>> you are watching book tv on c-span2 top nonfiction books and authors every weekend. book tv, television for serious readers. >> i'm katie, we are thrilled to host this event, his new book extra fly from a short history of living hunger. before we start, our to say thanks to stephen riverside books for making this happen and for all of you showing up. we are not able to host event, community of readers still here. we are thankful for your support and a chance to make space for connotation and connection. before we get started, a few housekeeping's developer. the speakers can see or hear but

can't hear you. there are a couple ways you can interact with the office into each other throughout the event which we highly encourage. first, on the speech bloom. post comments and thoughts of the chat, a great way to share appreciation. if you have a specific question you'd like answered, posted in the q&a, on the icon we will pull questions on the from unit in the later part of the program so your questions there. and partly extra life is available at the bookstore. purchase the book and many others on-site including his most recent book. order online for pickup and start worshiping anywhere in the

west. stephen stopped by, you can get a signed book by request. indicate were signed copy in order online. look for a signed copy in the store. if you care about the ongoing existence the independent bookstores, is a great way to show your support. her interviewer is randall munroe, author of the number one new york times bestseller how to. question and answer awkward of public book. he left the agency in 2006 to be on the internet full-time. public speaking with future authors, stephen, the best-selling author of 13 books including worker ideas come from. his the host and cocreator of the cbs cc series most of the podcast american innovation.

he lives in new york and california with his wife and three sons. his new book, ask her life is a surprising important story about how humans have doubled life in 100 years. he's going to tell us about the book and then will speak with randall and all of you. particularly. >> thank you, appreciate it. i am delighted to be here, this is the first official book to her event of the extra life world tour taking place entirely in this room because that's what happens in these times but it's wonderful, i am in brooklyn right now so it's perfect venue to start this out so thanks for having me and it's an honor to be here with randall, it's a huge event, everyone in my household is a huge fan.

he's the only author in all three of my sons have read his book. that's a big deal here so this is a real treat for me so i want to start with a couple of words about this project because it is a multi- platform project and it's a tv series that premieres tomorrow night as well on pbs 8:00 which i cohost david running four episodes every tuesday night but the project goes back about four or five years. i had written many years ago, a book which was the story about power in the 19th century and one reason i wrote the book was to remind people how much progress we've made in terms of

health and safety and reductions health and safety over the last 150 -- 170 years ago and it goes back to waterborne disease and 150 years ago big city, you could drink a glass of water and be dead and 48 hours, that was the reality of life so with that book many years ago i was trying to remind people that one, we've made a lot of progress and try to celebrate and also show some of the most important innovations in life are not the latest, zoom or whatever it is we celebrate the high-tech growth but sometimes it's just like clean drinking water which has changed a lot as i've always had that theme is an interest in it occurred to me about her years ago the story of life expectancy would be an interesting framing for the book you could talk about that number as a change over time, a

powerful indication of how much progress we've made in rows first think about it three or four years ago i thought there coming up on the centennial of the end of the spanish flu which ended in 1920 depending on how you did it and that was the last time in which there wasn't a serious sustained drop in global life expectancy. after that there was this century of extraordinary progress around the world really, particularly the last 30 or 40 years and we have effectively doubled the average lifespan during that time which of you think about, the most remarkable thing we've ever done as a species, extort anything with so many positive consequences but also negative as well, population growth and things like that so i thought if the book comes out, maybe we could do a television series and/or maybe from around 2020 that would be the anniversary of

the centennial spanish flu so the timing would be good for so i wrote the book for riverhead an early 2020 we were starting to get together production for the television show and all of a sudden the world was transformed by covered and what was kind of a loose historical peg that happened 100 years ago was suddenly, we are in the middle of one of the most important events in the history of modern history of human health and i had just written a book about, working on the television show so many things in the book are about what's happened over the last year, the central opening chapter and tomorrow night is about vaccines and history of vaccines, are public health data collection from allah how we develop their pdx for emerging

illnesses, the world we've been living in suddenly had newfound relevant so i have come to think about this project now that we are living here in 2021 and a 200 year history of right now, that's what it comes from that's how i visualize it now in my head and i hope it's not interpreted as a victory lap, there's a lot of encouraging trends celebrated in the book and a lot of heroes i think deserve to be more celebrated and achievement that should be widely known and eradication of smallpox, truly one of most momentous things we've ever done and yet most people know more about the moon landing the ratification of small boxes are

