We’ve all lived through a pandemic now. But did you know that so much of our pre-pandemic lives was the result of … pandemics? Abdul reflects on the marvel that for so many of us, the risk of dying of an infectious disease is so low — and why we’re at risk of losing that. Then he sits down with Prof. Jon Kennedy, Co-Director of the Center for Public Health and Policy at Queen Mary University in London and author of the new book “Pathogenesis: A History of the World in Eight Plagues.”

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: [music break] Healthcare CEOs made a collective $4 billion dollars in 2022. COVID cases are up 20% over the last two weeks. A three judge appeals court upholds severe limitations on Mifepristone access as the Supreme Court is set to weigh in. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] 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 had. 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. 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 pest only 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 an afterthought. But in this process, they’ve also rendered themselves all of those critical tools of public health an 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, 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 this subject, I came upon an innovative new book that encourages us to do exactly that. In his new book, Pathogenesis, sociologist Jon 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. Jon 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 Jon Kennedy. 

Dr. Abdul El-Sayed: All right, my friend. You ready to go? 

Jon Kennedy: Ready when you are, ready when you are. 

Dr. Abdul El-Sayed: All right. Can you introduce yourself for the tape? 

Jon Kennedy: Yeah. My name is Jonathan Kennedy. Dr. Jonathan Kennedy. I’m a reader um in politics and global public health at Queen Mary, University of London. And reader is um a kind of, I guess, a British eccentricity. It’s somewhere between associates and full full full professor in the US system, I believe. 

Dr. Abdul El-Sayed: Yeah. So I I um you know, I went to grad school in the U.K. and I I was always I always really appreciated the way that British titles and uh action verbs um underplay the thing that is being done. [laugh] Uh. So, you know, uh in the UK you stand for public office. In the U.S., we run for public office. And in uh the U.K., you all are readers, where we’re here, we just go on with with profess uh. 

Jon Kennedy: Yeah. 

Dr. Abdul El-Sayed: So. 

Jon Kennedy: Well, I hope. I hope I do more than more than read. Um. I’ve been writing a bit the last last few years as well, which we’ll we’ll talk about during the during the podcast. But yeah, it’s a, it’s a very funny title really but. 

Dr. Abdul El-Sayed: Well I I that you know that’s the reason we have you on is because you’ve been doing quite a bit of writing and you’ve written this really um fascinating book. Um. 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 around and spread to one another. 

Jon Kennedy: Yeah, well, I mean, I guess my, my interest began because I, I’m by background a historian and a sociologist. And um, 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 to Washington or Napoleon or um classes struggling against one another. These are seen as the the kind of driving forces of of history. And then, you know, a couple of years ago during the pandemic, um I was sat at home. My wife had just had a baby. Um. So I didn’t want to go out and and contract the virus. And all around me, there was this kind of death and destruction that, you know, would have been unimaginable a few a few months before. And it got me thinking, you know what a 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 uh we’ve been kind of uh um waylaid 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 of a welfare state in in Europe. And you see that time and time again um in many of the great political, economic, social transformations in the past um. Microbes, viruses, bacteria, other kind 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 um then I started looking into the science of a of of microbes. And um as a layperson, I found all sorts of really fascinating factoids. So um one, for example, is a a study that was undertaken a couple of years ago by some scientists in Belgium. And basically they wanted to look at the the genome, so the DNA of the bacteria in our stomachs. Um. And so they basically went through the feces of about 2000 Belgians, um so a pretty mucky job rather than the [?]. Um. But what they found was really, really mindblowing. Um. Something like 90% of these bacteria were capable of producing neurotransmitters. So um 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 thousands, even millions of years to, it seems, communicate with um 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, um to socialize, to be gregarious and to provide opportunities for these bacteria to jump from us to to other other hosts. Um. But I guess kind of as someone with a background in sociology, I found this fascinating because we think of uh we think of ourselves as kind of sovereign, sovereign beings in charge of our own, our own brains, at least um 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 uh that are really kind of influencing our moods and influencing the way that we that we think. So I was wondering if they have this impact on us as individuals, what role do they play um in the the body political, the body social, the body economic. Um. So it was really this kind of attempt to unify um 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. 

