Phantom Plague: How Tuberculosis Shaped History

by Vidya Krishnan

Harvard Public Health Magazine, Best Public Health Books and Journalism of 2022The definitive social history of tuberculosis, from its origins as a haunting mystery to its modern reemergence that now threatens populations around the world. It killed novelist George Orwell, Eleanor Roosevelt, and millions of others – rich and poor. Desmond Tutu, Amitabh Bachchan, and Nelson Mandela survived it, just.  For centuries, tuberculosis has ravaged cities and plagued the human body.  In  Phantom Plague, Vidya Krishnan, traces the history of tuberculosis from the slums of 19th-century New York to modern Mumbai. In a narrative spanning century, Krishnan shows how superstition and folk-remedies, made way for scientific understanding of TB, such that it was controlled and cured in the West.  The cure was never available to black and brown nations. And the tuberculosis bacillus showed a remarkable ability to adapt – so that at the very moment it could have been extinguished as a threat to humanity, it found a way back, aided by authoritarian government, toxic kindness of philanthropists, science denialism and medical apartheid. Krishnan’s original reporting paints a granular portrait of the post-antibiotic era as a new, aggressive, drug resistant strain of TB takes over. Phantom Plague is an urgent, riveting and fascinating narrative that deftly exposes the weakest links in our battle against this ancient foe. 

Genres: Nonfiction, History, Science, Medical, Health, Medicine, Audiobook

293 pages, Kindle Edition

First published February 1, 2022

Reviews

[🩶 April • A.M. Flynn • 🩶 · Rating 4 out of 5]

Some scary history and information. i love medical non-fictions.

[Steve · Rating 4 out of 5]

I had mixed feelings about this book and if I could, I would rate it 3.5 stars. I feel that the content is important and that it clearly shows existing inequities in healthcare, which would gain it a 5-star rating. While the book focuses on India, its lessons are broadly applicable to the developing world. All this made the book a compelling read. On the other hand, there was not a lot of science in the book and it strayed away from tuberculosis in order for the author to make points about current economic structures. I also did not enjoy the tone of the book which came across as pontificating, so much so that even when I agreed with the content, which was quite frequent, I was still ready to put down the book several times, hence the lower star rating. There are better books on tuberculosis out there, including Catching Breath by Kathryn Lougheed (which I received as an advance reader copy from the publisher). Thank you to Netgalley and PublicAffairs/Bold Type Book for the advance reader copy.

[Edith · Rating 3 out of 5]

5 stars for importance; 2 1/2 for execution. Ms. Krishnan is not a great writer; the information she retails is jumbled and sometimes repetitive. Fact checking seems to be a little weak: Jane Seymour was not the mother of Elizabeth I, and opinion is not settled as to the cause of Jane Austen's death. It is an esthetically unpleasing book. Angry books often are. However, in my opinion, she is right to be furious, and it's a book that should be read, and widely.

This book details the catastrophe that is global TB care. Even if you did not believe the details Ms. Krishnan provides, a person with any experience in how the goods of the world get apportioned would have guessed how distribution of effective TB treatments would be made. You might not, however, have guessed how completely these drugs are restricted from the poor and resourceless who need them, and how much more freely available they are to those with resources, especially in India, and especially in Mumbai, which appears to be the world capital of TB infection (and drug resistant TB, and multi-drug resistant TB).

Ms. Krishnan's indictment of Big Pharma, and the various forms of defending their intellectual property, as these companies fight to preserve their rights in drugs that make them thousands with every course of TB medication (but might be given to patients for much less) resonates particularly well at the moment in history. Her account of their doings, as well as the actions of governments and legal entities, is well worth reading.

If not otherwise motivated to do so by common compassion, why should the US and other developed countries care about what is happening in India? Because as life has recently illustrated, bacteria and viruses do not observe international borders. Drug resistant TB will be more than a phantom plague if we do not stop it where it now lives. I hope a better book on this extremely important subject appears; perhaps Ms. Krishnan herself will write it.

[laurel [the suspected bibliophile] · Rating 4 out of 5]

Less a look at tuberculosis and its place in history and more an examination of the unequal structures of the global health economy as it impacts Black and brown communities in India, China, and other high-poverty, high-population communities.

While there are several glaring errors (Jane Seymour did not give birth to Elizabeth I) that should have been caught during content edits, this contains a wealth of information, context and recommendations on how to adjust healthcare to help the patients and not line pockets.

