Like folks like us end up using things like experiments, how we use our survey data and how we go and look at Something Like rap lyrics in order to answer questions. Host professor Lester Spence at Johns Hopkins university is the author of stare in the darkness the limits of hiphop and black politics. University of Minnesota Press publisher. Host the name of the book is the malaria project. The author is Karen Masterson. Professor masterson, what is malaria . It is a series of disease. Its not one. Its caused by a parasite from the genus plasmodium and these different parasites to different dings and you find them in different parts of the world. But they all cause some similar symptoms lake intense fever. It looks furnace hot fevers and bone deep chills and body pain and headaches. Some wall hiding your liver and relapse years later. You never know whether youve gotten rid of it. Some in africa can clump together and cause circulatory problems and put you in a coma. You can play soccer in the morning and by evening you are dead. Malaria is the word we use to describe the diseases caused by this genus of parasites. Although there is a monkey malaria that is species and of a likely become the fifth human malaria. Its in the process of doing it now. This is the way the parasites had survived the ages. They infect to dinosaurs and made it through the ice ages. Probably and birds. There are many varieties of bird malaria. Then they went on to infect other species including primate and the primate species by what evolved to infect us. Host how many people in the area are infected with malaria . Guest it is very hard to measure because so many of the infections go uncounted. At the what Health Organization estimates around 300 to 500,000 a year. Im sorry. 300 to 500 million a year and about a million die every year at most of those are children and i forgot. Host why hasnt it been eradicated . Guest because the parasites that cause the disease are part of the environment. So to get rid of all malaria are carried by mosquitoes. So to eradicate malaria you need to be there removed people from mosquito populations or kill the mosquitoes. Both have been very difficult to do. So we have malaria throughout the United States. Malaria was throughout the world up until the 20th century. And then when scientists figured out that it was the mosquitoes that carried it malaria comes from the italian word malaria and before the turn of the century, scientists believe that it rose up from swamps and that you breathe it in and became sick because the fever always came out around the Spring Summer time when the waters for warning and you could smell the swamp. Once we figured out it was caused by mosquitoes, which was in 1898 the focus was on killing mosquitoes. In countries in regions that could afford the antimosquito work and put screens on homes where people were better off and had health care, the malaria rates plummeted in the elimination of malaria were there was still some outbreaks. In the u. S. South, italy Southern Europe because mosquitoes live longer and there are more of them, was much harder to get rid of the leiria in those areas tended to be less economically developed in the northern parts of the United States. Host sub six where is malaria today . Where can you find malaria . Guest you can find malaria just about anywhere where people are poor, where people live in poverty. The population ends up just living with malaria year round. So thats about 40 of the globe. 40 of the human population live with malaria. Host who discovered that it was a mosquito that carried malaria . Guest ronald are ross and he won the nobel prize for that. He then went on to create the first of what came to be known as the mosquito brigades. So his whole focus for england he was a researcher, a british researcher his whole focus was to try to reduce moss mosquito populations in the colonies of great britain, mostly africa. So that the colonists could penetrate deeper into these countries for resources because malaria was blocking the way. He was not successful in places like west africa because the mosquito populations there were so huge, and the carrier of malaria in most areas of africa is the most efficient carrier of these parasites. Its also what entomologists call a geriatric mosquito e because it lives so long, and because a mosquito must bite you twice to transmit malaria. They have to bite you to drink in the parasites, and then those parasites sexually reproduce in the gut of the mosquito, and a week to two weeks later depending on the temperature, the egg zack thats left behind sack thats left behind in the mosquito gut will get into the mosses quito issa live v. A. And then saliva, and then the mosquito has to bite you again. Places like africa, they live a long time so they can easily carry malaria, survive between two weeks, the week to two weeks that they need to carry the begs in their gut and then infect people. Host is there an antidote to malaria . Guest is there an antidote . There are drugs that can clear the parasites from your blood yes. They tend not to work for very long because the parasites they dont clear all the parasites, and the parasites that survive end up getting sucked in by mosquitoes, and they have developed then resistance to the drugs, and then the moss key stows spread those resistant parasites around, so drugs last a short while. I was at a conference yesterday where they talked about the spread of resistance to the most recent series of antimalaria drugs, and