Source of book: Borrowed from the library
Our local library did a feature display on vaccination recently, and I picked this one up.
Vaccination has, to put it mildly, become a political flash point here in the United States, the culmination of a number of factors including the Evangelical denial of science (and indeed reality), the politicization of everything including public health, the rise of Trump and his utterly irresponsible approach to politics, and the emotional need of right wingers to find an issue to flip the bird at “liberals.” And that’s how you get a pandemic that disproportionately kills and injures people with one set of political loyalties.
Vaccination has also, unfortunately, become one of the last threads in the unraveling of my own family, with my parents and sister going full conspiracy theory regarding Covid and the vaccines. This, from the parents who literally taught me about how much vaccines have done to rid the world of nasty diseases, who encouraged me to learn science, and who taught me critical thinking in the first place. This too has been the culmination of a long shift in their thinking, starting many decades ago. Starting with some fairly benign experiments in alternative medicine - mostly trying to eat better and avoid junk, which is pretty universally acknowledged as healthy - it went further and further into fads and superfoods and supplements. That this happened during my teens, when we already were making a swerve toward Gothard and Authoritarian Fundamentalism made it that much harder for me. The ever-changing diets left me feeling starved, and my pointing out that the articles and books my mom was relying on were so scientifically ignorant as to make obvious that the authors could not be bothered to learn basic Jr. High level chemistry or biology was not received particularly well. (That’s the problem with Authoritarian Fundamentalism - telling your parents they are wrong - objectively, scientifically wrong - is “rebellion” - something that still negatively affected our relationship well into my 40s.)
The reason I bring this up is that all of it was connected, via epistemic capture. The exact details of the belief about health and diet - and the very related issues of religion and politics as they affect real life people and situations - have changed and varied quite a bit. But the trajectory of how truth was distinguished from falsehood was a slow but steady descent into a distrust of all mainstream and/or secular sources of information and truth. At some point, the only information that could make it past the cognitive gatekeepers became information from the tribe - from people similar enough in politics and/or religion to be considered “one of us” rather than “them.” If the information was perceived as coming from the Republican Party/Fox News/White Evangelicalism/Alternative Medicine constellation, then it could be accepted, but outside data and ideas were viewed with increasing disbelief, to the point where having a dialogue centered on a common experience of reality was no longer possible.
An example of how this works:
“Your particular interpretation of this scripture is hurting us.”
“Well, that is the only possible interpretation.”
“Here are a number of other interpretations that are different.”
“Those interpretations are untrue.”
“How do you know?”
“These people from our religious tribe say this is the only interpretation.”
“But what about these people from the same background who say something different?”
“They aren’t from our tribe.”
“Why not?”
“Because they don’t believe the same interpretation of scripture.”
It is entirely circular, and no “outside” truth can penetrate, because of the epistemic capture. Combine this with a strong distrust of expertise, training, and experience as superior to tribal membership, and you have a nasty combination of factors that destroy the ability to identify and understand truth.
This is crucial to understanding the issues of both vaccinations in particular, and public health in general, and it explains the bizarre phenomenon of Donald Trump getting booed by his own fans for recommending the Covid vaccine (which he got, by the way.)
“Why don’t you get vaccinated?”
“My tribe tells me it is unsafe and ineffective. Use Ivermectin instead.”
[Shows data regarding safety and effectiveness of vaccine, ineffectiveness of Ivermectin.]
“That’s not what our tribe says.”
“Isn’t Trump like, the leader of your tribe? He says get vaccinated.”
“He’s part of our tribe, but not about this issue.”
“Why not?”
“Because he doesn’t say use Ivermectin instead of vaccines.”
And around and around and around it goes, and this has applied to so many public health issues. And so many other political issues that directly affect me and my friends and family. There is no piercing the epistemic capture.
This book isn’t really about that issue, but it does lay the groundwork for how the anti-vaccine movements of the past got started, and why they are so difficult to address. Since vaccines were invented, there have been anti-vaxxers. Some of them have had legitimate issues: particularly in the unregulated wild early days, many vaccines were contaminated with other diseases, impurities, and of dubious quality. These problems, in turn, led to the government regulation of vaccines and how they are tested for effectiveness and safety. The result has been an incredible level of safety for many decades.
