Skip to main content

Home/ History Readings/ Group items tagged medicine

Rss Feed Group items tagged

anniina03

Fake drugs: How bad is Africa's counterfeit medicine problem? - BBC News - 0 views

  • The proliferation of fake medicines in Africa is a public health crisis that can no longer be ignored, according to a UK charity.
  • Globally, the trade in counterfeit pharmaceuticals is worth up to $200bn (£150bn) annually, with Africa among the regions most affected, according to industry estimates. The World Health Organization (WHO) says 42% of all fake medicines reported to them between 2013 and 2017 were from Africa. The European region and the Americas (North and South) accounted for 21% each.
  • The WHO has itself noted that as more officers were trained and national regulators became more aware, the numbers of drug seizure reports went up. So it's possible areas with weak regulation and enforcement may be under-reporting the extent of the problem.
  • ...4 more annotations...
  • The WHO estimates one out of every 10 medical products in low- and middle-income countries, which includes most of Africa, is sub-standard or fake.
  • Analysis by the London School of Hygiene and Tropical Medicine for the WHO estimates substandard and fake anti-malarial drugs could be causing 116,000 extra deaths from the disease every year in sub-Saharan Africa at a cost to patients and health systems of on average $38.5m a year.
  • Fake medicine can often be indistinguishable from the real products, with the packaging as good if not better than the original.
  • There's also an issue with the cost of drugs in poorer countries. "If a good quality medicine from a known supplier is too expensive, people may try a cheaper one from an unlicensed supplier," the WHO says.
rachelramirez

Dying Infants and No Medicine: Inside Venezuela's Failing Hospitals - The New York Times - 0 views

  • Dying Infants and No Medicine: Inside Venezuela’s Failing Hospitals
  • “The death of a baby is our daily bread,” said Dr. Osleidy Camejo, a surgeon in the nation’s capital, Caracas, referring to the toll from Venezuela’s collapsing hospitals.
  • It is just part of a larger unraveling here that has become so severe it has prompted President Nicolás Maduro to impose a state of emergency and has raised fears of a government collapse.
  • ...13 more annotations...
  • Gloves and soap have vanished from some hospitals. Often, cancer medicines are found only on the black market. There is so little electricity that the government works only two days a week to save what energy is left.
  • At the University of the Andes Hospital in the mountain city of Mérida, there was not enough water to wash blood from the operating table. Doctors preparing for surgery cleaned their hands with bottles of seltzer water.
  • The hospital has no fully functioning X-ray or kidney dialysis machines because they broke long ago. And because there are no open beds, some patients lie on the floor in pools of their blood.
  • This nation has the largest oil reserves in the world, yet the government saved little money for hard times when oil prices were high.
  • So without water, gloves, soap or antibiotics, a group of surgeons prepared to remove an appendix that was about to burst, even though the operating room was still covered in another patient’s blood.
  • Ms. Parucho, a diabetic, was unable to receive kidney dialysis because the machines were broken. An infection had spread to her feet, which were black that night. She was going into septic shock.
  • In a supply room, cockroaches fled as the door swung open.
  • In April, the authorities arrested its director, Aquiles Martínez, and removed him from his post. Local news reports said he was accused of stealing equipment meant for the hospital, including machines to treat people with respiratory illnesses, as well as intravenous solutions and 127 boxes of medicine.
  • A holiday had been declared by the government to save electricity, and the blood bank took donations only on workdays.
  • For the past two and a half months, the hospital has not had a way to print X-rays. So patients must use a smartphone to take a picture of their scans and take them to the proper doctor.
  • Near him, a handwritten sign read, “We sell antibiotics — negotiable.” A black-market seller’s number was listed.
  • The ninth floor of the hospital is the maternity ward, where the seven babies had died the day before. A room at the end of the hall was filled with broken incubators.
  • The day of the power blackout, Dr. Rodríguez said, the hospital staff tried turning on the generator, but it did not work.
Javier E

The Coronavirus in America: The Year Ahead - The New York Times - 0 views

  • More than 20 experts in public health, medicine, epidemiology and history shared their thoughts on the future during in-depth interviews. When can we emerge from our homes? How long, realistically, before we have a treatment or vaccine? How will we keep the virus at bay
  • The path forward depends on factors that are certainly difficult but doable, they said: a carefully staggered approach to reopening, widespread testing and surveillance, a treatment that works, adequate resources for health care providers — and eventually an effective vaccine.
  • The scenario that Mr. Trump has been unrolling at his daily press briefings — that the lockdowns will end soon, that a protective pill is almost at hand, that football stadiums and restaurants will soon be full — is a fantasy, most experts said.
  • ...76 more annotations...
  • They worried that a vaccine would initially elude scientists, that weary citizens would abandon restrictions despite the risks, that the virus would be with us from now on.
  • Most experts believed that once the crisis was over, the nation and its economy would revive quickly. But there would be no escaping a period of intense pain.
  • Exactly how the pandemic will end depends in part on medical advances still to come. It will also depend on how individual Americans behave in the interim. If we scrupulously protect ourselves and our loved ones, more of us will live. If we underestimate the virus, it will find us.
  • More Americans may die than the White House admits.
  • The epidemiological model often cited by the White House, which was produced by the University of Washington’s Institute for Health Metrics and Evaluation, originally predicted 100,000 to 240,000 deaths by midsummer. Now that figure is 60,000.
  • The institute’s projection runs through Aug. 4, describing only the first wave of this epidemic. Without a vaccine, the virus is expected to circulate for years, and the death tally will rise over time.
  • Fatality rates depend heavily on how overwhelmed hospitals get and what percentage of cases are tested. China’s estimated death rate was 17 percent in the first week of January, when Wuhan was in chaos, according to a Center for Evidence-Based Medicine report, but only 0.7 percent by late February.
  • Various experts consulted by the Centers for Disease Control and Prevention in March predicted that the virus eventually could reach 48 percent to 65 percent of all Americans, with a fatality rate just under 1 percent, and would kill up to 1.7 million of them if nothing were done to stop the spread.
  • A model by researchers at Imperial College London cited by the president on March 30 predicted 2.2 million deaths in the United States by September under the same circumstances.
  • China has officially reported about 83,000 cases and 4,632 deaths, which is a fatality rate of over 5 percent. The Trump administration has questioned the figures but has not produced more accurate ones.
  • The tighter the restrictions, experts say, the fewer the deaths and the longer the periods between lockdowns. Most models assume states will eventually do widespread temperature checks, rapid testing and contact tracing, as is routine in Asia.
  • In this country, hospitals in several cities, including New York, came to the brink of chaos.
  • Only when tens of thousands of antibody tests are done will we know how many silent carriers there may be in the United States. The C.D.C. has suggested it might be 25 percent of those who test positive. Researchers in Iceland said it might be double that.
  • China is also revising its own estimates. In February, a major study concluded that only 1 percent of cases in Wuhan were asymptomatic. New research says perhaps 60 percent were.
  • The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually faded into the seasonal H1N1 flu.
  • The lockdowns will end, but haltingly.
  • it is likely a safe bet that at least 300 million of us are still vulnerable.
  • Until a vaccine or another protective measure emerges, there is no scenario, epidemiologists agreed, in which it is safe for that many people to suddenly come out of hiding. If Americans pour back out in force, all will appear quiet for perhaps three weeks.
  • The gains to date were achieved only by shutting down the country, a situation that cannot continue indefinitely. The White House’s “phased” plan for reopening will surely raise the death toll no matter how carefully it is executed.
  • Every epidemiological model envisions something like the dance
  • On the models, the curves of rising and falling deaths resemble a row of shark teeth.
  • Surges are inevitable, the models predict, even when stadiums, churches, theaters, bars and restaurants remain closed, all travelers from abroad are quarantined for 14 days, and domestic travel is tightly restricted to prevent high-intensity areas from reinfecting low-intensity ones.
  • In his wildly popular March 19 article in Medium, “Coronavirus: The Hammer and the Dance,” Tomas Pueyo correctly predicted the national lockdown, which he called the hammer, and said it would lead to a new phase, which he called the dance, in which essential parts of the economy could reopen, including some schools and some factories with skeleton crews.
  • Even the “Opening Up America Again” guidelines Mr. Trump issued on Thursday have three levels of social distancing, and recommend that vulnerable Americans stay hidden. The plan endorses testing, isolation and contact tracing — but does not specify how these measures will be paid for, or how long it will take to put them in place.
  • On Friday, none of that stopped the president from contradicting his own message by sending out tweets encouraging protesters in Michigan, Minnesota and Virginia to fight their states’ shutdowns.
  • China did not allow Wuhan, Nanjing or other cities to reopen until intensive surveillance found zero new cases for 14 straight days, the virus’s incubation period.
  • Compared with China or Italy, the United States is still a playground.Americans can take domestic flights, drive where they want, and roam streets and parks. Despite restrictions, everyone seems to know someone discreetly arranging play dates for children, holding backyard barbecues or meeting people on dating apps.
  • Even with rigorous measures, Asian countries have had trouble keeping the virus under control
  • But if too many people get infected at once, new lockdowns will become inevitable. To avoid that, widespread testing will be imperative.
  • Reopening requires declining cases for 14 days, the tracing of 90 percent of contacts, an end to health care worker infections, recuperation places for mild cases and many other hard-to-reach goals.
  • Immunity will become a societal advantage.
  • Imagine an America divided into two classes: those who have recovered from infection with the coronavirus and presumably have some immunity to it; and those who are still vulnerable.
  • “It will be a frightening schism,” Dr. David Nabarro, a World Health Organization special envoy on Covid-19, predicted. “Those with antibodies will be able to travel and work, and the rest will be discriminated against.”
  • Soon the government will have to invent a way to certify who is truly immune. A test for IgG antibodies, which are produced once immunity is established, would make sense
  • Dr. Fauci has said the White House was discussing certificates like those proposed in Germany. China uses cellphone QR codes linked to the owner’s personal details so others cannot borrow them.
  • As Americans stuck in lockdown see their immune neighbors resuming their lives and perhaps even taking the jobs they lost, it is not hard to imagine the enormous temptation to join them through self-infection
  • My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,”
  • It would be a gamble for American youth, too. The obese and immunocompromised are clearly at risk, but even slim, healthy young Americans have died of Covid-19.
  • The virus can be kept in check, but only with expanded resources.
  • Resolve to Save Lives, a public health advocacy group run by Dr. Thomas R. Frieden, the former director of the C.D.C., has published detailed and strict criteria for when the economy can reopen and when it must be closed.
  • once a national baseline of hundreds of thousands of daily tests is established across the nation, any viral spread can be spotted when the percentage of positive results rises.
  • To keep the virus in check, several experts insisted, the country also must start isolating all the ill — including mild cases.
  • “If I was forced to select only one intervention, it would be the rapid isolation of all cases,”
  • In China, anyone testing positive, no matter how mild their symptoms, was required to immediately enter an infirmary-style hospital — often set up in a gymnasium or community center outfitted with oxygen tanks and CT scanners.
  • There, they recuperated under the eyes of nurses. That reduced the risk to families, and being with other victims relieved some patients’ fears.
  • Still, experts were divided on the idea of such wards
  • Ultimately, suppressing a virus requires testing all the contacts of every known case. But the United States is far short of that goal.
  • In China’s Sichuan Province, for example, each known case had an average of 45 contacts.
  • The C.D.C. has about 600 contact tracers and, until recently, state and local health departments employed about 1,600, mostly for tracing syphilis and tuberculosis cases.
  • China hired and trained 9,000 in Wuhan alone. Dr. Frieden recently estimated that the United States will need at least 300,000.
  • There will not be a vaccine soon.
  • any effort to make a vaccine will take at least a year to 18 months.
  • the record is four years, for the mumps vaccine.
  • for unclear reasons, some previous vaccine candidates against coronaviruses like SARS have triggered “antibody-dependent enhancement,” which makes recipients more susceptible to infection, rather than less. In the past, vaccines against H.I.V. and dengue have unexpectedly done the same.
  • A new vaccine is usually first tested in fewer than 100 young, healthy volunteers. If it appears safe and produces antibodies, thousands more volunteers — in this case, probably front-line workers at the highest risk — will get either it or a placebo in what is called a Phase 3 trial.
  • It is possible to speed up that process with “challenge trials.” Scientists vaccinate small numbers of volunteers, wait until they develop antibodies, and then “challenge” them with a deliberate infection to see if the vaccine protects them.
  • Normally, it is ethically unthinkable to challenge subjects with a disease with no cure, such as Covid-19.
  • “Fewer get harmed if you do a challenge trial in a few people than if you do a Phase 3 trial in thousands,” said Dr. Lipsitch, who recently published a paper advocating challenge trials in the Journal of Infectious Diseases. Almost immediately, he said, he heard from volunteers.
  • The hidden danger of challenge trials, vaccinologists explained, is that they recruit too few volunteers to show whether a vaccine creates enhancement, since it may be a rare but dangerous problem.
  • if a vaccine is invented, the United States could need 300 million doses — or 600 million if two shots are required. And just as many syringes.
  • “People have to start thinking big,” Dr. Douglas said. “With that volume, you’ve got to start cranking it out pretty soon.”
  • Treatments are likely to arrive first.
  • The modern alternative is monoclonal antibodies. These treatment regimens, which recently came very close to conquering the Ebola epidemic in eastern Congo, are the most likely short-term game changer, experts said.
  • as with vaccines, growing and purifying monoclonal antibodies takes time. In theory, with enough production, they could be used not just to save lives but to protect front-line workers.
  • Having a daily preventive pill would be an even better solution, because pills can be synthesized in factories far faster than vaccines or antibodies can be grown and purified.
  • Goodbye, ‘America First.’
  • A public health crisis of this magnitude requires international cooperation on a scale not seen in decades. Yet Mr. Trump is moving to defund the W.H.O., the only organization capable of coordinating such a response.
  • And he spent most of this year antagonizing China, which now has the world’s most powerful functioning economy and may become the dominant supplier of drugs and vaccines. China has used the pandemic to extend its global influence, and says it has sent medical gear and equipment to nearly 120 countries.
  • This is not a world in which “America First” is a viable strategy, several experts noted.
  • “If President Trump cares about stepping up the public health efforts here, he should look for avenues to collaborate with China and stop the insults,”
  • If we alienate the Chinese with our rhetoric, I think it will come back to bite us,” he said.“What if they come up with the first vaccine? They have a choice about who they sell it to. Are we top of the list? Why would we be?”
  • Once the pandemic has passed, the national recovery may be swift. The economy rebounded after both world wars, Dr. Mulder noted.
  • In one of the most provocative analyses in his follow-up article, “Coronavirus: Out of Many, One,” Mr. Pueyo analyzed Medicare and census data on age and obesity in states that recently resisted shutdowns and counties that voted Republican in 2016.
  • He calculated that those voters could be 30 percent more likely to die of the virus.
  • In the periods after both wars, Dr. Mulder noted, society and incomes became more equal. Funds created for veterans’ and widows’ pensions led to social safety nets, measures like the G.I. Bill and V.A. home loans were adopted, unions grew stronger, and tax benefits for the wealthy withered.
  • If a vaccine saves lives, many Americans may become less suspicious of conventional medicine and more accepting of science in general — including climate change
Javier E

