 We will look back and say what was most amazing about this period is the speed at which we developed the vaccines and tested and distributed them. It took us four years just to identify the virus that caused AIDS in the 80s. So just imagine COVID where it's four years before we even know what is causing the outbreak. That's what would have happened if this just shifted 20 years, 30 years earlier in terms of when this outbreak happened. The rapid advance in vaccine technology, which is bringing an end to the COVID-19 pandemic, is best understood in the context of a series of innovations that more than doubled life expectancy over the last hundred years. This is the single most incredible thing that's happened in a century, argues the science writer Stephen Johnson in his new book, Extra Life, a short history of living longer, which is also running as a series on PBS. It's one of the greatest achievements in human history. The book explores how innovations in epidemiological statistics, artificial fertilizer, toilets and sanitation systems, vaccines and more have allowed billions of people to flourish until old age. Author and host Johnson was a founder of the pioneering website Feed in the 1990s and has authored a shelf full of books about human progress, including bestsellers such as The Ghost Map, which recounted how doctors and researchers ended the threat of cholera in 19th century London and future perfect, which argues that the modern network world is far more resilient than previous iterations. He talks with reason about how humans manage to massively increase their lifespan in the 20th century and whether we might do even better in the 21st. Stephen Johnson, thanks for talking to reason. Thanks for having me. What's the elevator pitch of Extra Life, a short history of living longer? Just right there in the subtitle, I guess. The basic elevator pitch is the simple fact of the story of life expectancy globally over the past 100 years. If you rewound the clock to the end of the Spanish flu in 1920, life expectancy in the United States was about 41. Globally it was probably somewhere around 35 and today, even in the middle of the worst pandemic since then, global life expectancy is just over 72. We have doubled the length of the average human life in that period and this book begins with the idea that that is the single most important thing that has happened over the last 100 years. If a newspaper came out once a century, that would be the headline, I think. Is it appreciated or is it that at any stage people are partway on that curve? They never really get that full view. Yeah, I think it's not appreciated. I mean, if it was appreciated, I think I would be here talking about the book because people would have a sense of it. It's not appreciated for two reasons, I think. The first is that it's progress in the shape that progress normally takes, which is that it's slow and incremental and made out of hundreds of thousands of small interventions. Slow incremental progress is the least interesting thing from a news cycle perspective. It just doesn't get covered. Secondly, it's unlike other forms of progress, like your smartphone or a skyscraper, those are tangible objects you can point to and say, wow, I have a supercomputer in my pocket. That's amazing. That's progress. With health, progress is measured in this bizarre way in non-events. The progress is I didn't die of smallpox when I was two or that accident I was in, I didn't die in the car accident because seatbelts were invented and I had to wear them. We don't tend to think about events that didn't happen for a reason, they didn't happen. We get this skewed sense of where the positive and big changes are happening. It's also interesting you point out, particularly in the 19th century, say in England and in the United States and then globally in different settings, that with the advent of industrialization, which is really undergirding a lot of progress, there were predictable or not predictable, there were measurable declines in health outcomes. Where did that come from? Because industrialization and the move into cities allows for greater carrying capacity, but it actually brought life down in the 19th century England for a while. It's a funny thing. That period, particularly in England, but also in the United States from about 1750 to 1850, I keep coming back and I've written about it a number of times and sometimes people are like, well, you're just such an anglophile, you're just obsessed with that period. It's like, no, that period is really interesting because something is happening there for the first time in the history of the world that is then going to basically be exported to the rest of the world. Some of that is industrialization. Some of that is urbanization, but it's also a story of a transformation in health. Two things are happening in that period. The first thing that's interesting is that some subset of the population in England starts to live longer in a steady sustained way, starting around 1750. You point out that that's actually wealthy people for the first time and that they were wealthy people were more likely to die younger than poor people or the average. Right before that, you actually had wealthy people because doctors were so bad. The wealthy people would go see doctors and get these terrible cures and have a lot of murder. That is one of the best parts of the book are the descriptions of King George III as well as George Washington being killed slowly or driven mad by their doctors. Just the amount of arsenic that was prescribed back in the day. But starting around 1750, you see for the first time the beginnings of this kind of takeoff, sometimes called the great escape, where some wealthy people start to live longer than the rest of the population. At the same time, the rest of the society, as it urbanizes and industrializes, starts to live shorter lives and you begin to get this huge gap, which really didn't exist before. Until 1750, it didn't matter whether you were the king of England or a popper or a hunter-gatherer. Your life expectancy was going to be the same. You start to get this gap and by the time that people start measuring it, so there's a kind of a hero in the book, this guy William Farr, who was a statistician in England in that period, he measured life expectancy in Liverpool around 1840. It was 25 was the average length of life