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The Current Transcript for November 1, 2016

Host: Anna Maria Tremonti

STORIES FROM THIS EPISODE

Listen to the full episode

Prologue

[Music: Theme]

SOUNDCLIP

Bubblegum. It was under the bleachers at the Rogers Centre. We scooped it out and I tried to wipe his mouth as much as I could and rinse it out.

ANNA MARIA TREMONTI: All we did was ask what's the most disgusting thing your kid has tried to eat? If the very idea of germs crawling over some gross object into your child's gullet makes you queasy, then you need to hear B. Brett Finlay extol the power of microbes. He says let them eat dirt. Most of it, not all, will help. How to save your child from an oversanitized world in half an hour. Also today, named and shamed for decades.

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Patient zero is the name used to describe this man, the airline steward, to protect his identity. He was a French-Canadian named Gaétan Dugas.

AMT: For years Gaétan Dugas was known as patient zero, the man who brought HIV/AIDS to the United States in what now seems like a combination of unclear scientific terminology, a typo and a search for a good story. Gaétan Dugas’ name dominated the headlines at a time when gay men were blamed and AIDS patients were shunned. Now 30 years after his death, more sophisticated research tools show the French-Canadian flight attendant was never a breakthrough link to the transmission of HIV/AIDS. In an hour we will hear from the researcher who corrected the record, as science and journalism are humbled by the facts. And Indigenous activists in Canada and across the US are urging the Lakota Sioux to stand their ground in a pipeline dispute they say has implications for native lands across North America.

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We’re natives of this land and they treat us like dirt. Now we're making our stand right here.

AMT: I'm Anna Maria Tremonti. This is The Current.

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No end in sight for Standing Rock protest against Dakota Access pipeline

Guests: Tara Houska, Merrill Matthews, Timothy Armstrong

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[Sound: Crowd commotion]

VOICE 1: [Through megaphone] You have to get off the pickup and move to the side.

[Sound: Bang]

[Sound: Protesters yelling]

VOICE 2: This is not okay.

AMT: Well, in North Dakota, a months-long pipeline protest came to a head last week as police moved in with tear gas and armoured vehicles. The protesters, led by more than 90 Indigenous groups from across North America, have been camping since April at the site of the Dakota Access pipeline. They say it's a threat to sacred land and to the Missouri River, which is the main water supply for the nearby Standing Rock Sioux Reservation. The pipeline would carry crude oil across four states to Illinois. It's a project that will cost $3.8 billion US. The Texas company behind it says it's safe, but the standoff continues and more than 200 protesters have been arrested there in recent weeks. Tara Houska is the national campaign director of Honor the Earth. She's been at the protests for months and we have reached her in Bismarck, North Dakota. Hello.

TARA HOUSKA: Hi, how are you?

AMT: What has it been like at the protest camp over the last couple of days?

TARA HOUSKA: We've seen a rapidly increased police response. We have violence on behalf of the police. In just the last few days we saw police use rubber bullets, mace, Tasers, you know less lethal rounds on Native American men, women and children demonstrating against the Dakota Access pipeline.

AMT: This started last Thursday when police moved in with riot gear. What was it that triggered that?

TARA HOUSKA: The police decided to raid essentially an encampment that had been constructed or that had popped up basically right on the pipeline route. You know directly in the path of the pipeline and occupation more or less to cease construction. The department of justice, the department of the army and department of the interior has actually asked you Dakota Access multiple times now to stop construction. The federal government has asked the company to stop. It has not. And so the police showed up to basically raid the Native Americans who are there occupying space on traditional treaty land.

AMT: Those arrests occurred a day before seven defendants in the rancher-militia occupation in Oregon were acquitted. Was that noticed at the time?

TARA HOUSKA: I think that it was definitely noticed that those folks were acquitted and you know meanwhile Native American women and children were being maced and treated with you know incredible violence simply for occupying space on traditional treaty land that had never been ceded. I mean those two situations could be not more different nor could the response be more different. You know I was personally there. I was almost hit directly in the face with a bean bag round. I was pulled back and it exploded right next to my head. I mean police were trying to hurt people to push them back.

AMT: Are you from that area?

TARA HOUSKA: I'm from Minnesota. I’m actually a member of Couchiching First Nation on the Ontario side of the border.

AMT: And this demonstration has since April brought Indigenous people from around North America What are you seeing? What does that say?

TARA HOUSKA: There are hundreds of nations that have joined to stand with Standing Rock against the fossil fuel industry. This has become more than just a single pipeline. This is a moment for Indigenous rights in which we're saying enough is enough. This is our homeland. This is our treaty land. You can't keep doing this to our communities. We cannot continue to you know allow one pipeline to disparately impact our communities and two, you know things like man camps to hurt our men, women and children you know at incredibly disparate rates. You know sex trafficking, human trafficking, drug use, violence, all those things increase when an extractive industry project goes through and our communities are always impacted at a higher rate.

AMT: Now the route of this pipeline has changed many times. It was originally slated to run through Bismarck, North Dakota. Why did it get rerouted toward Standing Rock?

TARA HOUSKA: It actually was rerouted from Bismarck because they were concerned about the drinking water. So risks of the drinking water, but yet it was perfectly fine to reroute it half a mile north of the reservation. So you know I don't understand the reasoning behind that other than you know a blatant example of environmental racism in which you know it's okay to impact a community of colour and it's not okay to potentially damage the largely white community.

AMT: And is the concern with this pipeline the fact that it will go under the Missouri River? Is it that section of pipeline or is it the root of the whole thing through the native lands?

TARA HOUSKA: You know I think it’s—the larger the concern is that it goes just half a mile north of the Standing Rock Sioux Nation. The Missouri River is a sole drinking water source. So when the pipeline leaks, that will contaminate the drinking water for those people. There's also 17 million people that live along the Missouri River and we don't need another pipeline. There are already several existing pipelines, aging, old pipelines posing great risk and so we don't need yet another one going on the river. You know but also yeah, this is about treaty land. This is about the fact that this comes from the Bakken, you know an ongoing source of fracking in the United States that continues to impact Indigenous communities and you know [unintelligible] our homelands.

AMT: And what do you say to those who say that this Dakota Access pipeline would parallel a natural gas pipeline that's already been operating there for years?

TARA HOUSKA: You know exactly what I just said, which is you know just because there's already a pipeline there doesn't mean you need to add more to the infrastructure. That's not an excuse to justify a completely unnecessary fossil fuel infrastructure project. You know if you want to do infrastructure for the people and not for profits, you know there are many different infrastructure projects the United States needs. You know we have aging bridges, aging roads. You know where's the renewable industry that actually you know benefits the people and not fossil fuels?

AMT: Do you think a compromise is possible?

TARA HOUSKA: I think that you know the Indigenous people here are not looking for a compromise. They're not looking for you know a payout or something of that extent. I mean this is—you cannot buy Indigenous [unintelligible]. You cannot buy Indigenous rights. The compromise will be when this project is abandoned and you know a strong statement is sent to the fossil fuel industry that you cannot independently choose to send your pipelines through our lands without full and preinformed consent.

AMT: I've caught you at an airport. You're leaving the area. Are you planning to come back?

TARA HOUSKA: I'll be back tomorrow.

AMT: It is November 1st. Winter is coming. How long do you think the protesters will be able to stay?

TARA HOUSKA: We call ourselves water protectors and many of us will be here until the pipeline is gone.

AMT: You're not backing down.

TARA HOUSKA: No. Absolutely not.

AMT: Thank you for speaking with me.

TARA HOUSKA: Thank you. Appreciate it.

AMT: Tara Houska is an attorney from the Couchiching First Nation and she is the national campaign director of Honor the Earth. We did request an interview with Energy Transfer Partners, the company behind the Dakota Access pipeline. No one got back to us. Merrill Matthews supports the company's right to build a pipeline. He's a resident scholar with the Institute for Policy Innovation. He's on the line from Dallas, Texas. Hello.

