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The Killer We Refused to See · What's Your Problem?

0:15
Speaker 1: Pushkin. Hey, it's Jacob. Before we start the show today,
0:23
Speaker 1: I just want to say thank you for listening. I
0:26
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0:49
Speaker 1: we can do to make the show better. And mostly
0:52
Speaker 1: thanks for listening. Here is the show. I'm Jacob Goldstein,
1:01
Speaker 1: and this is What's Your Problem. My guest today is
1:04
Speaker 1: Tom Levinson. He's a professor of science writing at MIT
1:07
Speaker 1: and the author of a book called So Very Small.
1:10
Speaker 1: It's a book that tells the story of one of
1:12
Speaker 1: the most important breakthroughs in the history of human knowledge.
1:16
Speaker 1: I don't think I'm overstating it. It's the discovery that
1:19
Speaker 1: germs caused disease. Before we figured that out, most people
1:24
Speaker 1: who ever lived died from infections. After we figured it out,
1:28
Speaker 1: scientists very quickly came up with new vaccines to prevent
1:31
Speaker 1: infections and new drugs that could treat infections after they happened.
1:36
Speaker 1: Realizing that germs caused disease and building on that insight
1:40
Speaker 1: has saved billions of lives. And there's something really interesting
1:44
Speaker 1: at the center of this story. Bacteria were first discovered
1:48
Speaker 1: in the late sixteen hundreds, but people didn't realize that
1:51
Speaker 1: they caused disease until the late eighteen hundreds. So Tom's
1:55
Speaker 1: book asked this big question, why did it take so
1:59
Speaker 1: long to figure it out? Which for me points to
2:01
Speaker 1: an interesting question for today. What does that tell us
2:05
Speaker 1: about the way humans understand the world. What does it
2:08
Speaker 1: tell us about our willingness or unwillingness to change our views.
2:13
Speaker 1: We started our conversation by talking about the first person
2:16
Speaker 1: ever to see bacteria. He was a Dutch cloth merchant
2:20
Speaker 1: and his name was Anthony van Lavenhook. In the late
2:24
Speaker 1: sixteen hundreds. He gets into building microscopes, which was like
2:27
Speaker 1: a popular hobby at the time, and he gets really
2:30
Speaker 1: good at it, which allows him to make this extraordinary discovery.
2:34
Speaker 2: Lavan, you know, the great breakthrough is he saw this
2:38
Speaker 2: entirely new domain of life. You know what I call
2:42
Speaker 2: in the book the microcosmos, This this utterly invisible to
2:46
Speaker 2: the naked eye, yet enormously rich and teeming with life
2:50
Speaker 2: and varieties of life and all kinds of things going
2:52
Speaker 2: on in you know, the gunk between your teeth and
2:55
Speaker 2: a drop of pond water, and you know, and so on.
2:57
Speaker 1: Well, you're doing this list, but he really did, right.
2:59
Speaker 1: He took the tartar from his teeth and put it
3:02
Speaker 1: on a microscopic slide. He did exactly and saw and
3:05
Speaker 1: saw what what did he see? When he looked at
3:07
Speaker 1: his own tooth gung?
3:10
Speaker 2: He saw what he referred to as well in English,
3:14
Speaker 2: animacules little tiny animals, right, and we now know they
3:19
Speaker 2: were bacterian in some cases, you know, protozoa and other
3:25
Speaker 2: forms of microscopic life, but definitely bacteria that had different shapes.
3:30
Speaker 2: He saw the little cilia the bacteria have to help
3:33
Speaker 2: them move. He saw corkskew shapes like that of the
3:38
Speaker 2: family of bacteria that includes the syphilis Bacterium, and little
3:43
Speaker 2: round ones so called cocy like Streptococcus, and many many
3:47
Speaker 2: others that are completely benign. He saw all these things,
3:51
Speaker 2: and you know what was impressive about that is he
3:55
Speaker 2: recognized that these were similar forms of life, and that
4:00
Speaker 2: they were all very very tiny they were all on
4:02
Speaker 2: a similar scale, but there was enormously you know, rich
4:07
Speaker 2: differences between them. There was a whole bunch of this stuff.
4:10
Speaker 2: And you know, we would call it now an ecosystem,
4:13
Speaker 2: a microbial ecosystem, a microbiome as the current term. But
4:19
Speaker 2: he saw enough to recognize that this was at least
4:21
Speaker 2: there in, you know, without the apparatus, without the ideas
4:24
Speaker 2: that could you bring it into our modern understanding.
4:27
Speaker 1: So he sees this, he doesn't keep it to himself.
4:30
Speaker 1: He actually publishes all these papers with detailed drawings of
4:34
Speaker 1: the bacteria. He sees other people basically confirm the findings
4:38
Speaker 1: and they see that they're bacteria everywhere. But then you
4:41
Speaker 1: ask this question in the book, because so this is
4:45
Speaker 1: late sixteen hundreds. He sees germs. They are germs. He
4:48
Speaker 1: doesn't use that word, but he knows what they are.
4:50
Speaker 1: They're little creatures that are living inside our body. And
4:53
Speaker 1: yet it's going to take two hundred years to figure
4:57
Speaker 1: out that germs cause disease, and so kind of an
5:00
Speaker 1: interesting animating question of your book is why did it
5:04
Speaker 1: take so long? Why did it take so long for
5:07
Speaker 1: people to make that connection? So what is your answer?
5:10
Speaker 1: Why do you think it did take so long.