during that period. That's happening because you're cramming all these people into these cities that are growing at an unprecedented rate. We did not have an understanding of the waterborne nature of diseases like cholera. You have, obviously, like respiratory viruses that are spreading because people are crammed together. You have pollution from all these industrial plants, but mostly you have contaminated water supplies. You have a huge number of young children who start to die. In New York in 1850, 60% of all deaths were children. That's what life was like in those cities. The naturalization, which ultimately leads to, in part, longer lives, in the beginning, the body count is just catastrophic. In the book you talk about there are, I guess first, the increase in average life expectancy is mostly by decreasing the number of kids who die very young. Yes, but it's not all that. One of the things that's been interesting to me talking about this book now, having worked on this idea for four years, is there's a subset of people who have this response who say, that's just an illusion. It's just that infant mortality dropped. There were a lot of people who lived two days, and that was just dragging the whole average down. Yes, we fixed that, and that's great, but we really aren't living longer. That's not true. It's a mix. We can calculate this because we have this category of life expectancy at birth in a society, and then life expectancy at other ages. In 1850, in London, life expectancy at birth was about 41 or something like that. But if you lived to 20, so you made it through the crucible of childhood, and you were actually an adult, your life expectancy would be about 60. Today in the UK, a 20-year-old can expect to live to 85. So we had massive problems, 40% of children died before they reached adulthood for most of human history. We reduced that by a factor of 10, at least, and we're lengthening life at the end of life as well. So it's happening at both sides. So you talk about interventions or changes that might have saved millions of people over the course of their life, and that includes things like anesthesia, the AIDS cocktail, angioplasty, obviously, you've listed them alphabetically, kidney dialysis. You have interventions that are inventions that saved hundreds of millions. Antibiotics, bifurcated needles, chlorination, which is incredible in pasteurization. One of the best chapters is the safest milk, which is just a window. That's a phrase everybody hears, but you don't know why milk was being touted as being safe until you know the history of it. But then you talk about things that say billions of people, and these are artificial fertilizer, toilets, and sewers, and vaccines. Let's talk a little bit about artificial fertilizer or about the growth of food processing first. How did that come about, and why did it have such a perfect effect? It's a really important part of the story. One of the ways to measure it is to look at what the population of the world was a hundred years ago, back when life expectancy was about 35. So it was just under 2 billion people. And right around at that point, in addition to the Spanish flu and World War I, there were terrible famines, or terrible famines that were happening in India, terrible famines that were happening in the early days of the Soviet Union, some of them self-inflicted. There were terrible famines happening in Persia, and today, of course, global population is just under 8 billion, largely as a result of improvements in human health that enabled us to live longer and our children to survive. If you had told someone in 1920 that we're going to have four times as many people on the planet in 100 years, they would have said to you, no, we won't, because we'll never be able to, we can't feed 2 billion people in the current situation. And so now we have 8, and most of them are fat. And most of them are fat. I mean, famine as a catastrophic experience that kills hundreds of thousands or millions of people in a society has effectively been eliminated. Now that you still have local famines that will pop up in situations, and you certainly have places in the world where there is chronic malnutrition. But the idea of a mass starvation event, really, I mean, the progress in that, particularly over the last 30 years, is astonishing. Maybe some of the best news. And that is, I guess we kind of acknowledged that, but not really. And I'm old enough, I was born in the early 60s. I'm old enough to remember, you know, the population bomb and Paul Ehrlich talking about, OK, overpopulation is the biggest issue. But also, you know, up through live aid in the mid 80s, you know, it was about African famines, which even then we realized they were more about politics than about agronomy or something. But like, that's all pretty much gone. Yeah, it's amazing. It's trying to, you know, it begins with artificial fertilizer, which is a really fascinating whole history. And then you have the Green Revolution, which kind of comes off of that. And you have, you know, organizations, too, that are, you know, kind of aid organizations that had to be invented to deal with these situations. So when you do have some kind of crop failure or political disturbance, you have organizations that can come in. And, and yeah, but it's a good point, you know, like Bob Geldof isn't right, isn't putting together, you know, rock star, but we, you know, feed the world was the slogan. And like, you're so much better at that. Right. The other thing about it, too, is that we underestimate, I mean, there's some wonderful work that's been done by people like Robert Fogel that looked at just the effects of chronic malnutrition on economic productivity that, you know, if you look at what we know about the diets of Europeans and the 1700s, is that they were kind of, they might not have been having, there were famines, of course, but they might not have been actually starving in large numbers, but they were really hungry. And you just can't be particularly productive in terms of labor. If you're on the edge of starvation. And so by, you know, starting in the mid 19th century, I guess, like the kind of calorie count that was available to everybody just increased massively because of fertilization and better ways of creating food. And in fact, there was this famous theory that the improvements in human health, it's known as the, I