This transcript has been edited for clarity.
Eric J. Topol, MD: Hi, I’m Eric Topol for the Medicine and Machine podcast. I am very pleased to welcome Steven Thrasher (@thrasherxy), Daniel H. Renberg, of Social Justice Journalism at northwestern University Medill School of Journalism. It has a new e-book called The Viral Underclass that we’ll be communicating about. Welcome, Steven.
Steven Thrasher, PhD: Thank you so much for having me, Eric. Es great to see you off Twitter.
Before we start with the book, I think let’s talk a little bit about your background. Explain this to us at New York University (NYU) when you worked for Saturday Night Live (SNL). Tell us about the first component of your career and education.
Thrasher: I grew up in Oxnard in Southern California and moved to New York City when I was 17 to go to film school at New York University. I worked at SNL as one of the best students in the school and my freshman year. I was a writer’s search assistant on the “Weekend Update” table my first year, then a writer assistant.
I worked in film production for years. The maximum line-up for me was shooting in a movie called The Laramie Project, about Matthew Shepard. The film itself was based on a technique from the oral history of theatre, making a play about Matthew’s murder. Eventually, I ended up hiring an editor for The Village Voice, where I covered the same-sex marriage movement across the country. I started writing about HIV and AIDS those years.
I ended up at Northwestern, where I have this wonderful assignment in journalism school that focuses on social justice journalism and LGBTQ people. I also have an appointment at medical school where I work at the LGBTQ Health Institute and our AIDS Research Center. I want to continue my journalism and also conduct peer-reviewed research, and I combine the two techniques. I have the privilege of training journalism scholars on health, medicine, and LGBTQ people, and training medical scholars on how to communicate.
Topol: It’s a very enriching trip. When you were thinking about writing The Viral Underclass and looking to perceive how viruses like HIV and COVID have a devastating effect on other people of color, the disabled, the poor, etc. , when did you come up with this eureka concept that you deserve?put a lot of effort into it? I know you were an investigative journalist, but when did it happen to you that I needed to be dissected?
Thrasher: Shortly before I started my PhD, I got to work on what I think would be my last journalistic story, which I still publish 8 years later: the story of a young man named Michael Johnson who had been arrested for alleged exposure and transmission. of the VIH. Se faced life in criminal. It was a case that evoked almost every mistake related to fitness and criminal prestige and black America. It also raised male issues similar to sexuality.
Through this case, I began to realize why corrupt justice was a bad way to deal with public health. I also noticed how anxieties about race, sexuality, and illness can pile up in other people. Michael’s story has been reported in Australia as if it was a global risk for HIV, as 40 million people worldwide are living with HIV. It became apparent to me temporarily that I could think about it for a long time.
The month I started graduate school, I started writing for The Guardian. When Michael Brown murdered in Ferguson, Missouri, I was sent there. Ferguson had a higher rate of AIDS than the surrounding area, and I began to see this overlap of black tactics. Americans specifically faced cops, poverty rallies, police violence, arrests, and HIV and AIDS. These maps overlapped a lot.
It’s my first “ah!” Moment. I wrote my thesis on this dating. This is called “contagious darkness. ” I have written about dating between the search for HIV and how and why HIV and AIDS have become so entrenched in black America in the United States. I looked before and after the advent of antiretroviral drugs, and how we saw a greater disparity among other people living with AIDS after the advent of drugs. HIV drugs have not addressed these disparities.
This was the basis of my doctoral work. When I finished it, I was thinking about what would happen and whether I would make an e-book from it. I started this assignment at Northwestern and discovered that I could write an e-book about business. So I was looking to figure out what form it would take when the COVID pandemic hit.
He didn’t know if he would still have a job. I didn’t know if there would be an ebook for sale. I didn’t know who was going to live or die from this pandemic. My agent very wisely reviewed my thesis, whose latest bankruptcy was titled “The Viral Subclass. “I had finished my thesis in an open and hopeful way, watching activists seeking to repeal legislation criminalizing HIV.
There was debate among them about the viral underclass, a term that had been coined by someone who had started an organization many years earlier to communicate about HIV criminalization in general. This activist organization said that if we started having HIV legislation that said everyone is prosecuted for it, but other people who have an undetectable viral load deserve not to be, it would create a viral underclass. They highlighted tactics in which other people who still had a detectable viral load would be further criminalized. But if other people have a detectable viral load, it’s because they’re poor. They don’t have constant access to medicines, because they don’t have a home.
Tanya, my agent, said to think of that as an analysis. So it was another wonderful “aha!” Time, because I learned that COVID cases and COVID deaths were expanding in March and April 2020, they were going down in villages I knew well because they were in spaces where there were also peak concentrations of HIV and AIDS.