COVID-19 Changed Science Forever - The Atlantic - 0 views

  • New diagnostic tests can detect the virus within minutes. Massive open data sets of viral genomes and COVID‑19 cases have produced the most detailed picture yet of a new disease’s evolution. Vaccines are being developed with record-breaking speed. SARS‑CoV‑2 will be one of the most thoroughly characterized of all pathogens, and the secrets it yields will deepen our understanding of other viruses, leaving the world better prepared to face the next pandemic.
  • But the COVID‑19 pivot has also revealed the all-too-human frailties of the scientific enterprise. Flawed research made the pandemic more confusing, influencing misguided policies. Clinicians wasted millions of dollars on trials that were so sloppy as to be pointless. Overconfident poseurs published misleading work on topics in which they had no expertise. Racial and gender inequalities in the scientific field widened.
  • At its best, science is a self-correcting march toward greater knowledge for the betterment of humanity. At its worst, it is a self-interested pursuit of greater prestige at the cost of truth and rigor
  • ...33 more annotations...
  • Traditionally, a scientist submits her paper to a journal, which sends it to a (surprisingly small) group of peers for (several rounds of usually anonymous) comments; if the paper passes this (typically months-long) peer-review gantlet, it is published (often behind an expensive paywall). Languid and opaque, this system is ill-suited to a fast-moving outbreak. But biomedical scientists can now upload preliminary versions of their papers, or “preprints,” to freely accessible websites, allowing others to immediately dissect and build upon their results. This practice had been slowly gaining popularity before 2020, but proved so vital for sharing information about COVID‑19 that it will likely become a mainstay of modern biomedical research. Preprints accelerate science, and the pandemic accelerated the use of preprints. At the start of the year, one repository, medRxiv (pronounced “med archive”), held about 1,000 preprints. By the end of October, it had more than 12,000.
  • The U.S. is now catching up. In April, the NIH launched a partnership called ACTIV, in which academic and industry scientists prioritized the most promising drugs and coordinated trial plans across the country. Since August, several such trials have started.
  • Researchers have begun to uncover how SARS‑CoV‑2 compares with other coronaviruses in wild bats, the likely reservoir; how it infiltrates and co-opts our cells; how the immune system overreacts to it, creating the symptoms of COVID‑19. “We’re learning about this virus faster than we’ve ever learned about any virus in history,” Sabeti said.
  • Similar triumphs occurred last year—in other countries. In March, taking advantage of the United Kingdom’s nationalized health system, British researchers launched a nationwide study called Recovery, which has since enrolled more than 17,600 COVID‑19 patients across 176 institutions. Recovery offered conclusive answers about dexamethasone and hydroxychloroquine and is set to weigh in on several other treatments. No other study has done more to shape the treatment of COVID‑19.
  • SARS‑CoV‑2’s genome was decoded and shared by Chinese scientists just 10 days after the first cases were reported. By November, more than 197,000 SARS‑CoV‑2 genomes had been sequenced. About 90 years ago, no one had even seen an individual virus; today, scientists have reconstructed the shape of SARS‑CoV‑2 down to the position of individual atoms
  • Respiratory viruses, though extremely common, are often neglected. Respiratory syncytial virus, parainfluenza viruses, rhinoviruses, adenoviruses, bocaviruses, a quartet of other human coronaviruses—they mostly cause mild coldlike illnesses, but those can be severe. How often? Why? It’s hard to say, because, influenza aside, such viruses attract little funding or interest.
  • COVID‑19 has developed a terrifying mystique because it seems to behave in unusual ways. It causes mild symptoms in some but critical illness in others. It is a respiratory virus and yet seems to attack the heart, brain, kidneys, and other organs. It has reinfected a small number of people who had recently recovered. But many other viruses share similar abilities; they just don’t infect millions of people in a matter of months or grab the attention of the entire scientific community
  • Thanks to COVID‑19, more researchers are looking for these rarer sides of viral infections, and spotting them.
  • These factors pull researchers toward speed, short-termism, and hype at the expense of rigor—and the pandemic intensified that pull. With an anxious world crying out for information, any new paper could immediately draw international press coverage—and hundreds of citations.
  • “There’s a perception that they’re just colds and there’s nothing much to learn,” says Emily Martin of the University of Michigan, who has long struggled to get funding to study them. Such reasoning is shortsighted folly. Respiratory viruses are the pathogens most likely to cause pandemics, and those outbreaks could potentially be far worse than COVID‑19’s.
  • Their movements through the air have been poorly studied, too. “There’s this very entrenched idea,” says Linsey Marr at Virginia Tech, that viruses mostly spread through droplets (short-range globs of snot and spit) rather than aerosols (smaller, dustlike flecks that travel farther). That idea dates back to the 1930s, when scientists were upending outdated notions that disease was caused by “bad air,” or miasma. But the evidence that SARS‑CoV‑2 can spread through aerosols “is now overwhelming,”
  • Another pandemic is inevitable, but it will find a very different community of scientists than COVID‑19 did. They will immediately work to determine whether the pathogen—most likely another respiratory virus—moves through aerosols, and whether it spreads from infected people before causing symptoms. They might call for masks and better ventilation from the earliest moments, not after months of debate
  • They will anticipate the possibility of an imminent wave of long-haul symptoms, and hopefully discover ways of preventing them. They might set up research groups to prioritize the most promising drugs and coordinate large clinical trials. They might take vaccine platforms that worked best against COVID‑19, slot in the genetic material of the new pathogen, and have a vaccine ready within months
  • the single-minded focus on COVID‑19 will also leave a slew of negative legacies. Science is mostly a zero-sum game, and when one topic monopolizes attention and money, others lose out.
  • Long-term studies that monitored bird migrations or the changing climate will forever have holes in their data because field research had to be canceled.
  • negligence has left COVID‑19 long-haulers with few answers or options, and they initially endured the same dismissal as the larger ME community. But their sheer numbers have forced a degree of recognition. They started researching, cataloging their own symptoms. They gained audiences with the NIH and the World Health Organization. Patients who are themselves experts in infectious disease or public health published their stories in top journals. “Long COVID” is being taken seriously, and Brea hopes it might drag all post-infection illnesses into the spotlight. ME never experienced a pivot. COVID‑19 might inadvertently create one
  • Other epistemic trespassers spent their time reinventing the wheel. One new study, published in NEJM, used lasers to show that when people speak, they release aerosols. But as the authors themselves note, the same result—sans lasers—was published in 1946, Marr says. I asked her whether any papers from the 2020 batch had taught her something new. After an uncomfortably long pause, she mentioned just one.
  • The incentives to trespass are substantial. Academia is a pyramid scheme: Each biomedical professor trains an average of six doctoral students across her career, but only 16 percent of the students get tenure-track positions. Competition is ferocious, and success hinges on getting published
  • Conservationists who worked to protect monkeys and apes kept their distance for fear of passing COVID‑19 to already endangered species.
  • Among scientists, as in other fields, women do more child care, domestic work, and teaching than men, and are more often asked for emotional support by their students. These burdens increased as the pandemic took hold, leaving women scientists “less able to commit their time to learning about a new area of study, and less able to start a whole new research project,
  • published COVID‑19 papers had 19 percent fewer women as first authors compared with papers from the same journals in the previous year. Men led more than 80 percent of national COVID‑19 task forces in 87 countries. Male scientists were quoted four times as frequently as female scientists in American news stories about the pandemic.
  • American scientists of color also found it harder to pivot than their white peers, because of unique challenges that sapped their time and energy.
  • Science suffers from the so-called Matthew effect, whereby small successes snowball into ever greater advantages, irrespective of merit. Similarly, early hindrances linger. Young researchers who could not pivot because they were too busy caring or grieving for others might suffer lasting consequences from an unproductive year. COVID‑19 “has really put the clock back in terms of closing the gap for women and underrepresented minorities,”
  • In 1848, the Prussian government sent a young physician named Rudolf Virchow to investigate a typhus epidemic in Upper Silesia. Virchow didn’t know what caused the devastating disease, but he realized its spread was possible because of malnutrition, hazardous working conditions, crowded housing, poor sanitation, and the inattention of civil servants and aristocrats—problems that require social and political reforms. “Medicine is a social science,” Virchow said, “and politics is nothing but medicine in larger scale.”
  • entists discovered the microbes responsible for tuberculosis, plague, cholera, dysentery, and syphilis, most fixated on these newly identified nemeses. Societal factors were seen as overly political distractions for researchers who sought to “be as ‘objective’ as possible,” says Elaine Hernandez, a medical sociologist at Indiana University. In the U.S., medicine fractured.
  • New departments of sociology and cultural anthropology kept their eye on the societal side of health, while the nation’s first schools of public health focused instead on fights between germs and individuals. This rift widened as improvements in hygiene, living standards, nutrition, and sanitation lengthened life spans: The more social conditions improved, the more readily they could be ignored.
  • The ideological pivot away from social medicine began to reverse in the second half of the 20th century.
  • Politicians initially described COVID‑19 as a “great equalizer,” but when states began releasing demographic data, it was immediately clear that the disease was disproportionately infecting and killing people of color.
  • These disparities aren’t biological. They stem from decades of discrimination and segregation that left minority communities in poorer neighborhoods with low-paying jobs, more health problems, and less access to health care—the same kind of problems that Virchow identified more than 170 years ago.
  • In March, when the U.S. started shutting down, one of the biggest questions on the mind of Whitney Robinson of UNC at Chapel Hill was: Are our kids going to be out of school for two years? While biomedical scientists tend to focus on sickness and recovery, social epidemiologists like her “think about critical periods that can affect the trajectory of your life,” she told me. Disrupting a child’s schooling at the wrong time can affect their entire career, so scientists should have prioritized research to figure out whether and how schools could reopen safely. But most studies on the spread of COVID‑19 in schools were neither large in scope nor well-designed enough to be conclusive. No federal agency funded a large, nationwide study, even though the federal government had months to do so. The NIH received billions for COVID‑19 research, but the National Institute of Child Health and Human Development—one of its 27 constituent institutes and centers—got nothing.
  • The horrors that Rudolf Virchow saw in Upper Silesia radicalized him, pushing the future “father of modern pathology” to advocate for social reforms. The current pandemic has affected scientists in the same way
  • COVID‑19 could be the catalyst that fully reunifies the social and biological sides of medicine, bridging disciplines that have been separated for too long.
  • “To study COVID‑19 is not only to study the disease itself as a biological entity,” says Alondra Nelson, the president of the Social Science Research Council. “What looks like a single problem is actually all things, all at once. So what we’re actually studying is literally everything in society, at every scale, from supply chains to individual relationships.”
Javier E

Why Medicine Is Cheaper in Germany - Olga Khazan - The Atlantic - 0 views

  • Germany's process has worked pretty well ever since Otto Von Bismarck set it in motion in 1889. But by 2009, the system started to break down. Drug manufacturers were introducing new drugs—knowing they'd be reimbursed by the sickness funds—but the new drugs weren't necessarily any better than the earlier ones. The result: Drug prices spiraled.
  • nter 2010's Pharmaceutical Market Restructuring Act, or Arzneimittelmarkt-Neuordnungsgesetz, abbreviated in German as AMNOG. As in "AMNOGonna pay drug companies for new meds that are more expensive but not any better than the old ones."
  • s soon as a new drug enters the market, manufacturers must submit a series of studies that prove it heals patients better than whatever was previously available. If the new drugs don't seem any better than their predecessors, the sickness funds will only pay for the price of the earlier version. Patients can still buy the newer medicine, but it's up to them to make up the price difference out of pocket.
  • ...3 more annotations...
  • the new regulation so far hasn't had a chilling effect on medical innovation: "Even though the Federal Joint Committee ruled 27 prescription drugs to have no added benefit, only five of these drugs have left the German market as a result."
  • Bahr's approach to pharmaceutical price regulation is market-driven, if you think about it. Why not force drug makers to compete with each other to prove they're providing added bang for patients' buck? Evzio, meet invisible hand.
  • The American style of drug pricing, meanwhile, is like shopping for clothes with a blindfold on, as Princeton economics professor Uwe Reinhardt put it. "In a truly competitive market, both the prices and the inherent qualities of the goods or services being traded are known to all parties ahead of any trade," he wrote in the Times' Economix blog. "By contrast, in the American healthcare market, both the price and the quality of health care have been kept studiously hidden from patients."
Javier E

How Public Health Took Part in Its Own Downfall - The Atlantic - 0 views

  • when the coronavirus pandemic reached the United States, it found a public-health system in disrepair. That system, with its overstretched staff, meager budgets, crumbling buildings, and archaic equipment, could barely cope with sickness as usual, let alone with a new, fast-spreading virus.
  • By one telling, public health was a victim of its own success, its value shrouded by the complacency of good health
  • By a different account, the competing field of medicine actively suppressed public health, which threatened the financial model of treating illness in (insured) individuals
  • ...27 more annotations...
  • In fact, “public health has actively participated in its own marginalization,” Daniel Goldberg, a historian of medicine at the University of Colorado, told me. As the 20th century progressed, the field moved away from the idea that social reforms were a necessary part of preventing disease and willingly silenced its own political voice. By swimming along with the changing currents of American ideology, it drowned many of the qualities that made it most effective.
  • Germ theory offered a seductive new vision for defeating disease: Although the old public health “sought the sources of infectious disease in the surroundings of man; the new finds them in man himself,” wrote Hibbert Hill in The New Public Health in 1913
  • “They didn’t have to think of themselves as activists,” Rosner said. “It was so much easier to identify individual victims of disease and cure them than it was to rebuild a city.”
  • As public health moved into the laboratory, a narrow set of professionals associated with new academic schools began to dominate the once-broad field. “It was a way of consolidating power: If you don’t have a degree in public health, you’re not public health,”
  • Mastering the new science of bacteriology “became an ideological marker,” sharply differentiating an old generation of amateurs from a new one of scientifically minded professionals,
  • Hospitals, meanwhile, were becoming the centerpieces of American health care, and medicine was quickly amassing money and prestige by reorienting toward biomedical research
  • Public health began to self-identify as a field of objective, outside observers of society instead of agents of social change. It assumed a narrower set of responsibilities that included data collection, diagnostic services for clinicians, disease tracing, and health education.
  • Assuming that its science could speak for itself, the field pulled away from allies such as labor unions, housing reformers, and social-welfare organizations that had supported city-scale sanitation projects, workplace reforms, and other ambitious public-health projects.
  • That left public health in a precarious position—still in medicine’s shadow, but without the political base “that had been the source of its power,”
  • After World War II, biomedicine lived up to its promise, and American ideology turned strongly toward individualism.
  • Seeing poor health as a matter of personal irresponsibility rather than of societal rot became natural.
  • Even public health began to treat people as if they lived in a social vacuum. Epidemiologists now searched for “risk factors,” such as inactivity and alcohol consumption, that made individuals more vulnerable to disease and designed health-promotion campaigns that exhorted people to change their behaviors, tying health to willpower in a way that persists today.
  • Public health is now trapped in an unenviable bind. “If it conceives of itself too narrowly, it will be accused of lacking vision … If it conceives of itself too expansively, it will be accused of overreaching,
  • “epidemiology isn’t a field of activists saying, ‘God, asbestos is terrible,’ but of scientists calculating the statistical probability of someone’s death being due to this exposure or that one.”
  • In 1971, Paul Cornely, then the president of the APHA and the first Black American to earn a Ph.D. in public health, said that “if the health organizations of this country have any concern about the quality of life of its citizens, they would come out of their sterile and scientific atmosphere and jump in the polluted waters of the real world where action is the basis for survival.”
  • a new wave of “social epidemiologists” once again turned their attention to racism, poverty, and other structural problems.
  • The biomedical view of health still dominates, as evidenced by the Biden administration’s focus on vaccines at the expense of masks, rapid tests, and other “nonpharmaceutical interventions.”
  • Public health has often been represented by leaders with backgrounds primarily in clinical medicine, who have repeatedly cast the pandemic in individualist terms: “Your health is in your own hands,” said the CDC’s director, Rochelle Walensky, in May
  • the pandemic has proved what public health’s practitioners understood well in the late 19th and early 20th century: how important the social side of health is. People can’t isolate themselves if they work low-income jobs with no paid sick leave, or if they live in crowded housing or prisons.
  • This approach appealed, too, to powerful industries with an interest in highlighting individual failings rather than the dangers of their products.
  • “Public health gains credibility from its adherence to science, and if it strays too far into political advocacy, it may lose the appearance of objectivity,”
  • In truth, public health is inescapably political, not least because it “has to make decisions in the face of rapidly evolving and contested evidence,” Fairchild told me. That evidence almost never speaks for itself, which means the decisions that arise from it must be grounded in values.
  • Those values, Fairchild said, should include equity and the prevention of harm to others, “but in our history, we lost the ability to claim these ethical principles.”
  • “Sick-leave policies, health-insurance coverage, the importance of housing … these things are outside the ability of public health to implement, but we should raise our voices about them,” said Mary Bassett, of Harvard, who was recently appointed as New York’s health commissioner. “I think we can get explicit.”
  • The future might lie in reviving the past, and reopening the umbrella of public health to encompass people without a formal degree or a job at a health department.
  • What if, instead, we thought of the Black Lives Matter movement as a public-health movement, the American Rescue Plan as a public-health bill, or decarceration, as the APHA recently stated, as a public-health goal? In this way of thinking, too, employers who institute policies that protect the health of their workers are themselves public-health advocates.
  • “We need to re-create alliances with others and help them to understand that what they are doing is public health,
rachelramirez

3 Scientists Win Nobel Prize in Medicine for Parasite-Fighting Therapies - The New York... - 0 views

  • 3 Scientists Win Nobel Prize in Medicine for Parasite-Fighting Therapies
  • They shared the $900,000 award with Youyou Tu, who discovered Artemisinin, a drug that has significantly reduced death rates from malaria.
  • Parasitic worms afflict a third of the world’s population, particularly in sub-Saharan Africa, South Asia and Latin America.
  • ...1 more annotation...
  • In Africa alone, it saves more than 100,000 lives each year.
krystalxu

What Do Chinese People Actually Think About Politics? | The Diplomat - 0 views

  • More than half of the respondents feel traditional Chinese medicine is superior to modern medical science
    • krystalxu
       
      depend on the region. Also, in my pov, since there is no measurement involved accurate chemical study in each medicine, the effectiveness of Chinese medicine is uncertain.
  • it points out that in 2014 there seemed to be a greater trend toward conservatism,
  • These statements seem to attempt to rule out any efforts to analyze whether people in various regions hold different views.
  • ...2 more annotations...
  • the views of people in various regions can’t all be exactly identical,
  • Interestingly, China’s state-run Global Times has lashed out at the academic report in an editorial in its English edition, with some rather spurious criticisms, seemingly opposed to any attempt to differentiate between political views of Chinese citizens.
    • krystalxu
       
      "over-protective" govt. blinds the public. It is really not the first time....This is more like a normal excercise in China in my pov. that the govt. lies to the public about certain events, and, when they get opposed from the public, the opposing group will be punished for their "wrongdoing"
Javier E

The U.K.'s Coronavirus 'Herd Immunity' Debacle - The Atlantic - 0 views

  • Herd immunity is typically generated through vaccination, and while it could arise through widespread infection, “you don’t rely on the very deadly infectious agent to create an immune population,” says Akiko Iwasaki, a virologist at the Yale School of Medicine. And that seemed like the goal.
  • Vallance and others certainly made it sound like the government was deliberately aiming for 60 percent of the populace to fall ill. Keep calm and carry on … and get COVID-19.
  • He says that the actual goal is the same as that of other countries: flatten the curve by staggering the onset of infections. As a consequence, the nation may achieve herd immunity; it’s a side effect, not an aim.
  • ...9 more annotations...
  • “The messaging has been really confusing, and I think that was really unfortunate,” says Petra Klepac, who is also an infectious-disease modeler at the London School of Hygiene and Tropical Medicine. “It’s been a case of how not to communicate during an outbreak,”
  • critics of the U.K. strategy argue that swift, decisive action matters more than future hypotheticals do. The country’s current caseload puts it only a few weeks behind Italy, where more than 24,000 cases have so overburdened hospitals that doctors must now make awful decisions about whom to treat.
  • First, we don’t know how long immunity against the new coronavirus, SARS-CoV-2, lasts. When people are infected with OC43 and HKU1—two other coronaviruses that regularly circulate among humans and cause common colds—they stay immune for less than a year. By contrast, immunity against the first SARS virus (from 2003) holds for much longer. No one knows whether SARS-CoV-2 will hew to either of these extremes, and according to one recent study, its behavior could mean anything from annual outbreaks to a decades-long quiet spell.
  • making a decent long-term strategy is hard when there are still two big unknowns that substantially affect how the pandemic will progress
  • a more granular analysis across Chinese provinces showed that the virus can still easily spread in humid areas, and a third modeling study concluded that “SARS-CoV-2 can proliferate at any time of year.” The bottom line: There’s a very wide range of possible futures.
  • South Korea, by contrast, seems to have brought COVID-19 to heel through a combination of social-distancing measures and extensive testing. Hong Kong, Singapore, and Taiwan have been similarly successful.
  • In a similar letter, more than 500 behavioral scientists called on the government to disclose the evidence behind its contention that the public will experience “behavioral fatigue” if restrictions are put in place too early.
  • Without strong guidance, British institutions and citizens have begun making their own decisions, going well over what the government recommends. Universities haven’t been told to close, but many have, sending students home, moving classes and exams online, and postponing graduations. Many care homes will not be admitting visitors. Soccer leagues have been suspended. The Queen has canceled public engagements. The Scottish government is planning to close schools and expand testing.
  • “We really need people to engage and to sustain individual control measures, like social distancing, for months at a time,” Klepac adds. “We’re in this for the long term and we need everyone to do their part. It is a very big ask.
Javier E