Unfortunately, the other effect of past anti-vax movements has been that few companies are interested in developing vaccines anymore, because the liability and hassle are too great to justify investments, particularly since vaccines need to be affordable and mass produced for whole populations. As we have seen with the Covid vaccines, we can still develop, test, and produce vaccines quickly - but it requires significant government intervention and investment or it simply doesn’t happen.
And then, there is the way that the anti-vax movement has undermined vaccination rates and public health generally. As the author puts it:
The volume and advocacy of false facts by an obnoxious and loud minority has overwhelmed the fact-based attempts by credible sources to expound the extraordinary health benefits of vaccination.
The book was published in 2018, so the author already is warning about Trump (although he doesn’t use the name) and his dangerous misinformation-based approach to vaccination. It was also pre-Covid, so we can see how his fears for the future came to pass in many ways. But also, the pandemic has shown that his optimism about the role of vaccines in our health and futures was well placed. Vaccines remain our most powerful weapon against disease, and one of the most crucial to our post-antibiotic future.
The author certainly has the credentials to back up his assertions, having studied and researched at Yale, worked in the pharmaceutical industry, and worked in public health focusing on Ebola, Dengue, and other tropical viruses of great threat. He also has done some crossover work on bioterrorism - something that is actually pretty related, because, as he quotes one of his past bosses as saying, “Mother Nature is a most dangerous and inventive terrorist.”
Mother Nature has been given some unique advantages over the last few hundred years, too. Just as the Plague was first spread rapidly around the world by the Roman Empire, the same factors drive the rapid spread of disease today: improved transportation, urbanization, and emigration.
And man, it is easy to forget how bad the plague was. We tend to think of later waves at the end of the Middle Ages, but the Roman wave in the 2nd Century also killed an incredible number. Adjusted for modern populations, this would be 150 million deaths in the US alone. Also, just as today, the sick and dying were preyed upon by charlatans looking to get rich from the suffering and fear of others.
The book turns to smallpox next, for obvious reasons. This is the only time that humans have exterminated a pathogen, and is the first major success story for vaccines. It is believed, based on modern genetic modeling, that smallpox jumped from rodents to humans sometime between 16,000 and 48,000 years ago. So it was with us for a long time. I won’t get into all the details, but the story of smallpox and the various ways humans have fought back - for centuries before Jenner made headlines - is a really fascinating part of the book.
I do want to mention that the parallels with our modern times are crazy. Soon after Jenner (and others) developed arguably one of the top five developments in human health, the charlatans came around, making claims about the harms of the vaccines (“you will turn into a human/cow chimera!” “it kills children!”) - while, of course, peddling their own quack remedies. Englishman William Tebb sure sounds like modern anti-vaxxers: he had money and influence, he claimed that vaccines had killed tens of thousands of children, and he wanted to sell you his remedy, namely Theosophy, a mystical theory of health. Oh, and he claimed that rejecting vaccines was the “right of individuals over government.” That sure sounds familiar.
Oh, and there is more. The organized anti-vax movement in the United States centered around a sketchy group calling themselves the “American Medical Liberty League.” They advocated for another quack medical practice, homeopathy, and sold “remedies” for such fake diseases as “disappointment in love.” Before anti-vax fearmongering became their big cause, they had previously advocated - and I am not making this up - against pure food and drug laws.
Notwithstanding these efforts, governments did the right thing and mandated smallpox vaccination - mandates absolutely work - and smallpox became increasingly rare. The World Health Organization - now a bogeyman for the Right Wing - was crucial in eradicating smallpox in the third world. It is hard to believe, since the US has been free of smallpox for longer, that it wasn’t until 1977 that the last case was documented. That’s during my lifetime.
Having started with the history of the plague and smallpox, the book then turns to an extended set of chapters on the immune system, bacteria, and viruses. This is where the author’s knowledge (and his skill in explaining complex ideas) really shine. I am pretty well educated on medical topics - I am married to a nurse, but also have loved science since childhood - but there were things I learned here. I also will say that this book has some of the best descriptions of how pathogens and immune systems fight each other, and how so many potentially pathogenic organisms have actually become symbiotic with us. Serious, this is great stuff, and worth reading the book for.
One chapter starts with a disclaimer for the squeamish which is worth quoting in its entirety.
