PAGE 91 At Austin State Hospital, the young Black man was taken: Packchanian’s biographical sketch indicates that between 1936 and 1941 he was a protozoologist for the US Public Health Service. The sketch is published online by the Truman G. Blocker, Jr. History of Medicine Collections housed at the Moody Medical Library at the University of Texas Medical Branch in Galveston.
PAGE 91 The researcher, Ardzroony Packchanian, had been asked to come to Texas: Packchanian’s obituary in the Galveston Daily News, May 8, 1987, states that “he was invited to study a few suspected cases of Chagas’ disease.” Correspondece shows that in one instance the Texas State Health Department turned over more than one thousand serum samples to him. Ardzroony Packchanian to Dr. J.V. Irons, 9 September 1948, box 6, folder 60, Truman G. Blocker, Jr. History of Medicine Collections, Moody Medical Library, University of Texas Medical Branch in Galveston.
PAGE 92 A few years later, Congress passed annual quotas: Mae M. Ngai, “The Architecture of Race in American Immigration Law: A Reexamination of the Immigration Act of 1924,” Journal of American History 86, no. 1 (June 1999): 74.
PAGE 92 He enrolled at the City College of New York: “Dr. A.A. Packchanian,” Galveston Daily News, May 8, 1987.
PAGE 92 He completed his doctoral work on sleeping sickness: Ardzroony Packchanian, “Experimental Trypanosoma brucei Infection and Immunity in Various Species of Animals; Blood Chemistry and Electrical Conductivity of Nagana Blood” (PhD diss., University of Michigan, 1933).
PAGE 92 News of his research had appeared in the New York Times: “’Kissing Bug’ Accused,” New York Times, August 26, 1939.
PAGE 95 In the 1940s, though, such antibody tests did not exist: A. O. Luquetti and G. A. Schmuñis, “Diagnosis of Trypanosoma cruzi Infection,” in American Trypanosomiasis, Chagas Disease: One Hundred Years of Research, 2nd ed., eds. Jenny Telleria and Michel Tibayrenc (New York: Elsevier, 2017), 679.
PAGE 95 And he spent a decade looking for people: Ardzroony Packchanian to Piero Manginelli, April 2, 1951, box 6, folder 61, Truman G. Blocker, Jr. History of Medicine Collection, Moody Medical Library, University of Texas Medical Branch in Galveston.
PAGE 95 He wanted to know what had come of Packchanian’s experiments: Garland G. Zedler to Ardzroony Packchanian, March 5, 1946, box 6, folder 60, Truman G. Blocker, Jr. History of Medicine Collection, Moody Medical Library, University of Texas Medical Branch in Galveston.
PHARMA BRO
PAGE 97 My sister had moved to Virginia where the Latinx population: Carole Morello and Dan Keating. “Va.’s Numbers of Hispanics and Asians Skyrocket as White Population Dwindles,” Washington Post, February 4, 2011.
PAGE 97 Donald Trump, then the leading Republican presidential candidate: Bethany McLean, “Poison Pill,” Vanity Fair, February 2016.
PAGE 97 In the fall of 2015, Shkreli’s company hiked the price: Andrew Pollack, “Drug Goes from $13.50 a Tablet to $750, Overnight,” New York Times, September 20, 2015.
PAGE 98 Immigrants, black Americans, and those living in poverty are more likely: Jeffrey L. Jones et al., “Toxoplasma gondii Infection in the United States, 2011–2014,” American Journal of Tropical Medicine and Hygiene 98, no. 2 (February 2018): 551–57.
PAGE 98 He went on Bloomberg Television and defended the price increase: Jared S. Hopkins, “Controversial ’Pharma Bro’ Shkreli Says ’Of Course’ He’d Raise Drug Price Again,” Bloomberg, December 23, 2016.
PAGE 98 He showed up at the Forbes Healthcare Summit: Dan Diamond, “Martin Shkreli Admits He Messed Up: He Should’ve Raised Prices Even Higher,” Forbes, December 3, 2015.