These Truths: A History of the United States (Jill Lepore) - 1 views

  • It was meant to mark the start of a new era, in which the course of history might be made predictable and a government established that would be ruled not by accident and force but by reason and choice. The origins of that idea, and its fate, are the story of American history.
  • It seems to have been reserved to the people of this country, by their conduct and example, to decide the important question, whether societies of men are really capable or not of establishing good government from reflection and choice, or whether they are forever destined to depend for their political constitutions on accident and force.6 This was the question of that autumn. And, in a way, it has been the question of every season since,
  • I once came across a book called The Constitution Made Easy.7 The Constitution cannot be made easy. It was never meant to be easy.
  • ...297 more annotations...
  • THE AMERICAN EXPERIMENT rests on three political ideas—“these truths,” Thomas Jefferson called them—political equality, natural rights, and the sovereignty of the people.
  • After Benjamin Franklin read Jefferson’s draft, he picked up his quill, scratched out the words “sacred & undeniable,” and suggested that “these truths” were, instead, “self-evident.” This was more than a quibble. Truths that are sacred and undeniable are God-given and divine, the stuff of religion. Truths that are self-evident are laws of nature, empirical and observable, the stuff of science. This divide has nearly rent the Republic apart.
  • The real dispute is between “these truths” and the course of events: Does American history prove these truths, or does it belie them?
  • The United States rests on a dedication to equality, which is chiefly a moral idea, rooted in Christianity, but it rests, too, on a dedication to inquiry, fearless and unflinching. Its founders agreed with the Scottish philosopher and historian David Hume, who wrote, in 1748, that “Records of Wars, Intrigues, Factions, and Revolutions are so many Collections of Experiments.”9 They believed that truth is to be found in ideas about morality but also in the study of history.
  • understanding history as a form of inquiry—not as something easy or comforting but as something demanding and exhausting—was central to the nation’s founding. This, too, was new.
  • A new kind of historical writing, less memorial and more unsettling, only first emerged in the fourteenth century. “History is a philosophical science,” the North African Muslim scholar Ibn Khaldun wrote in 1377, in the prologue to his history of the world, in which he defined history as the study “of the causes and origins of existing things.”11
  • Only by fits and starts did history become not merely a form of memory but also a form of investigation, to be disputed, like philosophy, its premises questioned, its evidence examined, its arguments countered.
  • Declaring independence was itself an argument about the relationship between the present and the past, an argument that required evidence of a very particular kind: historical evidence. That’s why most of the Declaration of Independence is a list of historical claims. “To prove this,” Jefferson wrote, “let facts be submitted to a candid world.”
  • In an attempt to solve this problem, the earliest historians of the United States decided to begin their accounts with Columbus’s voyage, stitching 1776 to 1492. George Bancroft published his History of the United States from the Discovery of the American Continent to the Present in 1834, when the nation was barely more than a half-century old, a fledgling, just hatched. By beginning with Columbus, Bancroft made the United States nearly three centuries older than it was, a many-feathered old bird.
  • In 1787, then, when Alexander Hamilton asked “whether societies of men are really capable or not of establishing good government from reflection and choice, or whether they are forever destined to depend for their political constitutions on accident and force,” that was the kind of question a scientist asks before beginning an experiment. Time alone would tell. But time has passed. The beginning has come to an end. What, then, is the verdict of history?
  • In deciding what to leave in and what to leave out, I’ve confined myself to what, in my view, a people constituted as a nation in the early twenty-first century need to know about their own past, mainly because this book is meant to double as an old-fashioned civics book, an explanation of the origins and ends of democratic institutions, from the town meeting to the party system, from the nominating convention to the secret ballot, from talk radio to Internet polls. This book is chiefly a political
  • Aside from being a brief history of the United States and a civics primer, this book aims to be something else, too: it’s an explanation of the nature of the past. History isn’t only a subject; it’s also a method.
  • The truths on which the nation was founded are not mysteries, articles of faith, never to be questioned, as if the founding were an act of God, but neither are they lies, all facts fictions, as if nothing can be known, in a world without truth.
  • Between reverence and worship, on the one side, and irreverence and contempt, on the other, lies an uneasy path, away from false pieties and petty triumphs over people who lived and died and committed both their acts of courage and their sins and errors long before we committed ours. “We cannot hallow this ground,” Lincoln said at Gettysburg. We are obliged, instead, to walk this ground, dedicating ourselves to both the living and the dead.
  • studying history is like that, looking into one face and seeing, behind it, another, face after face after face. “Know whence you came,” Baldwin told his nephew.17 The past is an inheritance, a gift and a burden. It can’t be shirked. You carry it everywhere. There’s nothing for it but to get to know it.
  • Nature takes one toll, malice another. History is the study of what remains, what’s left behind, which can be almost anything, so long as it survives the ravages of time and war: letters, diaries, DNA, gravestones, coins, television broadcasts, paintings, DVDs, viruses, abandoned Facebook pages, the transcripts of congressional hearings, the ruins of buildings. Some of these things are saved by chance or accident, like the one house that, as if by miracle, still stands after a hurricane razes a town. But most of what historians study survives because it was purposely kept—placed
  • As nation-states emerged, they needed to explain themselves, which they did by telling stories about their origins, tying together ribbons of myths, as if everyone in the “English nation,” for instance, had the same ancestors, when, of course, they did not. Very often, histories of nation-states are little more than myths that hide the seams that stitch the nation to the state.15
  • When the United States declared its independence in 1776, plainly, it was a state, but what made it a nation? The fiction that its people shared a common ancestry was absurd on its face; they came from all over, and, having waged a war against England, the very last thing they wanted to celebrate was their Englishness.
  • Facts, knowledge, experience, proof. These words come from the law. Around the seventeenth century, they moved into what was then called “natural history”: astronomy, physics, chemistry, geology. By the eighteenth century they were applied to history and to politics, too. These truths: this was the language of reason, of enlightenment, of inquiry, and of history.
  • Against conquest, slaughter, and slavery came the urgent and abiding question, “By what right?”
  • Yet the origins of the United States date to 1492 for another, more troubling reason: the nation’s founding truths were forged in a crucible of violence, the products of staggering cruelty, conquest and slaughter, the assassination of worlds.
  • Locke, spurred both by a growing commitment to religious toleration and by a desire to distinguish English settlement from Spanish conquest, stressed the lack of cultivation as a better justification for taking the natives’ land than religious difference, an emphasis with lasting consequences.
  • Unlike Polo and Mandeville, Columbus did not make a catalogue of the ways and beliefs of the people he met (only later did he hire Pané to do that). Instead, he decided that the people he met had no ways and beliefs. Every difference he saw as an absence.22 Insisting that they had no faith and no civil government and were therefore infidels and savages who could not rightfully own anything, he claimed possession of their land, by the act of writing. They were a people without truth; he would make his truth theirs. He would tell them where the dead go.
  • It became commonplace, inevitable, even, first among the Spanish, and then, in turn, among the French, the Dutch, and the English, to see their own prosperity and good health and the terrible sicknesses suffered by the natives as signs from God. “Touching these savages, there is a thing that I cannot omit to remark to you,” one French settler wrote: “it appears visibly that God wishes that they yield their place to new peoples.” Death convinced them at once of their right and of the truth of their faith. “The natives, they are all dead of small Poxe,” John Winthrop wrote when he arrived in New England in 1630: “the Lord hathe cleared our title to what we possess.”
  • In much of New Spain, the mixed-race children of Spanish men and Indian women, known as mestizos, outnumbered Indians; an intricate caste system marked gradations of skin color, mixtures of Europeans, Native Americans, and Africans, as if skin color were like dyes made of plants, the yellow of sassafras, the red of beets, the black of carob. Later, the English would recognize only black and white, a fantasy of stark and impossible difference, of nights without twilight and days without dawns. And yet both regimes of race, a culture of mixing or a culture of pretending not to mix, pressed upon the brows of every person of the least curiosity the question of common humanity: Are all peoples one?
  • Elizabeth’s best defender argued that if God decided “the female should rule and govern,” it didn’t matter that women were “weake in nature, feable in bodie, softe in courage,” because God would make every right ruler strong. In any case, England’s constitution abided by a “rule mixte,” in which the authority of the monarch was checked by the power of Parliament; also, “it is not she that ruleth but the lawes.” Elizabeth herself called on yet another authority: the favor of the people.48 A mixed constitution, the rule of law, the will of the people: these were English ideas that Americans would one day make their own, crying, “Liberty!”
  • In the brutal, bloody century between Columbus’s voyage and John White’s, an idea was born, out of fantasy, out of violence, the idea that there exists in the world a people who live in an actual Garden of Eden, a state of nature, before the giving of laws, before the forming of government. This imagined history of America became an English book of genesis, their new truth. “In the beginning,” the Englishman John Locke would write, “all the world was America.” In America, everything became a beginning.
  • England’s empire would have a different character than that of either Spain or France. Catholics could make converts by the act of baptism, but Protestants were supposed to teach converts to read the Bible; that meant permanent settlements, families, communities, schools, and churches. Also, England’s empire would be maritime—its navy was its greatest strength. It would be commercial. And, of greatest significance for the course of the nation that would grow out of those settlements, its colonists would be free men, not vassals, guaranteed their “English liberties.”
  • Beginning with the Virginia charter, the idea of English liberties for English subjects was planted on American soil and, with it, the king’s claim to dominion, a claim that rested on the idea that people like Powhatan and his people lived in darkness and without government, no matter that the English called their leaders kings.
  • Twenty Englishmen were elected to the House of Burgesses. Twenty Africans were condemned to the house of bondage. Another chapter opened in the American book of genesis: liberty and slavery became the American Abel and Cain.
  • To build his case against the king, Coke dusted off a copy of an ancient and almost entirely forgotten legal document, known as Magna Carta (literally, the “great charter”), in which, in the year 1215, King John had pledged to his barons that he would obey the “law of the land.” Magna Carta wasn’t nearly as important as Coke made it out to be, but by arguing for its importance, he made it important, not only for English history, but for American history, too, tying the political fate of everyone in England’s colonies to the strange doings of a very bad king from the Middle Ages.
  • Magna Carta explains a great deal about how it is that some English colonists would one day come to believe that their king had no right to rule them and why their descendants would come to believe that the United States needed a written constitution. But Magna Carta played one further pivotal role, the role it played in the history of truth—a history that had taken a different course in England than in any other part of Europe.
  • The most crucial right established under Magna Carta was the right to a trial by jury.
  • in 1215, the pope banned trial by ordeal. In Europe, it was replaced by a new system of divine judgment: judicial torture. But in England, where there existed a tradition of convening juries to judge civil disputes—like disagreements over boundaries between neighboring freeholds—trial by ordeal was replaced not by judicial torture but by trial by jury.
  • This turn marked the beginning of a new era in the history of knowledge: it required a new doctrine of evidence and new method of inquiry and eventually led to the idea that an observed or witnessed act or thing—the substance, the matter, of fact—is the basis of truth. A judge decided the law; a jury decided the facts. Mysteries were matters of faith, a different kind of truth, known only to God.
  • The age of mystery began to wane, and, soon, the culture of fact spread from law to government.
  • There would never be very many Africans in New England, but New Englanders would have slave plantations, on the distant shores. Nearly half of colonial New Englanders’ wealth would come from sugar grown by West Indian slaves.
  • One million Europeans migrated to British America between 1600 and 1800 and two and a half million Africans were carried there by force over that same stretch of centuries, on ships that sailed past one another by day and by night.42 Africans died faster, but as a population of migrants, they outnumbered Europeans two and a half to one.
  • In the last twenty-five years of the seventeenth century, English ships, piloted by English sea captains, crewed by English sailors, carried more than a quarter of a million men, women, and children across the ocean, shackled in ships’ holds.44 Theirs was not a ship of state crossing a sea of troubles, another Mayflower, their bond a covenant. Theirs was a ship of slavery, their bonds forged in fire. They whispered and wept; they screamed and sat in silence. They grew ill; they grieved; they died; they endured.
  • By what right did the English hold these people as their slaves?
  • Under Roman law, all men are born free and can only be made slaves by the law of nations, under certain narrow conditions—for instance, when they’re taken as prisoners of war, or when they sell themselves as payment of debt. Aristotle had disagreed with Roman law, insisting that some men are born slaves. Neither of these traditions from antiquity proved to be of much use to English colonists attempting to codify their right to own slaves, because laws governing slavery, like slavery itself, had disappeared from English common law by the fourteenth century. Said one Englishman in Barbados in 1661, there was “no track to guide us where to walk nor any rule sett us how to govern such Slaves.”46
  • With no track or rule to guide them, colonial assemblies adopted new practices and devised new laws with which they attempted to establish a divide between “blacks” and “whites.”
  • Adopting these practices and passing these laws required turning English law upside down, because much in existing English law undermined the claims of owners of people. In 1655, a Virginia woman with an African mother and an English father sued for her freedom by citing English common law, under which children’s status follows that of their father, not their mother. In 1662, Virginia’s House of Burgesses answered doubts about “whether children got by any Englishman upon a Negro woman should be slave or ffree” by reaching back to an archaic Roman rule, partus sequitur ventrem (you are what your mother was). Thereafter, any child born of a woman who was a slave inherited her condition.
  • By giving Americans a more ancient past, he hoped to make America’s founding appear inevitable and its growth inexorable, God-ordained. He also wanted to celebrate the United States, not as an offshoot of England, but instead as a pluralist and cosmopolitan nation, with ancestors all over the world.
  • No book should be censored before publication, Milton argued (though it might be condemned after printing), because truth could only be established if allowed to do battle with lies. “Let her and falsehood grapple,” he urged, since, “whoever knew Truth to be put to the worst in a free and open encounter?” This view depended on an understanding of the capacity of the people to reason. The people, Milton insisted, are not “slow and dull, but of a quick, ingenious and piercing spirit, acute to invent, subtle and sinewy to discourse, not beneath the reach of any point the highest that human capacity can soar to.”52
  • All men, Locke argued, are born equal, with a natural right to life, liberty, and property; to protect those rights, they erect governments by consent. Slavery, for Locke, was no part either of a state of nature or of civil society. Slavery was a matter of the law of nations, “nothing else, but the state of war continued, between a lawful conqueror and a captive.” To introduce slavery in the Carolinas, then, was to establish, as fundamental to the political order, an institution at variance with everything about how Locke understood civil society.
  • Long before shots were fired at Lexington and Concord, long before George Washington crossed the Delaware, long before American independence was thought of, or even thinkable, a revolutionary tradition was forged, not by the English in America, but by Indians waging wars and slaves waging rebellions. They revolted again and again and again. Their revolutions came in waves that lashed the land. They asked the same question, unrelentingly: By what right are we ruled?
  • Rebellion hardened lines between whites and blacks. Before Bacon and his men burned Jamestown, poor Englishmen had very little political power. As many as three out of every four Englishmen and women who sailed to the colonies were either debtors or convicts or indentured servants; they weren’t slaves, but neither were they free.61 Property requirements for voting meant that not all free white men could vote. Meanwhile, the fact that slaves could be manumitted by their masters meant that it was possible to be both black and free and white and unfree. But after Bacon’s Rebellion, free white men were granted the right to vote, and it became nearly impossible for black men and women to secure their freedom. By 1680, one observer could remark that “these two words, Negro and Slave” had “grown Homogeneous and convertible”: to be black was to be a slave.
  • Benjamin Franklin eventually settled in the tidy Quaker town of Philadelphia and began printing his own newspaper, the Pennsylvania Gazette, in 1729. In its pages, he fought for freedom of the press. In a Miltonian 1731 “Apology for Printers,” he observed “that the Opinions of Men are almost as various as their Faces” but that “Printers are educated in the Belief, that when Men differ in Opinion, both Sides ought equally to have the Advantage of being heard by the Publick; and that when Truth and Error have fair Play, the former is always an overmatch for the latter.”
  • But if the culture of the fact hadn’t yet spread to newspapers, it had spread to history. In Leviathan, Thomas Hobbes had written that “The register of Knowledge of Fact is called History.”74 One lesson Americans would learn from the facts of their own history had to do with the limits of the freedom of the press, and this was a fact on which they dwelled, and a liberty they grew determined to protect.
  • Slavery does not exist outside of politics. Slavery is a form of politics, and slave rebellion a form of violent political dissent. The Zenger trial and the New York slave conspiracy were much more than a dispute over freedom of the press and a foiled slave rebellion: they were part of a debate about the nature of political opposition, and together they established its limits. Both Cosby’s opponents and Caesar’s followers allegedly plotted to depose the governor. One kind of rebellion was celebrated, the other suppressed—a division that would endure.
  • In American history, the relationship between liberty and slavery is at once deep and dark: the threat of black rebellion gave a license to white political opposition.
  • This, too, represented a kind of revolution: Whitefield emphasized the divinity of ordinary people, at the expense of the authority of their ministers.
  • he wrote in 1751 an essay about the size of the population, called “Observations concerning the Increase of Mankind, Peopling of Countries, &c.”
  • Franklin guessed the population of the mainland colonies to be about “One Million English Souls,” and his calculations suggested that this number would double every twenty-five years. At that rate, in only a century, “the greatest Number of Englishmen will be on this Side the Water.” Franklin’s numbers were off; his estimates weren’t too high; they were too low. At the time, more than 1.5 million people lived in Britain’s thirteen mainland colonies. Those colonies were far more densely settled than New France or New Spain. Only 60,000 French settlers lived in Canada and 10,000 more in Louisiana. New Spain was even more thinly settled.
  • he wrote about a new race, a people who were “white.” “The Number of purely white People in the World is proportionably very small,” Franklin began. As he saw it, Africans were “black”; Asians and Native Americans were “tawny”; Spaniards, Italians, French, Russians, Swedes, and Germans were “swarthy.” That left very few people, and chiefly the English, as the only “white people” in the world. “I could wish their Numbers were increased,” Franklin said, adding, wonderingly, “But perhaps I am partial to the Complexion of my Country, for such Kind of Partiality is natural to Mankind.”
  • Franklin’s “JOIN, or DIE” did some of that, too: it offered a lesson about the rulers and the ruled, and the nature of political communities. It made a claim about the colonies: they were parts of a whole.
  • When Benjamin Franklin began writing his autobiography, in 1771, he turned the story of his own escape—running away from his apprenticeship to his brother James—into a metaphor for the colonies’ growing resentment of parliamentary rule. James’s “harsh and tyrannical Treatment,” Franklin wrote, had served as “a means of impressing me with that Aversion to arbitrary Power that has stuck to me thro’ my whole Life.”7 But that was also the story of every runaway slave ad, testament after testament to an aversion to arbitrary power.
  • The American Revolution did not begin in 1775 and it didn’t end when the war was over. “The success of Mr. Lay, in sowing the seeds of . . . a revolution in morals, commerce, and government, in the new and in the old world, should teach the benefactors of mankind not to despair, if they do not see the fruits of their benevolent propositions, or undertakings, during their lives,” Philadelphia doctor Benjamin Rush later wrote.
  • There were not one but two American revolutions at the end of the eighteenth century: the struggle for independence from Britain, and the struggle to end slavery. Only one was won.
  • The Revolution was at its most radical in the challenge it presented to the institution of slavery and at its most conservative in its failure to meet that challenge. Still, the institution had begun to break, like a pane of glass streaked with cracks but not yet shattered.
  • “I wish our Poor Distracted State would atend to the many good Lessons” of history, Jane Franklin wrote to her brother, and not “keep always in a Flame.”21
  • After Annapolis, Madison went home to Virginia and resumed his course of study. In April of 1787, he drafted an essay called “Vices of the Political System of the United States.” It took the form of a list of eleven deficiencies,
  • it closed with a list of causes for these vices, which he located primarily “in the people themselves.” By this last he meant the danger that a majority posed to a minority: “In republican Government the majority however composed, ultimately give the law. Whenever therefore an apparent interest or common passion unites a majority what is to restrain them from unjust violations of the rights and interests of the minority, or of individuals?”27 What force restrains good men from doing bad things? Honesty, character, religion—these, history demonstrated, were not to be relied upon. No, the only force that could restrain the tyranny of the people was the force of a well-constructed constitution. It would have to be as finely wrought as an iron gate.
  • At the convention, it proved impossible to set the matter of slavery aside, both because the question of representation turned on it and because any understanding of the nature of tyranny rested on it. When Madison argued about the inevitability of a majority oppressing a minority, he cited ancient history, and told of how the rich oppressed the poor in Greece and Rome. But he cited, too, modern American history. “We have seen the mere distinction of color made in the most enlightened period of time, the ground of the most oppressive dominion ever exercised by man over man.”40
  • If not for the three-fifths rule, the representatives of free states would have outnumbered representatives of slave states by 57 to 33.44
  • Wilson, half Franklin’s age, read his remarks instead. “Mr. President,” he began, addressing Washington, “I confess that there are several parts of this constitution which I do not at present approve, but I am not sure I shall never approve them.” He suggested that he might, one day, change his mind. “For having lived long, I have experienced many instances of being obliged by better information, or fuller consideration, to change opinions even on important subjects, which I once thought right, but found to be otherwise. It is therefore that the older I grow, the more apt I am to doubt my own judgment, and to pay more respect to the judgment of others.” Hoping to pry open the minds of delegates who were closed to the compromise before them, he reminded them of the cost of zealotry. “Most men indeed as well as most sects in Religion, think themselves in possession of all truth, and that wherever others differ from them it is so far error.” But wasn’t humility the best course, in such circumstances? “Thus I consent, Sir, to this Constitution,” he closed, “because I expect no better, and because I am not sure, that it is not the best.”
  • Except for the Massachusetts Constitution, in 1780, and the second New Hampshire Constitution, in 1784, no constitution, no written system of government, had ever before been submitted to the people for their approval. “This is a new event in the history of mankind,” said the governor of Connecticut at his state’s ratification convention.
  • Nearly everything Washington did set a precedent. What would have happened if he had decided, before taking that oath of office, to emancipate his slaves? He’d grown disillusioned with slavery; his own slaves, and the greater number of slaves owned by his wife, were, to him, a moral burden, and he understood very well that for all the wealth generated by forced, unpaid labor, the institution of slavery was a moral burden to the nation. There is some evidence—slight though it is—that Washington drafted a statement announcing that he intended to emancipate his slaves before assuming the presidency. (Or maybe that statement, like Washington’s inaugural address, had been written by Hamilton, a member of New York’s Manumission Society.) This, too, Washington understood, would have established a precedent: every president after him would have had to emancipate his slaves. And yet he would not, could not, do it.65 Few of Washington’s decisions would have such lasting and terrible consequences as this one failure to act.
  • In the century and a half between the Connecticut charter and the 1787 meeting of the constitutional convention lies an entire revolution—not just a political revolution but also a religious revolution. So far from establishing a religion, the Constitution doesn’t even mention “God,” except in naming the date (“the year of our Lord . . .”). At a time when all but two states required religious tests for office, the Constitution prohibited them. At a time when all but three states still had an official religion, the Bill of Rights forbade the federal government from establishing one. Most Americans believed, with Madison, that religion can only thrive if it is no part of government, and that a free government can only thrive if it is no part of religion.
  • The replacement of debtors’ prison with bankruptcy protection would change the nature of the American economy, spurring investment, speculation, and the taking of risks.
  • as early as 1791, Madison had begun to revise his thinking. In an essay called “Public Opinion,” he considered a source of instability particular to a large republic: the people might be deceived. “The larger a country, the less easy for its real opinion to be ascertained,” he explained. That is, factions might not, in the end, consist of wise, knowledgeable, and reasonable men. They might consist of passionate, ignorant, and irrational men, who had been led to hold “counterfeit” opinions by persuasive men. (Madison was thinking of Hamilton and his ability to gain public support for his financial plan.)
  • The way out of this political maze was the newspaper. “A circulation of newspapers through the entire body of the people,” he explained, “is equivalent to a contraction of territorial limits.” Newspapers would make the country, effectively, smaller.90 It was an ingenious idea. It would be revisited by each passing generation of exasperated advocates of republicanism. The newspaper would hold the Republic together; the telegraph would hold the Republic together; the radio would hold the Republic together; the Internet would hold the Republic together. Each time, this assertion would be both right and terribly wrong.