5:15
Speaker 2: You know, I've spent a lot of time in thinking
5:18
Speaker 2: about and writing different things to sort of try and
5:22
Speaker 2: understand what makes you know, scientific knowledge happen. And in
5:31
Speaker 2: this case, I think you see very clearly that it's
5:35
Speaker 2: very hard to replace an underlying theory without both a
5:42
Speaker 2: compelling need to do so there's something you can't explain
5:46
Speaker 2: that you really want explain, and with a coherent alternative
5:52
Speaker 2: theory that can explain what you need to have explained,
5:55
Speaker 2: and you know, advance advanced state of knowledge. And one
6:00
Speaker 2: of the reasons that's so hard to do is because
6:04
Speaker 2: you know, what we think at any given time is
6:09
Speaker 2: wrongly constrained by I guess you could call it a worldview.
6:14
Speaker 2: And the big thing that was going on in the
6:17
Speaker 2: seventeenth and eighteenth and into the nineteenth centuries was you know,
6:23
Speaker 2: the sort of the over the overarching question that made
6:26
Speaker 2: it hard to think about. The idea that these that
6:29
Speaker 2: these microbes could could actually, you know, meaningfully impinge on
6:34
Speaker 2: human life, actually do something to us. Was a notion
6:40
Speaker 2: of human beings outside of and sort of in command
6:45
Speaker 2: of nature. And at the start of the story that's
6:49
Speaker 2: expressed very much in religious terms, and you know that
6:52
Speaker 2: gets articulated into a very explicit hierarchy God at the top,
6:56
Speaker 2: than the angels, than humankind, and then sort of all
6:59
Speaker 2: the rest of nature. So when you observe when when
7:02
Speaker 2: you first see microbes, the idea that they may be
7:07
Speaker 2: consequential is very, very hard to get your head around.
7:13
Speaker 2: We're in command of nature. These are tiny, diminutive things.
7:17
Speaker 2: The idea that they could meaningfully you know, matter to
7:20
Speaker 2: us requires them to sort of climb up that great
7:24
Speaker 2: chain of being and develop an agency that you know,
7:28
Speaker 2: biblically and emotionally, is we really reserve for ourselves.
7:34
Speaker 1: The first part of what you said is interesting, right, Like,
7:38
Speaker 1: they thought they knew what caused disease, right, they thought
7:41
Speaker 1: it was humor's a bad air, and so they didn't
7:45
Speaker 1: think they had a problem. They didn't think they had
7:47
Speaker 1: a gap in their knowledge, which which has to have
7:50
Speaker 1: been part of it.
7:51
Speaker 2: You need to have a reason to change your ideas.
7:53
Speaker 2: And one of the things about you know, sort of
7:55
Speaker 2: pre germ theory ideas about disease is they were pretty effective. Right.
8:01
Speaker 1: Oh, the plague comes to town and there's a miasma
8:04
Speaker 1: in the air. Better get out of town. And if
8:06
Speaker 1: you get out of town and get away from the miasma,
8:08
Speaker 1: you want get the plague. Like it's not I mean,
8:11
Speaker 1: it's it's sort of wrong, but like, yeah, it's in miasthma,
8:14
Speaker 1: but what's really in the miasthma is bacteria. Like that's
8:17
Speaker 1: a better articulation.
8:18
Speaker 2: But that's right, I mean, you know, and the miasma
8:21
Speaker 2: explains why a bunch of people in the same place
8:24
Speaker 2: get the disease. You don't need to have the idea
8:26
Speaker 2: that there's something jumping between bodies that do that, or
8:30
Speaker 2: or you can even you know, like modify it a
8:32
Speaker 2: little bit and say, well, you know you get sick
8:34
Speaker 2: because of bad air, then you the sickness produces bad
8:38
Speaker 2: air in your own body and you exhale, and that.
8:41
Speaker 1: Not so far off right, not so far.
8:43
Speaker 2: You know, that's one of the issues. And and you
8:48
Speaker 2: know you have to to replace it. You have to
8:50
Speaker 2: be able to see that you could have you know
8:54
Speaker 2: that you have to be able to see an alternat explanation.
8:56
Speaker 2: And what happened and you know this is this is
8:59
Speaker 2: not conjecture. What really happened is people lost interest in microscopy.
9:03
Speaker 2: There was this you know, with Hook's book Micrographia, and
9:06
Speaker 2: then Levin Hook's you know, endless stream of letters going
9:09
Speaker 2: the Royal Society. There was a sort of burst of
9:11
Speaker 2: interest among you know, if you think it, sort of
9:15
Speaker 2: well off gentlemen, amateurs buying themselves microscopes, often buying sort
9:21
Speaker 2: of sets of slides. This is in the sixteen eighties
9:23
Speaker 2: and nineties. It's happening very very early on.
9:25
Speaker 1: So you're saying microscopy is a fad, exactly, And by
9:31
Speaker 1: the sixty nineties Hook is lamenting that the fad has
9:34
Speaker 1: already passed and no one's really interested.
9:36
Speaker 2: If you don't see microbes as anything other than curiosities
9:42
Speaker 2: confined to their own domain, it's very hard to imagine
9:46
Speaker 2: that they are, you know, the agents of the single
9:49
Speaker 2: most potent cause of death in human beings, I mean,
9:53
Speaker 2: infectious disease through history is what has generally killed us, right,
9:58
Speaker 2: And you know, that's a really big thing to explain,
10:00
Speaker 2: and it was a great leap, a very difficult leap,
10:03
Speaker 2: to say, these funny, little wriggling things you can see
10:06
Speaker 2: under a microscope might be the the agents of that
10:10
Speaker 2: enormously potent and terrifying force.