trying to remind people they are capable of these great achievements but is also recognizing it's not inevitable that this will continue in five will not necessarily keep marching upwards if we don't pay attention to the imports of public health changes to our behavior that can enhance our lifespan and people around the world so hopefully is a book that inspires people to keep working at this. that's my open spiel let me turn it over now. >> hi. congratulations on the launch of the new book even if it doesn't exactly went you expected. it's a quote book, i enjoyed it and thank you for it inviting me to talk about it. when are we going to die? [laughter] i can list out numbers individually if they want.

>> it's always funny looking at life expectancy because it is a weird number. it both -- it's not really how long you are expected to live or anyone, how long you live if this year's death rate continues forever so it's nice, life expectancy goes up a little bit every year that i live. there were a bunch of things in your book that caught my interest and i was curious to hear more about so iran an estimate many years ago, i don't know if this came from maybe another one of your books or maybe someone else that said tried to pick up the gear which on average people who went to a hospital were better because of it. broadly speaking, when did going

to see a doctor start helping of more than it hurt? >> i don't know if we really fully know the answer to that and obviously it would very place to place but that was one thing -- depending on what you are going for but that's one of the most things striking to me during the research for the book, how late medicine arrived as useful prevention so to give a little context, until about 1750, it really didn't matter where you work in the world life expectancy was pretty much evenly distributed at about 35 and that was a factor of largely 40% of children what die before they reached adulthood and less likely made it through childhood, it was rare you made

it to 70 or 80, so before the takeoff begins around 1750, first tremendous health inequality in the world but no health inequality. you could be the richest person in the world or porous, it doesn't have an impact on your health and the paradox of the story of life expectancy, we see progress, it opens up cap and you see elite living longer than the working poor and industrial countries go backwards for about 100 years so you have this long. were start to get better in the second half of the 19th century, industrial working class improve their life expectancy as well and you see the entire population in europe, united states living longer lives. that goes on steadily until with

brief interruptions until recently but the impact of medicine, going to the doctor getting a pill to make you live longer and cure disease you have or get rid of it in infection, it really doesn't have an impact until antibiotics, post- penicillin era select 1945, 507 up until then, i have some fun looking at old catalogs pharmaceutical catalogs from mike 1910 and it's like every medicine contains mercury and arsenic 37 different kinds of packaging it was a tremendous amount of junk out there you think of medicine as being in

progress but actually we've solved a lot of problems, we invented airplanes and radio and television and a bunch of things before we started making these drugs to improve our lives. >> one thing that i think has been driven home for a lot of us in the last year but it's always seemed impressive that the randomized controlled trials, no substitute for and you will hear doctors talking right now on tv and yes you can get this observational data but there are all these biases, it's hard to figure out what is causing what that's why the trial is the gold standard and it sounds like it was pretty recent. when did we come up with that and where does that rank in the

list of accomplishments? >> it ranks very high and it's not a coincidence randomized controlled trials emerge about the same time of penicillin and it an accident but what it enabled you to do people probably understand you can do trials or you have a control and the drug you are testing and nobody knows including the people earning the trial which subject is in which group it prevents bias in all these things and it was the first mechanism that enable people to forgot if something was working or not that was a crucial break. if you go back and look at the

role of the fda relating drugs up until the 60s, there was never the question from the drugmakers were not required to show that the drugs worked into the 60s. initially all they had to show with the ingredients listed on the bottle were in fact ingredients, about the initial standard so if you wanted to put arsenic, it would be listed on the bottle and then it became, make sure it doesn't do any actual harm to the patient taking the drug but they didn't actually have to prove that it was effective until the 60s and one reason, there wasn't really a way to measure so that was a major shift forward and i think we underestimate a couple of chapters when we think about the breakthroughs that drive

health forward, we are always looking for physical objects, the needle with the vaccine in the magic bullet, x-ray machine or whatever it is but a lot of the breakthroughs involved data and new patterns of data and now i think your work is connected to, and interesting -- there's no reason they couldn't happen developed earlier there some in these experiments miss have hundreds nobody really formalized as a technique until around 1950 so there's an alternating history or somebody invented the rct in 1850 instead of 1950 and perhaps medicine improves a little bit because