think it's pronounced McEwen or McKeon, that this McKeon hypothesis that the health improvements and longevity improvements that you see at the end of the 19th century and early 20th century really didn't come from medicine, which is true. And we can talk about that, but that they in fact came from rising standards of living largely like food production. That turned out to be not entirely true. Really, the improvements we'll get to are more about public health and sanitation, but certainly having more food on the table is. Yeah, like your immune system. I mean, you're more robust and resilient. Your immune system is better off. You know, then let, well, let's talk about toilets and sewers. You know, like, you know, and obviously, yeah, you know, this is like the Ralph Cramden, Ed Norton kind of honeymooners version of the world from underground. How does that play into this? And it's more, it's bigger than just toilets and sewers. It's clean water and everything. But how, how, how does that come about? Yeah. I mean, in some ways, this is the problem that I have with the book. When I am with the, with the show, they kind of shared the same vision, which is I'd initially wanted to really quantify, like how, you know, if we got an extra 35 years of life, say how many of those, how many of the days in that year did we get from this particular intervention or this particular intervention? And it turns out it's very hard to do that math exactly in part because the, it's very unusual to have a kind of a single innovation that works on its own. So the macro change that made a, probably the single biggest difference, maybe of all time, but certainly a massive difference to urban areas around the world over the last century and a half is just cleaning the drinking water. So water was, you know, in a big city like New York, where we are or, or London in the middle of the 19th century, you would drink a glass of water and be dead in 48 hours from cholera. And that was just the reality of life. And I'd written the whole book about this, you know, 16, 17 years ago, the ghost map about cholera in London. And so the first breakthrough was realizing that there were these waterborne diseases that were coming from contaminated water and that some of that was coming from the fact that our human waste was finding its way in these big crowded urban areas was finding its way into city, into the, the water supplies for big cities like the Thames and London. And so once you had that insight, you could say, OK, if we can build sewer systems that are attached to functioning toilets in people's homes rather than cesspools in their basements, and we can create reservoirs of water that is also separated from where the waste is going. And eventually, later at the end of the 19th century, the idea of chlorinating water came into being, which was very counter intuitive because chlorine is a poison if you drink it in large quantities. In large quantities, if you drink a cup of bleach or in trouble, but if you put a couple of drops in your water, you're safe. Exactly. It's deadly for bacteria, that dosage. But would you talk a bit and the book, The Ghost Map is about John Snow. I mean, it's about a lot of things, but about the kind of understanding that cholera is waterborne as opposed to miasma, which is kind of fascinating. But talk a little bit about John Snow, because he's also one of the central characters in this book and is a hero worth remembering at every opportunity. Well, I think one of the important things about Snow and about William Farr, who was the one who did those kind of analyses of life and death in Liverpool and other cities in that period, is that their primary tool in changing the story of human health in a very profound way was data. So Snow had this idea that cholera was in the water and that there was some invisible organism that was in the water that was causing people to get sick. Everybody else thought it was in the air, it was in smells and things like that. And what's fascinating about Snow and I think a really important lesson for us to remember, particularly in the context of COVID is that he solved this mystery and convinced the world that waterborne diseases were a real thing and that there was this organism without ever seeing it. He didn't have the microscopes of the day did not he tried to see it, but he couldn't see this organism was too small for the lenses of the day. It took another 20 years before they were able to identify the bacterium that causes cholera. He saw it indirectly using data. So he famously kind of made this map of this outbreak in Soho in London that showed that there was an intense concentration of death around this pump where people would get their water at a broad street in the middle of Soho. There's now a commemorative pump there that people can visit on their cholera tours of London. And I'm sure they're picking up like herpes simplex or something like that. So by showing with basically a data visualization technique, a map of kind of patterns of life and death in the streets of London, he was able to kind of solve this mystery and in fact, real change. And that's part of the argument that there's a chapter in the book and we did an episode of the show just called data about this idea that in that, particularly at the beginning of an outbreak, when you don't have a vaccine or you don't have a therapeutic, even today, data is often our best defense. You know, it was funny reading that chapter in an extra life. It reminded me of as a good Foucauldian, I believe, you know, Foucault in books like Discipline and Punish in the Birth of the Clinic and what not, talks about statistics and data as a means of social control, you know, and that, you know, essentially the French government and, you know, starting after Richelieu or during that period started counting people and counting what they did, et cetera, as a means of control. And your book kind of offers up an alternative interpretation of that. Yeah. That's very interesting. You bring that up, Dick. That's a good point because I was a major. I mean, Foucault was the single probably biggest influence in for me intellectually when I was in college. Anybody who, you know, studied English or cultural study, literary or cultural study in the past 50 years. And I, and I, in grad school, I studied with Sayid, who had kind of brought Foucault and Orientalism, brought