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Alan Rarig was found dead in a parking lot in Oklahoma. He's partly decomposed. He'd been shot twice, once to the head. It was a baffling tragedy. You'd think his wife would be devastated. But a far more frightening set of circumstances eventually came to light. She was either the black widow or bad luck. I don't know which.
people began to wonder, who was Sandra Bridewell? These guys didn't really see her coming. This is the unbelievable story of a femme fatale with a trail of bodies in her wake and a lifetime of deception that has never been fully aired. Until now. If something ever happened to me, then they would know who did it. From Sony Music Entertainment, this is Fatal Beauty, available now on The Binge. Search for Fatal Beauty wherever you get your podcasts to start listening today.
Hello, everyone, and welcome to the Mindscape Podcast. I'm your host, Sean Carroll. One of the great things about the existence of podcasts as a medium, I guess it's not that different from just interview shows on radio or TV, but they're a little bit more ubiquitous now. So they provide a glimpse into things almost as they happen, right? I mean obviously news events can happen very rapidly, but
The increase in knowledge that we get through scholarship and research happens on a relatively more leisurely timescale. And by talking to the kinds of people that we get as guests here on Mindscape, you can see... science and research more broadly as it is being done. You get some interesting results, but you also get some insight. into the messiness of we don't know the answer yet. We're still thinking about this. There's still some controversy. Let's see where we go.
And it becomes pretty obvious that, of course, we're all human beings. We have our favorite ideas, favorite ways of thinking and so forth. It's a human endeavor, science and scholarship more broadly. So it can be. possible to forget that it has always been that way. Because the science that was done in the past... we receive as students and readers and listeners in kind of a...
finished, polished form, right? We're given Maxwell's equations or Newton's laws in notation that is much easier to understand than what they actually used. And we're given the final result after they had to... go back and forth and think about lots of different things. So things we take for granted now. The earth is round. Species evolved from previous species due to natural selection. The germ theory of disease, for example, of course.
Diseases are carried by germs. That's very natural. Diseases can be contagious. One person talks to another one. They carry the disease now. It makes sense that some little agent was carrying the disease from person to person. But it took a long time, as it turns out, for the germ theory of disease to catch on. And it's worth revisiting that history, both because the science is fascinating, but also the twists and turns in the human side of the story are fascinating as well.
So today's guest is Tom Levinson, a longtime friend of mine. He is a professor of science writing at MIT and an active... author of a number of books that I can highly recommend, The Hunt for Vulcan. about looking for that little planet that was hypothesized to exist between the sun and Mercury back in the day. Einstein in Berlin, about some of Einstein's formative years. And my favorite, which is...
Newton and the Counterfeiter, about Isaac Newton's life after doing science when he became the boss of the Mint and hunted down counterfeiters in London. These are human stories. What can I tell you? Newton was a pretty bloodthirsty guy, to be perfectly honest. Anyway, Tom's most recent book. is called So Very Small, How Humans Discovered the Microcosmos, Defeated Germs, and May Still Lose the War Against Infectious Disease. It's a history book, a science book, a storytelling book about...
The various ways that we got from Van Leeuwenhoek looking through a little microscope and seeing that there were critters moving around to Pasteur saying, I can figure out how to defeat these guys. And not everyone agreeing with them along the way. In fact, some people fighting hard against them. And at some point you have to say a lot of lives could have been saved if people had just faced up to the scientific reality.
lessons for contemporary issues left for you to decide. So with that, let's go. Tom Levinson, welcome to the Mindscape Podcast. It is great, but nevertheless, the very first page of your new book... Kind of frightened me a little bit. You start talking about the bubonic plague in Oregon in 2024. I mean, you rush to say, don't worry, they tamped it down because we have modern medicine now.
It did raise the question, like, how many of these old-timey, terrible-sounding diseases are still lurking around out there? We'll be more systematic later in the podcast, but I just had to ask that one right away. All of them are out there except smallpox. Smallpox is the only disease. I mean, I love this factoid. The only... human infectious disease that has been rendered extinct in the wild there's no more virus out there except in a couple of
of freezer lockers, which is kind of nervous making that they're there. But, you know, essentially there's no smallpox circulating, hasn't been since at least 1980. And that's a remarkable thing because it used to be. the leading killer, and one in three of people who caught it would die most often. Terrible disease. But the rest of them, tuberculosis, uh you know consumption the the you know the the disease that took uh you know all those figures you know
the poet Keats and Henry David Thoreau and everybody else, that's still causing a million deaths a year worldwide. It's not... prevalent in the developed world, but it's still very much out there. And it's actually becoming an increasingly deadly threat. We can go into why later on. Cholera still pops up. And in fact, I saw a recent report that there's some cholera. Clearly, we know about measles. As we talk, there is a still uncontained outbreak in Texas.
And I understand now it's in measles cases have been identified in something, you know, 20 or something additional states. Three people have died so far in that one. And you can keep going on down the list. Polio has been on the very teetering edge of... of eradication for decades now But it's not quite extinct. And there are cases that pop up, including in the United States.
you know, as recently as 2022, 2023. And if we aren't careful, that could also break its current very narrow bounds and become a major problem again. So, yeah, they're all still out there. Well, it's interesting because your book is about the historical context. We have a lot of fascinating stories about how we got to germ theory and vaccines and fighting it and so forth. constantly there's a refrain of...
It wasn't easy. Like the scientist invented some stuff. And then there was politics and there was like establishment pride and all those things. And you can't help but read it and go, yeah, I guess those things are still around a little bit. Very much so. I mean, the book, So Very Small, began as a question from an editor, like, can you think of decisive moments in science? There are these, my UK editor. and said, I'm doing this series on decisive moments.
like, you know, Picasso's Guernica or Handel's Messiah, the first performance, that kind of thing. He says, but we have no science. What would be good idea? What would be good break points in science? And, you know, or coffee. And I thought of a couple and I said, well. Einstein going up the mountain in Mount Wilson and seeing the evidence that the universe is not static is a break point. You know, the world is different or the cosmos is different before and after that moment.
And I said, you know, I could do that, but I don't do that because I've written about Einstein a lot. Yeah. Enough. And I said, you know, I don't know anything about it, but germ theory strikes me as this really striking moment. And germ theory, you know, is this. idea that was definitively established in the 1870s and 80s.
And it basically says that infectious disease is not caused by some derangement of the body or environmental disturbance, a miasma or what have you, bad air, bad water, whatever. um in a sort of general sense it's caused by microbes and crucially Each different disease, cholera, you know, typhoid, whatever it might be, battlefield infections, all these kinds of things. Each specific condition was caused by a single specific microbe. That was an essential element of the...
