Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection

by John Green

We are powerful enough to light the world at night, to artificially refrigerate food, to leave Earth’s atmosphere and orbit it from outer space. But we cannot save those we love from suffering. This is the story of human history as I understand it—the story of an organism that can do so much, but cannot do what it most wants.

TB is both a form and expression of injustice.

tuberculosis has come to be seen as a disease of poverty, an illness that walks the trails of injustice and inequity that we blazed for it.

“Nothing is so privileged as thinking history belongs to the past.”

Sometimes, when people tell you that you’re in their prayers, it sounds like lip service. But not when Isatu says it.

it becomes strange indeed that illness has not taken its place with love, battle, and jealousy among the prime themes of literature.”

But I wonder if we also ignore illness because of our bias toward agency and control.

tuberculosis of the bone, wherein the bacteria scrape out tiny holes in the skeleton, leaving bones that resemble dead coral.

Something like 90 percent of people die of disease, a phenomenon so entrenched in human life that we attribute most such deaths to “natural causes.”

Treating disease—whether through herbs or magic or drugs—is unnatural.

Hospitals are unnatural, as are novels and saxophones.

Vonnegut reminds us that we are both inclined toward curiosity and inclined toward arriving at some kind of comprehensible conclusion.

Imagining someone as more than human does much the same work as imagining them as less than human: Either way, the ill are treated as fundamentally other because the social order is frightened by what their frailty reveals about everyone else’s.

I am an author, and I for one am deeply offended by the notion that my waywardness, peevishness, irascibility, misanthropy, and murky passions are caused by a derangement of bodily health, even as I am impressed by a nineteenth-century magazine’s ability to absolutely nail my personality.

Patients with active tuberculosis typically become pale and thin with rosy cheeks and wide sunken eyes due to the low blood oxygenation and fevers that often accompany the disease, and these all became signals of beauty and value in Europe and the United States.

The idea of becoming sick in order to look healthy or beautiful speaks to how profoundly consumptive beauty ideals still shape the world we share.

If the pale, thin, wide-eyed, rosy-cheeked beauty standard has proven astonishingly durable, the conflation of whiteness with consumption would prove even more devastating to human health and equity.

We love a narrative of the great individual whose life is shot through with major events and who turns out to be either a villain or a hero, but the world is inherently more complex than the narratives we impose upon it,

the era of consumption, an inherited condition that grew the soul by shrinking the body, ceased to exist. The era of tuberculosis, an infectious disease of the poor and marginalized, had commenced.

Research indicates that certain gut microbiomes are associated with major depression and anxiety disorders;

In Ethiopia, for instance, TB mortality rates in 1990 resembled those in the U.S. in 1882,

In the U.S., more than a quarter of all prescribed courses of antibiotics go unfinished.

Why must we treat what are obviously systemic problems as failures of individual morality?

Writing is like that for me, like I’m typing “Marco, Marco, Marco” for years, and then finally the work is finished and someone reads it and says, “Polo.”

And this is why I would submit that TB in the twenty-first century is not really caused by a bacteria that we know how to kill. TB in the twenty-first century is really caused by those social determinants of health, which at their core are about human-built systems for extracting and allocating resources. The real cause of contemporary tuberculosis is, for lack of a better term, us.

We must also address the root cause of tuberculosis, which is injustice. In a world where everyone can eat, and access healthcare, and be treated humanely, tuberculosis has no chance. Ultimately, we are the cause. We must also be the cure.