it to the United States in many ways. And I think that's right. I mean, you know, I think with the Foucauldian critique of data and surveillance as a means of social control, when you contrast that with the argument that extra life makes, which is that we end up getting, you know, major breakthroughs in health and longevity from from those kinds of surveillance techniques. I think it's possible that both those things can be true, right? That that they set up and obviously it's possible. Like once you create a kind of a surveillance state that is monitoring all these different levels and knows statistically all these things about you, that then becomes a tool that can be exploited for, you know, negative ends. But it also has this history of positive outcomes as well. And I don't think I think it's very hard to solve the problems that you have with urbanization and with industrialization that you will inevitably have when you gather that many people into that small amount of space. You can't solve those health problems without some kind of surveillance mechanism, but it has it's come around first full circle intellectually. That's good. Yeah. Well, and, you know, they're well, it's a kind of tangent, but even among Foucauld, Foucauld scholars, they're starting to see where he wasn't necessarily against all forms of this. Yeah. But I think, you know, the important thing about the value of that, I think that it left in my mind. And this is this is one of the things that I say about the life expectancy story is, you know, even with life expectancy, it's a mixed back, right? I mean, we have this population problem on some fundamental level. We have climate change because of the advances in public health that we've made in medicine, right? If we kept the population at two billion, we could have industrialized all we want, but there just wouldn't be enough people to really affect the atmosphere with carbon. If we'd stayed at that level. And so I think the important thing to stress with these things, and this is where Foucauld is useful, is that he was he was observing a change in society that was, you know, incredibly important and that it had elements that were progressive and it had elements that were reactionary was was probably to be. And now I mean, a lot of economists are talking about, you know, because global population is going to level off and start declining and in places like Japan, which has fewer people than it had in 2000. You know, can you have an economy that actually works if you have fewer and fewer people? So and the ageing, I mean, this is why, yeah, it's it. As I said at the beginning, I think it's the most important story because, you know, you have an aging population that has economic implications where, you know, most of the people are old and in retirement and not doing their youthful vital jobs. But it also affects everything from politics. I mean, I did a kind of back of the envelope calculation that I didn't put in the book, but, you know, I think it's right, which is that if the overall distribution of you know, the population by age had stayed the same as where it was in 1950 and everyone in those age groups voted the same way. Trump would have lost in a landslide and Brexit would have lost in a landslide. And so what we're seeing is with some of these political events is what happens when people live a lot, a lot longer life. A lot of the people who voted for Trump would have been dead in 1950. A lot of people who voted for Brexit would have been dead in 1950. Now they're not. And so that is steering the society. And this is if one of my pet theories is we're in a long kind of 20th century that started with Bismarck and the welfare state, the welfare state in America. And throughout the West is about old people and they we are getting older and voting, you know, we're skewing off sorts of kind of political ends. You know, the snow story also gives rise to you in a way, your work has always been going back to your early, I guess, your first book, Interface Culture. It's always been about networks and about groups of people producing results as opposed to the lone genius. But in extra life, you really kind of put a stake through the heart of the lone genius theory. And you talk about how Jon Snow super important as an individual and many other individuals throughout. But the lone genius is something we should put to rest. What do you mean by that? Yeah, I think actually, if you look back at my work, that the it's it's about network collaboration, but also about this question of how and why ideas emerge in the first one, when big momentous ideas show up, like how do how do they happen? And that's what led me to the network model. I was trying to figure out, like, when a new genuinely transformative idea shows up on the scene, whether it's a scientific idea or a cultural idea, you know, a technological idea, which is what was going on in interface culture so many years ago. Thank you for mentioning that very obscure book from 1997. I mean, but that's the era we're living. I mean, you know, it's funny you talk about like studying English. You know, I, you know, I'm sure you grew, you know, you were early on. You were like, well, you know what, there are genius authors. There are people who are in their garret. And, you know, it's a romantic ideal of a really smart person, usually a man, but not exclusively, who just comes up with something that's great and is transhistorical, but that's horseshit, right? And like, if nothing else, the past 30 or 40 years of cyberculture has shown that it's it's all about networks. So what's changed a little bit in my thinking that is building on that network idea is that I spent so much time focusing on how the original idea forms. And in book after book after book showed how it was almost always collaborative, usually multidisciplinary collaborative work where people with different forms of expertise come together and borrow ideas from each other. And that's how the original seed of the idea starts. But what extra life does that I haven't done so much before is focus on how those ideas then get big enough into circulation so that they make a difference in the world. And, you know, you alluded earlier to the story of milk in the book. And that's maybe the best example of this. So milk was incredibly dangerous in the middle of the 19th century, which is hilarious. Think about