112: Ladies and Germs
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Prologue
Ira Glass
Consider please, this White House scandal from the year 1881. No treason, bribery, or other high crimes and misdemeanors against the state, but the president still did not survive in office for four years. Of course, he had a much bigger problem than any faced by our current president, specifically a bullet in the back. President James A. Garfield was shot by an assassin in July of 1881. But here's the strange thing. Here's where the scandal begins. As he lingered, sick in bed from his infected wound, rumors began, possibly leaks from within the White House.
Nancy Tomes
So it's fairly clear from a modern perspective that the man was suffering from infection from the wound.
Ira Glass
Nancy Tomes is a historian at the State University of New York at Stony Brook.
Nancy Tomes
What's fascinating is that the wound itself was not sufficient to explain what was wrong with him. There was such a long history of popular belief that the White House was a very unhealthy place because of its bad plumbing. The rumor began to circulate that what really was wrong with Garfield was the state of the White House toilets, that they weren't properly hooked up to the sewer system and that he was being poisoned by sewer gas.
Ira Glass
Sewer gas. In the 19th century, as indoor plumbing was becoming more and more widespread, it just sort of freaked people out that there was something inside their own houses, this pipe, that connected them to a huge public sewer. It just seemed filthy. And they believed that gases rose from the decaying matter in the sewers, came back up the pipes, and made you sick.
And because our nation is of course crazy when it comes to the presidency, because the White House is, among other things, a national movie screen onto which we project a whole array of fears and misplaced idealism, we projected our national fear of sewer gas onto the presidency. The fear was so profound that in June of 1882, the Senate actually voted $300,000 to build a second White House, a second one, a sanitary one, free of filth, right next door to the original White House. And the idea was for his family to just move right in there.
Nancy Tomes
A lot of this was the work of Chester Arthur, who succeeded Garfield, and who wouldn't live in the White House. He was so convinced that it was unhealthy that he lived in a soldier's home to avoid exposing himself and his family to this danger, the sewer gas.
Ira Glass
One of the things that's really amazing reading about this is the way that you write about the press coverage, the equivalent to current tabloids.
Nancy Tomes
Yes.
Ira Glass
A paper company called the New York Herald, at one point they interview what they call a well-known plumber, and you just think-- a well-known plumber? An unnamed source who asserts about Garfield, quote, "The real trouble is sewer gas which is 10 times as bad and even more poisonous than foul air." And this same unnamed source claims there is not a perfect working sewer trap in the executive mansion.
Nancy Tomes
Indeed. And the whole concept of a sewer trap, that was to prevent that sewer air from backing up into your home. So an untrapped toilet was the portal of death.
Ira Glass
Naturally, this being the United States government, an independent investigator had to be brought in, in this case a sanitary engineer named George Waring, who had made a reputation for himself years before as an expert in these sort of plumbing issues, and could be trusted to issue a nonpartisan, objective report. He found that while there were problems in the White House plumbing system, they were nowhere near as bad as popular rumor had it. He concluded that President Garfield probably did not die of sewer gas, probably the bullet was enough.
The issue was of sufficient public importance that when his final report was issued, long excerpts were published verbatim, even in the New York Times. And one interesting footnote to all this, one of the changes that Waring recommended at the White House in his report, was that they install these new kinds of toilets, toilets of his own design, in this style that was still very new, namely, they were white and they were made of porcelain. And after this, toilets like this became a huge fad, eventually replacing wooden and metal toilets nearly everywhere in this country.
Nancy Tomes
Somehow this association between white and porcelain, it was sold by plumbing contractors, people like Waring who devised these kinds of toilets as safer, because the porcelain would be impervious. Nothing could kind of get in there and fester. And also you could see that it was clean.
Ira Glass
Now I bring all this up today, not to talk about the nature of the presidency, but to talk about hysteria and germs. All of this, everything in this story, occurred before the germ theory of disease had been proven. People did not know that germs were the way that disease is spread. That's why they were scared of things like sewer gas.
And it would be nice to think that with more information, factual information that we have today about how disease actually spreads, we would all become more rational, take rational precautions to protect ourselves. But the fact is, that is simply not happening. At this very moment, we are experiencing a boom in antibacterial soaps and skin products, antibacterial children's toys and kitchen implements, pizza cutters, and underwear, all marketed to healthy, middle-class people who, if they use the products as intended, will be no healthier as a result of using the products-- most of them. We want to be rational creatures, but we are flawed. We are not rational. And one area we see that all the time is when it comes to germs.
Well, from WBEZ Chicago and Public Radio International, it's This American Life. I'm Ira Glass. Today on our program, germs and our struggle to stay calm in a universe filled with microscopic creatures that can kill us or make us sick.
Act One of our program today, Biblical Thinking in a Digital World. Reporter Hannah Rosen did an investigation of the new antibacterial products. In her investigation, in her report, she mocked them as ineffective. She mocked the people who used them, until one day she went through her own transformation from rationality to irrationality. Act Two, 20th Century Germ. Germs were first understood at the turn of this century. And it turns out that the aesthetics of everyday life in this century, the way that we dress, the way that we groom ourselves, the way that we make our homes, are all the way they are partly in response to this new fangled idea of germs. We explain how.
Act Three, Ladies and Germs. We bring you one woman's story. Act Four, You Gonna Eat That? Reporter, author, and farmer Frank Browning on how irrational fear means that you probably are not going to see decent apple cider in your local grocery store this fall. Act Five, The Conqueror Germ. Sean Collins and the germs within us, the germs that can kill us, and the germs that do kill us.