there's finally a make a way of measuring. >> if we had gotten them earlier, if we had been able to look at the things we were doing to treat these conditions and check what worked, what you think would be the most helpful thing we would have stopped doing earlier? >> maybe bloodletting, perhaps. [laughter] was recommended well into the 20th century, repeatable doctors were saying that so that would be pretty high on the list. there's some things in the from the list of toxins were given to treat. insane for a period of time but

one of the early signs that he was raging against doctors think he was being poisoned by the doctor in years later they analyzed his hair and he had an unbelievable, i think it was arsenic poisoning based on the medicines he was being given so there are a lot of things exposed as being dangerous. >> you mentioned penicillin discoveries so it always seems weird to me as a general concept here is this mold, i'm going to rub it on here. [laughter] have always thought of that as a example of the idea has the biggest difference between how good an idea it is and how good

an idea it seems but i've always figured, it not like i can just go to the grocery store and find a multi- cucumber ticket home and get medicine that way. >> it's funny you say that because there is but doesn't do that although we are not recommending you do that. [laughter] this is not a science experiment but the penicillin story is my favorite story probably in the book and kind of the centerpiece of the show that comes out next tuesday, the penicillin a lot of people know, accidentally discovers the pet treatise on his desk, he goes on vacation and comes back and there is mold on the dish addict causing

bacteria in the dish to die basically and he is like bacteria killer, i'll name it penicillin 15 years later gets a nobel prize sodas are great story because anyone who, if i test don't clean this up, sometime i will win the nobel prize, to. happy accident so people love that story, i love it but it turns out really just a tiny part of the story because penicillin, it was really scaling up and making enough first, proving that it could cure a bacterial infection was not just what they were looking at the event was hard to make it and that was an extraordinary

adventure effective start for another 12 years later, it didn't really evolve and it's amazing global collaboration in the middle of world war ii all of these extra nice scientists, they are racing against the clock to scale up penicillin because so many soldiers were dying of infection and hospitals so if you could get a drug to cure them, he would have the advantage and it was top-secret so part of what i say but it shows you are priorities as a culture when you think about the famous top-secret military projects during work that involves global collaboration and bring scientists from around the world from you think about that but the penicillin project

just as riveting as the story and it involved life-saving medicine, not a weapon of mass destruction so i wonder why we don't, as much as the other story to get back to the cucumber which i thought i never found myself thing, one thing started to think about at the time, maybe there are other molds out there that could be replicated more effectively or might be more effective at killing bacteria so they sent soldiers around the world collecting samples. i think a biochemist who's nicked named moldy mary

illinois. , illinois to look for multigroup and she found a multi- cantaloupe in the the supermarket and to this day, the organically produced penicillin from the one cantaloupe. >> literally i am from peoria. that's when you can trace back the specific origin be like this copy of this came from that one spot. >> that legacy. >> so there are all of these different things cap have improved life expectancy and a lot of them aren't a device, it's likely realization that we should do things differently in

a better habit or piece of infrastructure or something so from where we are right now, if you are put in charge and can convince anyone to do something differently somewhere like where you are in new york or massachusetts or something and you want to bump up life expectancy you've got a pulpit and you can go to each house and give a ten minute seminar and why you need to do something or pass a law that as long as it's not too unreasonable, the people would follow, what would you do if you are trying to just improve how long everyone lives? >> well, i would say they should get this vaccine that's been developed. [laughter] >> i'm with you on that.

