Book Review: How To Survive a Plague by David France


My generation are some of the first to grow up with HIV infection as a treatable condition. We only know a world where combination HAART can give those newly infected an undetectable viral load and a nearly normal lifespan, so we largely lack the fear and stigma which surrounded AIDS from its beginning. It is easy for us to think, yes, HIV/AIDS was and is tragic, but the modern treatments are as good as a cure, so it’s no real problem now. But such complacency is wrong.

David France opens How to Survive a Plague with the funeral of Spencer Cox, a member of the AIDS Coalition to Unleash Power (ACT UP) who suggested that HIV researchers test  the drug Crixivan in large simple trials to produce data fast and get the drug on the market. This scene is not at the height of the plague but in 2013. The drug combinations he and many others were saved by in 1996 became ineffective, as his HIV strain mutated to snake past all available HIV drugs. What it is vital for those born after the plague years to know is that treatability does not entail dismissal. And France’s book details the struggle and stubbornness, as well as plenty of setbacks and self-aggrandizement, it took to get to where AIDS is today.

France runs a history of the science of HIV/AIDS alongside and intertwining with the history of activism. His writing is less pacy when writing on the research compared to when writing about the high drama of drug trials, but forgivable given his background. France is an AIDS activism insider. He is among the crowds of plague survivors at Cox’s funeral and is connected to the story’s main players. Though the scope and tone of the book somewhat resembles Siddhartha Mukherjee’s “Big Book of Cancer”, it does not attempt to magisterial objectivity. This means the book is How to Survive a Plague (as a gay male activist and journalist in New York, 1981-96). At the books heart is a small world of New York activists. San Francisco is a distant oasis separated by the dry sands of prejudice, to say nothing of the rest of the world. But narrowness is key to the intimacy France creates by following key figures like characters in a novel through what would otherwise be a fog of names, dates and acronymns.

Some of his stars include the musician Michael Callen, Richard Berkowitz and their physician Joseph Sonnabend, who together authored a 1982 book advising on safe sex. There is Larry Kramer, the mercurial playwright crucial in ACT UP’s founding and Peter Staley, the ex-Wall Street trader who protested against the high price of the drug AZT at the New York Stock Exchange. The book is rich in the tales of these and others fighting have AIDS taken seriously by scientists and law-makers.

What was new about the AIDS epidemic was how activists engaged with research. Theatre major and high school dropouts were reading the scientific literature on HIV/AIDS and presenting their own illnesses at conferences so they could challenge drug companies and government officials on funding and clinical trials. ACT UP’s famous mantra was “drugs into bodies”, they intended to get as many people on the best drugs quickly. This was strikingly at odds with a government and medical establishment characterized by it’s neglect, greed and indifference.

Successes finally emerged when researchers and activists worked together. AIDS activists suggested the parallel track method of clinical trials, which generated good data from a carefully controlled clinical trial, but those who aren’t the ‘perfect patient’ trials need can get the drugs. The drug Crixivan appeared promising in the early 1990s, so was rapid rushed from test tube to human trials via the substitution of animal trials for a ‘big chimp trial’, a scientist heroically took the drug themselves. But the manufacturer Merck faced was slow in producing enough of the drug for the Phase II trials, so driven by love and despair activist Tom Blout on Merck’s community advisory board was getting the drug bootlegged for lover Jim Straley, who died after his supply ran out.

Such a personal history of an emotive topic runs the risk of whiggish hagiography, but France’s acknowledgement of the failures and successes of activist groups keeps it balanced. The pitfalls of activist-driven medicine as shown in the case of AZT. Pressure from activists to value hast came at the cost of efficacy, when the good outcomes early in the Phase II clinical trial of the drug meant the trial was stopped prematurely and the drug approved in record time. But AZT was ultimately found to have no effect on lifespan, not captured in the short trial. But the scientists have plenty of flaws as well. There was a narrow focus by the NIH on trials of drugs which targeted the HIV virus, at the expense of developing treatment for the opportunistic infections which actually kill AIDS patients. But by the end of the plague, activists and scientists largely collaborated to temper each others’ faults. There is comedy in some of ACT UP’s stunts, such as the unfurling of a giant condom over the house of anti-AIDS research Senator Jesse Helms. But throughout the book runs a sense of the great, howling injustice of the willful ignorance of the AIDS crisis by those in power.

The book ends in 1996, the end of the plague years, the survivors dissipated. But the plague still shuffles on, wreaking havoc for those lacking access to treatment and bruised by previous treatments. AIDS casts a long shadow over the LGBTQ community, but the grief and anger spurred activists into becoming more vocal in demanding their own humanity be respected. The consequences of their actions reverberate in every pride march and every newly-out teenager today.


Burned Up Beech


In the park behind my parents’ house, there is a beech tree with a burnt out heart.

This park is really two suburban parks established in the 19th century by munificent local mill owners as a place for their workers to go other than the pub on weekend afternoons. Over the years the parks have fused. Together they grade into the surrounding woodland, these remnants of an older place from which the parks were carved and held in a suspended state, all else shorn and shrouded under houses.

