaker 2: the tubercular personality. And if we'd had an inherited genetic
Speaker 2: model for TB, he would have very much fit into
Speaker 2: that romanticization of the disease. But because he got to
Speaker 2: be in a different time in place, he was instead
Speaker 2: hugely stigmatized. It's very common for people who have TB
Speaker 2: to be dropped off at the hospital and completely abandoned
Speaker 2: by their families, in some cases to never see their
Speaker 2: families again. One of the most heartbreaking things I've heard
Speaker 2: from nurses working in TB hospitals is how they often
Speaker 2: have to be the only person at the funeral for
Speaker 2: someone who dies of TB, where that person is buried
Speaker 2: alone and the nurse or the nurses are the only
Speaker 2: people who are there. And you know that's because TB
Speaker 2: is seen as a disease of poverty. It's sometimes seen
Speaker 2: as a disease of demon possession, even a disease that's
Speaker 2: associated with all kinds of wrongly I think it's safe
Speaker 2: to say associated with all kinds of moral failings, and
Speaker 2: so it's really a hugely stigmatizing experience Henry talks about
Speaker 2: in a memoir that he wrote. He talks about the
Speaker 2: experience of being abandoned by his cousins, being abandoned by
Speaker 2: his friends. He was very fortunate not to be abandoned
Speaker 2: by his mother. So his mother I saw to stayed
Speaker 2: incredibly close to him, visited him almost every day for
Speaker 2: three years while he was hospitalized, and that made a
Speaker 2: huge difference in his life. But for many people that's
Speaker 2: not the norm, I think it's.
Speaker 1: Safe to say, which is just utterly heartbreaking. I mean,
Speaker 1: especially given that the stigmatizing, isolating disease is one that
Speaker 1: we've had effective treatments for since the nineteen fifties. How
Speaker 1: did the development of those treatments change the perception of tuberculosis.
Speaker 2: Yeah, so it went from being a death sentence to
Speaker 2: suddenly being a curable disease. I read a number of
Speaker 2: memoirs from people who lived in sanatoria. At the height
Speaker 2: of the TB crisis in the United States in the
Speaker 2: early nineteen hundreds, there were almost as many hospital beds
Speaker 2: for TV patients as there were for all other causes combined,
Speaker 2: and there were hundreds of these sanatoria around the country.
Speaker 2: There were cities like Asheville, North Carolina, Pasadena, California, that
Speaker 2: were essentially founded as tuberculosis colonies, and all of a sudden,
Speaker 2: these places just emptied out. I mean, you read about
Speaker 2: these people who lived in sanatoria. I read one memoir
Speaker 2: by a woman who lived in a sanatorium from the
Speaker 2: age of three until she was seventeen and suddenly strepped
Speaker 2: to micin made it so that she could go home,
Speaker 2: and she didn't even remember what it was like to
Speaker 2: be lovingly touched. She didn't remember what it was like
Speaker 2: to be with friends and family, be in that kind
Speaker 2: of like loud, boisterous environment of a home. But for
Speaker 2: many millions of people that was the case. I mean,
Speaker 2: the antibiotic era really dramatically reduced the burden of TV,
Speaker 2: but it also made it so that we imagined TV differently.
Speaker 2: Instead of being an incurable, chronic, terrifying condition, it became
Speaker 2: something that we know how to cure. The problem is
Speaker 2: that in many communities it remained an incurable chronic condition.
Speaker 1: And simply due to lack of access. And I think
Speaker 1: that we have a tendency, or at least here in
Speaker 1: the US, we have a tendency to think of like, oh,
Speaker 1: we solved that, we figured that out. Going back to
Speaker 1: that Charles Dickens quote of tuberculosis as the great leveler.
Speaker 1: But we see these patterns of disease and tuberculosis on
Speaker 1: a global scale that really show that it's not the
Speaker 1: disease that wealth never warded off anymore. What are these
Speaker 1: patterns that we see and how do they kind of
Speaker 1: reveal global priorities in public health?