10:14
Speaker 1: So okay, so the microscope fad goes away, people stop
10:20
Speaker 1: caring about and immaculate these tiny creatures, and we get
10:28
Speaker 1: to this point in the eighteen hundreds where we're not
10:32
Speaker 1: to germ theory at people aren't actually figuring it out,
10:34
Speaker 1: but they're getting better at understanding how infectious disease works. Right,
10:40
Speaker 1: And you talk about a few different people here. I mean,
10:44
Speaker 1: there's Florence Nightingale, you know, making sanitation at hospitals a
10:49
Speaker 1: thing and reducing the spread of disease that way. There's
10:51
Speaker 1: John Snow, the guy who figured out that everybody who
10:54
Speaker 1: drank from this one pump in London basically got cholera
10:58
Speaker 1: or you know, and they took the head off the
10:59
Speaker 1: pump and people stopped getting klera. And nobody knows that
11:02
Speaker 1: it's germs, but they're getting that there's a mechanism. But
11:04
Speaker 1: there's one person in this kind of middle period who
11:06
Speaker 1: I want to talk about at some greater length, who
11:09
Speaker 1: you're right about. And that's tell me if I'm saying
11:12
Speaker 1: it wrong, ignots Themovis.
11:16
Speaker 2: All right, Your German is undoubtedly better than.
11:20
Speaker 1: Mine, is better than nobody's. Who is he? Who were
11:25
Speaker 1: you gonna call him? Smovis that's what we're gonna say.
11:27
Speaker 2: Yeah, so or device. I think they probably both work.
11:33
Speaker 2: Simis was a a doctor and uh started his sort
11:40
Speaker 2: of professional career in Vienna at the at the the
11:44
Speaker 2: great hospital there, and he was working in in obstetrics
11:51
Speaker 2: and you know, handling childbirth. And he was hired was
11:55
Speaker 2: the junior assistant to the boss of the obstetrics service.
12:01
Speaker 2: And it was at a time when two things were
12:04
Speaker 2: going on. One did there was this critical vital really
12:09
Speaker 2: you know, sort of overall extremely important and useful development,
12:14
Speaker 2: an attempt to make medicine more scientific, and the way
12:17
Speaker 2: to do it was to do pathology basically, to cut
12:21
Speaker 2: open your mistakes and find out what's wrong. So when
12:23
Speaker 2: somebody died, you would dissect them, you perform an autopsy,
12:27
Speaker 2: and you would try and both study the sort of
12:29
Speaker 2: body as a whole, but really look for the mechanism,
12:33
Speaker 2: you know, what whatever had killed them did inside the body.
12:36
Speaker 2: And this was you know, absolutely vital to the development medicine.
12:40
Speaker 2: Led to all kinds of important ideas about the disease
12:45
Speaker 2: process and diagnostics and stuff like that, and it created
12:50
Speaker 2: in this case a repeated sequence of mechanism by which
12:55
Speaker 2: the doctors of Vienna were killing hundreds and you know,
13:00
Speaker 2: and then thousands of women in childbirth. So what happened
13:05
Speaker 2: was that as the use of autopsies to understand what
13:11
Speaker 2: happened to women who died in childbirth expanded, people would
13:17
Speaker 2: do the autopsies, wash their hands, you know, the way
13:21
Speaker 2: you and I might, you know, sort of after we've
13:23
Speaker 2: been cooking, so as what somebody put social handwashing, not
13:27
Speaker 2: you know, enough for medicine, and then go off and
13:30
Speaker 2: deliver a baby. Right, so whatever they had picked up
13:34
Speaker 2: from the corpse would be carried. You know, it's like
13:37
Speaker 2: it's you can't imagine a better disease vector. And so
13:42
Speaker 2: there was a fairly high death rate from this infection.
13:47
Speaker 2: What we now know is an infection with actually one
13:49
Speaker 2: of a few bacteria that was called child bed fever
13:52
Speaker 2: or prayer pool fever. And up until a critical change
13:56
Speaker 2: was made, it wasn't clear that this was done, that
13:59
Speaker 2: this was there was a specific singular mechanism that was
14:02
Speaker 2: doing this. Initially there you know, the hospital just accepts
14:06
Speaker 2: women into the you know, they come in and they
14:08
Speaker 2: go into one of two wards, but both of the
14:12
Speaker 2: wards are served by a mixed staff of doctors and
14:14
Speaker 2: midwives and then sort of you know, shortly before some
14:20
Speaker 2: of the ice gets there, that changes, the system changes.
14:23
Speaker 2: And this is you know, one of the interestings about it,
14:24
Speaker 2: this is, you know, this is a social change. There's
14:27
Speaker 2: nothing medical about this. They just decide that there's a hierarchy,
14:30
Speaker 2: and the doctors and medical students work on ward number
14:34
Speaker 2: one and midwives deliver babies in ward number two. And
14:38
Speaker 2: they would you know, you'd get admitted, you know, on
14:40
Speaker 2: Monday you'd go to ward one, and Tuesday you'd go
14:42
Speaker 2: to Ward two, and so on. You know, they just
14:43
Speaker 2: alternated day by day, and very rapidly it became clear
14:50
Speaker 2: that it was a deadly risk to end up in
14:52
Speaker 2: the hands of the doctors that they had, you know,
14:55
Speaker 2: many many times the rate of suffering from purple fever
15:00
Speaker 2: and dying of it in the doctor's ward then in
15:03
Speaker 2: the midwives ward. The question was why, And you know,
15:08
Speaker 2: before some of us got there, they did all kinds
15:09
Speaker 2: of investigations. Could they be ventilated differently? Was the laundry
15:13
Speaker 2: being done differently? They don't look for all these different things, notice,
15:17
Speaker 2: not looking at the personnel, just looking at possible external causes.
