Humans in Eight Plagues with Prof. Jon Kennedy

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Healthcare CEO has made a collective $4 billion in 2022. COVID cases are up 20% over the last

two weeks. A three-judge appeals court upholds severe limitations on Mifid-Pristone access

as the Supreme Court is set to weigh in. This is America Dissected. I'm your host, Dr. Abdul El-Sayed.

Let me start with the obvious. Neither you or I died of an infectious disease. After all, I wouldn't

be hosting this, and you wouldn't be listening to it if we hadn't. Now think about your siblings.

Chances are, none of them died of an infectious disease either.

In fact, the first time you probably really had to think about the risk of getting sick

and you or a family member dying of an infectious disease was at the peak of COVID.

And even then, the risks were historically low. What do I mean by that? I mean that for most of

human history, death by infectious disease was by far the highest probability outcome for you or a

loved one. And it wasn't just after a long, healthy life. It was an omnipresent risk from the day our

ancestors were born. It's taken literally hundreds of thousands of years to create the circumstances

where for the first time in human history, a few of us, those of us with enough money and societies

with enough money, get to live life without the ever-present fear of some tiny microbe we didn't

even know existed destroying us. But that didn't happen by accident. It happened because of the

millions of people who died prematurely before us. The millions of lives pocked and fevered and

pained that inspired millions that came after them to dedicate their lives to figuring out why it

happened and what we could do about it. It also took us instantiating what we learned into political

movements that built policies and procedures and infrastructure to make that possible. Think water

purification that guaranteed you didn't drink water that someone else used for, well, other purposes

before you. Or modern HVAC systems that can purify air at scale. Or workplace safety regulations that

protect you from crowded, hazardous, pestilent conditions. Or restaurants and food inspections

or vaccines. All of these things have all conspired to render infectious diseases that have killed

legions of our ancestors but in afterthought. But in this process, they've also rendered themselves,

all of those critical tools of public health, in afterthought too. And here's the thing about it.

Because we take for granted that infectious diseases are not a major concern in most of our

lives, we also take for granted the reasons why we get to take them for granted. We discount all

of those policies and procedures and infrastructures as the remnants of a bygone era and we tear them

down. From the anti-vaxxer movement to broader efforts to defund and dismantle public health

units across the country, we're at risk of undoing the investments that our ancestors and millions of

people living in less wealthy societies could only dream of. What's that quote about history?

Those who do not learn history are doomed to repeat it. If COVID proved anything, it's exactly that.

We'd ripped a lot of the guts out of America's public health infrastructure during the decade

leading up to the pandemic. An era where the greed of big banks ultimately led to the stripping of so

much of America's public infrastructure. And when the pandemic did hit us, the edifice of the

infrastructure we should have been able to rely upon was simply not up to the task. Over a million

Americans died, more per capita than most of our peers around the world. And it's because we'd

forgotten our history. So today, I want us to remember. As I thought about the subject, I came

upon an innovative new book that encourages us to do exactly that. In his new book, Pathogenesis,

sociologist John Kennedy tells the history of humanity from a different viewpoint. From the

view of the microbes that we too often forget. From the history of the first homo sapiens, the

bubonic plague of the middle ages, to the role of pestilence in our sordid history of colonialism

and enslavement to the present time. John traces just how important infectious diseases have been

to the history of our species, and just how unlikely our current present really is. So I

invited him to come on and share more on the show. Here's my conversation with Professor John Kennedy.

All right, my friend, you ready to go? Ready when you are. Ready when you are. All right, can you

reader in politics and global public health at Queen Mary University of London. And reader is

a kind of, I guess, a British eccentricity. It's somewhere between associate and full professor

I always really appreciated the way that British titles and action verbs underplay the thing that

is being done. So, you know, in the UK, you stand for public office, in the US we run for public

office. And in the UK, you all are readers, where we're here, we just go on with profess.

which we'll talk about during the podcast. But yeah, it's a very funny title, really.

and you've written this really fascinating book. Tell us why you wrote a book characterizing

the history of humanity in terms of the tiny little microorganisms we can't see that we carry

I'm by background, a historian and a sociologist. And, you know, they focus so much on the role of

humans, whether it's, you know, kind of great men from Jesus all the way to Washington and Napoleon,

or classes struggling against one another. These are seen as the kind of driving forces of history.

