(no subject)
Flu: The Story Of The Great Influenza Pandemic of 1918 by Gina Kolata
is not actually the story of the Great Influenza Pandemic itself, apparently because Kolata felt that Alfred Crosby's America's Forgotten Pandemic sufficiently covered the pandemic, and there was no need to more than briefly rehash Crosby in an early chapter. I have put Crosby's book on reserve and am eager to read it. But Kolata's book is the story of the afterlife of the 1918 Flu. And that's plenty of fill a fascinating book.
Context: In 1918, Pasteur's Germ Theory had been well established for decades. There was still some mild controversy around the edges, but basically it had been proven out again and again. Scientists thought that disease was caused by microorganisms called bacteria that could be observed via microscope. Different bacteria caused different diseases, and there was some tricksiness to this because bacteria didn't always have exactly the same shape and thus identifying a particular bacillus was as much art as science.
And a decade or two earlier, a very simple experiment had poked an exciting new hole in the germ theory: They had used a fine filter capable of filtering bacteria out of an infected fluid sample of, I think, Yellow Fever. They then used the filtered fluid to infect animals and found that it was still contagious. Aha! This proved that the Yellow Fever was caused by something much smaller than a bacteria, which became called a virus.
So scientists knew that some of the germs causing diseases were undetectable. This was the status quo of disease science in 1918. Many scientists suspected, correctly, that influenza was caused by a virus, but they had no way of proving it, no way of detecting its presence, no way of distinguishing it from any other virus.
1918 happens. It's terrible, tens of millions of people across the world die. More people die from influenza in 1918 than die in World War I. And scientists have very limited idea about what caused it and how to treat it or prevent a similar outbreak from happening.
And then Kolata traces what happens next. The scientists who kept poking away at the 1918 flu with limited resources and limited available evidence to try to make sense of what happened and help plan for the future.
The Norwegian-American pathologist and explorer who trekked to Alaska in the 1950s to try to find the frozen bodies of flu victims in permafrost and recover their lungs in an unsuccessful effort to extract the flu virus from them. The young government science team in the 1990s who used early PCR technology and a heaping dose of luck to extract partial gene sequences from the paraffin preserved extracts from the lungs of soldiers who died from the flu, and were able to then team up with the now retired pathologist to recover and successfully extract virus RNA from another Inuit flu victim in the permafrost. The former pig farmer turned virologist who discovered the connection between the antibodies for a 1930s swine flu and the antibodies of the 1918 flu, and the 1970s epidemiologists who tried to trace that connection backward when they diagnosed swine flu in soldiers at Fort Dix and needed to decide if that meant they had another 1918 level pandemic on hand and had to try to vaccinate the whole country.
The book is full of human drama and good science and I really enjoyed it.
Though... there's some human experimentation stuff in the book I found really unsettling. They tried to infect 'volunteer' prisoners with the 1918 flu to try to figure out how it was spread. I was upset by this but it wasn't all that surprising that shitty stuff like that happened during World War I. But when the 1979 swine flu was a thing people were worrying about, they also got some volunteers, perhaps a little less coercively this time, and tried to infect them with it. I was not prepared to learn that medical ethics was that poor in 1979, and it makes me wonder what terrible, unethical things researchers are still doing.
Cured: The People Who Defeated HIV by Nathalia Holt
is about two people infected with HIV who received different functional cures, a decade apart from each other, both referred to in the medical literature as 'the Berlin patient'. And it's about the complexities of anti-viral research, how treatments need to be so carefully tailored to the patient because of the incredibly intricate interactions between retroviruses and an individual's DNA.
And it's about the tension between the perception of the HIV patient community and the perception of the medical community about the progress made and the amount of effort thrown in. There's a general sense in the HIV community, I think, that there should have been a cure found much sooner, if not for the stigma of AIDS and homophobia and classism. Holt sees a much more complicated soup of human failings and lessons to be learned, about the difficulty of replication and the trouble scientists have when they need to overcome their egos and work together.
To be sure, some of this emerges from structural kyriarchical factors... the first Berlin patient was identified and treated by a GP deeply embedded in Berlin's gay community and therefore having the trust of his patients sufficient to aggressively test for the virus and then implement aggressive, inconvenient, and experimental treatment plans in partnership with patients he knew from long experience could be trusted were responsible enough to work along with him. The first Berlin patient was rare because his infection was identified early and aggressively treated with toxic anticancer drugs on a complicated timetable. Subsequent attempts to replicate this success, Holt argues, failed because other treatment providers didn't have the skillset or toolkit to be a GP in this sense within the communities most affected by AIDS.
The second Berlin patient, meanwhile, was only able to be successfully treated because he had the unfortunate combination of HIV and leukemia, and had to undergo a dangerous experimental bone marrow transplant which doubled as a gene therapy. When the book was written, this treatment hadn't replicated- Wikipedia says it now has, a handful of times.
There was something strange about reading this triumphant narrative of cure when the cure being discussed is so elusive and idiosyncratic and incomplete. Most of these disease history books I've been reading are discussions of historical, well understood problems that have largely been relegated to historical footnotes. There may still be mysteries, but they are not dangerous or pressing mysteries. We are still deep in the midst of fighting the war against HIV. That made the book a sometimes frustrating read, but I learned a lot anyway.