the phrase is swill milk. Swill milk is a classic New York story. Yeah. Could you explain what swill milk basically New York grew so quickly that you couldn't you couldn't get all this beautiful pasture that used to be in kind of Northern Manhattan basically got eaten up by the growth of the city. And we didn't have mechanical refrigeration back then. And so milk would spoil if it was coming into from too far away. And so they figured out this way to keep cattle, you know, in like the meat packing district with where they would get slop left over from distilleries and they would feed them basically the waste product from making whiskey, which just, you know, obviously right in the face of it. That's good. That's like, you know, it's recycling. So, you know, maybe on paper, it sounded good, but it turned out to be not healthy at all. And you had tuberculosis and milk. So milk was a big problem. And it is also great that there were dairy farms in Manhattan, like when it was being filling up with, you know, immigrants and becoming like unbelievably densely poppy. I think one of the things people forget about that period, you know, we think about horses, but there's just a lot of livestock in in big cities. Same thing with London. So. Milk was deadly, major killer of young children in that period. And this is one of those classic cases where we, you know, a lot of people will be like, I know how we solve that. It's written right there on the carton. Pasteurization. We solved it with chemistry. And, you know, a lot of this is this is something that's taught in schools on like a lot of what's in the book, which is, you know, Louis Pasteur and the germ theory. And he comes up with this innovation. And so we can think, oh, science solved it, you know. But in fact. Pasteurization is invented in 1865. And we don't have pasteurized milk as the standard on the shelves in New York until 1915. So it doesn't matter if some French chemist comes up with an idea in a lab somewhere, what matters is when does the milk get safe? And that was a 50 year process. And it involved not just science. It involved activism and legal reform and speeches. And there was a whole like kind of make milk safe social movement that happened. There was this guy, Nathan Strauss, who's one of the unlikely heroes of the book, who was the co-owner of Macy's. Right. And before that, the Brooklyn chain of Abraham and Strauss, which got sucked up by Macy. Yeah. And he became a big pasteurized milk advocate. And he was a major figure. That's a kind of subgenre of character in your in this work is the kind of millionaire or the successful business man who then has a craze, like half the time they're crazy, like James Hill or something, the railroad builder, but other times. And and and also a sub character in the sense of a non-scientist, non-position. There are a lot of those figures in the book that it that it takes people who who just happen to be good proselytizers to get. I didn't really pronounce that word very well, but to get, you know, to advance ideas in there. And that's part of the network that that's basically what I'm saying is that that, you know, there's a network that inevitably has to happen for ideas to form. And then there's a network, a wider network, generally, often involving non-specialists. Could you, you know, a really great example in the book is and this was mostly news to me about the way in which penicillin went from being discovered. And, you know, a lot of people are familiar with the kind of accidental discovery of penicillin, but then how penicillin got ramped up to a point where you you make the argument that it essentially was one of the reasons why the Allies won World War Two, because we had penicillin in the Germans for a variety of reasons did not. The core thing about the story of penicillin is that, yes, Alexander Fleming discovers it in his messy desk with his Petri dish. And that's the famous story. But on some level, while that was an important breakthrough and, you know, Fleming ultimately got part of the Nobel Prize for it appropriately. The real problem with penicillin was, could you make enough of it to save one human being from a deadly bacterial infection, much less the world? And there was a long period of time where that was very much in question. Fleming really never investigated that. It was kind of he discovers this promising mold and then kind of abandons the idea and it gets picked up at the beginnings of World War Two with folks at Oxford originally who realized that, you know, this is this could be a huge asset in the war, because as with every military conflict, probably in history, more soldiers were dying of infections back in the hospital than they were from the original kind of wound that they received. And so if you could keep those soldiers alive with a magic bullet of penicillin of antibiotics, it would be a huge advantage. And that effort ended up being this amazing kind of thrilling story of these scientists, both at Oxford and then they travel across because the Blitz is starting in England. So it's too dangerous to work there. And so the US government brings them over and they do all this amazing work. And to me, like that's the ultimate example of why our our historical memory is skewed in the wrong way. Like if you ask people, what's the famous story about a brilliant network of scientists from around the world racing against the clock to make a scientific breakthrough that will help the allies win World War Two? Everyone will say the Manhattan Project and the atomic bomb. But it's just as true of the story of penicillin. And yet actually that made more of a difference than it was a positive effect in the world rather than a weapon of mass destruction. Well, let's talk about vaccinations then and vaccines. And this again, incredibly well written, but and I'm going to mispronounce it. How did we get from variolation to vaccination? Variolation is this really interesting procedure that is ancient. We don't know exactly where it was first discovered and implemented. And it was probably independently discovered multiple places around the world did not develop natively in the West. It was not the product of enlightenment science. It's basically kind of a cruder version of vaccination. It was developed largely to fight smallpox, which was one of the most deadly diseases in the world, maybe in the history of human