And then, you know, a couple of years ago, during the pandemic, I was sat at home, my wife had just

had a baby. So I didn't want to go out and, and contract the virus. And all around me, there was

this kind of death and disruption that, you know, would have been unimaginable a few, a few months

before. And it got me thinking, you know, what, what's going on, you know, we think that as a,

as a species, we're so intelligent, you know, it's kind of intrinsic in the name that we give

ourselves homo sapiens, wise humans, but we've been kind of were laid by these tiny, tiny

microscopic organisms that are so small, we can't even even see. And it got me thinking, and I

started to look back through history at some of the great transformations, everything from

the extinction of Neanderthals 50,000 years ago, all the way up to the Industrial Revolution and

the emergence of a welfare state in Europe. And you see that time and time again, in many of the

great political, economic, social transformations in the past, microbes, viruses, bacteria, other

kinds of microbes have played a really, really important, important role. And it got me thinking

that, you know, in many ways, human history has been made not by men and women, but by by microbes.

And then I started looking into the science of microbes. And as a lay person, I found

all sorts of really fascinating factoids. So one, for example, is a study that was undertaken a

couple of years ago, by some scientists in Belgium. And basically, they wanted to

look at the genome, so the DNA of the bacteria in our stomachs. And so they basically went through

the feces of about 2000 Belgians, so a pretty mucky job rather than than me. But what they

found was really, really mind blowing. Something like 90% of these bacteria were capable of

producing neurotransmitters. So chemical messengers, like serotonin and dopamine,

that influence human moods. And this is really bizarre, because bacteria aren't capable of doing

this outside of human or animals bodies. So they've evolved over hundreds of 1000s, even millions of

years to, it seems communicate with, with their hosts. And we don't really know why. But one,

one theory is that if we have serotonin and dopamine coursing through our brains,

then we are more likely to go out to socialise to be gregarious, and to provide opportunities for

these bacteria to jump from us to to other other hosts. But I guess kind of as someone with a

background in sociology, I found this fascinating, because we think of we think of ourselves as

as kind of sovereign, sovereign beings in charge of our own, our own brains, at least,

even if there are other forces on us. And this study suggests that, you know, that's not even

the even the case, you know, we have these, these bacteria inside us that are that are really kind

of influencing our moods and influence in the way that we that we think. So I was wondering if

they have this impact on us as individuals, what roles they play in the body political,

the body social, the body economic. So it was really this kind of attempt to unify

kind of science and, and history, and in particular, microbiology and sociology

and history that really, really got me fascinated in the in the topic.

trying to ascertain the power of forces that are so ubiquitous that we often don't see them,

you know, you think about economics, and the role that either the macro or the micro cannot

economy played incentivizing certain behavior, you think about even, you know, this, this sort

of emerging field of climate sociology in the ways that are very, increasingly bleak, climate patterns

shape where people go. And what's fascinating is we all walk around carrying literally billions

of other beings inside and on us. And this is the first attempt I've I've really seen of somebody

trying to ask, Okay, what are the implications of what those beings want? Right? Because usually,

if something's happening, because of another being, it's because that being is hungry or

wants to procreate, right? Those are the two main driving incentives of, of another being.