Stay right here.
Act One: Biblical Thinking In A Digital World
Ira Glass
Act One, Biblical Thinking. Well our nation goes through waves of germ consciousness. Social reformers at the turn of the century tried to clean up the city slums, prevent the spread of tuberculosis and other diseases. Booker T. Washington proselytized among former slaves about middle-class cleanliness and the gospel of the toothbrush. When reporter Hannah Rosen noticed the latest wave of American germ consciousness kick in, she wrote about it for The New Republic magazine.
Hannah Rosen
I was either in a store buying-- I'm now at the age where some of my friends are having kids or about to have kids-- and I was in the toy store. And I was trying to buy something for someone. And I just noticed that everything was antibacterial. And I thought, hmm, that sounds strange, because kids eat dirt. So what good would it do to have sort of a little antibacterial chair. But there it was. I mean the fire trucks and the things that the kids chew on and the play pens, and everything was suddenly antibacterial.
And I just sort of looked into it. And realized there was just an entire universe, a booming universe of antibacterial products which just-- you could buy anything. You could buy an antibacterial television. In fact, a friend of mine in England had told me that there's an entire antibacterial supermarket. I just started to ask people. And then I realized that it was everywhere.
Ira Glass
Let me just ask you to read-- there's a little section in your article where you're explaining the extent of this. And you explain that now antibacterial soaps are 50% of the $2.1 billion soap market. And then you have this little passage where you try to convey how far this has gone.
Hannah Rosen
Sure. "It is already possible to spend most of your day in germ-free comfort. You can get a good night's sleep on an antibacterial pillow, snuggled under an antibacterial blanket, brush your teeth with antibacterial toothpaste, take a shower with antibacterial soap, dry off with an antibacterial towel, pull on your antibacterial socks and underwear, eat breakfast on your antibacterial tray, say goodbye to Spot in his antibacterial dog bed, give little Susie her antibacterial toy, grab a cookie from the antibacterial jar, spray the bus seat and your office phone with antibacterial cleaner, then come home and chop up some celery with your antibacterial knife for dinner."
Ira Glass
And the substance of your article really, you spend a lot of time in the article I mean mocking these products and the people who use them. And you argue essentially that for most adults, these things really do nothing.
Hannah Rosen
Yeah. It's probably that they just oversell themselves. I mean I imagine they don't have zero use. But most scientists say that the major disease risks from ordinary contact with ordinary everyday services and substances, like a table or a scissor or the kinds of things these things are used to protect, are basically zero. If you're a healthy adult, you don't have much risk from just touching things on your desk. And so these products don't do that much good.
Ira Glass
Another thing you pointed out in your article is that when we get a cold or a flu, what we're getting is a virus--
Hannah Rosen
Right.
Ira Glass
--which is very different from bacteria, which is what these things are actually targeted at.
Hannah Rosen
Right. And that's point two, is that in general a lot of diseases are caused by viruses, not germs. And so these don't help against viruses at all.
Ira Glass
What about for people with kids? Is there are some legitimate use for some of this stuff?
Hannah Rosen
I suppose. But I think even in most cases what will happen is that the kid will get kind of sick. And kids get kind of sick. I mean I don't have kids, but I have friends who have kids. And kids just are constantly getting sick. I mean like I said, kids eat dirt. They chew on each other. There's only so much you can do with a bit of Purell.
Ira Glass
Let me ask you to talk about Purell? Explain what this product is and explain kind of what you say about it in the article?
Hannah Rosen
Purell seems to be incredibly popular these days. I now see Purell everywhere. It's in airports and just everywhere. So basically, it's an antibacterial hand soap, which is sort of a combination of the alcohol they use in the hospital plus some sort of aloe vera lotion, so it feels good. And the company that started it was a company that actually made hospital products. And they suddenly realized that there was sort of a domestic use for this stuff.
And it comes in a pump bottle. And you sort of pump it on your hands and rub it on. And it feels like a lotion, but it's actually meant to kill the bacteria on your hand. So you now have sort of dead bacteria on your hand. It's not sort of preventative. I mean if you touch something else later, you'll just sort of get that thing again.
But my problem with Purell was that when they describe the product, they describe it as this sort of sunny, healthy thing. When you talk to the company, they'll talk to you about good family living, and take your kids on a camping trip, or a mother with her diapers. And they'll just describe it as sort of just another part of a Norman Rockwell American life.
But then if you look at the actual ads they run, they're clearly meant to appeal to the hassled yuppie in all of us. I mean they show this sort of Petri dish with these office products and some just disgusting looking germs all over your phone and everything. So they're actually meant for people who don't even have time to wash their hands after they go to the bathroom, or who just have four seconds to eat their lunch at their desk and so they have to use Purell, because it takes too much time to go to sink and wash your hands.
So their idea that they're not marketing to fear just isn't true. I mean you look at their ads and they're just terrifying. Nobody wants to know that there's this gross stuff on their phone, even if there is. It doesn't do you any good to know that.
Ira Glass
And it might not actually do you any harm, really. There's no proof that it does you any harm if you're a healthy adult.
Hannah Rosen
Right. That's my other thing. I mean all these sort of subway pole ads. I mean once you know that these germs are on your phone or on your desk, you'll never forget that. Every time you look at a subway pole, you'll just imagine it's sort of alive and crawling with maggots and worms. And you'll just have a hard time touching it. So I wish I had never known about this stuff. Because now it's just sort of there in my head. But there's no reason why you ever have to know that your stapler on your desk might have germs on it. It just sort of sounds yucky, even though it's meaningless.
