Category: Science

The Great Influenza

Cover image for The Great Influenza by John M. Barryby John M. Barry

ISBN 9781101200971

“It seemed now as if there had never been life before the epidemic. The disease informed every action of every person in the city.”

On the heels of The Great War—now better known as World War I—a much more rapacious killer swept the globe, leaving a death toll that dwarfed the war in its invisible wake. As the influenza pandemic raged, medical scientists practically took up residence in their laboratories, seeking the elusive pathogen that was piling up bodies on their doorsteps. Wave after wave broke over the globe, but still the cause, a treatment, a vaccine, remained just beyond grasp. Recently modernized, American medical science clashed with nature and fell short, despite the concerted efforts of investigators such as Paul A. Lewis, Oswald Avery, and the team of William H. Park and Anna Wessel Williams. John M. Barry combines war, disease, and history of medicine in this account of 1918 flu pandemic, which remains one of the deadliest in human history.

The Great Influenza is broadly interested in the history of medicine, and specifically the evolution of the American medical tradition, and how it came to be transformed and modernized, finally becoming a scientific endeavour. Barry goes so far back as the Hippocratic and Galenic medical traditions, tracing progress through Paracelsus and Vesalius before discussing the stagnation of medical progress, and America’s late arrival to the scientific medical revolution. He spends significant time on the establishment of Johns Hopkins in 1876, the first modern medical laboratory in the United States to be modeled after state of the art institutions in Europe. The hospital and medical school would be added later, and for the first time prospective doctors in the United States would be required to have a college degree, as well as be fluent in French and German for admission. The establishment and contributions of the Rockefeller Institute also receive significant attention, if not quite as much detail as Johns Hopkins. This contextualization takes up about the first quarter of the book before Barry turns his attention to the pandemic proper.

Barry begins in Kansas in January and February of 1918, following Dr. Loring Miner, who observed an unusually violent influenza among his rural patients that winter which may have been the forerunner of what is now thought of as the first spring wave of a pandemic that would ultimately take as many as 100 million lives. He then turns his attention to Camp Funston, also located in Kansas. Although he briefly acknowledges that the exact origin of the outbreak is not proven, he considers this the most likely, and proceeds from there. From army camp to laboratory to naval shipyard to community spread, Barry follows the pathogen, and the people who were trying to identify it, and create a treatment or vaccine. Barry’s account of the pandemic is largely Amerocentric. (For a book with a slightly more global perspective, I would recommend Pale Rider by Laura Spinney.) Late in the book Barry makes a brief circuit of the globe, with cursory accounts of the death tolls in various locales, but this is not the focus of the book. On the home front, he uses Philadelphia as a particular case study. The city was home to a naval shipyard, and held the Liberty Loan Parade to raise money for war bonds in late September of 1918, just as the deadly second wave was breaking upon the city. The results were catastrophic, almost apocalyptic.

At times Barry seems to wish he was writing a biography, with figures such as William Henry Welch, Paul A. Lewis, and—to a lesser degree—Oswald Avery occupying large amounts of his attention, even taking time to detail lulls in their careers when they were not making significant contributions. Welch, though not much of a laboratory scientist himself, was a key player in the transformation of the American medical establishment, and an important mentor and power broker in the field. Both Lewis and Avery spent the war and the years that followed in the laboratory investigating influenza, but neither would identify the virus, and their most signal scientific accomplishments would be in other areas. Lewis would be remembered largely for his work on polio, and Avery for his ground breaking discoveries regarding DNA. Both the war and the pandemic would pass, and it would be the 1930s before the virus was at last discovered. This receives only cursory attention in the final section.

A significant cautionary note that emerges from The Great Influenza is the danger of government misinformation and inaction. Because of the war, information about influenza was tightly repressed, as it was believed to have a negative influence on morale. As Barry puts it, “What officials and the press said bore no relationship to what people saw and touched and smelled and endured.”  In practice, the cognitive dissonance of seeing friends and neighbours dying all around while the press and government continued to print reassurances that there was nothing to be concerned about proved significantly more destructive to the social fabric. Trust eroded, and in the absence of reliable information, people simply had to fend for themselves. Read in the current circumstances of the COVID-19 pandemic, this makes The Great Influenza a chilling combination of reassurance and despair. It—which is to say the disease itself—could be so much worse, and yet more than a hundred years later, we are still making so many of the same mistakes.