PAGE 98 He then spent $2 million on the only existing copy of a Wu-Tang Clan album: Justin Hunte, “Martin Shkreli Plans to Bail-Out Bobby Shmurda,” HipHopDx.com, December 16, 2015.
PAGE 98 That same year, executives from Valeant Pharmaceuticals: Pollack, “Drug Goes from $13.50 a Tablet,” New York Times.
PAGE 98 A year later, the pharmaceutical company Mylan: Andrew Pollack, “Mylan Raised EpiPen’s Price Before the Expected Arrival of a Generic,” New York Times, August 24, 2016.
PAGE 99 a man who, in the summer of 2015, at the age of thirty-two, could: Diana Novak Jones, “Shkreli’s Ex-Co. OK to Pay $198K in Bonuses, Judge Says,” Law360, February 17, 2016.
PAGE 99 The World Health Organization considers benznidazole: World Health Organization Model List of Essential Medicines, 21st list (Geneva: World Health Organization, 2019).
PAGE 99 The drug can often eradicate the parasite: Maria Carmo Pereira Nunes et al., “Chagas Cardiomyopathy: An Update of Current Clinical Knowledge and Management: A Scientific Statement from the American Heart Association,” Circulation 138, no. 12 (September 2018): e169–e209.
PAGE 99 Studies have also found that women treated with benznidazole: Diana L. Fabbro et al., “Trypanocide Treatment of Women Infected with Trypanosoma cruzi and Its Effect on Preventing Congenital Chagas,” PLOS Neglected Tropical Diseases 8, no. 11 (November 20, 2014): e3312; and Sergio Sosa-Estani et al., “Etiological Treatment of Young Women Infected with Trypanosoma cruzi, and Prevention of Congenital Transmission,” Revista da Sociedade Brasileira de Medicina Tropical 42, no. 5 (September/October 2009): 484–87.
PAGE 100 Benznidazole, which interferes with the parasite’s protein synthesis: Constança Britto (director, Molecular Biology and Endemic Diseases Laboratory, Oswaldo Cruz Institute) in discussion with the author, November 13, 2019.
PAGE 100 this might explain why an observational study in Argentina: Rodolfo Viotti et al., “Long-Term Cardiac Outcomes of Treating Chronic Chagas Disease with Benznidazole Versus No Treatment: A Nonrandomized Trial,” Annals of Internal Medicine 144, no. 10 (May 2006): 724–34.
PAGE 100 The study that Professor Guhl had been working on: Carlos A. Morillo et al., “Randomized Trial of Benznidazole for Chronic Chagas’ Cardiomyopathy,” New England Journal of Medicine 373, no. 14 (October 2015): 1295–1306.
PAGE 100 In 2015, benznidazole was not approved by the US Food and Drug Administration: Caryn Bern, “Chagas’ Disease,” New England Journal of Medicine 373, no. 5 (July 2015): 456–66.
PAGE 100 Martin Shkreli bragged to investors that his company: This and other details about Shkreli’s plans and proposed price hike are from my reporting for “Pharma Bro’s Latest Move Targets Latinos,” Atlantic, December 14, 2015; and Pollack, “Martin Shkreli’s Latest Plan to Sharply Raise Drug Price Prompts Outcry,” New York Times.
PAGE 100 He boasted that this would generate millions of dollars: Helen Branswell, “How a System Meant to Develop Drugs for Rare Diseases Broke Down,” STAT, November 28, 2015.
PAGE 100 One study led by a clinical fellow from Harvard Medical School: Jennifer Manne-Goehler, Michael R. Reich, and Veronika J. Wirtz, “Access to Care for Chagas Disease in the United States: A Health Systems Analysis,” American Journal of Tropical Medicine and Hygiene 93, no. 1 (May 2015): 108–13.
PAGE 101 In South America, the cost of treatment with benznidazole: Andrew Pollack, “Martin Shkreli’s Latest Plan to Sharply Raise Drug Price Prompts Outcry,” New York Times, December 11, 2015.
PAGE 101 It also didn’t charge for another drug, nifurtimox: Jennifer Manne et al., “Supply Chain Problems for Chagas Disease Treatment,” Lancet Infectious Diseases 12, no. 3 (March 2012): 173–75.
