[Music]
Welcome to our virtual space
where thought leaders who in a variety
of ways have committed themselves
to improving our lives share their work,
perspectives on current affairs, and what
brought them to where they are today.
My name is Rob Lue and this is the
Xchange.
[Music]
All right. So David, first of all thank
you for doing this
and, um, thank you for, um,
joining us on the Xchange, where we're
really speaking with a whole variety
of academics and other experts and
getting us
sort of an insight into what they do but
also getting an insight into how the
COVID-19 pandemic
potentially has changed what they do, or
at the very least changed how they think
about their work.
So to give our listeners and viewers
sort of a window
into David Jones, David, would you mind
sort of sharing
what sort of work do you do and what are
the things
that really get you out of bed in the
morning? I do a lot of different things.
I'm officially or primarily at Harvard
as a historian of medicine
but I got here in a very roundabout way
and, uh, trained to do different
things some of which I still do. When I
was in college I was interested
in a bunch of different topics: history,
geology, biology.
Uh, after going back and forth like many
people do, I ended up
deciding to go to medical school but
while there, quickly got involved in the
history of medicine research project
and decided to keep doing that work, so I
decided to pursue the Ph.D.
in history of science as well.
When I graduated from those programs I
trained in psychiatry
because I was really captivated by the
clinical work and the challenges faced
by people
struggling with severe mental illness.
When I finished that training I joined
the faculty
at MIT in a program on science,
technology, and society,
continued to do clinical work for
several years,
and then also began teaching in the
Department of Global Health and Social
Medicine
at Harvard Medical School. So there were
several years,
uh, early in my career where I was doing
three different jobs at the same time,
uh, trying to juggle all of those and the
family,
and eventually it became too much
and so I gave up clinical work to focus
on the academic work.
I've now been at Harvard full time since
2011
but even here I still continue to teach
on a wide range of different topics:
history of medicine, medical ethics,
social medicine at Harvard Medical
School,
and it's been great because I get to
interact with a bunch of different
faculty in different disciplines,
uh, and it continues to keep me
interested and engaged
in the many different kinds of projects
that I've been involved with.
So something that our, um, listeners and
viewers often wonder
is, um, when when we think back to David
as a child,
what was it in your child- were there
things in your childhood that you would
say right now
pointed towards where you ended up?
Well I, I can't imagine I would have ever
have thought as a child that I would end
up
primarily as a historian. Right. Uh,
you know, I, I, I found something the other
day in my the closet of my
parents' house of a picture I had drawn,
uh, in first grade,
saying that when I grow up I either want
to be a fighter pilot or a doctor,
and I assume the fighter pilot was
because, you know, many young boys want to
do that
growing up, uh, in the height of the Cold
War, uh, but my father had been a
physician so that had always been
I think a default career plan for me as
well,
um, and no one in my family had ever done
academics like this, or certainly had not
done history.
Uh, my mom had been a history major so I
thought about it
but it was really in high school and
then in college that I got much more
interested
in history in addition to the sciences
and I have a very distinct memory,
and actually I tracked down this article
recently from spring of my senior year
in high school,
uh, the magazine Scientific American ran
an article about the black death,
uh, and the impact of this epidemic, uh, on
European life and society in the 14th
century.
I remember being totally fascinated by
that article. I ended up doing my final
project
for that AP Biology class about bubonic
plague,
uh, and I think that was my first
sustained interest
in the field that would end up becoming
my life work. I didn't of course realize
it at all at that time,
but i think that's really where my
interest in history of medicine, and
especially in history of epidemics, began.
Okay, that makes sense. Um, I have to say
that I've gotten to know you in terms of
your work
in the general education and teaching in
the General Education program at Harvard,
and as you know of course one of the
elements of general education
is this notion of how things like
science and history, etc,
are linked intimately with society and
with the lives that our students will
lead,
and I can't imagine someone that's
perhaps more appropriate for that kind
of linkage
than what you do right you know in terms
of your kind of work.
Can you comment a little bit about that
sort of intersection
between history and medicine and society
and technology
that is so central to how you think
about your own work? You know
it comes up in so many different places.
The -
and, and COVID has totally turned
everything on its head. I'm sure we'll
talk about that in a minute, but even in
life before COVID,
uh, it's been great to be able to explore
these intersections in my teaching and
also in my research.
I mean, as you know, one of the goals of
the Gen Ed program
is to ask students to make connections
between their their lives in the
classroom and outside the classroom
and the course I teach is a course on
medical ethics and history,
which I think must be one of the easiest
courses in the program to fulfill that
mandate
because the topics we cover are topics
of great interest and concern
to the students. No one wants to talk
about an issue
like abortion, as if it didn't happen on
campus, but you know, given that we have
15,000 students on campus
statistically there must be students
this, each year who are pursuing
pregnancy terminations or know people
who are pursuing pregnancy terminations,
so it must be part of their lives even
though
no one would be forthright in talking
about that.