In the interest of full disclosure, it is important to war the reader that much of this chapter is devoted to perhaps one of the least attractive concepts and words in the English language: pus. For as long as people have suffered wounds and infections - in other words, from time immemorial - pus has been a subject of considerable speculation, though understanding of its function, composition, and scientific beauty is comparatively recent.
Not too often “pus” and “scientific beauty” end up in the same sentence, but there you have it.
One of those things that I learned from this book was an interesting thing about CRISPR technology. It has been in the news a lot over the last decade, because of its use in, well, a whole bunch of stuff that uses DNA, RNA, and genetics generally.
But did you know that CRISPR was originally a function of the immune systems of bacteria? Me either. Apparently, some bacteria splice bits of viral DNA into their own genomes, in order to remember pathogens and defend against them. That’s pretty crazy.
The evolution from single-celled organisms to far more complex organisms required some upgrades to immunity, of course. I love this particular line about multicellular organisms:
At the risk of offending those enamored with the exquisite and undeniable beauty and complexity of the human body, consider that each of us is simply a tube within a tube. The outer tube is the body. This tube has a large surface area (e.g. skin) and occasional holes (e.g. eyes, nose, and genital orifices), which must be patrolled to halt myriad pathogens in an environment that even the most maniacal hygienist cannot (and should not) keep clean. A second, inner tube comprises the digestive tract, which is a large hole that penetrates all the way through the outer tube.
Thus, the Star Trek life forms that called humans “giant ugly bags of mostly water” were a bit off. We are more like giant tubes within tubes, with mostly water in between.
And speaking of tubes, I have to laugh at the (possibly apocryphal) story about a rather acerbic scientist, Rudolf Virchow, who was notorious for insulting his colleagues - and politicians. One politician supposedly challenged him to a duel, which Virchow said he would only agree to if he could choose the weapon: a Trichinella-loaded sausage.
One recurring item in the book is that of cytokine storms. Again, this book was published pre-Covid, but cytokine storms are nothing new. They are what makes Yellow Fever, for example, as deadly as it is, particularly on the second infection. For many who succumb to Covid, it is this that kills - the overactive immune response - rather than the damage caused directly by the virus. The challenge for vaccine developers, therefore, is how to train the immune system so that it reacts….but doesn’t overreact. Fortunately, this is not only possible, but it is how successful vaccines work, including the Covid vaccines.
[Side note on Yellow Fever: an excellent book is An American Plague by Jim Murphy. It is written with kids in mind, but is good for adults too. Between Hope and Fear talks about about this plague too, and adds the detail that it came to America because of refugees fleeing from Haiti after the slave uprising. The displaced French colonizers brought the disease with them…]
From time to time, the books I am reading overlap in weird and unexpected ways. In this case, the book mentions Sinclair Lewis’ award-winning novel, Arrowsmith, which is loosely based on the life of researcher Felix d’Herelle. In turn, later researcher Winston Harvey Price was inspired by the book - and then ended up having his life imitate the book. How does this fit with my other reading? Well, I am reading Elmer Gantry for Banned Books Week, and my copy of the book contains Arrowsmith and Dodsworth in the same volume. Stay tuned for a review of Elmer Gantry.
More nerdy stuff: in the extended discussion of the HIV virus and AIDS, the book talks about endogenous retroviruses (ERVs). Retroviruses are sneaky, tricky little buggers, although fortunately most are harmless to us. They manage to sneak parts of their genomes into ours, and an estimated 5-8 percent of our own DNA is actually bits and pieces of past retroviruses, aka ERVs.
The book talks a good bit about antibiotics, and how they work. And, why they are becoming ineffective. (Hey, news flash! Evolution is STILL HAPPENING, even if you don’t believe in it!) Vaccines, on the other hand, while they can be bypassed to a degree by mutations, are still remarkably effective - because they utilize the immune system rather than simple chemical processes.
In contrast to the shroud of doom that currently pervades anti-infective medicines, are, extraordinary, and enduring successes in the war between men and microbes have been achieved by vaccines. These vaccines were mostly discovered by mobilizing the immune systems of mice and men to recognize foreign invaders.
Side note here: because the book was written pre-Covid, it does not discuss mRNA-based vaccines, which have not only had great success in battling Covid, but promise to open up a whole new world of vaccines in the future.