  • Newspapers in the early republic weren’t incidentally or inadvertently partisan; they were entirely and enthusiastically partisan. They weren’t especially interested in establishing facts; they were interested in staging a battle of opinions. “Professions of impartiality I shall make none,” wrote a Federalist printer. “They are always useless, and are besides perfect nonsense.”92
  • Washington’s Farewell Address consists of a series of warnings about the danger of disunion. The North and the South, the East and the West, ought not to consider their interests separate or competing, Washington urged: “your union ought to be considered as a main prop of your liberty.” Parties, he warned, were the “worst enemy” of every government, agitating “the community with ill-founded jealousies and false alarms,” kindling “the animosity of one part against another,” and even fomenting “riot and insurrection.”
  • As to the size of the Republic, “Is there a doubt whether a common government can embrace so large a sphere? Let experience solve it.” The American experiment must go on. But it could only thrive if the citizens were supported by religion and morality, and if they were well educated. “Promote, then, as an object of primary importance, institutions for the general diffusion of knowledge,” he urged. “In proportion as the structure of a government gives force to public opinion, it is essential that public opinion should be enlightened.”95
  • “Passion” or variants of the word appear seven times in the Farewell; it is the source of every problem; reason is its only remedy. Passion is a river. There would be no changing its course.
  • Adams and Jefferson lived in an age of quantification. It began with the measurement of time. Time used to be a wheel that turned, and turned again; during the scientific revolution, time became a line. Time, the easiest quantity to measure, became the engine of every empirical inquiry: an axis, an arrow. This new use and understanding of time contributed to the idea of progress—if time is a line instead of a circle, things can get better and even better, instead of forever rising and falling in endless cycles, like the seasons. The idea of progress animated American independence and animated, too, the advance of capitalism.
  • The quantification of time led to the quantification of everything else: the counting of people, the measurement of their labor, and the calculation of profit as a function of time. Keeping time and accumulating wealth earned a certain equivalency. “Time is money,” Benjamin Franklin used to say.
  • The two-party system turned out to be essential to the strength of the Republic. A stable party system organizes dissent. It turns discontent into a public good. And it insures the peaceful transfer of power, in which the losing party willingly, and without hesitation, surrenders its power to the winning party.
  • Behind Madison’s remarks about “lessening the proportion of slaves to the free people,” behind Jefferson’s tortured calculations about how many generations would have to pass before his own children could pass for “white,” lay this hard truth: none of these men could imagine living with descendants of Africans as political equals.
  • If the battle between John Adams and Thomas Jefferson had determined whether aristocracy or republicanism would prevail (and, with Jefferson, republicanism won), the battle between Andrew Jackson and John Quincy Adams would determine whether republicanism or democracy would prevail (and, with Jackson, democracy would, eventually, win). Jackson’s rise to power marked the birth of American populism. The argument of populism is that the best government is that most closely directed by a popular majority.
  • He was provincial, and poorly educated. (Later, when Harvard gave Jackson an honorary doctorate, John Quincy Adams refused to attend the ceremony, calling him “a barbarian who could not write a sentence of grammar and hardly could spell his own name.”)68 He had a well-earned reputation for being ferocious, ill-humored, and murderous, on the battlefield and off. When he ran for president, he had served less than a year in the Senate. Of his bid for the White House Jefferson declared, “He is one of the most unfit men I know of for such a place.”69 Jackson made a devilishly shrewd decision. He would make his lack of certain qualities—judiciousness, education, political experience—into strengths.
  • Eaton, who ran Jackson’s campaign, shrewdly revised his Life of Andrew Jackson, deleting or dismissing everything in Jackson’s past that looked bad and lavishing attention on anything that looked good and turning into strengths what earlier had been considered weaknesses: Eaton’s Jackson wasn’t uneducated; he was self-taught. He wasn’t ill-bred; he was “self-made.”
  • Watching the rise of American democracy, an aging political elite despaired, and feared that the Republic could not survive the rule of the people. Wrote John Randolph of Virginia, “The country is ruined past redemption.”
  • “The first principle of our system,” Jackson said, “is that the majority is to govern.” He bowed to the people. Then, all at once, the people nearly crushed him with their affection.
  • The democratization of American politics was hastened by revivalists like Stewart who believed in the salvation of the individual through good works and in the equality of all people in the eyes of God. Against that belief stood the stark and brutal realities of an industrializing age, the grinding of souls.
  • The great debates of the middle decades of the nineteenth century had to do with the soul and the machine. One debate merged religion and politics. What were the political consequences of the idea of the equality of souls? Could the soul of America be redeemed from the nation’s original sin, the Constitution’s sanctioning of slavery?
  • Another debate merged politics and technology. Could the nation’s new democratic traditions survive in the age of the factory, the railroad, and the telegraph? If all events in time can be explained by earlier events in time, if history is a line, and not a circle, then the course of events—change over time—is governed by a set of laws, like the laws of physics, and driven by a force, like gravity. What is that force? Is change driven by God, by people, or by machines? Is progress the progress of Pilgrim’s Progress, John Bunyan’s 1678 allegory—the journey of a Christian from sin to salvation? Is progress the extension of suffrage, the spread of democracy? Or is progress invention, the invention of new machines?
  • A distinctively American idea of progress involved geography as destiny, picturing improvement as change not only over time but also over space.
  • If the sincerity of converts was often dubious, another kind of faith was taking deeper root in the 1820s, an evangelical faith in technological progress, an unquestioning conviction that each new machine was making the world better. That faith had a special place in the United States, as if machines had a distinctive destiny on the American continent. In prints and paintings, “Progress” appeared as a steam-powered locomotive, chugging across the continent, unstoppable. Writers celebrated inventors as “Men of Progress” and “Conquerors of Nature” and lauded their machines as far worthier than poetry. The triumph of the sciences over the arts meant the defeat of the ancients by the moderns. The genius of Eli Whitney, hero of modernity, was said to rival that of Shakespeare; the head of the U.S. Patent Office declared the steamboat “a mightier epic” than the Iliad.18
  • To Jackson’s supporters, his election marked not degeneration but a new stage in the history of progress. Nowhere was this argument made more forcefully, or more influentially, than in George Bancroft’s History of the United States from the Discovery of the American Continent to the Present. The book itself, reviewers noted, voted for Jackson. The spread of evangelical Christianity, the invention of new machines, and the rise of American democracy convinced Bancroft that “humanism is steady advancing,” and that “the advance of liberty and justice is certain.” That advance, men like Bancroft and Jackson believed, required Americans to march across the continent, to carry these improvements from east to west, the way Jefferson had pictured it. Democracy, John O’Sullivan, a New York lawyer and Democratic editor, argued in 1839, is nothing more or less than “Christianity in its earthly aspect.” O’Sullivan would later coin the term “manifest destiny” to describe this set of beliefs, the idea that the people of the United States were fated “to over spread and to possess the whole of the continent which Providence has given for the development of the great experiment of liberty.”23
  • To evangelical Democrats, Democracy, Christianity, and technology were levers of the same machine. And yet, all along, there were critics and dissenters and objectors who saw, in the soul of the people, in the march of progress, in the unending chain of machines, in the seeming forward movement of history, little but violence and backwardness and a great crushing of men, women, and children. “Oh, America, America,” Maria Stewart cried, “foul and indelible is thy stain!”24
  • The self-evident, secular truths of the Declaration of Independence became, to evangelical Americans, the truths of revealed religion. To say that this marked a turn away from the spirit of the nation’s founding is to wildly understate the case. The United States was founded during the most secular era in American history, either before or since. In the late eighteenth century, church membership was low, and anticlerical feeling was high.
  • The United States was not founded as a Christian nation. The Constitution prohibits religious tests for officeholders. The Bill of Rights forbids the federal government from establishing a religion, James Madison having argued that to establish
  • The separation of church and state allowed religion to thrive; that was one of its intentions. Lacking an established state religion, Americans founded new sects, from Shakers to Mormons, and rival Protestant denominations sprung up in town after town. Increasingly, the only unifying, national religion was a civil religion, a belief in the American creed. This faith bound the nation together, and provided extraordinary political stability in an era of astonishing change,
  • Slavery wasn’t an aberration in an industrializing economy; slavery was its engine. Factories had mechanical slaves; plantations had human slaves. The power of machines was measured by horsepower, the power of slaves by hand power. A healthy man counted as “two hands,” a nursing woman as a “half-hand,” a child as a “quarter-hand.”
  • With Walker, the antislavery argument for gradual emancipation, with compensation for slave owners, became untenable. Abolitionists began arguing for immediate emancipation. And southern antislavery societies shut their doors. As late as 1827, the number of antislavery groups in the South had outnumbered those in the North by more than four to one. Southern antislavery activists were usually supporters of colonization, not of emancipation. Walker’s Appeal ended the antislavery movement in the South and radicalized it in the North.
  • The rebellion rippled across the Union. The Virginia legislature debated the possibility of emancipating its slaves, fearing “a Nat Turner might be in every family.” Quakers submitted a petition to the state legislature calling for abolition. The petition was referred to a committee, headed by Thomas Jefferson’s thirty-nine-year-old grandson, Thomas Jefferson Randolph, who proposed a scheme of gradual emancipation. Instead, the legislature passed new laws banning the teaching of slaves to read and write, and prohibiting, too, teaching slaves about the Bible.43 In a nation founded on a written Declaration, made sacred by evangelicals during a religious revival, reading about equality became a crime.
  • One consequence of the rise of Jacksonian democracy and the Second Great Awakening was the participation of women in the reformation of American politics by way of American morals. When suffrage was stripped of all property qualifications, women’s lack of political power became starkly obvious. For women who wished to exercise power, the only source of power seemingly left to them was their role as mothers, which, they suggested, rendered them morally superior to men—more loving, more caring, and more responsive to the cries of the weak.
  • Purporting to act less as citizens than as mothers, cultivating the notion of “republican motherhood,” women formed temperance societies, charitable aid societies, peace societies, vegetarian societies, and abolition societies. The first Female Anti-Slavery Society was founded in Boston in 1833; by 1837, 139 Female Anti-Slavery Societies had been founded across the country,
  • After 1835, she never again spoke in public. As Catherine Beecher argued in 1837, in An Essay on Slavery and Abolitionism, with Reference to the Duty of American Females, “If the female advocate chooses to come upon a stage, and expose her person, dress, and elocution to public criticism, it is right to express disgust.”
  • Jacksonian democracy distributed political power to the many, but industrialization consolidated economic power in the hands of a few. In Boston, the top 1 percent of the population controlled 10 percent of wealth in 1689, 16 percent in 1771, 33 percent in 1833, and 37 percent in 1848, while the lowest 80 percent of the population controlled 39 percent of the wealth in 1689, 29 percent in 1771, 14 percent in 1833, and a mere 4 percent in 1848.
  • In New York, the top 1 percent of the population controlled 40 percent of the wealth in 1828 and 50 percent in 1845; the top 4 percent of the population controlled 63 percent of the wealth in 1828 and 80 percent in 1845.49
  • While two and a half million Europeans had migrated to all of the Americas between 1500 and 1800, the same number—two and a half million—arrived specifically in the United States between 1845 and 1854 alone. As a proportion of the U.S. population, European immigrants grew from 1.6 percent in the 1820s to 11.2 percent in 1860. Writing in 1837, one Michigan reformer called the nation’s rate of immigration “the boldest experiment upon the stability of government ever made in the annals of time.”51 The largest
  • Critics of Jackson—himself the son of Irish immigrants—had blamed his election on the rising population of poor, newly enfranchised Irishmen. “Everything in the shape of an Irishman was drummed to the polls,” one newspaper editor wrote in 1828.52 By 1860, more than one in eight Americans were born in Europe, including 1.6 million Irish and 1.2 million Germans, the majority of whom were Catholic. As the flood of immigrants swelled, the force of nativism gained strength, as did hostility toward Catholics, fueled by the animus of evangelical Protestants.
  • The insularity of both Irish and German communities contributed to a growing movement to establish tax-supported public elementary schools, known as “common schools,” meant to provide a common academic and civic education to all classes of Americans. Like the extension of suffrage to all white men, this element of the American experiment propelled the United States ahead of European nations. Much of the movement’s strength came from the fervor of revivalists. They hoped that these new schools would assimilate a diverse population of native-born and foreign-born citizens by introducing them to the traditions of American culture and government, so that boys, once men, would vote wisely, and girls, once women, would raise virtuous children. “It is our duty to make men moral,” read one popular teachers’ manual, published in 1830. Other advocates hoped that a shared education would diminish partisanship. Whatever the motives of its advocates, the common school movement emerged out of, and nurtured, a strong civic culture.56
  • With free schools, literacy spread, and the number of newspapers rose, a change that was tied to the rise of a new party system. Parties come and go, but a party system—a stable pair of parties—has characterized American politics since the ratification debates. In American history the change from one party system to another has nearly always been associated with a revolution in communications that allows the people to shake loose of the control of parties. In the 1790s, during the rise of the first party system, which pitted Federalists against Republicans, the number of newspapers had swelled. During the shift to the second party system, which, beginning in 1833, pitted Democrats against the newly founded Whig Party, not only did the number of newspapers rise, but their prices plummeted.
  • The newspapers of the first party system, which were also known as “commercial advertisers,” had consisted chiefly of partisan commentary and ads, and generally sold for six cents an issue. The new papers cost only one cent, and were far more widely read. The rise of the so-called penny press also marked the beginning of the triumph of “facts” over “opinion” in American journalism, mainly because the penny press aimed at a different, broader, and less exclusively partisan, audience. The New York Sun appeared in 1833. “It shines for all” was its common-man motto. “The object of this paper is to lay before the public, at a price within the means of everyone, ALL THE NEWS OF THE DAY,” it boasted. It dispensed with subscriptions and instead was circulated at newsstands, where it was sold for cash, to anyone who had a ready penny. Its front page was filled not with advertising but with news. The penny press was a “free press,” as James Gordon Bennett of the New York Herald put it, because it wasn’t beholden to parties. (Bennett, born in Scotland, had immigrated to the United States after reading Benjamin Franklin’s Autobiography.) Since the paper was sold at newsstands, rather than mailed to subscribers, he explained, its editors and writers were “entirely ignorant who are its readers and who are not.” They couldn’t favor their readers’ politics because they didn’t know them. “We shall support no party,” Bennett insisted. “We shall endeavor to record facts.”
  • During the days of the penny press, Tocqueville observed that Americans had a decided preference for weighing the facts of a matter themselves: They mistrust systems; they adhere closely to facts and study facts with their own senses. As they do not easily defer to the mere name of any fellow man, they are never inclined to rest upon any man’s authority; but, on the contrary, they are unremitting in their efforts to find out the weaker points of their neighbor’s doctrine.60
  • For centuries, Europeans had based their claims to lands in the New World on arguments that native peoples had no right to the land they inhabited, no sovereignty over it, because they had no religion, or because they had no government, or because they had no system of writing. The Cherokees, with deliberation and purpose, challenged each of these arguments.
  • Britain, Calhoun argued that if a state were to decide that a law passed by Congress was unconstitutional, the Constitution would have to be amended, and if such an amendment were not ratified—if it didn’t earn the necessary approval of three-quarters of the states—the objecting state would have the right to secede from the Union. The states had been sovereign before the Constitution was ever written, or even thought of, Calhoun argued, and they remained sovereign. Calhoun also therefore argued against majority rule; nullification is fundamentally anti-majoritarian. If states can secede, the majority does not rule.78 The nullification crisis was
  • New York abolished debtors’ prison in 1831, and in 1841, Congress passed a federal law offering bankruptcy protection to everyone. Within two years, 41,000 Americans had filed for bankruptcy. Two years later, the law was repealed, but state laws continued to offer bankruptcy protection and, still more significantly, debtors’ prisons were gone for good. In Britain and all of Europe except Portugal, offenders were still being thrown in debtors’ prison (a plot that animated many a nineteenth-century novel); in the United States, debtors could declare bankruptcy and begin again.
  • A nation of debtors, Americans came to see that most people who fall into debt are victims of the business cycle and not of fate or divine retribution or the wheel of fortune. The nation’s bankruptcy laws, even as they came and went again, made taking risks less risky for everyone, which meant that everyone took more risks.
  • the geographical vastness of the United States meant that the anxiety about the machinery of industrial capitalism took the form not of Marxism, with its argument that “the history of all hitherto existing society is the history of class struggles,” but instead of a romance with nature, and with the land, and with all things rustic. Against the factory, Americans posed not a socialist utopia but the log cabin.
  • Were all these vast designs and rapid strides worth it? Thoreau thought not. He came to this truth: “They are but improved means to an unimproved end.”112
  • Expansion, even more than abolition, pressed upon the public the question of the constitutionality of slavery. How or even whether this crisis would be resolved was difficult to see not only because of the nature of the dispute but also because there existed very little agreement about who might resolve it: Who was to decide whether a federal law was unconstitutional?
  • In the midst of all this clamoring among the thundering white-haired patriarchs of American politics, there emerged the idea that the authority to interpret the Constitution rests with the people themselves. Or, at least, this became a rather fashionable thing to say. “It is, Sir, the people’s Constitution, the people’s government, made for the people, made by the people, and answerable to the people,” Daniel Webster roared from the floor of Congress.14 Every man could read and understand the Constitution, Webster insisted.
  • The Notes, it appeared, could be read as variously as the Constitution itself. As one shrewd observer remarked, “The Constitution threatens to be a subject of infinite sects, like the Bible.” And, as with many sects, those politicians who most strenuously staked their arguments on the Constitution often appeared the least acquainted with it. Remarked New York governor Silas Wright, “No one familiar with the affairs of our government, can have failed to notice how large a proportion of our statesmen appear never to have read the Constitution of the United States with a careful reference to its precise language and exact provisions, but rather, as occasion presents, seem to exercise their ingenuity . . . to stretch both to the line of what they, at the moment, consider expedient.”22
  • A NATION HAS borders but the edges of an empire are frayed.23 While abolitionists damned the annexation of Texas as an extension of the slave power, more critics called it an act of imperialism, inconsistent with a republican form of government. “We have a republic, gentlemen, of vast extent and unequalled natural advantages,” Daniel Webster pointed out. “Instead of aiming to enlarge its boundaries, let us seek, rather, to strengthen its union.”24 Webster lost that argument, and, in the end, it was the American reach for empire that, by sundering the Union, brought about the collapse of slavery.
  • Although hardly ever reported in the press, the years between 1830 and 1860 saw more than one hundred incidents of violence between congressmen, from melees in the aisles to mass brawls on the floor, from fistfights and duels to street fights. “It is the game of these men, and of their profligate organs,” Dickens wrote, “to make the strife of politics so fierce and brutal, and so destructive of all self-respect in worthy men, that sensitive and delicate-minded persons shall be kept aloof, and they, and such as they, be left to battle out their selfish views unchecked.”
  • They spat venom. They pulled guns. They unsheathed knives. Divisions of party were abandoned; the splinter in Congress was sectional. Before heading to the Capitol every morning, southern congressmen strapped bowie knives to their belts and tucked pistols into their pockets. Northerners, on principle, came unarmed. When northerners talked about the slave power, they meant that literally.32
  • If the United States were to acquire territory from Mexico, and if this territory were to enter the Union, would Mexicans become American citizens? Calhoun, now in the Senate, vehemently opposed this idea. “I protest against the incorporation of such a people,” he declared. “Ours is the government of the white man.”
  • And yet, as different as were Wilmot’s interests from Calhoun’s, they were both interested in the rights of white men, as Wilmot made plain. “I plead the cause of the rights of white freemen,” he said. “I would preserve for free white labor a fair country, a rich inheritance, where the sons of toil, of my own race and own color, can live without the disgrace which association with negro slavery brings upon free labor.”
  • If the problem was the size of the Republic, the sprawl of its borders, the frayed edges of empire, couldn’t railroads, and especially the telegraph, tie the Republic together? “Doubt has been entertained by many patriotic minds how far the rapid, full, and thorough intercommunication of thought and intelligence, so necessary to the people living under a common representative republic, could be expected to take place throughout such immense bounds,” said one House member in 1845, but “that doubt can no longer exist.”45
  • even Americans with an unflinching faith in machine-driven progress understood that a pulse along a wire could not stop the slow but steady dissolution of the Union.
  • the Treaty of Guadalupe Hidalgo, under which the top half of Mexico became the bottom third of the United States. The gain to the United States was as great as the loss to Mexico. In 1820, the United States of America had spanned 1.8 million square miles, with a population of 9.6 million people; Mexico had spanned 1.7 million square miles, with a population of 6.5 million people. By 1850, the United States had acquired one million square miles of Mexico, and its population had grown to 23.2 million; Mexico’s population was 7.5 million.49
  • The Louisiana Purchase had doubled the size of the United States. In gaining territory from Mexico, the United States grew by 64 percent.
  • the territory comprising the United States had grown to “nearly ten times as large as the whole of France and Great Britain combined; three times as large as the whole of France, Britain, Austria, Prussia, Spain, Portugal, Belgium, Holland, and Denmark, together; one-and-a-half times as large as the Russian empire in Europe; one-sixth less only than the area covered by the fifty-nine or sixty empires, states, and Republics of Europe; of equal extent with the Roman Empire or that of Alexander, neither of which is said to have exceeded 3,000,000 square miles.”50
  • Sentiment was not Fuller’s way; debate was her way. She was a scourge of lesser intellects. Edgar Allan Poe, whose work she did not admire, described her as wearing a perpetual sneer. In “The Great Lawsuit: Man versus Men, Woman versus Women,” Fuller argued that the democratization of American politics had cast light on the tyranny of men over women: “As men become aware that all men have not had their fair chance,” she observed, women had become willing to say “that no women have had a fair chance.”
  • In 1845, in Woman in the Nineteenth Century, Fuller argued for fundamental and complete equality: “We would have every path laid open to Woman as freely as to Man.”56 The book was wildly successful, and Greeley, who had taken to greeting Fuller with one of her catchphrases about women’s capacity—“Let them be sea-captains, if you will”—sent her to Europe to become his newspaper’s foreign correspondent.
  • Reeling from those revolutions, the king of Bavaria asked the historian Leopold von Ranke to explain why his people had rebelled against monarchial rule, as had so many peoples in Europe that year. “Ideas spread most rapidly when they have found adequate concrete expression,” Ranke told the king, and the United States had “introduced a new force in the world,” the idea that “the nation should govern itself,” an idea that would determine “the course of the modern world”: free speech, spread by wire, would make the whole world free.61
  • Unlike Thoreau, who cursed the railroads, Free-Soilers believed in improvement, improvement through the hard work of the laboring man, his power, his energy. “Our paupers to-day, thanks to free labor, are our yeoman and merchants of tomorrow,” the New York Times boasted. “Why, who are the laboring people of the North?” Daniel Webster asked. “They are the whole North. They are the people who till their own farms with their own hands, freeholders, educated men, independent men.”
  • This attack by northerners led southerners to greater exertions in defending their way of life. They battled on several fronts. They described northern “wage slavery” as a far more exploitative system of labor than slavery. They celebrated slavery as fundamental to American prosperity. Slavery “has grown with our growth, and strengthened with our strength,” Calhoun said. And they elaborated an increasingly virulent ideology of racial difference, arguing against the very idea of equality embodied in the American creed.
  • Conservative Virginian George Fitzhugh, himself inspired by ethnological thinking, dismissed the “self-evident truths” of the Declaration of Independence as utter nonsense. “Men are not born physically, morally, or intellectually equal,” he wrote. “It would be far nearer the truth to say, ‘that some were born with saddles on their backs, and others booted and spurred to ride them,’—and the riding does them good.”
  • For Fitzhugh, the error had begun in the imaginations of the philosophes of the Enlightenment and in their denial of the reality of history. Life and liberty are not “inalienable rights,” Fitzhugh argued: instead, people “have been sold in all countries, and in all ages, and must be sold so long as human nature lasts.” Equality means calamity: “Subordination, difference of caste and classes, difference of sex, age, and slavery beget peace and good will.”
  • Progress is an illusion: “the world has not improved in the last two thousand, probably four thousand years.” Perfection is to be found in the past, not in the future.66 As for the economic systems of the North and the South, “Free laborers have not a thousandth part of the rights and liberties of negro slaves,” Fitzhugh insisted. “The negro slaves of the South are the happiest, and, in some sense, the freest people in the world.”67
