Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection is a book by American author John Green about tuberculosis, a curable disease usually brought on by the bacteria Mycobacterium tuberculosis that is the leading cause of death from an infectious disease. The book argues that the disease is not primarily caused by the bacteria anymore but by human choices. It was published on March 18, 2025, and is Green’s second nonfiction book. The book was well received and became a New York Times number one bestseller in nonfiction.
Everything Is Tuberculosis – Wikipedia
In his book, Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection, John Green explores the different versions of TB, its long history, and the stigma surrounding it and its political and social origins. I wrote a longer response here.
Highlights
If a reason is not immediately apparent, we will find one. I am reminded of a poem in Kurt Vonnegut’s novel Cat’s Cradle:
Tiger got to hunt,
Bird got to fly;
Man got to sit and wonder, “Why, why, why?”
Tiger got to sleep,
Bird got to land;
Man got to tell himself he understand.
Vonnegut reminds us that we are both inclined toward curiosity and inclined toward arriving at some kind of comprehensible conclusion.
Note: The challenge of curiousity and conclusion
How might the contemporary story of tuberculosis be different had we listened to African American physicians like Dr. A. Wilberforce Williams, who noted over a century ago that the real cause of TB was not race but “poverty, bad housing, bad sanitation, bad working conditions, long hours, high rent, [and] poor food”?
Note: Real cause of TB = poverty, bad housing etc
I should acknowledge, I guess, that one reason I’m interested in TB is that I have obsessive-compulsive disorder, and my particular obsessive worries tend to circle around microbes and illness. Before the germ theory of disease, we did not know that around half the cells in my body do not, in fact, belong to my body—they are bacteria and other microscopic organisms colonizing me. And to one degree or another, these microorganisms can also control the body—shaping the body’s contours by making it gain or lose weight, sickening the body, killing the body. There’s even emerging evidence that one’s microbiome may have a relationship with thought itself through the gut-brain information axis, meaning that at least some of my thoughts may belong not to me, but to the microorganisms in my digestive tract. Research indicates that certain gut microbiomes are associated with major depression and anxiety disorders; in fact, it’s possible that my particular microbiome is at least partly responsible for my OCD, meaning that the microbes are the reason I’m so deeply afraid of microbes.
Note: The impact of gut microbes on everything. This is something that I vaguely remember the Health Report discussing.
around 90 percent of people infected with TB will never become sick, because the body successfully walls off the TB in tubercle
Note: TB in a lot of us, dormant
In short, no fashion would suffice unless it was defined as hygienic by the patriarchal medical establishment. And moral hygiene—being clean not just in body but also in mind and action—continued to be seen as essential to controlling tuberculosis. One could not drink too much, or overindulge in any other vice, without risking inviting TB into one’s body.
Note: Being ‘clean’ in mind seen as relating to TB
Clean air, rest, and sunshine were believed to “infuse new hope and courage,” as one person put it, and so sanatoria focused on controlling the behavior of patients and requiring them to be largely immobile and outside whenever possible.
Note: Explanation of sanatoriums. I remember there was one in Mount Macedon.
Having been told that patients could not be exposed to bad news without risking their health, Gale never told Angie that her sister had died. But it didn’t matter. “I saw them wheeling a stretcher with a body on it down to the morgue. I knew right away it was my best friend Angie.” Gale was eight years old.
Note: No bad news for fear of ill health of the mind
When a program loses a large percentage of its patients, is this a compliance problem or a surveillance problem? Is it a patient’s fault when he or she cannot afford the food necessary to ward off the hunger brought on by the drugs?”
More broadly, is it a patient’s fault if they are too disabled by depression and isolation to follow through on treatment? 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?
Note: How do you measure the success of a program, with regards to compliance? Especially with the side-effects and challenges of support, such as access to food.
This is often not an environment patients are excited to return to—and yet somehow we always seem to blame the patient for noncompliance, rather than blaming the structures of the social order that make compliance more difficult.
Note: Structures of social order and success.
The real issue is not that TB is uncommonly good at selecting for resistance. The real problem is that in the forty-six years between 1966 and 2012, we developed no new drugs to treat tuberculosis.
Note: No appetite for drug development
When you write a novel, you are alone in it. I wrote that book alone, sitting in airports and coffee shops and lying in bed. But when writing, there is always for me a hope that one day I will not be alone—not in this work and not in this world. It is a bit like that old children’s pool game Marco Polo, where one person closes their eyes and swims around the pool trying to tag someone else. “Marco,” the person with eyes closed says, and the other pool-goers have to answer, “Polo.” “Marco, Marco, Marco,” cries one kid, and the others reply: “Polo. Polo. Polo.” Writing is like that for me, like I’m typing “Marco, Marco, Marco” for years, and then finally the work is finished and someone reads it and says, “Polo.”
Note: Writing as a game of Marco, Polo
Analyses of cost-effectiveness often only run skin deep. When looking at the larger costs—the cost of the ineffective pills, the cost of potentially further spreading drug-resistant TB, the cost of hospitalizing a kid who should’ve been in school, and all the other costs of not getting kids access to proper testing—GeneXpert tests should be in every clinic in every country with a high burden of TB. 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.
Tuberculosis is so often, and in so many ways, a disease of vicious cycles: It’s an illness of poverty that worsens poverty. It’s an illness that worsens other illnesses—from HIV to diabetes. It’s an illness of weak healthcare systems that weakens healthcare systems. It’s an illness of malnutrition that worsens malnutrition. And it’s an illness of the stigmatized that worsens stigmatization. In the face of all this, it’s easy to despair. TB doesn’t just flow through the meandering river of injustice; TB broadens and deepens that river.
Note: TB worsened by poverty and inequality
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.”
Note: TB worsened by poverty and inequality
TB in the twenty-first century is really caused by those social determinants of health, which at their core are about human-built systems for extracting and allocating resources. The real cause of contemporary tuberculosis is, for lack of a better term, us.
Note: TB worsened by poverty and inequality
We cannot address TB only with vaccines and medications. We cannot address it only with comprehensive STP programs. We must also address the root cause of tuberculosis, which is injustice. In a world where everyone can eat, and access healthcare, and be treated humanely, tuberculosis has no chance. Ultimately, we are the cause.
We must also be the cure.
Note: TB as a political disease
