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Correcting a Mistake in Everything Is Tuberculosis · 50 x 50 Science

2026-10-20 · explainer · John · 8:34 · watch on YouTube

Topic: Health (also: Science & nature, Global development) · mode: Explainer · tags: recurring series, self correction, heavy topic

In the Indiana entry of 50 x 50 Science, John corrects an omission in Everything Is Tuberculosis (TB's many efflux pumps, which push drugs out of the cell) and argues that curing TB means solving sociological problems (drug incentives, poverty, nutrition, delivery) as well as biological ones.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — Correcting an omission from Everything Is Tuberculosis; the Indiana entry in 50x50 Science

  • ★★ John says that in this video he corrects an important omission from his book Everything Is Tuberculosis. — 00:00:00 · Everything Is Tuberculosis
  • ★★ The video is the Indiana entry in 50x50 Science Across America, a national series in which 50 creators talk with scientists. — 00:00:00 · Indiana, United States
  • ★★ To research the video, John met Dr. Leslie Enane, a tuberculosis researcher in Indiana, joking that this will shock Hank, and consulted other experts around the world. (playful) — 00:00:00 · Indiana

00:00:29 — Two kinds of bacteria; biology is inseparable from sociology: drug incentives, TB's decline in the US, malnutrition and food distribution

  • ★★ John says the two broad kinds of bacteria, gram-positive and gram-negative, probably have not shared a common ancestor in billions of years; he is more closely related to mushrooms. (hedged) — 00:00:29
  • ★★ John says Mycobacterium tuberculosis is evolutionarily a gram-positive bacterium, but its cell wall is unusual: especially thick and waxy. — 00:00:29

  • ★★★ John says the first thing to know about tuberculosis is that biology is inseparable from sociology. — 00:00:29

    “biology is inseparable from sociology”

  • ★★ John says almost every tuberculosis researcher he talks to tells him he cannot understand TB's biomedical challenge without understanding its sociological challenge. — 00:00:58 · tuberculosis

  • ★★ John says the line drawn between the hard sciences and the social sciences is somewhat artificial. — 00:00:58
  • ★★ Dr. Leslie Enane treats children with tuberculosis and is also a researcher in implementation science, how children actually get diagnosed and treated for TB. — 00:00:58
  • ★★ John says a statin like his, taken daily likely for life, is a great drug for pharmaceutical companies to pursue, while an antibiotic taken briefly is good for patients but bad news for drug makers, since drugs are expensive to develop and a single course can only be priced so high. — 00:01:27
  • ★★★ John says that if humanity chose to incentivize the creation of antibacterial drugs they would be plentiful, but it currently does not, so they are not. — 00:01:56
  • ★★★ Tuberculosis remains the world's deadliest infectious disease, sickening over 10 million people and killing over 1.2 million every year. — 00:01:56 · tuberculosis
  • ★★★ John says the United States dramatically reduced its tuberculosis rate between 1890 and 1940 by making homes and factories less crowded and improving air circulation, which reduced airborne transmission. — 00:02:26 · tuberculosis, United States
  • ★★ Pasteurizing milk meant people stopped getting tuberculosis from infected cow milk. — 00:02:26
  • ★★ Lowering rates of absolute poverty reduced malnutrition, a huge risk factor for tuberculosis. — 00:02:26 · extreme poverty, tuberculosis
  • ★★ About half of the people who get sick with tuberculosis this year (2026) will also be malnourished. — 00:02:26 · tuberculosis
  • ★★★ John says malnutrition is sociological as well as biological: humanity makes enough food for the 8 billion people on the planet but distributes food, and medicine, badly. — 00:02:55
  • ★★ Very few people with tuberculosis get nutritional support, even though all the guidelines call for it and the science is clear that it improves outcomes. — 00:02:55 · tuberculosis

00:03:24 — TB's fatty cell wall, the omitted efflux pumps, and combination therapy