these resistant parasites are spreading from cambodia out to other parts of the world. And were seeing the resistant parasites in africa which is quite frightening because this is a front line drug for african countries, and most of the deaths caused by malaria happen in africa. Host how effective are innocents, sleeping nets especially . Guest you know, nets are probably the best technology we have against malaria. But you need to convince people to use them and its hard to convince People Living in sweltering heat to put another layer of material between them and what little air they get, especially during the summer when its hot. Another problem is that and this is Something Else that was talked about at the conference yesterday the mosquito es, they do what entomologists call refractory behavior. They figure out whats preventing them from getting their blood meal, and they change their behavior. So were seeing in africa where bed nets are being used quite intensely, World Health Programs are there really working with the villages to make sure that nets are used at night especially where there are Young Children involved, and they are seeing mosquitoes biting earlier in the day before people go to bed. So these, you know, this is its a good technology. In the United States we put up screens. And screens protect you for longer than bed net will. It protects you as soon as you go into the house. And youre cooking dinner and youre doing your nightly chores and youre still protected from the mosquito bite whereas in africa the bed net you its there for sleeping and sleeping only, and when these mosquitoes change their behaviors, they can still get access to you. Another problem is that most of the global Health Programs have focused on children, saving childrens lives and the lives of pregnant women because pregnant women lose whats called their acquired immunity over time. If youre infected enough, you develop a certain level of immunity to the deadly symptoms of malaria so that you will survive. It feels like a flu basically. You feel horrible and you still must lie in belled and you cant go and in bed and you cant go and harvest your crops, but you wont die because you have this certain level of immunity against the disease. Pregnant women lose that, and children havent got it yet. So most of the global Health Programs have focused on saving lives x now theyre talking about the need to get at the Larger Population because the Larger Population of people carry the parasites that the mosquitoes pick up and then give to pregnant women and children. So theyre not able to break the cycle of infection just by focusing on pregnant women and children. So now this is a much larger problem and a much bigger effort that they have to make. And it will require a lot more money if eliminate you know, some people use the word eradication, but eradication, when youre talking about a disease that exists in the environment, is a tricky word. Most of the people who work in the field of malaria especially cdc, the people who work on the ground and understand the disease will just use this word, elimination. Try to reduce the number of infected people and the number of mosquitoes so that you dont reach the threshold of an outbreak. You need to have a certain number of each to reach the threshold of an outbreak. If you can get those numbers down malaria will still exist in the environment, but it wont be endemic, and it wont be constantly infecting people. Host can, so malaria can be passed from person to person . In any way . Guest oh, just through mosquitoes. Host just through mosquitoes. Guest if i had malaria and i sneeze all over you, you are not going to get it. You know, if i wipe the sweat on my forehead and then shake your hand, you are not going to get it. It has to come to you from a mosquito, and it has to be a mosquito that has had parasites in its guts long enough for the sac to burst. Thats kind of the inference that are in the saliva, the mosquito bites you within minutes those parasites get to your liver to avoid your immune system and there they stay. And they reproduce, and they feed on your liver cells. And when then theyre mature enough, they bust out of your liver and destroy your blood cells until you become very sick, and your body responds with a high fever. The high fever is a sign that your immune system has really kicked in and is trying to reduce the number of parasites so that you no longer are sick enough for the symptoms but you still have the parasites in your blood. And there they mature or again, and they become sexually distinct, and they swim to the surface cells, the surface blood cells, and they emit a chemical to attract a mosquito so that the mosquito when you have malaria, you are more attractive to mosquitoes. They come and bite you, and they drink in these what are called adult versions of theyre shape shifters. Theyre constantly shaping, sorry, changing their shape. And then they get into the mosquito, and they sexually fuse, and they create a geneticallyunique set of offspring that are stickshaped, and they get into the saliva and then the cycle continues. Host Karen Masterson, how did you get interested in this topic . Guest so i was a political reporter, and i had covered congress for quite a while and i was interested in doing Something Else. I wanted to get back to science writing because i had been an environmental reporter for the philadelphia enfirer. I covered philadelphia inquirer. And to do that i decided that i wanted to research a