Patent law, ethics, medical experiments, government responses to pandemics, and other diseases are addressed at length, showing the long-ranging impacts of colonialism, capitalism and white supremacy upon the rest of the world.

At its core, it is a chilling look at the resurgence of a once "vanquished" foe.

[Armita · Rating 4 out of 5]

Forget about reading horror fiction- this one is probably scarier than anything Stephen King has ever written.

[Ali · Rating 4 out of 5]

"Poverty is the disease. TB is the symptom. The global fight against TB will be won, or more likely, lost in India. "

Honestly the cover for this book is not doing it any favours - underneath the staid exterior is a lively, high level, engaging social history of TB, not a medical or academic history. Krishnan had a journalists style, with a lot of context - digressions include the history of germ theory and the basics on the Tuskegee Syphilis Trials. It is in the second half of the book, however, where she sharpens her focus to the constellation of factors which has led to a massive expansion in drug-resistant TB in Mumbai. She weaves history, policy analysis together with the stories of TB survivors and activists. This specificity is, I think, the most successful part of the book as it is in these very specific stories that the scale of the catastrophe - not just with TB but will all infectious diseases - really becomes apparent. While overcrowding, growing wealth inequality and the rise of religious fundamentalism all factor into this story, her deepest condemnation is for the patent system which prevents global access to medication, and inevitably ensures the survival of adaptable viruses and bacteria. I did not realise that India's patent laws had traditionally defied the US-led market approach (although as with many things I learn, other things make more sense now!) and this was strangely cheering to know, even as it is under sustained attack. Finally, Krishnan leans in to the heroes here, making this a hopeful book, even amid the subject matter

[Tony Cundell · Rating 3 out of 5]

When I read the statement in the book that Jane Seymour was the mother of Elizabeth Tudor, I questioned the accuracy of the book. When I checked the references and found the vast majority were for websites not books, publications, scientific articles, etc it confirmed that the book had a low level of accuracy so was more an opinion piece that a well researched book.

Also there was no mention of Waksman discovery of streptomycin. A huge omission.

[Jennifer Mangler · Rating 2 out of 5]

This book was not what I was expecting. I was expecting a thorough history of tuberculosis. This was not that. The main focus of the book was on the TB epidemic in India. While I found that information fascinating (and now want to learn more about this), I couldn't help but be disappointed as I was expecting a more historical look at the disease. I rated it 2 stars because the title and description do not necessarily match the content.

[Manish · Rating 3 out of 5]

Phantom Plague is an important book. . The introductory chapters on Koch, Pasteur and Semmelweis were interesting but suddenly tapered off. I was looking forward to reading about the evolution of the front line antibiotics that became the mainstay of the treatment but Vidya Krishnan never ventures into it. TB being the indirect inspiration for Stoker to create the character of Dracula was something I never knew about.

While the book aims to cover the crisis of Tuberculosis, the bulk of it is centered on the harrowing experiences of patients diagnosed with DR and XDR TB in India (specifically Mumbai - the TB capital of the world). And the book is also a Marxist analysis of the global patent system, a critique of TRIPS and WTO and a scathing indictment of Johnson and Johnson's tactics to safeguard its flagship TB drug bedaquiline.The plan of the present Modi government to eliminate TB in India by 2025 is also portrayed to be a sham and detached from any coherent policy shifts in the bureaucracy.

[Jeff Kirchner · Rating 2 out of 5]

Not the book I was expecting to read

As a physician who spent my entire career caring for patients with HIV disease and a strong interest in Infectious diseases including TB this book was literally all over the place, clinically inaccurate at times and was too much of a political diatribe. I am all for global health equity. Will we ever see it - even in the United States. Sadly No. Find a new title for this book.

[Tini · Rating 1 out of 5]

Very important topic, but badly executed. Incoherent and apparently not a lot of fact checking as already the first page states a steroid, two anti malaria drug and antiviral drug as antibiotics.

[Christal Toussaint · Rating 4 out of 5]

Jam packed with information. A must read for anyone who has read or plans to read Everything is Tuberculosis by John Green. Krishnan offers an invaluable insight on the role of the west on ongoing global healthcare inequalities. Specifically eye opening with her descriptions of the politics of global pharmaceuticals.

