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1:00

is 99% Invisible. I'm Roman

1:02

Mars. You may know John Green as

1:05

a YouTubeer, a podcaster, or

1:07

a mega-selling young adult novelist,

1:09

but John's writing goes way

1:11

beyond novels. His latest book

1:14

is a nonfiction deep dive

1:16

into one of the oldest

1:18

and deadliest threats to humankind.

1:20

You know, if you told me...

1:23

Six years ago, then my next

1:25

book would be about tuberculosis. I

1:27

would have been duly surprised. I

1:29

did not think of tuberculosis as

1:31

being really much of anything. I

1:33

thought it was a disease of

1:35

the past, like a disease that

1:37

killed the guy in red-dead redemption

1:39

too, not a present tense phenomenon.

1:41

Tuberculosis is in fact the single

1:43

most lethal infectious disease in the

1:46

history of the world. It's been

1:48

infecting and killing humans for millennia.

1:50

But what makes the story of TB

1:52

so maddening and what drew drawn to

1:54

the topic is that the disease is

1:56

still killing over a million people a

1:58

year despite the fact that we... already

2:00

have a cure. John's book is called

2:02

Everything is Tuberculosis, and in it he

2:04

describes how foreign policy and corporate greed

2:07

make TB so hard to eliminate. He

2:09

also explains the history of tuberculosis and

2:11

all the unexpected and fascinating ways TB

2:13

has shaped our world. I really love

2:16

this book. It is both heartbreaking and

2:18

triumphant. It is full of fun facts

2:20

and sober realities. And I really just

2:22

want to have John on the show

2:24

to talk about all the stuff he

2:27

learned while writing it. So let's

2:29

start at the very basics. I

2:31

realized when I was reading this, I

2:33

didn't have a full grasp of what

2:36

tuberculosis actually was. So could you tell

2:38

me about it as a sort of

2:40

biological entity? What it does to you?

2:42

How does it spread? Yeah, so it's

2:45

a bacterial illness, but it's a weird

2:47

bacteria. It's a bacteria with a

2:49

really thick cell wall that takes

2:51

a long time to make. And

2:53

so relative to other bacteria... it

2:55

grows very slowly. Like I think

2:57

in a lab environment it doubles

2:59

every day whereas something like E.

3:01

coli will double every 20 minutes.

3:03

Wow. So it's an unusual bacteria.

3:05

But it also, that thick cell wall

3:07

makes it hard for infection fighting

3:10

cells to penetrate. And so usually

3:12

what actually happens is that a

3:14

bunch of white blood cells will

3:16

surround some bacteria and kind of

3:18

wall it off in what's called

3:20

a tubercle, which is why we

3:22

have the word tuberculosis. I think

3:25

it's technically pronounced tubercle, but I

3:27

don't like pronouncing it that way.