scientist because you can teach science through people if youre a narrative writer, if youre a storyteller. So i was up at the National Archives looking for world war ii records of wallace palling, and i worked with archivists who helped me through the byzantine process of trying to find records. Theres a whole room as large as in this one of nothing but finding aids. So its one binder at another that leads you to another. Youre tracking usually the contract number that scientist had with the federal government and so during world war ii he had a contract number through cal tech, and so i was trying to track that down, had an archivist working with me took three days. I got my call slip together i knew my call numbers, i put it in, and, you know, put it into the desk, and an hour later i had my box. The box was labeled p for people with the last name beginning with p so i opened it up, and there was nothing in there about palling. And i had been there so long, and i had had never done any archival research. So i just started flipping through the records, and i came across a memo that was written to the lead Public Health official in the state of massachusetts. It was from a federal researcher with the National Research council, and the letter asked if federal researchers could come in and infect patients at the boston psychopathic hospital with malaria so that drugs could be used against the infections. No less a than the no less than the wars outcome was at stake. The War Department was experiencing horrendous casualties because of malaria are, and the War Department needed a drug and the Scientific Community was pitching in to help and would he also allow Massachusetts State Hospital patients to become a part of this. And he said yes. So boston psychopathic hospital was one of about a half dozen who allowed researchers to infect their patients with malaria for these drug tests. Host this is the malaria project. Guest this is the malaria project. Host how long did it go on . How many people were infected . What were the results . Guest so it started it really started in 1940 before the war. Before the United States entered the war. Because scientists anticipated that malaria would be the biggest problem of the War Department. This is before normandy, this is before the battles in europe. This is when we were envisioning getting to hitler through his underbelly through north africa. I mean, this is finish it took a while for strategists to get there, but we figured italy would be a part of it. We knew that to contain japan we needed, we would be in the South Pacific where malaria was everywhere. So a very clever scientist proposed this project. He said look, the germans have come up with a project, a process for trying to find a drug for malaria and we should, we should model that here. They use their Drug Companies to come up with compounds ask then the federal researchers infect patients with malaria and then test their drugs on them, and we should do that here. But the actual project itself didnt start until the War Department really saw that they had a problem and that was when the fall of bhutan was largely because of malaria, and we were in guadalcanal and on the verge of losing that island which was very important, strategic island because of malaria and the War Department opened the spigot. The leaders of the departments that were overseeing the health of these soldiers started attending these meetings where all the ma lairologists were and said, wrote we need you and we need you to expand this program tenfold. We need 400 scientists working on this. We need all the Drug Companies that we can get involved in this. And so you saw this small project turn into the largest medical effort of the war. It was the number one medical purity of the war to find priority of the war to find a cure for malaria. Host Mental Health patients. Guest right. So to understand why this was acceptable, you need to understand the history of malaria and syphilis. These are two diseases that worked against one another. So an austrian scientist was a psychiatrist and had surmised that when his patients, his Mental Health patients came down with severe fever that sometimes they would be better off afterwards that their Mental Health problems would disappear. So he surmised there was something to do with a fever that could treat their Mental Health issues. And so he started infecting his patients with all kinds of microbes including tuberculosis. He had a german friend give him a little vial of tuberculosis, and he gave it to his patients to see if he could get the fevers high enough to cure them of their mental illness. And these experiments kind of spiraled out of control. But he thought that malaria might be a good candidate for treating these patients because certain types of malaria you can control with quinine. Not the kind that youve got in africa but the kind that you picked up in europe host the kind of malaria that you guest the kind of malaria that you picked up in europe. And its still all over asia its in south measuring now but it used to be south america now, but it used to be all over europe. So if you used that malaria to induce a fever and allow the fevers to go up high enough and then treat the fevers with quinine, 30 of the time you could cure the patient of whats called neurosyphilis. Its what would infect brain cells and cause brain damage. These fevers could kill the syphilis in these patients and they would walk away 100 cured. So this became a standard treatment. He won