PAGE 101 This drug was often not as well tolerated as benznidazole: Nunes et al., “Chagas Cardiomyopathy: An Update.”
PAGE 101 Investors gave his company $8 million in the hopes: Jones, “Shkreli’s Ex-Co. OK to Pay.”
PAGE 101 The morning after Shkreli and I exchanged tweets: Christie Smythe and Keri Geiger, “Shkreli, Drug Price Gouger, Denies Fraud and Posts Bail,” Bloomberg News, December 17, 2015.
PAGE 103 Harper’s documented how Shkreli’s notoriety: “Public Enemy,” Harper’s, September 2017.
PAGE 103 It got a new president and later a new name: Ron Leuty, “Pharma Bad Boy Martin Shkreli Is Gone, But 2 Companies Spark Over Drug He Snagged,” San Fr
ancisco Business Times, August 4, 2017.
HUNTING FOR THE KISSING BUG
PAGE 107 In 2013, she and her team screened more than two hundred shelter dogs: Trevor D. Tenney et al., “Shelter Dogs as Sentinels for Trypanosoma cruzi Transmission across Texas,” Emerging Infectious Diseases 20, no. 8 (August 2014): 1323–26.
PAGE 107 When—and if—the symptoms of the kissing bug disease show themselves: Dr. Roy Madigan (Animal Hospital of Smithson Valley) in discussion with the author, December 20, 2018.
PAGE 108 In the late 1970s, the state’s health department and Pan American University: J. E. Burkholder, T. C. Allison, and V. P. Kelly, “Trypanosoma cruzi (Chagas) (Protozoa: Kinetoplastida) in Invertebrate, Reservoir, and Human Hosts of the Lower Rio Grande Valley of Texas,” Journal of Parasitology 66, no. 2 (April 1980): 305–11.
PAGE 108 Almost thirty years later, in 2008, Sonia Kjos: S. A. Kjos et al., “Distribution and Characterization of Canine Chagas Disease in Texas,” Veterinary Parasitology 152, no. 3–4 (April 2008): 249–56.
PAGE 108 Infected dogs have also been found in Oklahoma, Louisiana, and Virginia: P. D. Nieto et al., “Comparison of Two Immunochromatographic Assays and the Indirect Immunofluorescence Antibody Test for Diagnosis of Trypanosoma cruzi Infection in Dogs in South Central Louisiana,” Veterinary Parasitology 165, no. 3–4 (November 2009): 241–47; Kristy K. Bradley et al., “Prevalence of American Trypanosomiasis (Chagas Disease) among Dogs in Oklahoma,” Journal of the American Veterinary Medical Association 217, no. 12 (December 2000): 1853–57; and S. C. Barr et al., “Trypanosoma cruzi Infection in Walker Hounds from Virginia,” American Journal of Veterinary Research 56, no. 8 (August 1995): 1037–44.
PAGE 108 In 2015, Melissa Nolan Garcia, an epidemiologist at Baylor College: Melissa N. Garcia et al., “Case Report: Evidence of Autochthonous Chagas Disease in Southeastern Texas,” American Journal of Tropical Medicine and Hygiene 92, no. 2 (February 2015): 325–30.
PAGE 109 When I started digging through medical journals: Kathryn M. Meurs et al., “Chronic Trypanosoma cruzi Infection in Dogs: 11 Cases (1987–1996),” Journal of the American Veterinary Medical Association 213, no. 4 (August 1998): 497–500.
PAGE 111 In 2003, researchers found DNA evidence: Karl Reinhard, T. Michael Fink, and Jack Skiles, “A Case of Megacolon in Rio Grande Valley as a Possible Case of Chagas Disease,” Memórias do Instituto Oswaldo Cruz 98, suppl, 1 (January 2003): 165–72; and Adauto Araújo et al., “Paleoparasitology of Chagas Disease: A Review,” Memórias do Instituto Oswaldo Cruz 104, suppl. 1 (July 2009): 9–16.
