Phantom Plague

December 15, 2021
A penetrating social history of a virulent disease. Drawing on two decades of reporting on tuberculosis and HIV in India, Krishnan makes her book debut with a hard-hitting indictment of the greed, politics, and racism that have led to the prevalence of drug-resistant tuberculosis. The disease, medical historians speculate, likely began in ancient Egypt and traveled across the world along trade routes. It ravaged 19th-century slums, where overcrowding and filth incubated an illness that had no cure. Its victims, though, were hardly limited to the poor. Among TB's sufferers were Orwell, Kafka, Eleanor Roosevelt, Chopin, and all of the Bront� sisters. Krishnan traces early efforts to stem contagion, including a campaign in the U.S. to ban spitting; although that effort failed, it led to the creation of public and hand-held spittoons. If men would not stop spitting tobacco, at least the mucus could be contained. The development of germ theory led to the creation of antibiotics, but while curing TB, overuse of antibiotics for all manner of maladies caused drug-resistant strains, especially rife in India. Ramshackle housing, inadequate medical care (doctors who fail to diagnose TB or prescribe correct treatment), and the rationing of drugs because of big pharma's patent monopolies all contribute to the rise of drug resistance. "Tuberculosis," writes the author, "demonstrates what happens to science when it leaves the lab setting and interacts with flawed human beings: patients, doctors, politicians, and rabble-rousers, all of whom have a unique effect on the course of the plague." Krishnan writes that the World Health Organization estimates 25% of the world population has latent TB, fueled by an "architecture of unfairness," inequality, and ignorance. Underscoring the vulnerability of the poor, Krishnan asserts that TB epitomizes "a new form of medical apartheid in which preventable and curable diseases, such as TB, are thriving while lifesaving medicines remain in a stranglehold." A timely, significant analysis of the dire consequences of public health failures.

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January 3, 2022
Journalist Krishnan debuts with a wide-ranging history of tuberculosis and a stark warning that the disease is mounting “a frightening comeback.” Starting in the 1800s, Krishnan documents anxiety in England and America over tuberculosis, then known as consumption, and details the contributions made by doctors Ignaz Semmelweis, Joseph Lister, and Robert Koch to the acceptance of germ theory and the eventual development and mass distribution of antibiotics that greatly reduced tuberculosis deaths in the middle of the 20th century. Krishnan then shifts focus to modern-day India, where the colonial and postcolonial development of Mumbai created overcrowded and unsanitary conditions ripe for tuberculosis to propagate and spread. She also explains how the weakened immune systems of HIV-AIDS patients in the 1980s and ’90s provided the bacterium with ideal circumstances for proliferation, how the “overuse of misuse” of antibiotics and the existence of “clinical deserts” in poorer parts of the world have allowed drug-resistant tuberculosis to spread, and how groups including the World Health Organization try to contain disease outbreaks in the face of conflicting national goals and commercial interests. Shot through with tragic and inspiring stories of patients and doctors who have battled against the disease, this is a bracing look at what might be the next public health catastrophe. Agent: Kelly Falconer, Asia Literary Agency.