99% Invisible: Everything Is Tuberculosis – Episode Summary
Release Date: April 8, 2025
Host: Roman Mars
Guest: John Green
Introduction
In the episode titled "Everything Is Tuberculosis," Roman Mars engages in a profound conversation with John Green, renowned YouTuber, podcaster, and bestselling author. They delve into the intricate history, persistent challenges, and profound impact of tuberculosis (TB) on human society. John Green introduces his latest nonfiction work, Everything Is Tuberculosis, which explores why TB continues to claim over a million lives annually despite the existence of effective treatments.
Understanding Tuberculosis
Roman Mars opens the discussion by seeking a foundational understanding of TB from John Green.
John Green (02:26):
"Yeah, so it's a bacterial illness, but it's a weird bacteria. It's a bacteria with a really thick cell wall that takes a long time to make and so relative to other bacteria, it grows very slowly."
Green explains that TB is caused by a slow-growing bacterium with a resilient cell wall, making it difficult for the immune system to combat. This biological complexity has allowed TB to persist and adapt over millennia.
Historical Perceptions and Cultural Impact
The conversation shifts to the historical and cultural interpretations of TB, particularly its romanticization in the 19th century.
John Green (05:16):
"Charlotte Bronte wrote, consumption, I am aware, is a flattering malady. And it was also seen as a disease that made you into a genius."
During the Industrial Revolution, TB, often referred to as "consumption," was paradoxically romanticized despite its deadly nature. Literary figures like Charlotte Bronte and poets like Percy Shelley portrayed TB as a condition that enhanced beauty and creativity, attributing it to noble traits.
Sanatoriums and TB Treatment Before Antibiotics
Roman Mars and John Green discuss the architectural and societal responses to TB before the advent of antibiotics, highlighting the rise of sanatoriums.
John Green (12:15):
"At the height of the sanatorium craze, there were almost as many hospital beds in the United States in sanatoria as there were in all hospitals combined."
Sanatoriums became widespread, serving as controlled environments where TB patients could rest and receive what little treatment was available. These institutions were often located in rural or mountainous regions, believed to provide the dry air beneficial for TB patients.
The Antibiotic Revolution and TB Cure
The introduction of antibiotics in the 1940s marked a turning point in the fight against TB.
John Green (13:58):
"When we started developing antibiotics in the 1940s... we could not only treat the disease and have it retreat, but we could cure it."
Antibiotics transformed TB from a fatal disease to a manageable condition in Western countries. The development of antibiotic cocktails in the 1950s led to a significant decline in TB mortality rates, allowing many to leave the sanatoriums and resume normal lives.
Persistent Challenges in the Global South
Despite advancements in the West, TB remains a critical issue in the Global South due to various systemic challenges.
John Green (18:46):
"That's why people are dying is because of price. I mean, getting the drugs where they need to be is a challenge, but price is the biggest barrier."
Access to affordable medication and proper healthcare infrastructure remains limited in many developing countries. High costs of diagnostic tools like the GeneXpert machine and life-saving drugs hinder effective TB management, leading to ongoing high mortality rates.
Personal Stories and Real-World Impacts
John Green shares a poignant encounter with Henry, a TB patient in Sierra Leone, illustrating the human toll of inadequate TB treatment.
John Green (20:15):
"Henry probably first got sick when he was 5 or 6 with TB and he started to get treatment, but then that treatment was interrupted... he developed a strain of tuberculosis that was resistant to our first line antibiotics."
Henry's story underscores the devastating consequences of interrupted treatment, which can lead to drug-resistant TB strains, leaving patients with few remaining treatment options.
Current Policy Challenges and Future Outlook
The discussion highlights recent policy shifts and their detrimental effects on global TB efforts.
John Green (24:40):
"Between 1966 and 2012 we didn't develop any new drugs to treat tuberculosis, which was a real catastrophe."
Policy changes, such as cuts to international aid and funding for TB research, have severely hampered progress. Additionally, pharmaceutical companies' patent manipulations have kept drug prices prohibitively high, limiting access to essential treatments.
Conclusion
Despite the bleak outlook caused by recent setbacks, John Green remains cautiously optimistic about eradicating TB.
John Green (28:36):
"I really believe that the end of the story for tuberculosis is the end of tuberculosis... we can live in that world, and right now we're taking steps away from living in that world."
Green emphasizes the importance of sustained effort, innovation, and global cooperation to overcome the cultural and systemic barriers that allow TB to persist. He calls for renewed commitment to TB eradication, highlighting it as a battle that humanity has the knowledge and tools to win.
This episode of 99% Invisible was produced by Christopher Johnson, edited by Kelly Prime, and featured music by Swan Real and George Langford. For more episodes and resources, visit 99pi.org.