civilization. And it basically involved finding somebody who had these smallpox smallpox pustules, scraping a little bit off of it and inserting a small amount, usually with a little incision in their arm with a lancet, and basically giving people a very low dose exposure to the deadly smallpox pathogen itself, which would then cause them to get a mild case of smallpox and then lifelong immunity. Two percent of the time they would die, but it was such a deadly disease. That's pretty good. Those were better odds of just leaving your kids and you talk a lot about how an English traveler, a woman saw it in Turkey. So you have this weird moment where as Turkey is kind of fading or the Ottoman Empire is fading. And actually that's like a huge gift to the West. And yeah, it's this amazing figure from that period, Mary Monogu, who was married to the ambassador to Constantinople to Turkey. And she observes this procedure that was commonplace there. And she has her children, very related, who are the first known British subjects to be very related. And then because she's an influencer in the day. And again, another figure like this non-medical figure, she persuades the Princess of Wales to very late their children. And basically that practice then spreads through British society in the 1700s. And it's one of the reasons why you start to see this takeoff in life. So she is to smallpox, but Kim Kardashian is to criminal justice reform. That's a beautiful way. Now I now I find it all makes sense. But again, it's these networks that are really kind of really kind of happenstance, too. I mean, like the more networks or the more connections you have, the more likely something good, I guess, is going to happen. And Jenner, who, Edward Jenner, who invents the actual first smallpox vaccine, which uses cowpox instead of smallpox as the kind of the agent to induce immunity, he himself was varulated and he practiced virulation throughout his careers in physician. So the idea was an improvement on a refinement on this earlier practice rather than this sudden transformation. I mean, vaccination is a big deal. It really did make a difference and Jenner deserves to accolade to us. But it's again, it's a more complicated story. You know, the book in many ways and this, you know, particularly for a libertarian audience, it presents both. It's it's fascinating because it's a history of the march of science and progress, kind of with a capital P. You know, even if people are a little nervous about that kind of stuff. But it is all in the kind of guise of public health in a lot of ways. And can you talk a bit about where does the end of kind of either individual initiative or non mandated initiative for you? Where does that kind of come to an end? And then it has to be pushed into, you know, a kind of more coercive state apparatus to spread this stuff throughout. Well, you know, it's there in the history of vaccines. I mean, anti-vax movements are as old as vaccines when they were stronger in the 19th century. And, you know, they were responding to mandatory vaccination laws that were passed in that period. And I think, you know, the argument that I would make to someone approaching it from a kind of a purely libertarian argument is that there is something in the nature of contagious diseases that makes it harder to stick to the ground of my personal choices or my personal choices, because you do have a wider you're in a network of contagion as long alongside the network of ideas that you're in. And the truth is that you are by choosing to not be vaccinated against a deadly disease that is currently, you know, highly present in a community. You are endangering other people with that choice. And so it's it's you can have other parts of society where you say, no, it's important to stick to these libertarian principles. But I think in the particularly in the case of, you know, of viruses where there is this transmission chain that is so important, that's a point where we need to we need to figure out a way for people to be able to stay true to their libertarian beliefs if they have them while making room for some of the interventions that public health requires. Reaching like herd immunity, whatever is the fastest way there are the most efficient way. Yeah. So, you know, one of the things because obviously this is all taking place with covid as a backdrop. And you mentioned, you know, the biggest pandemic since the 1918 flu or the Spanish flu, how, you know, how do you rate? You talk about the FDA and the CDC and the WHO, the World Health Organization. At one point, you talk about the World Health Organization as kind of like over the past 70 years or since it's been around, like no agency has done more to help extend human life. How do you think the WHO has done in the past year or so with covid? And, you know, FDA, CDC, these are all authorities that have taken a lot of hits for a lot of good reasons. Yeah, I think it has been a mixed bag. I mean, I think we will look back on this period with the long view, you know, 10 or 20 years from now, which is generally the view that I try to take on everything, perhaps to a fault and say what was most amazing about this period is the most important about this period is the speed at which we develop the vaccines and and and tested the vaccines and distributed them, particularly in a country like the United States. That is it is such a mind-boggling, incredible. And this is something I mean, we were talking, Anthony Fauci was talking a year ago about how it could be a couple of years before vaccines come out. And they were ready to go like messenger RNA vaccines were being made within days of the genetic sequence of the disease. The story that I always, you know, just raised as a comparison is that it took us four years to identify just to identify the virus that caused AIDS in the 80s. So just imagine covid where it's four years before we even know what is causing the outbreak. That's what would have happened if we if this just shifted 20 years, 30 years earlier in terms of when this outbreak happened. So your chapter on polio or your discussion of polio is like that, too, where there were vaccines by the mid 50s, but it took a long time to even kind of roll them out. And obviously, we had been dealing with polio for a long time before that. So the vaccines are an amazing story. I think we did not have, interestingly, like we