Dr. Abdul El-Sayed: That’s really um, really quite fascinating you know so much of of um the social sciences is about 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 microecono– economy play in incentivizing certain behavior. You think about um even, you know, this this sort of emerging field of climate sociology in the ways that are there in increasingly bleak uh climate patterns shape um where people go. And what’s fascinating is we all walk around carrying literally billions of other beings inside and on us. And uh 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? [laugh] 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 uh particularly capable, over time um their ability to swarm can be overwhelming. And, you know, in if the 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 uh– 

Jon Kennedy: Yeah yeah. 

Dr. Abdul El-Sayed: –then you are turned into dust. Right? And so it’s a really compelling viewpoint. Now um, I really appreciated how you broke the the various moments of uh history that, um you know, we’ll we’ll call them great men historians uh tend to tell down into a set of canonical uh events or microbiological events um 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. Um. 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 um 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, well, just say all the other dead and buried potential, you know, humanoid um species that that could have manifested on the earth? 

Jon Kennedy: Yeah. So I think the thing that’s really important to remember is that, you know, 50, 60,000 years ago, the world was so different to the one that we live in today. Um. It was actually in many ways a bit more like, you know, Lord of the Rings, when you have these different um types of humans um talking of course the races of humans, which is it’s a little bit problematic um in the modern day. But, you know, you don’t just have men. You also have your dwarves, your hobbits, your elves, your half elf, half humans um who formed the fellowship of the ring. Um. And similarly, 50, 60,000 years ago, Homo Sapiens were stuck in the African continent. And you had also some other species of 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 of Eurasia. And then when you get to kind of um Southeast Asia, you had other species of humans. So Homo Floresiensis, which is found on the island of Flores in Indonesia, which was actually pretty similar to a hobbit. It was um it was about one meter tall with disproportionately large, large feet. We’re not sure if they’re hairy or or not. And um 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 um really, really, really, really quickly. And this is one of the great kind of mysteries of the Paleolithic era. Why did this happen? Um. Why did we go from a multi species um 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, um just more intelligent than the other other species, and therefore we were able to outcompete, outcompete them. Um. But this this doesn’t really make make sense. Um. 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. Um. We know that they were painting on cave walls. We know that they were able to travel by boat um between the islands in the Mediterranean, um they certainly could talk to each other and communicate. Um. They seem to have buried their dead, maybe even with flowers, to kind of commemorate the the fallen family family members. And um 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 the question, why what what happened? And the most convincing explanation is infectious diseases. And the answer is pretty pretty simple, actually, that uh, you know, Homo Sapiens and Neanderthals would have been separated for, you know, hundreds of thousands of years. So they would have evolved in different disease environments and their immune system um would have evolved to cope with particular pathogens. So when they they met um maybe 60,000 years ago in the Eastern Mediterranean, um it would have been pretty, pretty devastating. Um. Homo sapiens would have carried pathogens that they had developed immunity to, um but the Neanderthals would have really got very, very sick or even died and and vice versa. And so we see this actually in kind of the eastern Mediterranean that over a period of tens of thousands of years um Homo Sapiens tried to push out and then they don’t seem to manage it, they the kind of um traces of them disappear. And also this happens to Neanderthals, they kind of move around into the eastern Mediterranean then kind of we find traces of them in caves in Israel and um places like like that. And then they and then they seem to to disappear. The trail kind of turns turns cold. Um. So this seems to be a period in which these two populations are meeting. And we know they met because um, you know, something like 2% of our DNA comes from from Neanderthals. We even um procreated with [?]– 

Dr. Abdul El-Sayed: They made did some other things. Yeah. [laugh]

Jon Kennedy: Yeah, exactly. Um. But but the thing was that um Homo Sapiens, having grown up in having evolved in um tropical Africa, would have carried more and more deadly pathogens. And this is a kind of um you know, this is still a theme today that the closer you get to the tropics, um the um the more and the more deadly infectious diseases that you you tend to find. And this is there’s a very simple explanation for this that um more of the sun’s rays reach the reach the earth. Um. Therefore, there’s more vegetation, there’s more animals living on that vegetation and um there’s more microbes living on those animals. Um. So as Homo Sapiens were pushing out of Africa, um they carried a greater disease burden. And so they would have overcome the the the Neanderthal [?] diseases before the Neanderthals overcame theres. And um so when they when they overcame the diseases, when they developed immunity, they would have been able to surge out of out of Africa and um spread throughout the world.

