Episode 25 - Germ Theory and Popular Culture with Nancy Tomes

(upbeat music) - Welcome to episode 25 of the Infectious Historians Podcast. I'm Merleisenberg, and I'm Lee Mordecai. Today is August 30th, 2020, and we're gonna talk about germ theory and germ panics during the 20th century in American culture. Our guest for this episode is Nancy Thoms, who is a distinguished professor at the History Department of Stony Brook University in New York. Nancy is the author of four books, and I'll just mention the last two. They are the gospel of germs, men, women, and the microbe in American life in 1998, and remaking the American patient, how Madison Avenue and modern medicine turn patients into consumers from 2016. She's also edited two volumes and runs a website called Medicine and Madison Avenue, which explores the history of health-related advertising. - Yeah, and that website actually has some classic ads, such as the "Often of Brides" made "Never a Bridead" for a list room. And more broadly, however, Nancy is interested in the intersections between social and cultural history in the United States and the history of medicine, often in the context of gender. And one of the themes that recurs in Nancy's publications, at least the ones I've seen, is the connection we've already discussed and the podcast between academia and the public sphere. Some of her many articles cover topics such as disease and popular culture, or maybe medicine and consumer culture over the 20th century. So hi, Nancy. - Hi, pleasure to be here. - Yeah, thanks for coming on our podcast. As usual in our episodes, we tend to begin by describing the local effects of COVID-19, where we are, and I guess I can start today. Here in Jerusalem, the attempts we've had to try and centralize the response to COVID have not worked well so far, mainly for political reasons. The person who is responsible for the national COVID response has not received the political support he needs. So we're actually getting more infections than before. This is still on our second wave here. And the big pilgrimage to Umain in Ukraine that I mentioned in the previous episode, this is still open with a lot of political dealings now behind the scenes, but also in front of the cameras, really. And instead of the people who really want to go, but cannot go now, these are generally religious and right-wing demographically. So these people actually join the weekly demonstrations against the government, which I've also reported on in previous episodes, which are mostly central left politically. So that's like an interesting combination that was unexpected for many of us. And how are things in anapolis, Merle? - You know, they go on about the same. It sounds like you leave where you claim that the second wave is ongoing. At some point, it's no longer a second wave. It just is what it is, Lee. But as I mentioned myself, we have now successfully trained my daughter to guilt trip people when we go on walks in the park. So when we run into people who are coming by us on the path and they're not putting on masks for that five seconds, she knows to turn to us and say, why are they wearing masks, mommy? Or why are they wearing masks, daddy? And the people actually get pretty mad. It's pretty amusing to see. - I wonder why, I wonder why Merle. - I mean, you know, train the three-year-old to basically teach people about germs. That seems the way to do this, moving forward. I mean, it's also as I've talked about, somewhat depressing because now they're kind of scared of walking toward people on a path. They've seen that as a bad thing when they actually ask if it's a smaller sidewalks day. You know, why aren't the people crossing the street telling to go away? So that's maybe the downside. But, you know, the guilt is the fun positive side. - So when does she trigger, right? So what distance is like too close? - For the masks? - Yeah. - When she sees people. - No, when she sees people and they're walking toward her, she immediately asks if they're not wearing masks or if they were in masks. - Okay, good job as a parent though, I guess. - Thank you, thank you. And where are you Nancy and what's it like there? - So I am on the island, which is outside of New York City. And if you had told me three months ago that New York was going to be held up as a success story, I would never have believed it. It was so scary here in March and April. We seem to have flattened the curve much, I think to all our surprise. I'm still a lot of anxiety. I wish I had a toddler that I could get to say things like that. A lot of anger, you know, I'm in a neighborhood that's kind of mixed Trump, anti-Trump, and you can just feel the tension in the grocery store. Almost everyone has started wearing the mask, but that has become the symbol of your party affiliation. A lot of anger control going on. I'm not a very brave person. And so the thought of running up to being as brave as your daughter, I'm scared if you see people. So usually anything. - So are things kind of back to normal, more or less over there? - No, not at all, not back to normal. More, not getting worse. We are all still maintaining our social distancing. I don't go out to eat, I really live a very limited life still, but there is a feeling of satisfaction that the death rates are down. And the infection level has dropped. I am worried about my university that did open with that hybrid, I'm praying that we really have tried hard to minimize potential spread. I'm on leave, so I'm watching it from the distance. - So how many of the students actually came back? - They had hoped for more than decided to come back. So we have about 6,000 students in residence. Some never left because they were international students, graduate students who decided to stay because if they left, they weren't gonna get that. But we've lost a lot of international students at Stony Brook and we're very sad about that. One of the joys of teaching. But no, things are not back to normal. - I guess it's better than some other places around us. - Yes. - Yeah, I mean, as you said, New York had it so bad that in some ways people in New York seem to have taken that at least very seriously as opposed to say Maryland where it was bad, not as bad as New York. And things here have basically leveled off at about a 3% positivity rate, which is in my mind still too high to do much, but everything is opening as if it's not. - So after that update, can you maybe just start us briefly, Nancy, with defining what germ theory is for people who might not know what that term is? - Germ theory, a phrase that emerged in the mid to late 19th century to describe the idea that what caused catching diseases, communicable diseases, we're living microorganisms that you could not see. So it starts out as a theory. There's a lot of resistance to it. Slowly new experimental methods of showing the connection between germs under a microscope and disease, it stops being a theory and it becomes a foundation. - So when more or less did this position become consensus? - It takes a civil war among the doctors. So it's about 20 years of arguing from the mid 1860s until I'd say the consensus pretty strong by 1885. For a long time historians