Or you just if you read the Crimson
regularly you'll see the debates about
does University Health Services have
too short a fuse or too short of a
trigger for sending
students off to McLean Hospital in the
setting of a psychiatric crisis,
uh, and the students have very strong
feelings about that.
Uh, often we'll talk about a question of,
like, attention deficit disorder,
uh, what kind of disease is it, uh, is the
treatment response of putting so many
people
on stimulants appropriate? Of all the
topics I've taught in the classroom,
many of which, many of which are great
controversies in American politics,
the only time I've seen students
actually screaming at each other
was in a debate about attention deficit
disorder and whether Ritalin
and Adderall were study steroids, it gave
people an unfair advantage,
or whether they were an appropriate
treatment for a serious illness.
And so students often bring very strong
feelings to the classroom,
which is a challenge for the teaching
staff. I always have to, you know,
advise the teaching fellows carefully
each fall that, when we talk about
abortion or mental illness or attention
deficit disorder
or end of life decision making, uh, we
have students who are dealing with these
problems
in their own lives or in their family
lives, you know, if you have a student, a
class of 100 students,
over the course of the semester there is
someone who's dealing with a grandparent
who's making a decision about withdrawal
of life support,
and so these are deeply personal issues
for the students
and it's a privilege to be able to teach
them and try to get them to think about
these in a sophisticated
academic way without losing sight
of the fact that these are very human
and relevant experiences for them.
Yes, of course. So without question, as
you've alluded to,
the COVID-19 pandemic is almost the
ultimate
unfolding and evolving case study that
sits squarely
in your sweet spot in terms of your work,
in terms of your field,
in terms of your teaching as well. So
naturally a lot is out there that has
happened already.
There is an equal amount, if not more,
that we don't know.
Um, right now from where you're
you're sitting, can you say, for example,
just
some of the critical ways in which what
we've seen with COVID-19
resonate strongly with sort of key
issues in your work?
Yeah, it's really been uncanny. Anyway,
historians would say, you know, you can
get great insight into the present and
future by studying the past, and so I
believe that to be true,
but it's been uncanny to watch that
actually happening
in real time. I remember, you know, when
reports of the epidemic, uh, first started
circulating in January and February,
initially whether I was in denial or
minimizing,
I wasn't that interested because it
seemed like
the most recent in a series of false
alarms and there had been a series of
scares about influenza in 2006 and 2009
which really didn't amount to much, uh,
and there had been the
SARS epidemic in 2002 and 2003 which was
very quickly contained.
Uh and so when COVID started to become
a problem,
initially I hadn't thought very much
about it and get calls from reporters
wanting to know what would a historian
think,
uh, and I'd usually say not very much and
then,
but you know, things started to change in
February, uh, and I like everyone else was
late to the game.
But I've been seriously engaged in it
ever since that time,
uh, and there are all sorts of things that
historians
would have predicted, really should have
been predicting back in January, and a
lot of us missed the boat there,
and the epidemic has played out
following a very familiar
script. You know, human societies have
been dealing with epidemics
for as long as we've lived in cities, so
thousands of years.
We have a lot of experience with this
particular kind of an epidemic, of a
respiratory virus,
mostly because of influenza and SARS,
and so we have a lot of experience about
how these
epidemics move into societies, where they
come from,
uh, the dynamics of minimization and
denial, which are really characteristic
of almost any
epidemic. Many friends and colleagues who
have gone back to read
Albert Camus' famous work, The Plague,
and they find it eerie how similar the
denial and minimization that he
describes in that fictional town
echoed what we all did back in January
and February
before people took this seriously.
Historians have described many cases in
which once the disease is recognized,
uh, society moves into a phase where they
attempt to explain what's going on and
to make sense of it all.
The explanation in this case was
relatively straightforward because
Chinese scientists
did us a big favor, you know, by the end
of the first week in January they had
identified the
virus and even posted the sequence, uh,
online. It's really a triumph of modern
bio, biological sciences, uh,
you know, the comparison case for
influenza in 1918,
uh, the virus wasn't recognized until the
1930s.
Uh, this was an episode of, like, really a
disease archaeology that had identified
the influenza virus
10 years, 15 years after the epidemic had
already passed.
Uh, in this case, we had the virus, really,
before the epidemic had really begun in
most of the world,
but even though it was explained in that
way, that's the mechanistic explanation,
is just one small part of what societies
do with epidemics.
There's also this question of who's
responsible,
you know, what, what's the moral, is
someone at fault, uh,
and there's a century's long track
record of this, you know, people blaming
Jewish people for Black Death in the
14th century
or of New Yorkers blaming Irish
immigrants for cholera in the 19th
century,
uh, or for, uh, religious and political
leaders in the 1980s blaming, uh,
homosexuals or drug users for AIDS in
the 1980s.