Ira Glass
Let me ask you to describe what happened. After your article was published, you found that you yourself went through a change.
Hannah Rosen
Yeah. Yeah. That was really terrible. It's like after I spent a month, or however long it was, just talking to people at various companies who did research about this, and I suddenly sort of went home and started to worry about what I was using on my cutting board. And should I disinfect my cutting board somehow? Or should we not have rare meat when I was at a restaurant. And just because I knew about this stuff, it's just the image is so gross you feel like you have some knowledge into an underworld. And you just can't somehow banish it from your head.
And I think I'm not the only one this happens to. I mean I mean the germs have gotten a lot of popularity recently. I mean there was a front page story in the New York Times magazine. There was a front page Time magazine story. And it seems to go in waves where every once in awhile, there's sort of a germ phobic panic.
Ira Glass
One of the things that you write about in these articles is you say, there's a paradox that as society gets cleaner, it searches for germs in even more remote places.
Hannah Rosen
Yeah. That was very interesting. I mean that seems to be a sort of theme of American history. It's moments when we're prosperous, when we're thinking about home life and domesticity. And so we start to turn to the home and its cleanliness. And you start to worry a lot about cleanliness. I mean you'd have these 1950s, lots of home ads, in which you'd have sort of sparkling, clean, shiny products in the home.
But one thing I pointed out is that, even in that, there's distinctions because the '50s ads they would be infused with this kind of sense of American progress. Here we are moving forward. This blender will save you X amount of time. This floor cleaner, well, boy, you don't have to bend down anymore. This is the new America. But now with this new household microbiology, it seems to have the exact opposite kind of grim tone to it. We thought we cleaned everything. Well no, we're going backwards now. All these things you thought were clean, were dirty. I think it's almost what happens to police officers who I've known, who start to think that there's danger everywhere, because they spend a lot of time around danger. So they think that world is the world.
Ira Glass
So after you spent a fair amount of time with scientists who are saying how germs are everywhere and pointing them out, when you would go around, you would literally sort of see and imagine germs everywhere in your environment?
Hannah Rosen
Yeah. Like I would go to the gym in the morning and I suddenly thought, oh god, should I sit on this bench? What's going to-- is there going to be bacteria growing between my toes if I take a shower in the gym? And just everywhere, I would be sitting and reading on my couch at home, and just watch for dust balls and think, is there dust balls? Or I cook dinner-- it's like every nice domestic activity was just suddenly ruined. It's just kind of infiltrated by this just horrible underworld that was suddenly kind of crawling up from my floorboards. Yeah.
Ira Glass
You wrote in a second article that you published after the first one, you wrote that you found that you were seized by a kind of dementia. And you wrote that an hour doesn't go by when your hand doesn't stray over to the bottle to squirt Purell on your perfectly clean hands.
Hannah Rosen
And I hate that. I mean what ultimate revenge for Purell that that should happen to me. I mean they'd send me all these products. I mean there was plenty of germ phobic people at my office at the time. So I gave most of them away. But then I couldn't give all of them away. So I just had this little bottle of Purell sitting on my desk.
And I would notice that if my hands felt sort of a tiny bit clammy or I was like picking up too much newspaper that day, I would just suddenly go over to the Purell and start squeezing it, and then thought, oh, did I have enough? But then knowing that it doesn't actually prevent anything, that maybe I should do it again. Because maybe in the three minutes since I did it last time, there's some bacteria that crawled on my hand.
Ira Glass
When you described it, it's almost like it's calling cue from across the room. Come to me.
Hannah Rosen
Maybe that's a good idea. They should have talking Purell.
Ira Glass
Then it would be too powerful. No one would be able to resist.
Hannah Rosen
Exactly.
Ira Glass
You know what is so disturbing about all of this is when you talk about the way that information works in this kind of situation, when it comes to germs, that is when you hear about the germs, then you become over-aware of them, and then you act irrationally.
Hannah Rosen
Uh-huh.
Ira Glass
It's almost like a pre-enlightenment view of what information does to a person. That is, that it won't lead to rational thinking. It won't dispel fear and paranoia, but in fact will lead to fear and paranoia. In a certain way it's very biblical. I mean its very Garden of Eden, that you will get this information. You will eat from the tree of knowledge. And then you will be expelled from paradise.
Hannah Rosen
Right. No, it's true. I mean one thing that writing this has done is transform my understanding of information. I mean I'm a journalist, so the more information the better. I'm not worried about the information at all. But then reading this has made me sort of see information in another way.
Ira Glass
So how's the battle for rational thinking going in your own life? I mean how's it shaping up?
Hannah Rosen
I think it's just sort of fading. I think I've lost a little bit, although not all of my germ consciousness. I mean now I think laziness has triumphed here. The battle still happens, but I'm just too lazy to actually just disinfect my cutting board or wash my hands.
Ira Glass
Thank god for education. It's the only thing more powerful than fear.
Hannah Rosen is now a reporter for the Washington Post.
[MUSIC - "GERM FREE ADOLESCENTS" BY X-RAY SPEX]
Act Two: 20th Century Germ
Ira Glass
Act Two, 20th Century Germ. Before people understood about germs, they knew some things about how disease spread, that you could get ill from contact with a very sick person or contact with human waste. But people were not exactly sure how you got ill. They thought that some diseases might just travel through the air, they thought that other diseases might be inherited. There was the whole sewer gas thing.