15:21
Speaker 2: So the idea that doctors might be killing their patients
15:25
Speaker 2: was something that the doctors investigating this issue would find
15:30
Speaker 2: very hard to accept. And we see this over and
15:32
Speaker 2: over again in the story of child bed fever, So
15:36
Speaker 2: you know that happens. Semmelviz comes along and he is
15:39
Speaker 2: now tasked with trying to figure out what drives the difference,
15:42
Speaker 2: and he similarly is confused until he goes away for
15:47
Speaker 2: a little vacation to Italy, comes back and he finds that,
15:51
Speaker 2: you know, his mentor and somebody who greatly values has
15:54
Speaker 2: died with symptoms that are very very similar to the
15:58
Speaker 2: symptoms that are killing the mothers who've just given birth,
16:01
Speaker 2: this purple fever. And it turns out that this guy
16:06
Speaker 2: had been doing an autopsy with students of a woman
16:09
Speaker 2: who died of this disease, and one of the students
16:12
Speaker 2: had cut him with one of the scalpels, and some
16:16
Speaker 2: ofvice recognized that had to be important, and that something
16:20
Speaker 2: passed from the body of the of the cadaver, the
16:23
Speaker 2: person who the woman who died, into the body of
16:26
Speaker 2: his mentor, and he said, aha, you know, the something
16:31
Speaker 2: happens in the autopsy room that takes the poison that
16:35
Speaker 2: kills these women and carries it on to the next woman,
16:38
Speaker 2: and that something has to be the hands of the
16:41
Speaker 2: people doing the autopsy, the doctors and medical students who
16:44
Speaker 2: are trying to learn from these women what happened. And
16:47
Speaker 2: it turns out that what happened is they became you know,
16:50
Speaker 2: those those those professional men became disease vectors. And he
16:56
Speaker 2: proved this case. You know, again, he had no idea
16:58
Speaker 2: what it was. His writings make it very clear there's
17:01
Speaker 2: no specific identification with a bacterium or what have you.
17:05
Speaker 2: He just knows that there's something real in the world
17:09
Speaker 2: that's making this journey, and he knows how the journey
17:11
Speaker 2: is being made. So it says, great, I'm going to
17:14
Speaker 2: put a chlorine solution sync between the autopsy room and
17:21
Speaker 2: the delivery wards and everybody who does an autopsy has
17:26
Speaker 2: to go and wash their hands with this chlorine you know, painful,
17:29
Speaker 2: really chlorine solution.
17:31
Speaker 1: What does he know about chlorine? Like, why does he
17:34
Speaker 1: do that?
17:35
Speaker 2: He knows it's caustic, and he knows it's used for
17:37
Speaker 2: deep cleaning, and that's basically it. And he says, you know,
17:43
Speaker 2: you have to scrub your hands until the cadaver's smell
17:47
Speaker 2: is off you and that turns out to be long
17:50
Speaker 2: enough to kill the bacteria and very rapidly the doctors
17:56
Speaker 2: and medical students. Ward approaches the same you know, complication
18:00
Speaker 2: and death rate from purple fever as the midwives, and
18:04
Speaker 2: you know, while there's a solution. And to me, one
18:07
Speaker 2: of the greatest tragedies this book documents is the fact
18:10
Speaker 2: that this solution was not picked up. It was rejected
18:15
Speaker 2: again in part because of this notion that doctor, you know,
18:17
Speaker 2: the the implication is clear, up until that point doctors
18:21
Speaker 2: had been killing their patients. Didn't mean to, didn't.
18:23
Speaker 1: Want to, I mean, including samulvisis right, like, how does
18:28
Speaker 1: he react to figuring this out?
18:31
Speaker 2: He's horrified, he says, he is. He recognizes himself as
18:35
Speaker 2: somebody who's who's you know, practice Up to that point
18:38
Speaker 2: he killed, killed women, and he becomes, you know, incredibly
18:43
Speaker 2: passionate about not doing that anymore, and so much so
18:47
Speaker 2: that he alienates his colleagues. He accuses them of murder,
18:50
Speaker 2: which was you know, true but impolitic, and he is
18:55
Speaker 2: driven out of Vienna. He goes back to his home
18:58
Speaker 2: in Budapest. He sets up the same regimen in the
19:01
Speaker 2: hospital he works in Budapest, continues to sort of have
19:05
Speaker 2: these controversies with colleagues, and finally, you know, he may
19:09
Speaker 2: have gone, you know, gotten sort of almost you know,
19:12
Speaker 2: clinically paranoid, but his former professional acquaintances and perhaps his
19:17
Speaker 2: family sort of conspire to get him locked into an
19:22
Speaker 2: insane asylum essentially where early in his stay, very early
19:25
Speaker 2: in his state, he's beaten so badly that he develops
19:29
Speaker 2: open wounds, and I you know, with this horrible irony
19:32
Speaker 2: of history, catches an infection and dies of it. It's
19:36
Speaker 2: one of the great sort of you know, the deaths
19:39
Speaker 2: of thousands of women who need not have died, maybe
19:42
Speaker 2: tens of thousands of women across Europe and the world
19:46
Speaker 2: more broadly, who need not have died if people had
19:49
Speaker 2: just followed Somelevice's procedure, these deaths would continue from you know,
19:53
Speaker 2: well past the eighteen forties when Civilis figured it out,
19:57
Speaker 2: up until you know, near the end of the century.