In a way, it didn’t make much sense because the new coronavirus and HIV are very different viruses in many ways, in the way they are transmitted and the time periods in which they act. But the concentration of instances was in similar places. That’s when I learned that a framework of a viral subclass can help us understand why other viruses have similar populations, even though the characteristics of those viruses are very different.
Topol: The independent replication of a momentary virus with the same extraordinary remarkable themes. But the United States appears to be vulnerable, on the verge of suffering from such inequalities because of its lack of universal access to physical care, unlike any other industrialized country.
Thrasher: Those of us who studied those things were terrified in February, March and April 2020 because it was like we were living in a wood-burning house and we saw the game coming.
My point of fear was rooted in thinking about AIDS, poverty and race. And the story of this in the United States is that drugs were available in 1996, but they didn’t reach other countries for another 7 years. Yet even in the United States, we had this terrible racial disparity. In 2016, the Centers for Disease Control and Prevention (CDC) predicted that if things didn’t change, 1 in 2 gay black men like me would be HIV-positive over the course of their lives. .
HIV works very slowly. From the moment other people become infected, it may take 5, 7, or 10 years before they become seriously ill. It can take up to 15 years before they die, if left untreated. However, there are still other people on the Mississippi. Delta who arrive at the emergency room with symptoms of terminal AIDS and live only a few weeks before dying. There is no explanation for this to happen, that those are other people who have never seen a doctor and have already been rejected. through society in all sorts of ways.
Knowing the context of this and how there were medications for this virus for about 26 years, and knowing how prevalent HIV is still in certain parts of the United States, terrified me about what would happen with COVID, especially since it is much more effective virus that spreads much more easily, and that it would introduce a fitness formula that would be completely overcome by treatment.
Topol: There’s no doubt about that. I wonder if you can go back for a moment. I know the paintings he’s done with Michael “Tiger Mandinpass” Johnson have been very impactful. He starts his eBook with that, and it’s a theme of the e-book, The Viral. He was sentenced to 30 years in prison, which was reduced to five years. Did your writings on your stage help you get out earlier?
Thrasher: I think the reporting we did on BuzzFeed helped. He had been most commonly portrayed as a monster and had very negative media coverage. Almost everyone in his life had abandoned him. He couldn’t get much help. The first 2 years I worked on the archive, national organizations didn’t touch it. The National Association for the Advancement of Colored People (NAACP), the Human Rights Campaign, the National Gay and Lesbian Task Force, not even the American Civil Liberties Union (ACLU) or AIDS organizations would have anything to do with him.
It was a dynamic that shamefully reminded me of the days when the NAACP didn’t accept cases where rape allegations entered the equation. These were the cases where other people ended up being lynched or executed. The Scottsboro Boys were not represented through them and were eventually executed.
I was able to tell Michael Johnson’s story much more fully. And many activists surrounded him and began to help him. Armed with some of the things he had reported, they were able to raise funds, get help from some other lawyer, and controlled to appeal. The judgment is annulled.
One thing I wish the court had ruled, which they overturned, was the unconstitutionality of the legislation itself: that it unnecessarily and cruelly others have something that is considered a disability under the Americans with Disabilities Act. However, those laws leave other people in criminals for life. But I feel very satisfied and proud to have played a role as a journalist to bring to light data that were useful to get him out of prison.
Topol: It’s gratifying to hear. When you’re an investigative journalist and you can help enable an action like that, it will have to be rewarding, that you can make changes, especially by cutting the criminal sentence of a guy who has been recklessly framed and won by 25 years. such an excessive sentence.
Thrasher: Thank you. The day you were released as a criminal was one of the happiest days of my life. I was satisfied that he was looking for me to be there. As a journalist, you don’t see the end of your stories. The story continues, he does well and lives his life. But it is rare for him to report something that is unsolvable and see it come to his conclusion. Recently, he sent me a picture of him holding my book. she saw him faint and continue on his way.
Topol: Now you’ve written about the 12 interconnected social vectors between HIV and COVID. Could you tell us a little bit about that? These are all important forces in our lives. I may not be able to pass by 12 o’clock, but I am interested not only in racism, individualized misfortune and capitalism, but also in the criminal state – the criminal state – speciesism, notoriously ism, the myth of white immunity. Give your opinion on those hooked vectors.
Thrasher: When I did my thesis, I thought about the criminalization of HIV and race. And this task expands on that. I see race as a factor, but there are all those other tactics to creating a viral underclass. In particular, I believe that the COVID-19 pandemic creates an opportunity for a lot of solidarity with other white people and with other people who have been affected. in other tactics.