[laughter] >> one of the big issues, i don't have an answer for one thing but thinking about people around me, who were talking earlier about this introduction of inequality as soon as life is expended, that should be our focus right now, a lot of focus on how far can we extend life? we could talk about that but can we push the envelope although he passed 120 or so which is seems to be about life expectancy, those are things to look at what it is the gap is the thing i think we want to spend our most focus on software i live in brooklyn, you can travel on the

train and average life expectancy when you get out of the neighborhood would be about eight years less than in my neighborhood. and in manhattan, there's places where life expectancy would be five or six years higher than where i live in fact just the most fundamental form of inequality. how much time do you have? you get to live to see your grandkids or great grandkids? i'm dodging the question a little bit because it's hard to say what the most important thing would be but i'm also not in the sense that our ability to keep track of those kinds of inequalities and ability to measure and build a public record say these people are living longer than these people, why? that's one of those advantages

were talking about, it's not about appeal or vaccine, is a way of looking but when you see these outcomes are think of the impact of covert compared to the white population, it is completely out of whack. able to see that is important because it forces you to ask questions so there is this new interesting development a number of folks have written about that shows up a little bit in the book and the show, this idea of weathering that one reason why you see african-american communities in the u.s. having lower lifespans is because there is a slow and steady impact of chronic stress on the body from living in poverty or discrimination in overtime, acts as dangerous as smoking cigarettes or driving a car

without a seatbelt but these slower more incremental social crises and problems, not actually toxins although there are toxins in those community specs also an issue so the idea of this psychological part living in that could have a material impact on your life span. that's a generally new idea and i think that's what we want to think about so i guess my answer would be we should eliminate racism and poverty, that would be the thing that would help a lot but saying it not just about traditional factors when we think about health, it's also political factors. >> i think that is really good and something that comes up a

lot reading the book, how much the story, that gap opening up and closing. so i was surprised to read about studies from the dickinson moun? ... >> the book starts with this

chapter about what i call that what i mentioned before of the average life expectancy around the world is 35 it didn't matter where you are. basically we believe that was the case all the way back into pre- agricultural times. the best estimates from the best hunter gatherer societies and archaeological sites been doing analysis of the damage that hunter gatherers maybe lived 30 years on average had similar childhood mortality rates to people in europe until 171800 which was 30 or 40 percent. we are not that different from

pre- civilization human beings until about 300 years ago there really is no progress on that front. the one point were there seems to be a noticeable trend in early history is precisely the moment where agriculture arrives we have a large settlement for the first time. and in that. where there is a noticeable decline it dropped to somewhere to 19 and some of these communities so those that have made the argument that it was the greatest mistake in history and then

basically were slave to it for thousands of years before we rose our way out of the original standard as hunter gatherers. with a fascinating question it raises the question that if it was a mistake, if it was a downgrade for humans in terms of quality of life and length of life why do people keep making that choice? what drove the adoption of the agricultural lifestyle? when it seemed like such a bad deal? that's a whole other thing to talk about another time but i bring it up in the book because it shows up at the end of the book because i wanted to remind people the upward march of extended life is not inevitable. it just will not keep

happening if we don't look at the evidence or listen to science over the problems that we have and we are facing climate change that could pose a serious threat to the extension of human life. we may have overpopulation problems in the coming years are mass migration may be resource problems are research and so famine. we know this is directly possible for people to adopt lifestyles causing life expectancy to go periods that backwards periods of time we did it during the industrial age. it's not enough just to sit back and say we solved at all now we have to watch them go on their merry way now we have to continue otherwise we can go backward.

>> there was a passage toward the end of the book that i thought was striking because you talked about this impressive list of here are the things that have saved hundreds of millions of lives and billions of lives like the bifurcated needle, refrigeration, toilets and sewers. and i tried to put the other list like that but you point something out about them and it never really clicked for me which was how few of those came from technological developments in the current sense like the private sector companies coming up with things and selling them to people and often those things were doing the opposite like

cars without seatbelts and you pointed out that most of these changes have come instead from activist struggling for reform university -based scientist sharing findings open source style nonprofit agencies where the breakthroughs of low income countries around the world. you said that may shift with private sector companies with immunotherapy or drug discovery but if the history is any guide we always have public option on our side as well. i thought that was a really interesting point. why do you think that is? why with the's changes seeming so technological and so many take the form of things that

you buy or interact within the end, why do they all follow that route? >> why is it ralph nader? [laughter] >> it has changed a little bit like the covid vaccine is a good example of that the model now we're moving toward is a public-private partnership with core science and open source style supported by governments, academic research and then you have private sector with those scaling capabilities big corporations have and that's a combination that may be the future but it really isn't the path penicillin was the first example pfizer was scaling up penicillin but most of the important research was done and funded by the military but

it was a private sector engagement with that as well. >> but before that point, a number of the things were deep infrastructure like the sewer system. it's very hard to make private sector reality to build sewers that something the state had to do to clean the water. and in some cases the big interpretations - - intervention like smallpox i really change the world but there was no private sector company that could build a profitable business vaccinating villagers in bangladesh. there is no way to make that make money see her dependent on different types of institutions like the who.

