Bookshelf

🎨 Impressions

Why would I read a book about the disease of tuberculosis? I’ve gotten to know the charismatic and frankly brilliant author John Green via his classic YouTube series called “Crash Course World History” in which he put dozens of hugely influential eras of mankind into bite-sized episodes, enriched with explanatory animations, lots of clever language and some running gags. He and his brother Hank were very early successful creators in the YouTube ecosphere.

They both worked together on numerous other projects and it seemed like whatever they touched became gold. Both published bestseller novels and founded multiple companies. Their weekly podcast “Dear Hank and John” had been a companion to me for years and so I learned about John’s fascination with this disease and couldn’t wait for the book to be published.

He is a very talented writer and I always enjoy it a lot when someone cares about a topic so much that the enthusiasm is contagious, no pun intended. It doesn’t really matter what the topic is. He had learned about the odd situation regarding tuberculosis we’re currently finding ourselves in just a few years ago when involved in some philanthropic work and realized that this problem deserves a lot more attention than it receives right now.

A deadly disease that’s completely curable but still kills over 1.2 million people each year, making it the deadliest disease on the planet? How can we let that happen?

The human condition is puzzling and your general suspicions will get confirmed. The rich nations don’t care enough about the poorer ones.

As a history geek, John Green also goes through the extensive and interesting role that the disease has played in the past. It has been with us for so many millennia it’s hard to say, but it required modern medicine to finally find out what tuberculosis actually is and how it works. Germ theory and identification of microorganisms happened only in the mid-19th century.

It was my first book of his I’ve read so far. And I now understand why his writing is so popular. The way he puts those sentences together on the micro-level is poetic without feeling pretentious. And the story-arc he weaves into this non-fiction scientific book by way of making young Henry from Sierra Leone a protagonist is wonderful. A true master at his craft.

I think he also took a few lessons from his YouTube career with him on how to keep humans engaged. The chapters are short and he moves between the several aspects he wants to shine a light on a lot, but without making it feel jumpy. The history, the medicinal and technical aspects, his personal story with his many visits to Sierra Leone and the boy Henry with his family’s history. Switching back and forth and furthering the threads one by one keeps this very entertaining. I’m sure this was a very conscious decision in order to keep people reading and thereby learning about the whole extent of the problem.

For me, what he set out to do with the book has certainly been accomplished. The disease is on my radar now and I am open to help solve the problem. I also think it’s a book that’s worth reading for everyone, especially those of us who know nothing about TB.

📔 Highlights

Introduction: Gregory and Stokes

We are powerful enough to light the world at night, to artificially refrigerate food, to leave Earth’s atmosphere and orbit it from outer space. But we cannot save those we love from suffering. This is the story of human history as I understand it—the story of an organism that can do so much, but cannot do what it most wants.

[..] tuberculosis has come to be seen as a disease of poverty, an illness that walks the trails of injustice and inequity that we blazed for it.

Chapter 1: Lakka

“Nothing is so privileged as thinking history belongs to the past.”

Chapter 4: That Wealth Never Warded Off

As of 2025, around 117 billion modern humans have lived. Over 100 billion were born before 1804. Almost everything that ever happened to us, and almost everyone who ever happened, happened before 1804.

Chapter 6: Tiger Got to Hunt

None of us actually wants to live in a natural world. And yet we tell ourselves that some—and only some—lives end naturally (which really means “acceptably” or “well”). We construct ideas about what constitutes a good time and manner of death.

It was an illness of the breath, of the place where the body interacts with the atmosphere, a process so sacred that the Hebrew word ruach, the Chinese word chi, the English word spirit, and the Inuit word sila all derive from words meaning breath or breathing.

Breath is life—respiration is the most visible and irrefutable sign that we are still here. To inspire is to breathe in; to expire is to breathe all the way out.

Chapter 7: The Flattering Malady

In Europe and the U.S., most white doctors believed that phthisis—as it was inherited by those with great sensitivity and intelligence—could only affect white people, and it was sometimes known as “The White Man’s Plague.” One American doctor, for instance, called it, “a disease of the master race not of the slave race.”

