Podcast Summary: "The Deadliest Disease in Human History"

People I (Mostly) Admire – Episode 157 (May 10, 2025)
Host: Steve Levitt
Guest: John Green

Overview

In this episode, Freakonomics co-author Steve Levitt interviews John Green, bestselling author and YouTube educator, returning to discuss his latest project: a book and activist campaign about tuberculosis (TB)—the world’s deadliest infectious disease. Their conversation dives into the modern realities, history, policy failures, and personal stories behind TB, while also exploring the roles of philanthropy, activism, and storytelling in combating a curable yet neglected global crisis.

Key Discussion Points and Insights

1. Why Tuberculosis?

• Perception vs. Reality:

  • Levitt admits surprise that Green is writing about TB, believing it to be a disease “that barely even exists anymore” (03:00).
  • Green reveals the global magnitude: “About 10 million people will get sick with tuberculosis this year, and about 1.25 million will die.” (03:32)
  • TB is largely invisible in the US: only 500 deaths last year, versus millions globally.
  • Green stresses the injustice: “We let this cure be where the disease is not, and we let the disease be where the cure is not.” (01:36)

• Moral Dimensions:

  • Green frames TB as "the exemplary disease of injustice"—a curable illness persisting because of resource and policy failures (04:36).
  • Levitt and Green discuss TB as a solvable problem that persists purely due to public policy and funding priorities.

2. Modern TB: Treatment Disparities and Policy Failures

• Resource Gaps:

  • In Sierra Leone, Green’s friend Henry could not access effective treatments due to cost/benefit rationing: “It didn’t make sense to offer him the newest and best treatments...” (05:45)
  • Even basic diagnostic tests ($15 each) are considered “too expensive” in poor countries (08:03)
  • Levitt: “We never actually get to the point of trying to allocate the expensive drugs… we just try the cheap ones and hope for the best.” (08:03)
  • Result: Multidrug-resistant TB is frequently fatal in low-resource settings; often, standard care is “supportive care… as they die.” (09:16)

• Pharmaceutical & Testing System Flaws:

  • No new TB drugs developed between 1965 and 2012 (07:06).
  • By contrast, rapid advances and investments are made for cancer and other diseases in rich-world settings.

3. Historical and Cultural Context

• Romanticization of TB:

  • Unlike most diseases, TB (once known as "consumption") became romanticized among 19th-century elites and artists—seen as a sign of beauty and brilliance.
  • Green: “Lord Byron said he would like to die of consumption because the ladies would say, how interesting he looks in dying.” (12:24)
  • Levitt muses on shifting beauty standards rooted in TB’s history (13:04).

• Scientific Breakthroughs:

  • German scientist Robert Koch discovered TB’s bacterial cause in 1882. Green details his path-breaking but flawed pursuit of a cure—an episode involving Sir Arthur Conan Doyle, who exposed the “cure” as ineffective (16:47).

4. Green’s Personal Involvement: The Power of Story and Activism

• The Human Connection:

  • Green became passionate about TB after meeting Henry, a boy in Sierra Leone with MDR-TB: “Our friendship is really the center of the book... statistics are powerful, but you need human stories to connect with...” (26:55)
  • The TB crisis offered Green a greater sense of “orientation in life” after achieving literary success, which paradoxically left him with a search for purpose (26:55).

• Comparing Philanthropy:

  • Levitt recalls Green’s earlier, more detached philanthropic efforts (supporting maternal health) and contrasts them with his personal, urgent commitment to TB (30:05).
  • Green: “I needed a deeper and more personal connection to that injustice, if that makes sense.” (31:29)

5. Modern Activism: Drug Pricing Fights

• Mobilizing the Nerdfighters:

  • Green’s dedicated fan community pressured Johnson & Johnson to stop extending its patent ("evergreening") on bedaquiline, a critical TB drug.
  • Green: “I asked people to reach out to Johnson & Johnson and let them know that it’s unacceptable to try to extend the patent...” (36:12)
  • The social media campaign led to real policy change: “Bedaquiline is now available for 55% less than it was just a year ago.” (37:23)

• Diagnostics Access:

  • Green also targeted Danaher, maker of the GeneXpert diagnostic system, for overcharging poor countries.
  • After public pressure, Danaher dropped prices by 20%, enabling millions more tests (39:32).
  • Green describes his tactic: “If the market is creating barriers… I try to, in my little way, try to rectify that.” (43:46)