a nobel prize in 1927 for it. This became a standard treatment for late stage syphilis neurosyphilis. And malariologists who were still in their infancy because there had only been a couple of decades since we figured out that malaria was caused by these parasites carried by mosquitoes this as an opportunity to the parasites. You couldnt pass them around this vials like you could with tuberculosis and share these microbes with other scientists so you could study them. You had to have an infected person. So State Hospitals that ran what was called malaria therapy had ample numbers of people infected with malaria. So it was a very innocent first stage for malariologists to come this and study malaria. They would just go into the State Hospitals that were running the therapy for these patients and draw their blood and study the parasites and it didnt take long for the dynamic to flip so that the Malaria Community was paying for the treatment of syphilis patients in State Hospitals so that they could use these patients to study them and also to test drugs on then. And when the war broke, this was the state that these two fields, these two medical fields were in, the field of psychiatry warning these malariologists not to overstep their bounds, to use only the kind controlled by quinine, not the one from africa. Quinine is not a reliable treatment of it. And he warned them not to use mosquitoes for the infections because when you invite an infection by way of a mosquito, youre inviting every stage of that parasite into the body. Not just the blood stage which if you took, if i took blood from you when you had malaria and injected it into another patient, that patient would just have that blood stage of malaria. And if you isolated that person and doesnt let mosquitoes bite that person, it would never go its beyond the liver stage, so its not going to stay in your body, and youre not going to walk away and have another outbreak of parasites and then pass it on. The field of malaria did not find these restrictions convenient. And so to study malaria, you needed to have the mosquitoes you needed to use more parasites, you needed to use all the parasites that caused malaria, and when the war broke germany and the United States developed these projects that used all phases of the parasites and all types of parasites to try to understand how to treat how to come up with a treatment. Host Karen Masterson when you discovered that memo in that box accidentally, did you have any concept that it would grow into the malaria project . Guest you know, i didnt because i was a daily reporter. And i didnt i thought i was writing an article that i would pitch to a magazine. I wondered if i had found another Tuskegee Syphilis experiment where men, black men in tuskegee were not treated for their syphilis because they werent told that they had it and so that researchers could simply observe the life cycle of this disease. Which was horrendous, because there was a treatment for syphilis at the the time. I taught i thought i had Something Like that. But i spent enough time with researchers, and i won a fellowship to go down to cdc and spend some time with researchers there and especially with one man, bill collins who had been at it long enough to have actually done some of that research on State Hospital patients. Because even after the war State Hospital patients with latestage syphilis were still given malaria as a treatment so that malariologists could study the parasites, and he was one of those people. And and he made me understand that this is a very nuanced project, that there was, there were many considerations that one needed to understand to put what went on during world war ii in context. And once i spent time with him, i realized there was no way i could write this in a magazinelength piece, that it had to be a book. And i had bookwriting friends who kept telling me you have a book here, you need to write this book. And i kept saying, well, you know, im not sure about this, give me some time. So i just, i continued my treks up to the National Archives. I went through r50 0 boxes and found 500 boxes and found bits and pieces of the story in a variety of different record groups, and once i saw the narrative arc in my mind i understood that i had a book. And so i found an agent, and we got a publisher, and i wrote it. Yeah. Host is this written so that the layman can understand . Guest it is written for the layman. It is a narrative. Im a storyteller, so i know that people like to read about other people. And so i chose three scientists really to focus on. My main scientist is lowell who i talk about, who i talked about earlier. Hes a very interesting, he was a very interesting map. He was a very good man. He grew up a poor, poor farm boy who didnt want to farm. And so to get out of farming he studied biology. He went to Indiana University and studied biology and he, you know, he said repeatedly totally by accident he tripped into malaria which i could identify with because it was totally by accident for me too. But he ended up getting a fellowship to go down and study the swamps in leesburg, georgia as a limbnologist, somebody who studies fresh water. The limbnologist for the or Rockefeller Foundation project. The only malaria administration in the United States, and it was run by samuel darling who was one of the leading thinkers on malaria. And what they were doing down there in south georgia in 1924 was trying to figure out what mosquitoes carried malaria because the malaria burden