To blame is part and parcel of the
epidemic response,
and it's been on clear display in, in
this case, whether it's,
you know, Trump or anyone else blaming
the Chinese, blaming World Health
Organization,
you know, in New York the governor and
the mayor have been sniping it, at each
other over who was most
irresponsible in their early response to
this epidemic.
Uh, unfortunately in this case, especially
in the US,
I think there's more than enough blame
to go around. Uh,
in retrospect an appalling number of
mistakes were made,
and now there was just a report in the
news this week that had we imposed a
lockdown even just a week earlier
it would likely have cut total mortality
in the US by half, if not by two-thirds.
We knew everything we needed to know to
justify that policy in
early March. No one was willing to do it
and so now we're just left with a lot of
regret and trying to figure out how we
can dig ourselves out of this hole.
So as you point out, I mean, from, you know,
all the historical cases that you have
mentioned and more,
there is a familiarity in terms of the
response,
or lack thereof, in terms of the blame
game
and the finger pointing that goes around,
etc, um,
but moving away from the familiar,
with COVID-19 so far, is there something
that really strikes you
as particularly unfamiliar, something
that really
surprised you, or is everything familiar
now that even though there is much that
is familiar?
Uh I think everyone from historians to
scientists,
uh, continue to, uh, express their
startlement, uh, about what has been going
on with all of this,
um, you know early on, again back in
February, once people started to worry
about this,
you know, the question was always which
past disease is this,
like, will this be like SARS or influenza?
Uh, it quickly became clear that it
wasn't going to be like SARS.
SARS has the great advantage of you're
only
infectious once you're symptomatic, so as
long as you contain all the symptomatic
people, like if you do fever screening,
you can stop the disease in its tracks,
and that's what happened in 2003.
Uh, COVID, like influenza, there's
asymptomatic transmission which makes it
extremely difficult to do any kind of,
uh, easy surveillance and quarantine and
so it quickly spun out of control.
People then said, well, we'll be like
influenza in 2009, which wasn't much of a
pandemic, or
1918, which will be a catastrophic
pandemic,
um, and now it looks like it'll be
somewhere in the middle.
Uh, but it's become clear there are many
ways in which this virus isn't really
like
either of those influenzas. It seems to
have
effects on far more organ systems in the
body
than influenza viruses typically do. I
mean, when you get the flu you can feel
crummy in many different ways,
but COVID seems to be much more
aggressive in some patients
of going after the brain and causing
interesting neuropsychiatric
problems, interesting for me as a
psychiatrist, horrible for the patients
and their families.
There are cardiac problems and a very
high percentage of people who have died
from
COVID seem to be dying from cardiac
complications,
and we're really just starting to figure
out, uh, these mysteries
over the past couple weeks. There have
been these reports of
children developing a illness that's
like a
previously rare phenomenon, Kawasaki
disease.
Kids are getting very sick weeks after
their initial COVID episode and I just
saw the news today in New York,
there are reports of adults having these
delayed inflammatory syndromes as well.
So the virus continues to throw up these
mysteries.
Um, the great mystery, of course, is will
we generate a vaccine against it?
Uh, human science has never produced a
successful vaccine against a coronavirus,
uh, in part because we've never really
tried,
so we never tried with as much energy as
we are right now.
They were making progress on a virus for
SARS, but then SARS was essentially
eradicated and that
wiped out the motivation to make a SARS
vaccine,
and last I heard, there's something like
102 distinct vaccine programs
now underway everyone hopes that one of
those will pan out
but there are many reasons why some
biologists are skeptical
about whether or not this will work in
the end or which of the approaches will
work.
Um, I saw a very interesting interview
in one of the Harvard publications today
with Max Essex, who is one of the leading
scientists
early in the AIDS fight and was one of
the first people to suggest that AIDS
was caused by a retrovirus.
He had spent time in the 80s working on
AIDS vaccines
and eventually gave up because he
predicted then that it would be an
exercise in futility, and unfortunately,
he seems to have chosen wisely in the
1980s. Uh,
he thinks that for viruses like this
you'll have a much better return on
investment
in pursuing treatments, not in vaccines,
and so he would advise us to invest
heavily in antiviral approaches.
With the analogy to AIDS, it's very hard
to know who will be right.