And I said, before that, you have... you know, and a much looser and vaguer understanding of disease. And after it, you have this very precise definition of what's involved in infectious disease. There are, you know, it gets very pricey. There are these things called Cox. postulates which are a list of rules about how to make sure that you have identified the correct sequence from pathogen to disease
you know, isolating the bacterium as viruses, as these were being worked out, viruses had not yet been observed. You know, the first ones were observed, the first one was observed in the 1890s. And, you know, so you identify the bacterium in a diseased, you know, in a diseased organism. You isolate it, you culture it, you give it to another healthy organism and you reproduce the same disease. You know, there are these rules that sort of how you establish that this is in fact the.
the pathogen um that all happens you know at this in this last quarter of the 19th century And, you know, there's a before and after. And with that knowledge, there are all kinds of things you can do that that are also part of the story I tell in the book. You know, you have. Ideas about public health were already advancing in this period that I call germ theory without germs, when it's recognized that there are pathogens of some sort, but it's not understood what they are and how the dynamic.
But even that lets you do some very important things. That's the cholera story with, you know. all that um but afterwards you can do you know targeted public health you understand why you're doing like clean water systems and so forth uh and making sure the sewage system doesn't interact with the water supply all these kinds of like basic really good things
You develop vaccines. There was one vaccine that existed, Jenner's cowpox vaccine, to prevent smallpox that was discovered essentially empirically or developed empirically in the late 18th century, 1790s. But there were no other vaccines. And then with germ theory, particularly pushed by Louis Pasteur. in that early period. But, you know, as with anything in science, lots and lots of other people are involved. But that's when you start getting vaccines against a much wider range of disease.
And of course, finally, third in the sequence, historically, you get chemical compounds that are discovered or developed that can attack an infection that's already lodged in the body. I mean, vaccines are sort of like the wall around the castle, right? If something gets through the wall, whether it's your skin or a vaccination or what have you, then you've got an infection and you need to do something about it. You want to do something about it. And that's where antibiotics come from.
And we got all those things out of germ theory. sort of i said you know germ theory there's a before and after and it's great and there's a decisive moment and everything's grand um And that's all true, but you and I both know that science is not usually simply a case of a eureka moment that changes everything, right?
And so, you know, I started looking into it a little bit more. I mean, I told my editor that he should find somebody who actually knew about medicine and the history of microbiology and all that sort of stuff to write it. I wrote two other books while this idea was still, you know, bouncing between us. And finally he said, you better write it. And I said, okay, I better write it. And, you know, along the way.
I discovered something that turned it into a book that really spoke to the way I think about the world. And that was, you know, it should have been obvious at the time, I guess, but it took me a while. I'm slow. It took me a while to get there. microbial world, there is actually a decisive singular moment when it was discovered. You know, microbes are not visible with the naked eye. You needed to develop instruments. The instrument in question is the microscope.
That comes about early in the 17th century. And people look at all kinds of things with it, but they don't, you know, partly because the early microscopes weren't that powerful and partly because... You know, it just it takes a while to realize that, you know, with this instrument, it's not just that you can see more detail on things you already know are there. Right. You look at a bee's wing.
Uh, one of the very famous early books is, um, you know, is, uh, uh, uh, micros, you know, sort of reports on my cross. that was written by two Italians. And there are these beautiful drawings of these magnified insects, and it's really cool. That really took a step forward when Antony van Leeuwenhoek, and I hope I apologize to my Dutch friends for my butchering that. He was a Dutch cloth merchant, a draper in Delft. And cloth merchants at the time used lenses to inspect the fabric.
And he became interested in... that magnified world. And he almost certainly saw a copy of Robert Hooke's Micrographia. in some ways, the first great popular science text, this book of magnificent microscope studies of both materials, points of needles and so forth, but lots of living things. But again, you know, he had pictures of a flea in the compound eye of insects and so forth. He saw in greater detail things that were, again, you know, perceivable by, you know, in some ways by human eyes.
and didn't penetrate deeper into the invisible realm, you know, invisible to us. And that seems to have inspired Leeuwenhoek. And it turned out he was a meticulous craftsman. He made these great single lens microscopes. that were incredibly powerful for the day. He was almost certainly making the most powerful instruments in Europe. And, you know, this work of his started 1673 or so. And by 1676.
He was really sort of feeling his oats and pointing his instrument or using his instrument on a wider and wider range of subjects. And he looked at a drop of pond water. And in that pond water, he saw what he called an immaculate. I love the name. Yeah, it's great. And he saw some things that are probably planaria or other, you know, fairly large multicellular microscopic organisms.
But then he, you know, looked lone enough and hard enough and his microscopes were good enough that he actually saw single-celled bacteria.
and we know he did not just because he reported and described it and you know you can you can see descriptions but uh i think the earliest surviving of his drawings he was a meticulous draftsman he drew pictures of lots of stuff that he studied uh comes from 1682 and there are four or five bacteria drawings on it and they are, you know, present day identifiable. as at least to families of bacteria, if not the specific strain. And those experiments have been replicated.
historian of science, made a single lens microscope and did it again and said, yes, he could have seen what he said he saw. So yeah, he really saw bacteria. And again, he saw them for the first time in 1676, and then he kept observing them. And one of the really interesting things to me is...
Within a very few years, he looked at it in pond water. He looked at it in other liquid sources. He infused peppercorns in water because he was interested to see what would happen with the peppercorns. But he also saw microbes there.
but at some point he took gunk from his between his own teeth and looked at that through the microscope and saw more and why is that significant at least it's significant to me and the answer is because that's when you know that's the first a recorded example of recognizing that microbes live inside us yeah you know teeth you know gunk between teeth is not very far inside us but still you know it's there and we can we can
you know, cohabit in the literal sense of the word with this whole microbial universe. That might have been an eureka moment, but it was certainly also a very creepy moment, don't you think? Oh, yeah. I mean, it's... But what's interesting is... So the question for the book was, all right, that's 1676. And the Robert Koch's demonstration that anthrax is caused by a bacillus B anthracis, a single microbe, which was the first. you know, end to end account of.
uh you know demonstration that you know anthrax is caused by a pathogen it's this pathogen and you can replicate it and it's a living you know microbial you know it's a bacterium um all that was set you know Koch did that from two or three days before Christmas in 1876. So, you know, two or three, you know, two or three weeks into January, he'd created a chain of infection with these, you know, you take some B. anthracis, give it to a rabbit.
Then when that rabbit got sick, he'd harvest blood and isolate the bacteria again and give it to the next rabbit. And he created this chain of infection and he isolated the bug. And he even also traced the life cycle of anthrax, which, you know, he caught them in their spore stage and he was able to activate. you know, motile bacteria from the spores. He nailed it in the space of three to four weeks. But that's 200 years after von Leeuwen.
And while it is, I think, formally impossible to say with certainty why something doesn't happen. That's still a long time. And I wondered why it was so long. What were the impediments to figure out? And that's really where the book got started. And what became exciting as I wrote the book is it became clear to me at least, and I hope I persuade readers, is that...
The broad outlines of why it was difficult to go from the first observation of microbes to recognizing that they actually matter to us in really important ways. That lens helps us understand why we're currently in trouble with infectious disease, why many of the advances of the last century and a half are now at least at risk, if not already really compromised.