Speaker 2: I mean, the pattern that we see is the pattern
Speaker 2: that you identified at the beginning of this conversation, which
Speaker 2: is that since TB became curable, we let one hundred
Speaker 2: and fifty million people die of it. Yeah, I mean
Speaker 2: probably more than that. That's a conservative estimate, and we
Speaker 2: have done that because of systems of resource distribution and
Speaker 2: where we allocate our resources. I have to tell you
Speaker 2: as we're recording this, I just received a message from
Speaker 2: my friend Attol Gawande, who was the head of Global
Speaker 2: health at USAID and saying that there are boxes of
Speaker 2: TV medication right now rotting in warehouses waiting to be distributed,
Speaker 2: and there's no way to distribute them. And that's the
Speaker 2: kind of thing that we have seen really for decades
Speaker 2: on various levels. You know, we've seen sometimes there are
Speaker 2: systematic attempts to get tuberculosis treatment to lots of people.
Speaker 2: A lot of times those attempts are very haphazard and consistent.
Speaker 2: They are you know, funded by small nonprofits or by individuals,
Speaker 2: and you know, not in a way that's long term
Speaker 2: sustainable or can deal with the size of the crisis
Speaker 2: that we face. And tb anywhere is a threat to
Speaker 2: people everywhere. I mean, I think it's really important to
Speaker 2: acknowledge that, Like, yes, we have dealt with TV in
Speaker 2: the United States, but we have had a TV outbreak
Speaker 2: in Kansas earlier this year. We have over ten thousand
Speaker 2: cases of active tuberculosis every year in the United States
Speaker 2: and probably over one hundred thousand cases of latent TV
Speaker 2: that we don't always identify, and so it's a truly
Speaker 2: global problem. Now it's very rare to die of tuberculosis
Speaker 2: in the United States because people can generally access healthcare,
Speaker 2: but it does happen. And as if we continue to
Speaker 2: let this disease spread among millions of people every year
Speaker 2: and we're inconsistent with treatment regimens, we are allowing the
Speaker 2: disease to have millions and millions of opportunities to evolve
Speaker 2: further resistance to the tools that we have to fight it.
Speaker 2: And because we haven't done a good job of inventing
Speaker 2: new tools over the last sixty years, that's a real issue.
Speaker 1: Yeah, I mean truly, and I appreciate that the global
Speaker 1: perspective of sort of how all of these things are
Speaker 1: playing together, and I want to kind of narrow in
Speaker 1: on Sierra Leone specifically to connect the dots between all
Speaker 1: of these different factors that contribute to people, you know,
Speaker 1: developing tuberculosis and then not receiving the care that they
Speaker 1: should be receiving. And there's you know, there's healthcare infrastructure,
Speaker 1: there's funding inconsistency, there's an overall lack of access. Can
Speaker 1: you sort of help me connect to the dots for
Speaker 1: how all of these things lead to tuberculosis as the
Speaker 1: end result.
Speaker 2: Yeah, I think that's exactly right. You have to understand
Speaker 2: this in historical context. We have to understand that tuberculosis
Speaker 2: did not just arrive in Sierra Leone. It did not
Speaker 2: just like show up in Henry one day. This happened
Speaker 2: because of a series of historical events and historical forces
Speaker 2: that go back for centuries. That go back to the
Speaker 2: Transatlantic slave trade, in colonialism and the extraction of resources
Speaker 2: from Sierra Leone's economy, and so many other factors. But
Speaker 2: you know, Henry in the end got sick because TB
Speaker 2: has been allowed to thrive in Sierra Leone for the
Speaker 2: last several hundred years and has been allowed to thrive
Speaker 2: since we developed tools to fight it. Henry developed drug
Speaker 2: resistant tuberculosis, and so for someone like him, treatment is
Speaker 2: very difficult. Not because it's impossible or because it's the
Speaker 2: treatment is made of gold, or we have to go
Speaker 2: to the moon to get it or something, but because
Speaker 2: the global health system thinks of tuberculosis as being very
Speaker 2: expensive to treat, and especially of drug resistant tuberculosis as
Speaker 2: being very expensive to treat. Now that's starting to change.
Speaker 2: But when Henry got sick in twenty eighteen, when he
Speaker 2: first was really diagnosed with drug resistant tuberculosis and became
Speaker 2: very very ill, there were very few options available to
Speaker 2: people like him in a country like Sierra Leone. If
Speaker 2: I'd gotten the exact same strain of drug resistant tuberculosis
Speaker 2: at the exact same time, I would have received an
Speaker 2: immediate molecular test to identify not just whether I had TV,
Speaker 2: but which antibiotics my TV would respond to. I would
Speaker 2: have been put on appropriate treatment immediately. I would have
Speaker 2: been isolated, and within a few months I would have
Speaker 2: been able to go home, and within a year I
Speaker 2: would have been healthy and cured. But that wasn't the
Speaker 2: case for Henry. Henry had to go to Leaca, to
Speaker 2: this tuberculosis hospital and he had to be put on
Speaker 2: second line antibiotics, which it turned out didn't work. And
Speaker 2: we would have known that they wouldn't work if he
Speaker 2: could have afforded that molecular test, but they weren't available
Speaker 2: in sierily.