Dr. Abdul El-Sayed: Mmm. You know, it’s it’s fascinating as as I digest this argument. 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 or Homo Sapien life uh course. It’s a matter of literally thousands of years in which there’s this sort of moment of interaction between these uh two different types of human beings. And um you’re talking about a, you know, a pre a prehistoric is not even the right term. This is a is a moment in which um so much of the scientific understanding that you learned when you were three, four and five didn’t really exist. Um. And so, you know, the capacity to 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 that– 

Jon Kennedy: Yeah, yeah and I think, you know, the thing to remember is that. You know, we we know that we have, you know, or particularly um Homo Sapiens who um whose ancestors have grown up for a long time in Europe, Asia um and America have kind of that 2% um Neanderthal genes. This is what Svante Pääbo, the um the winner of um last year’s Nobel Prize for medicine, kind of discovered about ten, ten years ago. But I think what’s really interesting is that the 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 of sub-Saharan Africa into a new climate um 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 northern climes. Um. But many of the genes that we have retained from Neanderthals relate to our immune system. Um. Because, you know, basically by having sex and reproducing with Neanderthals, we were able to wholesale acquire um new capabilities from um from Neanderthals that they’d taken hundreds of thousands of years to to evolve. So it’s kind of a inadvertent, unwitting form of biohacking in many ways, a way of kind of getting around the the kind of terribly slow process of Darwinian evolution by natural natural selection. So, yeah, it’s amazing what we it’s amazing what um we can now learn about this period um that so, so far in in the past. But I guess the other interesting thing to say is, you know, 50,000 years ago it seems like a long a long time ago, um but bacteria were were first kind of um first around something like three and a half billion billion years ago. So it really puts human life into perspective when we think that um humans as a species have been around for just 2 million years. Um. Homo sapiens, 200,000, maybe 300,000 years, and um these tiny little bacteria have been around for, you know, three, three and a half billion, billion years. It really shows how how kind of we’re squatting in a bacterial world in a way, and how we’ve had to evolve to live with with these these tiny, tiny microbes. [music break]. 

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Dr. Abdul El-Sayed: 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 um the the capacity for uh large scale human congregation and therefore large scale transmissibility of disease is now a foregone conclusion. Can you talk about um the advent of agriculture and the the impact that that had on the disease experience of of people at that time? 

Jon Kennedy: Sure. Um. So. You know, if we say that um Homo Sapiens have been around for 200 or 300,000 years, it was only 12,000 years ago that um our ancestors started to experiment with um with agriculture. So cultivating um seeds and plants and um trying to domesticate animals. And this first of all happened in the so-called Fertile Crescent in the in the Middle East. Um. And there were various other experiments that occurred a few thousand years later, independently in China, India, parts of West Africa, um even in in in south central and north North America. Interestingly, not in in Europe, though, which uh I always find quite, quite amusing because we like to see um but there’s a big move to see Europe as the the kind of seat of world civilization. But we were certainly a laggard in and with respect to agriculture, um but basically kind of when we were hunter gatherers, the the planet could maybe support about 10 million people. Um. And as we say, as soon as we settled down um and started cultivating crops and domesticating animals, this massively increased um the amount of people that could survive on on the Earth’s resources. Um. So Jared Diamond estimates, you know, pretty soon after that um you could support 100 times more people um with with agriculture than than with hunter gathering. And now we’re living in a world where there’s, what, seven, eight billion billion people um living precariously. But but still, it’s it’s really, really remarkable. And so, you know, 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. Um. And other people kind of believe it’s the the first step towards poverty and inequality. And, you know, it’s a I guess there’s a bit of truth to to both of those arguments. Um. But what’s really clear is that the transition to agriculture was an absolute boon for infectious diseases. Um. So for the first time in history, humans were living um cheek by jowl with one another, but also with animals, um both farm animals, and also the kind of parasites that would come and live on your on your grain. And um so this created the perfect environment, really for infectious diseases to jump from one species to another, which is, you know, more often than not, the source of infectious diseases. And then for these diseases to spread quickly throughout human communities, um first in in villages and um then by trade routes um with other parts of the 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 kind of genomic evidence from from um from bacteria and viruses, but also if you look at kind of archeologies so if you look at um things like um paintings in in Egyptian pyramids, you know, they are the first evidence of smallpox, for example, or you seem to see people suffering from polio. Um. You have people depicted with withered limbs using walking canes. But otherwise they seem to be seem to be young and and healthy. Um. 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 this first great kind of um technological development in human human history um also brought about kind of devastation from from infectious infectious diseases and um there’s some really fascinating research that has been done over the last couple of of years. So just a few months ago, they found the oldest evidence of plague bacteria so Yersinia pestis in in England. And it was about 4000 years old. And it’s really amazing how they how they do this. They basically kind of they remove um 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 they work. But also when you’re doing this, um you pick up other genetic material, um including the genetic material of the microbes that were in your blood at the time of death. Um. And so in these two in in a few people, they found plague plague bacteria. So this suggests that, um you know, 4000 years ago, there was a I guess we could call it a kind of Neolithic black death that um was causing chaos throughout throughout Europe. And as far as Britain, which at the time was a kind of really distant northwestern outpost of of Eurasia. Um. So, yeah, you can find out really fascinating things about, you know, pre-history and the really kind of um deep, deep past through ancient DNA research. 