3:29

It seems wrong. But this weirdness

3:31

is one of the reasons why

3:33

it's kind of... both persisted and

3:35

sort of inveigled its way into

3:37

culture over thousands and thousands of

3:40

years. And I'm really fascinated by

3:42

this. And I'm also fascinated by

3:44

the idea of like how it

3:46

was, you know, before people knew

3:48

of it as a bacteria, how

3:50

it was conceptualized. Can you talk

3:52

about some of the things that

3:54

you found about how, you know, ancient

3:56

civilizations treated this odd

3:59

bacterium? Sure, so we've had

4:01

tuberculosis or diseases very similar to

4:03

it for all, probably all of

4:05

human history and even further back

4:07

in the story of people, back

4:09

to homoorectus. And so we've had

4:11

a long time to imagine tuberculosis

4:13

and over the years we've imagined

4:15

it lots of different ways. Some

4:17

people saw it as a contagious

4:19

illness from the beginning and in

4:21

ancient China and ancient India. It

4:23

was often seen as contagious. Some

4:26

people saw it as an inherited

4:28

illness, especially in Northern Europe and

4:30

the United States. It was seen

4:32

as a genetic disease that was

4:34

associated with certain personality traits. If

4:36

we go all the way back,

4:38

we don't know that much about

4:40

how we saw tuberculosis, but we

4:42

know that it's probably responsible for

4:44

around one in seven of all

4:46

human deaths of the 120 billion

4:48

people who've ever lived about one

4:50

in seven have died of TB. And

4:52

this is like, by far the... the

4:54

championship killer of humans, correct? Yeah,

4:57

yeah, it's winning the all-time race in

4:59

terms of infectious diseases, but it's

5:01

also winning the current race, which

5:03

is especially discouraging because this year

5:06

TB will be our deadliest infectious

5:08

disease just as it has been

5:10

for most of human history. Yeah.

5:12

So tell me about that period

5:14

of time where tuberculosis was actually

5:16

called consumption when it was perceived

5:19

as a... genetic melody, a poetic

5:21

and romantic melody. Could you

5:23

tell me about that? Because

5:25

the real symptoms of tuberculosis,

5:27

coughing up blood, extreme weight

5:29

loss, those don't sound beautiful

5:31

or poetic. Yeah, so tuberculosis

5:34

has always been a highly

5:36

stigmatized disease, like any disease

5:38

that's seen as very serious

5:40

and threatening, but At the height

5:42

of what one person called the

5:44

frightful tuberculosis of humanity, at the

5:46

height of the Industrial Revolution, tuberculosis

5:48

was killing about a third of

5:50

all people. It was killing rich

5:52

people, poor people. Charles Dickens called

5:54

it the disease that wealth never

5:56

ward it off. It was a

5:59

disease that could... strike anyone anywhere.

6:01

And so we couldn't stigmatize it

6:03

away. We couldn't say, well, this

6:05

is just a disease of the

6:07

poor or just a disease of

6:09

drunk people or just a disease

6:12

of this marginalized group or that

6:14

vulnerable group because it was a

6:16

disease of everyone. And so for

6:18

a period of about 150 years,

6:20

especially in Northern Europe, it was

6:23

also a hugely romanticized disease. Consumption

6:25

was widely seen as an inherited

6:27

disease, and it was a disease

6:29

that made you literally more beautiful,

6:31

made your skin pale and your

6:34

cheeks rosy and your eyes wide.

6:36

Like even as her sister was

6:38

dying of tuberculosis, Charlotte Bronte wrote,

6:40

consumption, I am aware, is a

6:42

flattering malady. And it was also

6:45

seen as a disease that made

6:47

you into a genius that, like

6:49

I remember, Percy Shelley wrote John

6:51

Keats when Keats was dying and

6:54

said, well, you know, this consumption

6:56

is a disease that tends to

6:58

strike people who write good versus

7:00

as you have done. You know,

7:02

which was, which I find especially

7:05

interesting because Shelley knew that he

7:07

also had consumption. So in some

7:09

ways, Shelley was like, you know

7:11

who else is good. Okay, so

7:13

in the US and Europe consumption

7:15

made you this beautiful genius. But

7:18

then there was a shift from

7:20

that thinking to seeing it as

7:22

more of an infectious disease experienced

7:24

by people who are not privileged.

7:26

And that shift happens starting in

7:28

the late 1800s when scientists

7:31

discover that tuberculosis is

7:33

actually a bacteria. Yeah, almost

7:35

like a light switch. Very few

7:37

things in history are like a

7:40

light switch, and I'm exaggerating when

7:42

I say it's like a light

7:44

switch. It was really like

7:46

a decade, but that's that's

7:48

relatively short. You know, I

7:51

often have people say to

7:53

me, I wasn't aware that

7:55

consumption and tuberculosis were the

7:57

same disease that made you

8:00

beautiful, it made you sensitive, it

8:02

made you write beautiful poetry, is

8:04

completely different from the way we

8:06

imagine tuberculosis today. And those are

8:08

all cultural constructs, but of course

8:10

that profoundly shapes not just how

8:13

people live with the disease, but

8:15

also who lives with it and

8:17

who dies of it. And so

8:19

once we understood that TB was

8:21

infectious, we started to immediately or

8:23

almost immediately see it as a

8:25

disease of poverty of crowded working

8:28

and living conditions of the cities

8:30

that were called these, you

8:32

know, these these tubercular factories

8:34

of urbanity or whatever. Right.