Speaker 1: On at the time. Yeah. And so you mentioned that
Speaker 1: Henry had a drug resistant form of tuberculosis, and one
Speaker 1: of the primary reasons cited for the rise and spread
Speaker 1: of drug resistant tuberculosis is patient on compliance. But there
Speaker 1: is so much more nuance to that term patient non
Speaker 1: compliance that I really appreciate that you went into in
Speaker 1: your book and this how this term unfairly places blame
Speaker 1: and burden entirely on the patient without examining the reasons
Speaker 1: for non compliance. So can you sort of, you know,
Speaker 1: talk a little bit more about that and this nuance
Speaker 1: with non compliance sure.
Speaker 2: Well, first off, if you receive a seven day treatment
Speaker 2: of antibiotics to cure strep throat and you take it
Speaker 2: for six days, you're technically a non compliant patient. So
Speaker 2: just bare that in mind. I mean, how many of
Speaker 2: us have you know, not taken that last day of
Speaker 2: antibiotics because we felt better. Well, imagine having to take
Speaker 2: dozens of pills every day for four months, or six
Speaker 2: months or a year that make you very sick, that
Speaker 2: have side effects that you don't like. That's one thing
Speaker 2: to consider. But then also I remember once I was
Speaker 2: in Sierra Leone and I was making a home visit
Speaker 2: with a doctor and a community health worker, and the
Speaker 2: community health worker asked the young patient, have you been
Speaker 2: able to take your TV meds today? And she said, no,
Speaker 2: I don't have any food, and if I take them
Speaker 2: without food, I just throw up. I just throw them
Speaker 2: up immediately. And so the doctor said, well, you know,
Speaker 2: sometimes if you pour a little bit of sugar into
Speaker 2: your water, it can settle your stomach a little and
Speaker 2: allow you to take the medication. And that was the
Speaker 2: only thing that he was able to say to her
Speaker 2: because there were no resources to buy her food in
Speaker 2: that moment. And so is that a non compliant patient?
Speaker 2: I mean, if you throw up immediately after taking your
Speaker 2: medication because you don't have access to food, are you
Speaker 2: a non compliant patient? Are you a non compliant patient
Speaker 2: if you can't afford the transportation to get to the
Speaker 2: clinic every single day? Because still often patients have to
Speaker 2: be physically observed, it's called directly observed therapy. They have
Speaker 2: to be physically observed taking their medication every single day
Speaker 2: to make sure that they're quote unquote compliant. But that
Speaker 2: the burden of having to get to a healthcare facility
Speaker 2: every day, affording transportation, affording childcare, whatever the complexities are
Speaker 2: in your particular life, that burden is often overwhelming for people.
Speaker 2: So there are a number of reasons why people might
Speaker 2: be deemed non compliant or deemed loss to follow up,
Speaker 2: which is another phrase I find horrifying. And we have
Speaker 2: to make space for the healthcare system to meet the
Speaker 2: needs of patients rather than requiring patients to meet the
Speaker 2: needs of the healthcare system. We do a bad job
Speaker 2: of that everywhere. I mean, I don't think we do
Speaker 2: a particularly good job of it in the United States.
Speaker 2: I know that, like I struggle sometimes to get access
Speaker 2: to mental health care that I need, even though I
Speaker 2: have lots of resources available to me. But I think
Speaker 2: we need to do a much better job of it,
Speaker 2: especially in impoverished communities.
Speaker 1: The way that so many people with tuberculosis are treated
Speaker 1: just shows this lack of trust in them as individuals
Speaker 1: who also want to they don't want to be sick
Speaker 1: with this, Like it just sort of is that non
Speaker 1: compliance term really kind of has these connotations of like, well,
Speaker 1: they just don't care enough. It's like, of course they do.
Speaker 1: How could that be the conclusion, yeah right, yeah.