20:03
Speaker 1: Will be back in just a minute. So now we
20:17
Speaker 1: get into the second half of the eighteen hundred, second
20:20
Speaker 1: half of the nineteenth century, and we're finally going to
20:22
Speaker 1: crack it right. Pastor comes along he's going to be important.
20:26
Speaker 1: We're going to talk about him more in a minute.
20:27
Speaker 1: But the tea guy, it seems, is a country doctor
20:33
Speaker 1: basically whose name is Robert Koch. You have a nice
20:37
Speaker 1: sentence to start your chapter about him. I'm going to
20:40
Speaker 1: read it. There's very little known about the identity of
20:43
Speaker 1: one of the most important bodies in the history of medicine.
20:49
Speaker 1: What was it?
20:51
Speaker 2: It was an animal, possibly a horse, but it's not
20:56
Speaker 2: even that's not known. Almost certainly a domesticated animal that
21:01
Speaker 2: has died of a then well known but still not
21:06
Speaker 2: figured out disease called anthrax. And so a local police
21:13
Speaker 2: constable finds this animal sort of dead in a hedgerow.
21:17
Speaker 1: And where was he, by the way, he.
21:20
Speaker 2: Was in a you know what was then still part
21:22
Speaker 2: of East Prussia but is now Poland there was an
21:26
Speaker 2: antrak's outbreak going on in the area at the time.
21:31
Speaker 2: Cattle herds were affected by it.
21:33
Speaker 1: And people understood that there were outbreaks and that people
21:37
Speaker 1: could get this disease, and that animals could get it.
21:39
Speaker 1: And then some fashion it moved back and forth.
21:41
Speaker 2: Yes, human beings could get it, especially those who worked
21:44
Speaker 2: intimately with animals sheep shearers, for example, were at risk
21:49
Speaker 2: of it, this kind of thing. And so this was
21:53
Speaker 2: a couple three days before Christmas. But Cooke took the
21:56
Speaker 2: skin or the body, we don't know, and took samples
22:02
Speaker 2: from it, including presumably samples in his bloodstream, put them
22:08
Speaker 2: under a microscope. Saw a characteristic rod like bacterium, and
22:16
Speaker 2: his bacterium had been noticed already. It seemed to be
22:19
Speaker 2: associated with anthrax. But people hadn't made the last I mean,
22:23
Speaker 2: it was like it wasn't clear if they showed up
22:26
Speaker 2: because some other disease process made the animals susceptible to them.
22:31
Speaker 2: It wasn't clear what those bacteria were doing. And Cook
22:34
Speaker 2: then did the critical experiment. He identified the bacteria, He
22:40
Speaker 2: found a medium he could grow it, and it turned
22:42
Speaker 2: out to be the fluid inside catalyzed basically. And he
22:49
Speaker 2: had his family kept rabbits for food. So what he
22:52
Speaker 2: did is he purified a sample of these bacteria and
22:58
Speaker 2: he injected it into one of his rabbits, and it
23:02
Speaker 2: was clear the rabbit got sick. He was able to
23:06
Speaker 2: harvest more of the bacteria from its bloodstream, isolate the bacteria,
23:11
Speaker 2: grow it in culture, injected into another rabbit, and the
23:15
Speaker 2: rabbit got sick with the same disease anthrax visibly. And
23:20
Speaker 2: after you do that a few times, you keep this
23:22
Speaker 2: chain going, you realize that what's causing the disease is
23:25
Speaker 2: the bacteria.
23:26
Speaker 1: So he's just done it. It just happened in this
23:28
Speaker 1: little town in mind I pull and some random country
23:32
Speaker 1: doctor did the thing that nobody did for almost exactly
23:36
Speaker 1: two hundred years. Right, this is December eighteen seventy five,
23:40
Speaker 1: one hundred and ninety nine years after Anthony even leaven
23:44
Speaker 1: Hook right like, why him? Why then?
23:52
Speaker 2: Well, I think, I mean we talked a little bit
23:54
Speaker 2: about prayerble fever. There was a period of you know,
23:59
Speaker 2: forty years or so that I called sort of germ
24:02
Speaker 2: theory without germs. Yeah, when people start to realize that, yes,
24:06
Speaker 2: there is something that you know, some physical objects, some
24:11
Speaker 2: material little piece of the world that has to be
24:14
Speaker 2: involved in these process and they find this out through
24:17
Speaker 2: a number of different mechanisms, Partly you know Florence Nightingale's
24:20
Speaker 2: you know, emphasis on hygiene, you just keep filth away
24:24
Speaker 2: from people. Well, that implies there's something in the filth
24:26
Speaker 2: that does does the damage.
24:28
Speaker 1: We haven't talked about pasteur yet, right, but clearly here
24:32
Speaker 1: and again, you know, the big demonstration of this you
24:34
Speaker 1: mentioned John Snow who recognized that there.
24:38
Speaker 2: Was something in you know, some specific thing in contaminated
24:41
Speaker 2: water that reliably produced color and those who consumed it.
24:45
Speaker 2: And he demonstrated this not just with the pump. He did,
24:47
Speaker 2: you know, a whole bunch of different kinds of work.
24:49
Speaker 2: He showed it on on sort of citywide epidemiological scales.