PAGE 112 By 2016, they had a collection of almost two thousand bugs: Rachel Curtis-Robles et al., “Combining Public Health Education and Disease Ecology Research: Using Citizen Science to Assess Chagas Disease Entomological Risk in Texas,” PLOS Neglected Tropical Diseases 9, no. 12 (December 2015).
THE MILITARY’S SEARCH
PAGE 117 The United States military began hunting for kissing bugs in 1964: Warren Floyd Pippin, “The Biology and Vector Capability of Triatoma sanguisuga texana Usinger and Triatoma gerstaeckeri (Stål) Compared with Rhodnius prolixus (Stål) (Hemiptera: Triatominae),” Journal of Medical Entomology 7, no. 1 (January 1970): 30–45.
PAGE 118 In 2012, the US military published a study: Lee McPhatter et al., “Vector Surveillance to Determine Species Composition and Occurrence of Trypanosoma cruzi Infection at Three Military Installations in San Antonio, Texas,” US Army Medical Department Journal (July–September 2012): 12–21.
PAGE 118 When Dr. Hamer and her team tested almost two thousand kissing bugs: Rachel Curtis-Robles et al., “Combining Public Health Education and Disease Ecology Research: Using Citizen Science to Assess Chagas Disease Entomological Risk in Texas,” PLOS Neglected Tropical Diseases 9, no. 12 (December 2015).
PAGE 118 In 2018, it also had the highest rate of poverty: Camille Phillips, “San Antonio Poverty Rate Tops List of Large Metro Areas,” Texas Public Radio, September 26, 2019.
PAGE 118 close to 14 percent of the dogs in the city’s shelters: Trevor D. Tenney et al., “Shelter Dogs as Sentinels for Trypanosoma cruzi Transmission across Texas,” Emerging Infectious Diseases 20, no. 8 (August 2014): 1323–26.
PAGE 119 “A fully trained military dog costs”: Kyle Stock, “The Dogs of War Are in High Demand,” Bloomberg, August 28, 2017.
PAGE 119 In 2016, the military had approximately 1,800 dogs: Department of Defense: Medical Conditions and Care for End-of-Service Military Working Dogs (Washington, DC: United States Government Accountability Office, 2017).
PAGE 119 A retired dog handler told the San Antonio Express-News: Cathy M. Rosenthal, “Animals Matter: Military Working Dogs Still Considered ‘Equipment,’” San Antonio Express-News, April 3, 2013.
PAGE 119 In the late seventies, a Labrador retriever at Lackland: John M. Pletcher and Harold W. Casey, “Case for Diagnosis,” Military Medicine 143, no. 10 (October 1978): 689–94.
PAGE 120 Veterinarians at Lackland began reporting more cases: McPhatter et al., “Vector Surveillance to Determine Species Composition,” 12–21. This source also includes more information about the infection rates among these dogs.
PAGE 121 Between 2014 and 2016, the military screened: Joseph E. Marcus et al., “Diagnostic Evaluation of Military Blood Donors Screening Positive for Trypanosoma cruzi Infection,” Medical Surveillance Monthly Report 25, no. 2 (February 2018): 16–19.
PAGE 121 They included an eighteen-year-old who already: Bryant J. Webber et al., “A Case of Chagas Cardiomyopathy Following Infection in South Central Texas,” United States Army Medical Department Journal (January–June 2017): 55–59.
PAGE 121 After living in the exact location for thirteen years: Sonia A. Kjos et al., “Identification of Bloodmeal Sources and Trypanosoma cruzi Infection in Triatomine Bugs (Hemiptera: Reduviidae) from Residential Settings in Texas, the United States,” Journal of Medical Entomology 50, no. 5 (September 2013): 1126–39.
PAGE 122 The family noticed this uptick around the same time: McPhatter et al., “Vector Surveillance to Determine Species Composition,” 12–21.
PAGE 122 Starting in the late nineties, Texas had more than a million acres: Texas A&M Institute of Renewable Natural Resources, “Status Update and Trends of Texas Rural Working Lands,” Texas Land Trends 1, no. 1 (October 2014): 2.
PAGE 122 between 2010 and 2017, it had added more housing than any other state: US Census Bureau, “Census Bureau Reveals Fastest-Growing Large Cities,” release no. CB18-78, May 24, 2018.