Speaker 2: Right, Or that they're somehow like not dedicated, they're not
Speaker 2: adequately you know, they're not out of quickly hard working
Speaker 2: or committed to their own health or whatever. But like,
Speaker 2: you know, first off, lots of people struggled to take
Speaker 2: their medication. I struggled to take my medication. I don't
Speaker 2: know exactly why. I think some of it has to
Speaker 2: do with stigma, with this idea that you know, somehow
Speaker 2: I'm less I take medication to treat OCD in major depression.
Speaker 2: And some of it has to do with this idea
Speaker 2: that somehow, like I'm less whole or self sufficient or
Speaker 2: complete or whatever. If I need medication in order to
Speaker 2: be myself or in order to be well, some of
Speaker 2: it has to do with the burden of getting the medication,
Speaker 2: you know, And my burden of getting the medication is
Speaker 2: just calling up the pharmacy and getting a refill. It
Speaker 2: couldn't be easier for me. And yet still like that
Speaker 2: barrier sometimes feels overwhelming to me. And then you have
Speaker 2: to remember that a lot of people living with tuberculosis
Speaker 2: are also living with other health problems, including severe mental
Speaker 2: health problems. I remember meeting with a young man who'd
Speaker 2: been completely abandoned by his family, who struggled to take
Speaker 2: his medicaation, who'd been abandoned by his friends, who was
Speaker 2: utterly alone in the world, who felt absolutely hopeless, who
Speaker 2: was you know, consumed by depression. And you know, we're
Speaker 2: asking this person to make his way to a clinic
Speaker 2: every day so that he can take his medication. Like
Speaker 2: that's that's asking a lot.
Speaker 1: Yeah, I think these are these are aspects that aren't
Speaker 1: don't always come out in medical literature unless it's about
Speaker 1: this specific you know, the context of non compliance and
Speaker 1: what that what that actually reveals, given that some of
Speaker 1: this awful side effects of these tuberculosis medications. Seems like
Speaker 1: one way to overcome this would be to develop new
Speaker 1: drugs for the disease. Yet, as you discuss, very few
Speaker 1: tuberculosis drugs have been developed in recent years, and these
Speaker 1: newer drugs even are prohibitively expensive despite mostly being funded with,
Speaker 1: you know, with public funds. So what are some of
Speaker 1: the ways that people are working on this problem.
Speaker 2: Yeah, So this is a place of encouragement for me,
Speaker 2: And I'm sorry if this has been a largely discouraging conversation,
Speaker 2: but this really is a place of encouragement for me.
Speaker 2: Between nineteen forty four and nineteen sixty five, we developed
Speaker 2: something like eight classes of drugs to treat tuberculosis, and
Speaker 2: then between nineteen sixty six and twenty twelve we developed none.
Speaker 2: And all those years we could have been developing great
Speaker 2: tools to treat TB, but we didn't because the profit
Speaker 2: motive wasn't there. Now, and some of this has become
Speaker 2: complicated of late, but now there are more mechanisms in
Speaker 2: place to try to incentivize the creation of anti TB
Speaker 2: drugs and drugs in general that I consider diseases of injustice,
Speaker 2: diseases that are caused not primarily by whatever the pathogen is,
Speaker 2: but really by human choice, by human built systems, like tuberculosis,
Speaker 2: like cholera I think is another great example. Typhoid's a
Speaker 2: good example. Malaria is one of the big examples. In
Speaker 2: the twenty first century. All those diseases, I think they
Speaker 2: still don't receive nearly the amount of attention that they should,
Speaker 2: nearly the funding that they should, but they receive more funding.
Speaker 2: And so in the last ten or twelve years, we've
Speaker 2: developed some powerful new medications to treat TB, including bedaculin
Speaker 2: and dilaminid, which are really good drugs. Now, as you
Speaker 2: point out, they have historically been too expensive, and so
Speaker 2: we're using a lot of times second line antibiotics that
Speaker 2: are from the sixties that we know aren't very good
Speaker 2: and that are highly toxic, that can cause total hearing
Speaker 2: loss and up to twenty percent of people who take
Speaker 2: them lots of other adverse effects. But we're starting to
Speaker 2: see the better regimens roll out and more encouraging. Still,
Speaker 2: the amount of time that people need to be treated
Speaker 2: for tuberculosis is going down, so we're starting to see
Speaker 2: the NTB trials, which were funded by partners in health
Speaker 2: and doctors without borders. Those saw that we can cure
Speaker 2: TB in less time than we thought we could, and
Speaker 2: that's encouraging. So I think we have better tools than ever.