You might also like Spillover by David Quammen

The American Plague

Cover image for The American Plague by Molly Caldwell Crosbyby Molly Caldwell Crosby

ISBN 9781440620461

“Nature had found the perfect place to hide the yellow fever virus. It seeded itself in the blood, blooming yellow and running red.”

Long before the idea that mosquitoes could spread disease was scientifically proven and medically accepted, diseases like malaria and yellow fever were wreaking havoc, spreading from West Africa to the Caribbean and up the Mississippi River Valley on the gossamer wings of aedes aegypti. People who had never been in contact with anyone who was ill mysteriously succumbed, as if the disease was in the very air. In The American Plague, journalist Molly Caldwell Crosby chronicles how yellow fever arrived in North America, the devastating effects of an outbreak, the efforts to uncover how the disease was spread, and finally the journey to a vaccine.

The American Plague has two main subjects; the 1878 yellow fever outbreak in Memphis, Tennessee, and the work of Walter Reed, James Carroll, Jesse Lazear, and Aristides Agramonte on the Yellow Fever Board in Havana during the Spanish-American War. A Memphian herself, Crosby begins with the Memphis outbreak, a devastating event that killed at least 5000 people, in a city with a population of only 40, 000—half of whom fled at the onset of the epidemic. There were not enough doctors and nurses to care for the sick, and medical volunteers arriving in Memphis were often stricken by yellow fever within days of arrival, adding to the burden. With deep access to the local history, Crosby pulls out fascinating details, such as the caretaker’s daughter who kept the cemetery’s record book, writing down each name and ringing the bell for the dead, until she succumbed to yellow fever herself.

Economic imperatives and subsequent devastation surround this narrative, beginning with the slave trade, which was the vehicle that brought yellow fever from West Africa to the Americas, satisfying the thirst for free labour at the cost of human life. Crosby recounts how yellow fever would typically arrive in New Orleans via the Caribbean, and then make its way up the Mississippi River Valley. Port cities were caught between the desire to prevent disease and the economic benefits of not quarantining incoming ships. Cargoes such as fruit from the Caribbean could be destroyed by a quarantine. The Memphis Board of Health voted against a quarantine in 1878, only to have the city economically destroyed anyway; the outbreak was so severe that the city was bankrupted, and its charter revoked. I found this particularly striking in the midst of the fraught economic debates currently surrounding COVID-19 containment measures.

After illustrating the devastating effects of yellow fever on both human life and the American economy, Crosby shifts her attention to the efforts to discover the cause of yellow fever, and create a vaccine against it. When the Yellow Fever Board was assembled in Havana in 1900, they were building on the work of Dr. Juan Carlos Finlay, a Cuban doctor who had proposed the mosquito as the vector for yellow fever two decades earlier, to much ridicule. What is most interesting here, however, is the various controversies surrounding the work. Members of the board experimented upon themselves, and on army volunteers, but also carefully recruited and groomed new Spanish immigrants to Cuba, using large financial incentives to get them to consent to participating in the experiments. Army doctor Jesse Lazear, who was the head of the mosquito work, died of yellow fever which is now suspected to have been self-inflicted, but was covered up at the time. James Carroll eventually died in 1907 of the lasting complications of yellow fever contracted in the course of his work in Havana. From there Crosby goes on to the work of Max Theiler, who invented a vaccine for yellow fever, infecting thousands of American soldiers with hepatitis in the process—although to be fair to Theiler, he expressed his concerns about the widespread use of this vaccine and was overruled in favour of ensuring that American soldiers deploying for World War II were inoculated.

Although Crosby dedicates a significant amount of the book to medical investigations, I would describe this account of yellow fever as more cultural than epidemiological. She doesn’t delve deeply into any of the virology or the nitty gritty scientific details. Although she briefly mentions that the difficulty in proving the mosquito hypothesis was a matter of the timing of the reproductive cycle of the virus, she never does get around to fully explaining the viremic window for infection between mosquitoes and humans, or a more than cursory exploration of the zoonotic origins of the disease. Nevertheless, The American Plague is an interesting look at how one tiny virus significantly shaped the course of American history, and I would recommend it for those more interested in the human impacts of pandemic than the science surrounding it.