Um, the one thing I, even though there's
still this uncertainty about what kind
of,
uh, pharmaceutical payoff there will be
from all this research,
many countries have demonstrated the
ability to contain this virus
without relying on modern scientific
discoveries but just by doing the
traditional public health approaches
of screening, surveillance, containment -
countries that are not particularly well
funded. Vietnam, Cambodia, Laos
have done a stupendous job containing
this outbreak,
despite massive initial exposure, because
of their close contacts
with China, and they've really done it
with
aggressive and enthusiastic
implementation of what are really 19th
century public health technologies,
uh, of the sort that the United States
lost
interest in 100 years ago,
and now we're really paying that price
for our lack of interest in
the tried and true methods of public
health, you know,
so I mean, it's, it's, it's a fascinating
challenge to
not only predict where this will go, but
also to even fully understand the
different
dimensions of what's happening with the
pandemic.
So I mean, I've been struck, for example,
by
the significant variation in mortality
rates
based on what ethnic group, what
geographic area of the United States
you might be a part of, and so in a way,
what was something that has been said so
often is that the exacerbation
of the lack of equality in society is
really,
Um, coming to the surface. I know that
this issue of inequality and its
intersection with health
is something you've thought a lot about
and published on extensively.
From what you're seeing already, are
there some particular
angles on that issue that you think
you'll really be able to bring to bear
going forward
that will sort of uncover some new and
interesting insights into this issue?
Yeah, again, most of my response to that
is again covered by a profound sense of
of regret at many different levels which
I'll explain.
My, my initial work had been about this
issue of infections and inequalities.
When I
started graduate school, I quickly became
interested
in the the colonial encounter
between people from Europe and Africa,
and the people who had lived in the
Americas
before those other groups arrived, and
what had been clear since the 1500s
was that the arrival of Europeans and
Africans
triggered appalling mortality amongst
the American Indians,
and that epidemics had played a
prominent role
in that mortality. AAnd there are many
early reports in the early colonial
records
of epidemics having dire consequences
for the Indians while leaving
the Europeans seemingly untouched,
and so that, this question of how do you
explain differential susceptibility
has a 500 year history in, in the
Americas.
So I got very interested in that, uh,
really exploring two different questions.
One was much more of the
scientific material question of why was
it that Indian mortality or Indian
susceptibility to these infections was
so
high. Again, this is a question that has
engaged
scholars in many fields for a century
and the core debate, like so much in life,
is about was it genetics or was it
social,
and people like Jared Diamond have won a
Pulitzer Prize for a book that includes
the sentence
that "Indians had neither immune nor
genetic resistance to infectious disease,"
which is a completely ludicrous claim.
American Indians in fact do have
immune systems, and they do mount both
immune and genetic responses
to these diseases, and yet someone who's
a Ph.D. biologist, a professor at UCLA, can
still say that and can still win the
Pulitzer Prize and that book is still a
fixture
of middle school social science
curriculum in schools throughout this
country.
And so there's something about that
question of genetic explanations
that is deeply appealing for people
across the political spectrum.
Uh, there's no evidence that it's true
and there's
plenty of evidence that social factors
were really what was decisive.
You know, one of the things that most
people don't appreciate is that the
really severe epidemics,
between your, uh, experienced by American
Indians didn't start
in most of the Americas until a cent, a,
a generation or two after first contact.
So the Spanish show up in the Southwest,
what's now New Mexico, in 1560,
and you don't see major epidemics until
16 thir- until the 1630s.
The Spanish show up in Florida in the
mid 1500s,
and you don't see severe epidemics in
the southeastern, or what's now the
southeastern United States,
uh, until the 1690s. Uh, well, what had
happened in the 1690s,
in 1690s, Virginia and South Carolina
legalized the enslavement of American
Indians,
which triggered a series of wars in the
Southeast, as different Indian groups
raced
to enslave each other and sell them in
the slave markets, uh,
in Charleston, uh, and Virginia, and it's
in that setting that you see massive
epidemics that decimated
those groups, and so I had argued in that
work that
the history of epidemics for the
American Indians
is really a history of populations, not
born susceptible to disease as the
geneticists would have argued,
but the people who were made susceptible
by the disruptions that followed,
colonization, conquest, dispossession of
lands,
some people will say genocide, I'm not
sure if that's the right word, but
it was a horrific history that was
unleashed by the arrival of Europeans
here,
and then these disparities have
persisted even into the 20th century.
American Indian populations, especially
urban American Indians,
are the least healthy group in this
country,
whether the prevailing disease was
smallpox in the 18th century,
tuberculosis in the 19th century,
or heart disease, alcoholism, mental
illness in the 20th century,
American Indians have always had higher
rates than the general
population.
And, and one of the things I regret now
is, when
COVID started to become a serious
problem back in February and March,
uh, anyone who had read
my work, let alone myself who had written
this work, ought to have said
we need to be really careful, because
based on past history,
this is going to be a problem in Indian
country.