looked at that argument with contempt for the people who resisted the germ theory. But I think in recent years we've gone back and looking more at the terms of the debate and it's easier to understand what the objections were that even scientific people who can't do it. When you think about it even today, explaining how it is that things you can't see can make people sick and understanding all the different ways that the bad microbes get from me to you to make you sick, it's pretty complicated. And where did this happen? Does it say US story, European story? - So it starts as a European story. I'll see there's a prologue to it and that you can go back to ancient times and find little snippets of smart people saying gee, maybe what makes people sick is some kind of rule of enclosure. So that idea is floating around in the 17th century and we unlock events of very primitive microscope and you can see in a drop of water all these things swimming around and it's like, "Whoa, maybe this is what makes people sick." But that idea really got trashed in the late 18th and early 19th century. In part because the crazed or microscopy just went bananas and people were saying they could see germs with faces and nothing kind of stuff. It was like a parallel game. So if you were a serious scientist in the 1820s and the 1930s that an immacular hypothesis, that was nonsense. So it's in that context that of you, what we call shoe leather epidemiologists are noticing at outbreaks of cholera that seem to be localized. Well, maybe it could be a living organism behind these cholera epidemics. And then you have a whole lot of other people saying no, no, no. It's just this process called fermentation. You get the right conjunction of weather and soil and filth, you know, people's garbage, animal garbage, whatever, that's what causes cholera. And then once it starts, it can spread from person to person. So there's this idea that combination of filth and atmospheric conditions, you probably heard of my asthma theory. And that's partly the idea that their atmospheric changes. That's the prime way of explaining epidemic diseases in the 1820s, 30s and 40s. Along come a few people who say maybe what that ferment is in cholera, physical breathing, organism. But again, they're getting shouted down. Do you pastor who lays the foundation for a pivot in that discussion? He's working on fermentation in beer and wine. People who's beer and wine are getting all nasty. He understood this because the wrong permits are getting in there and he just kind of makes this off hand comment. And all this, he's a chemist publishing all of this dense work about chemistry fermentation. Maybe ferments a lot. That's like the 1857. But it's not until the 1860s that he starts to get more serious about that idea. In the meantime, you have a revelation in surgery that this is Lister. If you're very careful about spraying the air, you can cut post-operative infections. So clearly there's some fermentive matter in the air. What if that's living? So you begin to get a kind of group of scientists who are putting together a store and Lister and saying maybe the firmens that we're talking about are living micro-organisms. And it's that camp that really develops this gym theory of disease. OK, so that's a good explanation of what happened into 19th century. But how does this academic discourse really percolate into more popular ideas, popular culture? I mean, to the extent that there was one in the late 19th, early 20th century. So Louis back up a minute and give you the second part of the science story. And that is the development of new laboratory methods that can kneel down the specifics. That show, indeed, it is this specific bacteria that causes cholera, this specific bacteria that causes tuberculosis. That is not Louis Pasteur. That really is Robert Koch. So it's the development of laboratory methods. Primarily in German Koch starts out as a private doctor, but he's so amazingly successfully eventually has his lab at the university, trains, new researchers, develops a method for showing that specific micro-organism A causes disease A. You may have heard of the highly Koch postulates. People are still taught those in medical school. And basically, you isolate a pure strain of this microbe from a sick person or creature. Get a pure culture of it. Go through all these distillations. So you've got pure cholera. And then you show you can give another creature. They are not supposed to do this on people. And they don't usually. You'll give cholera to, I don't know, a rabbit or a mouse. I'm not sure what they used to give. This is all done with animals, unfortunately. You can show that you can give cholera to a well creature. And then you can go through the whole cycle again is really brilliant. And it's through that methodology that Koch just conclusively shows, bam, bam, bam, a number of major diseases. It starts with anthrax, which is not exactly a major threat, but it's so big, you can really study it. But then it's cholera, it's tuberculosis, microbes responsible for wound infection, which shows why Lister was working. Indeed, they're very, you know. So that is the kind of scientific breakthrough. And that starts in the late 1870s, carries on into the 1880s. And as that scientific body of work becomes more widely disseminated, that the critics of the germ theory start to lose ground. Now, oddly enough, even before many physicians were converted to the germ theory, there are popular exponents of the germ theory. And I found much to my surprise, a lot of the early, some of the most enthusiastic purveyors of germ theory were inventors who had devices that they wanted to sell, to fix to your toilet, cholera's down in the sewer system. How do you prevent it from coming back up? Believe me, when I hear all this stuff about the coronavirus in the bathroom, it just takes me right back to these inventors, who I really came to admire. They saw a good argument, and they jumped on it. A good argument or a good business opportunity. I mean, that's like the question, right? Well, hard to tell. And again, it's hard to tell to this day, whether it's just the commercial images behind it or if it really is a good thing. Can you maybe give us an example of one of these inventions? In the early iterations of the germ minis, the focus was on water. So people are hooking up toilets in their homes, in large numbers, in big cities in this time period. And once the word gets out there, that diseases like typhoid and cholera are spread by water, your toilet becomes the subject of potential contagion in your home. So there's this massive plumbing revolution that's basically how do you create a safe sanitary toilet system? So the idea of sanitation, sanitary, how do you keep sewer gas in the germs that are down in the sewer from coming back in? So there's this enormous innovation in terms of how toilets are set up to create a water seal. So the air doesn't come again. But there are also these devices. And in fact, when you build a new house, they still have them to vent the gas from your septic tank or your sewer, whatever it is. So these inventions that I'm talking about were new kinds of toilet mechanisms that would