More pandemic reads:

Spillover by David Quammen

Pale Rider by Laura Spinney

China Syndrome by Karl Taro Greenfeld

Spillover

Cover image for Spillover by David Quammenby David Quammen

ISBN 978-0-393-23922-5

“Make no mistake, they are connected, these disease outbreaks coming one after another. And they are not simply happening to us: they represent the unintended results of things we are doing.”

I picked up this book because my last couple of pandemic reads had left me particularly curious about the phenomenon of zoonosis. Zoonoses are diseases that originate in animals, usually harboured by a reservoir—a species that chronically carries the bacteria or virus but is not sickened by it—and are transmissible to humans. When the right set of circumstances occur, when the fragile ecological balance of the world is disrupted in a new way, a pathogen can spill over from animals to humans. Sometimes, that spillover is a dead end; the circumstances are so unique that they may never occur again. Or the virus can be transmitted to humans, but not between people: game over. But the thing that keeps virologists up at night is the pathogen spillovers that are not only virulent—highly deadly to humans—but also highly transmissible between humans once the species boundary has been breached. With the possibility of the Next Big One always looming, David Quammen takes the reader through famous outbreaks of zoonotic illnesses, with sections on Hendra, Ebola, malaria, SARS, Lyme, Nipah and HIV.

David Quammen is a journalist with a long history of covering zoonosis, with the consequent experience in translating a highly technical subject for a lay audience. As detailed in the book, his field journalism has taken him on several expeditions with top scientists working to trace the origins of various zoonoses, from Africa to Asia, following bats, gorillas, and chimpanzees. He interviews people as world famous as Jane Goodall, and specialists who are only rockstars to those who pay close attention to the world of virology. Spillover was published in 2013, and presages not only the 2014 Ebola outbreak, but the current COVID-19 situation as well. That isn’t to say that Quammen or his experts explicitly predicted it; in fact, the final chapter of the book focuses on influenza in particular, and the possibility of avian influenza (H5N1) achieving human-to-human transmission. But COVID-19 is, like influenza, an RNA virus with all the rapid mutation that entails. The broad point is not predicting any specific spillover, which would be virtually impossible, but rather illuminating the circumstances that make these types of events all but inevitable.

One very interesting trend that emerges is bats, which have been implicated as the reservoir host for a variety of spillover viruses. Nipah and Hendra, for example, are confirmed to originate with bats. In his 2006 book China Syndrome, Karl Taro Greenfeld followed the trail of SARS to palm civets in southeastern China’s wild animal markets. But in Spillover, Quammen takes the reader through more recent evidence that palm civets were actually an amplifier or transitional host that enabled the virus to reach humans from bats. Although the reservoir for Ebola remains unconfirmed, virologists are looking at bats with great interest. Unfortunately, Quammen’s reporting reveals that the significance of bats in all this is still poorly understood. It could just be that there are so many bats; at 1116 species, they account for one quarter of all mammal varieties. The fact that they live in large roosts conducive to spreading the virus within their communities, combined with their mobility and range could also be significant. But until bat immunology is better understood, the answer to why so many spillover events seem to originate with bats cannot be more than speculative.

I also found the section on HIV/AIDS particularly interesting because most of the books I have read on the subject focus on the cultural history, specifically the impact on the gay community. None of those books have tended to look further back than the Canadian flight attendant who become known as Patient Zero in a study that focused on a North American outbreak cluster in the early 1980s. Quammen’s interest is more epidemiological, and the story of HIV is particularly fascinating because the science suggests that the spillover event took place much earlier than one might have expected—perhaps as early as 1908. However, this section does get a bit bogged down with a long, imaginative tangent where Quammen uses the little available evidence to extrapolate a narrative sequence about a hunter who ultimately brings HIV out of the forest. The true Patient Zero for HIV will never be known, and while Quammen’s imagining isn’t implausible based on the available evidence, it nevertheless feels out of place in this otherwise very factual book.