Then came the germ theory, the notion that there are these tiny living microorganisms that can get on your hands or your clothes and then you can transmit these tiny little living creatures to somebody else by touching them or touching their food or by sneezing or by coughing. All of this was only discovered just before the turn of the 20th century.
Historian Nancy Tomes has written a book called The Gospel of Germs about how the germ theory spread in America, across America. It turns out that one of the characteristics of the 20th century is that it's the first time in human history that people understood how disease was transmitted and an entire aesthetics emerges, an entire way of living, based on the fact that people now wanted to avoid spreading germs to each other.
Nancy Tomes
Yes, you can see dramatic changes in interior decorations, in home design, in the revolt against a Victorian aesthetic, the plush, the ornate, the dust catching, because dust was one of the vehicles that the new bacteriology pointed to for germs.
Ira Glass
So what is the aesthetic? What is the emerging aesthetic?
Nancy Tomes
It's stripped down. It's a preference for less, rather than more. It's the use of hard surfaces, light colored surfaces, paint as opposed to wallpaper. Wallpaper was thought to hold germs and to breed germs.
Ira Glass
And in the bathroom itself, you describe how in Victorian homes, in homes in the last century, the bathroom would basically look like any other room. There'd be rugs, there'd be drapes, there'd be wood everywhere.
Nancy Tomes
The bathroom looked like a little parlor. But when the health reformers get a hold of that, I mean they see all of those rugs and trappings as dangerous vehicles that trap the sewer gas, that silk particles get embedded in there. So you end up with a bathroom that looks much more like our modern conception of a bathroom with porcelain on the floor, porcelain sinks, porcelain toilet fixtures, something that could be easily cleaned with strong soap.
Ira Glass
I mean essentially you arrive at a bathroom which is like an operating room in a hospital. I mean I remember the first time I ever saw an operating room. The thought you have is well, it's exactly like a bathroom, except there's a table.
Nancy Tomes
Yes, and the stripping down didn't apply just to the home, it also applied to the body and to the clothing. So with women, one of the changes that you see is a shortening of skirts, because long skirts swept along the street, picked up the dust, the dirt, that carried the germs. And there's a big push, starting in the late 19th century, to get a men to shave.
The idea of male authority in the 19th century was a long flowing beard and the mutton chops. And the anti-tuberculosis reformers say to American men, if you love your wife, if you love your child, shave that beard off. Don't give them these germ-laden kisses. And of course Gillette jumps on this, because they think, wait, I'm going to sell them razors.
Ira Glass
Right. Because none of these innovations ever happens without some sort of product tie-in.
Nancy Tomes
Exactly.
Ira Glass
Other innovations from the beginning of the age of germs, Kleenex and cellophane, Listerine, named after surgeon Joseph Lister. Also because of anti-tuberculosis activists, you get your own fresh bar of soap in a hotel room and you get clean sheets. And they fold the sheet back over the blanket, so you don't touch the germs on the blanket.
Nancy Tomes' history of all this is called The Gospel of Germs.
Act Three: Ladies And Germs
Ira Glass
Act Three, Ladies and Germs. It didn't take very long after the existence and characteristics of germs were proven before public health educators began to talk about the man problem. Men were not being vigilant about preventing the spreading of germs. A study in the 1920s in Muncie, Indiana, noted that men still refused to stop spitting, despite the widespread tuberculosis education campaigns that told them not to spit.
And most of the responsibility for preventing the spread of germs fell on women, when they cleaned their homes, when they prepared food. It is no surprise then that psychological studies today indicate that women are more likely than men to develop obsessions over cleaning and over germs. And it can go pretty far. Emily Colas is the author of this amazing and funny, and disturbingly honest account of her own obsession, called Just Checking. We asked her to read a brief excerpt here, as a case study on just how far things can go.
Emily Colas
The TV was on and I wasn't paying attention as I went to turn up the sound, so I was shocked to notice what was on the screen while my hand was still on the volume button. A guy who'd obviously been in a fight, was kneeling down, spitting blood into the snow. I froze in fear for a second, and then became obsessed with the idea that I had somehow contracted a disease from this television encounter. So much so that I was unable to keep it to myself.
My husband had always been able to rationalize my fears as either an unusual personality quirk or some hormonal pregnancy problem. But at this moment, he was no longer able to differentiate me from any other crazy person. That night he paced around the house in disbelief, biting his nails and shaking his head from side to side, saying "You don't really believe that, do you? The show was taped months ago. There's no way any disease could live that long in the air. Besides, there's a screen between you and the blood."
My husband and I generally kept a pile of about 20 garbage bags in one corner of our apartment. Which may seem out of character, for me to let them stay, but it was our trash and I knew nothing bad was in there. It was the communal trash that made me shake. So when it was time to take the bags out to the dumpster, my husband had to follow a whole hygienic procedure, to keep the neighbors' germs out of our place.
First the water had to be turned on and left that way, because if you touched the garbage and then the spigot, the spigot would get contaminated. Next he'd take one bag in his right hand and open the door with his left. Then he'd shut the door behind him and lock it, so that no one could get into the house. I guess I could have monitored, but he wanted me upstairs so I couldn't critique him. He'd take the bag down, stand a few feet from the dumpster to be sure not to touch it, and throw the bag in. Then he'd unlock the door, open it, slip his shoes off, come inside, and wash his hands.