MERRILL MATTHEWS: Hello.

AMT: What's your reaction to what you just heard Ms. Houska say?

MERRILL MATTHEWS: Well, I think you heard a couple of things. Number one, the reason I got interested in writing something on this was I was listening to National Public Radio and I thought I heard an awful lot of hyperbolic comments about what was happening. Of course, things have deteriorated recently but that's why I went and looked and said well, they're claiming that the government didn't contact us. They're claiming that they didn't get our counsel and so forth and they're invading certain lands and so I went and just looked at what the federal judge had to say because I don't doubt that the federal government sometimes does override people's rights and things like that. But when you look at what the federal judge had said in this, he went through the list of the things that the tribe, the Standing Rock Sioux tribe had said and he just essentially said that's just not the case. The government and the company tried several times to reach out to you to get your input and so forth. They brought in an archaeologist to make sure and to do various cultural surveys to make sure that they weren't invading any land. They changed their—they rerouted it I think about 140 times in different areas to make sure they were avoiding certain sensitive areas and so forth. And so it just looked to me like a number of things were being said that the judge did not confirm. And so I wrote a piece about that and the other thing I think I would say from what she said is—she hinted at it—this is really about environmental activism more than it is being concerned about Indigenous tribes. They're certainly concerned about that but that's being used as sort of the element here to make sure—to try to basically go against fossil fuel.

AMT: Well, hang on a second because it was rerouted you say 140 times. It was also rerouted from a predominantly white community over to where they are. She makes the point that the community of Bismarck got it rerouted for the same concerns.

MERRILL MATTHEWS: It certainly raises a concern when you're putting a pipeline down. I'm with a think tank so I've never done this, but I can imagine that you're trying to find the sort of the least objectionable way and then by moving it, paralleling it by the gas pipeline, the natural gas pipeline as you mentioned, I suspect they were just looking for a way that they said we're tracking something that's already down there. It's already to the extent that lands have been disturbed. It's already been disturbed and it doesn't seem to bother anybody so we'll just follow that path.

AMT: Right. But you use the word least objectionable and they argue that in fact it's not objectionable to the white residents, it's objectionable to the Indigenous residents.

MERRILL MATTHEWS: I understand.

AMT: Yeah. So why do you think the pipeline is a good idea?

MERRILL MATTHEWS: Well, pipelines are significantly safer than trying to transport crude oil and other things by rail. The Scientific American, the magazine in the United States looked at this and found it was I think roughly 70 times safer to transport things by pipeline. As you suggest and I think she conceded, some of the pipelines that we have out there and the infrastructure are getting old. But that's the reason why you build a new pipeline in order to be able to get the new technology and so forth so that you're avoiding the potential hazards that you could otherwise have.

AMT: Hmm. It's become a very divisive issue. You've got an election a week away. What do you think is at stake in this debate?

MERRILL MATTHEWS: Well, I think what's happening here is that the environmental community is—they're looking for any kind of national campaign to be able to stop and slow down the progress of fossil fuels. They were successful when the Keystone XL Pipeline that also started, would have started in Canada. There is a keystone pipeline that's been running out of Alberta, Canada through Canadian provinces down through North Dakota, South Dakota and on into Illinois. It's been running for about five years. The Keystone XL was going to be another one that started in the same place and just had a different route. They were successful in getting that pipeline squelched. And so I think the environmental community sees fighting pipelines as a next major way to be able to try to essentially hinder the fossil fuel industry.

AMT: And do you think that will change depending on who becomes president?

MERRILL MATTHEWS: It's a good question because they were able to get—even though the state department, US state department had signed off on the Keystone XL pipeline and said this is safe, the environmentalists were able to get Barack Obama to change, to sort of stop this and squelch the project. With that success, if they have Hillary Clinton in there I suspect they will pressure her. If it's Donald Trump, I think he would be less likely to listen to them.

AMT: Hmm. Okay. Well, Merrill Matthews, thanks for your thoughts.

MERRILL MATTHEWS: Thank you.

AMT: Merrill Matthews supports the company's right to build a pipeline. He is a resident scholar with the Institute for Policy Innovation. He joined us from Dallas, Texas. Indigenous communities across Canada are paying attention to what's happening at Standing Rock. This past weekend, members of the Kahnawake Mohawk territory blocked a bridge into Montreal to raise awareness of the issue in the States. Many Indigenous Canadians are already at the protest site or travelling there. Of course, for people who lived on this continent long before today's nation state borders were drawn those lines on a map can be more or less arbitrary and crossing them to join in a protest like Standing Rock is nothing new. In the 1970s, First Nations members travelled from Canada to the standoff at Wounded Knee in South Dakota at Oglala, the Pine Ridge Reservation. In the 1990s, Indigenous activists travelled north from the US to Oka, Quebec. Our next guest today was at Standing Rock last month. Timothy Armstrong is originally from Manitoba's Brokenhead Ojibway Nation. Today he works for the Kahnawake radio station near Montreal. He's a First Nations activist and he's in our Montreal studio. Hello.

TIMOTHY ARMSTRONG: Aanii, Anna Maria. Great to be with you.

AMT: So first of all, you went to Standing Rock in September?

TIMOTHY ARMSTRONG: Yes, I was there just after this infamous incident with the dogs being brought in and just after the governor, Governor Dalrymple called in the National Guard as well. So I came in about a week after that incident happened.

AMT: And why did you go?

TIMOTHY ARMSTRONG: Well, because I had to. Because I saw on social media the buildup that was happening and I saw that the numbers needed to be there. The solidarity that was happening all over Indian country, as we call it, was just unsurpassed. It was unprecedented. And I had to be there. I knew that I could do my part in any way that I could. You know I have—you know I think what happens is you're given certain gifts that the creator gives you and you should try to use them to help your people as much as you can. I've used it in many ways. I'm a singer-songwriter. I've written protest songs. I'm a graphic artist so I know how to catch somebody’s eye to get a message across like this whole you know like the slogan now, the hashtag #NoDAPL. You know that's almost like an art piece. Now it's almost like an “I Love New York” kind of thing and it's the kind of thing that needs to get out there. And what's nice is that once those messages get out there, people are going to wonder what “NoDAPL” means and they’re going to look it up and you know what, they're going to get informed about it.

AMT: Well, you're part of the Kahnawake action at the Mercier Bridge in Montreal. What were you trying to accomplish there? Is it still going on?

TIMOTHY ARMSTRONG: Well, it is still ongoing. I'm not one of the organizers. I do have several friends that are part of the camp that is up there right now. What they did was, it was first of all set up as kind of like I said, a lot of the signs that were being held up were #NoDAPL and people were giving out information, letting people know there was not a blockage of traffic, people were being able to go up the Mercier Bridge still. The Kahnawake peacekeepers were helping out with traffic, making sure it was safe for people to march halfway up the bridge and then back down as well. But it was more of an information session and the teepee that is still there, erected at the bottom of the Mercier Bridge, still stands there. And as far as I understand, today there will be a meeting in Kahnawake and they will decide how long that is going to stand up there in solidarity with the people in Standing Rock.

AMT: What's the wider issue here then? What's the wider importance of what we're seeing at Standing Rock and the fact that there are Indigenous protesters coming from Canada as well?

TIMOTHY ARMSTRONG: Well, you know what this thing has done for most, it's galvanized the native communities. If I had to look at one of the big pros for natives, it's we've had this spiritual reawakening. We realize that we are not alone, that we are all brothers and sisters, that we stand up for each other. You know we have faith in our ceremonies. People don't understand—a lot of these people were attacked while they were doing ceremonies. These people were conducting prayers you know to our creator for guidance and strength to keep going. And this is when they were getting maced. It's just you know it's amazing. We also know now that there's strength in numbers. I know that the camp right now is you know a couple thousand people or so but I know when I went down there, the numbers were at 5,000 and they were as high as 7,000 I believe, right in the middle of the summer as well.