[Andrea]

Going to stop reading this one. The premise is incredibly interesting, but I’m only 51 pages in and I’ve run across three content errors (miscategorization of medications as antibiotics [p. 1]; incorrectly identifying Princess Elizabeth’s mother [p. 25]; stating that Semmelweis’s best friend Markusovszky conspired to have him institutionalized, when it was actually a different colleague, Ferdinand Ritter von Hebra [p. 49]). I didn’t even realize the third example WAS a content error until, moved by the author’s gripping retelling of Semmelweis’s involuntary commitment, I took to Wikipedia/Google and discovered the mix-up.

While these errors might be incidental to the main thrust of the book, the fact that there were this many errors made me leery of continuing. I don’t want to read while constantly wondering if what I’m learning is true, especially since I am a nurse and reading this book would have informed my understanding of a disease that I could come into contact with and/or be expected to educate patients about.

[Leah · Rating 4 out of 5]

found out about this book from tiktokker john green. so much interesting information, my only problem was I didn't understand why it was structured the way it was. starts with a brief history of tb, then jumps to current day tb epidemic in india, then history of tb in india, and then info about other diseases like hiv. while I learned a lot about tb and the tb crisis in india, I actually think this book is less about the disease and more of an argument against patronizing humanitarian global public health interventions. the WHO basically caused widespread drug resistant tb through terrible, unscientific policies that severely limit which countries can get medications. a big chunk of the book is actually about patents and how developed nations support strict global patent regulations so that big pharma can continue to set prices for meds. fuck the WHO! fuck bill gates! paul farmer continues to look good, as usual.

[Shain Verow · Rating 5 out of 5]

It’s a great and concise history of the impact of TB on virtually every aspect of human history and culture, which is a subject near and dear to my heart. However, the real fire comes later in the book, where the author starts to get into why we have failed to defeat TB, why it is getting worse, and how legal structures, wealthy individuals, and corporations fight very hard to keep it that way.

That part is absolutely brutal, and having worked in biotech as long as I could morally stand it, I know it is extremely true from the other side of the table. It could easily be written off as a conspiracy, except it is well cited, well argued, logical, and tracks with other historical examples. So, yeah, we’re literally killing millions of people every few years to keep the powerful in power and the wealthy rich. I hope that you can read this and understand what is happening. This would have been my life’s work, except the problem is not intended to be solved, and solving it is quite risky.

[Amber · Rating 4 out of 5]

4.5⭐️ actual

*deep breath*

FUCK capitalism, FUCK international patent law, and FUCK! BIG! PHARMA!!!

[Sarah - All The Book Blog Names Are Taken · Rating 1 out of 5]

Nope. You don’t get to make glaring historical mistakes and expect me to continue reading your nonsense. On page 25 the author referenced Jane Seymour dying after giving birth to Princess Elizabeth.

About that…She died after giving birth to Prince Edward. And the website the author used, biography.com, clearly stated that multiple times in Jane’s entry. How did that make it past an editor? If a massively obvious error like that can get by editors, I can’t trust anything else in this book.

And considering the fact that historians believe Edward VI himself died of tuberculosis…come on.

[Bridget · Rating 4 out of 5]

In my John Green era. The history of TB was fascinating especially with how it influenced so many different policies and unconnected public health issues. I preferred the history component of the book more than the economic/intellectual property part. It did contain a rebuke of Bill Gates which I think is sometimes needed. Overall I learned a good global health perspective through tuberculosis.

[Adeline · Rating 4 out of 5]

the book certainly adds to one's understanding of the (counterproductive and profit-driven) interplay between healthcare, capitalism, and colonialism in context of tuberculosis

[Bearded Reader - Adam · Rating 4 out of 5]

The Phantom Plague: How Tuberculosis Shaped History by Vidya Krishnan is a fascinating exploration of how tuberculosis has shaped economics, global health, and social justice. While it touches on the science of TB, the book is more focused on the unequal global structures that impact Black and brown communities, particularly in India and China. Krishnan dives into how patent laws, colonialism, and capitalism have contributed to the resurgence of drug-resistant TB, making the book feel more like a critique of global public health policies than a medical history. Through compelling stories of survivors, activists, and policy failures, Krishnan highlights the ongoing crisis and offers hope for change. The book is engaging and accessible, never diving too deep into medical jargon but offering insightful context on a global scale. I give it 4 out of 5 stars for its depth, relevance, and thought-provoking analysis.

[Livia Frost · Rating 3 out of 5]

I loved the details about how tuberculosis shaped society, such as beards falling out of fashion due to hygiene concerns and skirts becoming slightly shorter to avoid dragging on the ground once germ theory was understood. The book also explored a lot of patent history, which was fascinating but not as directly focused on TB and its history.