in the south was so horrendous that no one felt that thered be any kind of Economic Growth in these Southern States with malaria because of this disease. So lowell cogshell went down and went into the swamps and he had to kill a couple of snakes that came at him but he studied the larva, the mosquito larva, to see if certain chemicals would kill them. And that was his introduction to malaria. And he became because of going down there as a college student, he became one of the countrys few malaria experts. And so the Rockefeller Foundation and the u. S. Public Health Service called on him every summer in between his studies, because he decided that from biology he was going to go to medical school, so he had many years in university and every summer he would go and work on malaria in the south. And through that became an expert and was one of the leading thinkers and most innovative thinkers on malaria when the world went to war. Host whats your job here at Johns Hopkins . Guest i teach. Host what do you teach . Guest so i teach writing courses, but i teach writing courses for science students, and i have one course that is specifically geared toward Public Health students. So i ask them, the ones for the Public Health students is a workshop, and i send them out into the city of baltimore where they have to find stories. And they have to actually get on the ground and work with communities. A lot of them will look at hiv, a lot of them will look at heroin addiction because baltimores the heroin capital of the country. They come up with a Public Health topic that they want to explore, and then they have to get on the ground, and they have to find a story, and then they bring it back to the class, and we workshop it and i help them develop their ideas into a story with an arc so that they can in the future if they want to tell stories about their research and the work that they do, theyll have the skills to do it. Host have you had malaria . Guest no, i have not. Ive not had malaria. When i was sitting next to bill collins at cdc when i was on the fellowship, we would chop the heads off of mosquitoes that had been infected. So the mosquitoes would pick up malaria from their monkey house, so they were cycling the lives of these parasites and theyd bring mosquitoes to monkey house where the rhesus monkeys were infected with malaria, and theyd bring them back to bill collins lab, put them in an incubator for the parasites to you know to develop the egg sac and for the egg sac to burst with these parasites and we would catch them just after the parasites with the saliva, put them under a magnifying machine, chop off the heads, then i would hand the head to bill and he would look under a microscope. And is while we were doing that one day, an infected mosquito flew off, and i was like bill we have a problem here, theres an infected mosquito in the room. And he looked up, and he was such a colorful funny, interesting man, and he looked up and said gosh i hate to see that, and then he went back down on his microscope. I didnt understand this community of malaria, and i didnt understand the parasites well enough yet because i hadnt launched into the different species and really tried to understand what they, the big differences between them, and so i just tracked it because i didnt want malaria and i tracked its flight pattern, and i lunged forward, and i killed it. And i could see bills kind of mouth curl up. And i went home and told my husband i was in the room with an infectious mosquito, i could have contracted malaria. But it was not until about five years later when i really started studying the monkey malarias because they were important to the project that i realized the kind of monkey malaria that we were working with could not jump species so he was just kind of having fun with me because i didnt understand that it was not going to infect me, that there was a mosquito loose in the lab was not a bug deal, but i didnt a big deal. But i didnt know it at the time. I traveled with a friend who came down with malaria when we were in africa and we were told when we got to the clinic that we got her there just in time because her, she was showing the early signs of cerebral malaria which can kill you. And the drug that was used to treat her was the one product that came out of this malaria project. It was the wonder drug that the project found which we actually ended up stealing from the germans. Host still in use today. Guest and its still this use today, yeah. In fact most of the drugs in use today were created during this project. So when a drug becomes ine peck chul because of ineffectual because of resistance, scientists at walter reed will go back to the series of 14,000 compounds that were made during the war and will pull another one off the shelves and study it. There were maybe a dozen that showed promise but then when the war ended, there was no more Research Money to develop them. So walter reed scientists have gone back, taken them off the shelf, developed them made them into different analogs and then handed them off to pharmaceutical companies to develop and use again in these programs overseas until those drugs become ineffectual because of resistance and start all over again. And just about every drug used today except for the i chinese herb that we learned about from the chinese, thats the one drug that didnt come from this project. Host and finally, Karen Masterson, how has your friends life changed since she got malaria . Are there limitations on what she can do