He used a pump soap so that he could use his clean wrist to pump some in the palm of his hand and not contaminate the dispenser. The water would stay on, and he'd move on to the next bag. He went through this procedure 20 times, once for each bag, until they were gone. If contamination occurred at any point during the process, say some brown liquid was on the outside of one of the bags and it got on his shirt, and I saw it, I would not be happy. I would have to go over the scene again and again in my head until I could find a way to convince myself that I wasn't really in danger of getting a disease. I'd inspect myself for cuts that the brown liquid might have gone into, go over the list of things we'd thrown out in the past weeks that could have been brown, or try to remember if anyone had come into our house who might have thrown something away, like a bloody tissue, that could have gotten on me.
If I couldn't shake the fear, I'd ask my husband to go through the discarded trash to find the contaminated bag and try to identify the liquid. He was usually pretty against this, so I had to beg. It was all I'd talk about for hours, and I guess in an effort to just shut me up, he'd relent. Of course, this trip was considered highly unsanitary and called for special protective measures. He had to put on clothes that he'd be willing to get rid of and carry paper towels so his hands wouldn't touch the bag directly. When he was finished with his inspection, he had to take off his clothes outside our front door, leave them to be thrown away, come in and do a double hand wash. Then I'd turn the shower on and he'd finish cleaning off.
I'd sit on the edge of the bed and wait for him to finish, so he could deliver his report. On this day, he identified the liquid as hamburger juice. A particularly insidious liquid that is close to the color and texture of human blood. My husband said that he smelled and tasted it and was sure that it was indeed from a cow. Looking back, I'm a little surprised that it was four more years before we separated.
Ira Glass
Emily Colas. Her book is called Just Checking.
Coming up, if a germ does kill you, what does the germ get out of it? Also impure food, impure thoughts. That's in a minute from Public Radio International, when our program continues.
Act Four: You Gonna Eat That?
Ira Glass
It's This American Life. I'm Ira Glass. Welcome there, ladies and germs. So that's the great thing about today's theme is I get to say ladies and germs as many times as I want. A privilege you don't get very often in public radio. Each week on our program of course, which choose a theme, Ladies and Germs, bring you a variety of different kinds of stories on that theme. Today's program, germs and why they make us leave the world of rationality for irrationality. We have arrived at Act Four of our program, Act Four, You Gonna Eat That?
One of the places that we fear germ contamination, is of course in our food, but of course this fear is not always justified. For example this fall, this very fall, chances are you will not be able to find fresh apple cider in your local grocery store. Now I'm talking about the stuff that comes straight from the farm, unpasteurized, dark brown. Usually it's this very careful blend of four or five different kinds of apples based on some farm family's old recipe.
Unpasteurized cider like this only makes up 3% to 5% of the nation's cider, but it is becoming harder and harder to find. And the reason-- Frank Browning is a reporter who often covers public health stories. He answers the question.
Frank Browning
First, truth in labeling. I'm not just an objective journalist. I have a farmer's bias. My brother and I grow apples on a hilltop in eastern Kentucky. And we make cider. This year, as last year and the year before that, we've been hauling our cider down to the Kentucky State Fair in Louisville.
Frank Browning
Is that good?
Man
Yeah.
Frank Browning
Here I am at the ag-produce tent, talking cider slushies.
Frank Browning
Apple cider slushies. Come get a free taste. Can't go wrong free. It's nothing but pure apple juice. People love them once they taste it.
When you drink one of our slushies, or for that matter when you draw a plain cup of fresh cider to your lips, we want to steal away all those awful memories you've accumulated of insipid canned apple juice. Tasting fresh cider should be like a eating a handful of autumn, honeyed and tart, nutty, spicy, playfully fragrant. It should play mischief with memory as it trickles across your tongue, washes over the palate, and makes you giggle silently at how exquisite of a treasure of the ordinary earth. But as I say, I'm biased.
Then came E. coli O157:H7. You've read about it in the papers, or heard about it on the nightly TV terror news. The great cider contamination scare. Like most apple growers, we saw the same stories. And we wondered, had cider fallen victim to that front line of bacterial armageddon that threatens all our collective fate? So I called up Joe O'Leary, the food safety scientist at our state Farm Extension Service at the University of Kentucky, and told him we were worried and confused about cider's health risks.
Joe O'leary
Well, you and a lot of other people. But the number of instances has really been extremely low. When you look at the number of small operators, and the number that have been a problem, it's only about three or four in this country in a 20-year period, and then there were one or two in Canada as well. And it may be a risk, but it's a fairly slight risk. But again, we've got to be concerned about these little children that could drink this.
Frank Browning
The problem is Odwalla. Isn't that a splendid name? Liquid beacon to the organo-yuppies of the health food movement, all natural, all organic juices, until somebody dumped a load or two of rotting fruit, presumably organic, into the mill and forgot to follow the company's own sanitizing procedures. And a little girl in Colorado drank that organic health food juice and died from E. coli poisoning. A million and a half bucks Odwalla paid to settle the matter.
There had been four other E. coli cases on small farms, all of them were traced to using apples we call drops, that have fallen on the ground and haven't been washed. Then you put that together with bad hamburgers, dirty sprouts, lettuce, contaminated berries from Guatemala-- never mind how great the actual risk is in epidemiological terms-- and we Americans brewed up a full-fledged food panic. In all the media coverage, there's something probably nobody told you. Cider can be produced safely and without pasteurization.
Now here's what family farms like ours do. We never use drops. We wash all our equipment down in high acid, dairy grade detergent, followed with a chlorine rinse. Then we run the apples themselves through a chlorine wash, just before grinding and pressing. All of that makes unpasteurized apple cider thoroughly safe. Unfortunately, in the hour of hysteria, that isn't enough.