AMT: We have seen concerns about pipelines in Canada. Is there a message here to politicians? Do you see any link? Do you see any parallels?

TIMOTHY ARMSTRONG: Well, the writing on the wall is sure there for Energy East, isn't it? I know that we have had the alliance treaty which was signed not too long ago with Serge Simon out of Kanesatake. And they said in no uncertain terms is Energy East going to be traveling through their territory. So it's a wakeup call to the oil industry and going back to Merrill Matthews talking about the oil industry, you know and just because it's got a really bad track record. It's an industry with a very bad track record. Since 2010, there is a watchdog group that has been monitoring just incidences. And now to be fair, it's any kind of leakage and there have been thousands of pipeline leakages. Don’t we have just right now a leak that's going on right now in Alabama? Right now at this moment, there is a leak going on there. So this is an industry that really doesn't—you know it doesn't monitor itself.

AMT: Yeah, there was an accident in Alabama. They were doing work—

[Crosstalk]

TIMOTHY ARMSTRONG: Yeah. Exactly. But see—

AMT: They hit a gas pipeline. It’s true.

TIMOTHY ARMSTRONG: Exactly. But if it was not there, that would not happen.

AMT: No, there was an explosion in Shelby County, Alabama.

TIMOTHY ARMSTRONG: Exactly. And now this industry is now going to have the black eye of not only are there going to be there—pretty well you know environmentally showing themselves to be kind of environmentally irresponsible. Now they're showing themselves to be ruthless to people that don't—you know that don't agree with them.

AMT: So do you see a compromise at all?

TIMOTHY ARMSTRONG: I really don't and another thing too is that another thing that Merrill Matthews—like there was the UN Declaration on the Rights of Indigenous People that we are supposed to be consulted with things that happen on our land. You know and if that's not being adhered to, then then where's the rule of law come in? And like you said, they've been asked several times by the government by all the people to cease the oil company.

AMT: Okay.

TIMOTHY ARMSTRONG: And they are still ongoing.

AMT: Timothy Armstrong, it's important to hear your voice in this too. Thank you.

TIMOTHY ARMSTRONG: Thank you very much.

AMT: Timothy Armstrong, First Nations activist in Quebec. We reached him in Montreal. Let us know what you think as this standoff continues and Indigenous people from Canada get involved as well. You can tweet us, we’re @thecurrentCBC. Find us on Facebook. Go to our website www.cbc.ca/the current and click on the contact link. Stay with us. Right after the news, let them eat dirt. That's a bit of parenting advice from Brett Finlay. He's a microbiologist. He says kids today could use a little more dirt in their lives and even in their mouths. I'm Anna Maria Tremonti. This is The Current on CBC Radio One, Sirius XM and online on www.cbc.ca/thecurrent.

[Music: Sting]

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Kids need to get dirty to ward off disease, says microbiologist

Guests: B. Brett Finlay

AMT: Hello. I'm Anna Maria Tremonti and you're listening to The Current.

[Music: Theme]

AMT: Still to come, he has been part of the popular lore of the AIDS epidemic for years. Gaétan Dugas, the French-Canadian flight attendant was called patient zero and blamed for bringing the disease to North America. New research is turning that story on its head and suggesting it's no more than a myth. We'll hear from the researcher behind the new findings and ask about the ethics of fingering a patient zero in any medical outbreak in half an hour. But first when it comes to keeping your kids squeaky clean, let's just say that train has left the station.

[Sound: Train whistle]

AMT: Parents and kids hang around at a model train ride in downtown Toronto on a sunny afternoon. Of course parenting isn't all about fun and games, especially those moments when you realize your child has gotten into something gross or maybe even picked up something gross and put it in their mouth. It happens all the time of course, as The Current’s Karin Marley found out.

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[Sound: Train bell ringing]

KARIN MARLEY: What is the most disgusting thing your child has ever picked up off the ground and put in her mouth?

VOICE 1: A feather? Like five minutes, I watched her put a feather in her mouth, yes.

VOICE 2: Bubblegum. It was under the bleachers at the Rogers Centre. We scooped it out and I tried to wipe his mouth as much as I could and rinse it out. [laughs]

VOICE 3: They eat food off the floor all the time.

VOICE 2: Yeah, we don’t honestly—I don't stress about it—in our house anyway, I don’t stress about it. [laughs] Outdoors would be a different matter. I would probably shriek before they got a chance to get their hands on it, to be honest.

VOICE 4: It was something like a fly on the ground which was maybe had a wing broken or something. So he thought it's kind of a little candy thing.

VOICE 5: I would have to say a pair of my disgusting, dirty underwear. You know I freaked out like at first glance but I went well, it is what it is, you know? So it's pretty bad. [chuckles]

AMT: Eww. You might be inclined to go “Eww,” at those stories. Yuck. But there's a growing body of research showing that maybe we should not be so disgusted and that a little more dirt is actually good for kids. B. Brett Finlay is a professor of microbiology at UBC. He's also the co-author of wait for it, Let Them Eat Dirt: Saving Your Child from an Oversanitized World and he joins us from Vancouver. Hello.

B. BRETT FINLAY: Hi, Anna Maria.

AMT: What did you think of those?

B. BRETT FINLAY: I loved it. I just loved it. [laughs]

AMT: So pre-chewed gum, insects, dirty underwear.

B. BRETT FINLAY: Oh, there you go. Yum. [laughs]

AMT: What do you think of all these things going into a kid's mouth?

B. BRETT FINLAY: Well, I mean it's kids being kids, right? You know they have a strong resemblance to Hoovers and they try and put everything in their mouth. I think it's the parental reaction that's even more interesting. You know the eww kind of factor. We’re starting to realize these kids do need this microbial exposure early in life and they're just doing what kids do and so maybe this isn't so bad.

AMT: But aren’t germs what make children sick?

B. BRETT FINLAY: Germs are certainly. I mean germs is a name for microbes that usually cause disease in people but not all microbes are germs and actually there's only 100 different microbes that cause diseases in humans and we have thousands of microbes living all over us on our skin, in our intestine. They don't cause disease normally, so they're actually part of us and this is where the real mind shift had to occur that we've in this assault on germs to kill everything, we're also killing the good ones off and we're not getting these good ones and that's affecting us later in life.

AMT: So parents shouldn't be as fearful about what their young children are being exposed to when it comes to germs.

B. BRETT FINLAY: Yeah. I mean it's a balance you know we say let them play in a sandbox but if that sandbox has says cat feces in it for example, which carries parasites, maybe they shouldn't do that or lick the floor in your own house but maybe not in the subway stations. The good thing is that we've really cleaned up our world and the chance of getting an infection if you pick up a handful of dirt or a stone or something now is way less than it used to be say 100 years ago.

AMT: So how do the good microbes help us and help children especially?

B. BRETT FINLAY: Yeah, this is where science has taken a major turn. So you know ever since Antonie van Leeuwenhoek invented the microscope 330 years ago and he saw there were microbes in his mouth, that's when microbiology was born. You know we’ve known there are microbes there and then Pasteur and Koch and others showed that there were germs that caused disease so we went on this huge sanitation kick to clean the world up. And we just thought any good microbe’s a dead microbe kind of thing and so we brought in vaccines and antibiotics and sanitation and clean food and water. And it’s the last under a decade we now realize that oops, these microbes actually do something and so the areas we’re finding these microbes help our bodies develop is they train the immune system. If you don't have microbes early in life, you can affect diseases such as asthma and allergies. If you don't feed them right, you can push yourself towards obesity and weight issues for example. And even more stunningly, a really exciting area is how they actually affect brain development. We know animals that don't have microbes in them, their brains don't develop normally. And so we have to rethink this whole concept. We realize that you know yes, we're homo sapiens, but we're filled with at least 10 trillion microbes. You know there's equal number of microbes as human cells in the entire body and these things are just part of this and we're depriving that part of our bodies so we don't develop normally.