keep the sewer gas from coming into the home or ways that you could burn off your sewer gas in a safe fashion. I discovered when President Garfield was shot and was being cared for in the White House, that these inventors offered their services because the White House was known to be a very unsanitary space. And so they were promising to come in. And here, you know, I have the latest sewer gas device that, you know, to help the president recover from his wounds, did work, he died. But yeah, they see a moment entrepreneurial opening and they ran with it. So you're saying that these entrepreneurs are the people who made the connection between the research, the science, and the public or the media also play a role here, did early advertising maybe? The advertising is a key part. The amount of coverage, like in major newspapers of the early-dream theory, not a lot. There's discussion in the medical and literature, but not so many stories like getting picked up in the New York Times. It is the advertisers who do a huge amount of work of making your average American aware that their germs out there, and that they may want to start changing their ways, the ways they live in order to avoid them. Listerine is another good example. Listerine starts out, Lister named after the surgical, Joseph Lister, he has nothing. He has no involvement in the company and probably was horrified that they were using his name this way. But the idea is, here's a disinfectant that can kill germs that you should start to buy and use on your body and in your home to disinfect yourself. So that's a Listerine ads are a major carrier of the fear of germs starting in the 1880s and continues on to this day. If you look at Listerine, they again, they saw a good idea and they stuck with it. One of the fun things I did in my research was just to watch how Listerine changed its germ pitch over the years. It was fascinating. Have you reported this back to the company? No, they would appreciate it. So what happens next then? There is a second phase in terms of the sort of early this advertising of popularization is more around the fear of toilets and toilet hygiene in kitchens as well, because your kitchen sink, all of these potential places for germs. But there's a second phase that kicks in in the 1890s and early 1900s when, again, using the scientific method, the experimentalist realized that it's just, it's not just water that's carrying the germs or air. It's also, they're also on people. So they start culturing people's hair. They start culturing people's skin. They realize that the big problem in surgery is the surgeon's hands. So surgical asepsis where you just have to get all the germs out of the area of surgery. This leads to a second phase where there's much more focus on the human body as the source of the problem. And you don't just have to disinfect your toilet. You have to disinfect your body as well. And some of the uses of lice all I cannot share because small children might hear this podcast. Again, unfortunately, some of what's happened with COVID, with the bleach drinking? That is, again, eerily throwing back to this total war on the human body to get rid of germs. It's something we had started to move away from with the understanding that our microflora are part of ourselves. And in fact, essential to our well-being, that we have the right kind of microbial friends in our bodies. But I'll tell you, COVID, that is all flying out the window again. You remember when you were supposed to eat yogurt to get the good stuff? Well, you don't hear much about that anymore. It's hand sanitizer and drinking bleach. So this idea is there by the early 20th century that they're good bacteria and bad bacteria. Again, that was one of Pester's points. Is good bacteria give good beer or good wine? It's the bad stuff you've got to get rid of. But how do you know them? And how do you come up with a method of living in the world that shields you against the bad ones? In many ways, our great-grandparents faced this kind of scary world where they weren't really sure what exactly they should be frightened of. Many kind of common ways of being in the world, for example, shaking hands or kissing babies got rethought in the early 20th century. There were public health posters that said, "Please don't kiss my baby. I don't want my baby to get sick." So a real fearfulness of human contact that comes about as a result of this new scientific way of looking at the human body. So to kind of follow up on that. So you mentioned-- or I guess we mentioned two different things. You mentioned kitchens in your answer now and you mentioned Listerin earlier. And I kind of alluded to the bridesmaid bride to the famous ad there. So both of these, at least in early 20th century context, are probably associated with women. So how active were women in this process? Turning germs into something that's all around us in our homes. We need to take care of this. Was this perceived as a woman's role in mysticating the house? Gender plays a huge role in assigning roles in the war against germs. So the man of the household needs to be thinking about the sanitation, the infrastructure. But it was the job of the woman of the household, the mom, the wife, to oversee the private side of public health, as I've called it, keeping the bathroom in the kitchen spotless. So this idea of antiseptic and then aceptic cleanliness becomes part of the cleaning routine. This is a time period when usually, at least for a middle and upper class women, they're staying home. The man's going out. So in terms of keeping the home safe, that's going to be a woman's responsibility. The more money you had, of course, the more you delegated this to your servants. And working class families who really start to get hit with these upgraded public health prevention techniques was much harder for them to maintain these new exacting levels of cleanliness, because they had to do it all themselves and often the running water and even having a sanitary toilet. We're not things that came with a working family's residence at the turn of the century. So there'd be class inequities in the ability of women, of wives and mothers, to be able to execute this new kind of domestic cleanliness. So one thing you seem to have sketched out is how this is a slow process that builds over time, right? And that it gets built up both in an academic and a quote unquote popular problem at, because that term is place. But are there moments of crisis that might accelerate this change, that might accelerate the adoption of some of these ideas here? I'm thinking of maybe rabies, for example, as a very feared disease that somehow might play a bigger role that would jumpstart some of these changes. Certainly the coverage of the famous case of-- I can't remember. I think there were six young boys from New Jersey that were bit by a rabid dog, and then sent to be treated with Pestora's rabies, antidote. That story, I think, is the late 1890s, is a big moment for media coverage of a disease crisis, and then the featuring of this dramatic scientific rescue. So that is a turning point in terms of media coverage of germ diseases, for sure. My colleague, Bert Hansen, has