tv Vidya Krishnan The Phantom Plague - How Tuberculosis Shaped History CSPAN April 14, 2022 3:09pm-4:11pm EDT
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want to go deeper into tonight's topic by producing your phone copy of her book. please use the link to pick up yours at third place books one of our many terrific local booksellers. beginning her career as a pioneer in the second oldest english-language newspaper, vidya krishnan held a 20 year career, reporting on medicine and science including recently extensive reporting about india's response to covid-19. she's written for the atlantic, "l.a. times", and for the british medical journal . vidya krishnan is the recipient meme fellowship e from harvard studying the impact of the behavioral antibiotics and an international health media fellowships award, global health journalism fellowship from oxford andnational press foundation s fellowship among others . amber payne is editor of the emancipator at boston globe and also a nieman fellow and
formerly served as managing editor of dd.com and as executive producer of both the vote and then. chris vidya's new book "phantom plague: how tuberculosis shaped history" is the subject of this discussion. join me in welcoming amber c-span payne and vidya krishnan. >> thank you for the introduction andvidya, it's great to see you again . >> thank you for having me. i will say i have a slightly unstable connection but we will see how this goes. >> we'll see how this goes and as i said when in doubt just want to start reading chapter 1. we have technical difficulties but vidya, we met as nieman fellows at harvard last year and you were always talking about tv,
always talking about tuberculosis and we knew you were working on this book. we didn'treally get it . we didn't get to. and kind of through the year as we got to know you and more about your background as a journalist, as a health and science and medical journalist and reporter, investigative reporter it started to come together but it didn't come together for me until i read your book and it's incredible but can you just 'set the scene for those here with us today who don't know you. what really led you to this very deep dive? this definitive socialhistory of tuberculosis ? >> thank you and i have been obsessed with this pathogen which i thought i have to write a biography about because the desires have been
building in my head for a decade. it also came in, it had a unique personality and i just can never stop talking about it and my friends at some point asked me to stop talking andstart writing which is what i did . i tried to put in as much into the book to kind of get other people interested in tuberculosis and starting with dracula although he does have to address that. >> let's talk about dracula and what does dracula have to do with tuberculosis. this would be a good time for you to read a passage from your book. >> thank you, i thought you'd
never ask. i start the book with an episode and i'm going to read a portion which kind of sets the scene for what people do. these things are just beyond human comprehension. goingto try to dive right in . it is okay, i'm going to dive right in. it's no coincidence ... [inaudible] track ella was terrifying and most citizens. it's also known that dracula lies in the honest of september. like all aliens dracula came with a strong anti-english sentiment.
the vampire brings us an anchor of the race. the book emerging from a whirlpool which is a scope of the late victorian debates in the east end of london and jewish migrants. their burgeoning numbers bring moral and physical affections to britain. empires have been a part long before stoker's novel. in the 1890s the short story the vampire is often credited .. he sent us trolling through the ancient folklore. but in dracula he gives us an
threat worthy. a word that can mean dragon ls but also mean devil. d he reaches london before he began navigating. vampire hunters in the novel, abraham van helsing were doctors as well as explores explorers in vampiremore. they're on a mission to destroy the invader . during this time they are reflections of each other. dracula is ena singular collection of medical anxiety . especially at the time in the most devastating example of this was the pandemic of 1817 which began in bangalore india. in southeast asia this was
the first of several pandemics to sweep across asia and europe during the 19th and 20th century. dracula traveled the world for hundreds of years, but it's what they could have been. the british army in an island of java recorded 1 million deaths so to those in london they never came from the east as was customary. there was an ongoing debate on how the disease would spread and dracula captured it perfectly as an integral element inthis book . >> you definitely start with this origin story nof bram
stoker's dracula which i thought was brilliant to make this clear connection between this hysteria and the terror of the infectious disease. the lengths we've gone to to historically find a cure. you give me some sympathy for dracula. he seems a little misunderstood. talk about that era. that era of medical discovery . and how this framework you use is still a cultural touch point that extends to present-day . >> there's this bizarre thing where it gives us a mural to understand something that we cannot understand that's what i found fascinating with dracula. and who i have a lot of sympathy for. likely the real guy glad the inhaler was so misunderstood. and jumping out that one
character would you have wknown? i'm finding you combine that with an aura of pestilence. it's such a twilight zone kind of it into because we are back again. we are again facing a pandemic and we are again facing nihilism. and there is a tsunami of misinformation which may not be here in the us but in india it's just, i finished this book before the pandemic began and everything that the pandemic started mainly me realize how we need to go back to the origin stories.