Spillover is on the long side—the print edition comes in at nearly 600 pages—and a bit technical at times, but if you’re only going to read one book about epidemics, this one combines multiple outbreaks into a single volume, highlights trends and commonalties, and provides a good basic understanding of  the relationship between virology, ecology, and epidemiology. The chapter on Lyme disease is particularly apt in its illustration of how important the ecosystem is to prevalence of a disease. If you’re not up for the full volume, Quammen has published Ebola and The Chimp and the River, both short extracts from this larger book focusing on Ebola and HIV respectively. If, like me, information is your coping mechanism of choice at the moment, you’ll emerge from Spillover with a much better contextual understanding of our current situation, armed with many of the essential concepts for understanding the virology and epidemiology underpinning the ongoing public health conversation that will be dominating our discourse for the foreseeable future.

You might also like Pale Rider by Laura Spinney

China Syndrome

Cover image for China Syndrome by Karl Taro Greenfeld by Karl Taro Greenfeld

ISBN 978-0-06-185153-7

“The season of SARS could be viewed as either an anachronism or a harbinger.”

Over the winter, a new virus emerged, sickening its victims with a severe respiratory illness that manifested with a high fever and a hacking cough. For an unlucky few, the illness degenerated into total respiratory failure as the lungs filled with fluid, and the organs shut down from lack of oxygen. As Lunar New Year approached, the Chinese government continued to insist that the situation was under control, even as cases began to spread. The story is eerily familiar, because we have all been living it. But Karl Taro Greenfeld’s 2006 book China Syndrome is a chronicle not of COVID-19, but of the SARS epidemic caused by a similar novel coronavirus that jumped the species barrier and sickened thousands in 2003 to 2004. At the time, Greenfeld was the managing editor of Time Asia, and based in Hong Kong, the first place outside of mainland China to be affected by the epidemic. The big news story of the year was expected to be the American invasion of Iraq. Instead, Greenfeld and his staff found themselves on the frontlines of reporting on the twenty-first century’s first major epidemic.

Each chapter is headed with the location and date, as well as the number of people estimated to have been infected or dead of SARS. The death rate in these estimates hovers around a chilling ten percent, and also grows in increasing contrast to the Chinese government’s public refusal to adjust their official numbers upward even as people continued to sicken and die. The book is insightful about the cultural conditions that lead to the denial and cover up. Greenfeld highlights the unprecedented transition of power that was occurring in Beijing at the time, as well as the emphasis on saving face and avoiding blame. Particularly telling is the fact that information about a disease outbreak is classified as a state secret in China. It was illegal to disclose this information anywhere but up the reporting line. Greenfeld witnessed a doctor arrested for talking to him about the outbreak, and another doctor that spoke up spent the rest of his life under house arrest. A Hong Kong virologist risked arrest by traveling across the border repeatedly to smuggle samples for his lab, since it was impossible to get any information out of the Chinese Ministry of Health.

Coming in at seventy-three—albeit often short—chapters, China Syndrome does feels somewhat drawn out, especially in the early chapters before the agent of the disease has been identified. As Greenfeld points out, however, the specific agent often isn’t all that important if doctors can treat the disease with existing methods. Investigators were at first highly focused on the possibility of avian influenza, and it is almost halfway through the book before the term “coronavirus” is even mentioned. By comparison, however, it took more than two years for scientists to isolate the agent responsible for the AIDS epidemic. The race for the answer features internal and international rivalries, and more than one false step along the way.

Before you decide to pick this one up, I would issue a warning for a few more graphic parts of the book. It includes descriptions of the conditions market animals live in, and how they are restrained and killed on site at the restaurants that serve them. Greenfeld also describes the liquidation of livestock that occurred once the virus’ host animal was identified and banned from sale. In the medical section, there is a detailed description of intubation that serves to illustrate why the procedure posed such a risk of infection to the healthcare workers who performed it on SARS patients. These don’t form huge swathes of the book, but it is worth knowing they are in there.