written really beautifully about this on a more, I won't call it day-to-day basis, but a more sort of slow, steady drip of knowledge or epidemics. When you have a cholera epidemic, when you have typhoid threatening, this tends to be a time period, both when the local public health department will start trying to publish rules about, this is the way you can keep your house clean. This is what you need to do to cooperate, to prevent this epidemic from getting worse. That raises consciousness. But you know, one of the biggest movements to popularize new thinking about germ prevention was not started by a classic epidemic disease, but instead by a very common disease that people didn't think was communicable, and that was consumption. Leading cause of death in the 19th century across classes, and this is probably the most startling research that Robert Koch ever did, was to show that consumption was, in fact, caused by tuberculosis. And why we start calling it tuberculosis instead of consumption. The realization that tuberculosis was a communicable disease really jump started a massive popular public health campaign to get people to change the way they cleaned their houses and also how they interacted with each other. The anti tuberculosis movement is really the role model for all the anti disease crusades that come after the campaign against polio. In many ways, you can see carryovers into the campaign against HIV/AIDS. A lot of the basic methods of outreach and taking a disease threat and making it real, and giving people kind of simple guidelines, do this, and be safe, really come from these anti tuberculosis societies. They start getting founded in the 1890s, and they really take off. It's the biggest public health crusade of the turn of the century and really does an amazing job of getting the word out about many areas of personal behavior that need to be changed. So in addition to this new focus on person-to-person, hair, hands, mouths, skin, contact, the bacteriological investigations also document how water but also food like milk can be a carrier of dangerous microorganisms. And this is a big part of the anti tuberculosis movement because they discover that cow's milk, bovine, tuberculosis can cause tuberculosis in the people who drink the milk. And it becomes a big push for a safer milk supply is a big part of what this anti tuberculosis movement goes after. In order to keep yourself safe from tuberculosis, you need to be careful with your food to make sure that it's cooked properly. Americans start to pasteurize milk to get rid of the germs in the milk for this very reason. Other countries get rid of that problem in other ways. But the United States decides to do it by pasteurization. So it becomes like a major teaching tool of how germs work and the wonders of bacteriology through this anti tuberculosis movement. So would the anti tuberculosis movement be part of what is described or maybe what you describe as germ panics? Yes, I could argue that this kind of teaching really laid the groundwork for an escalation of fear and anxiety. I'm a little uncomfortable with the moral panic phrase, although I haven't heard a better one, because it implies it's completely irrational, it wasn't completely irrational. People were catching tuberculosis. There were germs in the milk. The question was, how did you know where it was and what was too far to go to try to stay safe? One of the things they did in this time period, again out of a fear of tuberculosis, but it also, tuberculosis kind of becomes a stocking horse for all germ diseases, including the venereal, the sexually transmitted diseases, which are a big problem. They don't want to talk about that. Use that word, syphilis, or gonorrhea. So they'll talk about tuberculosis and other loathsome diseases. This was their code. But the things you have to do to try to stay safe and people were worried about paper money. They were worried about library books. I can't tell you what a shock it is to me to go to my library today. When I return to book, they hold it for three days out of fear of COVID. As a historian writing in 1998, I would often use the example of library books to kind of poke fun at how far they went. So I'm not doing that anymore. I'm trying to withhold judgment on what exactly is crazy to be afraid of. - Yeah, it's interesting you said that because I think that was, if I remember correctly, one of the first reports that came out about COVID in the beginning was that it stays on surfaces for up to three days, right? Which turned out to be a completely ridiculous study done in like an ideal test case from what I remember. But this was like the report. And so myself and actually members of my family, both my parents and my sister, we almost had like a competition to see who could isolate their stuff for the longest to make sure we put it aside for two days or three days. And then we had arguments over were you doing it long enough? - I think one of the stories you told on this podcast and correct me if I'm wrong, role was that you went to buy a liquor and you got the person from the liquor store to put the stuff, the liquor and the trunk of your car, then you drive it back home and just wait with the liquor and the trunk of your car for a few days before you took it out. - Yeah, but even the liquor store itself recognized this because they were only at that point taking call in orders, right? And it was out front of the store. So you had to call in the orders and then when you call them in, they said just call us when you get there, open your trunk and we'll put it in. So they themselves were doing the same thing I was doing essentially. Yeah, I left it in the car for an extra couple of days, but again, with all the reports, I say you can get this from surfaces then that's what you kind of react to. - And that argument was ongoing a hundred years ago as well, you could find some people saying, oh germs, they're easy to kill, sunlight. Just put everything out in the sun or open the window and they'll float away. But then you had other people saying, no, no, no, they're very hearty. And in fact, to these different points of view reflected different microorganisms. It's kind of unfortunate that anthrax was one of the first to be identified and studied because anthrax is pretty weird in that it can lie dormant in the soil forever and then get reactivated. And that kind of fear that dust and dirt could be reanimated like some Frankenstein monster. And there was cholera and typhoid in your house. Wow, it could create such a paralyzing since a panic. I mean, there are many examples of people who essentially develop germphobias, how it used being one of them who had such a strict mother in terms of how he was cleaned as a boy. I mean, he had many peculiarities as an adult that may go back to this fear of germs and the sense that your body is your enemy. But where does it stop being rational and start being irrational? As a historian, I was trying not to be too judgmental of my subjects, but today, I have a lot to say to myself about some of what's going on that is like, are these people crazy? When you're in it, it's hard to feel safe. Where what Merle described isn't a good