Here's how far it's gone. Ohio apple growers found themselves drowning in the full scale cider panic last year, organized by the State Agriculture Department. My friend Mitch Lynd, Ohio's biggest apple grower, told me the story.
Mitch Lynd
Well, the doggone-- as a result of this E. coli thing out of Colorado, this one incident, why the decision was made that maybe they ought to impose pasteurization on all these cider makers. Next thing we knew, we're called into this meeting and in effect we were told now, you fellas don't have to pasteurize. But we're going to advise the schools, saying now, don't let your children drink the cider from any of these farms or orchards if it hasn't been pasteurized.
Frank Browning
Ohio officials admitted the cider was safe. But said they were going to go ahead and scare people anyway.
Mitch Lynd
And their attitude was that if they're going to be wrong, they want to err on the side of safety. Well, it's like saying which is more safe, to drink two drops of beer before you drive down the road or one drop of beer before you drive down the road? One's twice as safe as the other, but neither one's very hazardous, you see.
Frank Browning
Time to call that state official, the one who read the riot act to all the growers. That would be Sam Waltz of the Ohio Department of Agriculture, a very nice man, who confirms that well, yes, there's never been a case of food poisoning from cider in his state.
Sam Waltz
Yes. We've never had, that we're aware of, a case of food poisoning from any bacteria that was attributed to cider. And we had a situation here in Columbus that was kind of unique. There was about 10 cases of human E. coli O157:H7 food poisoning reported in Columbus.
Frank Browning
And what kind of food product was this?
Sam Waltz
Well, early on one of the common foods that many of the 10 or so infected people had consumed was fresh cider. And there was a leak to the press-- don't know really where it came from-- that was covering this quite heavily at the time, a leak to the local press saying that cider was suspected. Of course, the investigation was not complete. And later on it was shown that cider was not the likely culprit, that more than likely it was some lettuce. But the fact that it leaked into the press that cider was a suspect food, fresh cider sales in the city of Columbus, which is a large market in our state, dropped by about 2/3 overnight. And just didn't recover for the rest of that season.
Frank Browning
And so then you contacted the media and urged them to press this issue?
Sam Waltz
Yes.
Frank Browning
How did that go?
Sam Waltz
It really went well. And the media was good to pick up on this. And it showed up in a lot of newsprint.
Frank Browning
And what did it say?
Sam Waltz
Basically positive that E. coli may be a hazard in cider, very rare. But that the cider industry here in Ohio is being proactive to do whatever they can to learn and employ techniques that will produce safe cider.
Frank Browning
But that included pretty much urging people not to drink unpasteurized cider, didn't it?
Sam Waltz
Ahh yes, and-- well, we took the position that if it's produced properly with proper sanitation, that unpasteurized cider is not a problem.
Frank Browning
Not a problem. Well, except that the main point of the press campaign was to convince parents that serving unpasteurized cider might kill their kids. None of it made any sense. And then I remembered something else Joe O'Leary, the food scientist from UK, said to me.
Joe O'leary
Well, another consideration is that these commercial juice processors, the really big outfits, they see the small farm cider operations as a threat in this. They're bringing bad publicity on the industry. And so that's one of the reasons why they are in favor of all these changes, in my opinion.
Frank Browning
So you think the big operators basically want to squeeze the little guys out?
Joe O'leary
Well, that's always the case, isn't it?
Frank Browning
Hmm, I said to myself. I've spent my life writing and reporting about the politics of money, the politics of health, even politics and agriculture. But somehow, my farmer self hadn't imagined that politics had crawled inside the rustic cider jug. What small growers have always supposed is that we're such a minuscule part of the juice biz that big processing companies and their Washington lobbyists never thought about us at all.
The heavy hitters in the American apple kingdom are in Washington state, Michigan, and New York. And they have a club, the US Apple Association. I call it Big Apple. It includes national packers and processors, and of course fields a clutch of lobbyists in Washington. And where do you suppose Big Apple stood on the pro-pasteurization cider crackdown? They lobbied against the FDA's decision this year to permit small growers to sell untreated juice, even if it is produced under sanitary conditions and labeled as unpasteurized.
Who else has been driving the pasteurization campaign? Another Washington lobbying group, the National Food Processors Association, which modestly represents many of the world's largest multinational food conglomerates. Tom Willard, the Processors' spokesman, was off at a conference when he called me back. He only wanted to talk safety.
Tom Willard
Well, food safety really affects everyone. If a consumer were to be made ill by a particular product, they could lose track of the fact whether it was pasteurized or not. That has a tendency to damage the reputation of all people in that sector. It's why we feel it's important that all juices be pasteurized. The food industry spends many, many millions of dollars a year to ensure that what they do to their products renders them as safe as possible. We think that if there is a safe and effective technology out there that can further ensure US food safety, it should be applied.
Frank Browning
Now I've spoken to a number of public health people, and they basically have said to me, you have a maximum of four E. coli cases ever in the history of the country, out of millions, probably billions, of gallons of cider that's been sold. And that this is another one of those cases of nutty American food panics.
Tom Willard
Well, I think that if you turn the situation around and say, here was a product that only caused three or four cases of illness anywhere. The question is not is that relatively few, but is there something effective that you know you can do that would render this completely free of that-- that that would not be an issue anymore. If there is an existing technology that is there that can be applied and is widely being applied, we don't really see why you wouldn't go ahead and require it.
