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The past is never dead. It's not even past

Not Even Past

How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS, by David France (2016)

By John Carranza

51wo3zzp4bl-_sx341_bo1204203200_In the 1980s, the United States experienced a new disease that seemed to target young, gay men living in New York City and San Francisco. From the beginning, those doctors and scientists willing to treat members of the gay community remained perplexed as to why these men, their ages ranging from their early twenties to their thirties, were falling ill with rare diseases that would not ordinarily affect someone their age. The earliest name given to this new epidemic was gay related immune deficiency (GRID) before it took the name acquired immune deficiency syndrome (AIDS), which was caused by the human immunodeficiency virus (HIV). The push for scientific advancement and treatment was not readily available to these young men, and many government officials at the state and national levels refused to acknowledge the epidemic that soon spread across the United States and affected groups other than gay men.

David France’s How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS is a complementary work of history to the 2012 documentary of the same name that documented the early years of the AIDS epidemic to the successful discovery a decade later of combination drug therapies that brought people with AIDS from the brink of death back to life. The main actors in France’s sweeping narrative are a group of men and women who formed the AIDS Coalition to Unleash Power, or ACT-UP, devoted to demanding action from the government and pharmaceutical companies for treatment. Their initiatives were influential in saving thousands of lives by the early 1990s.

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ACT-UP buttons from the 1980s (via Wikimedia Commons).

ACT-UP began as an informal group of gay men who were dying of opportunistic infections related to the compromised immune systems associated with AIDS. However, as time went on, the epidemic took more lives and the government remained silent, so they took it upon themselves to learn about their illnesses in order to demand government intervention and the development of medical treatments. In this way, many of them became citizen-scientists. They compiled the scientific data made available to them by competing scientists and used it to educate one another and the government officials that they lobbied. They pushed for medications that would treat their opportunistic infections, as well as the virus that causes AIDS once it was discovered. They were also first in realizing the safe sex might lessen the chances a person had for catching this new and mysterious disease.

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AIDS activists in the 1980s (Curve Magazine via the Odyssey Online).

France recounts the activism necessary to win visibility not just for gays, but also for other populations who became affected, such as intravenous drug users and women. ACT-UP’s activism undertook public demonstrations as a means of demanding more scientific research, access to drugs, and lower prices for those drugs once they were identified as possible treatments. In its earliest years of activism, the group modeled itself on the Civil Rights movement of the 1960s by practicing nonviolent civil disobedience and going into traditionally conservative parts of the United States to educate people. ACT-UP petitioned members of Congress for AIDS funding for research, fought with the Food and Drug Administration (FDA) to allow lifesaving drugs onto the market faster, set up needle exchanges for intravenous drug users, and protested on Wall Street. The early stages of ACT-UP’s activism included using the infamous symbol of the pink triangle with SILENCE = DEATH written beneath it, which was made into bumper stickers and posters that could be plastered all over the city, as well as hats and T-shirts. One of the enduring symbols of their activism is the AIDS Memorial Quilt, which was created in San Francisco to remember the lives lost in the epidemic. It made its first appearance on the National Mall in Washington, D.C. in the fall of 1987 when it included more than 1,900 panels.

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The AIDS Quilt on the National Mall in 2011 (via Wikimedia Commons).

David France’s book is a great achievement in that he details the events and lives of the people who lived through the AIDS epidemic over the course of approximately thirteen years. France achieves this not simply as a researcher with an eye for historical detail, but also as a person who lived through those events as a journalist. His ability to document the AIDS epidemic in the 1980s resulted in the ability to keenly observe developments while still keeping a certain level of objectivity. France uses extensive archival research, including the papers of the most visible activists and he draws on his own experience. Where possible, France conducted oral interviews with members of ACT-UP who are still alive today. France captures the emotion and frustration of the members of ACT-UP who pushed for access to life saving drugs while negotiating alliances and feuds among members of the group and the scientific community. How to Survive a Plague is essential reading, not only for members of the LGBTQ community, but for everyone who may have been too young or not have been alive during the 1980s and early 1990s when the fight for visibility and medication was still happening. How to Survive a Plague is an excellent example for understanding how activism works, how advocacy for those marginal members of society can be effective, and to show government and public health officials how not to handle a plague.
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What Killed Albert Einstein?

by John Lisle

On April 17, 1955, Albert Einstein’s abdominal aortic aneurysm burst, creating internal bleeding and severe pain. He went to Princeton Hospital but refused further medical attention. He demanded, “I want to go when I want. It is tasteless to prolong life artificially; I have done my share, it is time to go. I will do it elegantly.” In the early morning hours of April 18, the on-duty nurse heard him say a few words in German, which she could not understand, and then Einstein died.