And you can imagine when there are billions of them, even if they're tiny, and not particularly

capable, over time, their ability to swarm can be overwhelming. And, you know, if it,

the sort of profound implication of that is, if you don't believe it, think about what happens

after somebody dies, it's like those beings take over, and you are turned into dust, right? And so

it's a really compelling viewpoint. Now, I really appreciated how you broke the the various moments

of history that, you know, we'll call them great men historians tend to tell down into a set of

canonical events, or microbiological events that happened. And I kind of want to walk through some

of them here to give folks a taste of the set of arguments that you're making. One of the most

profound for me was at the very front of the book, your argument is that, like the very existence of

Homo sapiens, in the singular species, united species that we are right now, is likely a

function of a set of diseases that we carried and had become immune to, can you walk us through that

argument? And the implications for we'll just say all the other dead and buried potential, you know,

humanoid species that could have manifested on the earth? Yeah, so I think the thing that's

to the one that we live in today. It was actually in many ways a bit more like, you know, Lord of

the Rings, when you have these different types of humans, Tolkien calls them races of humans,

which is a little bit problematic in the modern day. But you know, you don't just have men,

you also have your dwarfs, your hobbits, your elves, your half elf, half humans,

who formed the Fellowship of the Ring. And similarly, 50, 60,000 years ago,

Homo sapiens were stuck in the African continent. And you had also some other species of humans

in Africa, but you had the Neanderthals in Western Eurasia. And then you had another

species of humans that were similar to Neanderthals called Denisovans, who were in the east

of Eurasia. And then when you get to kind of Southeast Asia, you had other species of humans.

So Homo florensis, which is found on the island of Flores in Indonesia, which was actually

pretty similar to a hobbit. It was about one meter tall with disproportionately large,

large feet. We're not sure if they're hairy or not. And the world was very different 50,000

years ago. And then suddenly something remarkable happened. All these other species of humans

disappeared. They became extinct within a few thousand years and Homo sapiens surged out of

Africa. And they spread really quickly throughout the so-called old world. And they even got as far

as Australia really, really, really, really quickly. And this is one of the great kind of

mysteries of the Paleolithic era. Why did this happen? Why did we go from a multi-species

world to a Homo sapiens world? And there's all sorts of explanations. And the dominant

theory is the idea that we Homo sapiens were just smarter, just more intelligent than the other

species. And therefore we were able to out-compete them. But this doesn't really make sense.

One, we've been around as a species for at least 150,000 years. So that's a long time for

that advantage to kick in. But also the latest evidence suggests that certainly Neanderthals

were not that different to us in cognitive ability. We know that they were painting on cave walls.

We know that they were able to travel by boat between the islands in the Mediterranean.

They certainly could talk to each other and communicate. They seem to have buried their dead,

maybe even with flowers, to commemorate the fallen family members. And so the more we learn

about Neanderthals, the more we realize that they were pretty similar to us in terms of cognitive

ability. And so this raises the question, why? What happened? And the most convincing explanation

is infectious diseases. And the answer is pretty simple, actually, that

Homo sapiens and Neanderthals would have been separated for hundreds of thousands of years. So

they would have evolved in different disease environments. And their immune system would

have evolved to cope with particular pathogens. So when they met maybe 60,000 years ago in the

Mediterranean, it would have been pretty devastating. Homo sapiens would have carried

pathogens that they had developed immunity to, but the Neanderthals would have really got very,

very sick or even died, and vice versa. And so we see this actually in the Eastern Mediterranean,

that over a period of tens of thousands of years, Homo sapiens tried to push out,

and then they don't seem to manage it. The traces of them disappear. And also,

this happens to Neanderthals. They move around into the Eastern Mediterranean, then

we find traces of them in caves in Israel and places like that. And then they seem to disappear.

The trail turns cold. So this seems to be a period in which these two populations are meeting. And we

know they met because something like 2% of our DNA comes from Neanderthals. We even-

Some other things, yeah. Yeah, exactly. But the thing was that

Homo sapiens, having grown up in, having evolved in tropical Africa, would have carried more and

more deadly pathogens. And this is a kind of, you know, this is still a theme today, that the closer

you get to the tropics, the more and the more deadly infectious diseases that you tend to find.