Frank Browning
Meaning, in plain talk, the producers who invented and control global brand identity prefer to eliminate everybody who does not have the capital or the market share to compete. Forcing independent apple growers to spend $25,000 or $30,000 on pasteurization equipment would drive about 3/4 of today's cider makers out of business. But then as I have said, I'm biased.
Now presumably, from Big Apple's point of view, it's better that way. Then consumers have nothing to judge Mott's and Tree Top and Red Chief against. When Americans panic over microbial contamination, it isn't market neutral. It boosts big business.
The campaign of fear is working. I called up the one city market where we sell our apples and cider, Pipkin's produce in Cincinnati and talked to Ben Pipkin.
Frank Browning
So Ben, what's been happening to cider sales this year?
Ben Pipkin
Cider sales this year, well, we're just getting ready to start on cider this year. Last year, sales were probably about, on the unpasteurized cider, about half of what they were last year. Yeah.
Frank Browning
We made our first delivery of the season to Ben the day of my phone call. And he told us that customers were lining up at the loading dock to buy the new fresh cider. Then over the weekend, the local press ran its by now annual panic stories. Ben's customers started wrinkling their brows with concern. Well, why not? If I knew nothing about growing applies, if I hadn't seen our sanitation system, and if every time I picked up the paper to read about cider, I was told about a little girl who died Colorado, I'd panic about drinking cider too.
Panics, whether about food, sex, or politics, require two essential conditions. First, the trigger must be something that hits us very close to home. Second, the object of the panic must be something we really don't understand. With fewer than 3% of the American population actively farming, few of us have any idea what it takes to lure plants out of the ground, or how it is that they find their way to the local supermarket's produce shelf.
And so we make myths, in this case of unseen microorganisms threatening our families. And we live by those myths, afraid of what we don't know. And it turns out for all too many people, the world of unseen, unexplained phenomena includes apple cider.
Ira Glass
Frank Browning's latest book is called Apples. His family orchard is in Kentucky.
[MUSIC - "COMFORT ME WITH APPLES" BY INDIA ADAMS]
Act Five: The Conqueror Germ
Ira Glass
Act Five. The Conqueror Germ.
Sean Collins
More often than not, we use the language of war when we talk about disease. Someone is said to battle cancer or to fight an infection. The truth is, the metaphor is an apt one. In the case of my friend Christopher, the germ won. It took some 15 years to happen, but it won. It didn't win each battle, but it won the war.
Ira Glass
Now this story of the germs within us, and what we fear most from germs, namely that they'll kill us. Sean Collins has this account of the battle that his friend Christopher Rose went through with a bug. Christopher grew up in a tiny farming community in central Illinois, but had more of a Noel Coward, kind of personality. A professional musician, he took a turn for the worse, after years, not too long ago.
Sean Collins
There is a fact of medicine late in the 20th century that seems absolutely absurd on its face. And it's this, just about the worst place you can be when you're really sick is in the hospital. 5% to 10% of all patients admitted to an American hospital, acquire an infection while they're there.
The rate of these so-called nosocomial or hospital-acquired infections is much higher in patients admitted to intensive care units. In fact, a measurable percentage of patients in ICUs die, not of the condition that landed them in the intensive care unit, but from one of these bugs they picked up while they were in the hospital. These germs, more often than not a strain of Staphylococcus aureus, are resistant to most, if not all, antibiotics. And they live there in the hospital. And they got Christopher.
If you lie in one position long enough, perhaps in as few as a few days, you're at risk for developing what are called pressure sores, which happen because your weight rests on just a few parts of your body, your butt, your tail bone, the backs of your elbows. What happens is the weight of your body pushes the blood out of the capillaries and your skin in those places. This happens especially if your blood pressure is low, which means the circulatory system doesn't bring as much oxygen to the tissue and it begins to die. The skin literally breaks down. The bugs that live in the hospital love this.
These pressure sores are huge gateways to the circulatory system. You might as well put up signs, this way in, this way to the rest of the body. Germs allowed direct access to the bloodstream kind of go wild, eventually growing on things like heart valves and eating away at them. It can cause death literally in a matter of hours. So for patients in ICUs, especially immobile ones, skin care is really important.
Of course, skin care was always important to Christopher. In college, when he didn't have rent money, he had a supply of Clinique products. And now the doctors really didn't want him to lose the defense his skin could provide.
In the end and on his own, Christopher did develop a nasty bed sore. A sample got sent to the lab to be cultured. And it came back positive for an antibiotic resistant bacteria, a strain of staph. As soon as that happened, signs went up on the door in big letters, CONTACT PRECAUTION. It told us to wash our hands upon entering the room and leaving. And to be gloved and gowned if any direct contact with the patient was expected. This was to keep the bug in the room. And to keep it from making forays into other rooms on the unit. And they would routinely draw his blood to see if it made it past his skin, past that last, best defense, and into his bloodstream.
Suddenly, all you can think about is every hospital show you've ever seen on television. Just how are you supposed to wash your hands in this situation? I found myself wondering if I should turn the water off with my elbows, or at least use the paper towel when touching the faucet. In the end, you take your cue from the nurses, and you see that soap and water seem to do the trick with a little friction under running water. Nothing too elaborate, really quite quick. But it's amazing how important that one act is in controlling hospital acquired infections.
The International Society of Infectious Diseases came out with a little book this year on controlling infectious outbreaks in hospitals. A friend of mine worked on that book, which chronicles ways to control infection in the operating rooms and ICUs and the morgue, basically everywhere in the hospital. My friend said that during its production, the working title for the book was Wash Your Hands, Stupid. That was rejected in favor of the more sober, Handbook of Infection Control in the Hospital.