8:36

And so once people in the US

8:38

and Europe figure out that TB

8:40

is contagious, that leads to this

8:42

sudden fixation on cleanliness. Can you

8:44

tell us more about that? Oh

8:46

yeah, an obsession with hygiene. I

8:48

mean, I think I republish in

8:50

the book, a poster that said,

8:52

you know, do not kiss babies.

8:54

Your kiss of affection brings the

8:56

risk of infection. And there was

8:58

a big thing, don't kiss babies,

9:01

which is, you know, if you've

9:03

ever had a baby, you just,

9:05

you want to just gobble them

9:07

up. But also, clean shaves became

9:09

very popular because there was this

9:11

so-called revolt against the whisker as

9:13

people believed that there must be

9:15

untold number of bacteria crawling in

9:17

those whiskers. Little did we know,

9:20

of course, that half of all

9:22

human cells are in fact microbial

9:24

that don't even belong to us.

9:26

Okay, so this is kind of the

9:28

part of the story, you know,

9:30

when people have some purchase as

9:32

to what causes TB and how

9:34

it spreads, that I feel like

9:36

the everything is tuberculosis part of

9:38

your book, everything is tuberculosis, comes

9:40

about. We're talking in the very

9:42

late 1800s, early 1900s, and we

9:44

start to see the disease influencing

9:46

the built world and design. So

9:49

can you tell me some of

9:51

the various ways in which everything

9:53

is tuberculosis? Yeah, I mean, tuberculosis

9:55

shaped history just as history shapes

9:57

tuberculosis. And so everything

9:59

from... the Adirondack chair, which was

10:01

invented to give people living with TB

10:03

a chance to sit at a very

10:06

specific position so they could ostensibly get

10:08

more oxygen into their lungs. to the

10:10

great state of New Mexico. New Mexico

10:12

had all the institutions needed for statehood

10:14

and was seeking statehood and the US

10:17

Congress turned them down again and again

10:19

because so many people in New Mexico

10:21

did not speak English as their first

10:23

language or were indigenous people and the

10:25

US just didn't want to include a

10:28

state like that to be frank because

10:30

of racism. And so people in New Mexico

10:32

were like, man, we got to recruit some

10:34

white people if we're going to become a

10:37

state. And the way they did that was

10:39

by reaching out. in cities to people who

10:41

were living with consumption or tuberculosis and saying

10:43

to them, hey, come to New Mexico, big

10:46

skies, clean air, dry air, you can dry

10:48

out those wet lungs of yours, and it

10:50

worked, you know, it was a big part

10:52

of the reason why, not the only reason,

10:55

obviously, but a big part of the reason

10:57

why Congress finally relented and brought New Mexico

10:59

into the union. And by the time

11:01

New Mexico did become a state, over

11:03

10 percent of all people in the

11:05

state were people living with tuberculosis. And

11:07

one of my favorite things from this

11:09

part of the book is the story

11:12

about tuberculosis and cowboy hats. Yeah, cowboy

11:14

hats definitely wouldn't exist or at least

11:16

not as we have them today because

11:18

John B. Stetson was living, was a

11:20

hat maker living in New Jersey when

11:22

he got sick with tuberculosis and was

11:24

told to go west and when he

11:26

went west, he eventually recovered. We don't

11:28

know why about 25% of people will

11:30

eventually recover from their active disease and

11:32

go on to live long healthy lives,

11:35

but... Some do, we've never understood that

11:37

and still don't fully. But John B.

11:39

Stetson was one of those who recovered. And

11:41

when he recovered, the first thing he thought was,

11:43

I think I can improve these hats. And that's

11:46

how he came up with the Stetson hat.

11:48

Because here to four, what were hats like?