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The Daily Princetonian front page on 18 April 1955 (via the Mudd Manuscript Library blog).

Dr. Janos Plesch, a physician and long-time close friend who occasionally treated the physicist, thought that syphilis caused Einstein’s deadly abdominal aortic aneurysm (AAA). He said that Einstein was “a strongly sexual person” who enjoyed the company of numerous women even while married. Dr. Plesch conjectured that AAAs usually have a syphilitic origin. Why, he thought, would it be so unreasonable to assume that Einstein contracted syphilis on one of his escapades? Some authors have echoed Plesch’s claim, repeating it as undoubtedly true because it came from a close confidant of Einstein. But numerous studies, both before and after Einstein’s death, show that the connection between syphilis and AAAs is small. According to a study in 2012, only around 1% of untreated late vascular manifestations of syphilis result in an AAA in the descending aorta, the kind Einstein had.

Also, no evidence of syphilis was ever reported in Einstein’s body, including his famously dissected brain. These facts do not definitively disprove that Einstein had syphilis, although it appears very unlikely, but they do beg the question: Is there a more probable explanation for why Einstein developed his deadly aneurysm? Strangely, though many scholars eagerly investigate every facet of Einstein’s life, few or none have analyzed the cause of his death.

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Einstein’s brain before dissection in 1955 (via Discover).

The type of aneurysm that Einstein had is statistically linked with being old and male. However, the majority of people developing an AAA also have a history of smoking. Only lung cancer is more closely associated to smoking among tobacco-related diseases. In an analysis of risk factors for AAAs in more than three million individuals, 80% of people who developed the aneurysm were smokers. Another systematic study found that current smokers were 7.6 times more likely to have an AAA than nonsmokers. The aneurysm’s prevalence and size are strongly linked to the amount of smoking one does, and Einstein was a heavy pipe smoker for decades.

Einstein’s doctors ordered him to stop smoking during his various illnesses. He sporadically obeyed. When friends gave him gifts of tobacco during these brief periods of abstinence, Einstein would open the gift, sniff to enjoy the aroma, and then give it away to someone else.  But Einstein always succumbed to the overwhelming temptation of his beloved vice. He often resorted to taking tobacco handouts from friends. Dr. Plesch especially felt sorry for the needy, embarrassed Einstein and provided him with a steady supply of tobacco and cigars despite the orders of Einstein’s other doctors and second wife, Elsa.

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Einstein and his second wife, Elsa (via Wikimedia Commons).

During his doctors’ smoking bans, when Einstein walked to the Institute for Advanced Study at Princeton, where he had worked since 1933, the old physicist picked up cigarette butts from the street and filled his pipe with bits of discarded tobacco. He initially walked to the Institute across from the nearby meadow, but he switched routes because the street offered more abandoned tobacco. Einstein tried to summon the courage to openly defy the bans, but he worried about offending his doctors.

In late 1948, Einstein had life-prolonging surgery to keep his AAA from bursting. The surgeon wrapped cellophane around the aneurysm. A photograph of Einstein leaving the hospital after surgery shows him inside a car with a pipe in hand. Soon after, Einstein became a lifetime member of the Montreal Pipe Smokers Club and wrote to its president, “Pipe smoking contributes to a somewhat calm and objective judgment in our human affairs.”

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The famous physicist in 1933 (via Wikimedia Commons).

Images of iconic figures associate smoking with intelligence: Einstein, Oppenheimer, Freud, Sherlock Holmes. The pipe gives them a pensive aura. Einstein depended on smoking—not for his genius, as some writers claim, but as a repetitive set of actions to soothe and comfort. For Einstein, this was a tolerable trade-off for his health and, ultimately, his life.

