Current medical theory has it that you can treat autoimmunity in two basic ways: squelch the entire immune system—communications HQ and attack troops alike—or disarm the forces preparing to do battle. Thus, a growing number of drugs are designed to intercept killer T cells (a seductive infiltration that is alluring in theory only—many of these drugs are made from the cloned DNA of rodents). The military metaphor, however, is only so accurate. If you’ve ever been in an army, read Catch-22, or heard through the grapevine about any world history whatsoever, you know that militaries are far from united forces and that military actions rarely function cleanly. When they do have a positive overall net result, it is often because the military units have the support of local populations.
That this logic applies to the immune system as well is finally gaining acceptance within the medical realm. A healthy immune system, research is slowly revealing, relies in large part on the native population of the digestive tract. That is, your stomach and intestines are intended to house a healthy balance of many strains of bacteria—including some that look like desiccated wieners, lesioned Whiffle Balls, and sentient tampons.
Gut flora, they’re called, to make them sound prettier than they are, or good bacteria. It’s pure marketing, of course: single-celled organisms are single-celled organisms; they are too tiny to contain intentions, and only perform single emotionless functions. The PR boost is necessary, however, due to the long history of malevolent gossip regarding germs. Ever since bacteria were first observed by Dutch cloth merchant and biology hobbyist Anton van Leeuwenhoek nearly 350 years ago, and the germ theory of disease gained dominance thanks to the subsequent discoveries of Louis Pasteur in the 1850s, humans have considered bacteria the enemy and sought to wipe it out.
Some of the more effective weapons in the artillery stronghold of anti-germ warfare have included consumer-grade antibacterial hand soaps as well as that travel-size hand sanitizer Great Auntie Linda keeps in her purse to use after every encounter with a door handle. Rumored to have been patented in 1966 by an immigrant nursing student in Bakersfield, California named Lupe Hernandez, hand sanitizer had a good fifty-year run before the FDA pulled it, alongside all hand soaps containing certain antibacterial agents. Washes containing triclosan and triclocarban “could pose health risks,” the FDA said in its September 2, 2016, ruling. The primary health risk? “Bacterial resistance,” the statement said, adding that no evidence had ever been offered that such cleaning agents are more effective than soap and water. (The Hernandez story, like the effectiveness of hand sanitizer itself, is apocryphal: the name Hernandez does not appear on any patents for anti-microbial cleansers registered in the 1960s.)10
The campaign to wipe out microbes is broad-sweeping, multifaceted, and cultural. Even more indicative than decades of over-the-counter consumables is that bacterial decimation has been institutionally condoned—the over-prescription of antibiotics is a constant reminder that germaphobia is authoritatively sanctioned. Industrially, too: the common practice of administering antibiotics to wipe out disease and stimulate growth in livestock intended for slaughter is more hidden but, disconcertingly, on the rise. After the Food and Drug Administration advised agricultural companies in 2013 to scale back the practice in meat intended for human consumption, Scientific American reported sales of antibiotics for use in livestock actually increased by 3 percent the following year.11 Forget how widespread use of antibiotics can empower superbugs for a moment and consider their impact on gut flora. Antibiotics’ most pressing threat to public health may be the eradication of healthy gut bacteria, which is, to bring it full circle, a contributing factor in the growing autoimmune epidemic.12
The known link between autoimmune disease and gut flora goes by the unsexy name of leaky gut syndrome, a disruption of the bacteria in the digestive tract that creates the conditions for intestinal permeability. When our gut walls leak, our immune systems are riled into action. Some studies have established a direct correlation between individuals ending long, harsh courses of antibiotics and the onset of autoimmunity. Others have identified popular food additives and preservatives as setting off leaky gut syndrome prior to full autoimmunity. Whatever the inciting incident, bacterial eradication seems often to precede a malfunctioning immune system.
Individual battles in the campaign to wipe out all bacteria have amounted to a full scale war that has waged, now, for over 150 years. Its intended target has been to wipe out “bad” bacteria—without much comprehension of what bacteria do, where they congregate, or how they might work in tandem with other, less “bad” bacteria. Antibiotics may gleefully treat or prevent everything from syphilis to tooth infections, but they’re also killing willy-nilly the stuff we require in our guts to keep us healthy.