AMT: So talk to me a little bit more about this. What emerging evidence is there linking the rise in certain illnesses to the microbes that live in our guts?

B. BRETT FINLAY: If you look at you know curves of infectious disease the last 50 years, they all go down. If you look at curves of let's say Western society diseases—so I'm including things like asthma, like allergies, like obesity, like type two diabetes, like inflammatory bowel disease, like depression, like stress, like anxiety, like autism—these things actually all have microbial links and only recently we started to realize this. And studies in both using animals that don't have microbes in them or studies that say look at antibiotic exposure you know the simple fact if you get courses of antibiotics in first year of life, you're at a much higher risk for getting asthma, allergies and becoming obese later in life, just because you shift your microbes.

AMT: Is it we’re shifting microbes or we're getting rid of microbes that would have helped us?

B. BRETT FINLAY: Well, what we're doing is we're decreasing the different numbers of them. And it's kind of like an ecosystem a rainforest you know that you want a bunch of species in there. And as we clean up our world and you know eating the refined white flour, white sugar type diets for example and not exposing kids to many things, we don't have the diversity of microbes that we now realize we actually need to have a healthy body.

AMT: How definitive is the science on how microbes and diseases are linked? Is it cause and effect?

B. BRETT FINLAY: There's a lot of correlations. The actual cause and effect is coming in some diseases more than others. Work we did with asthma, we found that if we looked in the feces of a three-month-old child, we can identify four microbes. If they had those four microbes, they were at a much less risk of getting asthma than if they didn't have these things. But the experiments when we actually took a child’s feces that had asthma and lacking these four microbes and put into animals that didn't have any microbes in them—so we're just putting human feces in plus or minus four bugs. If you put those four bugs in, you actually decrease asthma. So now we're starting to get in the world of well, maybe those microbes are actually doing something. We think they're training the immune system so you don't get asthma. So it's coming. You know things like if you take antibiotics in the first year of life, you have 20 per cent higher rates of asthma. If you're born by Caesarian section instead of vaginal delivery, you have a 20 per cent higher rate of asthma. If you live on a farm, you have 20 per cent less asthma rates. If you have a dog in the house, there's 20 per cent less asthma rates. So there's all these correlations but now it's just starting that we’re actually realizing these microbes actually do something in terms of how the immune system develops and basically how the body works.

AMT: How do the microbiomes of children today compare with those of their parents or grandparents?

B. BRETT FINLAY: Yeah, that's a terrific question. They live very differently. I mean I jokingly say that the world is coated in a veneer of feces. It’s full of microbes. And so you know if you're playing outside on a farm, if you're you know working outdoors all the time, you know you get very different microbes than if you're playing on an iPad or a screen for seven hours a day. There's a lot of concern that maybe these things are actually endangered species and if you want to go back to have the microbes minus the infectious diseases your great grandparents did, that maybe we can't go there.

AMT: That's why you called your book Let Them Eat Dirt. [laughs]

B. BRETT FINLAY: Exactly.

AMT: We'll get to that though. But now in terms of our health, what's the difference between hygiene and cleanliness?

B. BRETT FINLAY: Yeah, that's a tricky one. And often they're blurred. And hygiene is really you know cleaning up, getting rid of the germs, the bad bugs. Clean is just making sure that there's no mold in the corners and things and they are related. It's a balance between you know something is putrid and rotting in a corner and things, that's probably not good, but just because there's dust on the floor that doesn't necessarily mean that there's germs there.

AMT: Well, what are some examples of when parents go overboard on cleanliness?

B. BRETT FINLAY: Yeah. I think hand sanitizer is a terrific example and the FDA has actually just banned some of the anti-microbial components that go in it because they've shown they don't do any different than soap and water. So you don't need to wipe your child's hands 100 times a day every time they you know change swings on the playground. Once with soap and water before dinner, you know throw out the hand sanitizer. There's no studies to show that actually improves it and there are some studies show that might be detrimental. You know and I jokingly say we grew up in an acreage, we were playing in the dirt all the time and you know my brother and I would have a competition how big a ring of dirt around the bathtub could get that night? And if you got greater than an inch, that was a good day's play. Getting dirty is one thing but being supposed to you know nasty microbes is another. If someone is sick and sniffling, for sure wash their hands. But under most normal circumstances, the germs are actually not that prevalent and so let the kids get microbial exposure.

AMT: How early does the microbiome develop in humans?

B. BRETT FINLAY: Very early. It actually starts to get shaped when the mother is in the third trimester of pregnancy. And you know what she eats will actually affect which microbes the kid gets when the kid is born and that will then affect the kid later in life.

AMT: Well, you mentioned C-sections for a reason then, right?

B. BRETT FINLAY: Yeah, absolutely. So when you're born, vaginal delivery has—any woman who's done it knows it's a messy business—but you're exposed to both vaginal and fecal microbes. Ironically those are actually good for the kid. And those are the microbes that are actually involved in breaking down breast milk that the kid knows is going to get. If you're born by Caesarian section, you actually—your microbe’s more like the mother's skin because that's what it’s xposed to. And we know that a Caesarian section puts you at higher rates for allergies, for asthma, for obesity just because of the simple fact you didn't have when I call your very first birthday present, you know the big gulp on the way out where you acquire your microbes.

AMT: So is there anything parents can do to give an infant the microbes they missed?

B. BRETT FINLAY: Yeah, so that's a really interesting area. And in the book we're very careful to say that you know 10 per cent of all women are medically going to need a Caesarian section. It will save your life. So some women do need a C-section and we discuss various things in there. There's probiotics, there's diet and there's other things you can do. There are even things being considered now which is a vaginal swab—before the kid is born, you swab out the vagina and then when a kid is born by Caesarian section, you then colonize with that swab, that kid, on their mouth and their nose and other things with his mother's microbes.

AMT: And as they get older, what about diet? What should babies and children eat to develop the most diverse ecosystem in their gut?

B. BRETT FINLAY: Yeah, you hit the word right on the diverse concept. They should eat diverse. So you start introducing solid foods now at about four months while you're breastfeeding and it used to be we said you know avoid all allergens till three years of age. That's now been debunked and you want to start them fairly early in life. The idea is you can then experience these things early in life and won't react to them later. Now the other thing is that if you're eating white sugar and white flour, that's already pre-digested and so it’s absorbed very quickly in the upper intestine and yet down in the large intestine where all these microbes are, you're actually starving them. So it's another reason you have to eat your fruits, your vegetables, your you know your high fibres, your nuts, because these are the things that actually the microbes then chew on and they actually break these things down to provide us energy. It's not just the nutrients of these healthy foods you're supposed to be getting, now we realize these are actually microbial foods that actually help feed the kids through their bugs.

AMT: Hmm. And when it comes to the environment kids are living in, how do you figure out which ways of getting dirty are good and which are dangerous?

B. BRETT FINLAY: It is common sense and you know if you think how we live as a society if you're living on the 22nd floor of a condominium and you know the kids never you know never actually experienced a playground, you know I think you've got to worry about this. So some common ways, you know for example having a dog in the house, that actually decreases the incidence of allergies by about 20 per cent because dogs do what dogs do. They run around, they roll into everything and then come lick the kid. Cat lovers, I'm sorry. Cats don't do anything for you. They sit in a corner and snub their noses at you.

AMT: Those are fighting words. I hope you can scientifically back that up.

B. BRETT FINLAY: I know. I’m sorry. [chuckles] I can. The studies show that dogs improve things but cats—they don't—cats are not bad, they're just not good. They just don't do anything because I think they interact less with the kid than a dog does.

AMT: Now you're not telling people to actually eat dirt.

B. BRETT FINLAY: No, this is a tongue-in-cheek title. I'm not saying shovel dirt on a newborn infant. I think you know if I could really put the title right is you know let them eat the microbes that one normally finds in the environment, but that would never sell any books.

