Henk's Reviews > Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection

A fascinating book that is almost impossible not to read in one session. Examines the biological and societal factors related to the disease that still kills most humans every year
And so we have entered a strange era of human history: A preventable, curable infectious disease remains our deadliest. That's the world we are currently choosing.

John Green does an incredible job in Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection. I breezed through the book in one day and found it both very informative but also deeply humane.
Over a million people died of tuberculosis in 2023, more than malaria, typhoid and wars combined.
While curable in the rich world since mid 1950s, an estimated 150 million people have died since then, with deaths mostly linked with malnutrition.

Historical context and modern day relevance
Nothing is so privileged as thinking that history belongs in the past Green notes, and I must say I had the same thought that this disease was more part of the 19th century than particularly relevant today. Known as Phthisis till 1900, based on a root of a word for decay, tuberculosis led to massive societal change, leading to people going to the West of the USA to rest their lungs in a dry environment for instance. Stetson caught tuberculosis and became inspired to make better hats in the West, where he moved for his health, leading to the classical cowboy hats.
The three teenage conspirators of Franz Ferdinand all had tuberculosis, which might have made them especially reckless since they were sure to die quite young anyway.
But history, alas is not merely a record of what we do but also of what is done to us

Tuberculosis is theorised to have been carried by infected seals to the Americas, one of the few human diseases that occurred both in the old and the new world. An estimated 2 billion of people is infected currently, with the bacteria growing very slowly compared to other infections.
The main drugs used to fight tuberculosis is over 50 year old, with drugs resistance increasing over time to form a serious problem. Around half of all humans born died before the age of 5 before the 20th century and one analysis found that 15% of all deaths in London before 1730 was caused by tuberculosis, a percentage that doubled in the 19th century. The Bronte sisters died of consumption and Keats died at 24 of TB. Even George Orwell died of tuberculosis.
Tuberculosis and the pale complexion (and even white plague) were used interchangeably, due to lungs not performing their oxygen transport function well, leading to a new beauty standard that we see coming back in Dracula.

Modern day stigma of the disease
The disease was where the cure was not and the cure was where the disease was not.
Death rates of tuberculosis in the UK dropped by 90% after streptomycin was introduced in the 1940s, however 1999 Ethiopia illness rates for tuberculosis are as worse as 1882 US rates of prevalence of the disease.

No new drugs to combat tuberculosis have been invented since 1966
Sierra Leone, suffering through war and a collapsing healthcare system, is used by Green as an example of how tuberculosis keeps spreading in the modern world.
Sierra Leone’s per person healthcare budget is c. $60 per person (compared to a staggering €7.129 per capita in my home country of the Netherlands), with advance tuberculosis tests costing $25, marked at an at least 100% profit margin to Danaher corporation, a $137b company that has $24b of revenues annually.

Ultimate we are the cause, we should also be the cure.
Poverty driving the deadliness of the disease, with people not completing their antibiotics cure due to nausea driven by a lack of food. Stigma, social determinants of health, all leading to Green declaring Tuberculosis one of the diseases of injustice, with people in Sierra Leone developing sayings like: You live if you are rich, if you are not, you hope you get lucky.

This is a heartfelt, well researched and humane book on a disease that still has a massive impact, even though we in the rich world avert our eyes. Especially relevant in the context of the massive cuts to development aid and in the knowledge that we haven't developed new medicines against this killer for over 50 years and with diseases knowing no borders in a world full of displacement.