There are 12 other tactics to perpetuate a viral underclass through other types of viruses and, in the United States, through other presidential efforts. Trump’s administration has been incredibly reckless and irresponsible in all sorts of COVID tactics. But the death toll under Biden’s tenure is now about 150% of Trump’s. There are several reasons for this. But a strong point is that our criminal condition has changed. The United States has 4% of the world’s population, but we have about 25% of the world’s incarcerated people. At times, we had about 25% of COVID cases and 25% of COVID deaths. We have about 35% of monkeypox cases.
The criminal itself is such a vital vector for the spread of disease. It combines other people who are already predetermined to have all sorts of physical upheavals and economic instability and puts them all in one place. The prison itself can be a site of transmission. – this happens with HIV but also with hepatitis, tuberculosis and, more recently, of course, COVID-19, because COVID is transmitted so casually. It moves freely in those spaces. And with criminals more than criminals, other people come and go, and they come and go. The criminals themselves are, therefore, those transmission problems.
But they also create what I call secondary engines, so that once a user has been incarcerated, they are placed in all those other vectors that make them vulnerable to poor fitness outcomes. Once incarcerated, you are much more likely to become homeless, especially given the terms of the Clinton administration’s Welfare Reform Act that states that other people who have been arrested for drugs, not even convictions, only arrests, cannot live in public housing. This is one of the reasons why black homelessness is so high. When other people are incarcerated, it becomes almost to find works in the formal economy, in fact, a task that provides you with enough money for health insurance and smart health outcomes.
Prisons create those secondary engines, especially among blacks. That’s one reason AIDS rates among black Americans are even higher than they were among white Americans before drugs existed, and even though they had drugs for about 25 years.
Speciesism was probably the biggest learning curve for me writing this book. I don’t know where I first heard about him. I have many friends who are specialists in animal studies. above and beyond and learned everything I could about COVID 3 years ago, and a crash course on orthopox and monkeypox this summer.
It is vital to understand the role of nonhuman animals and where they come from, but also the dating that creates their continuous transmission. In large part, HIV is thought to have spread to humans from simian immunodeficiency virus when colonialists in the 1920s expelled African carriers. Probably through extracting those resources and killing the meat of wild animals, the other people who killed the animals brought the virus through cuts on their bodies. This is a non-unusual form of transmission that still occurs today in slaughterhouses and factory slaughter plants when other people acting as masons are cut down. This is one of the main pathways through which viruses enter humans.
I sought to better perceive this dating. Speciesism is a way in which human beings believe they are the most sensible thing in a pyramid. We ourselves are the most productive animals, even if we are animals that dominate everyone else. One of the other people I talked to in the book, Alice Wong, says there’s a clever explanation for why to think viruses are the higher organisms. In fact, they are much more effective than humans. We will have to have respect for them and for other animals.
As climate change pushes more living things into a smaller part of the world, we’re potentially going to have a lot more zoonotic leaps. Monkeypox does not come from monkeys but from other animals. We will have to perceive these relationships and not see the human being dominating all other animals without respect or limits. We will have to leave room for other creatures so as not to enter their territory and create situations that can lead to viral transmission.
For me, to think about the interdependence that happens with disabled patients and how other people with disabilities have a sense of interdependence, without independence but understanding that we have connections with others and that we negotiate with others. Seeing ourselves as interdependent with other species can help. We create larger situations where viruses don’t circulate as freely and spread to humans in tactics that can be just as fatal to us.
Topol: This is a critical point with all the other reservoirs that have been established to exist with COVID as an example, only white-tailed deer, hamsters and cats and all kinds of mammals, where there is a reservoir and potential for overflow or incubation of new variants that can hang out with us again.
It inspires me that you didn’t leave us with all this sadness about the gravity of the situation, about how overwhelming the structural inequalities are. But you came up with the concept of a map. This may just be a card to global liberation. Maybe you can elaborate on that.
Thrasher: Viruses taught me a lot. I’ve been thinking about it since I started getting involved in homosexual activism and AIDS activism. I learned that I am the beneficiary of all these paintings that were done through other people from the AIDS Coalition to Unleash Power (ACT UP) and the other people who got done around AIDS in the ’80s and ’90s. There have been enormous political benefits to this. ACT UP has reported all kinds of social movements, adding the Black Lives Matter movement and the Occupy Wall Street movement. The movements are not successful without delay. We’ve seen the president cancel student debt as a result of the activism paintings that began during Occupy Wall Street 11 years ago.
So I almost have a sense of guilt from the survivor. I try not to settle for this, but knowing that so much of my gay life and the culture I’m a part of is based on the horrors of AIDS in the ’80s and ’90s, it gave me a bit of survivor guilt. . .