AMT: Let Them Eat Dirt sounds a lot catchier.

B. BRETT FINLAY: Yeah, yeah.

AMT: But of course as you point out, we see everything as dirt. And that's your point. We have to stop seeing everything as dirt.

B. BRETT FINLAY: Yeah, I think we have to stop seeing everything as you know as potentially infectious and it's going to kill you because this is a hangover for the last century of hygiene we've had. And I think we have to realize that dirt is not necessarily bad. It can be, you know if it's from a cesspool or something, of course it's bad. But I guess the idea is you know we realize that these kids need microbial exposure. Bubble wrapping them and keeping them perfectly clean is probably not the best thing for you and for the poor germaphobe mothers out there, I mean I feel sorry for them because they're trying to do the very best, keep their—you know we've been told keeping our kids clean is the best thing you can do for it, but unfortunately the science is now telling us that that's actually not the best thing you do and these poor mothers have to ease off a bit. And you know get over the eww factor and realize that kids are going to be kids, they're going to put a lot of strange things in their mouth. And this is part of them sort of experiencing the world and sort of tasting the world we live in, as well as replenishing these microbes that they need to develop.

AMT: When children do get sick, parents often turn to doctors who give them antibiotics. What have scientists been finding out about the harm antibiotics can do to the microbiome?

B. BRETT FINLAY: Yeah. So first of all, let me state that antibiotics, these are wonder drugs. I think they were the best medical discovery in the last 100 years. They have saved countless millions of lives. If you have a bacterial infection that is susceptible to antibiotics, they will save your life. Now that being said, like most good things, we will overuse them and we use them for all sorts of things that perhaps we shouldn't and this is causing problems. So everyone has heard of anti-microbial resistance. We all know the more you use antibiotics, they become resistant, they don't work. What we're now realizing though is that antibiotics are not harmless. They carpet bomb the microbes. They kill germs nicely, great, but they also kill good microbes equally well. And when you take antibiotics, you upset your microbes hugely. And the reason this is a big problem in kids is because early in life, kids’ microbes are bouncing around and putting in an antibiotic is a major assault on microbial population. And we realized this actually disturbs them and they can't sort of become normally. So early use antibiotics, as I've said, are linked to increased rates in pretty much all the Western diseases including asthma and obesity, et cetera. And so with antibiotics, you know I urge caution, we should use them if needed. But if it's say a viral infection, which antibiotics don't work for, like pediatricians are now going sort of to a watch and wait type thing. If a kid has an ear infection, they will perhaps wait 24 hours to see whether antibiotics are really warranted or not in that case. Perhaps the biggest crime of antibiotics is 80 per cent of our antibiotic use is used as growth supplements and agriculture. Canada and the US do this. Europe has banned this. And we are dumping millions of pounds of these antibiotics straight on the environment and that yes, they cause an increase in growth in pigs, sheep, cattle, whatever. But you know kids are animals too and there's some thought that this is actually contributing to childhood obesity, this huge antimicrobial exposure.

AMT: And that's worth mentioning and really paying attention to because obviously it's not solely then about what goes in their mouths when they're sick.

B. BRETT FINLAY: Yeah, very much so.

AMT: And also, but there are parents who will be listening whose children have had severe illnesses who have needed antibiotics. What can they do as that child gets older in order to equip them in a better way because the antibiotics may have actually now had you know, have an effect that was unintended?

B. BRETT FINLAY: Yeah. And what we're learning about antibiotics is one dose, one course of antibiotics is probably okay but the more courses of antibiotics you take, the worse off your microbes get. And so in the book and on our website, we actually discuss ways you can actually replenish these things. Diet is a major way. There are some probiotics, especially for post-antibiotic diarrhea. There's some probiotics that seem to work fairly well on that, which are just live microbes that help replenish the population. So there are things you can do about it. Don't beat yourself up if your kid has to have antibiotics, I mean like I said these are wonder drugs. But also think okay, I've hurt my kids’ microbes. What can we do to help them get back to normal?

AMT: Do probiotics do everything the packages claim they do?

B. BRETT FINLAY: [chuckles] The problem with probiotics is you can claim whatever you want on that package. They’re not regulated like drugs. Some probiotics work sometimes. They're not as spectacular as antibiotics. So I think in the future, we're going to see much better probiotics that will be 10 or 20 microbes that we know have a certain role to play and you will take say a pill of this whole ecosystem. Again on the website, we linked to a study that links all the clinical double blind placebo-controlled trials that have been done with probiotics that which ones work and which ones don't work because it's bewildering when you go to the probiotic shelf and say which one do I take for what?

AMT: Now since we have been talking about things that make people say eww, let's talk fecal transplants.

B. BRETT FINLAY: Yahoo. [laughs]

AMT: What has the research been showing about their use in treating diseases that have been linked to the microbiome?

B. BRETT FINLAY: Now okay, let's get the eww factor out of the way because this is definitely there. I mean one gram of feces which is one centimetre by one centimetre, it’s sort of the size your little finger. That contains more microbes than the entire population of people. So feces is filled with microbes. And what we realize—

AMT: How exciting. Keep going.

B. BRETT FINLAY: Yeah. [chuckles] Sorry for the people eating breakfast now. Yeah. So where we learned fecal transfers really seem to work is there’s disease which Ontario and Quebec have experienced a lot of is Clostridium difficile. This is a bacterial pathogen you get when you take antibiotics and they wipe out your microbes and these microbes actually fend off and keep the place safe from pathogens. When C. difficile crawls in, it can be a fatal disease. It's a terrible disease which is caused basically by getting antibiotics. So then they started treating it with antibiotics and of course it causes these so it didn't really fix it very well. It had maybe a 20 per cent cure rate. So then they reasoned well, let's put some good bugs back in there and let's push the C. difficile that way. And so there's really terrific studies out there now that saying if you do a fecal transfer, you can cure 95 per cent of these people. So plug your nose but it worked and so that says that we can now actually change the intestinal microbes. So now they're trying these things and all sorts of different diseases like inflammatory bowel disease and autism and various other things to see is there hope in that area?

AMT: Autism as well.

B. BRETT FINLAY: They’re trying it. It's a scary area right now but there are some—well, we know that autistic children, their intestinal microbes are different but maybe because they eat differently. But the problem with fecal transfers, the reason it works so well with C. diff is that it's a terrible pathogen if you have it, but it's kind of a wussy pathogen and it gets displaced by pretty much any microbes. In inflammatory bowel disease, you're doing fecal transfer, your gut is inflamed so that basically it's on fire already and you’re asking these microbes come in, put the fire out and then boot the other bugs out and then actually set up a healthy population. Sometimes it works, sometimes it doesn't. And it's really dependent on the donor. So the science is going well, what does that donor have that the other one doesn't? And once we identify those microbes, you know we'll be able to, as the expression goes, “repopulate” people with the correct microbes that actually will do something. So that's where the future of that’s going.

AMT: And we've talked about some of this in the past, it is quite extraordinary that this can actually address some of these diseases. But now, there are YouTube videos that demonstrate how to do fecal transplants at home. I'm guessing you shouldn't be doing DIY fecal transplant?

B. BRETT FINLAY: Do not. Yeah. They say all you need a blender. Don't do it. I mean if you perforate the guy, you will cause sepsis and you can kill yourself. I mean do this under medical conditions. And the other thing is I mean feces is a body fluid transfer, I mean you learn from hepatitis and HIV and all these other blood borne things that when you transfer body fluids, there's sometimes things in there we just don't know about yet. And there actually was one study where they did fecal transfer from an obese sister to a lean sister and the lean sister actually became obese even though they cured the disease sort of thing. So there may be side effects to this. So it's early stages and this is not a DIY thing.

AMT: Okay. Do not do this at home, yes. What promise do you see in the future of microbial science?