Dr. Abdul El-Sayed: You know, it’s a fascinating thing, right? Because before then we’d mainly lived in clans. And if you had, you know, by dint of being out and exposed through hunting, you had become exposed to the kind of virus that that 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, um and uh many of whom are in deeply impoverished circumstances and cannot leave. Uh. You have this situation where now you’ve you’ve you’ve sacrificed whole um whole towns and cities uh to particular diseases. And that that persists um today. I mean, so much of what we experienced 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 um it’s it’s fundamentally changed that nature. One of the things that you talk a lot about is colonialism and it almost it almost parallels the history that you shared uh hundreds of thousands of years ago with the the spread of these different kinds of humans. Um. But, you know, in colonial history, you have this pushing out of of groups and this use almost of disease as a as a bioweapon to subjugate other folks. Um. Can you talk a little bit about, you know, the role of of disease in in the colonial enterprise? You know, anybody listening in the U.S. will will know about the stories of the use of smallpox against Native Americans. But um but you know how how how broad was this? 

Jon Kennedy: Yeah. I mean, I think it’s it’s useful for North American listeners, readers to kind of go back a thousand years when um Scandinavian seafarers um Vikings who were living in Iceland and Greenland first discovered um North America and they called it Vinland. And there they found this kind of um green, wonderful place that they wanted to live in. They wanted to settle. And they tried several times to do this, um but on both occasions they were fought back by the um native population and um they they weren’t able to able to settle and colonize North America. Um. So I think, you know, it’s really important to remember that it’s it’s actually quite difficult for um one group of people to go to another populated part of the world and um defeat the the native population and um kind of set up a new a new colony. It’s a it’s a really tough, tough thing to do. Um. And this kind of when we take this into account um what happened 500 years later um when the Spanish came across Mesoamerica and um South America, it demonstrates just how remarkable the Spanish conquest of the Americas was. Um. So if we think of Hernán Cortés, um who conquered the great Mexico Aztec empire in the 1520s, he managed to do this with about a thousand, a thousand people. And you know this was a a vast, sophisticated empire. Um. Tenochtitlan, the the capital city of the empire, maybe had 200, 250,000 people. So this was a city that was that was four times the size of the biggest city in Spain at the time. Um. So this idea that Europeans were um more advanced, um it’s just it’s just flawed. You know, um the key to the the Spanish conquest of Mesoamerica was um smallpox, which arrived just before the the the Spanish managed to defeat the the empire. And um of course, because the Native Americans hadn’t been exposed, they were immunologically naive. And um the disease kind of killed maybe a third or half of the population and left the European conquerors untouched. Um. And then it raced ahead of the of the Europeans, and it devastated the Inca Empire. And, you know, kind of a decade later, you have um Francisco Pizarro, who comes along with 168 men and manages to conquer this great um empire in in South America that stretched more or less the whole length of the of the continent. And it wasn’t just the military victories rights. It was the fact that um that the Spanish formed these new. These new colonies on the on the ashes of the old empires. And they ruled them for hundreds of years. And we can still see the the consequences of that now, um whether it’s the language or the or the religion. And it wasn’t just smallpox. There were other diseases that came over. So it was kind of wave after wave of plague. And scientists have estimated that the population of the Americas fell from maybe about 60 million to 6 million– 

Dr. Abdul El-Sayed: Wow. 