  • ★★ Tuberculosis mostly affects people in low- and middle-income countries, and there is less incentive to create drugs for illnesses that mostly affect poor communities. — 00:03:24 · tuberculosis
  • ★★ John says single-celled organisms must take in nutrients without being permeable, and tuberculosis, with its big fatty cell wall, has erred on the side of not being permeable. — 00:03:53
  • ★★ Building its cell wall takes tuberculosis a long time, so it divides more slowly than E. coli, but once built the wall is like a fortress that drugs struggle to get past. — 00:03:53
  • ★★★ John says Everything Is Tuberculosis discusses the fatty cell wall but omits efflux pumps. — 00:04:22 · Everything Is Tuberculosis
  • ★★★ Efflux pumps are small proteins that pump waste and toxins out of a cell, including drugs that get past the cell wall; tuberculosis has about 70, more than most bacteria. — 00:04:22
  • ★★★ Tuberculosis is treated with combination therapy, several antibiotics acting differently: isoniazid attacks the cell wall as it forms, while rifampin enters the cell and disrupts its RNA synthesis. — 00:04:52
  • ★★ Combined with a couple of other drugs and given daily for four to six months, this combination eventually cures tuberculosis. — 00:04:52 · tuberculosis

00:05:21 — Downsides of long treatment; good news in drug development, bedaquiline and new drugs

  • ★★ The long TB treatment has downsides: more toxicity and side effects, costly patient support, and transport to the drugs, a cost usually borne by the person with TB. — 00:05:21 · tuberculosis
  • ★★ John says people knew penicillin killed Staphylococcus aureus long before they knew how, and how many drugs work, including Tylenol, is still unknown. — 00:05:50
  • ★★ With better maps of pathogens, drug development now more often starts from how a drug might work and then looks for a compound, which is starting to save time and money. — 00:05:50
  • ★★ John says most of the TB researchers he talks to say this is a good moment for developing new tools to fight tuberculosis. — 00:06:19 · tuberculosis
  • ★★★ Promising TB drugs and vaccines are in development, and people are starting to imagine curing TB within four to six weeks or less, which would be a huge change. — 00:06:19 · vaccine, tuberculosis
  • ★★★ John says there are already better drugs than a couple of decades ago, such as bedaquiline, which has proven hugely powerful against tuberculosis, especially drug-resistant TB; better versions of bedaquiline are in development because the cell wall is better understood. — 00:06:19
  • ★★ With a better understanding of the TB cell wall, new drugs may inhibit building the wall, choke off the bacterium's energy sources or starve it of cholesterol. (hedged) — 00:06:49
  • ★★★ As Dr. Leslie Enane reminded John, TB breakthroughs are only useful if systems are built to deliver them to the people who need them. — 00:06:49

00:07:18 — A teenager in the Philippines without drugs; implementation science; solving biological and sociological problems

  • ★★★ Earlier this year (2026) in the Philippines John met a teenager just diagnosed with TB who was told no treatment was available because of drug stockouts; every drug in his proposed regimen is over 60 years old. — 00:07:18 · tuberculosis
  • ★★★ John says that if 60-year-old TB drugs cannot reach people, getting brand-new drugs to them is asking a lot, which is why Dr. Leslie Enane's field, implementation science, exists. — 00:07:18
  • ★★ John believes some people watching his video will live to see a world where tuberculosis is no longer the world's deadliest infection. — 00:07:47 · tuberculosis
  • ★★★ To bring about a world where tuberculosis is no longer the deadliest infection, John says, both biological and sociological problems must be solved. — 00:07:47 · tuberculosis

In the description and comments

  • ★ John thanks Dr. Leslie Enane at Indiana University, Dr. KJ Seung and Dr. Eric J. Rubin for their help with the video and says any errors are his own. — video description
  • ★ In a channel comment John says he always makes at least one error and will surely have to correct his correction. (playful) — creator comment
  • ★ The description asks viewers to donate a piece of their art to the Project for Awesome. — video description · Project for Awesome

Threads in this video

Where the stories that moved here went next

Mentioned

Central: cell wall · efflux pump · Everything Is Tuberculosis · implementation science · malnutrition · Mycobacterium tuberculosis · tuberculosis

Also: Works: 50 x 50 Science · 9-1-1: Nashville

Concepts: Antibiotic · Bacteria · bovine tuberculosis · combination therapy · Escherichia coli · extreme poverty · fungus · Gram-negative bacteria · Gram-positive bacteria · infectious disease · isoniazid · multidrug-resistant tuberculosis · Pasteurization · penicillin · pharmaceutical industry · rifampicin · Staphylococcus aureus · statin · vaccine

Places: Indiana · Philippines · United States

Products: Bedaquiline · Tylenol

Only in the description or credits: Eric J. Rubin · Indiana University · KJ Seung · Leslie Enane · Project for Awesome

Also centred on cell wall: The Worst Disease in Human History

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