Maybe you can help us understand what would have been the mindset of the people in the pre-germ theory era. You've already mentioned miasma theory, but we knew that disease was infectious, or at least infectious disease. I'm guessing that people had ideas about how diseases were spread either by... touch or breathing or whatever? Was there some consensus as to what they thought happened before they said it was a little microbe?
Well, that's, I mean, for, you know, sort of for the philosophy of science, that's what's so interesting about this case, right? How does a theory get replaced? Well, you know, there's the big broad outlines.
turn to Thomas Kuhn, or you can turn to people who've argued with Kuhn or whatever. But something that I really think is true in a bunch of different domains is that the easy conventional sort of high school version that theories change when a fact comes along that the theory can't accommodate.
That's tricky on so many levels. We could talk a lot about that if you wanted. But one of the problems for making the connection between microbes and disease is... that there was already a pretty coherent theory of disease that... that didn't particularly predict things, but it accurate or it adequately described what was observed. So when you have something like the plague, There were two questions. What is a disease? You know, what's happening when you get sick?
And how does a disease move from one person to the next? Those are obviously related questions, but you can distinguish between them. And there were... a variety of detailed accounts of disease and certainly the more people observed different conditions people recognized the plague as something other than other fevers that you might encounter. And in part, they recognized it because the plague has some characteristic markers, like the buboes of the bubonic plague.
lesions that burst on your skin and so forth. And even though that's not a universal symptom of the plague, it's common enough that there are ways to recognize it as the plague and not as... what we would now call typhoid or something else. But, you know, so there was some, you know,
People in the past are not dumber than we are. They have less information or different information, but they're not, you know, stupid. And so there were detailed observations and people obviously wanted to know what was going on when you had a terrible event. But the basic idea is that there is, you know, that healthy bodies are in a form of balance.
You know, there was humoral theory, the four humors that have to be imbalanced. But there are, you know, sort of other broader, you know, you could sort of generalize that. You didn't have to be a Galenist and say, no, it's the humors. There were, you know, what were called chemical physicians. which were people who were looking at more detailed accounts of...
you know, the substances that make us up. And people were beginning to be aware of bodily systems. I mean, this was, you know, William Harvey working out the system of blood circulation. is not just important for that one story. It sort of gives you a way to think about how the body works that was distinct from what went before. But overall, the idea is, you know, when you're healthy, your body's in balance and ill health is some derangement.
And if you think about it as a sort of broad statement, you know. It's still true. It's a metaphorical way of talking about what's going on. Yeah. Look, you know, think about diabetes. It's a problem of insulin regulation. Well, when your insulin... regulatory system is working as it should. You know, you don't have diabetes and when it isn't, you do. That's a form of imbalance. It's still, you know, it's not a crazy concept. It's perfectly.
understandable one, and it adequately described what was observed with the naked eye. And similarly with the spread, the origins, where does the first case come from and then how does it spread? There were a range of possible sources. I mean, ultimately the source. you know, was expressing judgment on individuals or societies. And this judgment, you know, the judgment was expressed through the events that happened to you in life, including illness. But, you know, it was well established that.
People live in the material world and divine judgments and the devil's blandishments, etc., occur through natural means. There was a scientistic approach to understanding both, you know, satanic and divine regulation of the world or interaction with. And so you look for things like and, you know, that's where miasmas come in. It's, you know, literally bad air. It could come from an emanation from the earth. It could be, you know, the foulness of.
As you move forward in time, the idea is that the... bad city conditions, unhygienic conditions, produce these miasmas that are deranging. You don't need to have some sort of supernatural or origin for these things. They can be perfectly straightforward. And again, when you think about it, and this is sort of skipping ahead in the book, this is where some of the critical ideas of the 19th century came.
You don't need to know about germs specifically to recognize the correlation between, you know, fetid odors and decaying flesh and so forth as not great things to, you know, raise your kids. So you have all this knowledge and you have a persuasive. And the great thing about miasmas is you don't have to invent a mechanism for carrying them from place to place because. If it's in the air or if it's somehow in the environment, it can move from...
And, you know, there was the idea of contagion, which, you know, comes from the root to touch. You know, so obviously handling somebody diseased was understood as a risk. for the person doing the work, but also contagion as a concept sort of grew more indirect.
I had the image in my head of the old 1950s early slush box automatic transmissions, you know, the hydromatic, where the gear changes are carried through water. You know, you don't actually have a direct mechanical connection between bits of metal. you know the idea of early disease contagion being kind of hydromatic contagion struck me as, as, uh,
sort of a plausible metaphor. But all that, you know, you can look at the Great Plague of London, which is sort of where the book proper starts, and you've got a sufficient explanation.
Now, you did have people who were looking both for specific treatments that might actually help with the the plague and they had you know no idea and the things that were proposed were ineffective though in some cases may have made people more comfortable when they were asked to drink more alcohol or something um But you also had, you know, some attempt to think about what kind of substance, what seeds of disease in the language of the time.
might be going from, you know, what was in the miasma, what was the, you know, the active ingredient, as it were. And again, you know, all that is... fully plausible and you can squint just right and see in this concept of seeds of disease. seeds of disease, a precursor, something, an idea that could lead you to microbes.
But there was nothing in the thinking of the time that required them. Right. And there was no indication that whatever these seeds might be, you know, they could be, you know, inert, they could be. you know uh they could be sort of gaseous they could be almost anything right uh there's no no pointer to toward some specific identifiable living element.
Of course, during the Great Plague of London, this was, you know, 10 years before Leeuwenhoek first saw microbes. But, you know, there were diseases that went, you know, diseases didn't stop in 1676. But this is something that's interesting that comes out in the book. It is quite a span of time in between van Leeuwenhoek and then the acceptance of the germ theory of disease. But not only were people fighting disease at the time, they were doing so at least sometimes.
in ways that, in retrospect, make perfect sense if you believe the germ theory of disease. So in the book, you talk about Jon Snow is a famous guy, Florence Nightingale as the... nurse and a lot of modern methods of being clean and well-behaved. But the one I have to ask about, since we don't have infinite time, is Cotton Mather. who is more famous for other reasons, but apparently he was quite the experimental medical doctor.
Well, I wouldn't. He's more of an eager magpie than an actual rigorous experiment. I mean, he he so cotton mather, of course, is is. a puritan minister he's most famous for his role uh in the salem witch trials in which he deeply believed in the truth of the testimony of those who are accusing people of being witches and believed in sort of dream evidence. I dreamed this happened and thought that that was how Satan would communicate.
and was thus directly implicated in the deaths of a lot of people who were clearly, you know. Shouldn't have been killed. And at the same time, you know, and he was part of this, he was not just a Puritan, any Puritan minister. He was, you know, if there can be such a thing, he was part of the Puritan aristocracy. father and uncles and his whole family was basically in the business of being Puritan leaders.
You know, he's a very funny character. He apparently, when he was a student at Harvard back in the day, he apparently had some inclination to become a doctor, to study medicine.