idea because the theme that you make one little mistake and you're dead, that was very big in the old-term theory. And it's coming back today as well, one fall step and boom. - I think that in COVID, one of the things that became very clear early on, and to, again, reiterate some of what Merle said earlier, is that we simply don't know, right? So we don't have perfect knowledge. Our knowledge is very flawed. And I think at the beginning of COVID, there was a lot of, as a non-scientist, reading what the scientists had to say, there was a lot of uncertainty. The examples given, like the example Merle gave, but also more broad. I mean, who's getting infected when how, that was all unclear. And since us normal, regular human beings don't really have any way to know other than listening to the scientists, it actually makes much more sense to be your risk of verse and to do as much as possible because if you're mistaken, you can die. You and your loved ones can all die, like, very quickly. - I think a big difference between now and then is this process you're describing of the scientific churn, that is normal. That is the way science works. If it's something new and complicated, they don't know right away, they keep going at it, they keep trying at eventually a consensus emerges. I mean, it took 20 years with the germ theory of disease. With COVID, we've cycled through it pretty quickly. You could make the argument that we've gotten to pretty sound understanding of a novel coronavirus, pretty darn quick, but it feels like forever. - Yes, and also the amount of resources spent on COVID, I mean, resources, both monetary resources, but also time and I have no idea how many labs, at least in my university, just retrofitted and left everything they were doing and just tried to work on COVID. So both that and the probably unprecedented interaction between researchers of different nationalities and so forth. - It was a very nimble response, but also likely to be a lot of false starts. And I think the level of media attention that studies are covered exhaustively, that later turn out to be flawed or incorrect, they are reported in good faith. By journalists, I think you're, many people have this notion of science that they should get it right the first time and this kind of backtracking comes across as sinister. Something's wrong here. We should be able to have figured this out and not be having such a difficult time. Very unrealistic expectations of what can be done with a new viral disease. I mean, I still have to explain to my undergraduates that viruses and bacteria are very different and that viruses are a lot harder to control. They mutate, we don't have chemotherapy agents that can just wipe out a virus. So we're still at a level of where that is a hard concept to get across. I think where I may depart from some of the commentators is I don't see that as a function simply of how stupid people are. It's also a function of the way modern biomedicine sells itself. I mean, my university, it is supposed to be STEM at 24/7. The rest of us are there maybe on a good day, have some use. But I think science is oversold itself. It's become very embedded with in this country, corporate interests, kitchen, kitchen is what you hear. So you have this kind of wonderful possible story of collaboration around new vaccines. But then you have the who's going to try to have exclusive control and make a lot of money off of that. And then there's a wonder why people are suspicious of new vaccines. It's like, I am not an anti-vaxxer, but I don't find it hard to understand suspicions that people may have. Simply because this has gotten to be such a messy overlap of science and business. And I think it fits into some of the other trends that are prevalent in recent years, right? So fake news, I guess, they're the broad term that we want to describe on one hand. And let's start with media, media responsibility, media reporting, social media policing, content on both those platforms. It's complicated stuff, yeah. It is indeed, and in the new work I'm doing, that is really what I'm trying to wrap my head around is the kind of media piece of it and the interactive media piece of it. Because all the problems I described with germ panics and explaining things to people in 1910, try to imagine that in 2020 now that we have social media that basically anybody can say almost anything, they're not good, they're message taken down. It's a Wild West show. And yes, the big platforms are starting to try to figure out what is irresponsible to leave up. But there, for all the reasons I know you know, very reluctant to jump into the censorship. In fact, there's been more of that lately than I would have predicted even a year ago because it just seems out of control. But I want to go back up to the point of misinformation and where does it come from? Information that turns out to be incorrect. A scientific study that then gets corrected can live on and continue to be cited. It becomes misinformation itself. So this idea that if we just communicated science, better, if you media people would just get it right, we wouldn't have this problem, I think, is really oversimplified because it is the normal science itself that generates ideas that have to be revised. And if that's covered closely in that churn, you're going to have that uncertainty. You're going to have somebody who can go back and find that Fauci said, mass or no big deal. He's changed his mind correctly, in my opinion. But the fact that he said that has now become this big political talking point and also a way to kind of bash COVID, the wearing of mass. Yeah, I think one thing that's become pretty apparent for me is how much living through the science as it's developing has taught me a lot about-- I mean, I've known how science works, but how much the day-to-day as it work and change pretty abruptly. And I think, as historians, we tend to gloss over the-- for us, the decades long change for you, maybe the year-long, the annual changes. And I think we kind of lose sight of some of that nuance often in the back and forth in our own work, perhaps. I think the slow science movement, which you've probably run across is an effort on the part of medical educators and clinicians and researchers to start realizing that maybe we need to acknowledge that science is a process and that this churn is part of getting to the right answers. So people are more patient. I mean, the impatience to understand COVID is very striking. Maybe because I am a historian and I lived all those years looking at how long it took and all the different twists and turns before they got to the kind of basic ideas that we still believe in, it took a long time. And yet, having that kind of patience-- again, when people are dying, it's very hard to encourage people to be patient. I mean, I can probably tell a personal story for Merle and myself. So when we published this article in a science journal, they had an embargo in which you're not supposed to show this article until a certain point, a specific hour on a specific day. So we gave a few interviews before everything went live. And the moment it went live, you just like hit refresh on your browser. And