  • HISTORY TEEMS WITH mishaps and might-have-beens: explosions on the Potomac, storms not far from port, narrowly contested elections, court cases lost and won, political visionaries drowned. But over the United States in the 1850s, a sense of inevitability fell, as if there were a fate, a dismal dismantlement, that no series of events or accidents could thwart.
  • over the United States in the 1850s, a sense of inevitability fell, as if there were a fate, a dismal dismantlement, that no series of events or accidents could thwart.
  • Douglas promoted the idea of popular sovereignty, proclaiming, “If there is any one principle dearer and more sacred than all others in free governments, it is that which asserts the exclusive right of a free people to form and adopt their own fundamental law.”75 Unfree people, within Stephen Douglas’s understanding, had no such rights.
  • the Fugitive Slave Law, required citizens to turn in runaway slaves and denied fugitives the right to a jury trial. The law, said Harriet Jacobs, a fugitive slave living in New York, marked “the beginning of a reign of terror to the colored population.”76 Bounty hunters and slave catchers hunted down and captured former slaves and returned them to their owners for a fee. Little stopped them from seizing men, women, and children who had been born free, or who had been legally emancipated, and selling them to the South, too. Nothing so brutally exposed the fragility of freedom or the rapaciousness of slavery.
  • February 1854, at their convention in Philadelphia, northern Know-Nothings proposed a platform plank calling for the reinstatement of the Missouri Compromise. When that motion was rejected, some fifty delegates from eight northern states bolted: they left the convention, and the party, to set up their own party, the short-lived North American Party. Nativism would endure as a force in American politics, but, meanwhile, nativists split over slavery.
  • Lincoln’s was the language of free soil, free speech, and free labor. He grounded his argument against slavery in his understanding of American history, in the language of Frederick Douglass, and in his reading of the Constitution. “Let no one be deceived,” he said. “The spirit of seventy-six and the spirit of Nebraska, are utter antagonisms.”
  • As a nation, we began by declaring that “all men are created equal.” We now practically read it “all men are created equal, except negroes.” When the Know-Nothings get control, it will read “all men are created equal, except negroes, and foreigners, and Catholics.” When it comes to this I should prefer emigrating to some country where they make no pretense of loving liberty—to Russia, for instance, where despotism can be taken pure, and without the base alloy of hypocrisy.
  • “That negroes, whether slave or free, that is, men of the African race, are not citizens of the United States by the Constitution.” The implications of the ruling stunned his readers. Even Americans who held no strong views on the question of slavery—and they were rare enough—were nonetheless shocked by the court’s exercise of the authority to determine the unconstitutionality of the law.
  • “A large meeting of colored people” was held in Philadelphia in April, at which it was resolved that “the only duty the colored man owes to a Constitution under which he is declared to be an inferior and degraded being, having no rights which white men are bound to respect, is to denounce and repudiate it, and to do what he can by all proper means to bring it into contempt.”
  • “You may close your Supreme Court against the black man’s cry for justice, but you cannot, thank God, close against him the ear of a sympathising world, nor shut up the Court of Heaven.” Taney’s interpretation of the Constitution would be ignored, Douglass predicted. “Slavery lives in this country not because of any paper Constitution, but in the moral blindness of the American people.”102
  • APHOTOGRAPH STOPS TIME, TRAPPING IT LIKE A BUTTERFLY in a jar.
  • No other kind of historical evidence has this quality of instantaneity, of an impression taken in a moment, in a flicker, an eye opened and then shut. Photographs also capture the ordinary, the humble, the speechless. The camera discriminates between light and dark but not between the rich and the poor, the literate and the illiterate, the noisy and the quiet.
  • portraits were also closely associated with death, with being trapped in time, on glass, for eternity, and, even more poignantly, with equality.3 With photography, Walt Whitman predicted, “Art will be democratized.”
  • Morse had long predicted that the telegraph would usher in an age of world peace. “I trust that one of its effects will be to bind man to his fellow-man in such bonds of amity as to put an end to war,” he insisted.8 War was a failure of technology, Morse argued, a shortcoming of communication that could be remedied by way of a machine. Endowing his work with the grandest of purposes, he believed that the laying of telegraph wires across the American continent would bind the nation together into one people, and that the laying of cable across the ocean would bind Europe to the Americas, ushering in the dawn of an age of global harmony.
  • But war isn’t a failure of technology; it’s a failure of politics.
  • Debate is to war what trial by jury is to trial by combat: a way to settle a dispute without coming to blows. The form and its rules had been established over centuries. They derived from rules used in the courts and in Parliament, and even from the rules of rhetoric used in the writing of poetry. Since the Middle Ages and the founding of the first universities, debate had been the foundation of a liberal arts education.
  • (Etymologically and historically, the artes liberales are the arts acquired by people who are free, or liber.)10 In the eighteenth century, debate was understood as the foundation of civil society. In 1787, delegates to the constitutional convention had agreed to “to argue without asperity, and to endeavor to convince the judgment without hurting the feelings of each other.”
  • Some twelve thousand people showed up for their first debate, at two o’clock in the afternoon on August 21, in Ottawa, Illinois. There were no seats; the audience stood, without relief, for three hours.
  • They’d agreed to strict rules: the first speaker would speak for an hour and the second for an hour and a half, whereupon the first speaker would offer a thirty-minute rebuttal.
  • And, as to the wrongness of slavery, he called it tyranny, and the idea of its naturalness as much an error as a belief in the divine right of kings. The question wasn’t sectionalism or nationalism, the Democratic Party or the Republican Party. The question was right against wrong. “That is the issue that will continue in this country when these poor tongues of Judge Douglas and myself shall be silent,” Lincoln said.16
  • The price of slaves grew so high that a sizable number of white southerners urged the reopening of the African slave trade. In the 1850s, legislatures in several states, including South Carolina, proposed reopening the trade. Adopting this measure would have violated federal law. Some “reopeners” believed that the federal ban on the trade was unconstitutional; others were keen to nullify it, in a dress rehearsal for secession.
  • “If it is right to buy slaves in Virginia and carry them to New Orleans, why is it not right to buy them in Cuba, Brazil, or Africa and carry them there?”21 Proslavery southerners made these arguments under the banner of “free trade,” their rhetorical answer to “free labor.”
  • To George Fitzhugh, all societies were “at all times and places, regulated by laws as universal and as similar as those which control the affairs of bees,” and trade itself, including the slave trade, was “as old, as natural, and irresistible as the tides of the ocean.”
  • In 1855, David Christy, the author of Cotton Is King, wrote about the vital importance of “the doctrine of Free Trade,” which included abolishing the tariffs that made imported English goods more expensive than manufactured goods produced in the North. As one southerner put it, “Free trade, unshackled industry, is the motto of the South.”23
  • Darwin’s Origin of Species would have a vast and lingering influence on the world of ideas. Most immediately, it refuted the racial arguments of ethnologists like Louis Agassiz. And, in the months immediately following the book’s publication—the last, unsettling months before the beginning of the Civil War—abolitionists took it as evidence of the common humanity of man.30
  • The truths of the Confederacy disavowed the truths of the Union. The Confederacy’s newly elected vice president, a frail Georgian named Alexander Stephens, delivered a speech in Savannah in which he made those differences starkly clear. The ideas that lie behind the Constitution “rested upon the assumption of the equality of races,” Stephens said, but
  • “Our new government is founded upon exactly the opposite idea: its foundations are laid, its cornerstone rests, upon the great truth that the negro is not equal to the white man; that slavery . . . is his natural and moral condition. This, our new government, is the first, in the history of the world, based upon this great physical, philosophical, and moral truth.”52 It would become politically expedient, after the war, for ex-Confederates to insist that the Confederacy was founded on states’ rights. But the Confederacy was founded on white supremacy.
  • Opposition to free speech had long been the position of slave owners, a position taken at the constitutional convention and extended through the gag rule, antiliteracy laws, bans on the mails, and the suppression of speakers. An aversion to political debate also structured the Confederacy, which had both a distinctive character and a lasting influence on Americans’ ideas about federal authority as against popular sovereignty.
  • Secessionists were attempting to build a modern, proslavery, antidemocratic state. In order to wage a war, the leaders of this fundamentally antidemocratic state needed popular support. Such support was difficult to gain and impossible to maintain. The Confederacy therefore suppressed dissent.55
  • By May of 1861, the Confederacy comprised fifteen states stretching over 900,000 square miles and containing 12 million people, including 4 million slaves, and 4 million white women who were disenfranchised. It rested on the foundational belief that a minority governs a majority. “The condition of slavery is with us nothing but a form of civil government for a class of people not fit to govern themselves,” said Jefferson Davis.
  • There would be those, after the war ended, who said that it had been fought over states’ rights or to preserve the Union or for a thousand other reasons and causes. Soldiers, North and South, knew better. “The fact that slavery is the sole undeniable cause of this infamous rebellion, that it is a war of, by, and for Slavery, is as plain as the noon-day sun,” a soldier writing for his Wisconsin regimental newspaper explained in 1862. “Any man who pretends to believe that this is not a war for the emancipation of the blacks,” a soldier writing for his Confederate brigade’s newspaper wrote that same year, “is either a fool or a liar.”
  • Lincoln would remain a man trapped in time, in the click of a shutter and by the trigger of a gun. In mourning him, in sepia and yellow, in black and white, beneath plates of glinting glass, Americans deferred a different grief, a vaster and more dire reckoning with centuries of suffering and loss, not captured by any camera, not settled by any amendment, the injuries wrought on the bodies of millions of men, women, and children, stolen, shackled, hunted, whipped, branded, raped, starved, and buried in unmarked graves.
  • No president consecrated their cemeteries or delivered their Gettysburg address; no committee of arrangements built monuments to their memory. With Lincoln’s death, it was as if millions of people had been crammed into his tomb, trapped in a vault that could not hold them.
  • People running for Congress didn’t have to meet property requirements; they didn’t have to have been born in the United States; and they couldn’t be subjected to religious tests. This same logic applied to citizenship, and for the same reason: the framers of the Constitution understood these sorts of requirements as forms of political oppression. The door to the United States was meant to be open.
  • Before the 1880s, no federal law restricted immigration. And, despite periods of fervent nativism, especially in the 1840s, the United States welcomed immigrants into citizenship, and valued them. After the Civil War, the U.S. Treasury estimated the worth of each immigrant as equal to an $800 contribution to the nation’s economy,
  • Nineteenth-century politicians and political theorists interpreted American citizenship within the context of an emerging set of ideas about human rights and the authority of the state, holding dear the conviction that a good government guarantees everyone eligible for citizenship the same set of political rights, equal and irrevocable.
  • The Civil War raised fundamental questions not only about the relationship between the states and the federal government but also about citizenship itself and about the very notion of a nation-state. What is a citizen? What powers can a state exert over its citizens? Is suffrage a right of citizenship, or a special right, available only to certain citizens? Are women citizens? And if women are citizens, why aren’t they voters? What about Chinese immigrants, pouring into the West? They were free. Were they, under American law, “free white persons” or “free persons of color” or some other sort of persons?
  • In 1866, Congress searched in vain for a well-documented definition of the word “citizen.” Over the next thirty years, that definition would become clear, and it would narrow.
  • In 1896, the U.S. passport office, in the Department of State, which had grown to thousands of clerks, began processing applications according to new “Rules Governing the Application of Passports,” which required evidence of identity, including a close physical description Lew Wa Ho worked at a dry goods shop in St. Louis; the photograph was included in his Immigration Service case file as evidence of employment. Age, _____ years; stature, _____ feet _____ inches (English measure); forehead, _____; eyes, _____; nose, _____; mouth, _____; chin, _____; hair, _____; complexion, _____; face, _____ as well as affidavits, signatures, witnesses, an oath of loyalty, and, by way of an application fee, one dollar.12
  • The Fourteenth Amendment, drafted by the Joint Committee on Reconstruction, marked the signal constitutional achievement of a century of debate and war, of suffering and struggle. It proposed a definition of citizenship guaranteeing its privileges and immunities, and insuring equal protection and due process to all citizens. “All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside,”
  • “No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.”20
  • During the drafting of the amendment, the committee betrayed the national phalanx of women who for decades had fought for abolition and for black civil rights by proposing to insert, into the amendment’s second section, a provision that any state that denied the right to vote “to any of the male inhabitants of such state” would lose representation in Congress. “Male” had never before appeared in any part of the Constitution. “If that word ‘male’ be inserted,” Stanton warned, “it will take us a century at least to get it out.”21 She was not far wrong.
  • Women protested. “Can any one tell us why the great advocates of Human Equality . . . forget that when they were a weak party and needed all the womanly strength of the nation to help them on, they always united the words ‘without regard to sex, race, or color’?” asked Ohio-born reformer Frances Gage. Charles Sumner offered this answer: “We know how the Negro will vote, but are not so sure of the women.” How women would vote was impossible to know. Would black women vote the way black men voted? Would white women vote like black women? Republicans decided they’d rather not find out.
  • In the federal census of 1860, 24,282 out of 34,935 Chinese toiled in mines. Although some Chinese immigrants left mining—and some were forced out—many continued to mine well into the 1880s, often working in sites abandoned by other miners.
  • An 1867 government report noted that in Montana, “the diggings now fall into the hands of the Chinese, who patiently glean the fields abandoned by the whites.” Chinese workers began settling in Boise in 1865 and only five years later constituted a third of Idaho’s settlers and nearly 60 percent of its miners. In 1870, Chinese immigrants and their children made up nearly 9 percent of the population of California, and one-quarter of the state’s wage earners.
  • Their rights, under state constitutions and statutes, were markedly limited. Oregon’s 1857 constitution barred “Chinamen” from owning real estate, while California barred Chinese immigrants from testifying in court, a provision upheld in an 1854 state supreme court opinion, People v. Hall, which described the Chinese as “a race of people whom nature has marked as inferior, and who are incapable of progress or intellectual development beyond a certain point, as their history has shown.”29
  • And what about the voting rights of U.S.-born Chinese Americans? Much turned on the Fifteenth Amendment, proposed early in 1869. While the aim of the amendment was to guarantee African Americans the right to vote and hold office, its language inevitably raised the question of Chinese citizenship and suffrage. Opponents of the amendment found its entire premise scandalous. Garrett Davis, a Democratic senator from Kentucky, fumed, “I want no negro government; I want no Mongolian government; I want the government of the white man which our fathers incorporated.”33
  • Douglass spoke about what he called a “composite nation,” a strikingly original and generative idea, about a citizenry made better, and stronger, not in spite of its many elements, but because of them: “I want a home here not only for the negro, the mulatto and the Latin races; but I want the Asiatic to find a home here in the United States, and feel at home here, both for his sake and for ours.”36
  • Tilden won the nomination anyway and, in the general election, he won the popular vote against Hayes. Unwilling to accept the result of the election, Republicans disputed the returns in Florida, Louisiana, and South Carolina.
  • Eventually, the decision was thrown to an electoral commission that brokered a nefarious compromise: Democrats agreed to throw their support behind the man ever after known as Rutherfraud B. Hayes, so that he could become president, in exchange for a promise from Republicans to end the military occupation of the South. For a minor and petty political win over the Democratic Party, Republicans first committed electoral fraud and then, in brokering a compromise, abandoned a century-long fight for civil rights.
  • As soon as federal troops withdrew, white Democrats, calling themselves the “Redeemers,” took control of state governments of the South, and the era of black men’s enfranchisement came to a violent and terrible end. The Klan terrorized the countryside, burning homes and hunting, torturing, and killing people. (Between 1882 and 1930, murderers lynched more than three thousand black men and women.)
  • Black politicians elected to office were thrown out. And all-white legislatures began passing a new set of black codes, known as Jim Crow laws, that segregated blacks from whites in every conceivable public place, down to the last street corner. Tennessee passed the first Jim Crow law, in 1881, mandating the separation of blacks and whites in railroad cars. Georgia became the first state to demand separate seating for whites and blacks in streetcars, in 1891.
  • “Capital buys and sells to-day the very heart-beats of humanity,” she said. Democracy itself had been corrupted by it: “the speculators, the land-robbers, the pirates and gamblers of this Nation have knocked unceasingly at the doors of Congress, and Congress has in every case acceded to their demands.”44 The capitalists, she said, had subverted the will of the people.
  • In the late nineteenth century, a curious reversal took place. Electoral politics, the politics men engaged in, became domesticated, the office work of education and advertising—even voting moved indoors. Meanwhile, women’s political expression moved to the streets. And there, at marches, rallies, and parades, women deployed the tools of the nineteenth-century religious revival: the sermon, the appeal, the conversion.45
  • 1862 alone, in addition to the Homestead Act, the Republican Congress passed the Pacific Railway Act (chartering railroad companies to build the line from Omaha, Nebraska, to Sacramento, California) and the National Bank Act (to issue paper money to pay for it all). After the war, political power moved from the states to the federal government and as the political influence of the South waned, the importance of the West rose. Congress not only sent to the states amendments to the Constitution that defined citizenship and guaranteed voting rights but also passed landmark legislation involving the management of western land, the control of native populations, the growth and development of large corporations, and the construction of a national transportation infrastructure.
  • The independent farmer—the lingering ideal of the Jeffersonian yeoman—remained the watchword of the West, but in truth, the family farming for subsistence, free of government interference, was far less common than a federally subsidized, capitalist model of farming and cattle raising for a national or even an international market. The small family farm—Jefferson’s republican dream—was in many parts of the arid West an environmental impossibility.
  • Much of the property distributed under the terms of the Homestead Act, primarily in the Great Basin, was semi-arid, the kind of land on which few farmers could manage a productive farm with only 160 acres. Instead, Congress typically granted the best land to railroads, and allowed other, bigger interests to step in, buying up large swaths for agricultural business or stock raising and fencing it in, especially after the patenting of barbed wire in 1874.46
  • In 1885, an American economist tried to reckon the extraordinary transformation wrought by what was now 200,000 miles of railroad, more than in all of Europe. It was possible to move one ton of freight one mile for less than seven-tenths of one cent, “a sum so small,” he wrote, “that outside of China it would be difficult to find a coin of equivalent value to give a boy as a reward for carrying an ounce package across a street.”48
  • instability contributed to a broader set of political concerns that became Mary Lease’s obsession, concerns known as “the money question,” and traceable all the way back to Hamilton’s economic plan: Should the federal government control banking and industry?
  • No group of native-born Americans was more determined to end Chinese immigration than factory workers. The 1876 platform of the Workingmen’s Party of California declared that “to an American death is preferable to life on par with a Chinaman.”55 In 1882, spurred by the nativism of populists, Congress passed its first-ever immigration law, the Chinese Exclusion Act, which barred immigrants from China from entering the United States and, determining that the Fourteenth Amendment did not apply to people of Chinese ancestry, decreed that Chinese people already in the United States were permanent aliens who could never become citizens.
  • Populists, whether farmers or factory workers, for all their invocation of “the people,” tended to take a narrow view of citizenship. United in their opposition to the “money power,” members of the alliance, like members of the Knights of Labor, were also nearly united in their opposition to the political claims of Chinese immigrants, and of black people. The Farmers’ Alliance excluded African Americans, who formed their own association, the Colored Farmers’ Alliance. Nor did populists count Native Americans within the body of “the people.”
  • In 1887, Congress passed the Dawes Severalty Act, under whose terms the U.S. government offered native peoples a path to citizenship in a nation whose reach had extended across the lands of their ancestors. The Dawes Act granted to the federal government the authority to divide Indian lands into allotments and guaranteed U.S. citizenship to Indians who agreed to live on those allotments and renounce tribal membership.
  • In proposing the allotment plan, Massachusetts senator Henry Laurens Dawes argued that the time had come for Indians to choose between “extermination or civilization” and insisted that the law offered Americans the opportunity to “wipe out the disgrace of our past treatment” and instead lift Indians up “into citizenship and manhood.”58
  • But in truth the Dawes Act understood native peoples neither as citizens nor as “persons of color,” and led to nothing so much as forced assimilation and the continued takeover of native lands. In 1887 Indians held 138 million acres; by 1900, they held only half of that territory.
  • In 1877, railroad workers protesting wage cuts went on strike in cities across the country. President Hayes sent in federal troops to end the strikes, marking the first use of the power of the federal government to support business against labor. The strikes continued, with little success in improving working conditions. Between 1881 and 1894, there was, on average, one major railroad strike a week. Labor was, generally and literally, crushed: in a single year, of some 700,000 men working on the railroads, more than 20,000 were injured on the job and nearly 2,000 killed.59
  • In 1882, Roscoe Conkling represented the Southern Pacific Railroad Company’s challenge to a California tax rule. He told the U.S. Supreme Court, “I come now to say that the Southern Pacific Railroad Company and its creditors and stockholders are among the ‘persons’ protected by the Fourteenth Amendment.”
  • In offering an argument about the meaning and original intention of the word “person” in the Fourteenth Amendment, Conkling enjoyed a singular authority: he’d served on the Joint Committee on Reconstruction that had drafted the amendment and by 1882 was the lone member of that committee still living. With no one alive to contradict him, Conkling assured the court that the committee had specifically rejected the word “citizen” in favor of “person” in order to include corporations. (A
  • Much evidence suggests, however, that Conkling was lying. The record of the deliberations of the Joint Committee on Reconstruction does not support his argument regarding the committee’s original intentions, nor is it plausible that between 1866 and 1882, the framers of the Fourteenth Amendment had kept mysteriously hidden their secret intention to guarantee equal protection and due process to corporations. But
  • in 1886, when another railroad case, Santa Clara County v. Southern Pacific Railroad, reached the Supreme Court, the court’s official recorder implied that the court had accepted the doctrine that “corporations are persons within the meaning of the Fourteenth Amendment.”62 After that, the Fourteenth Amendment, written and ratified to guarantee freed slaves equal protection and due process of law, became the chief means by which corporations freed themselves from government regulation.
  • In 1937, Supreme Court Justice Hugo Black would observe, with grim dismay, that, over the course of fifty years, “only one half of one percent of the Fourteenth Amendment cases that came before the court had anything to do with African Americans or former slaves, while over half of the cases were about protecting the rights of corporations.”63 Rights guaranteed to the people were proffered, instead, to corporations.
  • He devised an economic plan that involved abolishing taxes on labor and instead imposing a single tax on land. Tocqueville had argued that democracy in America is made possible by economic equality; people with equal estates will eventually fight for, and win, equal political rights. George agreed. But, like Mary Lease, he thought that financial capitalism was destroying democracy by making economic equality impossible. He saw himself as defending “the Republicanism of Jefferson and the Democracy of Jackson.”72
  • Between 1889 and 1893, the mortgages on so many farms were foreclosed that 90 percent of farmland fell into the hands of bankers. The richest 1 percent of Americans owned 51 percent of the nation’s wealth, and the poorest 44 percent owned less than 2 percent.
  • For all its passionate embrace of political equality and human rights and its energetic championing of suffrage, the People’s Party rested on a deep and abiding commitment to exclude from full citizenship anyone from or descended from anyone from Africa or Asia.
  • Many of the reforms proposed by populists had the effect of diminishing the political power of blacks and immigrants. Chief among them was the Australian ballot, more usually known as the secret ballot, which, by serving as a de facto literacy test, disenfranchised both black men in the rural South and new immigrants in northern cities.
  • to deliberate at length over the secret ballot. Quickest to adopt the reform were the states of the former Confederacy, where the reform appealed to legislatures eager to find legal ways to keep black men from voting. In 1890, Mississippi held a constitutional
  • Both by law and by brute force, southern legislators, state by state, and poll workers, precinct by precinct, denied black men the right to vote. In Louisiana, black voter registration dropped from 130,000 in 1898 to 5,300 in 1908, and to 730 in 1910. In 1893, Arkansas Democrats celebrated their electoral advantage by singing,         The Australian ballot works like a charm         It makes them think and scratch         And when a Negro gets a ballot         He has certainly met his match.82
  • One Republican said, “I felt that Bryan was the first politician I had ever heard speak the truth and nothing but the truth,” even though in every case, when he read a transcript of the speech in the newspaper the next day, he “disagreed with almost all of it.”85
  • In 1894, Bryan tacked an income tax amendment to a tariff bill, which managed to pass. But the populist victory—a 2 percent federal income tax that applied only to Americans who earned more than $4,000—didn’t last long. The next year, in Pollock v. Farmers’ Loan and Trust Company, the Supreme Court ruled 5–4 that the tax was a direct tax, and therefore unconstitutional, one justice calling the tax the first campaign in “a war of the poor against the rich.”