we just take for granted and science is a gift that we need to value as a gift. part of what this book does is using different stories. through the book you find the ghost stories but their stories within stories and i hope you find this interesting. >> definitely. you trace the spread of tv from the us and europe in the 19th century to developing countries and it's flourishing today but give us just a brief rundown. the state of tv today and how did mumbai become the epicenter and such an incubator of the disease? >> we have 4 million infections.
the pandemic actually worked because of the way it was in lockdown so things are worse than they ever been for tb patients. last year 1.3 million people died of tv and there are key myths about tv. people think it's a disease of the past. neither of those things are correct. people think that it's the disease with one origin which is lungs. this is also not correct. tv is like cancer. or tv in the spine. and the last is i think curable. it needs to be curable e when we treat antibiotics. there's such overuse of antibiotics.
especially with the pandemic. but we know how to ... [inaudible] the most powerful antibiotics in medicine so i feel like ... [inaudible] you tell the story of a few women . you point to this, there's either a lack of treatment, overtreatment, the wrong treatment. i learned about these drug resistant forms of tv. i wonder how, the question is how is that still happening but i wanted to reference you wrote in chapter 5 called antibiotic apocalypse on the move and you wrote when
you're talking with these doctors, listening to the doctors talk about antibiotic resistance is like hearing characters in a horror movie as they navigate limited options . one doctor joked about being point in the film whereyou realize the call is coming from inside your own house . connect us all to this issue of treatment. >> in particular that's what it seems like at this point. we now know because of the pandemic that lujan has just engulfed the world through the antibiotic apocalypse in the slums of mumbai. for now it's flowing in the ghetto but we now know it's a springboard and it just springboards out. and it feels like they're
stuck in a horror movie it's because they increasingly on a daily basis see patients where we are back again at the point of where all doctors can do is watch patients die and that is often a type of misusing medicines. we are completely not understanding medicines but also india like the us again has a problem with their healthcare system so doctors are not incentivized to, there incentivized to give the treatment that keeps the patient as a client or you know, what there incentivized to enter extract as much money from teach patient and in particular all that has added to what is now most medical negligence because if you're poor you're treated
dignity and compassion and your undertreated and if you're rich you're overtreated but between these two there's just motivation in tv treatment. doctors are going mad looking at this and that's why one character was trying to say, i will say he captured it in a very visual way by comparing it to a horror movie. that's where we are at. >> definitely. it's an important point to that you make that it's not just, it is mass medical negligence. it's a patient killer and it doesn't really discriminate between the rich and the poor. it's finding a way but we can't talk about india without talking about thepast and about race and isracism . you draw parallels even between cast and race and the
system of discrimination among the east and the west ut so i wanted to talk more about that and how tv and other laces have been fueled bythis deliberate as you call it deliberate architecture of unfairness . >> thank you for that question. one of the things that's happened in india as we are in a postcolonial nation. which is why i had to leave the health deficits that would be in the refugee communities and minority communities in african-american neighborhoods and they are particular studies i rely on to make this comparison between race and cast also i find myself in this twilight zone i live between the us and india and it's such a unique position to be in ask
someone who writes about social injustice because you see these two completely different systems of discrimination, mostly because it's skin color and is easily identifiable. cast in a country where like india where everyone looks the same is so much more insidious but the effects of it, we're seeing minority communities and poor neighborhoods and then there's poor sanitation and they do not work in these neighborhoods the way they work . and all of this leads to more infectious diseases but also more crime heand then there's this way of talking about neighborhoods like the bad neighborhoods, the people who live there so the neighborhood is filled with