11:50

So they had like, they had coonskin caps

11:52

in the West, which were literally bug infested,

11:54

right? Like, like, disgusting. And then they had

11:57

straw hats that were brought up from people

11:59

who lived in Mexico. Mexico or Texas,

12:01

which worked great, except when it

12:03

rained, when they weren't particularly waterproof.

12:05

And so John B. Stetson was

12:07

like, oh, I can solve this

12:09

problem. Easy. I'm literally a hat

12:12

maker. I know how to do

12:14

this. Okay. So another invention that

12:16

you write about that's related to

12:18

TB is the sanatorium, which is

12:20

a type of building that we don't

12:22

see built or used anymore, but

12:24

was a huge part of society

12:26

during the late 1800. Can you

12:28

talk about? the sanatorium boom in Europe

12:31

and the US? I mean, nowadays,

12:33

these sanatorium, I don't know if

12:35

this is your relationship with them,

12:37

but they're primarily like urban exploring

12:39

spaces. Exactly, yeah. You know, like

12:41

they're mostly sort of abandoned buildings

12:44

in the middle of weird places

12:46

that 27-year-olds go to feel alive.

12:48

That's right. But at the height

12:50

of the sanatorium craze, there were

12:52

almost as many hospital beds in

12:54

the United States in sanitoria as

12:57

there were in all hospitals combined.

12:59

these huge buildings where people living

13:01

with TB would be sent or

13:03

would go in order to try

13:05

to recover their health. These places

13:07

were all often in rural places

13:10

or in mountain air was one

13:12

way that people tried to respond

13:14

to TB. Dry air was another

13:16

way, like California advertised itself as

13:18

the land of new lungs to

13:21

try to encourage people. I think

13:23

almost as many people went to

13:25

California seeking treatment for TB as

13:27

went to California during the gold

13:29

rush, actually. So it was quite a

13:31

movement of people all around. And all

13:34

they're doing inside the sanatoria is just

13:36

sequestering people to rest with their tuberculosis.

13:38

It's not really a treatment center. No,

13:40

it was a rest center. So they

13:42

would call it curing and you would

13:44

have to cure for eight or ten

13:46

hours a day. And when you were

13:48

curing, you'd often be outside trying to

13:50

take in the sunshine, but you couldn't

13:52

move. You were discouraged from talking in

13:54

many cases. You were discouraged from having

13:56

visitors because that could excite your nervous

13:58

system, which was seen as a... as worsening

14:00

TB, and so it was a

14:03

really highly, highly controlled life. So

14:05

let's talk about the cure for

14:08

tuberculosis. At what point did

14:10

people figure out how to

14:12

fight it rather than just

14:14

live with it? We didn't have

14:16

a cure until the 1940s when

14:18

the first antibiotics were synthesized, and

14:20

that was just a game changer

14:22

for tuberculosis. When my great uncle

14:25

died of TB in 1930, his

14:27

name was Stokes Goodrich, and when

14:29

he died of TB, there was

14:31

just nothing that could be done.

14:33

You know, they put him in

14:35

a sanatorium, he had the best

14:38

care that money could buy, and

14:40

he died anyway, and that was

14:42

the story over and over again.

14:44

But once we started developing antibiotics

14:46

in the 1940s, and then eventually,

14:49

by the early 1950s, realized that

14:51

we could use these early 1950s.

14:54

treat the disease and have

14:56

it retreat, but we could

14:58

cure it. And in that

15:00

moment, hundreds of thousands

15:02

of people who were living

15:04

in Sanitoria were suddenly able

15:06

to go home, live their

15:08

lives. It was an utter

15:10

miracle, a scientific miracle of

15:12

the highest order. And Between

15:14

1945 and 1965 we developed

15:16

seven or eight different classes

15:19

of antibiotics that can fight

15:21

TB. It was this hugely

15:23

successful period in the fight

15:25

against the disease. In the 70

15:28

years since we found a cure,

15:30

tuberculosis has been effectively wiped

15:32

out in Western countries, thanks

15:35

to a combination of prevention,

15:37

widespread TB testing, and powerful

15:40

antibiotics. But throughout the global

15:42

South, not only has TB

15:44

persisted, it is thriving. After

15:47

the break, we'll talk about how a

15:49

disease with a cure can still be

15:51

killing millions of people and what

15:53

the future of TB might hold. What

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does it mean to be rich? Maybe