But of course, the pull of the family business was too strong. The family business being- being a minister yeah exactly uh he was you know he was ordained in and gave his first sermon at his father's church which was the leading church in boston when he was ordained something like um 20 of the population of boston was in the audience i mean it was like you know he was a big deal his family was big
in that line of work. But he was clearly also both intellectually ambitious and interested in the natural world. 20, 30 years after the witch trials, he started writing to the Royal Society in London with these sort of American curiosities. And some of these things were just bonkers. Remember, the Royal Society early on was itself, you know. range from this incredibly serious, important stuff to
You know, you look at it and you laugh. I mean, Robert Boyle, the great, you know, sort of patron saint of chemistry, very early on in the Royal Society history, read a paper to the... to the assembled fellows about a monstrous calf you know i mean it ranged you know truly their interest ranged all over the map and and mather presented these sort of american wonders some of them very
very real interesting bits of natural history, some of them these sort of legends that he seems to have accepted credulously. And the Royal Society loved him and published him and made him a fellow of the Royal Society. And he was also, really as part of his ministry and his intellectual life, very interested in all things related to medicine. He collected anecdotes. He collected recipes that people had for cures or nostrums. He really, I think.
had a sense that it was sort of his duty as a minister and essentially a representative of God on earth. to do what he could for, you know, the health and well-being of both his community, but sort of, you know, by communicating with the Royal Society or whatever, the world at large. And he was, in fact. genuinely one of the pioneers of vaccination.
being one of the earliest proponents of smallpox inoculation or variolation, as it's sometimes called, where you take smallpox material from somebody who's suffering from a hopefully mild case of the disease. and you scratch marks into a healthy person's arm or arms. They often did it in multiple limbs.
And you mix this stuff in. And the idea is to give the person a mild case, a very, hopefully very mild case of smallpox and thus confer on them what had already been observed to be the result of a smallpox infection. which was lifelong immunity to any further cases of the disease. And it's not literally vaccination. You've not developed a vaccine, but inoculation is sort of the broader category of which vaccine.
Right. And this is the earliest attempts in Western Europe and the Americas to engineer immunity. to a naturally occurring disease and that's that to me is the distinction that's key because vaccines are a particular way to engineer that Mather learned about this technique first from his slave. an African man who had been gifted to him by members of his congregation who told him about undergoing this procedure in Africa.
And then when in the mid-1710s, the Royal Society published two papers from doctors working in the Near East, in Turkey. One was from definitely in Turkey. I'm trying to remember where the other one was working. I can't cat off the top of my head. Anyway, that also described the use of this, you know, inoculation, smallpox inoculation in Turkish medicine. Mather wrote to the secretary of the Royal Society, having seen this paper and said, you know, I can attest that my servant.
as he called him, his slave, had already told him about this and that he followed this up with conversations from other people with knowledge of it. And that this seemed to him such a promising, promising. preventative for this really deadly, horrible scourge of a disease, that should smallpox visit Boston again, he said, I will attempt to get this method used. And sure enough, a few years later in 1721, smallpox comes back to Boston.
tries to persuade Boston's medical community to do inoculation. Only one member of that community agrees to do so. Others vehemently oppose. A common theme in the book, like we said. Right. Well, and the interesting thing is they oppose him for multiple reasons. One, there is, you know, certainly there's risk and there are dangers involved. You're doing, you know, the Human Subjects Committee might have had some words to say, right?
But the other reason is, you know, this was a proxy for a battle over power. you know, sort of professional power. Who had the right to do medicine? You know, not Puritan ministers, goddammit. You know, there was one European-trained MD in Boston at the time.
who clearly bitterly resented the incursion into his prerogatives, but also was part of a broader power struggle in Boston where a number of people... uh up to and including you know james franklin ben franklin's brother who was the publisher of the first independent non-censored newspaper in the in the colony. We're saying, you know, we've got to reduce the influence of Puritan ministers. And this is a club to beat, you know, Mather with, and by extension, the Puritan establishment.
significant resistance up to the point of a direct attack, you know, on Mather's life. Somebody threw a bomb through his window, which fortunately didn't explode. But, you know, no joke. And so... Ultimately, they were able to inoculate a few hundred Bostonians with almost entirely good results. several thousand Bostonians got sick and something like 14% of them.
um and you know the question was those were lives that could have been said right saved right so the inoculated people essentially all survived Essentially, there's a bit of controversy because a few died and the question was, were they already ill or had they died of something else? And the person who was doing the inoculation said, yes, they were all, it wasn't me. You know, it's hard to say exactly, but the proportion of people who suffered serious, yeah.
A huge proportion of Boston got sick, a substantial chunk of them. And it was a relatively mild strain of smallpox, clearly, because a 14% death rate was below the average. But still, that's, you know, a lot of people.
Yeah. I was, uh, you know, Boston was under 10,000 people. I think, again, I'm pulling, I should look at the book right now, something like 900 people died. So it's, you know, that's a big chunk of Boston. Right. Yeah. Um, and, uh, You know, and the objections to this inoculation campaign.
were sort of the prototype for what would come after. Some legitimate medical concerns and a lot of other stuff going on at the same time. Political issues, cultural reluctance to attempt whatever was going on. specific social enmity. Right. All those things mix in, and that's not what you think of usually as an explanation for why some scientific event doesn't happen. You do if you've read some science. You do if you know a little bit about the history, so that's not surprising to me.
Speaking of personalities and conflicts and things like that, let's leap forward to the real germs. And Louis Pasteur, I guess, is the first person to talk about. Obviously, from your book, I get the impression that on the one hand, he deserves as much credit as he gets. He really did do a lot of other things. On the other hand... Just like the more familiar examples to me of Newton and Leibniz, there were rivalries and jealousies and bitter priority disputes going on.
Absolutely. Just to put a market in, I hope we can cycle back to the story of childbed fever, because that's a really classic and important case in this. I think it sets up some of what we're seeing now. Oh, we can talk about childbed fever. Let's do it. Yeah. We're not going to run out of electrons. Okay. So childbed fever, purple fever is an infection. There are actually a number of different bacteria that can produce its symptoms.
And it happens to women who have just given birth. And it can be devastating. I mean, it's very free. What's interesting is there's a whole sort of social history dimension to it. Purple fever is described in... uh you know ancient pythagorean texts even um so people knew about it in antiquity and it you know clearly is a disease that didn't just pop up in europe in uh the 16th 17th century But there was a change that happened.
Up until sometime in the 16th to 17th century, childbirth had been largely the province of women. know, it's handled by midwives or, you know, and, you know, it's very local. So if, you know, you wouldn't have in a village 12 women giving birth in the same week, right? You know, that's not usually how it works. And reports of prayer pill fever are sparse from that period.
And partly they're sparse because, you know, this was not, you know, that community was not a writing community. There weren't journals of midwives and so forth and so on. But in the as, you know, European cities grow and power centralizes and you have things like. increasingly formal associations of medical, of experts in some sense, doctors, childbirth becomes increasingly sort of overtaken by male doctors.