24:52
Speaker 2: He proved it more than once with sort of individual
24:56
Speaker 2: locations where that had clearly been the source of a
24:59
Speaker 2: local outbreak. Again, he had no idea what the thing was,
25:04
Speaker 2: but he knew there was a thing, and you could
25:07
Speaker 2: interrupt its journey, you could stop it, and then people
25:11
Speaker 2: wouldn't get sick. So the ground was finally being prepared.
25:15
Speaker 2: You know, remember at the beginning of this conversation we said,
25:17
Speaker 2: you need both the worldview that allows you to recognize
25:21
Speaker 2: that something might be possible, like it's possible bacteria could
25:25
Speaker 2: harm us, but you also need a problem that the
25:28
Speaker 2: existing theory can't explain. And that's what this germ theory
25:33
Speaker 2: without germs sort of period was all about coming up with.
25:37
Speaker 2: You know, Okay, if cholor is caused by a material thing,
25:40
Speaker 2: what is it. You know, a carepool disease, child bed fever,
25:44
Speaker 2: travels from patient to patient, you know, as some guck
25:48
Speaker 2: on a doctor's hands. What's in the guck? You know,
25:50
Speaker 2: these kinds of things set up the final step that
25:54
Speaker 2: Coke took brilliantly. You know, well that thing is this
25:58
Speaker 2: micro and you know, the critical thing that really cemented
26:04
Speaker 2: germ theory was not just Coke's experiment, but the quite
26:07
Speaker 2: rapid recovery of other bacteria that cause their own specific
26:12
Speaker 2: diseases of both animals and people. But if you have
26:15
Speaker 2: disease after disease after disease in rapid succession shown to
26:20
Speaker 2: be driven by these very specific living pathogens, then all
26:25
Speaker 2: of a sudden you have not just an example, you
26:27
Speaker 2: have a theory. You have a broadly explanatory idea.
26:31
Speaker 1: So now now that the world has this theory and
26:37
Speaker 1: everybody believes him, unlike with zemmolweis right, good things start
26:41
Speaker 1: happening right for human health. And I feel like here
26:46
Speaker 1: we should talk about Pastor. So let's talk tell me
26:48
Speaker 1: about Pastor.
26:50
Speaker 2: Well, past here is one of the people who really
26:51
Speaker 2: gets sort of the modern germ theory h era going.
26:56
Speaker 2: Once Coke shows that Anthrax is a bacterial disease. Pasture
27:03
Speaker 2: basically sees Coke as having jumped in on his field.
27:07
Speaker 2: In some ways, there's a real rivalry the development gene
27:09
Speaker 2: the two men, but he recognizes the power of the idea,
27:13
Speaker 2: and he has two things. He tries to identify other
27:16
Speaker 2: disease agents as coc had done, But most importantly, he
27:19
Speaker 2: really kicks off the modern age of vaccination. He works
27:23
Speaker 2: on and achieves amazingly a vaccine for anthrax. Within a
27:28
Speaker 2: very short order, Pastor's lab is churning out anthrax vaccines
27:34
Speaker 2: enough to, you know, within months, inoculate tens of thousands
27:38
Speaker 2: of animals. And he does the same for other diseases.
27:41
Speaker 1: Right, So, until this point, there was one vaccine, right
27:46
Speaker 1: famously for smallpox, which was kind of a lucky break, right, Like, yeah, exactly,
27:49
Speaker 1: Kantor noticed that people who worked with cows didn't get
27:52
Speaker 1: smallpox and sort of put together that you could give
27:54
Speaker 1: somebody cow pox basically and they wouldn't get small pox.
27:57
Speaker 1: But it was a one off and that was all
27:59
Speaker 1: we had, right, And now we have germ theory, and
28:02
Speaker 1: Pastor has created like a vaccine factory basically, right, he's
28:06
Speaker 1: making one after another because of the power of this
28:08
Speaker 1: theory now because of right inside.
28:10
Speaker 2: It, and people recognize that pasture has invented not just
28:13
Speaker 2: a singular vaccine, but a method. You know. There's an
28:15
Speaker 2: article in The New York Times basically said, you know,
28:19
Speaker 2: the expectation is that every infectious disease, every disease organism
28:24
Speaker 2: will have a vaccine associated with it, will be able
28:28
Speaker 2: to control infectious disease basically, you know, for the first
28:33
Speaker 2: time ever, and human beings won't have to die of
28:35
Speaker 2: these terrible things. Yes, and they were not entirely right,
28:39
Speaker 2: but there are vaccines for you know, measles and tetanus
28:45
Speaker 2: and theory and whooping cough protests. And this is a
28:48
Speaker 2: direct result of germ theory and of you know, past
28:51
Speaker 2: year's early work and.
28:51
Speaker 1: Coax and and as is like not that long after that,
28:55
Speaker 1: it forty years after that or something fifty years after
28:57
Speaker 1: that that we get antibiotics. Right, the last big great
29:01
Speaker 1: tool that is comes to us because of right term theory,
29:05
Speaker 1: I mean, and it's I mean, that's obviously not a
29:06
Speaker 1: magic bullet. Nothing as a magic bullet, never call anything
29:09
Speaker 1: a magic bullet. But it's a very good bullet, like antibiotics,
29:13
Speaker 1: it's still antibotic because it's whatever. They are incredible bullets.
29:17
Speaker 2: Oh, it's it's utterly transformative.
29:19
Speaker 1: Yeah, I mean vaccines.