The world of medicine has never been entirely separate from the world of politics, and the overlap comes in public health. One of the fun things about this book is the well-researched and documented histories of public sector involvement in fighting disease. One particularly interesting one was about St. Louis in the 1800s. As the book notes, hard to believe now, but St. Louis was once a progressive and innovative town, on the cutting edge of liberal ideas. Including ones that were considered socialist then and now - public parklands open to all, for example. And also public-sector control of health. The story in the book is about the diphtheria antitoxin, which St. Louis decreed could only be manufactured and distributed by the government, so that it could be offered for free to the poorest citizens of the city, rather than hoarded for profit.
As is the case for a lot of science and medicine, there were women involved in many of the great innovations, but their contributions were overlooked and in some cases suppressed. Give the men the credit - the white men, of course. This book tries to correct that by giving the entire history of the pertussis (whooping cough) vaccine, which was developed by a trio of women. Two of them, Pearl Kendrick and Grace Eldering, got official credit, although their names are hardly household ones. But the third woman in the trio was Loney Gordon, an African American scientist who managed to rise from poverty, get her degree, and yet found that she couldn’t get a job that wasn’t menial. (Case in point: she attempted to get a dietician position, but was told that white male cooks wouldn’t take direction from a black woman.)
So, all these great innovations in the 20th Century. So many diseases that used to be terrible largely gone. Shouldn’t everyone celebrate this? Well, nope. The book returns again to the anti-vax movement. Because it happened when I was very young, I do not remember the panic about the DTP vaccine. Led by the now-notorious Harris Coulter - not trained in medicine or science, but an advocate for….wait for it….homeopathy - the movement gained a lot of press, despite a lack of scientific foundation. As the book notes, then as now, anti-vaxxers rely on selective presentation of facts, half-truths, inaccurate data, and even outright fabrication. Unfortunately, “simplistic, unscientific, biased, and inaccurate” rhetoric tends to get the attention of the media - it sells in a way that evidence-based, peer-reviewed information does not.
One of the lawsuits that arose from this movement occurred in the United Kingdom, and, fortunately, the verdict was in favor of the vaccine manufacturers. One of the things the judge in that case noted was that nearly half of the allegedly harmed children had not even received the vaccine. That is, in layman’s terms, the anti-vax plaintiffs LIED. The “research” was fabricated, made up, full of inaccuracies, because the actual truth did not prove the anti-vax theory.
This, by the way, is the theme that you will see in EVERY anti-vax movement - a need to lie, because the truth does not support their beliefs.
The DTP (now TDaP - reformulated to be less effective, but with fewer side effects) is just one of the vaccines targeted. In my lifetime, the focus switched instead to the MMR vaccine - measles, mums, and rubella. For reasons I do not understand, the public imagination seems to view these as benign diseases. They are not.
The acronym designates a single vaccine that prevents three of the greatest mass murderers of children: measles, mumps, and rubella. Despite the extraordinary public good that this vaccine has and continues to deliver, these three letters have been the source of some of the most dangerous misinformation, both blatant and unintended, that increasingly threatens the lives of billions around the world.
And yes, measles is a terrible disease, not some mild infection. Measles has been responsible for 200 million deaths in the past 150 years. That’s million, not thousand. And those are the ones we are sure it caused. It turns out that childhood mortality took a huge dive once measles vaccination became common. Why? It turns out that measles doesn’t just act directly to harm the body. It actually erases the immune memory, making children (and adults) vulnerable to diseases that they otherwise would have been protected against. Bad, bad news.
And equally bad news is that MMR vaccination rates are headed downward. Why? Well, to understand that, I need to mention one of the most evil people alive today: Andrew Wakefield.
When the history books are written, it is probable that Wakefield will be understood to have been responsible for millions of unnecessary deaths. He will be considered up there with brutal dictators who slaughtered their own people. And he did it for the same reason: to get fucking rich. He did it for money and fame and attention.
HE LIED.
That is the bottom line here. As the book makes clear (and there is ample documentation easily available to show this), Wakefield literally fabricated data. He lied. He made stuff up. And he did it so that he and a lawyer buddy could….tell me you saw this coming….sell an alternative quack remedy. As the investigation that led to Wakefield losing his medical license showed, Wakefield was “paid to fabricate [his] findings.”
That is evil, plain and simple.
This is the frustration with where we are at right now. One evil man, paid to fabricate his findings, is literally believed by millions. Never mind that vaccines are not even correlated with higher autism rates. Never mind the dozens of subsequent studies that failed to show any link. Never mind the millions of lives saved by the MMR vaccine. The charlatan is, for reasons that I will never understand, more credible to many than the actual evidence.