Paths are threaded through the wood; heavy rain causes the clay to shift under the soil and the path occasionally slumps into the river. Trees are pulled in as well, swept away or up turned with their great roots to the sky. An Anthropocene Scene; the trees have plastic bags tangled into them like trapped ghosts. And little bags of dog poo decorate the trees like Christmas decorations, left by those without the patience to find a bin. But the growth-stretched skulls carved 15ft up a tree trunk hint at a deeper history.

This beech tree is situated behind a running track. It is a subliminal space; amateur athletics to the back, to the front the uncanny knocks of woodpeckers. Wild and illicit, but mundane and suburban as well. Beside the beech is a fallen brethren. Someone decided this trunk should have been planed into a seat, to this the woods have sent hyphae and added shelves of bracket fungi. There is a little clearing in front of my tree, a perfect setting for a ritual.

I walk these woods alone at strange and secret times, tapping out the same route year after year so that I do not really travel through space but instead through time, seeing each tree change its face for a new season. My ritual is ecological and personal, I move through time as it changes nature and changes myself.

Others have other rituals in this place, events I do not see but find evidence of. In cucumber-cool summer mornings I find crushed cans, little plastic baggies and the charred remains of a fire in the clearing. It is a natural place to congregate. A wild tamed no place to loosen your mind with drink and drugs.


I’ve always known the tree as having a gaping black wound from its roots stretching two metres up the tree and through the bark, pith and heartwood. All that the fire has left is a centimetres thick crescent at its back. I do not know when it happened, when the heartwood burned. It must have been quite a scene, flames licking up the trunk; fire ascending. I don’t blame who did it, I know the tempting itch of fire on wood is one sometimes not easily overcome. When the ash settled, what remained was a top heavy tree. Above a mostly intact stumpy trunk and branches, but below supported by the fragile inches of tissue that link the rest to the roots.

But this does not mean the tree is dead.

Trees are resilient in a very different way to animals. Lacking the choice of a quick escape all plants are hardy, but trees’ bulk prevents them from taking the cowardly annual option. They must retain their trunks all year, feeding the living tissue stored sugars and minerals. Whilst leafless, the tree starves until spring budding. Unlike vertebrates who tuck stem cell deep into the bone marrow, plants keep their stem cells under the bark throughout the tree. This means the idea of the individual blurs when we considered plants. For many plants, a part can break off and use its stem cells to form a new, cloned whole. These stem cells allowed my beech, horrifically mauled, to still put out leaves for another spring and nuts for another autumn. Though the heartwood is burnt, the name is deceptive. For a tree is not run by the heart, or anyone part. If the xylem and phloem course through the remaining tissue, the plant can endure, adapt and bloom once more.

The beech’s cavity is large enough for me to stand inside. The air changes, gone is the fury and wet-cold of the winter wind. Where the heartwood once is still and warm. The sounds of the woods are muffled.

I think of Ariel imprisoned and tormented in the pine and how different this is. I would have the tissues knit over me and take me in and we will grow together, a full canopy.

But chimerism is no solution. I meet this tree so often as it is a thing living despite unspeakable damage done to it and I want to learn from it, not join it. I want to know endurance in a harsh world where harsh things are done; I want to know how to have been burned and keep living.


The Poison Chronicles: Deadly Doping with Strychnos nux-vomica

I wrote a blog post for the Manchester Herbarium on the many roles of strychnine.

Herbology Manchester

dsc_0805Strychnos nux-vomica‘s bumpy nuts

Guest post by Laura Cooper

Strychnine is an infamous poison. It is most well-known by its appearance in the novels of Agatha Christie as an effective but unsubtle method of murder. It was widely available in the 19th century from chemists as a rat poison, but this was taken advantage of by a number of real life serial killers including Dr Thomas Cream who gave disguised as a medicine and in alcohol. But strychnine had another side to it. Its caffeine- like stimulating effects means it has been used as a performance enhancing drug in competitive sports.

wp_20161220_15_08_17_pro Herbarium sheet of Strychnos nux-vomica

Strychnine, along with the toxin brucine, is present in the seeds of Strychnos nux-vomica. Though its name is lurid, it does not have anything to do with vomiting, “nux vomica” translates as ‘bumpy nut’. S. nux-vomica is in the family Loganiaceae and…

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The Reification of Gender

The Socially Porous Brain Case. Illustration by Laura Cooper.

Some of my earliest memories of school life have within them the division between two groups of child; boys and girls. This split often didn’t feel enforced by adults or ourselves. Even in reception classes I recall a subtle difference, felt rather than known, between these two ways of lumping bodies and minds. Subtle beginnings are where the thin edge of a larger wedge become established. The majority of children in the West seem to pass through the stages from oblivious infant to a perceptive practitioner of their gender so smoothly and consistently that it looks like the unfurling of an innate biological capacity. Even children who know they are gender non-conforming often grasp wholesale the stereotypes of the gender they weren’t assigned at birth rather than pick the best of both. Though the crudest manifestations of gender diminish after the age of seven or so, these gender stereotypes stick with us in adulthood. From the consistency of this diverging behaviour, it has been argued that it is caused by a similar dimorphism inside the heads of people of different genders. Some then imply that these differences are unavoidable. Brain activities marches out into the world as behaviour, and no amount of good intentions can stop this, so the argument goes.