Jon Kennedy: –in 100 years after the after the after the arrival of um Christopher Columbus. So, you know, literally decimated. And um you can even see the impact of this in ice cores that are drilled in the Arctic. Um. So you can see the fall in the amount of carbon dioxide in the air um because of the the decline in slash and burn agriculture. And scientists have even suggested that this contributed to the little ice age. So the cold medieval period when the the Thames used to used to freeze over for several months a year and the um entrepreneurial townsmen would build cafes and pubs and ice rinks on the on the Thames and um have these what they called frost 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 North America as well, because um, you know, there were certainly several attempts to um settle in what became New England before the pilgrims were were successful and the pilgrims weren’t um weren’t successful because they were particularly well, well organized. They were a pretty ragtag bunch of um bunch of a bunch of people, and um they were pretty badly organized, which makes sense because they arrived in the middle of in the middle of the New England– 

Dr. Abdul El-Sayed: Winter. 

Jon Kennedy: –winter. Um. And the only reason they were really successful is because um they arrived a couple of years after a devastating pandemic um in the the Massachusetts Bay, which maybe killed 90% of the of the population. And in fact, when you read the accounts of the pilgrims, they settled in one of the abandoned villages um and they even kind of managed to to survive by um taking grain from the houses. And that’s one of the ways that they were able to get through the winter without without starving. So, yeah, the whole conquest of of the Americas really can’t be understood without um without germs. And I know kind of a while ago, Jared Diamond talked about um guns, germs and steel. But I think, you know, when we actually look at the the latest data, um it would be more accurate to say germs, germs, germs. 

Dr. Abdul El-Sayed: And, you know, that story doesn’t often get told um about how it was pestilence that was brought over to an immune naive population that wiped away a large proportion of that population. And instead, history gets told from the perspective of the the folks who brought that over and then agency is attributed to those people, which creates all kinds of racialized hierarchies that are um that are thought to be uh self-evident as a function of, quote, “winners and losers.” And instead, actually, uh a lot of this has to do with the evolution of of very tiny things that that that we didn’t even um understand at the time. You talk you know 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 and and read through it. I want to um ask a couple of questions just about modern times, um 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 passed infectious diseases, which, you know, is just a reification of exactly that pattern I just talked about. These are infectious diseases that uh weren’t systematically affecting upper and middle income people in high income societies, uh but infectious diseases that persist in lower and middle income societies and in um in in 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 uh infectious diseases um for the enrichment of very few. Can you talk about the way that that operates yeah even now and today? 