you get dozens of reports-- I mean, places we interviewed with, but also tons of other websites that just copied the content. I'm not entirely sure how it worked. But that, I guess, day was big. And afterwards, interest dropped considerably, almost to zero. You sell on the first day, and everyone forgets about it all afterwards. Yes, and it's been fascinating for me to watch what's happened with the COVID and the way historical work has been brought into it. It is kind of like, we're the dessert, or we're the kind of, whoah, isn't this interesting? They had an anti-masculine concern for Cisco. I mean, the number of reporters who've called me about mass, but there is also the sense that I'm here for my entertainment value. I've kind of lost any hope that the historical piece will actually inform policy, in part, because you probably know about the study of the World War I pandemic that Howard Merkel and others, and I was brought in in a second wave of that group. We did all this studying about social distancing and the influenza for the bush and then the Obama pandemic plans that then nobody used, because Donald Trump was in office. So I've kind of had a crisis of, why are we doing this in the sense that that loop of where it gets into a setting where people could actually work with it. Here's irrational to me, to think about all the money that was put into that pandemic plan. And by George Bush, of all people, starts it. Obama carries it on, and then all that work. And we do none of it. That's pretty depressing. Yeah, I found a chart, as I think I've told you before, from a magazine in the middle of March, breaking out all the different cities that you guys had obviously done in terms of the influenza pandemic and showing that, you know, if you do this versus that, this brings back a wave at this point, this type of wave, and this was March. And so people said, look, this could happen. And in fact, that's literally what's happened everywhere in America, because we just decided we weren't going to follow. Now it seems from having talked to a number of other guests that other countries have actually followed some of this planning, which is kind of ironic that it was a US-based thing that other countries have followed. And I think there, besides our political problems, also just the size matters, this country is so big that I think that, in and of itself, really made it difficult to come up with a cohesive plan. But it's hugely, I'll just say, personally embarrassing to me as a historian who values public health and who's tried to do my bit. But it's also exposing the lack of funding for public health. Again, my students don't understand that medicine is not public health. And we've cut public health spending since the recession of 2008. People are wondering, why are they doing this that the other-- they have no budgets. The budgets go to the academic medical and the for-profit medical side of things. It's not going into basic public health prevention and hasn't for decades. So yes, we're caught napping. And the big excitement is around a vaccine, which, again, is something that's going to be administered through a doctor's office or whatever. It's not the same as the kind of big-level interventions that public health movements want to do. So you mentioned, Nancy, you had an existential moment of, why are we doing this? So do you have an answer for us of why we're doing this now? So we can sleep at night. The fact that no one's paying attention now-- I mean, maybe someday they will. We just have to keep trying and keep trying to cut through the noise. And maybe I would say to myself, I need to be patient, that we're not done with this yet. On a good day, I think maybe this will wake people up to the need to value public health more. Do you think there might be an issue of the public not really getting, quote, unquote, history in the same way that some of them might not be getting, quote, unquote, science, like you mentioned earlier? Yes. And there's definitely been a decline of interest in history because it's not seen as something that will lead to a good job. I mean, I have a great job. But yeah, it's so stem-oriented at the moment that the thought something in the past could actually inform what you're doing in the present seems to be a little old fashioned. But again, in some ways, I think this pandemic has awakened interest in the history of infectious diseases because there is so much that still seems the same in the experiences we are having. Are there any other ways in which we today living during COVID may or may not experience or think about history differently than other generations in the past? I guess maybe the one thing that I haven't mentioned, maybe I need to throw in there, is the historicity of what scares people. In my book, I talk about the fact that being born in 1952, I did not grow up with a tremendous fear of infectious diseases. It was HIV/AIDS that taught me. These things are real. And so many of these issues about what can make you sick, and who is a danger to you really front and center with HIV/AIDS, a really interesting conversation with a very young journalist where she said to me, "I've never been scared of germs." I mean, she was like me all those years ago. This is her first experience because she was too young during the AIDS epidemic to know that kind of terror. But there were other scares as well, right? There was Ebola, I guess, which is the big story in the 1990s. But so you're saying that was not as scary or that scare it was not as well-founded? In the extent to which Ebola, later SARS, Zika, I mean, there has been a whole litany of these new diseases, but really they're following the HIV/AIDS. I mean, that in terms of global and number of people killed, Ebola doesn't come close. It's very scary, and it got people's attention, if you say Ebola today, you get a reaction. I think this young woman wasn't scared of Ebola. She didn't think that she was likely to get it. So where you're really scared that you might get it or you're a family member, this is a real pandemic in the sense lots and lots of people getting exposed. It's much more comparable to the influenza, the Spanish flu than it is to Ebola. Even though HIV actually takes so much time until it actually affects you, right? In many ways, it's not at all like the coronavirus. Retrovirus, you can be infected for many years before that symptoms actually arise. It's a really horrible, tricky little bugger. But the kind of fears that had activated the library books and the touching the money and the hugging and kissing, that stuff really got activated big time with HIV/AIDS. Again, there was a very quick turnaround to say, this is how it spreads and it's not through shaking hands. People didn't believe it and really wanted stricter control of the disease than was warranted. So I remember growing up as a kid in the late '80s, early '90s, that we had all these questions and answers about what you could do. If you knew a person in front of you has HIV, what can you do with them? I mean, can you bring them into your house? Can you have the same dinner with them? Can you sit in them with the same classroom? Even as a kid, I remember that there was