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with Capella University. Learn more at

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Capella.EDU. We are back with John

17:22

Green talking about his new

17:24

book, Everything is tuberculosis, the

17:27

history and persistence of our

17:29

deadliest infection. So you read about how

17:31

even though TB has been deadly for

17:34

so long and still is, we have

17:36

developed some very effective ways for preventing

17:38

TB and surviving the infection. So can

17:40

you talk about that? So there's just

17:43

the functional advance of the drugs

17:45

themselves, but there's also advances in

17:47

terms of how we distribute that

17:49

stuff. So in the 25 years

17:51

since I graduated from college, TB

17:53

deaths have dropped by about 50%.

17:55

And a lot of that's due to

17:57

investment, especially by the US government.

18:00

The US government has long been

18:02

the leading funder of TB research

18:04

and also TB response overall. Also

18:06

other governments stepping up have played

18:08

an important role in places from

18:10

Sierra Leone to the Philippines. So

18:12

that's the key to like, you

18:14

know, distributing this stuff at scale.

18:16

But there's also been other major

18:18

innovations in terms of our ability

18:20

to detect TB earlier, and then

18:22

also to offer preventative care. So

18:24

we can offer a shorter course

18:26

of antibiotics to somebody who's been

18:28

exposed to TB to make sure

18:30

they never get sick. And that

18:32

can be a very effective way

18:34

of stopping chains of transmission. Yeah.

18:36

Another key component to tuberculosis because

18:38

the way it functions, you know,

18:40

biologically, is like detection is almost

18:42

as important. as the drugs to

18:44

treat it. Can you talk about

18:47

the role of detection when it

18:49

comes to tuberculosis? Yeah, detection is

18:51

super, super important. We've got a,

18:53

it helps to detect the disease

18:55

earlier because then you don't have

18:57

permanent lung damage. And we have

18:59

these wonderful tools that we've had

19:01

for a long time called chest

19:03

x-rays where you can tell pretty

19:05

quickly if someone has tuberculosis. We

19:07

also have now over the last

19:09

10 or 15 years developed these

19:11

incredible molecular tests that in about

19:13

two hours can tell you not

19:15

just if someone has TB, but

19:17

which antibiotics there TB will respond

19:19

to. Total game changers. Unfortunately, they're

19:21

really expensive. I was in a

19:23

lab one since Sierra Leone and

19:25

I saw their gene expert machine

19:27

and I said. Oh, you have

19:29

a gene expert machine. That's so

19:32

cool. And he was like, yeah,

19:34

if only we could afford the

19:36

tests. Oh my God. Well, what

19:38

really struck me when I was

19:40

in your book is that there's

19:42

a real contrast between the West

19:44

and the rest of the world.

19:46

1.25 million people still die of

19:48

TB every year, mostly in the

19:50

global South. And that number is

19:52

insane to me because this is

19:54

a disease that we cured. So

19:56

why is TB still a problem

19:58

for so much of the world?

20:00

Right. curable disease, but it's not

20:02

easy to cure. Like when we

20:04

think about antibiotic-related bacterial infections, a

20:06

lot of times we're thinking about

20:08

like a strep infection in our

20:10

throats or that kind of thing,

20:12

which can be treated with seven

20:14

to ten days of antibiotics, TB

20:17

requires at least four months of

20:19

daily antibiotics taken in a very

20:21

specific cocktail, often six months, sometimes

20:23

longer. And it is onerous because

20:25

we still often use a strategy

20:27

called directly observed therapy where you

20:29

have to be seen by someone

20:31

who isn't in your family taking

20:33

your medication each day. And if

20:35

for some reason you couldn't get

20:37

to the clinic if you were

20:39

too sick, if you couldn't afford

20:41

transportation, whatever that is, then you

20:43

wouldn't be able to access your

20:45

medication and you could experience an

20:47

interruption in treatment. Right. And you

20:49

actually talk about one patient that

20:51

you met. at a TV hospital

20:53

in Sierra Leone, and you get

20:55

into how his story shows exactly

20:57

how incredibly expensive and hard it

20:59

can be to access good treatment.