criminals. that's a common thing to say in india where you don't talk about neighborhoods that way. and i feel like it's unfair to make this comparison. often it comes down to the same point because how different these systems of discrimination are, this has the same precise impact on minority communities twhere they don't get healthcare, there in some human housing. and that every time they are up against the health system, they are making their dignity and i use systems within the book, the los angeles drive is something i talk about to make a comparison to indian neighborhood but i also thought about this dusky child where the entire country was being treated when the population was
denied over and over again and once you talk about medical apartheid, you can't talk about infectious disease without talking about class and gender. >> the section on trustee, i feel like i learned a lot there as well .. i feel like we know it, we've heard about it but of course we don't get to learn about in school unfortunately but i was interested in how that fits into your exploration and you also went into hiv and that struggle across the board and you drew these parallels in medical yhistory that i think are important and are relatable for all audiences but going back to the drug, to squash this
global health epidemic, tb. start with tvthere are other issues . what did you learn, kind of can you get a couple of examples of things that you felt was to dive into and i want to get to just the question of how do we reform the drug industry but let's talk about these drugs. and the issue. >> again, i live between the us and india and india is the pharmacy of the .world. but what we do is basically manufacture drugs at a fraction of the cost for american pharmaceutical companies so for example pfizer , when we outsource the drug making to india, make it at a fraction of the cost. the drums will be exported back to the us but they
slapped charges on jit which are not justifiable anymore and one of the things that i hope the book forces is that the price accommodations cannot be had in silos. again the patients on the same. other technologies n, are even having the same collimation of disease? there are monopolies that are enforced on the rest of the world . all the ways laws are drawn up, developing nations, one part of this was one of the things we cannot talk about drug pricing without calling
into question the moral morality. it says that this is not the cost of intervention so it's a country where you have systems like coaching because we don't have a robust health system. anyway, it's a long winding road tsaying that who decided to have a conversation about an economic safety? i don't know who decided at what point that it's okay to let people die. isit's there's morals underlying this and it they don't have these and was is profitable for them. we have these cost-effective measures and less effective measures.
>> i don't want to call it unjust. but it's just unjust. it's unfair and there's no way of beating around the bush. one of the things this book does is talk about medicine as a knowledge monopoly. and that's not been done before. using tv as an example but the same time this book was written before the pandemic began and i think that's a change. everything that i learned in the last few chapters has come to pass andit's been very frustrating to watch that . >> it's pathetic. because we draw this direct line between colonialism and patents of these
pharmaceutical drugs and technology so i wanted you to sketch that out for us. you spend a great part of that, that great chapter explaining the issue with the patents . can you sum up the issue with patents and tv drugs ? >> this again came from this frustration. we are constantly told anby pharmaceutical companies that the quality of drugs in these countries have been manufactured is not good. but they outsource all their clinical trials through lack of donations which is why i think the book gives me the skills to dive into the story of the origin of intellectual property law which began to be in mission in 1883 when
there was a scramble in africa and asia. and when files wanted to regulate trade and what we do through the 21st century in these laws and india again has become the british empire had property law long before most european nations. we had one in 1856. all of this kind of comes from a very unsettled result where you manufacture raw materials but they cannot ever demand the quality. as well as these laws in the late 19th century. working with the intention to roll the dice. and they currently roll the
dice in favor of multinationalcorporations . intellectual property historically has been to promote diverse nations. so india when it was invaded we were manufacturing ships and all of these spices but when the british came in, they used raw materials, british textile industry attacked the roots of this. this has always been recent. it's not just india. it's not a coincidence that more people from the pandemic are dying in black and brown nations. this is not a traversable infectiousdisease .