  • POPULISM ENTERED AMERICAN politics at the end of the nineteenth century, and it never left. It pitted “the people,” meaning everyone but the rich, against corporations, which fought back in the courts by defining themselves as “persons”; and it pitted “the people,” meaning white people, against nonwhite people who were fighting for citizenship and whose ability to fight back in the courts was far more limited, since those fights require well-paid lawyers.
  • After 1859, and the Origin of Species, the rise of Darwinism contributed to the secularization of the university, as did the influence of the German educational model, in which universities were divided into disciplines and departments, each with a claim to secular, and especially scientific, expertise. These social sciences—political science, economics, sociology, and anthropology—used the methods of science, and especially of quantification, to study history, government, the economy, society, and culture.96
  • For Wilson’s generation of political scientists, the study of the state replaced the study of the people. The erection of the state became, in their view, the greatest achievement of civilization. The state also provided a bulwark against populism. In the first decades of the twentieth century, populism would yield to progressivism as urban reformers applied the new social sciences to the study of political problems, to be remedied by the intervention of the state.
  • The rise of populism and the social sciences reshaped the press, too. In the 1790s, the weekly partisan newspaper produced the two-party system. The penny press of the 1830s produced the popular politics of Jacksonian democracy. And in the 1880s and 1890s the spirit of populism and the empiricism of the social sciences drove American newspapers to a newfound obsession with facts.
  • The newspapers of the 1880s and 1890s were full of stunts and scandals and crusades, even as they defended their accuracy. “Facts, facts piled up to the point of dry certitude was what the American people really wanted,” wrote the reporter Ray Stannard Baker. Julius Chambers said that writing for the New York Herald involved “Facts; facts; nothing but facts. So many peas at so much a peck; so much molasses at so much a quart.”
  • Ballot reform, far from keeping money out of elections, had ushered more money into elections, along with a new political style: using piles of money to sell a candidate’s personality, borrowing from the methods of business by using mass advertising and education, slogans and billboards. McKinley ran a new-style campaign; Bryan ran an old-style campaign. Bryan barnstormed all over the country: he gave some six hundred speeches to five million people in twenty-seven states and traveled nearly twenty thousand miles.
  • But McKinley’s campaign coffers were fuller: Republicans spent $7 million; Democrats, $300,000. John D. Rockefeller alone provided the GOP with a quarter of a million dollars. McKinley’s campaign manager, Cleveland businessman Mark Hanna, was nearly buried in donations from fellow businessmen. He used that money to print 120 million pieces of campaign literature. He hired fourteen hundred speakers to stump for McKinley; dubbing the populists Popocrats, they agitated voters to a state of panic.108 As Mary Lease liked to say, money elected McKinley.
  • Turner, born in Wisconsin in 1861, was one of the first Americans to receive a doctorate in history. At the exposition, he delivered his remarks before the American Historical Association, an organization that had been founded in 1884 and incorporated by an act of Congress in 1889 “for the promotion of historical studies, the collection and preservation of historical manuscripts and for kindred purposes in the interest of American history and of history in America.”110
  • like journalists, historians borrowed from the emerging social sciences, relying on quantitative analysis to understand how change happens. Where George Bancroft, in his History of the United States, had looked for explanations in the hand of providence, Frederick Jackson Turner looked to the census.
  • The difference between Turner’s methods and Bancroft’s signaled a profound shift in the organization of knowledge, one that would have lasting consequences for the relationship between the people and the state and for civil society itself. Like Darwinism, the rise of the social sciences involved the abdication of other ways of knowing, and, indirectly, contributed to the rise of fundamentalism.
  • Across newly defined academic disciplines, scholars abandoned the idea of mystery—the idea that there are things known only by God—in favor of the claim to objectivity, a development sometimes called “the disenchantment of the world.”111 When universities grew more secular, religious instruction became confined to divinity schools and theological seminaries.
  • theologian at the University of Chicago’s divinity school defined modernism as “the use of scientific, historical, and social methods in understanding and applying evangelical Christianity to the needs of living persons.”112 Increasingly, this is exactly what evangelicals who eventually identified themselves as fundamentalists found objectionable.
  • Influenced by both Jefferson and Darwin, Turner saw the American frontier as the site of political evolution, beginning with the “savages” of a “wilderness,” proceeding to the arrival of European traders, and continuing through various forms of settlement, through the establishment of cities and factories, “the evolution of each into a higher stage,” and culminating in the final stage of civilization: capitalism and democracy.114
  • “American democracy is fundamentally the outcome of the experiences of the American people in dealing with the West,” by which he meant the experience of European immigrants to the United States in defeating its native peoples, taking possession of their homelands, and erecting there a civilization of their own. This, for Turner, was the story of America and the lesson of American history: evolution.116
  • Douglass, who, as the former U.S. ambassador to Haiti, had represented the nation of Haiti at the Haitian pavilion, was the only eminent African American with a role at the fair, whose program had been planned by a board of 208 commissioners, all white.117 There were, however, black people at the fair: on display. In the Hall of Agriculture, old men and women, former slaves, sold miniature bales of cotton, souvenirs, while, in a series of exhibits intended to display the Turnerian progress of humankind from savagery to civilization, black Americans were posed in a fake African village. “As if to shame the Negro,” Douglass wrote, they “exhibit the Negro as a repulsive savage.”118
  • “A ship at anchor, with halliards broken, sails mildewed, hull empty, her bottom covered with sea-weed and barnacles, meets no resistance,” Douglass said that day, turning the idea of a ship of state to the problem of Jim Crow. “But when she spread her canvas to the breeze and sets out on her voyage, turns prow to the open sea, the higher shall be her speed, the greater shall be her resistance. And so it is with the colored man.”
  • He paused to allow his listeners to conjure the scene, and its meaning, of a people struggling against the sea. “My dear young friends,” Douglass closed. “Accept the inspiration of hope. Imitate the example of the brave mariner, who, amid clouds and darkness, amid hail, rain and storm bolts, battles his way against all that the sea opposes to his progress and you will reach the goal of your noble ambition in safety.”124
  • The majority in Plessy v. Ferguson asserted that separation and equality were wholly separate ideas. “We consider the underlying fallacy of the plaintiff’s argument to consist in the assumption that the enforced separation of the two races stamps the colored race with a badge of inferiority. If this be so, it is not by reason of anything found in the act, but solely because the colored race chooses to put that construction upon it.” The resulting legal principle—that public accommodations could be “separate but equal”—would last for more than half a century.
  • The sole dissenter, John Marshall Harlan, objecting to the establishment of separate classes of citizens, insisted that the achievement of the United States had been the establishment, by amendment, of a Constitution that was blind to race. “Our constitution is color-blind, and neither knows nor tolerates classes among citizens,” Harlan wrote, and it is therefore a plain violation of the Constitution “for a state to regulate the enjoyment by citizens of their civil rights solely upon the basis of race.”
  • What all these laws had in common, Harlan argued, was that they were based on race. And yet a war had been fought and won to establish that laws in the United States could not be based on race; nor could citizenship be restricted by race. The court’s opinion in Plessy, Harlan warned, was so dreadfully in error as to constitutional principles that “the judgment this day rendered will, in time, prove to be quite as pernicious as the decision made by this tribunal in the Dred Scott Case.”128 This prediction proved true.
  • Four centuries had passed since continents, separated by oceans, had met again. A century had passed since Jefferson had declared all men equal. Three decades had passed since the Fourteenth Amendment had declared all persons born or naturalized in the United States to be citizens.
  • And now the Supreme Court ruled that those who would set aside equality in favor of separation had not violated the nation’s founding truths. In one of the most wrenching tragedies in American history—a chronicle not lacking for tragedy—the Confederacy had lost the war, but it had won the peace.
  • Lippmann started out as a socialist, when even mentioning the masses hinted at socialism; The Masses was the name of a socialist monthly, published in New York, and, especially after the Russian Revolution of 1917, which brought the Bolshevists to power (“bol’shinstvo” means “the majority”), “the masses” sounded decidedly Red.
  • But Lippmann soon began to write about the masses as “the bewildered herd,” unthinking and instinctual, and as dangerous as an impending stampede. For Lippmann, and for an entire generation of intellectuals, politicians, journalists, and bureaucrats who styled themselves Progressives—the term dates to 1910—the masses posed a threat to American democracy.
  • This change was wrought in the upheaval of the age. In the years following the realigning election of 1896, everything seemed, suddenly, bigger than before, more crowded, and more anonymous: looming and teeming. Even buildings were bigger: big office buildings, big factories, big mansions, big museums. Quantification became the only measure of value: how big, how much, how many.
  • To fight monopolies, protect the people, and conserve the land, the federal government grew bigger, too; dozens of new federal agencies were founded in this era,
  • “Mass” came to mean anything that involved a giant and possibly terrifying quantity, on a scale so great that it overwhelmed existing arrangements—including democracy. “Mass production” was coined in the 1890s, when factories got bigger and faster, when the number of people who worked in them skyrocketed, and when the men who owned them got staggeringly rich.
  • “Mass migration” dates to 1901, when nearly a million immigrants were entering the United States every year, “mass consumption” to 1905, “mass consciousness” to 1912. “Mass hysteria” had been defined by 1925 and “mass communication” by 1927, when the New York Times described the radio as “a system of mass communication with a mass audience.”3
  • And the masses themselves? They formed a mass audience for mass communication and had a tendency, psychologists believed, to mass hysteria—the political stampede—posing a political problem unanticipated by James Madison and Thomas Jefferson,
  • To meet that challenge in what came to be called the Progressive Era, activists, intellectuals, and politicians campaigned for and secured far-reaching reforms that included municipal, state, and federal legislation.
  • Their most powerful weapon was the journalistic exposé. Their biggest obstacle was the courts, which they attempted to hurdle by way of constitutional amendments. Out of these campaigns came the federal income tax, the Federal Reserve Bank, the direct election of U.S. senators, presidential primaries, minimum-wage and maximum-hour laws, women’s suffrage, and Prohibition.
  • And all of what Progressives accomplished in the management of mass democracy was vulnerable to the force that so worried the unrelenting Walter Lippmann: the malleability of public opinion, into mass delusion.
  • Progressives championed the same causes as Populists, and took their side in railing against big business, but while Populists generally wanted less government, Progressives wanted more, seeking solutions in reform legislation and in the establishment of bureaucracies, especially government agencies.6
  • Populists believed that the system was broken; Progressives believed that the government could fix it. Conservatives, who happened to dominate the Supreme Court, didn’t believe that there was anything to fix but believed that, if there was, the market would fix it. Notwithstanding conservatives’ influence in the judiciary, Progressivism spanned both parties.
  • Woodrow Wilson himself admitted, “When I sit down and compare my views with those of a Progressive Republican I can’t see what the difference is.”7
  • Much that was vital in Progressivism grew out of Protestantism, and especially out of a movement known as the Social Gospel, adopted by almost all theological liberals and by a large number of theological conservatives,
  • The Social Gospel movement was led by seminary professors—academic theologians who accepted the theory of evolution, seeing it as entirely consistent with the Bible and evidence of a divinely directed, purposeful universe; at the same time, they fiercely rejected the social Darwinism of writers like Herbert Spencer, the English natural scientist who coined the phrase “the survival of the fittest” and used the theory of evolution to defend all manner of force, violence, and oppression.
  • argued that fighting inequality produced by industrialism was an obligation of Christians: “We must make men believe that Christianity has a right to rule this kingdom of industry, as well as all the other kingdoms of this world.”9 Social Gospelers brought the zeal of abolitionism to the problem of industrialism.
  • In 1908, Methodists wrote a Social Creed and pledged to fight to end child labor and to promote a living wage. It was soon adopted by the thirty-three-member Federal Council of Churches, which proceeded to investigate a steelworkers’ strike in Bethlehem, ultimately taking the side of the strikers.10
  • Washington, in the debate over the annexation of the Philippines, Americans revisited unsettled questions about expansion that had rent the nation during the War with Mexico and unsettled questions about citizenship that remained the unfinished business of Reconstruction. The debate also marked the limits of the Progressive vision: both sides in this debate availed themselves, at one time or another, of the rhetoric of white supremacy. Eight million people of color in the Pacific and the Caribbean, from the Philippines to Puerto Rico, were now part of the United States, a nation that already, in practice, denied the right to vote to millions of its own people because of the color of their skin.
  • “You are undertaking to annex and make a component part of this Government islands inhabited by ten millions of the colored race, one-half or more of whom are barbarians of the lowest type,” said Ben Tillman, a one-eyed South Carolina Democrat who’d boasted of having killed black men and expressed his support for lynch mobs. “It is to the injection into the body politic of the United States of that vitiated blood, that debased and ignorant people, that we object.”
  • Tillman reminded Republicans that they had not so long ago freed slaves and then “forced on the white men of the South, at the point of the bayonet, the rule and domination of those ex-slaves. Why the difference? Why the change? Do you acknowledge that you were wrong in 1868?”14
  • The war that began in Cuba in 1898 and was declared over in the Philippines in 1902 dramatically worsened conditions for people of color in the United States, who faced, at home, a campaign of terrorism. Pro-war rhetoric, filled with racist venom, only further incited American racial hatreds. “If it is necessary, every Negro in the state will be lynched,” the governor of Mississippi pledged in 1903.
  • By one estimate, someone in the South was hanged or burned alive every four days. The court’s decision in Plessy v. Ferguson meant that there was no legal recourse to fight segregation, which grew more brutal with each passing year.
  • Nor was discrimination confined to the South. Cities and counties in the North and West passed racial zoning laws, banning blacks from the middle-class communities. In 1890, in Montana, blacks lived in all fifty-six counties in the state; by 1930, they’d been confined to just eleven. In Baltimore, blacks couldn’t buy houses on blocks where whites were a majority.
  • In 1917, in Buchanan v. Warley, the Supreme Court availed itself of the Fourteenth Amendment not to guarantee equal protection for blacks but to guarantee what the court had come to understand as the “liberty of contract”—the liberty of businesses to discriminate.16
  • A generation earlier, he’d have become a preacher, like his father, but instead he became a professor of political science.23 In the academy and later in the White House, he dedicated himself to the problem of adapting a Constitution written in the age of the cotton gin to the age of the automobile.
  • “We have grown more and more inclined from generation to generation to look to the President as the unifying force in our complex system, the leader both of his party and of the nation. To do so is not inconsistent with the actual provisions of the Constitution; it is only inconsistent with a very mechanical theory of its meaning and intention.” A president’s power, Wilson concluded, is virtually limitless: “His office is anything he has the sagacity and force to make it.”24
  • the U.S. Supreme Court overruled much Progressive labor legislation. The most important of these decisions came in 1905. In a 5–4 decision in Lochner v. New York, the U.S. Supreme Court voided a state law establishing that bakers could work no longer than ten hours a day, six days a week, on the ground that the law violated a business owner’s liberty of contract, the freedom to forge agreements with his workers, something the court’s majority said was protected under the Fourteenth Amendment.
  • The laissez-faire conservatism of the court was informed, in part, by social Darwinism, which suggested that the parties in disputes should be left to battle it out, and if one side had an advantage, even so great an advantage as a business owner has over its employees, then it should win.
  • In a dissenting opinion in Lochner, Oliver Wendell Holmes accused the court of violating the will of the people. “This case is decided upon an economic theory which a large part of the country does not entertain,” he began. The court, he said, had also wildly overreached its authority and had carried social Darwinism into the Constitution. “A Constitution is not intended to embody a particular economic theory,” Holmes wrote. “The Fourteenth Amendment does not enact Mr. Herbert Spencer’s Social Statics.”
  • Wilson pointed out that the Constitution, written before mass industrialization, couldn’t be expected to have anticipated it, and couldn’t solve the problems industrialization had created, unless the Constitution were treated like a living thing that, like an organism, evolved.
  • Critics further to the left argued that the courts had become an instrument of business interests. Unions, in fact, often failed to support labor reform legislation, partly because they expected it to be struck down by the courts as unconstitutional, and partly because they wanted unions to provide benefits to their members, which would be an argument for organizing.
  • conservatives insisted that the courts were right to protect the interests of business and that either market forces would find a way to care for sick, injured, and old workers, or (for social Darwinists) the weakest, who were not meant to thrive, would wither and die.
  • “No other social movement in modern economic development is so pregnant with benefit to the public,” wrote the editor of the Journal of the American Medical Association. “At present the United States has the unenviable distinction of being the only great industrial nation without compulsory health insurance,” the Yale economist Irving Fisher pointed out in 1916.36 It would maintain that unenviable distinction for a century.
  • In California, the legislature passed a constitutional amendment providing for universal health insurance. But when it was put on the ballot for ratification, a federation of insurance companies took out an ad in the San Francisco Chronicle warning that it “would spell social ruin in the United States.” Every voter in the state received in the mail a pamphlet with a picture of the kaiser and the words “Born in Germany. Do you want it in California?” The measure was defeated. Opponents called universal health insurance “UnAmerican, Unsafe, Uneconomic, Unscientific, Unfair and Unscrupulous.”
  • “Scientific management has no place for a bird that can sing and won’t sing,” answered Taylor. “We are not . . . dealing with horses nor singing birds,” Wilson told Taylor. “We are dealing with men who are a part of society and for whose benefit society is organized.
  • Jim Crow thrived because, after the end of Reconstruction in 1877, reformers who had earlier fought for the cause of civil rights abandoned it for the sake of forging a reunion between the states and the federal government and between the North and the South. This wasn’t Wilson’s doing; this was the work of his generation, the work of the generation that came before him, and the work of the generation that would follow him, an abdication of struggle, an abandonment of justice.
  • War steered the course of American politics like a gale-force wind. The specter of slaughter undercut Progressivism, suppressed socialism, and produced anticolonialism. And, by illustrating the enduring wickedness of humanity and appearing to fulfill prophecies of apocalypse as a punishment for the moral travesty of modernism, the war fueled fundamentalism.
  • Bryan’s difficulty was that he saw no difference between Darwinism and social Darwinism, but it was social Darwinism that he attacked, the brutality of a political philosophy that seemed to believe in nothing more than the survival of the fittest, or what Bryan called “the law of hate—the merciless law by which the strong crowd out and kill the weak.”77
  • Germany was the enemy, the same Germany whose model of education had secularized American colleges and universities, which were now teaching eugenics, sometimes known as the science of human betterment, calling for the elimination from the human race of people deemed unfit to reproduce on the basis of their intelligence, criminality, or background.
  • Nor was this academic research without consequence. Beginning in 1907, with Indiana, two-thirds of American states passed forced sterilization laws.
  • In 1916, Madison Grant, the president of the Museum of Natural History in New York, who had degrees from Yale and Columbia, published The Passing of the Great Race; Or, the Racial Basis of European History, a “hereditary history” of the human race, in which he identified northern Europeans (the “blue-eyed, fair-haired peoples of the north of Europe” that he called the “Nordic race”) as genetically superior to southern Europeans (the “dark-haired, dark-eyed” people he called “the Alpine race”) and lamented the presence of “swarms of Jews” and “half-breeds.” In the United States, Grant argued, the Alpine race was overwhelming the Nordic race, threatening the American republic, since “democracy is fatal to progress when two races of unequal value live side by side.”79
  • fundamentalists were, of course, making an intellectual argument, if one that not many academics wanted to hear. In 1917, William B. Riley, who, like J. Frank Norris, had trained at the Southern Baptist Theological Seminary, published a book called The Menace of Modernism, whose attack on evolution included a broader attack on the predominance in public debate of liberal faculty housed at secular universities—and the silencing of conservative opinion.
  • The horror of the war fueled the movement, convincing many evangelicals that the growing secularization of society was responsible for this grotesque parade of inhumanity: mass slaughter. “The new theology has led Germany into barbarism,” one fundamentalist argued in 1918, “and it will lead any nation into the same demoralization.”
  • “If my re-election as President depends upon my getting into war, I don’t want to be President,” Wilson said privately. “He kept us out of war” became his campaign slogan, and when Theodore Roosevelt called that an “ignoble shirking of responsibility,” Wilson countered, “I am an American, but I do not believe that any of us loves a blustering nationality.”
  • Wilson had in fact pledged not to make the world democratic, or even to support the establishment of democratic institutions everywhere, but instead to establish the conditions of stability in which democracy was possible.
  • nearly five million were called to serve. How were they to be persuaded of the war’s cause? In a speech to new recruits, Wilson’s new secretary of state, Robert Lansing, ventured an explanation. “Were every people on earth able to express their will, there would be no wars of aggression and, if there were no wars of aggression, then there would be no wars, and lasting peace would come to this earth,” Lansing said, stringing one conditional clause after another. “The only way that a people can express their will is through democratic institutions,” Lansing went on. “Therefore, when the world is made safe for democracy . . . universal peace will be an accomplished fact.”88
  • Wilson, the political scientist, tried to earn the support of the American people with an intricate theory of the relationship between democracy and peace. It didn’t work. To recast his war message and shore up popular support, he established a propaganda department,
  • Social scientists called the effect produced by wartime propaganda “herd psychology”; the philosopher John Dewey called it the “conscription of thought.”89
  • To suppress dissent, Congress passed a Sedition Act in 1918. Not since the Alien and Sedition Acts of 1798 had Congress so brazenly defied the First Amendment. Fewer than two dozen people had been arrested under the 1798 Sedition Act. During the First World War, the Justice Department charged more than two thousand Americans with sedition and convicted half of them. Appeals that went to the Supreme Court failed.
  • “If we want real peace,” Du Bois wrote, “we must extend the democratic ideal to the yellow, brown, and black peoples.” But after the United States entered the war, Creel called thirty-one black editors and publishers to a conference in Washington and warned them about “Negro subversion.”
  • Du Bois asked black men who could not vote in the United States to give their lives to make the world “safe for democracy” and asked black people to hold off on fighting against lynchings, whose numbers kept rising.91
  • Wilson signed a tax bill, raising taxes on incomes, doubling a tax on corporate earnings, eliminating an exemption for dividend income, and introducing an estate tax and a tax on excess profits. Rates for the wealthiest Americans rose from 2 percent to 77, but most people paid no tax at all (80 percent of the revenue was drawn from the income of the wealthiest 1 percent of American families).
  • Wars, as ever, expanded the powers of the state. It rearranged the relationship between the federal government and business, establishing new forms of cooperation, oversight, and regulation that amounted to erecting a welfare state for business owners.
  • As the war drew to a close, the reckoning began. American losses were almost trivial compared to the staggering losses in European nations. Against America’s 116,000 casualties, France lost 1.6 million lives, Britain 800,000, and Germany 1.8 million. Cities across Europe lay in ashes; America was untouched. Europe, composed of seventeen countries before the war, had splintered into twenty-six, all of them deeply in debt, and chiefly to Americans.
  • Before the war, Americans owed $3.7 billion to foreigners; after the war, foreigners owed $12.6 billion to Americans. Even the terrifying influenza epidemic of 1918, which took 21 million lives worldwide, claimed the lives of only 675,000 Americans. The war left European economies in ruins, America’s thriving. In the United States, steel production rose by a quarter between 1913 and 1920; everywhere else, it fell by a third.98 The Armistice came on November
  • Wilson left a lasting legacy: his rhetoric of self-determination contributed to a wave of popular protests in the Middle East and Asia, including a revolution in Egypt in 1919; made the nation-state the goal of stateless societies; and lies behind the emergence and force of anticolonial nationalism.100
  • Thirty black men were lynched in 1917, twice as many the next year, and in 1919, seventy-six, including ten veterans, some still wearing their uniforms, having fought, some people thought, the wrong war.101
  • IN 1922, when Walter Lippmann turned thirty-two, he wrote a book called Public Opinion, in which he concluded that in a modern democracy the masses, asked to make decisions about matters far removed from their direct knowledge, had been asked to do too much. “Decisions in a modern state tend to be made by the interaction, not of Congress and the executive, but of public opinion and the executive,” he’d once observed.108 Mass democracy can’t work, Lippmann argued, because the new tools of mass persuasion—especially mass advertising—meant that a tiny minority could very easily persuade the majority to believe whatever it wished them to believe.
  • The best hope for mass democracy might have seemed to be the scrupulously and unfailingly honest reporting of news, but this, Lippmann thought, was doomed to fall short, because of the gap between facts and truth.
  • Reporters chronicle events, offering facts, but “they cannot govern society by episodes, incidents, and eruptions,” he said.109 To govern, the people need truth, sense out of the whole, but people can’t read enough in the morning paper or hear enough on the evening news to turn facts into truth when they’re driven like dray horses all day.
ethanshilling