21:01

So tell me about meeting Henry.

21:04

Yeah, so in 2019, my wife

21:06

Sarah and I were visiting Sierra

21:08

Leone with Partners in Health to

21:10

learn about the maternal health care

21:12

system there, which Sarah and I

21:14

have been working on with pH

21:16

on strengthening with the government for

21:18

a long time. And... on the

21:20

last day of our trip, a

21:22

couple of the doctors we were

21:24

traveling with asked if we could

21:26

visit the TV hospital. And when

21:28

I got there, I opened the

21:30

car door and this kid was

21:32

right there and he just physically

21:34

grabbed me by the t-shirt and

21:36

started walking me around the hospital

21:38

and I learned that his name

21:40

was Henry and that's also my

21:42

son's name. And he looked about

21:44

the same age as my son.

21:46

I just I was immediately taken

21:49

with this kid. He was so

21:51

charming and charismatic and he and

21:53

he took me to the to

21:55

the wards I was astonished by

21:57

how sick people were I had

21:59

never you know I've worked in

22:01

hospitals and and stuff but I

22:03

I'd never seen that many people

22:05

that sick in one place before.

22:07

And he took me to the

22:09

kitchen where the food was made,

22:11

and then eventually we made our

22:13

way back to the doctors. And

22:15

they kind of shooed him away.

22:17

And I said, whose kid is

22:19

that? Is that one of y'all's

22:21

kids? And they said, no. That's

22:23

one of the patients we're really

22:25

concerned about, actually. And it turns

22:27

out that Henry wasn't nine, like

22:29

my son was. He was 17.

22:31

His body had just been stunted

22:34

by malnutritionented by malnutrition by malnutrition

22:36

and then by TB. And then

22:38

by TB. I mean, Henry probably

22:40

first got sick when he was

22:42

five or six with TB, and

22:44

he started to get treatment, but

22:46

then that treatment was interrupted, which

22:48

happens sometimes. And when that happens,

22:50

you have a much higher chance

22:52

of developing drug-resistant TB, and that's

22:54

what happened to Henry. He developed

22:56

a strain of a strain of

22:58

drug-resistant TB, and that's what happened

23:00

to Henry. He developed a strain

23:02

of tuberculosis that was resistant to

23:04

roar back. When those second line

23:06

antibiotics fail, it was called the

23:08

injectable regiments. When those injectables fail,

23:10

you know, I had one doctor

23:12

tell me that's when you put

23:14

the stethoscope down. There's just not

23:16

much you can do. And, you

23:18

know, that is the case for

23:21

the vast majority of people who

23:23

are like Henry. Yeah, it's really

23:25

heartbreaking. One of the other obstacles

23:27

that countries run into is the

23:29

exorbitant cost of care. Like the

23:31

gene expert TB testing machine that

23:33

you talked about, which costs about

23:35

$25 to test one person. That's

23:37

more than half of what Sierra

23:39

Leone spends on health care per

23:41

person each year. And then there's

23:43

the agreed of the pharmaceutical companies,

23:45

which can charge whatever they want

23:47

to for life-saving drugs. But you

23:49

also say that there's been some

23:51

successful pushback against that. Yeah, so

23:53

between 1966 and 2012, we didn't

23:55

develop any new drugs to treat

23:57

tuberculosis, which was a real catastrophe.

23:59

But then in 2012, we did

24:01

develop some new ones. The most

24:03

important of which is probably bedeculin,

24:06

which is a drug that was,

24:08

the research and trials for it

24:10

were funded primarily by public money,

24:12

primarily by the US government, but

24:14

the patent is actually owned by

24:16

Johnson and Johnson, a pharmaceutical company.