B. BRETT FINLAY: I think the future is huge. I honestly think it's causing a biological revolution in biomedical science. So what we're realizing, I took a list of the top 10 reasons why Canadians and Americans die. Nine of those 10 reasons have a microbial linkage. And the fact that you can do things like fecal transfers or prebiotic, probiotics, antibiotics type things, you can shift the microbes pretty easily. It's much easier to do that than it is to do you know correct a person’s gene because we still can't do that yet. Personalized medicine, for example, I mean you and I are 99.99 per cent genetically identical. Well, minus a chromosome difference. But we have at best 50 per cent of the microbes the same. So when people are taking drugs like chemotherapy, we now realize that there's a major microbial component and sometimes chemotherapy works in some and doesn't work in others. And there's been two beautiful studies out now showing that you know depending on which, you know what their microbial composition is, they can actually predict whether they respond to chemotherapy or not. So it's impacting on so many areas of biomedical health that we just never even dreamt about a few years ago.

AMT: It's extraordinary. So you know we began talking about letting children eat dirt—metaphorically speaking—but like get them away from the oversanitized world. What should adults be doing?

B. BRETT FINLAY: Eat more dirt. [laughs] Or keep eating dirt. I don’t know, what could be the sequel to—no, I think early in life, there's no doubt microbes play a major role in setting it up, but we now realize throughout your life they play a major role in obesity and things. There’s some very exciting stuff coming out now on personalized diets. So we've all been on diets, now they kind of work but don't work and look around the world you know that it's not working so well. So what these Israeli researchers did is they actually characterized what everyone ate and what microbes they had and which foods caused a glucose spike which then leads to obesity and diabetes. And now based on that, for $300 you can mail in a fecal sample, they will analyze your microbes and they will say well, you can eat ice cream and pizza but you definitely cannot eat lasagna. And so they personalize these diets and then when they compare that head to head with the standard diets, they’re just blown away because they're now tailoring the diet from the microbes that are in you and that are digesting your food, which I think is a profound step forward in the whole dieting business.

AMT: So interesting, huh? We search outward to find out so many things about our world and it's all inside of us. [chuckles]

B. BRETT FINLAY: Yes, it's absolutely amazing.

AMT: It's been great to talk to you. Thank you for your insights. Thank you for your work.

B. BRETT FINLAY: Thank you, Anna Maria.

AMT: B. Brett Finlay, a professor of microbiology at the University of British Columbia, co-author of Let Them Eat Dirt: Saving Your Child from an Oversanitized World. He's also the co-founder of three companies working on projects related to the microbiome. None is yet at the stage of selling products. B. Brett Finlay joined us from Vancouver and you can find more information about his research on microbes and kids—including that list of probiotics that have been clinically tested—at www.letthemeatdirt.com or find the link on our website www.cbc.ca/thecurrent. Now we want to hear from you on this. What is the most disgusting thing your child has put in his or her mouth? How did you react? Do you have trouble giving up the hand sanitizer or do you jump in mud puddles yourself? Let us know. Send us an email. Go to our website www.cbc.ca/thecurrent, click on the contact link. You can find us on Facebook or on Twitter @thecurrentCBC. If you're joining us partway through, download the podcast or listen right online: www.cbc.ca/thecurrent. And stay with us. Coming up next, questioning the origin story of the AIDS epidemic and questioning the need for an origin story at all. Well, you'll remember in the news just in the last couple of days, we found out that the naming of Gaétan Dugas as patient zero is a very flawed thing. And we'll talk to the researcher who sets the record straight. I'm Anna Maria Tremonti. This is The Current.

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New research clears Gaétan Dugas as 'patient zero' in AIDS epidemic

Guests: Richard McKay, Ron Rosenes, Kerry Bowman

AMT: Hello, I'm Anna Maria Tremonti. This is The Current.

SOUNDCLIP

So you shouldn’t fear someone who has AIDS, or has symptom of AIDS, because there is no specific reason why you should get in contact with AIDS.

AMT: Okay. He’s really hard to understand there. He’s garbled in that tape, but that’s Gaétan Dugas, the man known for decades as patient zero of the AIDS epidemic. He was caught briefly on tape there in 1983 at the first ever AIDS Vancouver Community Forum when a mysterious new disease was starting to devastate the gay community. The French-Canadian man was a flight attendant with Air Canada. He died of AIDS in 1984. And in the popular 1987 book on AIDS called And the Band Played On, American journalist Randy Shilts identified Gaétan Dugas as patient zero. He has been vilified ever since as the one man responsible for—as the link to the disease coming to North America. New research using old blood samples has questioned that narrative and exonerated Gaétan Dugas. Richard McKay is the co-author of the new paper in the journal Nature. He's an historian specializing in the history of medicine and he is also the Wellcome Trust research fellow at Cambridge University. We have reached him in London, England. Hello.

RICHARD MCKAY: Hello, Anna Maria. It's a pleasure to be here.

AMT: Well, it's really important to talk to you. Take us back—when did you first suspect that Gaétan Dugas was falsely labeled as what was known as patient zero?

RICHARD MCKAY: That's a great question and I think it kind of gets to the heart of one of the challenges of conveying this as news in that I read And the Band Played On as probably my first source of information about AIDS back in the early 2000s and I was really, among many things, seduced by the story that Randy Shilts portrayed of Gaétan Dugas. And as somebody who came of age myself in Vancouver, its gay community, I was struck by the sense of closeness to where I had grown up. And when I went to the University of Oxford to start a Master's degree, I knew I wanted to work on the history of AIDS and look at the media in some way. And after reading a fantastic work of history by the historian Judith Leavitt about the experiences of Typhoid Mary Mallon, Mary Mallon, a cook in the early 20th century in New York City who found herself on the sharp end of public health as ideas about how disease spread changed very quickly and she struggled to accommodate her views of the world with those changes. It encouraged me to—Judith Leavitt makes the comparison, draws a comparison between Gaétan Dugas and Mary Mellon.

AMT: To be clear now, Gaétan Dugas died before Randy Shilts' book came out. He was not—in his lifetime, he was not known publicly as patient zero by the wider public.

RICHARD MCKAY: By the wider public, that is true. So the wider public encountered him—

AMT: Posthumously.

RICHARD MCKAY: Posthumously, sometimes through reading And the Band Played On, but most likely through the widespread media coverage that accompanied Randy Shilts’ book coming out. And it's true that Randy Shilts suggests that some people in the gay communities in which he travelled, in which Gaétan Dugas travelled before he died, did know of this connection to the CDC's cluster study through which he came to be identified inadvertently as patient zero. But what I really wanted to say was that in 2005, when I began being interested in this story, it was very clear that ever since Shilts’ story had come out in 1987, that a number of people—activists, AIDS activists across North America and some scientists—had raised questions about it. So I was able to draw upon a long history of protest to inform the history that I set out to write. So that aspect was not new.

AMT: Okay. So they raised protests because he was essentially demonized.

RICHARD MCKAY: Absolutely. And it was essential to the history that Randy Shilts was writing. In 1986, he set out to write a version of the history that he felt passionately about. But he wanted to write it for a heterosexual audience—so a mainstream audience—and he wanted to build it around stories of heroes and villains. And so although he didn't know about Gaétan Dugas when he started writing his book, the stories that he heard about the individual linked to the cluster study. It fit right into the framework in which he was making sense of his history.

AMT: Who gave him the name?

RICHARD MCKAY: That is tricky to work out. And I've poured through the records. I mean a key part of the research that I've done was to look through the hundreds and hundreds of pages of notes that Randy Shilts took through his interviews which formed the basis often down to the word from the interviews that would become the story threads in his book. And so although some people have suspected that it would have been his close connections to public health officials which might have led them to give him the name, it would seem that it was people who were living with AIDS at the time who obviously did not know what Shilts would do with this story but knew that the communities of patients at the very beginning anyway, of identified out patients who were active in the community. They knew each other. And so Shilts was able to ask questions of those people and work out who this individual was.