AstraZeneca Vaccine Under More Scrutiny After Denmark Death - The New York Times - 0 views

  • Denmark reported on Saturday that two people had experienced brain hemorrhages after receiving the AstraZeneca Covid-19 vaccine, one of whom died.
  • A spokesperson for the Capital Region of Denmark confirmed the death, and the Danish Ritzau news agency reported that the other person, a female civil servant in her 30s, was critically ill.
  • Millions of people in dozens of countries have received the AstraZeneca Covid-19 vaccine with few reports of ill effects, but the European Medicines Agency, the continent’s top drug regulator, conducted a review after several countries paused the use of the vaccine.
  • ...6 more annotations...
  • On Thursday, the agency said that it considered the vaccine safe, although it would continue to watch for any connections to blood disorders.
  • “Right now we are examining whether this is the exact same disease picture with multiple blood clots, a low count of platelets and hemorrhages,” Tanja Erichsen, a director at the Danish Medicines Agency
  • This is the second death in Denmark after a person was given the AstraZeneca vaccine. Norway is examining the deaths of two people who received the vaccine.
  • Some of the continuing caution has been driven by preliminary findings from medical experts in Norway and Germany that suggested a possible link between the vaccine and the extremely rare blood disorders.
  • Dr. James Bussel, an expert on platelet disorders and a professor emeritus at Weill Cornell Medicine, said the occurrence of abnormal clotting and low platelets in people under 50 is uncommon.
  • Researchers in both Germany and Norway will continue investigating and in Germany, where the vaccine is again being administered, doctors are now warning anyone receiving an AstraZeneca shot to see a doctor immediately if they have headaches, dizziness or blurred vision more than three days afterward.
mimiterranova