You know, COVID mostly seems like a
disease of cities, uh,
so you might say, well, why would you be
worried about people who live on these
rural
reservations, but they had said the same
thing about tuberculosis in the 19th
century
and were surprised to find that
tuberculosis was a huge problem
on the Lakota reservations or on the
Navajo reservation,
and this was a parallel situation. We,
people, myself included,
didn't clue in that this was going to
hit the reservations hard,
and then when the report started to come
out, uh, in early April that the Navajo
reservation,
uh, has one of the highest attack rates
with this disease anywhere in the
country,
I just realized, uh, this, that was
about the most predictable thing of this
epidemic, uh,
and very few people actually had
predicted it, uh,
and no one had started the precautions
that might have helped
to mitigate that impact until it was too
late. Um, that's really frustrating.
Now that this has happened, I think we
need to do what we need to have been
doing for centuries, is to
figure out ways to target resources to
the most vulnerable people,
uh, in our country, whether it's American
Indians or people in various,
in our city neighborhoods that have had
very high risk. Uh,
it will really require excess resources
going to certain populations
to try to get on top of this, uh, and we
have to figure out how to mobilize the
political will to make that happen.
So I think something that you keep sort
of bringing back is
the importance of really learning from
the past,
right, learning from what has happened
historically and having the will and the
wherewithal
to actually apply it to what's about to
happen or could happen
right, right now in the present. Um,
I'm curious, I know that as someone that
um, teaches, so successfully in the
General Education program,
I know you spend a lot of time thinking
about,
from your field, from your sort of, uh,
perspective, from the combination of
things that you worry about,
what should an educated individual
that isn't necessarily going to become a
historian
or a scientist, what do you want them to
get out of it,
out of your course that you think really
sets them up positively
for the future? So, to broaden that kind
of
mission or effort, which I know you, um,
really believe in,
if you could wave a magic wand and
choose your place,
middle school, high school, college,
is there something based on what you're
seeing now, and dare I say,
maybe the regrets that you have
expressed, that you think, you know, if I
could wave a magic wand, if I was in
charge of it all,
I would make sure that this element
is available to students at this level
to have exposure to,
what would that be? I'd probably do it
differently, at some, several of those
different levels
that you have mentioned. So with my two
children having recently gone through
middle, middle school
social science curricula, uh, if I could
wave my wand,
the first thing I would do is purge
those curricula of Guns, Germs, and Steel,
which I think is a pernicious influence,
in a prominent place in middle school
curricula,
with a, with a specific goal to get
people to understand the ways in which
epidemics specifically but the phenomena
of disease in general
are really social phenomena, or at least
susceptibility to disease is a social
phenomenon, and if you want to understand
the problem of health disparities,
which are a huge problem that affect
everyone in society,
you really need to understand the ways
in which, the ways we have structured our
society:
how income is distributed, how political
power is distributed,
uh, have a huge impact on the diseases
that we
suffer. I, sometimes I'll get asked,
do I believe that we choose the diseases
that we
suffer, uh,
and at first pass, the answer is no, like
no one as a 12 year old says, okay, over
the course of this life these are the
diseases I want to experience,
how do I bring that about? That's not
what we do. People are trying to choose,
hopefully, to be,
to be healthy and yet at a societal
level,
we have chosen, or society has acted in
such a way,
such that we accept certain kinds of
risks
and distribute those risks unevenly
across society
such that a certain kind of burden of
disease is the result,
and it's hard not to see that as a
process of choice and I think if you
could get
into the minds of, whether it's middle
schoolers or high schoolers,
this notion that the diseases we suffer
are the result of
political and social decisions and
policies that we have made,
that would be a really useful
reorientation to get people to think
about the kinds of policies that we
would
pursue to to have a healthier population.
Now, obviously, it's difficult. The,
the one thing that we do that causes the
most deaths each year is cigarette
smoking. It's still only at five or six
hundred thousand deaths each year.
Uh, cigarettes could be banned, there are
many reasons why they're not
banned, uh, I'm not neces- I mean I would
support a ban, I don't think that's
realistic.
Uh but I think people just need to have
a conversation about, like, what is the
consequence of doing that.
Or we have very permissive policies
about alcohol and then
high tolls of drunk driving deaths and
domestic violence and suicide related to
alcohol.
We need to be having conversations about
the kinds of choices that we make
to allow this. Or we have a food
environment
that has fostered a massive epidemic of
heart disease, uh,
both in the US and now worldwide, you know, 10
million deaths a year from heart disease
is the world's leading cause of death.
It's not inevitable. There were not 10
million deaths from heart disease 100
years ago. It's the result of decisions
that were made over the course of the
20th century
and to get people to understand the ways
in which,
whether it's direct or indirect,
individuals and societies have a huge
impact on the diseases we suffer
and we can do something about them.
And there've been very interesting
conversations in the aftermath of, well,
not in the aftermath, in the midst of
COVID,
about environmental policy,
and COVID has demonstrated that, uh,
societies can in fact substantially
reduce their carbon emissions.