A smarter species, one capable of learning from its past, might have considered the contributions of unseen populations before declaring indiscriminate battle, but Western medicine (and its propaganda bureau) never stopped to consider the innocent casualties of its war on germs. There was even a George W. Bush-style “Mission Accomplished” moment when George W. Bush himself whipped out a bottle of hand sanitizer on national television in November 2008 upon shaking the hand of new president-elect Barack Obama. Bush countered accusations of racism by embracing the more socially acceptable label of germaphobe and claimed the substance could cure the common cold. It worked. Purell, on the market by then for twenty years, finally hit the mainstream. Mission Accomplished!
No surer sign of failure exists than a televised declaration of victory, for bacterial resistance to antibiotics has been around for as long as antibiotics themselves, even if Bush’s weapon of choice has just been pulled off the market. In 1946, one hospital in England calculated the number of patients with penicillin-resistant staph infections at 14 percent and saw that number nearly quadruple two years later to 59 percent.13 Penicillin resistance lead to the development of the alternative, methicillin. MRSA, or methicillin-resistant Staphylococcus aureus, first identified in 1961, made headlines in the 1990s when its effects worsened and infections spread.14 These were early superbugs, the origin story of our little modern antiheroes. In recent days, the name “superbug” has come to describe even more powerful strains of multi-drug-resistant bacteria, or MDR. (The much ballyhooed, pan-resistant MCR-1 is the most-cited example.)
The imminent superbug apocalypse of special-report lore and the real life but silent autoimmune epidemic are of course part and parcel of the same modern medical foible. A 2014 UK look at the economic impact of microbial resistance suggests that current rates of death from multi-drug-resistant bacteria—around 23,000 per year in the United States and slightly more in the European Union—will grow to ten million global deaths per year by 2050.15 In response to such predictions, medical researchers and drug manufacturers have been scrambling for stronger weapons, mostly new antibiotics, or new combinations of old antibiotics, to treat ailments including pneumonia and tuberculosis long considered conquered but slowly reemerging in drug-resistant bacterial strains. New antibiotics naturally means new superbugs, but also the continued depletion of our gut bacteria, which the latest research suggests will only contribute to the rise in autoimmune disease.
But it may also be that the rise of superbugs is the problem to which autoimmunity responds. Spend some time dabbling in the far fringes of science, and a question emerges: Is autoimmunity just another mutation in a gloriously designed immune system that we never understood in the first place?
Few reasonable medical professionals will counsel the acquisition of an incurable disease as part of any wellness program, but many will helpfully suggest immune-boosting measures like increasing intake of vitamin C, selenium, and zinc, or taking probiotics to “balance” the gut. Such “immune-boosting” measures reflect the upside to crippling autoimmune disorders that medicine has yet to understand or cure. Actually, there’s quite a bit medical science doesn’t yet understand, including how overactive immune systems might actually respond to antibiotic-resi
stant microbes. However, one theory is that overactive immune systems will respond to superbugs in the exact same way they respond to everything else: by letting those killer T cells loose to engage in a fight to the death.
Of course, the lack of actual research into autoimmune responses to multi-drug-resistant bacteria hasn’t stopped drug manufacturers from trying to emulate autoimmunity in order to fight cancer. Nivolumab, sold under the brand name Opdivo, is approved to treat certain skin, lung, and kidney cancers. It is, more or less, an autoimmune disorder in a syringe. An expensive one, too: a single, full course of the drug costs between $120,000 and $200,000. Opdivo—alongside similar drugs Yervoy and Keytruda—is part of a new wave of immune-boosting or “immunotherapy” drugs that inhibit the command center of a healthy immune system, shutting off potential signals to the killer T cells to stand down so that they, in essence, must overreact. The drugs sound like they’re from the future, but the technology is not so advanced: it remains unclear whether the immune system’s command center will be able to resume normal, healthy function once the full treatment has been administered. This, from the manufacturer’s website, will sound familiar: “Opdivo can cause your immune system to attack normal organs and tissues in many areas of your body and can affect the way they work . . . . These problems can become serious or life-threatening and can lead to death.”
Whether or not FDA approval for such “immune-boosting” drugs to treat antibiotic-resistant bacteria is just over the horizon, off-label use could stand in as a treatment order until approval comes. So if you’re losing sleep over those nasty ole superbugs, you can calm your pretty little head. There may already be a drug response to save you from the pending apocalypse.