i argue in the book invention of institutions like that is as important we didn't use to have organizations that could do that and now we do. and then the weird thing about medicine which you would think there would be a basic mechanism in the market where if a pharma company made junk medicine they didn't do anything the market would punish that and reward menace and that worked so there would be a financial incentive even before the fda came along to regulate to steer form on - - pharma to better drugs but that's different from all other consumer goods because there is the placebo effect people think they are taking a pill that makes them better some of the time disproportionately get better but also people have their own internal pharmacies most of

the time they do get better if you do sell them bogus tell and often a will get better on their own because of the placebo effect or their immune system and they will attribute it to the pill and buy more. if you make fake television 30 percent will not take the fake program home they will see a television that doesn't work. there is something fundamental about the development of medicine that the traditional logic of markets developing the most efficient outcome not just what i consumer needs does not always work. >> i want to mention if anyone has questions feel free to

open the q&a tab then we can go to those in a minute. but i want to ask that you mentioned a tv show a couple of times. i believe that is coming out tomorrow? >> yes. 8:00 o'clock. >> i haven't seen a lot of programs that do this way you learn a lot of history but you see in the context of the present moment that the

challenges we made it all last fall and early winter of this year so everything was in lockdown my cohost was in the middle of england that was in major lockdown so logistically it was enormously complicated process to get it made but we also felt we were right in the middle of the story so we did manage to get it done but that does come out tomorrow. >> so you were talking to doctor fauci the day the results came out? did he know what they were going to be quick. >> yes it is possible he had nine a day or two before but when he talked to us about it it's like he just learned it he was saying at one point i

have had a lot of bad breaks we had a great break with this when we have taken 60 percent efficacy but 95 is so off the charts it is you have no idea. >> he is very charming of course in the show. >> you have also mentioned that you have paperback coming out and it is a book i have enjoyed a couple of your books but i was not familiar with this one so tell me about it. >> so tomorrow is the publication date for the paperback release for the last but they came out one year ago. it's called enemy of all mankind. it is a single thread narrative the goes off in different directions and it's about a pirate, a completely different topic who pulls off

a heist of an indian treasure ship in 1695 and triggers a global crisis that leads to the first global manhunt in the history of the world is like the story the first global capitalism with the older regimes in india and rising appropriations with the east india company with the pirates so people are interested that book is newly out in paperback with the classic tale of history for father's day a great father's day book. >> sorry my brain was derailed by the mention of pirates. [laughter] it's like the real-life version of the rabbit hole you told me that little bit now i

say no we're doing an event but i want to go read more. [laughter] so we have a couple of questions in the q&a. but the first question is connected to what we were discussing earlier that life expectancy did not vary by social status but then began to so why is that? why did that start? >> the big change which is central to the vaccine story is that there was a technique so it is famously invented by jenner in 1796. and he gets a lot of credit like fleming.

but there is an earlier technique some college inoculation it's like a smallpox scab somebody who has it and then insert that putting in a powder to put it up through their nose to give them a very mild case of smallpox it's much more dangerous than vaccination. 2 percent of the population would die but it was so deadly that it was the better and safer choice. so be too developed outside of the west we don't know where it was first developed we think it was independently discovered and made its way into turkey and have british

aristocratic woman randomly moved to constantinople and she saw people being vaccinated and at that period she and documented her children. she brought it back as a technique in convince the prince of wales to inoculate her children and it spread as a technique through the elites because of the role model that i like to see this marked reduction among the elite and that period and a lot of those are children so because child mortality is such a big driver of life expectancy decline

that's when you first start to see that increase because the children of the elites are not dying of smallpox. >> you mentioned child mortality and this is a question i feel there are a couple of different stories of life expectancy that you hear. and now is just child mortality. ryan tomlinson just asked me today how much is it? what is the life expectancy of 30 or 40? >> it is very interesting since i started to work on the process on this project a regular response lifespan