And at least in the cities, it happens in hospitals where you get, you know, you do get a lot of women in the room at the same time. And that's when you start to see not just individual cases of purple fever popping up from time to time, you know, bad luck.
you know so the wrong bacteria happened to be in the lying in chamber you know that could happen um but when it happens you know in a lying in hospital you have the perfect conditions for the bacteria, the pathogens to move from patient to patient. And that's what happened. You know, as very early on in the history of the hospital, you have you have stories, you have reports of essentially epidemic.
The problem with hospitals is they're full of sick people. It's a terrible place to go. They're full of sick people. If you have a person, you know, delivering, you know, attending a delivery and then, you know, wiping their hands off and moving on to the next person, you can see where the problem might arise, right? So over the course of the 17th and 18th century, there are repeated reports of outbreaks of purple fever where dozens or more women will suffer and many die from this condition.
And, you know, you start seeing like conditions, you know, you might have sort of a two or three year run where there's just this, you know, ongoing transmission of purple fever. And again, There were a whole bunch of different theories adduced as to how this might happen. It didn't appear to be a contagious disease, right? Because, you know.
If a woman in a hospital falls sick and then a woman in a home falls sick, unless you notice that the same person attended both births, it doesn't appear that there's any connection right right the two people don't touch each other all that So there was no urgent need to try and identify a sort of course of causation, right?
But. You know, people did notice that the sort of explanations for how some derangement of how the milk was being expressed or other issues that might attend a difficult childbirth. um you know that that was that didn't really explain why you'd get clusters of cases in a place And so in 1795, you know, well before, you know, the conventional story is this is all worked out in the 1840s in Austria. But no, in 1795, this doctor in that, you know.
you know well-known center of medical research aberdeen scotland um in 1795 a a local doctor started delivering babies and and took notes on the midwives who were who were delivering babies and there was this ongoing chain of infections and people suffering and dying of purple fever
He tried a couple of different explanations. He looked at weather reports to see if there was a correlation with weather conditions. I mean, again, there was no base of knowledge or theoretical insight that drove this. purely empirical. What's going on? So he looked for correlations. And eventually he started noticing that there was, it didn't take him that long. He started noticing that there were sequences of infections.
Both he and the midwives would go from patient to patient to patient, and those patients would, in sequence, come down with this terrible, debilitating, too often fatal condition. And he wrote it up and he said, basically, you know, we're the cause. He didn't say it basically, he said it explicitly. He said, you know, it shocked him to realize that he had been the source of his patience. And, you know, he wrote this and published it in 1795.
And nothing happened. He was basically driven out of town. The midwives were furious at him for suggesting that they might be killing their patients. It didn't get picked up in London. So something happened, but not acceptance of his ideas. Yeah. And a few years later, he died of, I think, tuberculosis and was basically lost to his.
And, you know, there's no, you know, but the idea was there. And, you know, if you looked at that and you could say, OK, there is something that is moving from patient to patient on the doctor's hands or on the midwife's hands. And we need to interrupt that. That was not a difficult leap to make. but it didn't get made. And science didn't know about microbes at that era.
They knew about microbes existing. They did not connect them with disease. I know we're sort of looping and looping. One of the most interesting things in the book, one of the things I found most surprising... was that Cotton Mather, in the 1720s, you know cotton mather uh witch burner um actually wrote down a suggestion that layman hooks animaculi animacules um might be the cause of diseases. And he even got this, you know, different animacules could cause different diseases.
This was, you know, he wrote it down. The book he wrote it down in was a manuscript at his death and wasn't actually published until the 1970s. And he almost certainly derived the idea from somebody else, a doctor who wrote in this one brief mention in a British paper. And again, these ideas were thinkable. People could imagine it clearly. We have that absolute existence proof, right?
It struck no chord and the idea essentially disappeared for well over a hundred years, which is still to me, I mean, I. I try to explain it. I think I do explain it. But when you just stop and think about it for a minute, it's mystifying and incredibly saddening when you think about how much loss and pain and suffering.
derived from the fact that nobody picked up on that. Well, there's a lot of ideas in the history of science that nobody picks up on. But here's something where it's kind of obviously important to make progress on this. And you might hope that people are... responsibly searching around for every possible hypothesis to go test. You would. And I mean, one of the things to, if people listening to this take one thing out of it. The truly remarkable thing.
that Leeuwenhoek did is he revealed not just more information about something, but a whole new realm of material existence that no one had suspected existed before. You know, up until that moment, we didn't know about the microbial world, the microcosm. And it's there. And we now know how incredibly rich and important it is and how deeply embedded in the history of life on Earth and all the different things we can now say about microbes.
It seems to me analogous to the impact that we would feel if we got definitive proof of life on another planet. Right. It's that revelatory. You would have thought that that would have led to more speculation. i mean again to sort of push the analogy think of all the writing from people you know in the 19th century and on about life on other planets.
You know, that very early movie of the Lumiere Brothers' Journey to the Moon. I mean, the idea of, you know, clearly the existence of other worlds beyond our own is enormously stimulating. Well, here was a whole nother world, wholly unsuspecting. Teeming with creatures that are unlike the creatures we see with our naked eye that have different shapes and
means of locomotion that have, you know, apparently whole, you know, societies, ecosystems, interactions going on that have been there all along beyond the limits of our senses. And now they're there. I am a little perplexed why that wasn't crazier, right? You know, why that didn't make people jump more. Yeah. But just as I mean, I know I rabbit on too long about such stuff, but just to sort of round off the purple fever story. Flash forward to Boston in the 1840s. Oliver Wendell Holmes, Sr.
mediocre poet, Boston Brahmin, and medical doctor. At that point, a young medical doctor. And he, at a meeting of a local medical society, somebody raised the question about... how you can explain a then ongoing purple fever outbreak. And Holmes took it on himself to try and study it. Unlike this doctor in... In Scotland, Holmes was not, you know, he didn't have an OB practice. He wasn't delivering babies. He was a young and relatively inexperienced doctor.
And he just did this from the records, case records. And he tracked the birth. cases of purple fever, deaths and attendance. And he, you know, in a relatively short period of time, he reported back to the medical society that, yeah.
um there are patterns of infection and the common element is the doctor and you know what needs to happen is the doctor has to make sure or the midwife i mean the medical person attending the birth needs to make sure that they are um you know fully cleansed of you know whatever is going on between births um and he published this as well as giving it as a society And again, not only did sort of nothing deeply change, he got a severe and actually contemptuous pushback from established
OBGYN practitioners. And the one that really stuck in mind was perhaps the top such doctor in the US at the time, a Philadelphia doctor named Meigs or Meigs, M-E-I-G-S. Again, I'm not sure how it was pronounced. responded that it was, you know, that, you know. that Holmes writing was the maunderings of a sophomore and that what he concluded couldn't be true because, and I quote, a gentleman's hands are clean.
there you go qed right um and then you know the story sort of concludes with the most well-known one, which is Ignaz Semmelweis working in the Vienna General Hospital with the two wards where there's one ward handled by midwives who do not do pathology, do not dissect. the bodies of women who have died.