Uh, whether or not this is by choice you
could, you could
bicker with, uh, but we have demonstrated
the ability to reduce CO2 emissions on a
global scale.
Many people agree that we need to do
that going forward to prevent the
climate crisis.
Uh, will we be willing to do that in the
absence of COVID?
I hope so. I'm not going to hold my
breath but again, it's one of these
things, it's an event that has
demonstrated
the kinds of things that actually are
within our control,
uh, if we motivate to intervene against
them, I think that would be a very
important
message to convey. So it's the notion of
decisions that we make,
both individually, as a government, as
leaders and as a society.
Right, yeah. And that our decisions have,
have real consequences, things that
would seem hopeless, I think, if you had
spoken to someone in the 1950s,
when heart disease was at its peak in
the United States, and
you know, people our age, people in their
40s or 50s, were routinely dropping dead
of heart attacks,
and if you had said then 50 years from
now
we'll have this epidemic under control,
uh,
i think a lot of people in the 50s would
have said that's just impossible, we
don't know enough,
uh, there won't be political support for
doing these kinds of things,
but research was done, decisions were
made, cultural practices shifted,
and heart disease mortality has fallen
70 percent since
1960. It's probably the single biggest
improvement in, uh, human health history
ever,
except maybe improving the safety of the
water supply,
which was done in the US in the 19th
century, uh, tremendous impact.
Uh, there's still much more that could be
done, it's still the leading cause of
death in this country,
so it's very much a work in progress,
but we have done tremendous things
sometimes when we've set our minds to it.
Sometimes sort of more
inadvertently, like, you know
there has been a war on cancer, there was
never a war on heart disease,
uh, there have been various public
education
campaigns against heart disease that
have usually been perceived in a
slightly half-hearted way,
you know, tobacco control for instance,
but in that case, even these half-hearted
conflicted
programs have a huge net
effect and, you know,
the same thing with, you know, the, the
fight against AIDS.
In 1984 the federal government promised
an AIDS vaccine in two years.
It didn't happen, uh, but many other
things did happen,
uh, and the AIDS epidemic is still very
much with us, there are about
hundred and seventy thousand deaths a
year, I think is the latest number,
It should be zero and so seven, seven
hundred seventy thousand is much bigger
than zero,
uh, but it's better than two million,
which is what it was
ten years ago, uh, and things seem to be
heading in the right direction,
uh, AIDS could be eradicated even without
a vaccine,
we just need to get hundreds of people who
are HIV positive
onto effective treatment and get them to
maintain that such that no one is
infectious and then the virus would,
would die as that generation
of people passed. Now that's obviously
require
sustained effort over the next 80 or 100
years,
but it's possible if it's important
enough for us to do it,
and the question is how do we convince
people that it's important enough for us
to do.
No, absolutely. Yeah, yeah, that's a, that's
sort of an
interesting way to think about, um, what
and what can we do
in terms of what we teach in schools at
various levels
to enable that level of decision making
and agency,
um, um, in our students. You know, it comes
up, like, no,
what kind of tenor should we have when
we teach about COVID?
There have been many people especially
environmental activists
of various sorts who have said this is
an epidemic of our own doing,
whether it's the nature of climate
change and deforestation,
changing human contacts with animal
reservoirs of these obscure viruses, or
whether it's
industrial agriculture with influenza
viruses coming out of
giant pig farms in the United States, or
the portrayals of how Chinese people
interact with meat markets or whatever
it is.
People will say that COVID was just
waiting to happen
because of environmental degradation,
misuse of animals, all these sorts of
things,
and it was inevitable. Now I, I suspect I
would agree with most of those claims,
uh, that the fact of
recurrent introduction of animal viruses
into human populations
is inevitable and more likely now than
it was in the past,
uh, but I think the inevitability stops
there.
We could respond very differently when
that happens
and some countries have responded
enormously well,
Vietnam, which I mentioned earlier, has
been on alert against,
mostly against influenza viruses for the
past 20 years or so, you know, many of
these viruses each year emerge out of
Southeast Asia.
Vietnam and other countries have done
the good work to set up surveillance
systems
and so they have testing capacity, they
have
community health workers who've been
doing contact tracing for years
in many parts of the country, which is
you know, in the rural areas of the
country, you know, each village will have
a community health worker
who already knows all the people and
already knows who all their contacts are,
so when you hear that, you know, Frank
tested positive,
you have a pretty good sense of who,
who's frank's, who frank's contacts were,
which makes contact tracing pretty easy,
um, but Vietnam's a big country, 100
million people,
uh, and they have urban areas and they
figured out how to do this kind of
public health well in those urban areas,
so that when they heard rumors that this
new virus was circulating in China,
they just activated the system that
existed, uh,
and they've had something like 350 cases
and zero deaths
despite 100 million people, many of whom
live very closely with animals and a
gargantuan land border with China.
