Everything is John Green
From teaching to teen angst to tuberculosis, John Green has got you covered
A book to read: EVERYTHING IS TUBERCULOSIS by John Green
I’ve loved John Green for years. Back in the early 2000s he released a trio of books about quirky teenage boys1 falling in love and being hilarious with their friends, and finding their Great Perhapses.
I read and loved them all back in 2008. This is not an especially unique take. His first book won the Printz Award and pretty much brought YA literature into the 21st century.
Now I’m re-reading his early books via audio on car trips with my daughters. Is there anything better than sharing your favorite books with your kids?
John Green was an early YouTube star. His CrashCourse History channel (one of his many, many channels) remains a mainstay in my classroom. Every September, I open the school year by playing his TedTalk on Why Learning is Awesome (and why building a community of learners is also awesome). Here’s that lesson if ya want it.
In 2014 he wrote the insanely popular THE FAULT IN OUR STARS which was promptly made into a movie. There were more books. More movies.
The obvious next step for a bestselling YA author and YouTube God is to write a book about the history of tuberculosis. Duh.
The book (of course) is amazing. EVERYTHING IS TUBERCULOSIS is John Green’s first-person account of learning about the disease. He covers the history of TB, weaving together the narratives of James Watt, John Stetson, the assassin who started WWI, and his own great-uncle to explain the history of the disease that was once the “flattering malady” of the wealthy and poetic.
Disease and decay are often beautiful - like the pearly tear of the shellfish or the hectic glow of consumption - Henry David Thoreau2
Once wealthy nations had the resources to combat tuberculosis, the way people viewed the disease shifted from “consumptive chic”3 to a highly stigmatized illness.
John Green, of course, takes readers through the discoveries, breakthroughs, and science of the 20th century. He explains, in the most accessible way possible, how a variety of scientists worked together to learn about the disease and create ever-evolving diagnostic tools and treatments.
The center of the novel is the story of Henry Reider, a TB patient in Sierra Leone who met John Green when he was 17. Henry’s complicated TB story highlights John Green’s central thesis in the book: In the 21st century, ZERO people should be dying of TB. Humanity has the knowledge and drugs needed to cure patients. However, healthcare systems in impoverished nations are still struggling to bridge the gap between drugs/knowledge and successful treatment. In 2023, over a million people died of tuberculosis. One million is nowhere near zero.
We know how to live in a world without tuberculosis. But we choose not to live in that world.4
TB is a tricky problem for impoverished countries because the disease thrives on folks who are stressed and malnourished. Also, treatment depends on a patient taking a long course of antibiotics. If there is an interruption in that medicine (if, for example, a US President decides to allow a billionaire to cut all USAID funding, which helped deliver medicine), a TB patient can develop drug-resistant TB which is much more expensive to cure.
In places like Africa, where healthcare budgets are small, the goal is to treat TB in the most cost-effective/standardized way possible. This usually means DOTS (Directly Observed Therapy), wherein:
Diagnosis via a cheap smear microscopy
Problem: This misses 50% of cases, especially in children. Only the sickest and most infectious patients test positive. Therefore people who COULD have been easily cured go undetected until the disease gets worse
Treatment is standardized. Everyone receives the same drugs for 6-9 months, whether they work or not.
Problem: The smear microscopy test doesn’t tell doctors which strain the patient has and therefore what drugs will be more effective. Such tests exist…for patients in wealthy countries.
Patients are directly observed taking medication each day
Problem: People (who are very sick and usually poor) have to get to a clinic every day for 6-9 months so someone can watch them swallow their pills. This often means that people have to quit their jobs to manage the daily trek to the clinic. Also, once a TB patient starts to get better, they get ravenously hungry. This is bad news if they’ve had to quit their jobs and no longer have money to purchase food.
Although this DOTS system has saved many, many lives and is certainly better than no system at all, the discrepancy between standardized/cost-effective healthcare available in poor countries and the personalized healthcare that is available to those in wealthy countries is heart-wrenching.
The heart-wrenching continues on and on. John Green writes that TB is “a disease of vicious cycles: It’s an illness of poverty that worsens poverty. It’s an illness that worsens other illnesses…It’s an illness of weak healthcare systems that weakens healthcare systems. It’s an illness of malnutrition that worsens malnutrition…TB doesn’t just flow through the meandering river of injustice; TB broadens and deepens that river.”
This is not a book without hope though.5 John Green contrasts those vicious cycles with what he, lovingly, calls virtuous cycles.
He writes of how TB programs started because of protests from nuns, TB patients, and their caregivers. Their protests spurred governments into action, which led to the funding of DOTS. Once some people were successfully treated, they began pushing for access to drug-resistant drugs so their friends could stay alive too. A virtuous cycle.
John Greens tells stories of individuals who, once TB patients, are now leaders in the push for more personalized TB treatment in their countries.