Chapter 8: The Bacillus

“If the importance of a disease for mankind is measured from the number of fatalities which are due to it, then tuberculosis must be considered much more important than those most feared infectious diseases—plague, cholera, and the like.”

We love a narrative of the great individual whose life is shot through with major events and who turns out to be either a villain or a hero, but the world is inherently more complex than the narratives we impose upon it, just as the reality of experience is inherently more complex than the language we use to describe that reality.

When Koch presented his paper proving that TB was caused by what he called Mycobacterium tuberculosis, “there was no applause, no murmuring, no debate,” Thomas Goetz writes in his brilliant book The Remedy. “The crowd was simply, utterly, absolutely speechless.” The scientist Paul Ehrlich would later write, “I hold that evening to be the most important experience of my scientific life.”

Chapter 9: Not a Person

But then as now, tuberculosis does not travel primarily through paths forged by race, except insofar as human power structures force it to.

Stigma is a way of saying, “You deserved to have this happen,” but implied within the stigma is also, “And I don’t deserve it, so I don’t need to worry about it happening to me.” This can become a kind of double burden for the sick: In addition to living with the physical and psychological challenges of illness, there is the additional challenge of having one’s humanity discounted.

It was long believed, for example, that cancer resulted from social isolation, or from bottling up one’s feelings. Even when these explanations are cruel and dehumanizing, we embrace them—because tiger got to sleep, and bird got to land, and man got to tell himself he understand.

Chapter 10: A Study in Tuberculin

Microbes challenge my very understanding of myself—what am “I,” in the end, if half of me isn’t me, and the half of me that isn’t me dictates some of “my” thinking and feeling?

Chapter 11: Trepidation and Hope

In the U.S., entire cities were founded by and for people with tuberculosis, including Pasadena, California, and Colorado Springs, Colorado. Southern California came to be known as especially salubrious, and tens of thousands of people relocated there [..].

Chapter 13: Where the Cure Is Not

Global health, like any field, loves to shorten its phrases to make them obvious to experts and inaccessible to neophytes.

Is it a patient’s fault if they or their children become so hungry that they feel obliged to sell their medication for food? Is it a patient’s fault if their living conditions, or concomitant diagnoses, or drug use disorder, or unmanaged side effects, or societal stigma result in them abandoning treatment? Why must we treat what are obviously systemic problems as failures of individual morality?

Chapter 15: Dr. Girum

But the obsession with cost-effectiveness often ends at, “Can we get this disease diagnosed more cheaply?” rather than a broader consideration of the human costs.

A 2024 study commissioned by the WHO found that every dollar spent on tuberculosis care generates around thirty-nine dollars in benefit by reducing the number (and expense) of future TB cases, and through more people being able to work rather than being chronically ill or caring for their chronically ill loved ones.

Chapter 18: Superbug

How can I accept a world where over a million people will die this year for want of a cure that has existed for nearly a century?

Chapter 19: Vicious Cycles

It was impossibly expensive to treat HIV in poor communities…until drug companies were pressured to lower prices by 95 percent, at which point it suddenly became affordable.

In fact, between 1985 and 2005, roughly as many people died of tuberculosis as in World Wars I and II combined.

Chapter 20: Hail Mary

A child born in Sierra Leone is over one hundred times as likely to die of tuberculosis than a child born in the United States. This difference, as Dr. Joia Mukherjee writes, is “not caused by genetics, biology, or culture. Health inequities are caused by poverty, racism, lack of medical care, and other social forces.”

Chapter 22: Virtuous Cycles

And so we must fight not just for reform within the system but also for better systems that understand human health not primarily as a market, but primarily as a shared priority for our species.

Chapter 23: The Cause and the Cure

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. But we can choose a different world. In fact, we will choose a different world. The world will be different a generation from now. The question is whether we will look back in gratitude at the virtuous cycles, or in horror at the vicious ones.

Ultimately, we are the cause. We must also be the cure.