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

by John Green

having trained as a doctor, to be unable to save his own son from disease.

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.

We know how to live in a world without tuberculosis. But we choose not to live in that world.

“Where are the drugs? The drugs are where the disease is not,” Dr. Mugyenyi said. “And where is the disease? The disease is where the drugs are not.”

these physicians will be unable to save their patients, because the cure is where the disease is not, and the disease is where the cure is not.

we’ve allowed over 150,000,000 humans to die of tuberculosis. I started writing about TB because I wanted to understand how an illness could quietly shape so much of human history. But along the way, I learned that TB is both a form and expression of injustice. And I learned that how we imagine illness shapes our societies and our priorities.

In most people, the infection will lie dormant for a lifetime. But up to 10 percent of the infected will eventually become sick, a phenomenon we call “active TB.” People are especially likely to develop active TB if they have a weakened immune system due to other health problems like diabetes, HIV infection, or malnutrition.

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

the history and present of tuberculosis reveal the folly and brilliance and cruelty and compassion of humans.

in my mind everything is about tuberculosis, and tuberculosis is about everything.

To me, it was a disease of history—something that killed depressive nineteenth-century poets,

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

In general, colonial infrastructure was not built to strengthen communities; it was built to deplete them.

“Pain is in the body. It leaves no trace for the historian, unless complaints about it are recorded.” But I wonder if we also ignore illness because of our bias toward agency and control.

But history, alas, is not merely a record of what we do, but also a record of what is done to us.

We know consumption has been with us for a very long time.

consumption-like illnesses three million years ago. In fact, tuberculosis is listed in Guinness World Records as the oldest contagious disease.

“lung exhaustion.”

“wasting ...

“to decay.”

“Of all maladies,” Hippocrates tells us, “it was the most virulent and the most difficult, and exacted the most deaths.”

“destroyed palace.” A

“Toxic Drugs bring no cure; short needles cannot seize [the disease].”

“consumption”

Daoist priests began referring to the illness as shīzhài, or “corpse disease,”

consumption the disease that “wealth never warded off,”

Precisely because consumption was so fundamentally different from other infections,

Some classical thinkers did even approach a germ theory of disease long before microscopy could confirm it. Around a thousand years ago,

seven hundred years after Ibn Sina first proposed that consumption might be caused by invisible organisms,

Tuberculosis is, on many levels, a weird disease. Infections can lie dormant for decades, or for a lifetime. The illness has an unpredictable course—it may kill its victims within a few months, or over many years, or not at all. Treatment can appear effective only for the illness to come roaring back for reasons we still don’t fully understand.

Right now, over two billion people have been infected with a microorganism called Mycobacterium tuberculosis.

M. tuberculosis is a near-perfect human predator in part because it moves very slowly. The bacteria has an uncommonly slow growth rate.

M. tuberculosis grows so slowly because it takes a long time to build its unusually fatty, thick cell wall, which is a formidable enemy to the immune system.

But other times the causes are mysterious—something in the body’s balance shifts, and slowly the body is overwhelmed with bacteria.

The classical physician was a kind of detective[*4] whose job was to listen carefully to a person’s story, pay close attention to their appearance, and then use that information to identify a culprit.

*4 It’s no coincidence Sir Arthur Conan Doyle, who created the deductionist detective Sherlock Holmes, was—as we’ll learn later—a physician and tuberculosis researcher.

“Death is natural. Children dying is natural. None of us actually wants to live in a natural world.”

Treating disease—whether through herbs or magic or drugs—is unnatural. No other animals do it, at least not with anything approaching our sophistication.

Mental illness, for example, is often romanticized as bringing on creative genius or other superpowers. Brilliant detectives like Sherlock Holmes and Adrian Monk are portrayed as having their powers of detection enhanced by their obsessive thought spirals even as they are also stigmatized for their eccentric and off-putting behavior.

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.

Conan Doyle immediately saw what Koch did not:

Conan Doyle went home to England and within a decade published his first Sherlock Holmes story, all about a detective who uses reasoning and evidence to reach rigorous conclusions about causes of death, meaning that Holmes’s work was not so distant from that of his author.

But there is limited profit motive.[*2] The underinvestment in new classes of drugs to fight bacterial illnesses is the central cause of growing antibiotic resistance.[*3] It’s easy to blame patients or providers or pharmaceutical companies, but really all of humanity has collectively chosen not to put more of our shared resources toward new treatments for disease. Some of this can be chalked up to our economic systems—the newest antibiotics will not be prescribed as often, meaning they won’t be as lucrative as, say, developing a drug that hundreds of millions will take to control blood pressure. This is why when new antibacterial drugs do come out, they are often priced very highly.[*4]

I would never accept a world where Hank might be told, “I’m sorry, but while your cancer has a 92 percent cure rate when treated properly, there just aren’t adequate resources in the world to make that treatment available to you.” That world would be so obviously and unacceptably unjust. So how can I live in a world where Henry and his family are told that? How can I accept a world where over a million people will die this year for want of a cure that has existed for nearly a century?