29:21
Speaker 2: You put vaccines and antibiotics together, and it's really true.
29:24
Speaker 2: You know, in nineteen hundred, the top several leading causes
29:29
Speaker 2: of death were all one form of infectious disease, disease
29:32
Speaker 2: or another. The you know, by the latter half of
29:37
Speaker 2: the twentieth century and certainly by the end of twentieth century,
29:43
Speaker 2: you know, infectious diseases don't make a dent. It's heart
29:46
Speaker 2: disease and cancer and auto accidents.
29:49
Speaker 1: I mean, I feel like a lot of the to
29:51
Speaker 1: the extent people talk about this stuff now, they talk
29:53
Speaker 1: about antibiotic resistance and vaccine hesitancy or anti vaccines whatever,
30:00
Speaker 1: and like those seem like very valid causes of concern.
30:04
Speaker 1: And yet when you zoom out to the historical kind
30:08
Speaker 1: of dimensions we've been talking about, like we're still doing
30:11
Speaker 1: great by historical standards with respect to infectious disease. We are.
30:16
Speaker 2: And the question is, I mean the question I think
30:20
Speaker 2: that keeps me up at night. Is that condition going
30:25
Speaker 2: to remain in place or are the fact that it's
30:27
Speaker 2: you know that as a matter of the way we
30:29
Speaker 2: have used and developed antibiotics sort of running out of
30:33
Speaker 2: steam and leaving us in a position where they will
30:36
Speaker 2: be less and less effective. That already seems to be happening.
30:40
Speaker 2: And of course, if you have a pandemic disease, the
30:44
Speaker 2: idea that one of our chief weapons against it might
30:47
Speaker 2: not be as effective is really kind of scary. And
30:51
Speaker 2: that's even more true of vaccines. It wasn't that long ago.
30:56
Speaker 2: We've only had the sort of vaccines for the childhood's
30:59
Speaker 2: you know, the common suite of childhood diseases since beginning
31:03
Speaker 2: in the nineties, really beginning of the nineteen fifties and
31:05
Speaker 2: then accelerating in the nineteen sixties. And you know, you know,
31:10
Speaker 2: the measles vaccine, for example, comes in and is licensed
31:12
Speaker 2: in the US nineteen sixty three. There are plenty of doctors,
31:17
Speaker 2: you know, pediatricians who trained in the intervening decades, who
31:21
Speaker 2: have never seen a case of measles. We've forgotten how
31:25
Speaker 2: miserable a disease it is, even if it doesn't kill you,
31:28
Speaker 2: and it could kill you, and resquandering this enormous life
31:33
Speaker 2: saving Promethean gift that that germ theory has given us
31:38
Speaker 2: in for reasons, don't I deplore and don't fully understand.
31:43
Speaker 1: Let's abstract one level, right, There is this question at
31:48
Speaker 1: the center of your book, which is why did it
31:50
Speaker 1: take so long, hundreds of years from the time humanity
31:54
Speaker 1: recognized that bacteria exists till we realize that they cause disease?
31:59
Speaker 1: Do you think humanity has gotten better at changing our minds?
32:07
Speaker 2: I see no evidence at all that human nature has
32:12
Speaker 2: fundamentally changed.
32:13
Speaker 1: Well, that's the when you say human nature has fundamentally changed,
32:16
Speaker 1: you're loading the diet.
32:18
Speaker 2: That's true.
32:20
Speaker 1: I mean, certainly the rate of discovery has increased the
32:23
Speaker 1: amount of just even just to go back to the
32:26
Speaker 1: tools idea, like the sharing information idea, like we're sharing
32:30
Speaker 1: information way better, way faster, with way more people.
32:36
Speaker 2: I mean, I think we have a better infrastructure of
32:43
Speaker 2: knowledge than we used to. But I think because science
32:48
Speaker 2: is so complicated and because it matters so much in
32:51
Speaker 2: so many of the ways we live, the fact is
32:55
Speaker 2: that science has become this kind of political football where
32:59
Speaker 2: people you know, use beliefs about certain scientific questions as
33:05
Speaker 2: markers of political tribal identity. That doesn't lead you to truth,
33:11
Speaker 2: but it's really powerful. And that's where I see a
33:14
Speaker 2: lot of our problems being right now. Whether that will last,
33:16
Speaker 2: whether we'll be able to grow out of that in
33:18
Speaker 2: the next decade or so, I very much hope so.
33:21
Speaker 2: But we could be going into a sort of know
33:24
Speaker 2: nothing age where we will lose the advantages of germ
33:27
Speaker 2: theory and other ideas that have been established painfully by
33:32
Speaker 2: decades or centuries of work.
33:37
Speaker 1: We'll be back in a minute with the lake round.
33:51
Speaker 1: Let's finish with the lightning round. What's your favorite humor?
33:55
Speaker 1: Black bile, yellow bile, phlegm or blood?
33:58
Speaker 2: Oh I'm all in on blood.
34:01
Speaker 1: Oh interesting, I like the hot.
34:03
Speaker 2: I like the hot.
34:04
Speaker 1: What's one lesson we should learn from the south Sea Bubble?
34:09
Speaker 2: The most important lesson we can learn from the south
34:13
Speaker 2: Sea Bubble is that be wary of the trojan horse
34:22
Speaker 2: of financial innovation. That is too complicated to explain. So,
34:28
Speaker 2: you know, we got hammered in the early two thousands
34:33
Speaker 2: by the subprime mortgage catastrophe, and what was really what
34:39
Speaker 2: really drove that was a series of you know, newly
34:42
Speaker 2: invented financial instruments that radically increased the amount of leverage
34:48
Speaker 2: and hence the the size of the catastrophe that would
34:51
Speaker 2: follow when, you know, should it all come crashing down.