And this is, there's a very simple explanation for this, that more of the sun's rays reach the

earth. Therefore, there's more vegetation, there's more animals living on that vegetation,

and there's more microbes living on those animals. So as Homo sapiens were pushing out of Africa,

they carried a greater disease burden. And so they would have overcome the Neanderthal

diseases before the Neanderthals ever came there. And so when they overcame the diseases,

when they developed immunity, they would have been able to surge out of Africa

Our time horizon as human beings living in 2023 is so dramatically shortened from the time horizon

of the history that you're describing, right? And, you know, as you talk about this,

it's not a matter of any individual Neanderthal or Homo sapien life course. It's a matter of

literally thousands of years in which there's this sort of moment of interaction between these

two different types of human beings. And you're talking about it, you know, a prehistoric is not

even the right term. This is a moment in which so much of the scientific understanding that you

learned when you were three, four, and five didn't really exist. And so, you know, the capacity to

withstand or heal, we think was really quite limited at the time. And so you're just talking

about this like edge of transmissibility between these two different diseases. And it really only

takes a couple of them over a couple of hundred years, right, to seasonally come back and then

wipe out a whole group of people. One thing... Yeah, yeah. And I think, you know, the thing to

have grown up for a long time in Europe, Asia, and America have kind of about 2% Neanderthal genes.

This is what Svante Paabo, the winner of last year's Nobel Prize for Medicine, kind of

discovered about 10 years ago. But I think what's really interesting is that the genes that we've

retained from Neanderthals, they're not random. They're ones that gave our ancestors an advantage

as they were pushing out of sub-Saharan Africa into a new climate and a new disease environment.

So some of these genes relate to our skin color and our body hair, so helping us survive in the

cold, dark, northern climes. But many of the genes that we have retained from Neanderthals relate to

our immune system because, you know, basically by having sex and reproducing with Neanderthals,

we were able to wholesale acquire new capabilities from Neanderthals that they've

taken hundreds of thousands of years to evolve. So it's kind of an inadvertent, unwitting form

of biohacking in many ways, a way of kind of getting around the kind of terribly slow process

of Darwinian evolution by natural selection. So yeah, it's amazing what we can now learn about

this period that's so, so far in the past. But I guess the other interesting thing to say is,

you know, 50,000 years ago, it seems like a long time ago, but bacteria were first around something

like three and a half billion years ago. So it really puts human life into perspective when we

think that humans as a species have been around for just two million years, Homo sapiens 200,000,

maybe 300,000 years, and these tiny little bacteria have been around for three and a half

billion years. It really shows how kind of we're squatting in a bacterial world, in a way,

and how we've had to evolve to live with these tiny, tiny microbes.

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I want to fast forward here to the moment that we start farming as a means of producing a

predictable amount of food. And the other thing that comes out of the farming ecosystem is,

well, by definition, if you're farming a plot of land, you got to stay put on that plot of land.

And it creates a space where the capacity for large-scale human congregation and therefore

large-scale transmissibility of disease is now a foregone conclusion. Can you talk about

the advent of agriculture and the impact that that had on the disease experience of people

it was only 12,000 years ago that our ancestors started to experiment with agriculture. So

cultivating seeds and plants and trying to domesticate animals. And this, first of all,

happened in the so-called Fertile Crescent in the Middle East. And there were various other

experiments that occurred a few thousand years later, independently in China, India,

parts of West Africa, even in South, Central and North America. Interestingly, not in Europe though,

which I always find quite amusing because there's a big move to see Europe as the

kind of seat of world civilization, but we were certainly a laggard with respect to agriculture.

But basically, when we were hunter-gatherers, the planet could maybe support about 10 million people.

And as you say, as soon as we settled down and started cultivating crops and domesticating

animals, this massively increased the amount of people that could survive on the Earth's resources.

So Jared Diamond estimates pretty soon after that, you could support 100 times more people

with agriculture than with hunter-gathering. And now we're living in a world where there's what,

seven, eight billion people living precariously, but still, it's really, really remarkable.