Speaker 2: We have better diagnostic tools than ever. We're on the
Speaker 2: cusp of maybe having a tongue swab test for TV
Speaker 2: that would be game changing and very inexpensive. We have
Speaker 2: better drugs than ever, we have shorter regimens than ever,
Speaker 2: and on all those fronts we are starting to see
Speaker 2: real progress in the last ten years.
Speaker 1: Yeah, that is really encouraging, and I think that it's
Speaker 1: easy to get wrapped up in all of that. The
Speaker 1: challenge is ahead of us, but it is so important
Speaker 1: to remember that there are people who are doing really
Speaker 1: excellent work and really trying to change things when it
Speaker 1: comes to the way that we treat and deal with tuberculosis,
Speaker 1: and these sustained improvements that we would be able to
Speaker 1: make when it comes to tuberculosis, you know, requires investment
Speaker 1: in healthcare infrastructure, in treatment and early detection and active
Speaker 1: case finding. And if we did a better job with tuberculosis,
Speaker 1: that would be money saving in the long run, like
Speaker 1: tremendously so, and I hate could always bring it to money.
Speaker 1: But that is such a crucial part of every single
Speaker 1: like public health decision. Why does that calculation not seem
Speaker 1: to matter.
Speaker 2: Every dollar we invest in TV brings forty dollars in
Speaker 2: future health benefits, And every time we end a chain
Speaker 2: of transmission of TV, it means less TB in the world.
Speaker 2: You know, TB is a curable disease, which means that
Speaker 2: we could eliminate it. We could live in a world
Speaker 2: without TV. If you think about how much we used
Speaker 2: to spend on tuberculosis in the United States, when we
Speaker 2: had seven hundred thousand hospital beds devoted to the disease,
Speaker 2: and how much we spend on it now, you see
Speaker 2: that impact right Like you can just see it intuitively
Speaker 2: that we used to spend a ton of money on
Speaker 2: TV in the US and now we have to spend
Speaker 2: much less. Although we're having to start to spend more
Speaker 2: because we're seeing more TV in the US. I think
Speaker 2: the reason we don't make those investments is because we're
Speaker 2: quite shortsighted when it comes to public health, and so
Speaker 2: we think, I mean, Paul Farmer used to rail against this.
Speaker 2: He used to talk about the everybody talks about the
Speaker 2: cost of treating TB, and nobody talks about the cost
Speaker 2: of not treating TV, and the cost of not treating
Speaker 2: TV is so high, but we're accustomed to paying that cost.
Speaker 2: We've been paying that cost in an ongoing way for generations.
Speaker 2: It's time to start paying the cost to treat TB
Speaker 2: and find out the benefits of not having to pay
Speaker 2: the cost of not treating TB.
Speaker 1: Not to mention that so many of the structural improvements
Speaker 1: that would help to reduce the burden of tuberculosis would
Speaker 1: make a major impact in so many other aspects of
Speaker 1: infectious disease. It's that totally, especially when there's interactions between
Speaker 1: tuberculosis and your immune system, and if you're infected with
Speaker 1: this disease and tuberculosis, then that maybe that makes active
Speaker 1: tuberculosis more likely. It's it all is interconnected, and we
Speaker 1: are able to make large scale changes that would impact
Speaker 1: tuberculosis and many many other things.
Speaker 2: Yeah, and I think you're right that when we invest
Speaker 2: in a disease like tuberculosis, we also invest in a
Speaker 2: stronger healthcare system. When we're doing active case finding for TB,
Speaker 2: we're also checking people's blood pressure. We're also checking for diabetes,
Speaker 2: we're also checking, you know, for other noncommunicable diseases. And
Speaker 2: that's a really important thing to understand that stronger healthcare
Speaker 2: systems overall, they get stronger healthcare systems overall, and investment
Speaker 2: in healthcare that really strengthens the system is not just
Speaker 2: good for tuberculosis. It's also good for malaria. It's also
Speaker 2: good for HIV. It's also good for diabetes and any
Speaker 2: other disease that people get.
Speaker 1: Yeah, it's it's all, it's all. It's like they're all connected.
Speaker 2: You know, it's almost like they're all connected.
Speaker 1: How about that. Yeah, So I want to wrap up
Speaker 1: on a hopeful note and with two with two final
Speaker 1: questions for you. The first is Henry. What is what
Speaker 1: is Henry up to these days?