And the other ward run by doctors and male medical students who do, in fact, you know, this is part of the great transformation of medicine into a science. You do pathology. You study the diseases in the body by dissecting and analyzing the corpses. Mostly, this was this enormously rigorous and productive advance in the way you teach and think about medicine. It leads to all kinds of good stuff.
But not here. So, you know, you dissect somebody who dies of cerebral fever and guess what you have on your hands and body and clothes if you're not, if you don't sterilize. And so lots and twists and turns in the story, but Semmelweis... figures out that this is the meaningful distinction between the two outcomes. The midwife's ward has a very, very low rate of purple fever, and as many as 10% of the patients in the other ward fall victim to it. So it's a big deal.
And he says, okay, we're going to stop this. He puts a chlorine solution. that, you know, next to the autopsy room and says, you can't go back to the ward until you wash your hands thoroughly, until there's no smell left. You know, again, didn't know about germs. He didn't know what it was. He just said there's these, you know, cadaverous particles. And they're associated with death, so you've got to wash the stink of death off.
And that turned out to be enough, long enough, enough sterilization so that the, you know, when, when that was done. the doctor's ward very rapidly approached the same levels of infection that the midwives had already achieved. So it was, you know. Again, he had no idea what, just cadaverous particles, he had no idea what was causing the disease, what the pathology of the disease was, how it developed, what the chemical, biochemical mechanism, none of that.
All he knew is that when medical students and doctors walked from cutting up a corpse to delivering a baby, bad things happened. Let's stop those bad things, right? Let's just pull a wall between. And, um, again, you know, the tragedy is he was not though, though he got, his ideas got some traction in some place. Broadly, his conclusions were rejected, both within the German-speaking world and beyond.
you know several more decades before the idea of proper sterile conditions really took hold Well, and when Pasteur does eventually come along and sort of put things together and put the germ theory on a proper footing... His inspiration or his route into it was not through trying to cure diseases, right? That was a clear thing to try to do, but he was just trying to make sure that you made wine correctly and reliably. He did refer to it.
was sort of a term at the time, diseases of beer and wine. Okay, good. There was a metaphor clearly in his mind. But yeah, his, you know, the first real... demonstration of a you know of a bad thing happening because of the metabolic in the metabolic work of a of a bacterium was a posterior study of making beet juice um so he had went this was in the 1860s he had a maybe it might have been late 1850s excuse me i misspoke um
He had a student, he was a young professor of chemistry. He was not a biologist and he was certainly not a physician. He was teaching chemistry at the University of Lille, and one of his students was the son of a local... manufacturer who made beet alcohol, among other products. And they were having a bad run at the time where, you know, instead of producing alcohol, they produced this foul smelling useless. And, you know, they want to know why. And Pastor agreed to take a look. And.
eventually identified a lactic acid bacterium. So instead of, you know, yeast metabolizing sugar and water into alcohol, you had lactic acid bacteria metabolizing. their inputs into this foul-smelling, nasty, industrially useless lactic acid, hence the name, within the beet juice. He was able to say, basically, you want to make sure your vats of beet juice are free of these bacteria before you go in and give them some insight into industrial processes.
But that was the first insight where he saw that two things, really, that bacteria free floating in the atmosphere, microbes free floating in the atmosphere, could reach and affect. substances like beer wine beet juice soup whatever so there's this notion that there is potential pathogens that we are surrounded by all the time and that these microbes actually do have meaningful, large-scale physical effects on the scale that human beings occupy.
And there were a whole series. I mean, he did. There was that insight took him in a bunch of different directions. It included, you know, finally, you know, his his. often regarded as the definitive and final destruction of the concept of the spontaneous generation of life. Right. But it also took him through into a bunch of different aspects. microbial role in biochemical products.
more generally. Well, that's what I learned from that part of the book was that, you know, an important aspect of it, because it's always hard when we know or we think we know now what is going on. Like, why didn't they know? It's not that hard. But the existence of the microbes was known, but the idea that they could...
have an effect was less clear, right? People thought that for the wine thing, there were chemical reactions, sure. But the idea that these little beasties are contributing to those chemical reactions was apparently a little bit of a barrier. It was, yeah, it took a long time. I mean, it took a long time even to associate yeast with the fermentation. And then the idea that you have yeast that are doing fermentation, but these bacteria, which are yet smaller and simpler organs.
can muck it up, can produce different fermentations that lead to results we don't want. That was another big step. But the, you know, I think this is where one of the theme, you know, this is where I argue something that I think is, is I hope one of the. that people engage with. I mean, they feel free to disagree, but asking the question, why did it take so long? You are ultimately asking for cultural and social reasons.
And a gentleman's hands are clean is one example of essentially hierarchical thinking. There is a social order and people at the top of the order are not capable of and certainly not responsible for bad things happening lower down.
well there's a broader sense of that and i think it starts in religion but certainly doesn't just stay there this notion you know scali naturi in latin scale of nature and often referred to as the great chain of being title of one of the classic books in cultural history love joys the great chain of of being um but you know it's this notion and you see it in the first chapter of genesis that you know there
God, there are heavenly creatures, and then there's humankind. And all the rest of creation is given into our dominion explicitly in the text of that first chapter of Genesis.
and this gets elaborated in a bunch of different ways and you get you know by the middle ages and later you get these you know beautiful elaborate drawings showing you know an old white-haired gentleman sitting on a throne at the top, and angels with their wings, and then people, and then all the way down to rocks and dirt, you know, through the ranges. some hierarchically organized view of the kingdom of life and so forth. structure, I think, makes it easy to believe and hard to disbelieve.
is that authority goes from the top down. Authority and agency. Agency. And not the other way. Right. Effect. So I think, and again, you see those ideas, it doesn't have to be divine, you know, or the divinity and the explicitly religious framing of it can become, can drift very far into the background. The idea that humankind is superior to the animals is one that you can believe without needing to have the authority of Genesis. The idea of white people are entitled to rule.
Others is certainly one that was persuasive to an awful lot of people for a long, long time, and perhaps to some folks. Still, you know, the idea that there is a hierarchy of agency and authority is one that persists in lots of different. And I think it mattered here. I think it was very, very hard to imagine that microbes...
which were delightful to look at, and it's wonderful to be a tourist in the microcosmos. The idea that they could turn around and have agency or impact on... us crowns of creation it's a very hard hard thought to think you need to i think and and that's one of the things i think i chronicle in the book you need to accumulate a lot of um you know ideas and uh
And specific instances where you see something is going on in the disease process that needs explanation to really kind of let go of the idea that. in some sense the bad things that happen to humans humans do to each other yeah that's an easy idea easy idea to master you know but uh but to extend that and say well you know Despite our big brains and our, you know, opposable thumbs and our tool using these, you know, single celled, simple creatures can really mess us up.
That takes some thinking. Okay. And do we properly give Pasteur credit for finally saying that out loud, clearly for everyone to see? I know there was some... I mean, yes, I think Pasteur and Robert Koch are the two people who are most associated as the major founding figures in germ theory. And yes, they did. They were enormously. You know, they had enormous impact. They made major discoveries. They were rivals. Pasteur really did try to undermine...