And so certainly, some people see the adoption of agriculture as the first

giant leap on the road towards human civilization, which we're benefiting from

now. And other people kind of believe it's the first step towards poverty and inequality. And

I guess there's a bit of truth to both of those arguments. But what's really clear is that

the transition to agriculture was an absolute boon for infectious diseases. So for the first

time in history, humans were living cheek by jowl with one another, but also with animals,

both farm animals and also the kind of parasites that would come and live on your grain and

food. So this created the perfect environment, really, for infectious diseases to jump from one

species to another, which is more often than not the source of infectious diseases. And then for

these diseases to spread quickly throughout human communities, first in villages and then by trade

routes with other parts of the world. And so many of the infectious diseases that have really

devastated humans for the last few thousand years emerged in the wake of this transition to

agriculture. So we see this both if we look at genomic evidence from

bacteria and viruses, but also if we look at archaeology. So if you look at

things like paintings in Egyptian pyramids, they are the first evidence of smallpox,

for example, or you seem to see people suffering from polio. You have people depicted with withered

limbs using walking canes, but otherwise they seem to be young and unhealthy. And so,

yeah, I think it's really fascinating. And there's also kind of things that we can talk about that

are relevant today, but this first great kind of technological development in human history

also brought about kind of devastation from infectious diseases. And there's some really

fascinating research that has been done over the last couple of years. So just a few months ago,

they found the oldest evidence of plague bacteria, Yersinia pestis, in England, and it was about

4000 years old. And it's really amazing how they do this. They basically kind of

remove some material from ancient bones. And I guess one use of this is to try and find

out the DNA of the people whose bones they were. But also when you're doing this,

you pick up other genetic material, including the genetic material of the microbes that were

in your blood at the time of death. And so in a few people, they found plague bacteria. So this

suggests that 4000 years ago, there was, I guess we could call it a kind of Neolithic Black Death

that was causing chaos throughout Europe and as far as Britain, which at the time was a kind of

really distant Northwestern outpost of Eurasia. So yeah, you can find out really fascinating

things about prehistory and the really kind of deep, deep past through ancient DNA research.

you had, by dint of being out and exposed through hunting, you had become exposed to the kind of

virus that truly can spread in humans, it might wipe out the clan. But because we lived in clans,

it sort of protected the whole. And then all of a sudden, you have this thing called, quote,

civilization, where people are all fixed, living very, very close with one another,

and many of whom are in deeply impoverished circumstances and cannot leave.

And you have this situation where now you've sacrificed whole towns and cities to particular

diseases, and that persists today. I mean, so much of what we experience with COVID is not just that

we live very close to each other, but it's that we live very close to each other and now are

hyperconnected by things that can move the span of the world in a day, right? So it's fundamentally

changed that nature. One of the things that you talk a lot about is colonialism, and it almost

parallels the history that you shared hundreds of thousands of years ago with the spread of these

different kinds of humans. But in colonial history, you have this pushing out of groups and this use

of disease as a bioweapon to subjugate other folks. Can you talk a little bit about the role

of disease in the colonial enterprise? Anybody listening in the US will know about the stories

of the use of smallpox against Native Americans, but how broad was this?

years when Scandinavian seafarers, Vikings who were living in Iceland and Greenland first

discovered North America, and they called it Vinland. And there they found this kind of

green, wonderful place that they wanted to live in, they wanted to settle, and they tried several

times to do this. But on both occasions, they were fought back by the Native population, and

they weren't able to settle and colonize North America. So I think it's really important to

remember that it's actually quite difficult for one group of people to go to another populated

part of the world and defeat the Native population and set up a new colony. It's a

really tough thing to do. And when we take this into account, what happened 500 years later

when the Spanish came across Mesoamerica and South America, it demonstrates just how remarkable

the Spanish conquest of the Americas was. So if we think of Hernán Cortés, who conquered the great

Mexico or Aztec Empire in the 1520s, he managed to do this with about a thousand people. And this

was a vast, sophisticated empire. Tenochtitlán, the capital city of the empire, maybe had