Speaker 2: So? Henry was sick for a really long time and
Speaker 2: it took a long time to cure Henry. But thanks
Speaker 2: to the Sierra Leonian Ministry of Health and the organization
Speaker 2: Partners in Health, the medicine that Henry needed was finally
Speaker 2: made available to him and he survived TB. He was cured.
Speaker 2: He is a healthy, happy young man now. He's twenty
Speaker 2: four years old and he's a student at the University
Speaker 2: of Sierra Leone. He's studying business and human resources. I'm
Speaker 2: immensely proud of him. We're very close and he's just
Speaker 2: doing awesome.
Speaker 1: It's amazing. And he has a TikTok channel. Is that right? Oh?
Speaker 2: Yeah, he definitely has a TikTok And he also has
Speaker 2: a YouTube channel and he wants you to subscribe, So
Speaker 2: google Henry Writer YouTube.
Speaker 1: Good.
Speaker 2: Good.
Speaker 1: So we have this roadmap for how to make things
Speaker 1: better with tuberculosis. We know what we can do, we
Speaker 1: have people working on it. What are you most hopeful
Speaker 1: for in the next in the near future, in the
Speaker 1: maybe distant future, what do you most hope to see happen.
Speaker 2: Well, we have a really good roadmap for how to
Speaker 2: eliminate TB globally as a public health threat. And it
Speaker 2: goes by an acronym. Like everything in the world of
Speaker 2: global health, like everything in the world of tuberculosis, the
Speaker 2: acronym is STP Search Treat Prevent So first, large scale
Speaker 2: active case finding like we did in the US in
Speaker 2: the nineteen forties and fifties, where we had mobile vans
Speaker 2: with chest X rays inside of them fan out across
Speaker 2: the country, offer people free chest X rays and then
Speaker 2: find cases that way, so you're not only finding cases
Speaker 2: when people are so sick that they come into the hospital.
Speaker 2: You're identifying the disease earlier, when it's easier to treat
Speaker 2: and there's less risk of long term disability. And then
Speaker 2: there's the second letter T for treat. Treat every single
Speaker 2: person with tuberculosis, offer them the kind of care that
Speaker 2: they need in order to get well. And then the
Speaker 2: last letter P stands for prevent preventative therapy. So we
Speaker 2: have a way of making sure that somebody who's exposed
Speaker 2: to TB never gets sick. It's one month of preventative antibiotics.
Speaker 2: And so if we offer preventative therapy to all the
Speaker 2: close contacts of the people we identify with TB, we
Speaker 2: can end that chain of transmission completely. This is a bold,
Speaker 2: ambitious plan. You know. Some of the estimates say that
Speaker 2: it would cost twenty five billion dollars a year, but
Speaker 2: as you pointed out, each of those dollars would result
Speaker 2: in forty dollars of future benefit to our species, and
Speaker 2: more importantly, it would result in six point six by
Speaker 2: some estimates, million fewer deaths over the next seven years.
Speaker 2: And there is hardly a better bet in global health
Speaker 2: than that.
Speaker 1: Yeah, I completely agree, John. It has been so fantastic
Speaker 1: to chat with you and an honor to meet you,
Speaker 1: truly thrilling. Thank you so much for a great conversation.
Speaker 2: Thank you so much. Erin. It's so cool to be
Speaker 2: able to meet you and to be on the pod.
Speaker 2: I really appreciate it.
Speaker 1: A huge thanks again to John Green for taking the
Speaker 1: time to chat with me. That was such a great conversation.
Speaker 1: For more tuberculosis talk, check out our website this podcast
Speaker 1: will kill You dot com. We're all post a link
Speaker 1: to where you can find Everything is Tuberculosis, as well
Speaker 1: as a link to John's site, and don't forget you
Speaker 1: can check out our website for all sorts of other
Speaker 1: cool things, including but not limited to, transcripts, quarantine and placy,
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Speaker 1: Goodreads list, a first hand account, form, and music by Bloodmobile.
Speaker 1: Speaking of which, thank you to Bloodmobile for preventing the
Speaker 1: music for this episode and all of our episodes. Thank
Speaker 1: you to Leana Squilacci and Tom Bryfogel for our excellent
Speaker 1: audio mixing. And thank you to you listeners. Listen, I
Speaker 1: hope you liked this episode and our loving being part
Speaker 1: of the TPWKY book Club. A special thank you, as
Speaker 1: always to our fantastic patrons. We appreciate your support so
Speaker 1: very much. Well, until next time, keep washing those hands.