There is a definite sense of eerie deja vu in reading this book, from the slowly escalating rumours, and mutters about biological warfare, to the runs on particular kinds of equipment and supplies, to the very timeline and symptoms of the illness itself. Yet perhaps the most eerie part is the unheeded warning that SARS now represents. As Greenfeld details, the Chinese government banned the sale of the animal found to be the reservoir of the virus, and seized and destroyed the existing stock. But the closure of the urban markets where live animals were sold was only temporary, and within months they were back in business, operating much the same as before, with thousands of diverse, defecating, bleeding, doomed animals trapped in close quarters with one another, and the people who sold, butchered, and consumed them. One threat was eliminated, but the conditions for another such zoonotic outbreak remained much as they ever were.

You might also like Pale Rider by Laura Spinney

Pale Rider

Cover image for Pale Rider by Laura Spinneyby Laura Spinney

ISBN 978-1-61039-768-1

“The number of dead could have been as high as 100 million—a number so big and so round it seems to glide past any notion of human suffering without even snagging on it. It’s not possible to imagine the misery contained within that train of zeroes. All we can do is compare it to other trains of zeroes—notably the death tolls of the First and Second World Wars—and by reducing the problem to one of maths, conclude that it might have been the greatest demographic disaster of the twentieth century, possibly of any century.”

The influenza epidemic that began in 1918—which became known as the Spanish Flu—has drawn a lot of interest in recent months as comparisons are made to the current situation with COVID-19. Pale Rider by Laura Spinney was published in 2017, shortly ahead of the flu pandemic’s centenary year. As such, it is quite current, but of course does not directly address our present circumstances. Spinney tracks the influenza’s two year path around the globe, while also providing historical context, history of medicine, and a significant look at recovery and collective memory as it relates to the pandemic. By the numbers, the contemporary estimate of deaths was 20 million, but over the years that has risen to 50-100 million as more records and evidence come to light. Probably about one in three of the then 1.8 billion living people would have become infected, and while most recovered, up to five percent of the sick may have perished.

I selected this title from among a few popular books about the 1918 pandemic as it is noted for its attempt to take a more global approach to understanding the outbreak. Other previous titles have a more North American and European focus, despite the fact that these areas were not the hardest hit. According to Spinney, that dubious honour likely goes to India, though the numbers for China are murky. In addition to addressing the first recorded case, at Camp Funston military base in Kansas, and covering the impact on the Western Front as well as the acquisition of the “Spanish Flu” nomenclature, Spinney goes further afield to dig into the available numbers for places as various as China, Persia, India, Australia, Iceland, and more, resulting in a more complete picture of the global impact.

The structure of the book is circular, and somewhat repetitive. Rather than following a chronological timeline, Spinney takes a locale-by-locale approach that covers the same chronology multiple times in different places. Despite the repetition, this is an effective structure for sinking into each location and getting a full sense of their experience of the pandemic, which had huge regional variations. Australia, for example, experience only the third wave, having effectively kept out the deadly second wave with a maritime blockade. Spinney also covers three major theories about where the flu may have emerged before it surfaced and was recorded in Kansas, but with a careful eye to the contemporary prejudices that may have been shaping these hypotheses, particularly with regard to China. Within the United States, she addresses the tenements of New York, as well as the remote villages of Alaska, and highlights how differences in responses between cities led to vastly different death rates.

In addition to tracking the pandemic, Pale Rider provides and explains historical context about where the development of medical understanding and technology stood when the pandemic began. Notably, the electron microscope was not invented until the 1930s, meaning that while bacteria could be seen on an optical microscope, viruses—which are about twenty times smaller—were still invisible. Spinney briefly traces the evolution of Western medicine in relation to contagious diseases, and in specific locales such as Indian, China, and Persia, she also addresses how this knowledge was interacting with local medical traditions like Ayurveda. In the West, she also briefly chronicles the backlash against traditional doctors for their failure to prevent the outbreak in the first place.

A notable cautionary note that emerges from Pale Rider is the danger of mass gatherings for any purpose. Influenza does not distinguish between a church service and an armistice parade, a wedding or a funeral. Particularly chilling is Spinney’s account of the Spanish city of Zamora, which was among the hardest hit in that country. Zamoran congregations actually swelled as the pandemic raged, and the populace sought solace and prayed for relief. The city had a zealous new bishop who encouraged religious gatherings, called novenas, promoted the adoration of relics, and continued to distribute communion, all activities that send a shiver down the spine of anyone with a current understanding of the germ theory of disease.