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Read more by John Lisle on Not Even Past:

Review of This New Ocean: The Story of the First Space Age, by William Burrows

Contributions to Behind the Tower

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Health Care: A Historical Snapshot

by Sally Clarke

All the debates about health insurance have emphasized how expensive health care has become.  According to the Center for Medicare & Medicaid Services, as of 2010 (the most recent year available) health care constituted 17.9% of the U.S. economy.  Health care expenses have risen steadily since 1929, as shown in the first chart.  The second chart indicates that this expenditure has had a good payoff: life expectancy has risen from about 60 years in the 1920s to just short of 80 years today.  (The big dip in 1918 reflects the influenza pandemic.) One task of historians is to identify disjunctures between the past and the present, and the two charts illustrate this point. 

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(Source: Historical Statistics of the United States: the Millennial Edition On-Line, series Bd33 and Ca74; Center for Medicare & Medicaid Services, “National Health Expenditures,” accessed May 11, 2012.)

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(Source: Historical Statistics of the United States: the Millennial Edition On-Line, series Ab644; U.S. Bureau of the Census, Statistical Abstract of the United States: 2012, Table 104; and Sherry L. Murphy, Jiaquan Xu, and Kenneth D. Kochanek, National Vital Statistics Reports, 60.4 [January 11, 2012], accessed May 11, 2012.)

 

Going back to 1929, health care claimed less than four percent of the economy, and less than ten percent of Americans had hospital or surgical benefits. Yet in the fifty years from 1880 to 1930, life expectancy rose from 40 to 60 years, or by the same amount as in the years since 1930.  How was it possible for life expectancy to rise as much in the first historical era as the second without recording a surge in health care expenses?

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A doctor examines a child before administering a vaccine in 1941.

Scholars point to two important improvements in life expectancy.  First, there was a sharp fall in infant mortality.  Massachusetts provides the best data on these early years.  In 1872, 19 out of 100 infants did not live to see their first birthdays.  Throughout the 1880s and 1890s the infant mortality rate remained above 150 deaths per 1,000.  By 1929, however, the rate had fallen to 62 deaths per 1,000.  Second, life expectancy improved because there was a drop in deaths tied to tuberculosis and other diseases like measles, typhoid, scarlet fever, and diphtheria.  TB was the worst of diseases, but it dropped from 194 deaths per 100,000 in 1900 to 71 deaths in 1930. These declines came about before vaccinations were available, so what explains the drop in mortality rates?

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A child waits to receive a measles vaccine in 1941.

One source for the rise in life expectancy was improved hygiene in the care of infants.  A second source was improved public health, notably the eradication of bovine TB and the pasteurization of milk.  Improvements also stemmed from better nutrition.  Data is limited, and while from 1909 to 1930 per capita consumption of calories on a daily basis was flat, production of many fruits and vegetables, such as oranges and carrots, rose. Processed foods also became common. I would add another development: the fall in the workweek.  During the late 19th century, Americans worked an average of 10 hours a day, six days a week.  By the end of the Great Depression the workweek had shortened to roughly 40 hours a week.  People did not physically wear out in the 1930s, as they had in the 1880s.  They also did not suffer the number of industrial accidents that they had faced during the late 19th century.

In many ways, the two historical eras are not comparable. But there is one insight from this review of the years before 1930.  To the extent that nutrition was important in the first era as a “cheap” way to boost life expectancy, nutrition remains one cost-effective strategy in reducing diseases like diabetes and raising life expectancy today.

All statistics are found in Susan B. Carter, et al., Historical Statistics of the United States: Millennial Edition Online (New York: Cambridge University Press, 2006).

Photo credits:

Arthur Rothstein, “Dr. Tabor examining Randolph Darkey, before inoculating him against measles, in the community health center, Dailey, West Virginia,” December 1941

U.S. Farm Security Administration/Office of War Information Black & White Photographs via The Library of Congress

Arthur Rothstein, “Elizabeth Darkey, daughter of one of the project families, waiting in the health center to be inoculated against measles. Dailey, West Virginia,” December 1941

U.S. Farm Security Administration/Office of War Information Black & White Photographs via The Library of Congress

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