a lot of concern about it, and I think I was probably shielded from most of the nastier parts of HIV. It's a reason I wrote The Gospel of Germs was living through the HIV/AIDS epidemic and realizing how many of those rules were basically-- they were saying, it's not the old rules. It's not the TB rules. It's not the stuff you used to hear or even a common cold. This is different. Here's how it's different. But people really had that basic rules about touching and, again, who is safe to be around. It strikes me that it's very difficult to do, right? Especially today, right? When we think about the kind of discourse that we have today of 288 character tweets, and you're supposed to convey your idea there or like tweet storms or whatever, conveying to people who have like a ton of other things going on in their lives, that there are so many different ways you could get infected. So many different pathogens out there is extremely difficult to do. And I think we're not there and we're not-- we don't seem to be heading there, at least to my mind. That's a question that I really want to think more about of what might be an alternative. Because I think what you just said is absolutely the challenge we face. Right now, we're so focused on COVID. We're not thinking about other endemic problems of modern living. It's the balance and the ability to kind of triage what it is you really most need to do. And that can change over time. Right now, we need to behave differently because COVID is real. It's out there. And we need to stay away from it. But when COVID goes away, how many of these habits do we need to keep doing? So that is not an easy answer. But even with COVID, everything was distilled into maybe two, three or four, three basic guidelines. Wash your hands, put a mask, maintain social distancing of six feet. I think that those are like the key points, I think. Yep. Which is all pretty standard and not COVID-specific. That's true. The mask wearing is going to be interesting because we weren't really wearing masks. I would predict that a lot of people will continue to wear masks as they did in countries that encountered SARS and really got started wearing masks and then continued. And in fact, have masks ready to go when COVID-- whereas in my household, the only reason we had in me is we had home remodeling to keep the dust out of our noses. We felt really lucky that we had those. I like that I still see a lot of people wearing those masks. So clearly, people like stocked up from the mirror and that's still a thread when there's-- I mean, in the beginning, we tried to make our own masks. So we made some for fine. And then we bought one type, which were just multiple layers of cloth. And now we have a third type, actually, which are lighter, but they have a filter in them. Yeah, that sounds really good. Yeah, so those I like the most because they're lighter, but they have a filter. The downside-- and I'm told you can buy all types of accessories now, so this is a burgeoning, consumerist field if you were, the ones that just go around your ears. The problem with them is when you take them off, you have to hold it or what do you do with it. And so that's why I like the tie ones, too. So we can have debates about this. Maybe we should have someone only when we talk about masks and optimal types. Maybe someone from business, we could bring in someone from like a corporation or something. That would probably be a first for us. I bet that thing we can do it, too. Have a kind of tie-in, too, whatever product you want. Yeah, I don't know. I do think the consumer angle is important because-- especially in the United States, because we blur information and advertising to a degree that other countries don't. It goes way back in our historical DNA of a country that really likes to advertise and sees this as central to a modern, healthy, free market capitalist economy is that you have to be able to advertise and that you don't want to reign, reign that in. So advertising, corporate advertising, is protected under free speech rules. Very unusual. When I say this to my European friends, they're like, what? And that's probably when I've talked about what I do in Europe, the question I get the most eyebrows about is, how can you people allow direct to consumer advertising of prescription drugs? Doctors don't like that. But again, that's seen as the right of good business practice is you should be able to promote your product and that the rules that apply to New England Journal of Medicine article standards of truth don't need to apply. So that's been a really wonderful, I think, wide-ranging conversation, both from the 19th century, from the beginnings of germ theory, all the way through consumerism, my particular consumer habits during COVID, perhaps, and some of yours as well, which I found really wonderful to talk with. So I want to thank you so much for coming on, Nancy. It's been a pleasure, great talking to you. Yeah, thanks so much. It was a lot of fun, and we learned a lot. Good, and stay safe. [MUSIC PLAYING] So I thought that was a really good introduction to some of the ideas we've discussed earlier on this podcast, things such as germ theory that came over in several of our previous episodes, germ panic, which is a term that-- I mean, we started maybe using now, but we've definitely touched upon germ panics in the past. And even hygiene, which also came across in recent episodes. Yeah, I thought it was a nice summation of a lot of threads that we've been putting together. And especially as well, your favorite, typically, which is popular culture and how that influences academia and vice versa. Yes, so Nancy's episode actually made a lot of sense after Priscilla's episode from last week. Both of them actually discussed popular culture and academia, and this my favorite term, feedback loop between both of these tiers, right? But I think Nancy does it in a different way, probably more historic way, pretty obviously because of her background, while Priscilla was doing it in a more literary way of more thinking about the narrative, broadly speaking. Yeah, I think it's also about where the grounding comes from. I mean, Nancy, if remember correctly, in the introduction of book, quotes Mary Douglas's famous book on impurity and danger, which is often also cited by Peter Brown, who's in our field on light and equity, about how popular culture and, as it were, elite culture are actually one and the same. And so you can see those influences very strongly, I think, in both of their works. Yeah, and an additional thing that Nancy did was to actually bring in advertising and consumerism in a much more prevalent way, right? I mean, if there's a high to low culture, advertising is probably the lowest of the low culture, right? It's just like the thing nobody wants really wants to take that seriously, at least not, as a topic of historical research, unless you're like into the history of advertising or something. But I think what she did very well, both on the podcast, but also in her other work that the website that I mentioned at the beginning of this interview, she brought that together, she showed how advertising actually goes really hand in hand with