did not have the kind of international repository of data that you would have expected to have had for everybody knew we were going to have a respiratory virus pandemic at some point, you know, whether it was going to be this bad. But, you know, this is not a surprise to anybody who studied this all. And if you look at a lot of the early kind of data collection trying to figure out what was really going on, we were flying blind. And a lot of the folks that actually created the data sets were folks who did it on a volunteer level, you know? And so that created, you know, we talked about how important data is in the early days of an outbreak that created an opening. And then for some of our political leaders to try and shut down the identification of data and, you know, make it sound like the caseloads were less than they were. So there were mistakes made that then got amplified by people at organizations like the CDC and the WHO. I don't know. I think there's a legitimate question about how China was handled in all this. Right. That's a big part of the criticisms of the WHO. I honestly don't I haven't really studied that part of it. So I should just kind of refrain from from talking about it. But I hope that it doesn't. I mean, you know, one of the stories is probably the most important to me in this. But and it really comes out, I think, in the in the TV version and the conversation I do with Larry Brain about this, which is the story of smallpox eradication and how momentous an achievement that was. And, you know, the CDC and particularly the WHO were right into that. We couldn't have done it without that kind of institution. And so I hope we don't come out of covid with a sense of, you know, oh, public health organizations and institutions are, you know, ineffective. And but can I, you know, you mentioned the AIDS, the FDA, you know, and there's a lot of stuff going on, a lot of blame to be had. And also just, you know, this was a novel thing that nobody knew how to deal with. But the FDA was terrible. I mean, you know, it took AIDS activists to really kind of, you know, challenge the FDA, you know, what are what are the types of ways in which something like the FDA were also 50 years into a steady decline and trust and confidence in all institutions, whether it's big business or big government and philanthropies and whatnot. How might the FDA or the CDC kind of revamp itself so that it actually, you know, is more efficient than, you know, than what it is now? Yeah. And there's another even more relevant question. I mean, that that wasn't relevant, but there's even more timely question about regulatory oversight of drug development or vaccine developments, which is, as you said, we had the covid vaccines in, you know, we have the basic prototype for them in February of 2020. Right. And that's shocking. And so and we had, you know, early phase one results, you know, in the middle of 2020, we knew that they worked. It seemed like they worked whatever. There is an argument that, you know, at a certain point, it was it would have been better to just start distributing them, given the number of people that were going to die over the next, if we'd known particularly how bad the winter was going to be, that actually breaking all the rules and just accelerating the process and getting them into arms earlier. And if we see problems, we see problems and we deal with them. Almost certainly that would have saved more lives in that net, you know, even if there had been a public health, it is kind of it's a numbers game, right? It's like cost versus benefits. So, you know, you don't want to have, you know, you don't want to have a drug that goes out and kills more people than it says. But when you know that it's not going to do that, it's kind of criminal not to. The problem is there's also first do no harm. Right. And so if you, you know, willingly, knowingly give people a drug where you say, we don't really know whether it's safe or not. And it turns out not to be safe, even if it saves more lives on average. It's not pure utilitarianism, right? And so there is a sense of particularly because you're talking about public trust as well. And so if you release a vaccine that turns out to be even though it's saving more lives in the end, if it kills a significant number of people through some kind of side effect you haven't detected yet, that erodes public trust, particularly in the age of the Internet. So it's a very complicated decision. But again, there's a problem with these kinds of institutions, which is that we never hear about the success stories. You know, I mean, I wrote in in Future Perfect, the book I wrote a number of years ago, I wrote about the chicken gun that the FAA uses to test jet engines. You know, throw these, you know, bird strike simulations, which which ended up being kind of central to the design of the Airbus that survived the bird strike and the famous miracle on the Hudson. And, you know, when something like that happens, all we hear about is Captain Sully, the hero pilot. And we don't hear about like, wow, there were so many years of like testing these engines. Forget the humans, the chicken. They don't get they get chicken run. They don't get a solid. So we don't have. I mean, that's part of part of what I try and do. And, you know, there's some like heroic bureaucrats in extra life. You know, that's a tough. Yeah, that's a tough sell, right? Yeah. And again, it's it's trying to figure out. And, you know, particularly in thinking about it in a libertarian context, like, you know, do, you know, surely there is some role for some kind of oversight when we're talking about drugs. And. But it's when it takes, you know, a decade plus and tens of billions of dollars to bring a marginally improved version of an existing drug to market. Something has gone haywire. Yeah. And so we need to figure out, like, where have we done it? Well, right. And where where have, you know, you want to, in a sense, be able to test this hypothesis, right? Like, how many how many times did we did we slow down something that, you know, would have actually been better if we'd released it earlier and actually see what the record is? It's just very hard to see that. It's not what would you, you know, what are what are possible ways that organizations like the FDA or CDC could regain, you know, because, you know, kind of trust or confidence. And I was