[Jordan · Rating 5 out of 5]

This is an in-depth historical and modern day context and draws connections from dracula to patent laws to HIV/AIDS and back to tuberculosis (because it is in everything). So well-researched, so infuriating, so eye-opening. “In a global pandemic, deaths don’t just happen. They are inflicted on people, sometimes legally.”

[Audrey · Rating 5 out of 5]

This was an excellent read, taught me a lot, and changed how I think. Very recommendable book that looks at where medicine should be and what the current issues are in getting there.

[liv · Rating 4 out of 5]

“minority communities rarely get to be patients, they are only research subjects”

that pretty much sums it up! fuck big pharma and fuuuck ip laws

[Katelyn · Rating 5 out of 5]

This was so good. A really incredible overview of not just tuberculosis but also the tragic patterns we see in the intersections of public health, racism, classism, corporate greed, and research.

[Bharathi Arunan · Rating 4 out of 5]

“The idea of a better ordered world is one in which medical discovery will be free of all patents and there will be no profiteering from life and death.”

An important account of the status in the country today.

[Cristina · Rating 4 out of 5]

I found this book very interesting and educational. It’s not only about tuberculosis but also about other infectious diseases and the history of hygiene. It shows how mankind can be really greedy and ignorant. And sadly now I learned also about the Tuskegee experiments, another horrible thing humans did which I was not yet aware of.

[Katie · Rating 3 out of 5]

I think a better title for this would be "How History Shaped Tuberculosis" - it was interesting, but talked WAY more about other topics than it did about actual tuberculosis.

[Kristin · Rating 5 out of 5]

This eye-opening book is both a fascinating historical count of how tuberculosis has been viewed and treated over the past two centuries and a compelling critique of the societal factors that have led to its burgeoning spread in poorer countries despite the discovery of highly effective treatments. From the desperate slums of Mumbai, where horrifically cruel, sunless buildings breed disease, to the institutions and organizations that consistently fail to recognize the humanity of patients, the problem with tuberculosis is shown to be one that is manufactured by our modern way of life. There are plenty of culprits, including the use of charitable organizations to ensure distribution is limited, to the privileges of patent systems that reward hoarding and greed. There is also the systemic racism that underlies the disparities in healthcare between the rich and the poor. While this is a distressing and depressing scenario, the are some glimmers of hope in the activism of TB survivors inspired by the AIDS activism that eventually made AIDS treatment more available to more people. Yet AIDS, which is still severely under-treated in many parts of the world, is part of a “cursed duet” that has spurred TB spread. Tuberculosis is one of the great scourges of our world, and our lack of attention to it is a serious threat to global health. Yet unless we change the social and political factors that continue its spread and under-treatment (and misdiagnosis and mistreatment, rampant in Mumbai), we will never eradicate this persistent and dreadful disease. This book is a wake-up call to change.

[Zuz reads · Rating 3 out of 5]

2.5

I picked this up after reading John Green's thoughtful discussion of TB. I had hoped for a more comprehensive history of TB - as this title promised. This book is interesting. But it does not live up to the promise of its subtitle.

This is not a comprehensive TB history. And it does not focus on how TB shapes general history. This book jumps around between various discussions of moments in history and in our modern world that are more directly and less directly related to TB.

This book starts with a story of pre germ theory TB superstition in the US in the late 1800s and Dracula myths in Europe around this same time. It mentions moments of older TB history - but does not discuss these anecdotes with any rigor. The book then turns to the over told story (at least for anyone vaguely familiar with the history of medicine) of Dr. Semmelweis at great length and spends significant time on Dr Koch and his various successes and failures and how Sir Arthur Conan Doyle interacted with him. All of this feels like a very long digression which is only vaguely TB related. The next section turns to TB in modern India (with some references to older Indian history). The last section spends significant time discussing the legal and economic forces in the global pharmaceutical industry and takes a digression to at length discuss the history of the Tuskegee experiment. Overall this was a jumble. All of these chapters were interesting. But overall the effect is disjointed.

The author I think mostly wanted to speak to the crisis of drug resistant TB in modern India. This section was the strongest and contained the most new information for me. The rest of it felt like random tacked on medical history that the author learned while trying to understand the problem of MDR TB. But overall this ended up not being a rigorous history nor a rigorous scientific discussion of this disease or its treatment.