I take a look at thinking of viruses as teachers. We are taught without knowing it, but there are classes that we can learn about how to better organize our world on a practical level. What AIDS activists have done to respond to AIDS is one reason why billions of people have now been vaccinated. he opposed COVID quickly, as activists disrupted the process by which vaccines and drugs were subject to regulatory scrutiny and brought them in much faster, when they could save millions of lives.
In this way, I think viruses have taught us a lot. But when we think about climate substitution, when we think about the migration patterns that are going to be caused by climate substitution and other political problems that we face, I think viruses give us this map of understanding that there is no distinct and distinct self you. There is this biological matter that can potentially be transmitted between us, and our fates are connected to each other.
There are practical tactics to consider it that go beyond nations. With the outbreak of monkeypox this summer, a Nigerian doctor saw monkeypox behave differently and thought there was probably some kind of mutation that caused him to start having sex in Nigeria in 2017. He wrote an article about it and asked for resources to examine it, and most of the time the world ignored him. In fact, the United States ignored it. If the United States had supported studies in other parts of the world that don’t affect us directly, we may not be dealing with the monkeypox epidemic now.
Viruses continually tell us that the fates of other people on the planet are interconnected. The threat we face is not the same, but our destinies are connected to each other. When we think about climate change and the changes that are taking place. To take place in the world, there are many kinds of which we have been informed in recent years. The hardest thing for me is that we’re going to have a connection between us, whether we like it or not. . And the boundaries that we believe are very strong around gender, race or nationality are fictions. Viruses can interbreed with each other, and they give us a map for how to work with each other in an interconnected way.
Topol: If only we took the right kind of action to be informed and perceive our interdependence. In conclusion, I wonder what you mean. You wrote this ordinary book. It was just published in August. You have to think about what’s next, of course, the most sensible part of your training and the lucky students you have in Northwestern classes. Where will you focus your efforts on the next career breakdown?
Thrasher: More immediately, I like teaching and having time to spend with the students. I worked on monkeypox this summer, and many of the classes I learned from COVID and writing this eBook apply to monkeypox. I can write contextual things, but also, in a very rudimentary way, I look for tactics to send data to the network and how to help other people get vaccinated quickly.
I have a few projects that I think about next. One is the role of African-American police officers in the United States. I was working on this before the pandemic and learned that police play a vital role in virus transmission. Many of the social injustices I have noticed occur because of the police. they seem to be mitigated when more black police officers occupied real jobs and were also portrayed in fiction.
Hennepin County, where I reported on George Floyd, is about 82 percent white. There are 3 other people running for sheriff; Two are black and one is from South Asia. So I’m working on that.
And then I go back to the original edition of this e-book, in a way, where I write about Michael Johnson’s case about my circle of relatives and being a queer person. ilvalid. But I’m talking a lot about my ebook this year and I’m looking to make sure COVID rarely gets very, very prevalent, and make sure that monkeypox is rarely abandoned prematurely here in the United States.
Topol: Just because the number of cases is decreasing, you are far from having monkeypox under control. And as you rightly pointed out, other young people may now think it could have been a pandemic every hundred years. , and they don’t have to worry about anyone else for the rest of their lives.
I think we know more but, unfortunately, because of climate and environmental change and so many other factors, we are going to meet the families of viruses that we have already seen; mutations in addition to the viruses that have led, as you said, to apepox; or the resurgence of polio. This has only been a wake-up call about infectious diseases. I never knew anything about infectious diseases until I had to consult a COVID specialist to see if I could help.
All the things you just discussed seem seductive. Your ability to dig deeper is a wonderful quality. I hope you will have the opportunity to address each of the issues you have just discussed. We will all benefit.
Thank you very much for the correct paintings you have already done. The viral subclass is a contribution that I hope the entire medical network will benefit from. Thank you very much, Steven.
Thrasher: Thank you. It’s a real honor to be here.
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Director, Scripps Institute of Translational Sciences; Professor of Molecular Medicine, Scripps Research Institute, La Jolla, California; Editor-in-Chief, MedscapeDisclosure: Eric J. Topol, MD, disclosed the following applicable monetary relationships: serving as (d) director, officer, partner, employee, advisor, representative or trustee of: Dexcom; Illuminates; molecular stethoscope; Search diagnostics; Blue Cross Blue Shield AssociationReceived a grant from: National Institutes of Health
Assistant Professor, Director Daniel H. Renberg, Department of Journalism, Northwestern University Medill School of Journalism, Evanston, Illinois Disclosure: Steven W. Thrasher, PhD, disclosed any applicable monetary relationships.
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