Coke's sort of claim of unique discovery with the anthrax bacterium. Probably, you know, Pasteur did important stuff with anthrax, including coming up with an anthrax vaccine. He certainly overstated and he did mess with Koch. Koch did not take that well and responded really in very hostile and even more belittling terms to Pasteur. Most of that just doesn't matter. I mean, it didn't matter at the time. Both people went on and had the careers they had without really impediment.
It just clearly pissed them both off. And there was an enormous – at that point, I also remember there's an enormous – franco-german rivalry exactly yeah stomped france in the in the war of 1870 um so there was that nationalistic animus as well um but again it's important to realize that um Pastor seeded some of the first major derivatives of germ theory. News of his work on yeast and fermentation. reached Joseph Lister, a doctor practicing in Scotland.
And Lister realized that if these bacteria lurking in the air could contaminate beet juice or beer or what have you, then they could also perhaps... explain the terrible problem of surgical wound site infections, which were basically made, you know, much surgery impossible to do and many surgeries very dangerous.
you would have a compound fracture of a limb and more often than not surgeons would amputate rather than treat because the likelihood of infection was so high that kind of And Lister invented essentially sterile surgery and showed that you could, in fact, if you. did you know originally very elaborate work to try and you know wall off the wound site from bacteria you could in fact perform surgeries that had you know previously been
fraught with danger or simply unthinkable. I do want to... Go ahead. I'm sorry, go ahead. I was just saying, that happened in the 1860s. Tragically, it happened just after the Civil War. Civil War was tough. Yeah. And, you know, more people died of disease and wound infections than died of, you know, immediate battlefield trauma by like two to one.
Well, the chronology is definitely interesting. So I wanted to, you know, again, skip to the highlights here. But vaccination, now real vaccination, becomes a real thing. predate again Pasteur, but he had a famous experiment with the sheep that I really loved. I mean, it's famous in some circles, but let's pretend that not everyone listening has heard about it. Okay. So as I said, Pasteur invented an anthrax vaccine. Again, one of the reasons why it's always...
fraught to say, well, Pasteur was this great giant colossus of stride. People had identified a bacterium with anthrax case. Before that, these rod-shaped bacteria were showing up.
you know people actually explicitly wondered if they were simply a correlate you know you get sick with anthrax and that makes your body your body less you know able to defend itself against you know the slings and arrows of outrageous fortune and these bacteria are opportunistically you know making their home in your bloodstream that kind of thing um nobody actually sort of definitively established these bacteria where the pathogen until Koch did it.
But there was this, it was certainly known that this bacterium was present in essentially all cases of anthracite. uh by you know a decade or more before pasteur started working two or three decades before coke uh got got his uh got his interest going so um Koch identifies and establishes and nobody, you know, it's now, you know, clearly the correct answer that this one particular bacterium is in fact the source of the symptoms of the disease. when they infect an animal or a person.
And Pasteur works to... His basic method was to try and pass the bacteria through repeated animals until it was attenuated. keep, you know, recycling it. And, you know, he tried different aging them in cultures. And there are lots of different ways that he worked to try and create less pathogenic versions of the microbes. And he eventually got it. Again, there's a little controversy. Did he in fact have a live attenuated?
vaccine by the time he did this famous experiment or had somebody worked on actually a killed version where they fix the bacteria in some chemical. There's, you know, the notebooks are a little funky there. And he announced that he had a vaccine and some anti-germ theory, an anti-germ theory doctor said, prove it. and challenged him to this test where he was going to take, there would be two groups of sheep.
I think there were a couple of goats involved as well. And they're going to separate them up and half of them, all of them were going to get injected with anthrax. So, you know, given the disease and then half would be, but half would have been previously injected with the vaccine and half would not. And Pasteur said, okay, and took his vaccine to this farm not that far out of Paris and did the test. And it was one of those, you know.
like they draw it up kind of experiences where basically all the control group that went unvaccinated died and all the vaccinated animals were, you know, happily gambling around the field. And it was regarded and presented certainly in the popular press. really good at representing himself in as this sort of clear triumph and clear demonstration of the truth of germ theory.
You know, it's one of the things we didn't—you wrote a long book. I'm sorry, Tom, but we didn't get to talk about all the cool stuff. People should buy the book. But one of the themes that comes through, aside from the sort of establishments always resisting you, is... the effectiveness of good science communication, and in particular graphic design. You know, Florence Nightingale, Jon Snow, and certainly Pasteur was a master of publicity.
They got their points across not always by just having the better data or theory but by being a little – there's some showmanship involved as well. Absolutely. you know, that's no surprise. No surprise at all. When you say it that way. Yeah. It's just, I mean, I guess what's surprising to us with our present presentist bias is that they figured that out, you know, back then, but you know, again, Robert Hook.
you know, that book, Micrographia, he, you know, he, he wanted, he wrote that book to sell and it did. Um, uh, but yes, uh, It is interesting to me that, as you say, Nightingale with her, essentially the invention of polar diagrams, Nightingale was a formidably... intelligent and gifted person. She had an unusual education for aristocratic young women or elite women of her time. She did have some training in mathematics. And she really...
had a gift for data representation that Tufti would have been proud of, I think. You don't think Florence Nightingale, graphic designer, but very much that was in her wheelhouse. And she was able to, you know, these lovely circular, she called them coxcomb because they were supposedly vaguely like that, you know, thing on top of a rooster's head.
But, you know, you could really see the change in death rates from before and after introducing, you know, proper hospital hygiene in the Crimea, Crimean War. And similarly, Jon Snow's... sort of gift for graphical representation, map-based, geographical, I'm sorry, not graphical, geographical representation of data, again, made his case that
Small, not smallpox, cholera was a disease of some specific contaminant in water. I mean, very, very difficult to argue with. I mean, people did, but still it was a very persuasive. Yeah, just so people know, like these are maps of, you know, block by block, house by house in London. These people got it. These people didn't. Here's the water supply. Draw your own conclusions. Right. It was, you know.
It was even, you know, it even sort of accommodated the fact that London's streets are this ridiculous tangle. Exactly. Because, you know. Snow was able to show that even though... some of the cases of cholera that were centered on this one bad source of water, the Broad Street pump. that some of those seem to be quite far away and there were other houses nearer that weren't affected. But he was able to show that even though the Crows flight
birds flight distance was greater to those places. The actual distance through the streets to the water supply, all the cases were In houses where the closest water supply was that one pump on this street. He was good. And despite all of this human genius, we can wind it up by coming to the present day. Not everyone is convinced. I mean, maybe before explaining that not everyone even in the present day is convinced.
not just the efficacy of vaccines, but even, I hesitate to say it, but some people are a little skeptical of the germ theory of disease right now. remind ourselves how effective vaccines have been in making the world a better place. I mean, you paint a vivid picture. You say you cure disease. That sounds good. but a wholesale change in life expectancy and demographics more generally that we kind of take for granted.