health in the United States at least. Yeah, and I thought the other thing, which came up was movies, for example, which we talked about with Robert Albert before. And in particular, she was talking about Howard Hughes. And here, I always think of the movie The Aviator. So Howard Hughes, for me, is just Leonardo DiCaprio Le. I don't know if that's something that sticks out for you. You know, OK. I'm not going to comment on that. But The Aviator, there's a scene in which Leonardo DiCaprio locks himself in a room and is so scared of disease or he washes his hands like crazy. And you know, I always thought he was insane and crazy and clearly a germaphobe. But as I talked about in this podcast, I understand him a bit more now, right? I mean, clearly me sticking vegetables outside in a cooler for three days during the month of March and April seems in retrospect rather insane. I mean, yes, I know, right? In retrospect, it does seem insane. But it's not to say that your actions back then made no sense. I think they actually did make a lot of sense because you did not know what was going on, right? You didn't really know, so why not be safe? Yeah, I think it argues for, as we've said on other episodes, the importance of chopping up your dates as finally as you can, right? I mean, you know, how I thought and how everyone thought in February was very different than March, they've been very different than May or June or even now. And I think that is something to really reflect upon and resonate. Yes. And I think that also connects to one of the things that we mentioned during the interview is the way in which these ideas are conveyed in media and social media today, right? So you have to like stay up to date to really adapt to the current cutting edge, bleeding edge, knowledge, whatever, right? But you really have to do that today. Otherwise, your responses would be ineffective at best and maybe even risky and less optimistic scenarios. Yeah, although it also argues at the same time kind of for the inverse, which I think she pointed out, which is for many of these ideas and discourses, the slow process of change, right? And that there are moments of acceleration. But we talked about the rabies, famous rabies incident, but that the slow work and changes in some ways more central and more critical and perhaps the big flashy moments. Yeah, I think it's a correct point. Change is not linear and it doesn't happen at the same pace. And I think both of those kind of simple truths are difficult for us humans to really grasp. Yeah, I think that's fair. So as we conclude our episode, I want to talk today, Lee, about what do you want to do with the last week of summer? So for us, summer is actually over in two days. Summer here is pretty strictly July and August. That's where when all schools are off, so that is summer. That's when people travel and go abroad and so on. We don't have any like special weekend. Within those two months, at least not like a holiday weekend. Personally, my daughter is going to daycare. She's going to start daycare in a couple of days. You know, my thoughts, Lee, I'm not sure any of these childcare places are particularly safe. But you know, what's fascinating to me and it has to do with at least in the United States with regulation is while many schools are not opening, childcare places are opening, because who regulates them is very different. Yeah, there was a debate about this here, too. And I think the argument was that kids at school age are like 10-year-olds or whatever. They can kind of take care of themselves kind of at least, or at least the parent doesn't have to be full-time with them, so the parent can still be productive if you have like a 10-year-old at home. But if you have like a two-year-old or like a one-year-old or whatever, not having anyone to take care of them actually makes the parent or parents unproductive. So at least here, the government really wanted to push these daycares back into businesses quickly as possible, whereas the educational system is lower priority. So what you're basically saying is the only thing that matters is capitalism and financial support and that actually education, which is the point, even of childcare, I would say, right, that your daughter learns something when she goes to childcare is just irrelevant to this whole conversation, at least as it's been framed. - Yes, I think that would probably be true in both our countries and both our countries and at all educational levels, I think. I mean, yes, on one hand, education, broadly speaking, our quote-unquote, is important and is held as an ideal, at least for some cases, especially for higher education. But on the other hand, there are very real pressures within the system of things that are more important to open and things that are less important to open. Now, the other thing about the education, of course, is that higher the educational level is. So higher education, like schools, high schools, primary schools, and so on. Supposedly, the easier it is for the people undergoing that education to work remotely, right? I mean, it's kind of difficult. I'm sure you know this much better than I do. It doesn't really mean much to set your kids or probably almost three at this point, in front of a screen for, I don't know how long and trying to have conversation with their teachers, right? Yeah, no, that's perfectly true. Your daughter couldn't go in front of a screen, right? It would be completely worthless. So I understand. It's interesting to me how the whole debate is framed, right? Because ultimately, we think, at least, to reflect some of what we talked about with Nancy today, that at the moment, the science seems to suggest that kids are less susceptible. But it's obviously all the caregivers and the teachers who are particularly susceptible. And that's why the schools in many ways haven't opened, even in New York, where the rates are pretty low. They're still thinking about doing remote learning because the teachers don't want to go back. And that's true in New Jersey, my wife tells me that. So what's your plan for Labor Day? Any special going to the beach, a special beach, maybe? No, we were gonna go to the beach today, but it rained a lot yesterday. And so when it rains, the bacteria level is too high to really go in the water. So we didn't go to the beach today. That's why we went to the local park. We're thinking about going if it's open to the National Upper Freedom, which is closer to the DC. And then potentially meeting up with some friends who live in DC so that they come out part of the way and we'll just stay slightly far away from them. That's the plan. I don't know. We'll see, it'll be weird. I think because Labor Day is when the academic calendar in most places in the United States has already or we'll be starting back up. And that's obviously not gonna be the case. Right, I mean, my office is still not open for at least another month. Okay, so I guess that just before Labor Day, we can probably conclude our episode. So have a nice Labor Day weekend for all of our American listeners. Yeah, and until next time, stay safe. Stay socially distanced and enjoy some fun in the last day of summer. (gentle music)