In the latter part of the book, Spinney dives into the difficulty of trying to tease apart the inextricable impacts of the one-two punch that was the Great War with a pandemic following close on its heels. Although more people died in the pandemic, the war remains much better remembered, though Spinney suggests that the centenary is changing that, and no doubt the current situation will also contribute to the revival of interest. For those wondering whether they would be up to reading this book at the moment, I found the author’s approach thorough, but largely not grisly, though there are some dark spots. Spinney leans more towards statistics rather than graphic descriptions of the physical suffering of the flu victims.

Range

Cover image for Range by David Epsteinby David Epstein

ISBN 978-0-7352-1448-4        

“Everyone is digging deeper into their own trench and rarely standing up to look in the next trench over, even though the solution to their problem happens to reside there.”

Most people by now are familiar with the ten thousand hour rule, as studied by Anders Ericsson, and made famous by Malcolm Gladwell. Journalist David Epstein examines an opposing approach to learning, putting aside the concept of early specialization, followed by many hours of deliberate practice, in order to explore the potential benefits of wide sampling for learning, creativity, and problem solving, before specialization takes place. His inquiry takes the reader through the unconventional career paths of famous innovators such as Vincent Van Gogh, tracks the surprising scientific breakthroughs made by outsiders in fields in which they have no formal training, and highlights how the ability to integrate broadly remains a uniquely human strength.

It is important to note that Epstein is not dismissing this earlier research, or discounting specialization altogether. Rather, he is interested in dissecting our mythologization of this one method of learning, and figuring out in which realms this strategy is applicable, and in what areas it puts us at a disadvantage. The resulting reporting reveals a fascinating range of situations where unusual training paths, and outside collaborators have had an outsize influence on innovation, creativity, and problem solving. He specifically identifies “kind” domains in which the rules are relatively fixed, and feedback is immediate, and more “wicked” domains where results take longer to reveal themselves, and the rules are subject to change at any moment, if any patterns can be discerned at all.

Epstein has a great eye for stories, and a knack for telling them well. He opens each chapter with a case that illustrates the point, before he lays out the somewhat drier data that buttresses his argument. One of the most fascinating of these is the story of the figlie del coro, female orphans and foundlings from the Venetian ospedali. Given over to the orphanage by their mothers—who were probably sex workers—the girls were raised to music from an early age, taught to sing and play a variety of instruments. Although these women were hailed as among the best musicians of the period, and had the vaunted early start, they spent much less time per day practicing than today’s classically trained musicians, and they switched and sampled instruments often. In fact, they were known to switch places mid-performance. Their story illustrates that even in “kind” domains like classical music, there are paths to outrageous success that do not follow what we think of as the typical path. And the examples provided are not just historical; in the world of modern music, Yo-Yo Ma tried violin and piano before settling on the cello.

Yet another of Epstein’s gripping stories comes from endeavours like InnoCentive, a company founded to search for unusual solutions to sophisticated problems that have stumped experts in the fields from which the problems arose. Thus, a man with experience working with concrete solved the problem of how to remove congealed oil from an environmental recovery barge, and the dean of a library school who had no library science background discovered a potential link between migraines and magnesium deficiency, which was documented in the available literature, but which no researcher or neurologist had ever connected before. These cases make for a compelling argument not only for individual range, but for diversity within teams that are solving problems, so that not everyone is working out of the same toolbox.

Given the early pressure for students to specialize, and the popularity of books such as Grit, which valourize persistence to a fault, Range offers an interesting counterpoint to this tendency to try to get ahead. Yet Epstein points out that students who chose to specialize early were more likely to switch fields later. Education doesn’t just provide work skills, it also helps students identify the areas that are a good match for their strengths and preferences. Experience is never wasted, and exploration is part of the point of education. We cannot know in advance how seemingly unrelated skills may help us down the road.

You might also like Rest by Alex Soojung-Kim Pang

Custodians of the Internet

Cover image for Custodians of the Internet by Tarleton Gillespieby Tarleton Gillespie

ISBN 978-0-300-17313-0

“The fantasy of a truly ‘open’ platform is powerful, resonating with deep, utopian notions of community and democracy—but it is just that, a fantasy. There is no platform that does not impose rules, to some degree. Not to do so would be simply untenable.”

