Sitting down with Howard Markel

Howard Markel, a social and culture historian of medicine, is an expert on quarantine procedures in the United States. He has worked with the CDC and Department of Defense on issues of public health and epidemics and became a central voice in the media during the Ebola outbreak earlier this year. He’s written two books on the quarantine issue, “Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892” and “When Germs Travel: Six Major Epidemics that Have Invaded America since 1900.” The Herald sat down with Dr. Markel to learn about his failed attempts as a fiction writer, his work in AIDS clinics in the 1980s, and how to look at the Ebola epidemic through a historical lens.

YH: You majored in English at the University of Michigan. How did you go from being an English major to becoming a medical historian?

Markel: When I was an English major, I wanted to be a doctor. I somehow wanted to be a doctor who took part in medical humanities. I hate the word because I don’t know what it means. I always wanted to be a writer. But I wasn’t a very good fiction writer.

So I went to medical school, and the first year of medical school is extremely boring—all you do is memorize stuff, phone books worth of stuff. A professor who I had done bench work with suggested that I go talk to a very senior professor, who had just retired and was writing a history of the medical school, this was the University of Michigan. He said, “What do you want to be when you grow up?” and I said, “pediatrician,” which I did, and I am, and he said, “Oh good, you can write the chapter on pediatrics.” I knew nothing about history.

I took one or two courses in history as a college student. I always loved it but I certainly 
didn’t know anything about
how historians do research. For me, as a writer, it was a
great moment because with history I didn’t have to write plot. They were already written. So, I could just write about the
 people and the plots took care of themselves. I finally found something that I could write about.


YH: You mentioned you wanted to become a pediatrician, but the majority of your writings have to do with immigration and social stigma of large pandemics. How did your interests shift?

Markel: I got into epidemics because when I was an adolescent physician in Baltimore, the bulk of my practice was sexually transmitted diseases. A friend of mine said that he really needed some help in his AIDS clinic, and would I come help. I think I learned more about myself, and others, and doctoring, and caring for people in that clinic than anything I’ve ever experienced before or since.

But I really enjoyed it and a lot of my patients would ask me, “Hey doc, do you think I’m going to be quarantined because I have AIDS?” No, that’s not the right tool to even use. It’s a sexually transmitted disease. But, I kept getting that question over and over and over again. And, as a doctor, you don’t get those kinds of questions over and over again. You’ll get like, “will it hurt?”

Then, it suddenly hit me. Oh gosh, some of my patients were gay men. A lot were intravenous drug users. And, I finally figured out that they had been stigmatized on so many levels. It’s not that big of a leap to think that you might be quarantined, put away on an island somewhere because you had AIDS. So, I became very interested in not the medical uses of quarantines but the social uses or misuses. And I thought, that’s something I’d like to think about. That’s the essence of a PhD thesis.

My historical interests are post-Civil War to about World War II. So, who are the big scapegoats then? Well, it was immigrants. So, where are all of the immigrants coming to? And most of them, 75 percent of them, came to New York. I thought, well, there has got to be an epidemic in New York City where an immigrant group was blamed for it. So, I got all these annual reports for the city of New York’s health department about from 1866 to about 1925 and I read through them, really boring stuff. And then I found these two 1892 epidemics. One was typhus in February and the second was cholera in September and both were blamed on Eastern European Jews.

Now, I am of Eastern European heritage. I am Jewish and my grandparents immigrated and they spoke Yiddish and my parents were children of immigrants so they spoke Yiddish. So, I felt an affinity to these groups of people, and I also figured, well a lot of people have done immigrant history, not just medical history. But, very few historians who look at immigrant history look at the immigrant press. Every immigrant group had their own newspaper or newspapers in their own language. So I learned Yiddish to read about what these people thought about these epidemics as they unfolded. And, of course, they didn’t like them very much and they also thought they were being discriminated against. And, in fact, they were.

I really loved epidemics because they have plots. They have beginnings, middles and ends, and they are really wonderful laboratories, if you will. They are social laboratories of a particular society. How do they react to stress? How do they react to people they don’t like? How do they react to government? They are really neat crucibles to study how a given society at a given time is reacting.

YH: You mentioned that during your time at the clinics you learned a lot about yourself and others—could you elaborate on that?

Markel: Well, at the time, I was—I guess the word is widowered. My first wife died of cancer when I was 28 and she was 30. I had a lot of good friends and family but I didn’t have a lot of people I could talk to who were my age who had lost a partner or a spouse in their 20s. And, you know, most of us like to be with people our own age.

In that clinic, there were not just my patients there. There were also their partners. They helped me as much as I helped them. It was neat. I didn’t know a lot of gay men. I’m a straight guy from the suburbs of Detroit. I didn’t know a lot of intravenous drug users and I also rarely treated adults as a pediatrician. So, that was kind of neat too because that’s a very different experience. There was a lot of commitment, a lot of bravery because particularly these young people were facing really scary, terrible deaths back then. They would come in all thin. I say they were wobbly. Even the way they walked was wobbly.

YH: Looking at what happened with the H1N1 influenza pandemic in 2009 or the Ebola one more recently, how has the U.S.’s response differed from past epidemics?

Markel: Well, for one, we are better at it, but we still have a ways to go…I was just at the Presidential Bioethics Comission a few weeks ago. The idea that the President of the United States would want to know about the ethical care of the handling of victims, not the public at large, but the people with the infectious disease in question, is truly historic. That’s not the question people in the past were asking—you’re sick, you’re sick, go away. You’re going to die anyway because there is no medicine.

What I worry about, and what I see in epidemics again and again—even today, most of us forget about the pandemic or epidemic once it’s over. I call it this profound amnesia. SARS, bird flu, Ebola. And so that’s my biggest concern. Once you forget about those things, the same conditions that led to it in the first place are still there.

YH: What message did you try to convey in your interactions with the public media on Ebola?

Markel: Well, there were a couple things. We live in a global village and an outbreak anywhere can go everywhere. There is no Atlantic Ocean or Pacific Ocean. You can get anywhere to everywhere else in under a day. The days that I wrote about with the immigrants in the 1890s, that’s history. We have to really think a lot harder about public health as a global health issue. Germs travel. They don’t respect boundaries. They don’t respect sovereign rights. So, that’s one thing.

The other thing was when the quarantine was being misused especially by Governor Christie, with a nurse named Kasi Hickox. Well, that was just a steak dinner for somebody like me because I have seen quarantine misused. And in this case, it was misused I think for political gain. And, it reminds us that these things are not relics in a museum. They still exist and we still have to be very careful about them.

I think finally, too, is not to blame the person with the disease. It’s bad enough having the disease and we all get sick. Those were the things I tried to impart.

—Interview condensed by the Herald




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