looking, I was separate from this Pew Research in 2015 did a survey where they asked people based on political ideology, like, do you think childhood vaccination is safe? 12 percent of liberals said no, 10 percent of conservatives. Now we have a world in which, you know, a majority of like Republican men don't want the covid vaccine. You know, and so like it's clear like vaccination, you know, conjures up a lot of fears and it seems to be kind of politically fungible. It's, you know, depending on who's in office or whatever. But what are ways that the FDA or CDC might regain kind of a moral or scientific or, you know, political high ground? You know, one thing I think that I've been wrestling with a lot over the whole covid crisis on a personal level, but I think it has implications for society and for institutions, particularly like the FDA and the CDC, which is all of this at heart is about risk, right? Trying to calculate like how risky is this particular behavior or this particular strategy? And, you know, what is the magnitude of the risk? And one of the problems that I think public health authorities have is that one, human beings don't aren't good at calculating risk intuitively. And, you know, the difference between you can say, well, this is riskier than that. But if the, you know, is it, you know, five percent riskier or is it five hundred times riskier? And there is a massive difference there. And we don't we basically don't have a standardized way of talking about risk that people can understand. And I actually have come to this, I've been floating around. I want to share with you for the first time this hair braiding scheme that I have, which is there's been some talk about a unit of risk and sometimes it's called a mort, right? A mortality rate. What is it? You know, and the problem is that in the abstract, just one mort isn't really a useful kind of idea. But I think you could you could we know very precisely the risk from from driving automobiles, right? Yeah, there's X number of fatalities per hundred million miles driven. So you can say, you know, one mort or one auto mort is the risk that you take by driving a hundred miles. If you take a road trip, you know, for two hours, this is the mortality risk of that most of us happily take, you know, two hour car rides without really worrying about it. But we know there's some risk there. So then once you have that as something that people kind of intuitively understand, you could then say, hey, by the way, like I did, again, back of the envelope calculations with us, just walking around New York City at the height of the covid epidemic here, unmasked, you know, in March was two thousand auto morts. It was two thousand times more dangerous than driving two miles in your two hours in your car. And so if you could figure out a way to kind of express this to people where it's like, look, what is your what is your risk? Well, are you are you a daredevil skier? You know, are you the person who, you know, make sure that they're belted up when they drive or you what where are you in the spectrum? And here's here's here the actual, you know, order of magnitude impacts of these choices. You know, if you if you wear a mask, you're going to reduce it by this many morts. If you get vaccinated, it's going to be, you know, a thousand times safer. And just kind of having a way of describing it that actually allows people to say, OK, I know where I am on kind of risk tolerance. I would think if we can come up with like incredible schematics of the heat of Buffalo style chicken wings, we should be able to come up with something, right? What, you know, as a final kind of topic of conversation, what's in the pipeline to, you know, what's the next doubling of human age? What, you know, what's the what's the timeline for that if there is one? And what are the likely things that are really going to produce the next big leap? Yeah, it's a great question. So two things. We have a very clear path despite the last year where life expectancy is going to go backwards because of COVID. We have a very clear path, I think, to raising, you know, life expectancy in the U.S. about 77 in parts of the world like Japan's 85, whatever, you know, we can get that to 90, 95. Just using the existing tools we have, the ones that are just coming up like immunotherapy for cancer and things like that. We're going to, you know, we have, you know, we have some amazing things in our arsenal RNA as a platform is going to be really important. But there seems to be an outer boundary of how long people can live. That boundary has grown a little bit, but it's very hard to live past 110. It happens vanishingly small. So a lot of people are going to live to 100. But the question is, can we push through that outer boundary and, you know, actually live to 120 or 150 and as you say, double it again? And that will only happen if we have a, you know, real paradigm shift in our understanding of aging and the aging process itself. And there are a lot of interesting people out there who are not, you know, cranks, who think that there are also a lot. There are a lot of interesting cranks. Yes, but there are a lot of serious scientists out there who believe that, you know, I mean, when you're 25, if you can remember what that was like, I could barely remember it. That's about 353. You know, you have this period of your life after you grow into an adult before you hit about 35, where your body really doesn't age. Like nothing really changes during that period. And what we've come to realize is that that's something is happening to keep your body from aging during that period. Like your cells are being instructed to repair themselves constantly and not age. And so the question is, could you instruct those cells to just keep going with that process longer and basically keep everyone kind of permanently 30 years old? If we do that, then you then you can imagine a scenario where we have people living into their, you know, 150s. And we think that population is going to level off in the middle of the, you know, second half of the 21st century. And we're going to have declining global populations. But if people start living to 150, that's all bets are off. Right. Well, we're going to leave it there. We've been talking with Stephen Johnson, author, most recently of Extra Life, a short history of living long. Thanks for talking. Have a nice day.