Fast forward now, it is late 2019. My wife has the chance to fly to Alabama and spend a week at the FEMA training center, along with a whole spectrum of medical professionals and first responders. They do a series of mock scenarios, including a pandemic, as part of their disaster response training and brainstorming. She is also struck by the fact that FEMA has a whole wall of missing - unfilled - positions. Donald Trump, who combines a contempt for the law with gross incompetence, has essentially ignored FEMA and let vacancies go unfilled. At about this time, there comes word of a SARS-like virus that has shown up in China, probably, like SARS, one that crossed over from bats or other mammals. Uh oh.
Covid-19 reaches Kern County in February, and by March, much is shut down to attempt to slow the spread. My wife, the ICU nurse, is on the front lines. With every surge, she works long hours; managers end up shift leading, and charge nurses cover multiple jobs, because of short staffing, exploding patient numbers, and staff illnesses.
For our family, this was a time of great stress. Nobody yet knew how deadly Covid would be - would it end up killing 20% of front-line workers, like SARS did? And it wasn’t just the old and ill that were in ICU and dying. It was people in their 20s and 30s too. I have vulnerable lungs, and if she brought it home, would she end up with me in her unit and nobody to take care of the kids?
It was a huge relief when the vaccines became available, after quick development but thorough testing for safety and effectiveness. My wife was one of the first in our county to get the shot - she and some colleagues did it on live television, and she gave an interview about it, in addition to being featured in a long-form news story on Covid. (Yeah, she’s a total badass.) Several months later, the vaccine was released for my older teens and myself, and eventually for all the kids. We have gotten vaccinated and boosted. And, interestingly, none of us have gotten Covid. I know, we are some of the few to not have gotten a breakthrough infection. (Amanda is considering being part of a study of people who have completely avoided Covid despite constant exposure - there may be a genetic component that will help us better understand immunity.)
So yes, for very good reasons, we are in favor of vaccines. And are dismayed to see that the evidence in favor of Covid vaccination is ignored or disbelieved by so many. It is clear that the Covid vaccine is one of the safest ever developed. It is equally clear that it is astonishingly effective in reducing the risk of serious illness and death - and despite the ever-evolving virus, remains effective in reducing transmission. (Both because it still prevents some infections, and because it appears to greatly reduce asymptomatic transmission - meaning that people can avoid others when symptomatic, or at least mask up. That’s how we have a number of people we know who had one family member get sick, but not spread it to the others - even living in the same household.)
But the story doesn’t stop there, of course. As Covid became increasingly politicized – mostly because of Trump and his sycophants – the burden on my wife was greatly increased. She was accosted and borderline assaulted in public for wearing a mask. She and her colleagues were heckled in public by Right Wingers when in uniform. Nurses were casually accused – by acquaintances of mine, no less! – of falsifying medical data – exaggerating Covid cases and deaths, supposedly in order to increase hospital profits and make Trump look bad. She has had to put up with family members who deny that their loved ones are dying of Covid, and then accuse the nurses of killing them. Family members, convinced that Ivermectin or Hydrochloroquine are miracle cures (thanks to Trump…) have demanded that she and her staff administer these drugs, although they are ineffective and not approved for use – it would be against hospital policy and standard medical practice to do what they demand. She and her colleagues have been threatened with violence at work, accused of all sorts of horrible things by those who believe the propaganda.
This is the problem: when you believe lies, you don’t just hurt yourself. You hurt others. You hurt immunocompromised people who do not develop an immune response. You hurt the medical workers you count on to treat you for other illnesses. You hurt other sick people by clogging the hospitals with unvaccinated patients. And you cause trauma and stress for everyone you slander with your conspiracy theories.
The title of the book refers to Kinch’s dueling emotions. On the one hand, vaccines have fulfilled great hope - we have eradicated some diseases, and made others into rare occurrences. But on the other, fear of vaccines - irrational fear based on lies - has lead to declining vaccination rates, and thus to a resurgence of diseases like the measles, and even circulation of polio in the United States - something that would have been unthinkable when I was a child. Hell, I know people crippled by polio! This isn’t ancient history. Many of those living today - my parents included - are old enough to remember people dying, ending up in iron lungs, or being paralyzed as children due to this terrible disease. And yet. And yet this memory seems to have faded, and the lure of the siren songs of charlatans selling snake oil and fear seem stronger to them.