hasn't really changed to dale babies are not dying anymore and that is not true that's not the explanation. it is true infant mortality has gone way down but it's much more complex. if you look at the numbers and that was is an amazing advance because childhood was an incredibly dangerous time just 100 years ago and 150 years ago two out of five of your children would die that was par for the course. so it was the most perilous point of your life until you got very old when you were five or two. so to think all that has been

transformed so we should not just dismiss that. but we also know the terms in the uk in 1920 if you live 220 your life expectancy at that point is 60 so bunch of kids were dying so if you made it to 20 past the crucible of childhood you can live another 40 years now you can live to about 85 years. that is 25 extra years the grown-up scott. that is a generation that's the difference between grandkids and great again on - - great grandkids. and now in recent years countries like the united states where there is progress

it's happening at the older part of the spectrum because we have gotten the most out of a can of childhood and infant mortality. so i to jerry and or centenarians over 100 years old are the fastest growing demographic we meet a lot of 100 -year-old people out there. >> someone asks about the articles that you see in the newspaper about a human lifespan revolves around stories and they live 130 years so how helpful or hurtful is that mindset and why do some have a long lifespan quick. >> there does seem to be some

variation so talk about the blue zone and there is some inherent ability with longevity so there is a genetic component to make some live longer and with diet and lifestyle are obviously a huge factor as well. when they try to figure out how long hunter gatherers lived, doing that observationally the people that you're supposed to make in the beginning i can do with my mouth but the western demographers would try to understand how long people were living in a society but a

lot of the 60 or 70 -year-olds did not look very old because of their exercise they were not sitting at their desk all day so they looked fit it was hard to tell how old they were because the numbers system stopped at three asking how old they were it would be older than three that's the only answer they had. [laughter] so it was hard to figure out how will they were but their lifestyle clearly made a difference in terms of their physique. >> and i really liked that you did not well on that question that you talk a little that at the end of can we live forever and that was an interesting discussion but i do get tired of the stories where we found

the key to living forever this one way to squeeze out a few more years. but i feel like it so much more interesting of a story and how we have kept from dying and all the other steps so i want to throw in a question of my own. another person i had not really learned about was francis kelsey and just for the people here, give a summary of who she was. >> she was basically a figure who started her career early on and then involved in a

terrible drug poisoning case one of the sulfa drugs that predates penicillin and basically then had illustrious career at the fda and ended up playing a key role as a regulator to keep the manufacturer that we saw and was be sold as anti- anxiety medication and medication for morning sickness causing terrible birth defects. so in the early sixties to

look more rigorously if these drugs work and stopping it from getting to the market in the united states and getting presidential medal of distinguished service. and a wonderful figure the things that we celebrate and then to attribute to government regulators with the heroic narratives that is practically a swearword now and it is stifling of progress. it is a huge sign progress sometimes you need to accelerate things but building

up that kind of institution you have vaccines but also the fda and then we should remind ourselves that is progress also. >> and the obvious context we are all sitting here with many of us having gotten the vaccine developed in the last year and whenever i read through the studies or clinical trials of the vaccines i'm struck by how those randomized trials are just so good. but there is so many ways to do it wrong. and the fda and briefing documents and reports i instruct. it is weirdly inspiring. those that work so hard to get at the truth for no reason other than it will help other

people. i really appreciate that you celebrate that. it is worth celebrating and especially worth celebrating in an obvious and a visceral way right now. >> thank you. a lot of it tries to figure out ways those people and what they do narratively compelling. a lot of the stories, you could do it looking at these jobs but it is a mystery. so how do we figure out? so there is some detective work.

someone tries to subdue the threat and if you have ingredient you can build a story and once you build the story then you can get people to think about it and say that's amazing to solve the problem. sometimes somebody comes for the wonder drug or stopping a dangerous drug from getting on the market because they are relying on statistical tools. >>

[laughter] thank you for joining us. i am honored. >> thank you. >> thank you to you both for the fantastic discussion and to everyone for joining us. get extra life that greenlight bookstore.com. . . . . ♪♪ ♪♪