The the one message I'd like to leave with anyone listening to this is our release from the fear of infectious disease is, in historical terms, incredibly.
people are familiar with the story of of of you know public health infrastructure you you know you create clean water you create uh you know you you get clean air you reduce the incidences of all kinds of diseases enormously if you just did that it would be a huge change But the combination of vaccines and antibiotics means that for at least people in the developed world and increasingly in the rest of the world. diseases that were once inescapable are now
or curable really readily. And in London, as late as 1900, there was still a significant rate of infant and child mortality. And that basically is not a problem. The fact that U.S. child mortality, infant mortality is worse than the rest of the developing world is a fact and a serious problem and has. social and political roots, not medical ones, we know we can prevent these maternal and child
a social choice, even if we're not conscious of making it. But broadly speaking, In 1952, there was a terrible polio outbreak in the United States and thousands died and more were affected with lifelong consequences. And two or three years later, the first polio vaccine came out. And that threat, you know. Our parents or our grandparents were terrified to let their kids go to the swimming pool in the summertime in the 40s and 50s.
you know, that's no longer an issue. The vaccines against common childhood illnesses... There were a couple done before the Second World War, but most of them emerged between 1950 and the end of the 1950s. That's not very long ago. It's recent enough so that I... And though I'm sure you wouldn't think to look at me old enough so that I was a kid before the rubella vaccine, which was the last in the list to show up, was available and I caught it.
German measles, it was also called. And it was really unpleasant. And I was lucky because there are possible lifelong consequences for rubella and I didn't get them. So that's great. But, you know.
And now, however, or up until very recently those things were i mean measles was declared eradicated in the us uh around 2000 it's back um the uh you know up until very recently No one no parent had to had to seriously worry that their child would be killed or damaged by diseases that for almost all of human history were devastating companions just things that you had to deal live with um so uh
And again, I think there are a lot of different reasons for this. There are explicit political reasons. There are just the fact that amnesia, this sort of this... lack of experience means it's very hard to credit that the threat exists. That's a human... perfectly normal human reaction to things. If you've never seen it, it's hard to believe it's real, right?
But the anti-vaccine movement and more broadly, the sense that public health in general, not just vaccine regulations, but the other things we might do. like, you know, wear masks and physically separate during COVID. These are seen by, I think, too many as unwarranted intrusion. into the individual liberties of everyone.
That's not precisely the same as the kind of hierarchical chain of being kind of stuff I associate with the difficulty of getting to germ theory, but it's clearly a kissing cousin. You know, there is a sense that there is a, you know, still a hierarchy of agency. is inviolate right and you know other you know it's uh And you see that happening in our politics right now. RFK Jr. is...
His HHS is rewriting vaccine guidelines to emphasize that vaccines are an individual choice and that there are complications and all that sort of stuff. There are risks to vaccines, et cetera, et cetera. And this is very much locating. the choice and decision-making power over the sort of creation of these ecological niches for infectious disease. It's locating that in... you know your choice and my choice and everybody else's choice and um
You know, if the consequences of those choices were confined to the individual, that would be one thing. But one of the things about infectious disease is it is, wait for it, infectious. It moves from person. So those choices have impacts beyond the individual. And that's something that we find in our society right now and in our politics right now, something that's very, very difficult to accommodate.
And it's also a case where, you know, you can believe whatever you want, but at some point as a scientist, I do believe there are objective facts out there about how the world operates. But there are crucial differences in the timescales and tangibility of those facts. You can think you can walk through a door, but if you try it, you will instantly figure out you don't.
You can think that vaccines cause more harm than good and you can get away with it for a while, right? You know, for... months years whatever other people are being affected i'm not being affected and so it's just so much harder to overcome all of the human foibles in the equation when there's that much wiggle room in something, a complex system like society, politics, medicine. Absolutely. And I should emphasize the.
One of the things that's happened, you know, there was vaccine hesitancy from the very beginning. And in earlier times, there was generally more reason behind it. Vaccine, like any other technology, has advanced and improved over time. One thing that's really different in 2025 than was true in 1970 or 1920 or 1850 is an understanding of... disease and immunity down to the molecule you know molecule or atomic level right um these are extremely well characterized
You know, it's not that you know everything. There's lots and lots of stuff that is not known about specific mechanisms and pathways and all kinds of stuff. But an enormous amount is known. And the mechanism by which vaccines have their... the reasons why some vaccines confer lifelong or extremely long-lasting protection and others do not is part of the interaction between vaccine and pathogen. all these kinds of things. These are understood. They've been well-characterized.
And there's no room for doubt anymore about the fact that A, vaccines work, B, how they work, and C, what their limitations are. And D, what the consequences of rejecting all. can be. One of the things that happens is if polio were to escape, I've seen model studies that show that it could very, very rapidly produce extremely large scale. because the global...
The global state of polio vaccination has been waning since polio has been eradicated. Why do you need to vaccinate? Well, you know, it's gone everywhere in Afghanistan or Pakistan. And the only reason you'd vaccinate. is if a you know a case showed up yeah yeah so the you know The risks are real and growing.
And one of the things you'll see is, as I suggested earlier in the book, that some of the issues in thinking about microbes were unrelated to anything to do with the science of microbes or the natural history of microbes. But, you know, well established social and cultural. predispositions well similarly right now a lot of the anti-vaccine stuff is now has sort of leapt the bounds of say the autism community where they were
terribly misled by that early paper that suggested falsely that there was a connection between vaccines and autism. Now it's left the bound. But I think for an awful lot of people, So being anti-vaccine is not actually a statement about what you know or believe about how the immune system works. It's an affinity marker of I'm with this group and this group has included as part of its political catechism that vaccines are a bad thing.
Yeah, we just talked about that literally recently with political scientist Liliana Mason. And I mean, you and I both know that 10 years ago. If you said it's so annoying that conservatives are denying science like climate change or whatever, you would get the response. But, you know, the liberals deny vaccines or modern medicine and so forth. It's shifted quite a bit for obvious reasons. It has. And again, it's not surprising. All of us offload some of our knowledge and judgments to...
We don't have time to become masters of many things, much less everything, right? So if people we admire and respect say, you know, the sun rises in the east, we don't actually need to go out there with a compass and make sure of it ourselves. and that's true for all kinds of things um so when you know too many political leaders um You know, make make political hay out of. you know, opposing vaccines or what have you.
It's not surprising that large sections of their followers would say, okay, well, I don't need to go study that myself. You know, Joe Rogan or whoever says this and and, you know, he wouldn't lie to me on the radio, whatever. Robert F. Kennedy says that, you know, he's the secretary of health, you know, health and human services. He's not going to lie to me, etc.
And you just go on about your business. And again, it's not surprising. It's very human. We all do some variation of that. But in this case, it has tragic and fatal consequences. So don't take it personally, Tom, but after the podcast is over, I'm going to go wash my hands. You put the cleanliness into our heads. But Tom Levinson, thanks very much for being on the Mindscape podcast. Thank you so much for having me, Sean.