Christopher had made it clear that he wanted to be treated aggressively, as long as there existed a real possibility that that treatment would lead somewhere-- his words. So he was aggressively treated. The condition that landed him in the hospital was something called a necrotizing vasculitis, which manifested itself as a sort of creeping paralysis, that began in his feet and worked its way up his legs, to his hips, to his chest, and then from his fingertips, to his hands, to his arms. Day by day, the loss of feeling would progress. Inch by inch, the movement of his extremities first became awkward, then impossible.
The metaphor of battle became obvious as his body became a sort of war map. Reports of troop movements were filed by the members of the house staff on the rheumatology service, especially a dreamy, dark-eyed resident Christopher especially liked. Armed with mallets and pins, this otherwise good natured dreamboat would poke and prod and pinch and whack at my friend, all the while maintaining the guise of friendly conversation-- can you feel this, can you move your toes, how about grasping my hand. Good.
Christopher wanted to comply with the instructions, but couldn't. The terrain of battle was becoming unfamiliar to him, the fog of war was obscuring the landscape. He was losing ground. They tried something called plasmapheresis, where his blood was removed and cleaned. He said it was to remove the bad humors. All this further weakened his defenses, and the germs took advantage of the cracks in the ramparts.
Now about this war metaphor-- the US military has in place at this moment a plan to fight two wars at once, or to fight one big war in two major theaters of action at the same time. Asking the US military to fight three wars at once, would be asking too much. They've said as much. So it was with my friend.
Besides the creeping paralysis and the bug on his butt, Christopher acquired a pneumonia, a relatively rare type of pneumonia caused by cytomegalovirus. Here's the odd thing about CMV, most of us live with it in our bodies all the time. Hour by hour, we successfully fight it off. Most of us are winning that little battle right now. But people like Christopher, people with immune systems damaged by HIV, they end up dying of a bug they've lived with all their lives.
His pneumonia got progressively worse, his lungs so filled with fluid that they could barely exchange any gases. It was because his pulmonary function was so poor that the decision was made to withdraw treatment and to allow him to die. That was his wish, that if there was no real hope for meaningful recovery, that extraordinary treatment be discontinued. So on a spring evening at the end of March, some three months after he first went into the hospital, his parents, whom he loved so much, and about 20 of his friends, stood around his bed in the ICU, as a technician turned a knob on the ventilator and allowed him to breathe room air instead of a mixture artificially rich in oxygen.
He stopped taking breaths on his own a few minutes later, even though the ventilator was pushing air in and out of his lungs. Minutes later his heart rate slowed. And then the monitor above his bed tolled an alarm and spat out a strip of paper. Two minutes later, another alarm and another strip of paper. A minute later, one last strip spilled out of the machine and curled to the ground, like a receipt. Someone wondered out loud if it was the hospital bill. I took it home. It says Christopher Rose, 26 March 1998, 19 hours, 53 minutes, asystole. And below that, there's a flat line drawn across the width of the graph paper.
We all just sat there for a while. There is an unmistakable look a dead body has. Within just a couple of minutes, the color of the body changes, the skin turns ashen, a luminescent gray. You can see why people have always believed that something has left the body-- spirit, breath, ruha, pneuma, soul.
It is no accident we say that someone has expired. Some people walked out of the room. Others stayed. I stayed for a while. And I found myself wondering how long will it survive? How long will the HIV, the virus that caused all this, how long will it stay alive under that dead man's skin?
I had the distinct and odd feeling that death is a gradual thing, a process. The person is said to have died, but then death begins in earnest at the cellular level. Once the circulation of blood stops, the cells are deprived of oxygen and they begin to die.
But how long would the HIV continue to live after it had killed its host? I did some research. And it turns out the best guess is that the human immunodeficiency virus can survive for many days post-mortem, in tissues preserved under laboratory conditions-- that according to the International Society of Infectious Diseases.
The truth is we don't know precisely how long the virus survives in a cadaver. It might die in the blood rather quickly, but live in a pocket in the spleen for instance, for a little while longer. We know that it outlives the host for a little while, but not that long, perhaps less than a week.
Which brings me to this question, is it worth it? That extra week in a dead man's blood, is it worth all the bother? Is it worth it hitching a ride for the better part of my friend's life, being the source of endless anxiety and pain, only to outlive him by a week at the most, maybe only for a day or so. It hardly seems worth it to me. Christopher lived his entire adult life with this hanging over his head, waiting for this to happen, and the bug won, and then death claimed them all.
Ira Glass
Sean Collins is the Senior Producer of NPR's All Things Considered.
Credits
Ira Glass
Our program was produced today by Nancy Updike and myself, with Alix Spiegel and July Snyder. Contributing editors Jack Hitt, Paul Tough, Margy Rochlin, and consigliere Sarah Vowell. Production help from Laura Doggett, Sylvia Lemus, and [? Sahini ?] Davenport. Music help today from Mr. John Connors.
Special thanks today to penicillin. To buy a cassette copy of this or any of our programs, call us here at WBEZ in Chicago, (312) 832-3380, (312) 832-3380. Our email address, [email protected]. Well, you can listen to most of our programs for free on the internet at our website at www.thislife.org. This American Life is distributed by Public Radio International.
[FUNDING CREDITS]
WBEZ management oversight by Torey Malatia, who of course refers to the door of the This American Life studio as--
Nancy Tomes
The portal of death.
Ira Glass
I'm Ira Glass. Back next week with more stories of This American Life.
Announcer
PRI, Public Radio International.