Notable Quotes

• “I was so compelled by it. I was like, this is the solution. This is the way out...which are just insane.” – John Green, on his editorial misdirections (20:07)
• “We let this cure be where the disease is not, and we let the disease be where the cure is not. I find that reprehensible.” – John Green (01:36, 32:47)

6. Barriers & Solutions: The Economics of TB Innovation

• Innovation Disincentives:

  • Levitt warns of the risk that activism could deter R&D: “If you’re too good at what you’re doing, it can actually have long term detrimental effects.” (44:41)
  • Green agrees and notes the system problem, not just corporate greed.

• Buyouts as Solutions:

  • Levitt proposes government "patent buyouts" as a policy fix: Governments should buy out patents, pay companies appropriately, and let drugs go generic—aligning incentives for innovation and access (47:51).
  • Green: “I think that’s a great idea and I’d never thought of it before...we don’t have to wait X number of years between discovery and rollout.” (47:51)

Technology, Storytelling, and Impact

Books vs. YouTube: Reaching Audiences

• Green notes that, by releasing his TB Crash Course video (free, >2 million views) before the book, he increases impact and awareness: “I don’t think I told [my publisher].” (52:59)
• On books: “It’s so intimate. It’s so long form. It takes a tremendous commitment of time and attention.”
• On YouTube: “Immediacy...but a very crowded and loud space.” (53:59)

Economics of Creative Work

• Levitt observes: “There’s really no comparison [in earnings]... you’re talking about $4 per book versus 1/40 of one penny for a YouTube view.” (55:32)

Telling Henry’s Story

• Green left Henry’s personal story out of the YouTube video, saving it for the book, to better honor the reality and privacy of an ongoing life story (57:23).
• They remain close: “We talk almost every day...he just finished his final exams for the year.” (58:13)

The Challenge of Purpose After Big Projects

• Levitt asks about post-project “crashes” or emptiness.
• Green: “I think I found the thing that’s going to animate much of the rest of my life...the fight for health equity, the fight for more access to healthcare...” (61:29)

Memorable Moments & Quotes (With Timestamps)

On the Continuing Crisis:

• “Tuberculosis kills about as many people as HIV and malaria and typhoid and Ebola combined.” — John Green (03:59)
• “TB exists because we allow it to exist.” — John Green (04:36)

On the Power of Story:

• “Statistics are powerful, but you need human stories to connect with in order to really change your life.” — John Green (26:55)

On Activism:

• “My issue is with charging the world’s poorest countries...when we know that that’s going to limit the number of people who can access the tests.” — John Green (39:15)
• “If the market is creating barriers to that, then there’s something wrong.” — John Green (43:35)

On Policy Solutions:

• “What we should do… is have [governments] buy out the patent, and then let’s put the drug into the public domain and allow everyone to make it.” — Steve Levitt (47:12)

On Personal Impact and Purpose:

• “For me, tuberculosis has given me a job.” — John Green (28:25)
• “I think I found the thing that’s going to animate much of the rest of my life.” — John Green (61:29)

Important Timestamps

• 01:36 — Green’s “crime against justice” quote
• 03:32 — Green presents the TB death toll
• 08:03 — Cost and failure of TB drug testing in poor countries
• 12:24 — On the romanticizing of TB in cultural history
• 16:47 — Conan Doyle’s role in debunking TB “cure”
• 26:55 — The personal and global stakes for Green’s work
• 32:47 — “Letting the cure be where the disease is not...”
• 34:33 — Nerdfighter activism targeting pharmaceutical patents
• 47:12 — Levitt’s proposal for government patent buyouts
• 53:59 — Green discusses the immediacy and limits of YouTube vs. books
• 61:29 — Green on finding new lifelong purpose through TB advocacy

Conclusion

This episode balances shocking statistics, nuanced policy critique, activism strategy, and deeply personal testimony. John Green, through storytelling and activism—both on the page and online—has become a leading voice in the fight against tuberculosis, transforming a neglected global health crisis into a personal crusade for justice, innovation, and equity. Steve Levitt’s searching questions and economic insights add depth, especially around the failures—and hopes—of public policy to finally end the world’s deadliest infectious disease.