Medical Journals Reluctant to Take On Racism, Critics Say - The New York Times - 0 views

  • The top editor of JAMA, the influential medical journal, stepped down on Tuesday amid a controversy over comments about racism made by a colleague on a journal podcast. But critics saw in the incident something more pernicious than a single misstep: a blindness to structural racism and the ways in which discrimination became embedded in medicine over generations.
  • “The biomedical literature just has not embraced racism as more than a topic of conversation, and hasn’t seen it as a construct that should help guide analytic work,”
  • Medical journals like JAMA favor studies linking race or racial inequities to socioeconomic or biological factors, she and other critics said. Less often do their editors, mostly white and male, accept papers that explore how systemic racism shapes the health care experiences of Black and brown people, they said.
  • ...2 more annotations...
  • JAMA’s reckoning came after Dr. Edward Livingston, an editor in a podcast discussion, suggested “taking racism out of the conversation” about societal inequities and said that “structural racism is an unfortunate term to describe a very real problem.” Communities of color were held back not by racism, he said, but by socioeconomic factors and a lack of opportunity.
  • Since his arrival, the journal has added four editors and four editorial board members, and in June, introduced a section of the journal’s website called Race and Medicine. Although the journal does not have self-reported information on race, half of the new additions are people of color, and three — including the new executive editor — are women, he said.That’s a step in the right direction, but journals will also have to learn to address racism more directly in order to improve lives, Dr. Bassett said. As health commissioner of New York City from 2014 to 2018, she made confronting racism a central part of her work.“When you can’t see what’s in front of you, and you can’t talk about it, you obviously can’t solve it,” she said. “That’s just no longer acceptable.”
anonymous

European Medicines Agency Finds AstraZeneca Vaccine Safe And Effective : Coronavirus Up... - 0 views

  • The European Medicines Agency said the AstraZeneca vaccine is safe, after several EU member states, including Germany, France, Italy, and Spain, suspended its use over reports of blood clots in a small number of people who received it.
  • "This vaccine is safe and effective in preventing COVID-19, and its benefits continue to be far greater than its risks," said Dr. Sabine Straus,
  • The committee made the announcement after days of scientific assessments of the cases of blood clots – some fatal – in people who had received the vaccine.
  • ...6 more annotations...
  • The committee found no evidence of a quality or batch issue, and it delved into the data concerning blood clots.
  • It found that the number of thromboembolic events reported after vaccination is lower than expected in the general population, and concluded that there is no increase in the overall risk of blood clots with the AstraZeneca vaccine.
  • There are still some uncertainties, the committee noted, citing very rare case reports describing "specific, unusual events" of a combination of blood clots, low blood platelet levels, and bleeding.
  • "The evidence we have is at the moment not sufficient to conclude with certainty whether these adverse events are indeed caused by the vaccine or not," Straus said.PRAC will continue to gather information and studies on these conditions.
  • out of almost 20 million people who received the vaccine in European countries, there were seven reported cases of disseminated intravascular coagulation and 18 reported cases of cerebral venous sinus thrombosis. Such cases were not identified in the large-scale clinical trials.
  • "The Committee was of the opinion that the vaccine's proven efficacy in preventing hospitalisation and death from COVID-19 outweighs the extremely small likelihood of developing [these rare conditions]," PRAC said in a statement. "However, in the light of its findings, patients should be aware of the remote possibility of such syndromes, and if symptoms suggestive of clotting problems occur patients should seek immediate medical attention and inform healthcare professionals of their recent vaccination."
rerobinson03

Opinion | Drug Prices Are High Thanks to Research That Americans Pay For - The New York... - 0 views

  • “I worry about the day where the vaccine will no longer be free,” the director, Dr. Rochelle Walensky, said this month, referring to the fact that the government is providing coronavirus vaccinations to all Americans at no cost. “What about if we need a third booster?” Dr. Walensky asked. “What happens then? Who’s going to pay for that?”
  • This question should concern every American and every policymaker in Washington. These vaccines, which are critical to ending the scourge of Covid-19, were developed with government funding and purchased for $10 to $19.50 per dose with taxpayer dollars.
  • Many experts now predict that Covid-19 booster shots will become a regular part of our lives for years. An increase in the price of coronavirus vaccines would have considerable impact on American health care spending. If Pfizer raised the price of its coronavirus vaccine from $19.50 per dose to $175, a yearly shot for every American adult would cost $44.7 billion and could increase annual U.S. drug spending by 9 percent.
  • ...2 more annotations...
  • Yet in the United States, the government often funds research and development and then hands off the ownership of vaccines and medicines to companies that can charge whatever price they think the market will bear. Drug companies often demand a premium price to compensate for early risk that was actually borne by taxpayers.
  • In the coming weeks Congress is expected to advance legislation that would allow Medicare to negotiate drug prices. President Biden has pledged his support. This year, we can achieve reforms that both advance innovation and ensure Americans can afford the medicines — and vaccines — we need.
anonymous

EU Medical Panel Recommends Authorizing Moderna Vaccine : Coronavirus Updates : NPR - 0 views

  • The European Union is preparing to make the Moderna COVID-19 vaccine available to all its member countries, as the European Medicines Agency recommends authorizing the drug on a conditional basis.
    • anonymous
       
      Do the vaccine trials happen in Europe before they go over to America?
  • The medical agency's human medicines committee endorsed the Moderna vaccine during a meeting Wednesday, saying it is safe and effective for people of age 18 and older.
  • It would be the second vaccine to get EU authorization.
  • ...3 more annotations...
  • The European Commission, the EU's executive arm, will now fast-track its decision about whether to authorize use of the vaccine.
  • Like the Pfizer vaccine, the Moderna vaccine requires two doses to be effective. Both medicines work by using messenger RNA to induce the body to produce antibodies to help fight off an infection by the coronavirus. They essentially trick the body into making the same spike protein that the virus uses to invade cells — but without the dangerous coronavirus being present.
  • The benefit of mRNA vaccines, like all vaccines, is those vaccinated gain this protection without ever having to risk the serious consequences of getting sick with COVID-19."
rerobinson03

The UK Just Approved the Pfizer Covid Vaccine. What Happens Next? - The New York Times - 0 views

  • The first rigorously tested coronavirus vaccine was given a green light for use on Wednesday in Britain. Doses of the vaccine, made by the American pharmaceutical giant Pfizer and a small German company, BioNTech, will be injected starting next week, the government said.
  • Rather than accepting the findings of vaccine makers, American regulators painstakingly reanalyze raw data from the trials to validate the results, poring over what regulators have described as thousands of pages of documents.
  • Regulators in Britain and elsewhere in Europe lean more heavily on companies’ own analyses. Instead of sifting through raw trial data and crunching the numbers themselves, regulatory agencies often will study a drugmaker’s reports and, unless there are anomalies, ground their decisions in company-provided documents.
  • ...7 more annotations...
  • “In the U.K., they’ve just been able to say, ‘We have the data, we’re having the meeting,’” said Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine.
  • To speed the process, Britain’s Medicines and Healthcare Products Regulatory Agency had its experts review vaccine data as it became available, and separate teams worked in parallel on different parts of the process, rather than one waiting for another to finish.
  • The countries that remain in the European Union are waiting for its regulator, the European Medicines Agency, to authorize a vaccine. Like the F.D.A., the European regulator has scheduled a Dec. 29 meeting to consult outside experts and offer an opinion on the Pfizer vaccine.
  • Pfizer plans to ship 800,000 doses to Britain in the coming days. Starting Tuesday night, those doses were being prepared for shipping at a factory in Puurs, Belgium, BioNTech said.
  • A government advisory body released its list of vaccine priority groups on Wednesday. At the top of the list are nursing home residents and workers, followed by people older than 80 and health and social care workers.
  • The British decision will not in itself bring vaccinations closer anywhere else. But Pfizer executives said on Wednesday that they had already heard from other countries that, in light of Britain’s go-ahead, were looking to accelerate their own approval processes.American regulators, despite months of pressure from Mr. Trump, have maintained that they will follow their plan and review Pfizer’s vaccine to the F.D.A.’s standards.
  • The United States has pre-ordered 100 million doses of the Pfizer vaccine.
Javier E

Suddenly, It Looks Like We're in a Golden Age for Medicine - The New York Times - 0 views

  • “I’ve been running my research lab for almost 30 years,” says Jennifer Doudna, a biochemist at the University of California, Berkeley. “And I can say that throughout that period of time, I’ve just never experienced what we’re seeing over just the last five years.”
  • “You cannot imagine what you’re going to see over the next 30 years. The pace of advancement is in an exponential phase right now.”
  • surveying the recent landscape of scientific breakthroughs, she says the last half-decade has been more remarkable still: “I think we’re at an extraordinary time of accelerating discoveries.”
  • ...16 more annotations...
  • Beyond Crispr and Covid vaccines, there are countless potential applications of mRNA tools for other diseases; a new frontier for immunotherapy and next-generation cancer treatment; a whole new world of weight-loss drugs; new insights and drug-development pathways to chase with the help of machine learning; and vaccines heralded as game-changing for some of the world’s most intractable infectious diseases.
  • the vaccine innovations stretch beyond mRNA: A “world-changing” vaccine for malaria, which kills 600,000 globally each year, is being rolled out in Ghana and Nigeria, and early trials for next-generation dengue vaccines suggest they may reduce symptomatic infection by 80 percent or more.
  • the mRNA sequence of the first shot was designed in a weekend, and the finished vaccines arrived within months, an accelerated timeline that saved perhaps several million American lives and tens of millions worldwide — numbers that are probably larger than the cumulative global death toll of the disease.
  • As the first of their kind to be approved by the Food and Drug Administration, they brought with them a very long list of potential future mRNA applications: H.I.V., tuberculosis, Zika, respiratory syncytial virus (R.S.V.), cancers of various and brutal kinds.
  • A Nobel laureate, Doudna is known primarily for Crispr, the gene-editing Swiss Army knife that has been called “a word processor” for the human genome and that she herself describes as “a technology that literally enables the rewriting of the code of life.”
  • many of their back stories do rhyme, often stretching back several decades through the time of the Human Genome Project, which was completed in 2003, and the near-concurrent near-doubling of the National Institutes of Health’s budget, which helped unleash what Donna Shalala, President Bill Clinton’s secretary for health and human services, last year called “a golden age of biomedical research.”
  • A couple of decades later, it looks like a golden age for new treatments. New trials of breast-cancer drugs have led to survival rates hailed in The Times as “unheard-of,” and a new treatment for postoperative lung-cancer patients may cut mortality by more than half. Another new treatment, for rectal cancer, turned every single member of a small group of cases into cancer-free survivors.
  • Ozempic and Wegovy have already changed the landscape for obesity in America
  • although the very first person to receive Crispr gene therapy in the United States received it just four years ago, for sickle-cell disease, it has since been rolled out for testing on congenital blindness, heart disease, diabetes, cancer and H.I.V
  • all told, some 400 million people worldwide are afflicted by one or more diseases arising from single-gene mutations that would be theoretically simple for Crispr to fix.
  • in theory, inserting a kind of genetic prophylaxis against Alzheimer’s or dementia.
  • In January, a much-talked-about paper in Nature suggested that the rate of what the authors called disruptive scientific breakthroughs was steadily declining over time — that, partly as a result of dysfunctional academic pressures, researchers are more narrowly specialized than in the past and often tinkering around the margins of well-understood science.
  • when it comes to the arrival of new vaccines and treatments, the opposite story seems more true: whole branches of research, cultivated across decades, finally bearing real fruit
  • Does this mean we are riding an exponential curve upward toward radical life extension and the total elimination of cancer? No. The advances are more piecemeal and scattered than tha
  • “The biology and the science that we need is already in place,” he says. “The question now to me is: Can we actually do it?”
  • Sometimes these things just take a little time.
lilyrashkind

Celebrate Women's History Month With These Frontline Female Trailblazers Kids News Article - 0 views

  • Celebrated every March, Women's History Month honors the often-overlooked contributions of women in history, society, and culture. This year's theme — "Women Providing Healing, Promoting Hope"— salutes both the brave frontline workers of the ongoing COVID-19 pandemic and the countless women who have provided healing and hope throughout history.
  • Elizabeth Blackwell, who made history in 1849 by becoming the first woman to earn a medical degree in America, did not even want to be a doctor. She was happy being a teacher — a more "suitable" career for women in the 19th century. She only decided to pursue medicine after a close friend, who was dying of cancer, said her experience would have been better under the care of a female physician.
  • In 1857, Blackwell recruited her sister Emily — the third woman to earn a medical degree in America — and a physician friend to establish the New York Infirmary for Indigent Women and Children. The free clinic provided female doctors with much-needed training and experience. She also founded the Women's Medical College of the New York Infirmary — the first four-year all-female medical college. The pioneer continued to advocate for women in medicine till her death in 1910 at age 89. Since 2016, Blackwell's birthday — February 3 — has been designated National Women Physicians Day.
  • ...2 more annotations...
  • Jansen's fascination with medicine began at a young age, thanks to her father's ability to cure her frequent throat infections and coughs. "You're a small person, and you have this violent cough, and you feel sick as a dog," she recalls. "And then you get this drug. And it makes you feel better."
  • A few years after earning her Ph.D. in 1984, Jansen accepted a job at Merck's vaccine division. Her first challenge was to create a vaccine for the human papillomavirus, which was believed to cause cervical cancer in the 1980s. Jansen faced significant opposition, both from researchers — who thought the vaccine would not work— and Merck's finance gurus — who believed it would not be profitable. But she persisted. The Gardasil vaccine, approved in 2006, now earns Merck billions of dollars annually.
Javier E

'Tragic Battle': On the Front Lines of China's Covid Crisis - The New York Times - 0 views

  • China was the first country to experience the panic of Covid when it emerged from Wuhan in 2019. Then, for the past three years, the country largely suppressed the virus with a costly mix of mass testing, strict lockdowns and border closures. The government could have used the time to bolster its health system by stockpiling medicine and building more critical care units. It could have launched a major vaccination drive targeting the millions of vulnerable older adults who were reluctant to receive a jab or booster. China did little of that, however, plunging into crisis mode again like in the early days of Wuhan.
  • A Shanghai hospital predicted half of Shanghai’s 25 million residents would eventually be infected and warned its staff of a “tragic battle” in the coming weeks, according to a now-deleted statement the hospital posted last week on the social media platform WeChat.
  • “In this tragic battle, all of Shanghai will fall, and all the staff of the hospital will be infected! Our whole families will be infected! Our patients will all be infected!” the statement read. “We have no choice, and we cannot escape.”
  • ...4 more annotations...
  • Medical staff say they could have avoided the medicine shortages that have forced some facilities to ration drugs. There also could have been more time to set up a more effective triage system to avoid overcrowding
  • ne of the fundamental problems with China’s health system is its overreliance on hospitals for even the most basic care.
  • “In the U.S. people have their own primary physicians, but there are few ways in China to get care from the medical system except to go to an E.R. at a big hospital,” said Dr. Qiao Renli, a pulmonary and critical care doctor at the University of Southern California, who has taught and practiced medicine in both China and the United States.
  • The deluge of Covid patients is not the only challenge hospitals are facing. One of the ripple effects of the outbreak has been a widespread shortage of blood for transfusions because of the shrinking pool of eligible donors.In the southwestern city of Kunming, a blood bank said in a statement that the city was getting a fraction of the 500 donors per day it needs to keep up with demand, and that the shortage had started to affect pregnant women and patients in intensive care units.
Javier E

Deficit Hawks Down - NYTimes.com - 0 views

  • Mr. Obama’s clearly deliberate neglect of Washington’s favorite obsession was just the latest sign that the self-styled deficit hawks — better described as deficit scolds — are losing their hold over political discourse.
  • Why have the deficit scolds lost their grip? I’d suggest four interrelated reasons.
  • First, they have cried wolf too many times. They’ve spent three years warning of imminent crisi
  • ...5 more annotations...
  • It should have been obvious that the deficit would come down as the economy recovered. But this point was hard to get across until deficit reduction started appearing in the data.
  • Now it has — and reasonable forecasts, like those of Jan Hatzius of Goldman Sachs, suggest that the federal deficit will be below 3 percent of G.D.P., a not very scary number, by 2015.
  • the third reason the deficit scolds have lost influence: the contrary doctrine, the claim that we need to practice fiscal austerity even in a depressed economy, has failed decisively in practice.
  • Consider, in particular, the case of Britain. In 2010, when the new government of Prime Minister David Cameron turned to austerity policies, it received fulsome praise from many people on this side of the Atlantic. For example, the late David Broder urged President Obama to “do a Cameron”; he particularly commended Mr. Cameron for “brushing aside the warnings of economists that the sudden, severe medicine could cut short Britain’s economic recovery and throw the nation back into recession.” Sure enough, the sudden, severe medicine cut short Britain’s economic recovery, and threw the nation back into recession.
  • there was also clearly a lot of bad faith involved, as the scolds tried to exploit an economic (not fiscal) crisis on behalf of a political agenda that had nothing to do with deficits. And the growing transparency of that agenda is the fourth reason the deficit scolds have lost their clout.
1 - 20 of 296 Next › Last »
Showing 20 items per page