200, 250,000 people. So this was a city that was four times the size of the biggest city

in Spain at the time. So this idea that Europeans were more advanced, it's just flawed. The key to

the Spanish conquest of Mesoamerica was smallpox, which arrived just before the Spanish managed to

defeat the empire. And of course, because the Native Americans hadn't been exposed, they were

immunologically naive. And the disease killed maybe a third or half of the population and left

the European conquerors untouched. And then it raced ahead of the Europeans and it devastated

the Inca Empire. And a decade later, you have Francisco Pizarro, who comes along with 168 men

and manages to conquer this great empire in South America that stretched more or less the whole

length of the continent. And it wasn't just the military victories. It was the fact that

the Spanish formed these new colonies on the ashes of the old empires, and they ruled them

for hundreds of years. And we can still see the consequences of that now, whether it's the

language or the religion. And it wasn't just smallpox. There were other diseases that came

over. So it was wave after wave of plague. And scientists have estimated that the population

of the Americas fell from maybe about 60 million to 6 million in 100 years after the arrival of

Christopher Columbus. So literally decimated. And you can even see the impact of this in

ice cores that are drilled in the Arctic. So you can see the fall in the amount of carbon

dioxide in the air because of the decline in slash and burn agriculture. And scientists have

even suggested this contributed to the Little Ice Age. So the cold medieval period when the Thames

used to freeze over for several months a year and the entrepreneurial townsmen would build cafes

and pubs and ice rinks on the Thames and have these what they called frost fairs. So it shows

how even 500 years ago the world was really interconnected. But we can even think about

the relevance of this to North America as well, because there were certainly several attempts to

settle in what became New England before the Pilgrims were successful. And the Pilgrims

weren't successful because they were particularly well organized. They were a pretty ragtag

bunch of people. And they were pretty badly organized, which makes sense because they

arrived in the middle of the New England winter. And the only reason they were really successful

is because they arrived a couple of years after a devastating pandemic in the Massachusetts Bay,

which maybe killed 90% of the population. And in fact, when you read the accounts of the Pilgrims,

they settled in one of the abandoned villages. And they even managed to survive by taking grain

from the houses. And that's one of the ways that they were able to get through the winter without

starving. So yeah, the whole conquest of the Americas really can't be understood without

germs. And I know a while ago, Jared Diamond talked about guns, germs, and steel. But I think

when we actually look at the latest data, it would be more accurate to say germs, germs, germs.

to an immune naive population that wiped away a large proportion of that population. And instead,

history gets told from the perspective of the folks who brought that over. And then agency

is attributed to those people, which creates all kinds of racialized hierarchies that are

that are thought to be self-evident as a function of, quote, winners and losers.

And instead, actually, a lot of this has to do with the evolution of very tiny things that

we didn't even understand at the time. You talk very movingly in your book about the implications

with respect to the transatlantic slave trade. I really recommend that listeners pick up the book

and read through it. I want to ask a couple of questions just about modern times, because,

you know, we think we live in an age, or at least pre-2020, we thought we lived in an age where we

were past infectious diseases, which, you know, is just a reification of exactly that pattern I just

talked about. These are infectious diseases that weren't systematically affecting upper and middle

income people in high income societies, but infectious diseases that persist in lower and

middle income societies and in low income parts of high income societies. And the subtext here is

just the level of inequity that changes your epidemiologic experience in modern times. You talk

quite a bit about the role of capitalism in moving a lot of these surges and in, I hate to say it,

exploiting infectious diseases for the enrichment of very few. Can you talk about the way that that

industrial revolution in England and the fact that, you know, if we look back to the

first half of the 19th century, this was a period of, you know, really incredible wealth creation

in England. But at the same time, it was a period in which life expectancy wasn't increasing. And

this is because the wealth was being created in these vast factory towns in the north of England.