No matter what web platforms you use, the contents presented to you inside that software shell are shaped by a series of policies and decisions which are probably largely invisible to you as the end user. Focusing on the major English language platforms, Custodians of the Internet analyzes the myth of the neutral platform, introduces the US regulatory scheme that gave rise to the current state of affairs, and examines the strengths and weaknesses of the different moderation methods currently in use, as well as making some modest proposals for how adjust the situation going forward. Tarleton Gillespie is both an academic and a tech industry insider, employed by Microsoft Research New England, as well as Cornell University. The book is published by Yale University Press.

Custodians of the Internet aims to focus our attention on the hidden work that the social media platforms would rather have remain invisible. Content moderation functions silently behind the scenes, and the end user never knows what it is they do not see. Moreover, thanks to personalization algorithms, they do not know what they see that others do not, and vice-versa. The content is not only moderated, it is also curated, often to maximize engagement and time on screen. Platforms have worked very hard to preserve this illusion of smooth operation, requiring their third-party moderators to sign non-disclosure agreements, and remaining tight-lipped about how they decide what to allow on their sites, and how their algorithms function. Most people spend little or no time thinking about what isn’t on the platforms they use, or why they see what they do see, but these invisible boundaries are what shape and distinguish these spaces, and constitute them into usable, monetizable products.

Gillespie also attempts to encompass the inherent and irreconcilable complexity of the moderation endeavour, and the broad range of unseen work it entails, from policy teams, to crowd workers, to individual users who are deputized rate or report content. He includes analysis of three main moderation strategies, which are editorial review, user flagging, and automatic detection. Each strategy has constrains and weaknesses. For example, editorial review is hugely labour intensive, flagging mechanisms can be abused for social or political purposes, and even potential violations automatically detected by a computer often need to be verified by human eyes. While it is easy for users or the media to criticize a particular moderation decision or policy, Gillespie is determined to highlight the broader context and framework inside which each individual decision is ultimately made and disputed.

Gillespie identifies two categories that platforms tend to fall into when it comes to moderation; they position themselves either as “speech machines” or “community keepers,” and build their policies around those stances. However, he does not oversimplify, noting the tension and interplay between the two camps, and how platforms ricochet between these justifications when trying to position themselves in the best possible light, often after an individual decision comes under scrutiny. As Gillespie puts it, “If social media platforms were ever intended to embody the freedom of the web, then constraints of any kind run counter to these ideals, and moderation must be constantly disavowed. Yet if platforms are supposed to offer anything better than the chaos of the open web, then oversight is central to that offer—moderation is the key commodity, and must be advertised in the most appealing possible terms.” It is a contradiction that can never be fully reconciled, and one that is inevitably shaped by the economic imperatives of making a platform profitable as well as functional.

For those unfamiliar with American law, Gillespie includes an introduction to Section 230, the provision of telecommunications regulation better known as “safe harbor” that holds intermediaries or conduits innocent of any responsibility for the speech or content of their users. It further stipulates that moderation in good faith does not change this provision. This regime was designed for the telephone era, and Gillespie convincingly argues that social media platforms, which the law could not have foreseen, “violate the century-old distinction between deeply embedded in how we think about media and communication,” and further that they constitute “a hybrid that has not been anticipated by information law or public debate.” The book is not largely focused on solutions, but Gillespie does propose that safe harbour need not be unconditional. Rather, platforms could be asked to meet certain requirements in order to maintain that status, whether that means greater transparency or improved appeal structures. However it seems likely that the platforms would vociferously oppose any change to this generous provision, which grants them the best of both worlds—the right to remove any content they please, but responsibility for none of it.

Gillespie is largely interested in looking at the big picture, and at the breadth of content which platforms host and police. Policies must be designed to cover a wide range of content, and Gillespie seems less interested in specific case studies, except in so far as they show how a broad dictate such as “no nudity” can come into conflict with a more specific situation, such as breastfeeding, to which he dedicates a chapter. Gillespie is also interested in problems of scale, and the issues that arise when a platform is home to multiple communities of people with conflicting values, and differing ideas about where lines should be drawn. Small, homogeneous online communities that believe they do not require moderation often get a rude awakening when they receive a large influx of new users who do not share their presumed values.