AMT: Right. I just want to like clarify because you did hard scientific research that figured out that Gaétan—Gaétan Dugas was essentially named as this guy who was the link to bringing HIV/AIDS to North America, like the one person who was promiscuous and travelling a lot because he was a flight attendant and brought it to North America. That was the narrative of the day, correct? Essentially in a nutshell.

RICHARD MCKAY: [chuckles] That's more of a nutshell than I'm ever comfortable saying, but yes. TYeah.

AMT: No, but that was the understanding. That was the public understanding, right? But you have clearly done the work that shows—what did you do? What work did you actually do to show that that was not true?

RICHARD MCKAY: Now are you asking about my historical research which kind of grows out of my doctorate and which fed into this Nature study or about the Nature study in particular?

AMT: Well, what was it that the study that you did that was—you’re so able to just say this didn't happen the way that it was said to have happened?

RICHARD MCKAY: [sighs] So I—and I struggle with this, I'm a historian so I think that context matters for everything. So which story thread to say? I’ve spent over 10 years investigating this history since 2005 when it began as my Master's thesis. It grew into my doctoral research. And I was interested in looking at how dating back centuries, there's this impulse in many societies facing epidemics to identify the earliest cases and there’s overlapping interests sometimes to understand why from a public health perspective, sometimes to implement preventive measures and sometimes to lay blame. And it's very difficult to avoid, unless one is being explicit, the overlapping of these different impulses. And so I think it's important to make clear that the CDC researchers, when they were conducting their initial study in 1982 and eventually got published in 1984, they never suggested that this—they never suggested in print—that this was the first patient. But it was through the—when I say first patient, the first patient in North America—which would accord with what we currently understand with the idea of patient zero. The term patient zero grew inadvertently through a combination of factors: this longstanding centuries- old impulse to identify the initial source. The CDC's inadvertent use of a zero instead of an O to represent an individual in their study. And then Randy Shilts’—he became really fascinated with this story and when he realized that he could, through his journalistic skills, find out information about this man and became convinced that this individual was an example of a villain and an irresponsible gay man in contrast to what he viewed as the responsible gay man. That's how the story got off the ground.

AMT: Right. But where was the CDC? If that was the case, if zero was a typo, it was supposed to be patient O and it didn't mean what the public took it to mean, why did the CDC let this go on for years? Why didn't they ever correct it?

RICHARD MCKAY: Well, within a day or so of this the media explosion—and I'm kind of in a way conscious of living through a similar explosion with the result of attention to this study this past week—the CDC representatives were in a tricky position because it's vital to public health interests that they not divulge the identity of people that shared sensitive information about their sexual lives to them. So they adopted a neither confirm nor deny that Mr. Dugas was a—

AMT: Right, but they could have said there's no such thing as a patient zero, we never said patient zero.

RICHARD MCKAY: And they do—right from 1987 when this story came out, there were attempts to suggest that the spokesman from the CDC said you know we couldn't know whether he was the first case. And in fact, it's one of the co-authors on our paper. I think it was Harold Jaffe that was that spokesperson on the day.

AMT: Okay. Richard McKay, we're almost out of time but basically you looked at blood samples. Am I correct that also you and your colleagues that also made it clear that Gaétan Dugas was part of a study but he was not the epicentre of anything? Am I correct?

RICHARD MCKAY: So I was brought in to provide historical context for the work that the lead author in his lab Michael Worobey at the University of Arizona did. And I really get the sense that we're just scratching the surface of what this story means. So I must say stay tuned for—read an article that I wrote in 2014 that's available, I understand will be made available online through the CBC. And stay tuned for my book on this next year. It'll come out from the University of Chicago Press in 2017 and I am able to go in much more detail into some of these really fascinating questions.

AMT: Okay. Well, Richard McKay, thank you.

RICHARD MCKAY: Thank you so much. I'm a real fan of your show.

AMT: Well, thank you. Richard McKay, his article is in Nature. He specializes in the history of medicine in the department of history and philosophy of science at the University of Cambridge and we reached him in London, England. Well, we're going to keep on with this discussion. I have Ron Rosenes with me now. He's a community activist and a researcher living with HIV since the early eighties. Many of those diagnosed with HIV in the eighties, including Gaétan Dugas, have died. Medical advances mean that many others survived. Those still living with HIV from that era can relate to the stigma that was attached and what was going on and how Gaétan Dugas’ name was used. Ron Rosenes, hello.

RON ROSENES: Good morning, Anna Maria.

AMT: As you listen to Richard McKay—and it's true, we've so much to talk about—but essentially, Gaétan Dugas was vilified publicly as this person who was believed to have brought this illness because there was this simplification that said this illness came with one person into North America.

RON ROSENES: It always struck me as odd and nonsensical that we would attribute one individual and vilify that person as a vector of disease. I think it's really easy, in fact, in hindsight to look back and demonize a number of people whose thinking around the origins of the epidemic and sources of infection all proved to be faulty. And I say that as somebody who was living you know with HIV since the very early days of the epidemic and I remember over the years thinking that you know we shouldn't really be that hard on Randy Shilts. He was one of the first people to write about this and he did so in 1987. For me, when I look back now, I think the best analogy to that time is to think about it as being in the fog of war and it was very difficult for us to make sense of anything. And you know Randy himself succumbed to HIV—

AMT: In 1994.

[Crosstalk]

RON ROSENES: —and his illness in 1994.

AMT: Well, and we should point out, Randy Shilts was with the San Francisco Chronicle. He thought when a disease that no one could name and understood began to show up, he actually convinced his newspaper to make him a full-time reporter to cover HIV/AIDS because he thought it was such a big story and it needed full-time coverage. So he was trying to make sense of things.

RON ROSENES: He was but you know over the years when we look back now, you will find examples of cultural theorists who really tried over the years to debunk this notion. And I, you know as one member of the community and along with lots of other people always thought it was just a nonsensical notion. Moreover—

AMT: Also the blaming. I want to get to that because it was easy then for the rest of the media to pick up on this. And for society at a time when it was looking to blame and it was scared and it was very homophobic, it was really—

[Crosstalk]

RON ROSENES: It was all of those things.

AMT: It was part of that swirl. Talk to me a little bit about that.

RON ROSENES: It was all of those things. So when I talk you know a little bit about how it felt, you know the fact is that at that point in time, there was so much that we didn't know. I mean we really, really thought that AIDS was being caused by—it was a constellation of events if you will or a collection of illnesses and opportunistic infections that were being caused by a constellation of factors. And we didn't even know that there was a single causative agent. So when we look back, we have to remember that this was a time when for example, there was a fight that went on for two years between the French, led by Luc Montagnier and Françoise Barré-Sinoussi, and Robert Gallo in the United States, really fighting over the intellectual property rights of who had discovered this virus. Then we had President Ronald Reagan who for seven years wouldn't say the word because you know those people didn't vote. So this was a time when people were dying by the tens of thousands—if you look at the United States and Canada—over that period. When we were put away in hospitals where people came to us double gloved and double masked, where we used to make sort of gallows humor jokes about the only food we might get in the hospital was flat food like pizza, which somebody could slide underneath the door. So this was a really, really dark time and you know even our same sex partners at the time were often prevented from visiting us or having proper visitation rights at hospitals that supported very unjust policies.

AMT: Your partner died of HIV/AIDS.

RON ROSENES: He did. We were together for 15 years, beginning in the late seventies and he succumbed in 1991.

AMT: And you were diagnosed—like in the early days as well.

RON ROSENES: Well, he was diagnosed in 1983. He was in an early study at the University of Toronto and they were not supposed to give the results because there was nothing you could do for people back in the day. But they did give him the result and we both knew that we had picked up HIV in New York. You know people need to bear in mind, regarding the whole notion of origin here, that for most of the 1970s, this virus was circulating particularly in cities like New York where many people gathered and where this was a time of great sexual liberation, not just gay sexual liberation, but you know as gay men we don't actually own promiscuity. And you know the virus had been circulating and so I didn't get a confirmatory test until the mid-eighties but I know that I've been living with this virus since the very early days.