It's remarkable and they're not unique.
You know, Taiwan has done something
similar, Laos and Cambodia have done
similar things,
and you just compare the US experience
to that, uh,
we didn't choose the COVID-19 epidemic,
no one wanted the COVID
epidemic, no one set out on new year's
and said, what can we do to be the world
leader in COVID, uh,
but we did make a whole series of other
decisions,
the result of which is now this huge
epidemic that's wreaking havoc in the
United States,
and people really need to understand
that, you know, decisions have
consequences.
We have tremendous capacity, whether it's
medical or public health capacity,
uh, and we just need to have good
leadership and wisdom,
uh, other countries have shown the way
and we just have to figure out
now how to catch up. Yeah, no. Very well
said.
So um, David, so here's a question on
perhaps a lighter note,
um, you know, just to give our
listeners and viewers a little bit of a
further insight, and or 360 view of David
Jones.
When you're not thinking about history,
pandemics, infectious disease, things like
that,
what does David do for fun? What other
stimulating
activities, sort of, are you passionate
about?
For better or for worse COVID has given me
more time than usual to pursue some of
these things.
Uh the thing I, I likely found find most
useful both for
health and peace of mind and also,
strangely, for writing,
uh, is exercise, especially jogging
in the summer or spring, or cross-country
skiing
in the winter, which can be done easily
and affordably from a base here in
Boston.
Uh, somehow I often get my best thinking,
if not in the shower,
uh, it's while I'm jogging and, and
you know, sports physiologists have all
sorts of theories about what it is that,
uh, endurance exercise does to human
bodies, and the ways in which
there's not, you know, uh, Lieberman's
arguments about the way that humans are
uniquely dissolved,
evolved to run and these commensal
relationships between running and
how our brain works, I really find that
to be true,
and so I've been enjoying a lot recently
the relative absence of traffic from
roads
and less pollution on the roads, and so
I've been getting out a lot.
My daughter who's in high school is on a
cross-country ski team,
uh, and so she has gotten me interested
in roller skiing,
uh, which I'm not at all convinced is a
safe activity,
is it slightly safer with less traffic
on the roads,
we've been doing a lot of that over the
past two months. I haven't broken
anything yet but I think that's just a
matter of time.
And then the other thing I've done is
gone back to when I was in college, I
played a lot of guitar,
and I had this great guitar teacher in
Porter Square
who would tell me this story that when,
when he was
at some younger stage in his life he
decided he wanted to become a classical
guitarist, he was mostly a folk guitarist,
so he moved to New York City, started
taking lessons with the classical
guitarist,
uh, and the guy said, well, if you want to
do classical guitar you have to learn to
play this set of scales that have been
designed by Andre Segovia,
and when you master those scales then
come back and we'll talk.
Uh and so my teacher said, wait, at the
time I had an apartment that had a
rooftop deck overlooking the Hudson
River, and so I'd just sit on my deck for
eight hours a day and play these scales,
and then you know, two months later he
went back to the guitar teacher, and then
was as, has had a very successful career
as a guitarist. Now I haven't been doing
eight hours a day,
uh, but I have decided that this moment,
uh,
takes away my excuse and I now need to
do something that I've been wanting to
do for 30 years
and to figure out how to master these
Segovia scales,
and i've actually made a lot of progress
over the past two months,
and that's been very satisfying, uh, and I
think it's good exercise for my
wrists, which would either be otherwise
be strained by too much time spent at
the keyboard
or on Zoom meetings, and so between
exercise and playing music,
uh, I think it's been good to
keep morale going during this time. Also
it's, it's, um, it's something that I think
so many of us
experience, which is, you know, there are
all these twists and turns
in your career, in your life, um, in your
sort of sequence through schooling, etc,
and um, we are where we are right now but
sometimes it's an interesting exercise
to think about, well, was there a fork at
some point in the road in the past,
where if I'd gone left instead of right
or right instead of left,
maybe I'd be doing this instead.
And I'm like - so for example for myself I
had a very specific fork in the road
after college, and I'm curious, David, if
for you
would there be a different David Jones
in a parallel universe
that went left instead of right and what
would he be doing?
Yeah, there have been so many of them and
and often when I, when I look back,
uh, on life, which, you know, I was often
asked to do when I was training in
psychiatry,
I would often worry that many of my
decisions, uh,
were externally motivated, not internally
motivated, and somehow I wasn't
an authentic self in some way, uh, but it
really is amazing.
I mean if you're at places, and Harvard
is probably
one of the best places to be for this,
where there are many many different
opportunities available to you,
you can never pursue everything that's
out there, so you do have to make these
choices.