The precise details of the things in the brain that cause gendered behaviours have changed over time, as Cornelia Fine details in Delusions of Gender. From Victorian ideas about the small size of the female brain to more recent conjectures about high male foetal testosterone levels and the larger female splenium of the corpus collosum better linking the ‘verbal’ and ’emotional’ parts of the brain, many specific neuroanatomical differences have been argued for. But there is little evidence for any of these differences being robust or significant, or even real. However, rather than address each proposed difference on a case by case basis, more sociologically minded neuroscientists and psychologists such as Fine have looked to the root of this argument.


In his book The Mismeasure of Man, Stephen Jay Gould writes about the fallacy of reifying intelligence. This is where we take the abstract and complex concept of human mental activity and reduce it to the simpler concept of intelligence, defined narrowly as doing well in specific intellectual tasks. It is treated as a single thing, this is reification. This implies that there must be an intelligence ‘centre’ in the brain we can pinpoint. But this thinking is fallacious, as it attempts to reduce the multifarious ways human mental states can manifest, the qualities of which are determined by your upbringing, your society, your biology, your reaction against all three as well as dashing of randomness, into a single biological entity. This fallacy then grafts itself onto another fallacy, that what is biological is innate. Therefore, the argument goes from intelligence the thing to the spatial thing that permits intelligence to the innateness of intelligence. Sweep away the subtleties of the social world, here is reductive biofatalism.

And thus also with gender. The reification of gender to a brain thing takes us down the path of reductive biofatalism. The differences in male and female brain development, whatever this may be, is said to mean that the female infant’s brain unfurls as a wonder of intuition and empathy, whilst the male’s is honed into a systematising machine. The seed and pathway of this unfurling is determined, and nothing good-natured liberals can do will change this, so the argument runs.

But such an argument would only work if the social environment had no impact on the brain during development. This is far from true. We humans owe our great cognitive power to our brain’s extraordinary malleability in response to the environment. Without this no human culture would be possible, as how else could we learn our mother tongue? Psychological changes must produce or be caused by changes in the brain. To suggest anything else would be to throw aside five hundred years of material science and resort to crude ideas of the immaterial psyche. Some seem to forget this easily, but it is undoubable that the brain is sculpted by the world it forms in. From the extremes of foetal alcohol syndrome to the subtle every day instance of memory, the brain changes constantly in response to the environment, social and otherwise. In Cornelia Fine astute image, she refers to the “psychologically permeabl[ity of] the skull that separates the mind from the sociocultural context in which it operates”. The skull is not a fortress against the environment, but a porous psychological veil through which society can impinge into the deepest recess.

How does this relate to gender? It does so because of the subtle and unsubtle ways in which the sex of a child is stressed from birth. For most, a newborn is a gender first and a name second. Even a child raised in a so called ‘gender neutral’ way will likely know their gender. Drawing on the subtle clues their parents let slip and the attitudes of others they will realise what being this gender means in their society. Children between about five and seven years seem to me to be the most gender-fixated of all humans, probably because they have little else going for them. Gender gives them membership of a particular identity club rich in tropes to take on and satisfy their yearning for a social identity when the identity labels of available later like lawyer, heavy metal fan, socialist, bisexual etc. are unavailable. Thus the cues about what being a girl or boy means are picked up and followed and the child self-socialises themselves into their gender role. Of course, this is often not so perfectly smooth as this, but most do achieve consolidation into this role.

This whole process sculpts the brain. For women, as the child does the activities deemed feminine, the connections between brain regions and neural pathways involved with this strengthen and this becomes her life-long psychology and behaviours. This results neural dimorphic between men and women, but as far as I am aware the differences are not specific, vary between individuals considerably and don’t cause radical differences in cognition. This makes single-sex education due to neuroanatomical differences as logical as educating the children who learnt the violin at age 6 away from non-musical children.

Men and women do think differently, but this is likely entirely due to differences in the social environments of men and women rather than a sexually dimorphic ‘gender organ’ or physiological systems are the reifiers would have it. Rather than the gender binary being neuroanatomical a priori, the social gender binary is etched into the brain. But the reifer’s profoundest error is the idea of the autonomy of biological development. The womb is seen as a inviolable temple where the instructions of the genetic code are read out and post-natally the brain-case as sealed to the outside world. In contrast, I find Fine’s image of the psychosocially permeable skull a wonderful metaphor to think with. The body lets in all sorts of environmental influences in through its walls. Our development is not a soliloquy, but a cacophony of voices, each contributing different lines of varying importance which collectively take this human body and mind on life’s voyage through time.