In this broad discussion, Custodians of the Internet is laying the groundwork for our emerging conversation about the role the platforms have played during the growth of the web as our dominant form of media, and the role we want these platforms to play in public discourse going forward. This is part of a larger discussion about not only moderation, harassment and free speech, but also data privacy, the gig economy, microtargeting, algorithmic bias, and more. The distribution of power and responsibility will shape our future in ways we have only begun to comprehend.

Invisible Women

Cover image for Invisible Women by Caroline Criado Perezby Caroline Criado Perez

ISBN 978-1-4197-2907-2

“Routinely forgetting to accommodate the female body in design—whether medical, technological, or architectural—has led to a world that is less hospitable and more dangerous for women to navigate. It leads to us injuring ourselves in jobs and cars that weren’t designed for our bodies. It leads to us dying from drugs that don’t work. It has led to the creation of a world where women just don’t fit very well.”

In a data driven world, evidence is everything. But so much of our data is biased, or incomplete, often entirely failing to account for a full half of the population. Author Caroline Criado Perez—known for receiving death threats for advocating to have Jane Austen on the back of Britain’s £10 banknote—calls this the “gender data gap.” And while Criado Perez believes that this gap is, generally, neither deliberate nor malicious, it nevertheless has consequences, ranging from inconvenient to deadly. Poised on the edge of a future where proprietary black box algorithms will use this data to make decisions humans can barely understand, amplifying this invisible bias by orders of magnitude, Criado Perez argues that it is more important than ever that we collect this data, and separate it by sex in order to prevent women from falling through the cracks of a male default world.

Invisible Women reads as a veritable laundry list of gaps, omissions, and injustices that result from presuming a male default in everything from medicine to urban planning to product design. Testing treatments on young (mostly white) males, and then adjusting for women and children, presumes a level of understanding of human biology that we have yet to achieve, and probably never will if we continue to avoid studying large segments of the population. It can also lead to astonishing oversights, such as building houses without kitchens. This happened in the wake of not one, but several disasters in South East Asia, where only consulting with men about the process of rebuilding lead to the creation of houses that failed to include the facilities that were predominantly the domain of women. Some of the examples are glaringly obvious, while others are patched together through a variety of smaller or older studies that give us an impression of what we might be missing because we’ve failed to study “atypical” patterns or behaviours that are in fact only atypical for men.

Done well, science is a tool for discovering the truth about our world. Done poorly, it can enshrine falsehoods and half-truths as doctrine. And leaving women out of almost all medical research for the sake of simplicity and reducing variables is just one example of how research can arrive at such half-truths—truths that are valid for one half of the population, but do not necessarily hold for the other. After nausea, Criado Perez found that the most commonly cited adverse drug reaction among women was that the drug simply didn’t work. For the author, this also raises an equal but opposite question; how many drugs that would have worked for women, but not men, never made it past trials because they were not effective in the majority of the (male) study participants? It is this kind of default thinking that can lead a company to make bank on a drug that stimulates erections in men, while completing ignoring the fact that the same drug was reported in trials to complete eliminate menstrual cramps in women for up to four hours. That’s like sitting on a gold mine and ignoring half of it.

In a book about gaps and biases, I did notice one significant omission in the discussion. Not once does Criado Perez mention transgender women. Nor is the term cisgender ever used. This is in spite of the fact that the she acknowledges that “the female body is not the problem. The problem is the social meaning we ascribe to that body, and a socially determined failure to account for it.” Criado Perez follows three themes through the book, which are the female body, women’s unpaid care burden, and male violence against women. While transwomen’s medical realities are different than those of ciswomen (and probably in the middle of an even bigger data gap thanks to their small numbers) they are very much a part of the latter two, most especially male violence against women. Combined with neglecting to discuss the singular they pronoun in a discussion of gender inflection in languages, and a couple of comments that reduced gender to genitals, I was left wondering if Criado Perez was thinking intersectionally. This was a glaring omission in an otherwise very thorough book which included many examples specific to working class women, women of colour, and women in the developing world.