34:54
Speaker 2: And almost everyone dealing in those instruments didn't know what
34:58
Speaker 2: they were dealing with. And when that's happening, there will
35:02
Speaker 2: be some people who figure it out and they'll get rich,
35:06
Speaker 2: and the rest of us will pay the price. So
35:09
Speaker 2: you know what you're talking about before you put the
35:11
Speaker 2: rent money into your financial gamble.
35:15
Speaker 1: You've written about a very large number of very eminent
35:20
Speaker 1: famous scientists, and I'm curious, are there any non obvious
35:24
Speaker 1: traits they seem to share.
35:29
Speaker 2: I think one of them is what Einstein was famous for,
35:36
Speaker 2: which you know, it's a kind of stubbornness. I once
35:41
Speaker 2: spoke with with a physicist to knew Einstein well, and
35:44
Speaker 2: he said, the difference between him and the rest of
35:47
Speaker 2: us wasn't you know, he wasn't better than and in fact,
35:51
Speaker 2: it was worse than an awful lot of physicists At mathematics.
35:55
Speaker 2: He was really really good at framing a problem, and
35:58
Speaker 2: that's actually a common that's a trait that I think,
36:02
Speaker 2: you know, great scientists share. But the most important thing
36:05
Speaker 2: that this guy who knew Einstein said was the fact
36:10
Speaker 2: that he was willing to sit with a problem if
36:13
Speaker 2: he thought it was important, he would sit with a
36:14
Speaker 2: problem as long as it took so. And most scientists,
36:18
Speaker 2: if they can't figure something out after two or three
36:20
Speaker 2: years or whatever, say Okay, that one's you know, that
36:23
Speaker 2: one's not for me. I'll go find something else to
36:25
Speaker 2: think about. Einstein, you know, worked on special relativity, you know,
36:30
Speaker 2: for eight or nine years from the first time he
36:32
Speaker 2: thought about the question. General relativity was another decade. He
36:38
Speaker 2: wrestled with quantum mechanics or quantum theory basically all his life.
36:43
Speaker 1: I mean, is there a kind of hindsight bias there? Like,
36:47
Speaker 1: are there lots of scientists who are super stubborn and
36:50
Speaker 1: wrestle with things for a long time. We just don't
36:52
Speaker 1: know who they are because they'd ever been to break
36:54
Speaker 1: it through.
36:54
Speaker 2: Because I mean, I don't think it's the only thing
36:57
Speaker 2: you need, But you asked for a characteristic they share.
37:00
Speaker 1: Yeah, fair enough, it's necessary, but not sufficient, not sufficient.
37:04
Speaker 2: I mean, I once had the good fortune to run
37:06
Speaker 2: into Jonah Saulk at an airport, right and we ended
37:10
Speaker 2: up I recognized him, and I somehow.
37:13
Speaker 1: Made the polio vaccine, made.
37:15
Speaker 2: The polio vaccine. Yes, and I went up and talked
37:18
Speaker 2: to him, and this was you know, in the in
37:21
Speaker 2: the eighties, so you know, he did the polio vaccine
37:24
Speaker 2: in the fifties. And what was really interesting is the
37:29
Speaker 2: same issues, the same questions. I mean, he was really
37:33
Speaker 2: interested in the question was, you know, just how do
37:35
Speaker 2: you develop vaccines for intractable diseases? And what I met
37:38
Speaker 2: him he was working on did not succeed, but working
37:40
Speaker 2: on trying to come up with an HIV vaccine. You know,
37:44
Speaker 2: this was a man who had, you know, a view
37:46
Speaker 2: of the world and a view of his sort of
37:49
Speaker 2: corner of the world that led him to focus on
37:52
Speaker 2: big issues and stay with him as long as it took,
37:56
Speaker 2: or as long as he had And that turns out
37:59
Speaker 2: to be something that really really I think, yes, you
38:04
Speaker 2: can end up with a with a career that does
38:06
Speaker 2: not produce anything because you stayed on the wrong problems
38:08
Speaker 2: too long or you know, as Einstein did. You know,
38:11
Speaker 2: he was working for the last couple decades of his life,
38:13
Speaker 2: three decades of his life on a problem for which
38:16
Speaker 2: the tools were not yet there to really address seriously,
38:19
Speaker 2: mathematical tools and the observational tools that would have helped
38:22
Speaker 2: him to try and generalize from the existing theories. You
38:26
Speaker 2: know he was premature on that's all right. He got
38:30
Speaker 2: a bunch of other things.
38:31
Speaker 1: Right, Thank you for your time.
38:33
Speaker 2: Well, it's a pleasure. I really enjoyed this conversation. Thank you.
38:43
Speaker 1: Tom Levinson is the author of the book So Very Small,
38:46
Speaker 1: and he's also a professor of science writing at MIT.
38:50
Speaker 1: Please email us at problem at pushkin dot fm. We
38:54
Speaker 1: are always looking for new guests for the show. Today's
38:57
Speaker 1: show was produced by Trinomanino and Gabriel Hunter Chang, who
39:01
Speaker 1: was edited by Alexander Garretton and engineered by Sarah Brugeret.
39:06
Speaker 1: I'm Jacob Goldstein, and we'll be back next week with
39:08
Speaker 1: another episode of Mine, What's Your Mother?