And people were moving from the countryside to work in these factories. And there wasn't a

democracy at the time. So people didn't really care about the factory workers. They just let

them live in their slum accommodation. And it was dirty, crowded, and sanitary. So at the same time

that these factories were kind of manufacturing all of this kind of remarkable produce and shipping

it across the world, you had the workers living in horrible conditions. And, you know, life expectancy

figures in central Manchester, for example, in the middle of the 19th century were 25. So really

shocking. And health only started to improve when you get towards the end of the 19th century,

and you have a gradual kind of democratisation of British politics. And so in about, what would it

be? 1867, you have the Second Reform Act, and 60% of the working class population, or the working

class male population, we should say, are enfranchised. And then they start voting for

mayors and municipal politicians that kind of campaign on an agenda of building

sanitation systems, piping fresh water into the cities. And this is when you see the kind of

massive improvement in public health and life expectancy in England. And I think there's an

important lesson there that capitalism is amazing in some respects, in the sense that it has

encouraged wealth creation in a way that other ways of organising the economy haven't.

But there's also a massive danger to capitalism when the state doesn't intervene to regulate

capitalists, then really it can have a terrible impact on the population. And we saw that in the

first half of the 1800s. And we also see that now, right? And, you know, I know you work in

public health, Abdul, and, you know, you can see the role that private corporations

have in creating public health crises when, you know, the state doesn't regulate them,

whether that's kind of companies polluting the water, or whether it's selling products

that are dangerous to our health, whether that's cigarettes, alcohol, ultra processed food.

And so I think, you know, there's an important lesson from the book that,

you know, certainly, if certainly kind of laissez-faire, or, you know, kind of

unregulated capitalism, you know, creates an enormous amount of wealth for the economic elite,

but it doesn't really do anything to benefit the majority of the population. In fact,

it can have a devastating effect on the health of the majority of the population. So

there is an important policy lesson there that, you know, there does have to be regulation. You

know, if we look throughout history, the state plays an important role in kind of, you know,

basically providing a mechanism by which this fantastic economic growth can be converted into

broad based health and well-being for the whole of the population. And it's a lesson that we seem

to have forgotten in the UK, and I guess, to an extent in the US over the last 30 years or so,

but it's certainly a terrible shame that we're not learning lesson from that.

is to leverage capital and all that capital can afford to create more money. And what we forget

is that that can often be agnostic to what the downstream external consequences are to people's

health. And so whether it's making sure that that system of capitalism isn't exploiting people's

bodies to make a dollar or make a pound, or it's making sure that the earnings of that are

redistributed into infrastructure that protects the whole, you got to have a functioning state.

And, you know, some of the arguments I get in with more laissez-faire capitalists

hinge on this idea that somehow regulation is what gets in the way of even more value creation.

And the funny thing I think a lot of folks tend to forget is that the ultimate enemy

of capitalism is monopoly. And that's the end outcome of capitalism. So like capitalism is

itself self-defeating, like that's just the nature of the beast. And so it cannot exist

without some force pushing back to make sure that all of the substrate, right, the public goods,

the people to work and to buy are healthy and able to actually function in that system.

you know, kind of even if we think of pretty, you know, pretty centrist economists like

Jeff Sachs, Jeffrey Sachs, who is at Columbia still, you know, he talks about the poverty

trap and the role that infectious diseases play in the poverty trap, the fact that, you know,

if as an individual, you are ill, then you can't work or you can't go to school. Maybe someone has

to take time off work or off school to look after you. You might well have to spend a large amount

of your family's money on out-of-pocket medical expenses. And so this has a devastating impact on

the economic viability of a household. But when, you know, you take whole countries or regions

where this is happening to thousands or millions of people, this has a devastating impact on

the economy. And this basically kind of makes it very, very difficult to escape poverty. And

it makes it much more likely that subsequent generations will also get ill and suffer the

same kind of terrible negative feedback loops. So, you know, having a healthy population is

a crucial part of having a wealthy society as well. And I appreciate that point. And I

and taking time to illustrate the ways in which our own failure to remember that point has allowed

us to be exploited by other creatures, the ones that we don't see and for a long time didn't know

existed. John, really appreciate you joining us here today. It was really a really helpful

conversation to put in context so much of what I think folks are newly being reminded or have

been reminded over the last four years or so. Our guest today is the author of the book Pathogenesis.