24:18

And when their patent expired, they

24:20

tried to file a secondary patent,

24:22

not on the drug itself, but

24:24

on a compound that makes the

24:26

drug more effective. TB activists in

24:28

India very smartly went to court

24:30

and said, look, this is not

24:32

real innovation. This is just a

24:34

company trying to extend its patent

24:36

forever. And after they extend their

24:38

patent because of this compound, they'll

24:40

find another compound to extend the

24:42

patent for and we'll never get

24:44

this drugs price down. And price

24:46

is a huge barrier. This is

24:48

why people are dying, is because

24:50

of price. I mean, getting the

24:53

drugs where they need to be

24:55

is a challenge, but price is

24:57

the biggest barrier. And the Indian

24:59

court was like, yeah, there's no

25:01

real innovation in this compound. This

25:03

is just an attempt to evergreen

25:05

a patent. And so in India,

25:07

it became possible to get generic

25:09

badacklin. But in almost all of

25:11

the world, there was still the

25:13

secondary patent stopping generic production. And

25:15

lots of people came together and

25:17

pressured Johnson and Johnson to abandon

25:19

their secondary patents, which to their

25:21

credit, they eventually did completely so

25:23

that now the price of bad

25:25

acolin in just two years has

25:27

gone down by over 60%. So

25:29

we're living in a particularly devastating

25:31

moment right now for tackling TB.

25:33

Since January, the Trump administration has

25:35

cut USAID and pulled the US

25:38

out of the World Health Organization.

25:40

We've eviscerated international aid programs that

25:42

funded treatment for tuberculosis, and there's

25:44

also looming threats to drug research.

25:46

And even here in the US,

25:48

where we'd almost eliminated TB, we've

25:50

been seeing cases rise in the

25:52

last several years. And as someone

25:54

who's been looking closely at the

25:56

history of... I'm curious

25:58

how this moment

26:00

is landing for

26:02

you. Yeah, I mean,

26:05

you know, not to put too fine

26:07

a point on it, but I would

26:09

like to live in a world where

26:11

whatever the deadliest infectious diseases is one

26:13

we don't know how to cure, right?

26:15

Because at least then, at least then

26:17

it's a technology problem, not a culture

26:19

problem, not a failure of human built

26:21

systems, not a failure of extractive capitalism.

26:23

It's just that we don't have something

26:25

figured out yet. With TB, we have

26:27

it figured out. We know what to

26:29

do. We've done it before. And then

26:31

almost all at once, there's

26:34

been this absolute devastation

26:36

of watching us walk

26:40

away from that

26:42

progress. And not

26:44

just, and the real

26:46

problem is that you don't just walk

26:48

away from progress, you embrace regression.

26:50

That's what we're doing right now. We're

26:52

embracing an actively worse world. And

26:54

how do you see these cuts hitting people in the world

26:56

with TB? It's just devastating.

26:59

I mean, we're gonna see the number

27:01

of people who die from TB go

27:03

up. Every single person right now who's

27:05

had their treatment interrupted, and we don't

27:07

even know how many people that is,

27:09

but it's tens of thousands, hundreds of

27:11

thousands. Every single one of those people,

27:13

even if they get back on medication

27:15

in the next few weeks, it's

27:18

likely that in many of those

27:20

cases that medication won't work anymore because

27:22

the bacteria will have had an opportunity

27:24

to evolve resistance. And to have done

27:26

that so chaotically, so suddenly

27:28

without any warning across the

27:30

board with an axe rather than

27:33

a scalpel, I

27:35

don't know how to

27:37

express the devastation I feel. I mean,

27:39

I don't feel hopeless. I don't feel despair.