in my country they do not have a booster shot as yet. >> it's maddening. we're going to start to take some audience questions. everyone feel free to continue to submit questions. but i do need to ask about bill gates. and the gates foundation, huge nonprofit. given up 60 million in grants since they began last year alone. they funded work in 134 countries there appeared in the space of health equity research, development funding . but to quote you, you write bill gates has adequate the mind of a genius and the morals of the. let's talk about. >> thank you for that question. so india is the largest
beneficiary of the gates foundation and my entire career as a health reporter i've been with mister gates quite a few times. and mister gates wants to solve malaria. we have a disease with coronavirus has been canceled but what he did was the oxford university funded vaccines. he handed it to an indian company as a package monopoly so only one company in india manufactured their jobs. for the rest of the world. and it doesn't take a genius to find that concentrated supply for the world. i don't know if you remember the devastating second wave they had six months ago and
that drove the vaccine supply to 91 countries and all of this is because mister gates is one of the champions of monopolies and for the life of me i cannot address how they keep talking about this complicated ways to get vaccines to poorer countries when the simplest and most t direct way is to fund more technology and let these nations manufacture it ourselves, manufacturing and exporting it to them. i do quote a nigerian in the book says charity is the opium of theidrich . that's the crux of what the gates foundation again, the moral opinion or way of making healthcare available
is to not fund healthcare. it comes from a completely nsunsettling view of the world. i do feel the last is just incapable of looking at the world without giving itself the role of thesavior . and we keep coming back to or we saw this during hiv where just in africa which is where the best work, the minute you elevate charity to some high principle of justice, what are not talking about is the profits the companies are turning red and the gates foundation needs to come under scrutiny i believe. mainly because of their toxic kindness. what they get from that charity is this position of superiority and the gates
foundation is the largest polluter of it. his foundation also hires companies on export and there's too much interest. this is a man not elected to public office, is not a scientist, he's not a doctor . he has much power and no one questioning it. that's again something i wanted to talk about in the book. [inaudible] >> yes. thank you for breaking that down. you have this example in the book to of an hiv drug that was going to be given for free. can you just share some of that moment and how that actually proved to be a watershed moment for hiv drug pricing? >> when the hiv drugs at some
point the hiv drugs were not available in india and africa because they were priced at $10-$15,000 per patient per year. most people in the us cannot afford it and i go into how this hiv drug was entirely funded by american taxpayers. but what happens to the entire portion of the research and development of the drug is subsidized either by universities, most of the drawings in the last two decades have come out of universities . but the minute they get the potential to get to the market, is acquired by a pharma company and the social role of medicine is the secular purpose of this becomes pharma companies.
the hiv drug what happens apis easy he is a meat that drug for another day and it's a watershed moment, the crisis came crashing down this summer they were literally starting to cost $16 per patient per year. and that anis the early 90s and around the same time they went into force in 1995 to make sure that something like this never happens and the company supply was headed by a family making pharmaceuticals at that point . for making the drugs
available at cheaper rates where in africa and in asia, this whole colonization as someone who lives in the south, my career has been writing about infectious diseases and watching people die like flies. that is the urgency through the point of view of people and that's what i do when i talk about the hiv mmovement. people who died from hiv we need to don't need to keep making that mistake so iemillions of people have to die to commit to someone in the developed world.
these technologies don't even cost money. >> that's a great point. going to go into some of our questions in the chat and there's one question here. we have been so aware of the covid vaccine disparity between rich and poor nations. are there other vaccines that this is the same problem for and we just haven't acknowledged it ? >> absolutely. the cancer drugs are a big problem. tv drops, i go into the book by jacqueline and that drug is a genuine example of public health communities coming together, funding are in the four vaccines desperately needed and the drug became available monday to a monopoly. egypt is one of the countries affected by hep c and this grant program is more expensive than gold.