He's a reader in politics and global health in the Center for Public Health and Policy at Queen

Mary University in London. And he joined us to talk about his new book, Pathogenesis. John,

care companies made in 2022? Four billion dollars. Yes, I don't have a cold. That's

billion with a B. That's an average of 64 times the earnings of the average health care employee.

Yes, 64 times. To put in perspective, the average CEO made more in one week than their average

employee made all year. Now, you know, this is a regular beat here at America's second.

And the reason I cover this isn't because I begrudge anyone their money. No, it's because

this explains so much of what's wrong about American health care dynamics. Health care

companies call themselves, quote, nonprofits. That means that in theory, they're not driven

by earnings of investors or stockholders. Instead, they're driven by the earnings of their CEOs.

That means that from the very top, they're incentivized to maximize revenue.

And that means doing so many of the shitty things they always do. How else do you explain hounding

your most indigent patients who had to go into debt to pay for their health care? How else do

you explain jacking up the cost of basic services? How else do you explain whittling down the amount

of time that any doctor has to see their patients while holding those same doctors accountable to

their patient satisfaction scores? How else do you explain win at all costs consolidations that

leave patients with fewer and fewer options? The reason this matters is because we've commodified

health care so profoundly that we've sucked the basic humanity out of it and explains so much of

the worst things about our health care system. So next time you ask why, remember, four billion

dollars is probably why this is, unfortunately, the second week in a row that I felt compelled

to cover COVID. And that's because cases are up 20 percent over the last two weeks. Thankfully,

hospitalizations and deaths remain quite low, but the fact that cases are up suggests that we may

see a bump in those two metrics in the next few weeks. What's particularly concerning is that we're

about to watch as temperatures begin to drop and the kids go back to school. Don't get me wrong.

I'm not saying we should change anything about that. I'm saying that it's worth watching out.

Aside from getting our vaccine boosters, I want to highlight one more thing that all of us can be

doing about it, and that's indoor air purification. You've probably heard me say this before. Schools

received millions of dollars to invest in improvements in infrastructure through the

pandemic, and air purification should be at the top of that list. Not only is it critical for

COVID prevention, but it's also critical to prevent so many other airborne diseases, colds, flus,

RSV, et cetera. Finally, this happened this week. A federal appeals court yesterday imposed

restrictions on the abortion pill Mifeprestone, but the ruling will not take effect until the

Supreme Court makes a decision about the case. This ruling follows an April decision from Texas

federal court judge, Matt Kaczmarek, upending decades of precedent and the power of the FDA

by arguing that the commonly used abortion medication Mifeprestone's decade-old FDA approval

should be overturned. The three-judge appeals court tried to find some compromised position,

reversing the FDA ruling, but placing major restrictions on Mifeprestone access,

including eliminating medication by mail and requiring a physician's visit to get access.

None of this matters for now, considering that the Supreme Court has put a stay on both rulings

until it decides whether or not to hear an appeal. But remember, this is essentially the same court

that banned Breaux, so not great. We'll watch the space for you. That's it for today. On your way

out, don't forget to rate and review. It does go a long way. And listen, if you've got some friends

out there who are health conscious and interested in getting the real story on some things, tell

them about the show. Word of mouth still matters. Also, if you love the show and want to rep us,

I hope you'll drop by the Crooked store for some American Dissected merch. Don't forget,

we've got those SIGPOD brochures. American Dissected is a product of Crooked Media.

Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma LeCrank.

Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz,

and a special thanks to Naomi Bierenbaum, our intern, for her incredible work this summer.

Theme song is by Taka Asazawa and Alex Rugiera. Our executive producers are Leo Duran,

Sarah Geismar, Michael Martinez, and me, Dr. Abdul El-Sayed, your host. Thanks for listening.

This show is for general information and entertainment purposes only. It's not

intended to provide specific health care or medical advice and should not be construed

as providing health care or medical advice. Please consult your physician with any questions

related to your own health. The views expressed in this podcast reflect those of the host and

his guests and do not necessarily represent the views and opinions of Wayne County, Michigan,

or its Department of Health, Human, and Veteran Services.