Jon Kennedy: Yes, I think it’s a it’s useful to start off by thinking about the industrial revolution in in England and the fact that, you know, if we look back to the first half of the 19th century, um this was a period of, you know, really incredible wealth creation in in England. Um. But at the same time, it was a period in which life expectancy wasn’t wasn’t increasing. And this is because the wealth was being created in these vast factory towns in the north of England and um people were moving from the countryside to work in these factories. And um there wasn’t a democracy at the time. So people didn’t really care about the the factory workers. Um. They just let them live in the in their slum accommodation. And it was dirty, crowded, insanitary. So at the same, at the same time that these factories were kind of manufacturing all of this. All of this kind of remarkable produce and shipping it um across the world. You had the workers living in horrible conditions and, you know, life expectancy figures in in central Manchester, for example, in the middle of the 19th century were 25. Um. So really kind of, really shocking. And they only started to or health finally started to improve when you get towards the end of the 19th century and you have a gradual kind of democratization of um British, 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, I should say, are enfranchised. And then they start voting for um mayors and municipal politicians that um that kind of campaign on an agenda of building um building sanitation systems, um piping fresh water into the cities. And this is when you see the kind of massive improvements in public health and life expectancy in in England. And I think there’s an important lesson, lesson that, you know capitalism is amazing and in some respects in the sense that, you know, it um has encouraged wealth creation in a way that other other ways of organizing the economy haven’t. Um. But there’s also a massive danger to capitalism when um the state doesn’t intervene um to regulate capitalists, then um really kind of it can have a terrible impact on the on the population. And we saw that in the first half of the 1800s. And we we also see that see that now right and um, you know. I know you work in in public health [?] you know you can see the role that um private corporations have in creating public health crises when um you know the state doesn’t regulate them, whether that’s kind of um companies polluting the water or whether it’s selling products that are dangerous to our health, um whether that’s cigarettes, alcohol, ultra processed food. Um. And so I think you know, there’s a there’s an important lesson from the book that, you know, certainly um if certainly kind of laissez-faire um or, you know, kind of unregulated capitalism, um you know, creates an enormous amount of wealth for the economic elites. But it doesn’t really do anything to benefit the the majority population. In fact, it can have a devastating effect on the health of the majority of the population. So um there is an important policy policy lesson there that, you know, there does have to be regulation. Um. You know, if we look throughout history, um the state plays an important role in kind of um you know, basically providing a mechanism by which this fantastic economic growth can be converted into broad based health and wellbeing for the whole of the the population. And it’s a lesson that we seem to have forgotten um in the UK and I guess to an extent in the US over the last 30, 30 years or so. But um it’s certainly a a terrible shame that we’re not learning lessons from that. 

Dr. Abdul El-Sayed: Yeah, I really appreciate that point because we forget that the nature of capitalism 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 um 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 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 um are healthy and and able to to actually function in that system. 

Jon Kennedy: No no exactly. Poverty is or kind of disease, ill health is a is a massive driver of of poverty. Right? You know, kind of um even if we think of pretty you know, pretty centrist economists like Jeff Sachs, Jeffrey Sachs, who um is at Columbia still, um 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. Um. Maybe someone has to take time off work or off school to look after you, um you might well have to spend the large amount of your family’s money on um out of pocket medical expenses. And so this has a devastating impact on the economic viability of a of a household. But when you know you take whole countries or regions where this is happening to thousands or millions of people, um this has a devastating impact on on the economy. And this basically kind of makes it very, very difficult to escape, 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 feedback loops. So, you know, having a healthy population is um a crucial part of of um having a wealthy society as well. 

Dr. Abdul El-Sayed: And I appreciate that point and I um particularly appreciate you highlighting that through the course of so many eras of our history uh 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, that and the ones that we don’t see and for a long time didn’t know existed. Jon, we really appreciate you joining us here today. It um it was really a really helpful conversation to put in context so much what of what I think um folks are newly being reminded or have been reminded over the last uh four years or so. Uh. 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. Uh. And uh he joined us to talk about his new book, Pathogenesis. Jon, thank you so much for taking the time. 

Jon Kennedy: Thank you so much Abdul. It was a real pleasure. [music break]

Dr. Abdul El-Sayed: As usual, here’s what I’m watching right now. Guess how much the CEOs of America’s health care companies made in 2022? $4 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 Dissected. 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’s 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, $4 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% 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, etc.. Finally, this happened this week. 

[clip of unspecified news reporter] A federal appeals court yesterday imposed restrictions on the abortion pill, mifepristone. But the ruling will not take effect until the Supreme Court makes a decision about the case. 

Dr. Abdul El-Sayed: This ruling follows an April decision from Texas Federal Court Judge Matt Kacsmaryk, upending decades of precedent and the power of the FDA by arguing that the commonly used abortion medication, mifepristone’s decade old FDA approval should be overturned. The three judge appeals court tried to find some compromise position, reversing the FDA ruling, but placing major restrictions on mifepristone 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 Roe. So not great. We’ll watch this 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 America Dissected merch. Don’t forget, we’ve got those sick pod bro shirts. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illick-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz and special thanks to Naomi Berenbaum, our intern for her incredible work this summer. Theme song by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Michael Martinez, and me, Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] 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 Veterans Services.