AMT: Well, that was another thing that we learned about, that it had an incubation period.

RON ROSENES: Exactly. So it was incubating in New York for about 10 years. And my understanding is that by the time people became symptomatic, there were roughly one in two gay men in New York who were already infected. And so people were dying in great, great numbers while other people were either dithering at the political level or activists were organizing in an amazing fashion to get the scientists moving. And you know people can read about it. There's a new book coming out by David France that I've seen an advance copy and it really goes into amazing detail about all of the political and community activism that was taking place at the time to get the scientists moving and to get them thinking.

AMT: In fact, breast cancer, people with breast cancer took a page from AIDS activists to force more research on disease.

RON ROSENES: I believe they did. I really truly—

AMT: Yeah, they did because AIDS activists really were very—they would show up at conferences and demand that scientists and pharmaceutical companies pay attention.

RON ROSENES: Well, not only were we the canaries in a coal mine, but in the 1989 AIDS conference in Montreal, people like Tim McCaskill here in Toronto, led activists on to the stage and forced their way into these scientific conferences and it was in fact community activists who said we've got to read up on what's going on here and who gave the idea to some of the scientists at the NIH, the National Institutes for Health in the US, that they needed to look at an approach that might require the use of multiple drugs. We were all being offered in 1988, AZT, the first drug in toxic doses. It killed more people than it saved.

AMT: And you're an anomaly. You have survived a very long time.

RON ROSENES: You know I have an odd destiny, I suppose. There are lots of people like me. I'm not alone certainly. But through I think a combination of both genetics and good fortune, I am both a long term survivor and I'm certainly a witness. I'm a witness both to a huge and inestimable amount of loss, personal loss, but I'm also a witness to phenomenal scientific advances. Today, I think I'm a pioneer because I'm now in the first cohort of people living and aging with HIV and now encountering a whole new set of really unexpected and unanticipated challenges.

AMT: Sounds like I should have you back to talk just about that.

RON ROSENES: Oh, that's another show for sure.

AMT: Okay. Ron Rosenes, thank you very much for coming in.

RON ROSENES: My pleasure. Thanks, Anna Maria.

AMT: Ron Rosenes has been living with HIV/AIDS since the early days of the epidemic. He's in Toronto. And we're going to pick up on this now, Gaétan Dugas was not the first and will not be the last so-called patient zero associated with a medical outbreak. There's an important medical need to track outbreaks to their sources. The practice of identifying a patient zero does raise ethical questions. Kerry Bowman is a bioethicist at the University of Toronto. He's here with me in the studio. Hi.

KERRY BOWMAN: Good morning, Anna Maria.

AMT: What is the lesson of Gaétan Dugas?

KERRY BOWMAN: Well, you know the lesson is in this pursuit of patient zero—and we see this with other illnesses and other profiles—what tends to happen is we lose sight of the very ethical principles that are foundational in North American healthcare practice. So those are the rights of the autonomous patient and the security of confidential information. So what tends to happen is when we get into an emergency situation or a public health situation—and I'm not saying there's not a rationale for this—we tend to shift from I'm going to go a little academic from what we call principalism, autonomy, to a utilitarian model meaning what is the best outcome for the largest number of people? So in a sense we don't have a coherent ethical structure for both public health emergencies as well as individual patients and Gaetan Dugas. There is a clear example of that. He was incredibly demonized. How that information ever slipped out in terms of identifying him by name is you know an incredible story in and of itself that it ever happened.

AMT: We should clarify: he was very cooperative. He was early diagnosed. He was very cooperative with the Centers for Disease Control, gave them lots of blood plasma samples, all of that. And so somehow they—and there was a typo. So patient zero was in their mind was never what it has now become.

KERRY BOWMAN: Yeah. It meant outside California.

AMT: But it might have been patient O, mean patient—that's right. Zero meant outside of California and patient O meant—yeah, okay.

KERRY BOWMAN: So a lot of—

AMT: Why did the scientific researchers not say wait a second, like stop this?

KERRY BOWMAN: That is the very problem and the mindset that that really takes over in healthcare is when we are dealing with epidemiology, when we're dealing with broad public health issues, our mindset shifts enormously to big picture and very much away from individual patients. And it is something we have to rethink. It's extremely damaging. And if you look at the longer term outcome, as both guests have clearly said of this, the demonization of gay men, I mean even from a public health point of view it probably led to less testing, less social engagement and the destructive element is huge. And we see this throughout Western culture. It seems to be particularly problematic in North America, where we do really you know respect autonomy in a very powerful way and Typhoid Mary, at 1908, the American Medical Association used the term Typhoid Mary in a publication. 2009—I'm not going to use patient names here—but there was a toddler essentially in Mexico who was considered the first patient with swine flu, publicly identified and the family had to live with the fallout.

AMT: And ebola—there was no attempt to trace back to a little girl who drank some soup, had some soup that they said was made with a bat. They weren't sure but it was out there.

KERRY BOWMAN: No. No. And when you look at whether that patient zero—I don't even love that term—that small child, there's no powerful evidence that that actually occurred. This is hypothetical again that that even occurred.

AMT: But the search for the origin of an infectious disease is not in of itself a bad thing.

KERRY BOWMAN: It's not. It's not. But if things become conflated, these patients, that young boy in Mexico, you know the small child in West Africa, they did not cause this. They did not cause the illness. And it gets turned around in people's minds that these individual people are responsible for massive implications. The mother of the boy, the swine flu child in Mexico, people were saying that her son caused this. So you know the ethics of it, everything we believe in, in terms of protection of confidentiality—that actually we've made great strides with in Canada in recent years—gets turned around.

AMT: And we saw it with SARS as well.

KERRY BOWMAN: We saw it with SARS. And I was then and am now on the frontlines of Toronto healthcare and it was very, very, very interesting time. We were broadsided. I think mostly we got it right. And it's led to some very good research at my university, University of Toronto, in terms of the balancing of this, which a lot of good people have worked on. So I think we've made some progress. But again, you know because we're untested with these broad emergencies or wars, we tend to have one system when times are good and then when times get really difficult, we completely shift to a utilitarian model without a great bridge between the two.

AMT: And we also demonize countries, huh? You make the point.

KERRY BOWMAN: We absolutely.

AMT: Mexico, swine flu. What's going on with Zika right now? Are we making the same mistakes with the Zika virus?

KERRY BOWMAN: No, and Zika you know a lot of blame is being focused on Brazil and Brazilians and all kinds of behaviour. But Zika again is coming from you know it comes from a Ugandan forest. I've actually been there. The Zika Forest in Uganda. So there's a lot of, you know a lot of these things are incredibly negative and are going to need a lot more attention. There's no question about that.

AMT: So there's a real lesson here for the media.

KERRY BOWMAN: There's a real lesson and you know what is sexier than patient zero? I mean people just eat it up. They love it. You know the book itself, Randy Shilts’ book, I actually found the balancing of hero and villain problematic when I read the book. I wasn't buying it. I was a healthcare worker even then when I read it and I saw that as problematic.

AMT: Kerry Bowman, important to hear your voice in this. Thank you.

KERRY BOWMAN: Thank you very much.

AMT: Kerry Bowman, bioethicist at the University of Toronto with me in our Toronto studio. That's our program for today. If you want to weigh in on this discussion, find us on Twitter. We are @thecurrentCBC. Go to our Facebook page or go to our website www.cbc.ca/thecurrent. Stay tuned for Radio One with q—Tom Powers speaking with Phil Collins today about his new memoir. I'm Anna Maria Tremonti. Thank you for listening to The Current.

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November 1, 2016 full episode transcript

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