PAGE 122 In 2018, Apple announced it was building: Will Anderson, “A Primer on Robinson Ranch, 7,000 Acres of Central Texas That Will Be Home to New $1B Apple Campus,” Austin Business Journal, December 15, 2018.
PAGE 122 Insects that carry disease are usually sensitive to temperature shifts: A. Marm Kilpatrick and Sarah E. Randolph, “Drivers, Dynamics, and Control of Emerging Vector-Borne Zoonotic Diseases,” Lancet 380, no. 9857 (December 2012): 1946–1955.
PAGE 122 kissing bugs tend to feed more frequently: S. S. Catalá, F. Noireau, and J.-P. Dujardin, “Biology of Triatominae,” in American Trypanosomiasis, Chagas Disease: One Hundred Years of Research, 2nd ed., eds. Jenny Telleria and Michel Tibayrenc (New York: Elsevier, 2017), 149.
PAGE 122 That said, scientists have pointed out that it is hard to isolate: Kilpatrick and Randolph, “Drivers, Dynamics, and Control of Emerging Vector-Borne Zoonotic Diseases,” 1946–55.
PAGE 123 In Chile, one group of researchers mapped the risk: Salvador Ayala et al., “Estimando el efecto del cambio climático sobre el riesgo de la enfermedad de Chagas en Chile por medio del número reproductivo,” Revista Médica de Chile 147, no. 6 (June 2019): 683–692.
PAGE 123 Argentinian researchers looked at five species: Soledad Ceccarelli and Jorge E. Rabinovich, “Global Climate Change Effects on Venezuela’s Vulnerability to Chagas Disease is Linked to the Geographic Distribution of Five Triatomine Species,” Journal of Medical Entomology 52, no. 6 (November 2015): 1333–43.
PAGE 123 In 2013, researchers from the University of Texas-Pan American: Miroslava Garza et al., “Projected Future Distributions of Vectors of Trypanosoma cruzi in North America under Climate Change Scenarios,” PLOS Neglected Tropical Diseases 8, no. 5 (2014): e2818.
PAGE 123 In 2015, the CDC granted Texas researchers: “Texas Medical Center, UTHealth Researcher Awarded CDC Grant to Study Chagas Disease in Texas,” press release, September 14, 2015.
PAGE 123 It was part of an initiative to tackle a handful: Centers for Disease Control and Prevention, “Parasitic Infections Also Occur in the United States,” press release, May 8, 2014.
PAGE 124 The list of neglected parasitic infections includes: Jeffrey L. Jones et al., “Toxoplasma gondii Infection in the United States, 2011–2014,” American Journal of Tropical Medicine and Hygiene 98, no. 2 (February 2018): 551–57.
PAGE 124 Also on the list: toxocariasis, a disease caused by: Kathleen McAuliffe, This Is Your Brain on Parasites: How Tiny Creatures Manipulate Our Behavior and Shape Society (New York: Houghton Mifflin Harcourt, 2016), 94; and A. Farmer, T. Beltran, and Y. S. Choi, “Prevalence of Toxocara Species Infection in the U.S.: Results from the National Health and Nutrition Examination Survey, 2011–2014,” PLOS Neglected Tropical Diseases 11, no. 7 (July 2017).
PAGE 124 Every year, the disease blinds at least seventy people: Centers for Disease Control and Prevention, “Parasitic Infections Also Occur in the United States,” 2014.
PAGE 125 A year after the grants were announced, a study: Jennifer Manne-Goehler et al., “Estimating the Burden of Chagas Disease in the United States,” PLOS Neglected Tropical Diseases 10, no. 11 (November 2016).
PAGE 125 The CDC has recorded fewer than a hundred such infections: Centers for Disease Control and Prevention, email message to author, April 20, 2020.
PAGE 126 She had more than fifty bites from kissing bugs: Patricia L. Dorn et al., “Autochthonous Transmission of Trypanosoma cruzi, Louisiana,” Emerging Infectious Diseases 13, no. 4 (April 2007): 605–7.
The Kissing Bug Page 22