Yeah, I remember, you know, a whole bunch
of them when I was an undergraduate.
I had always been interested in
evolutionary biology. One of the reasons
I had come to Harvard,
uh, was because there were these great
characters here then, Stephen Jay Gould,
E.O. Wilson, Richard Lewontin, uh, and I
said I want to work with them,
uh, but then you get there, and you get
here, and you realize that, you know,
someone like Gould had an incredibly
difficult reputation on campus
for not being the friendliest, the most
accessible person, uh,
but I took some courses with him and I
really wanted to work with him and so I
have a very clear memory of going to his
office,
uh, in the MCZ one day, you know, he had
advertised office hours, no one would go,
uh, but standing outside that very old
door in those,
in that building and trying to decide
whether or not I had the courage to
knock on that door and go in,
and I did, it was terrific, he was so
surprised to see a student actually
there, because no one would ever
come and he ended up being my senior
thesis advisor
for a history project, not for a biology
project. You know, and he was,
he was a busy person who wasn't the most
available advisor in the world but was
such a great opportunity just to
get to work with someone like him and
hear his stories and hear his view on,
well, you know, totally intimidating, uh,
but still great fun,
and then I remember in medical school
when I was, when I was starting to get
interested in doing some research along
the way,
at the time you had the summer off
between first year and second year, and
so if you wanted to get involved in a
research project, that was the time to do
it
and there were two projects that I was
deciding between, uh, one was this history
project,
uh, and i got involved with the professor
there
on doing investigations of the research
that had been done during the cold war
to deliberately expose humans to
radiation in
order to understand the health effects
of radiation, which was an interesting
scientific project
and one that was crucial to the military
in the emerging atomic
industries, uh, so it's a very exciting
research project,
but also as an undergraduate I'd been
really interested in earth sciences
and Harvard had just started a
center for, from what was called in the
Center for
Health and the Environment at the Medical
School, uh,
led by, uh, two physician
researchers, uh, who are doing really
interesting work and this was,
you know, right after the, the Rio Earth
Summit in 1992,
so there's a lot of excitement about
climate change and environmentalism and
this was going to be the science of the
future,
and they had started doing early
research on the health effects of
climate change,
and so I was trying to decide between
these two summer research projects and
so i emailed one of these guys and said
I'd like to talk about doing this,
because I was leaning in the direction
of the environmental science, uh,
do you have time to meet and he said,
unfortunately I'm about to go out of
town
to a research site, uh, I'll be gone for
the next six weeks, we could talk after
that,
uh, I had to submit the proposal before
then so I couldn't meet with him,
so it's like, oh okay, I'll just do the
history project,
and you know, I suspect if he had been
able to meet,
I might have ended up getting a Ph.D. in
earth sciences, not in history of science,
and my career would have gone off in a
totally different direction. I'm totally
happy
with my work as a historian so I don't
regret that decision,
but recently my research work has sort
of moved back in that direction,
and i've started doing work on the
history of the health effects of air
pollution,
which I stumbled into because of
previous work I'd been doing on heart
disease,
that said heart disease is the
leading cause of death worldwide now,
even in places like India,
and work done by researchers at the
School of Public Health
going back to the 1980s had actually
shown that most people who die of air
pollution aren't dying from the
respiratory effects.
Everyone thinks that air pollution is
bad for your lungs, it is,
but what it's really bad for is your
heart, so most air pollution deaths are
actually cardiac deaths
and that got me interested in this
question, well, what's the relationship
between air pollution
and the world's epidemic of heart
disease?
When were these connections made, how
come it hasn't gotten as much attention
as it probably deserves,
and so now I'm actively involved in the
series, a series of projects related to
this question
of the health effects of air pollution,
uh, which have gotten me involved with
the Harvard Center for the Environment
and Dan Schrag and all the people
there, and so even though I did have this
divergence back in the spring of my
first year of medical school,
those interests have, have now looped
back together.
I find that to be really satisfying in
some way. Yes, that's a fantastic note,
actually,
to end on, is that, um, no decision is
final, right,
and that in fact things do come back. You
can loop back to things, perhaps in
different ways
from the way in which you might have
engaged with them earlier, but certainly
they,
they very much remain a part of your
life. Well, David, thank you so much for
spending the time, for sharing your
insights,
and also sharing of yourself in terms of
your journey
in what is clearly during this time of
COVID-19
a particularly relevant, timely, and
important field
in terms of our understanding of the
pandemic. So on behalf of the Xchange
it's been really fantastic having you,
and I suspect that as time goes by,
um, if you don't mind, I might actually
reach out again because I suspect there
are going to be new twists and turns
in this story of COVID-19 that I'd love
to get your take on,
I think. Happy to talk anytime. All right,
fantastic.
Thanks so much David.
[Music]
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