Of course, the most obvious virtuous cycle of all is John Green himself. Being humble, John Green doesn’t overtly mention his role in his worldwide campaign to take down tuberculosis, but even a casual John Green fan knows it.
Towards the end of EVERYTHING IS TUBERCULOSIS, I read the following line: “PIH6 found the money needed to treat Henry. Henry would be the first Sierra Leonean to receive this kind of highly personalized, tailored cocktail…” I immediately had a suspicion about where said money was “found.”
My suspicion is the thousands and thousands of dollars that PIH “found” came directly from John Green’s pockets. I have no proof, but John Green did later organize a successful GoFundMe for Henry and his family. He reportedly donates $1 million annually to fight the disease on top of what his “nerdfighter” community has raised.
Another facet of the fight against TB is the fight against drug companies. Because TB is typically a disease experienced by people in poverty, it is not cost-effective for drug companies to develop TB drugs (as opposed to say, the weight loss drug Ozempic). Coupled with that are pharma companies trying to keep prices high. Johnson & Johnson’s 2013 drug bedaquiline is super effective for patients with drug-resistance TB but most couldn’t access it for years. At $900, it was not cost-effective. When J&J’s patent was due to expire in 2023, the company tried various schemes to hold onto it’s patent or file secondary ones, ensuring J&J profits would rise as people in Africa died. John Green writes:
After negotiations with global health organizations and loud protests from anti-TB activists, J&J backed down, allowing generic bedaquiline…As a direct result, the price of bedaquiline dropped by over 60 percent almost overnight.
Those negotiators and protestors? You guessed it - led by John Green. He’s testified at UN meetings and met with Congress on Capitol Hill about drug funding. His video Barely Contained Rage: An Open Letter to Johnson & Johnson is the thing that spurred all those loud protests.
John Green is my hero.
My Thoughts on Standardized Medicine and Standardized Education
John Green’s discussion about treating TB patients with standardized and cost-effective systems made me think about education. Granted, almost everything makes me think of education.
Just like treating TB patients has to be done on a personalized, case-by-case basis, such is also the case in public schools. Teaching has to be done kid-by-kid-by-kid also. Sure, you can give everyone the same assignment, but it takes a semi-decent teacher to make each kid actually do the work required to learn. How I convince Seamus7 to do his work is totally different than how I convince Lynette to do her work. Some classes need different strategies, as Adrian Neibauer writes about as he describes “cookie-cutter lessons and standardized classroom experiences that lose sight of the actual students they are meant to help,” in Same Day, Same Way.
I think this is what drives me so crazy about EdTech people touting their AI-powered systems, as if you could simply expose a group of 20 or 50 or 100 students to some Khan Academy program crap and expect them to learn. That’s just as ridiculous as giving every TB patient the same drugs, even though it’s known that many patients are likely to be sick with TB strains resistant to those drugs. In medicine and education, personalization is key. And personalization with a PERSON, Bill Gates. Not an AI-powered bot.
Place to explore: Firland Sanatorium: Shoreline, WA
Since “Everything” is tuberculosis, I figured that a quick internet search could give me a clue about the history of TB where I live (north of Seattle).
Indeed it did. A one-minute internet search brought me to the Firland Sanatorium.
Built in 1911 by the Anti-Tuberculosis League of King County, the sanatorium housed patients with tuberculosis until they moved to a new site in 1947.
In 1948, Firland was sold to CRISTA, a Christian missionary-type organization. Now the building is part of a compound that includes King’s private schools, retirement community, and media center.
Here it is!
Primary Sources on the TBVoices Project
I love sharing “regular people” primary source narratives with my students, and the TBVoices Project has short video clips of dozens of Seattleites who have shared their tuberculosis experiences through the TB Voices Project. I particularly love Shirley’s story of how she had a friend smuggle her out of Firland Sanatorium in the trunk of her car. Shirley went to a doctor who sent her right back…although she did stop for a burger and fries before returning to the sanatorium.
Happy Teaching, Traveling, and Reading! May you all stay happy and healthy this week.
whom one suspects are quite similar to John Green himself
as quoted in EVERYTHING IS TUBERCULOSIS, page 66
The term was coined by Carolyn Day, EVERYTHING, page 67
EVERYTHING, page 4
Or as John Green writes: “Mere despair never tels the whole human story, as much as despair would like to insist otherwise.” (Pg 167).
Partners In Health - read more about Partners in Health and the late, great Dr. Farmer in MOUNTAINS BEYOND MOUNTAINS
The names, of course, are not my actual student’s names.
Excellent post! I loved Everything is Tuberculosis; it was tragic and beautifully written. I’m definitely going to use your John Green TED talk lesson for my students next year. Thanks for sharing!
Thanks for sharing-this was so interesting! I remember during Covid and my daughter had to watch John Green’s Crashcourse lessons that her teacher would assign online. I enjoyed them so much I would tell her to come find me so we could watch them together. Now I have another book to add to my summer read list-thank you!