This entry was originally posted at https://seekingferret.dreamwidth.org/255544.html. Please comment there using OpenID. There are
comments.
is not actually the story of the Great Influenza Pandemic itself, apparently because Kolata felt that Alfred Crosby's America's Forgotten Pandemic sufficiently covered the pandemic, and there was no need to more than briefly rehash Crosby in an early chapter. I have put Crosby's book on reserve and am eager to read it. But Kolata's book is the story of the afterlife of the 1918 Flu. And that's plenty of fill a fascinating book.
Context: In 1918, Pasteur's Germ Theory had been well established for decades. There was still some mild controversy around the edges, but basically it had been proven out again and again. Scientists thought that disease was caused by microorganisms called bacteria that could be observed via microscope. Different bacteria caused different diseases, and there was some tricksiness to this because bacteria didn't always have exactly the same shape and thus identifying a particular bacillus was as much art as science.
And a decade or two earlier, a very simple experiment had poked an exciting new hole in the germ theory: They had used a fine filter capable of filtering bacteria out of an infected fluid sample of, I think, Yellow Fever. They then used the filtered fluid to infect animals and found that it was still contagious. Aha! This proved that the Yellow Fever was caused by something much smaller than a bacteria, which became called a virus.
So scientists knew that some of the germs causing diseases were undetectable. This was the status quo of disease science in 1918. Many scientists suspected, correctly, that influenza was caused by a virus, but they had no way of proving it, no way of detecting its presence, no way of distinguishing it from any other virus.
1918 happens. It's terrible, tens of millions of people across the world die. More people die from influenza in 1918 than die in World War I. And scientists have very limited idea about what caused it and how to treat it or prevent a similar outbreak from happening.
And then Kolata traces what happens next. The scientists who kept poking away at the 1918 flu with limited resources and limited available evidence to try to make sense of what happened and help plan for the future.
The Norwegian-American pathologist and explorer who trekked to Alaska in the 1950s to try to find the frozen bodies of flu victims in permafrost and recover their lungs in an unsuccessful effort to extract the flu virus from them. The young government science team in the 1990s who used early PCR technology and a heaping dose of luck to extract partial gene sequences from the paraffin preserved extracts from the lungs of soldiers who died from the flu, and were able to then team up with the now retired pathologist to recover and successfully extract virus RNA from another Inuit flu victim in the permafrost. The former pig farmer turned virologist who discovered the connection between the antibodies for a 1930s swine flu and the antibodies of the 1918 flu, and the 1970s epidemiologists who tried to trace that connection backward when they diagnosed swine flu in soldiers at Fort Dix and needed to decide if that meant they had another 1918 level pandemic on hand and had to try to vaccinate the whole country.
The book is full of human drama and good science and I really enjoyed it.
Though... there's some human experimentation stuff in the book I found really unsettling. They tried to infect 'volunteer' prisoners with the 1918 flu to try to figure out how it was spread. I was upset by this but it wasn't all that surprising that shitty stuff like that happened during World War I. But when the 1979 swine flu was a thing people were worrying about, they also got some volunteers, perhaps a little less coercively this time, and tried to infect them with it. I was not prepared to learn that medical ethics was that poor in 1979, and it makes me wonder what terrible, unethical things researchers are still doing.
Cured: The People Who Defeated HIV by Nathalia Holt
is about two people infected with HIV who received different functional cures, a decade apart from each other, both referred to in the medical literature as 'the Berlin patient'. And it's about the complexities of anti-viral research, how treatments need to be so carefully tailored to the patient because of the incredibly intricate interactions between retroviruses and an individual's DNA.
And it's about the tension between the perception of the HIV patient community and the perception of the medical community about the progress made and the amount of effort thrown in. There's a general sense in the HIV community, I think, that there should have been a cure found much sooner, if not for the stigma of AIDS and homophobia and classism. Holt sees a much more complicated soup of human failings and lessons to be learned, about the difficulty of replication and the trouble scientists have when they need to overcome their egos and work together.
To be sure, some of this emerges from structural kyriarchical factors... the first Berlin patient was identified and treated by a GP deeply embedded in Berlin's gay community and therefore having the trust of his patients sufficient to aggressively test for the virus and then implement aggressive, inconvenient, and experimental treatment plans in partnership with patients he knew from long experience could be trusted were responsible enough to work along with him. The first Berlin patient was rare because his infection was identified early and aggressively treated with toxic anticancer drugs on a complicated timetable. Subsequent attempts to replicate this success, Holt argues, failed because other treatment providers didn't have the skillset or toolkit to be a GP in this sense within the communities most affected by AIDS.
The second Berlin patient, meanwhile, was only able to be successfully treated because he had the unfortunate combination of HIV and leukemia, and had to undergo a dangerous experimental bone marrow transplant which doubled as a gene therapy. When the book was written, this treatment hadn't replicated- Wikipedia says it now has, a handful of times.
There was something strange about reading this triumphant narrative of cure when the cure being discussed is so elusive and idiosyncratic and incomplete. Most of these disease history books I've been reading are discussions of historical, well understood problems that have largely been relegated to historical footnotes. There may still be mysteries, but they are not dangerous or pressing mysteries. We are still deep in the midst of fighting the war against HIV. That made the book a sometimes frustrating read, but I learned a lot anyway.
This entry was originally posted at https://seekingferret.dreamwidth.org/255544.html. Please comment there using OpenID. There are
comments.