one of the things again we see the same things. these are taxpayer-funded drugs. one is funded by german taxpayers, one is funded by indian taxpayers, american taxpayers. just athey don't want to share and iit is coming back, one of the things that is a big frustration is where someone like bernie sanders talks about trying to help and where he saying the most nonsensical things but the one about access to medicine and right to health is a global one because what we have is a global monopoly, all of which are based in the us or japan. and these patients also start having this conversation as a global one, we cannot hold
the system to account and to me all of it beginswith control . we cannot have drugs or legally the same way we did. it's just not sane. >> yes. our next question going back to the discussion on gates. are you suggesting the who in global health would be better off without bill gates financial contribution? what is anyone else doing in the us that is making a tangible difference ? >> this is a complicated question. but if i have to say yes, they would be better without the fundamental course of funding here. again, there's medicines and patented medicines, there's something called chthe medicine packing school which is an
ideal based in dc. available on site but this is an example that there are 100 ways to fund global health where this one says that countries olcan pull together the money and then give it to countries so they can then manufacture drugs for tb or malaria or whatever. but the thing is pharmaceutical companies are not ready to sell the package. they don't want to open their books peto say exactly how much they spent resourcing. what they say is it's one has to pay for all the failures that came beforethem . with who again, it's not an
american organization. but what now does, the public had a brilliant essay where it said and i quote it in my book. what we see is a hostile takeover of who by the gates foundation . this becomes monogamous for for a certain philanthropic organization h. it comes at the cost of black and brown national health and these are the reasons why global health has never been here. we're at a point where we have many challenges from climate change and multiple infectious disease, pandemics and they are all on the move. will we get to the point that we have to stop making hills of people and again, the gates foundation for years
has been throwing money at india's problems but none of them have found structural fo solutions that we can make hospitals better because then that means that justice means it has to be continued in four countries so big philanthropy can come and help and the biggest example of this was in thesecond days . india had never seen investment like that and we carry intergenerational trauma, and they're invested in their goal. so short answer is it's not a solution to our problems. >> thank you for that question. here's another question. you've been brainstormingthis book for years . what was the real push inspired you to start and how
has your research or perspective changed this? >> i wish i had an uncle that was knocked ... [inaudible] i write about this one who had to go to court and that kinda shook me and i still cannot reconcile ... [inaudible] we wanted to protect the patent of an american company and this teenager is an example of how ordinary families are getting just destroyed. i just can't recording it as a longform essay.
eventually i had someone who did an intervention and at that point i had 25,000 words . they made me realize i have a book and maybe write a book proposal which i did very grudgingly but then i did find a publisher. how has the changed me? i kind of feel the one thing that i learned reporting on the book, i did end up spending a lot of time in the us. it's that you need more black and brown solidarity. i realize how callously people can do this. when i was in india i realized how the system was not solvable but when i spent time in the us and in the us,
black and brown communities have mortality for the same, living in the same cities. it kind of made me realize how we need one unified voice if we are to talk about trying to help and i really hope the book achieves that message. >> thank you for that. another question we have is what is the biggest myth about tv and what did everybody know? >> i will say people are traumatized. i had some work saying i had nightmares.that i had tv but the biggest myth about tv is it affects just belongs. and i write in the book which is why i focus on patients.
i write about one kid who has tv in her ankle bone and tv in the brain, and is not known but this is my reason. i profile patients who had tv not in the lungs because the community doesn't realize tv is exactly like cancer. and it's exactly as toxic as cancer. so yes. >> another question. i'm a nursing student at u of w which departments office person do i contact to actually contribute to global health? i'm frustrated because so many health clinics in my hometown throwaway expired doses ofvaccines . >> yesterday i was reading about how canada is making millions of vaccines and i
believe again, i do not know the solutions in the us or canada as much but i am a sociologist by training and i do believe that the solution to this is in the politics of contacting your local representatives. one way to start is these vaccines are desperately needed in africa and its hard to watch it just expire or when i have lost so many friends and family members in the last few years t who would have lived if you know, if we just learned to share and be kind are to each other and i do believe the solutions for this medicalproblem are political . >> connecting to covid, i
wonder if you could talk about how covid has turned tb into a bigger threat and what can be done about that? >> so in countries in high border countries such ias india and south africa are two of the countries with the highest borders. what happened enwith covid in india was terrifying because they could not reach health systems or get the medicines which meant that because they were lumped in with their families they credit that disease to their loved ones and it has been heartbreaking . i keep getting emails from tv patients saying i'm terrified i'll infect my mother.