In particular, I fear that we are headed for a significant split in our country. We will have states like California (which finally eliminated religious and philosophical exemptions for vaccination) and more Right Wing states, where the diseases of the past will become endemic once more, and negatively affect the lives of millions. And why? Because of the lies of evil charlatans like Andrew Wakefield, and the demagoguery of fascists like Donald Trump and Ron DeSantis. (They both are, by any reasonable measure, fascists. I am not going to argue this one.)
As in the past, the solution is collective action. Mandates work. Government sponsorship and subsidies for vaccines make them available to all. Public health requires public cooperation. Herd immunity requires that everyone get vaccinated. These are not controversial within the scientific community or the public health community. The question is, will we have the political will to do it? Or will we sacrifice lives to the lies of charlatans? I guess we will find out.
I wish I had more confidence that we could win over the anti-vaxxers. My experience with my own family, though, gives me pause. I am not sure how to persuade, when reality itself is off the table. When expertise, knowledge, hard-won experience, and anything that requires hard work, is disdained, in favor of whatever ear-tickling nonsense comes from the tribe. It was disheartening to see that the Ivermectin hoax was swallowed, apparently without the thought of checking with my wife about that - I mean, she is literally on the front lines of Covid. But her training, her knowledge, her experience with experimental treatments early in the pandemic and with the effects of vaccination later - all that was disrespected completely. But so it has been for other things too - theological, political, scientific - the epistemic capture has essentially become complete, and there is no remaining common ground for persuasion. What will it take? I guess the death rate from Covid isn’t high enough to persuade those whose political loyalties are that strong. Would a 20% rate be enough? In the future, we may well find out.
***
Just a note here about one of the conspiracy theories in play here: there is a great mistrust of mRNA vaccines, mostly because they are new, and anything new is automatically suspect for many people. The theory (which my parents apparently believe) is that mRNA changes your body permanently, and that all of us who got the vaccine will develop autoimmune diseases soon.
Here is the thing: what mRNA vaccines do is deliver a tiny piece of instructions to create one small part of the Covid virus - namely the spike proteins that allow it to cling to and infiltrate the cell. This creates a memory in the immune system so that the virus is recognized as a threat next time. Seriously cool, right? You don’t need the whole virus, just a bit of it.
I really hate to break it to anti-vaxxers, but real viruses are far worse than this. Rather than just a few random protein instructions, viruses do this whole nefarious thing. They break into your cells, and insert a complete instruction sequence to take over your cell’s manufacturing process, use it to make more viruses, then blow up the cell on the way out. It isn’t just instructions for one protein - it’s instructions to make the whole virus. Yes, this is terrifying if you think about it. And you know what? The virus is doing the exact same thing as the vaccine - except far worse. So if you genuinely believe that a bit of mRNA does all those bad things (It doesn’t) - imagine how much MORE the actual virus is doing to you!
Seriously. If you cannot be bothered to learn the actual science involved, for god’s sake, stop spewing your ignorance and expecting it to be treated as truth. You are embarrassing yourself and the rest of us. And putting others at risk. Just stop it.
***
On a related note:
“Whoever loves discipline loves knowledge, but whoever hates correction is stupid.” ~ Proverbs 12:1.
I am reminded of this all too often. A significant part of the unraveling of my relationship with my parents has been because I have pushed back against lies they have believed. But because of the underlying Authoritarian Fundamentalism, I have become the enemy - the rebellious child, the one who “says mean things.” The writers of Proverbs didn’t pull punches. To refuse to be corrected when you are wrong is….stupid. And that applies even if you are older, and believe yourself to be in authority over younger people. One of my goals for myself is to remain open to new information, to better information, to changing my mind given evidence I am wrong - even as I grow older and eventually old. I never want to be so wedded to an ideology or a tribe that I cannot be persuaded to reconsider erroneous beliefs. I know I have changed a lot over time - primarily because I have learned and experienced more, and come into contact with ideas and people that are different from what I knew as a child. I hope that I can continue to do so throughout my life.
***
Posts that are related:
An American Plague by Jim Murphy
The Astonishing Life of Octavian Nothing by M. T. Anderson
The Ghost Map by Steven Johnson