27:41

I refuse to feel hopeless, but it's been

27:43

a long time since I was this discouraged. What

27:46

are some of the things that

27:48

have happened specifically that you've seen

27:50

sort of like what has been

27:52

shut and changed? What sort of

27:54

protocols have been altered? What is

27:56

it that is causing this regression? So

27:59

almost immediately, there were stop

28:01

work orders issued related

28:03

to almost all TB

28:05

response, HIV response, malaria

28:07

response. But the word was

28:09

that there were exceptions

28:11

for life-saving medication. That's what

28:14

everyone was told. Now,

28:16

functionally. As far as I could

28:18

tell, and I have a lot

28:20

of friends in this space, and

28:22

I work with a lot of

28:24

people, very little money was actually

28:26

moving, if any. And so you

28:28

can say that life-saving medication is

28:30

flowing, but it wasn't. Instead, you

28:32

know, I would get pictures from

28:34

friends of warehouses full of TB

28:36

medication just rotting in the warehouse

28:39

for want of a continued work

28:41

order. And then more recently...

28:43

all or almost all TB

28:45

response was just cut

28:47

completely, just ended. And

28:49

that's the case for malaria

28:52

response as well, for a

28:54

huge percentage of our HIV

28:57

response, and it's just

28:59

devastating. So many people

29:01

are going to die. Just like

29:04

you, I am incredibly discouraged

29:06

by this moment. It feels

29:08

like... an unimaginable amount of cruelty

29:10

to allow this stuff to happen.

29:13

And I don't want to put

29:15

you in a position where you

29:17

have to provide us with hope,

29:19

but could you share anything that

29:21

you're feeling in terms of what

29:23

could be done, what would put

29:25

us on the right path? Yeah, I mean... The

29:27

nature of being a person is that you

29:29

feel like today is the last day of

29:31

human history, right? Because it's the last day

29:34

of human history you've lived through. It feels

29:36

like the end of the story. Like there

29:38

was a, you know, I started out zero

29:40

and then I ended up 47. And that's

29:42

the story of my life, right? Right? But

29:44

of course that's not the story of my

29:46

life, hopefully. Hopefully this isn't the last day.

29:49

This is not the end of the story.

29:51

It feels like the end of the story

29:53

because it's the last bit I've lived through,

29:55

but it's the middle of the story. And

29:57

so that's why we have to fight and

29:59

scratch. and continue to be hopeful because it's

30:01

the middle of the story. And I really

30:03

believe that the end of the story for

30:06

tuberculosis is the end of tuberculosis, this disease

30:08

that has been with us for the whole

30:10

300,000 years that we've been here. How amazing

30:12

would it be to be able to live

30:14

in a world where that's no longer a

30:16

public health threat? Well, we can live in

30:18

that world. And right now we're taking steps

30:21

away from living in that world, but those

30:23

aren't the last steps we're ever going to

30:25

take. John,

30:27

I've had such a great time

30:29

talking with you. I really loved

30:31

it and I love the books

30:33

so much. Thank you for having

30:35

me. Thank you for offering to

30:37

read the book and for just

30:40

being such a kind soul

30:42

in the world right now.

30:44

99% Invisible was produced this

30:46

week by Christopher Johnson and

30:48

edited by Kelly Prime. Mixed

30:51

by Martin Gonzales, music by

30:53

Swan Real and George Langford.

30:55

Kathy, too, is our executive

30:57

producer, Kirk Colstead is the

30:59

digital director. Delaney Hall is

31:01

our senior editor. The resident

31:03

team includes Chris Burube, Jason

31:05

De Leon, Emmett Fitzgerald, Vivian

31:07

Lay, Loshma Dawn, Joe Rosenberg,

31:09

Jacob Medina Gleason, and Me,

31:11

Roman Mars. The 99% Invisible

31:14

logo was created by Stephen

31:16

Lawrence. We are part of the Series

31:18

XM podcast family, now headquartered six blocks

31:20

north, in the Pandora Building building. In

31:22

Beautiful. Uptown. Oakland, California. You can find

31:25

it on Blue Sky as well as

31:27

our own Discord server. There's a link

31:29

to that, as well as every past

31:32

episode of 99PI, including one where I

31:34

talked to John Green about his book

31:36

and podcast, The Anthropocene Review, which is

31:39

actually one of my favorite episodes. You

31:41

will find it at 99pi.org.