and all of these things have actually also resulted in a different in people using our health systems, the health systems so i feel like the next couple of years will see an uptick in mortality inbut i do believe that our opportunities here are something like the nhs will stop the world war and every time i am optimistic because why tv, it's overflowing with funds. these diseases have never had that retention and the opportunities we used to diagnose can be also used d to treat tv. and there is a way to kind of nudge programs the same way as many pennies nudge systems to screen someone who's
coming in because they're likely to have an opportunistic infection. these are all solutions but i do believe in the next couple of years if health systems and again, health ministries and politicians are it's going to change. >> .. it's an opportunity to address science all of this. >> i didn't expect to hear you say that. [laughter] >> it's very offbrand for me.
[laughter] >> but that's realistic. we have a question and we just have time for one more so if anybody has anything, get it in there. what are the reviews in your book like in india versus the u.s.? to find both parties picking up on certain things? >> the book has not been released in india. i am very nervous about the because it became the book, it's a compilation of stories i was not allowed to report for the newspaper i was working for so i remain on edge about the reaction in india. the reaction in the u.s. i will say, again as someone who has american friends and journalists
get frustrated by someone like me would not be allowed to make this about the u.s. but also india. i am thankful, i do hope -- this is why weec expect more from the u.s., we leave believe in the u.s. because something like that in my country and such a political commentary on something so uniquely indian, glad allowed and i'm glad i have the privilege to have that within this base.
>> the countdown to april, april 1. i didn't get to talk about the cast equality movement, we talked about cast a little bit and in your book you described how it was inspired by the civil rights movement in the united states. can you share about that? >> thank you for that question, i s am the geek. unique between india and the u.s. he came to india and he visits most countries, he went back and launched this which inspired the hiv movement which many movements but also in india,
this, this is why i believe in the need for black and brown solidarity across nations and it's such a beautiful but fragile relationship and i was surprised not enough and i was happy to be included because it's entirely in keeping with the jim crow era or south africa were very few people know about it and we talk aboutt how it impacts many other
ways, education for example but we never foregrounded in conversation about access to health movements. >> i think your example is a good one, the journey we go through the book and it's all interconnected, i think you really weaved the story well together in these different parts. last question, you did touch on some hope but really what do you hope the take away is from your book? >> thehe book ends with a very strong call for the properties
or negotiating such that it gives equal value to brack and brown life, not just for controlling black and brown countries for the patient who lived there, i do hope if there is one take away or two takeaways, i would like for the toxic medicines that are making patients go deaf but they are used because other medicines are not available, i really hope government is listening, they give, take out injectors that are toxic. have a conversation that's more realistic about the laws without accusing the people of being to
emotional, it not an easy conversation to have but we need it now. >> thank you so much. it was a pleasure and honor to talk to youin about your book especially since you and i and other fellows made at trip to mercy brown's grave, do you want to explain who i that is quick? >> remains buried in the chestnut hill cemetery in rhode island and i'm lucky when i was in m boston -- [inaudible] i hope you pick up the book, it
has a lot of humor. >> it does, it does. get your s copy, thank you so much. back to town hall. >> thank you so much for leading this conversation, it was nice to have you here. thank you for calling in from your beautiful location and thank you for zooming in with the panel tonight and educating us on your beautiful book and i am so excited, i know it's going to be great and i am so excited for you. >> thank you so much, this was such a pleasure to talk with you. ♪♪ >> book tv every sunday on c-span2 teachers leading authors discussing their latest nonfiction books. 2:00 p.m. eastern coverage of the virginia festival of the book in charlottesville, other
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