There may however be a simpler solution. The same overreliance on bacteria-killing agents that brought about superbugs in the first place may also have set the stage for their demise. Perhaps the key to warding off a superbug onslaught cannot be found in the form of more drugs at all, but in the proliferation of disease. Diseases that, for better or worse, are already reaching epidemic levels. If you’re lucky, in other words—and some fifty million Americans already are—you won’t need some spendy drug to keep your whole family safe from the already rallying single-celled troops.
Some doctors (off the record, of course) are already noting the upside of the autoimmune epidemic to some of their patients.
“Oh, ha ha, I wouldn’t worry about that,” I heard one rheumatologist tell a patient concerned about adding MCR-1 to her polyautoimmune disease list after hearing a news report about the superbug in the waiting room. Her body’s immune system, the doctor essentially told her, wouldn’t stand for such an attack. “Chronic illness sucks,” the doctor said conciliatorily, “but the one thing you will never have to worry about is the superbug apocalypse.”
There’s a city-wide yard sale going on in Marfa, Texas, about sixty miles north of the US-Mexico border, and what’s for sale, mostly, is baby clothes. The teen pregnancy rate here is rumored to astound. A backlash, one imagines, against the cold inhumanity of the Minimalist occupation that moved into town after artist Donald Judd first did in 1971. Also for sale: interestingly rusted tools that won’t fit in my backpack, books of the how-to, cooking, and joke variety, and wholly inappropriate items for June in West Texas: wreaths, fake snow, holiday lawn ornaments. Inside someone’s home behind the row of tabled goods, someone boils a pot of beans. It smells like warm protein and onion.
I am drawn to table displaying a collection of bottles enigmatically labeled “1.50 ALL.” They are confusing for reasons beyond whether the price is per piece or by collection: the containers are new, and each bears a dot-matrix-printed label falsely touting a folksy curative. One, for example, is a rejiggered Newman’s Own Salad Dressing bottle, still bearing the signature plastic screw cap, while two others contain liquids that had resolved genuine medical ailments before their recasting, now, as fake medicines. The various back-bedroom quacks conjured to respond to imagined concerns, and the potions not, in fact, created by them in the long-ago prospectin’ days include: Abel’s Dysentery Powder, Mrs. Smith’s Finest Headache Drop’s [sic], Clark Stanley’s Snake Oil Liniment, and Gus’s Pure Liver Tonic. Nearly all of them also bear an image that seems to have been scanned at a breathtakingly low number of dots per inch: the caduceus, or the Staff of Asclepius—commonly recognized as the “medicine symbol,” a snake or two entwined around a rod—but we’ll come back to that.
Under this serpentine mark—of authenticity, natch—are listed each potion’s “ingredients.” The label for McQuirre’s Joint & Leg Cramp Formula with Quinine, for example, states “Ingredients: Salt Water,” and indeed, a ring of salt deposits crowd the cap, and the air wafting from it tastes mildly tinny. The Liver Tonic is made with a stale-smelling “Grape Juice,” while the Rheumatism and Body Ache Rub claims “Mineral Oil.” Abel’s Dysentery Powder, should you find yourself with a make-believe case of that bloody diarrhea symptomatic of a potentially deadly parasitic or bacterial infection, is to be treated here with “Flour.” The bottle labeled Pure Smelling Salts is in fact filled with a floral-scented “Bath Powder”—an interesting substitution, given recent findings that bath salts contain a chemical linked closely to MDMA or Ecstasy, and men who’ve confessed to snorting it have reportedly chewed off major portions of other men’s faces. Even more interestingly, the pungent bottle labeled Marshal’s Skin Easement Soak is said to contain “Smelling Salt.”
Borders are ever-present in Marfa. Between the Latino and white sides of the segregated cemetery; between art-tourist destinations and the feed stores and refrigerator repair shops that are so clearly indicative of daily banal needs for two separate economic and social classes. There is also, of course, the Border Patrol Headquarters.
Borders within Marfa are patrolled by language—not just the Spanish-English divide, but by the varying connotations of vocabularies specific to differing social, professional, age, and gender groups. Local teens, when they’re not out impregnating each other with abandon, derogatorily call the recent wave of artist whites “Chinatis” after one of two foundations established to uphold and expand the legacy of the Minimalist Donald Judd. (When they are out impregnating each other, they sometimes do so at the Chinati Foundation, where a vast field is filled with Judd’s concrete boxes, one of the few public spaces in town to offer any privacy.)
The older Latinos in town display ambivalence toward “outsiders,” another local name for the recent cultural immigrants who are primarily white. For their part, the “outsiders” behave as occupiers: they form community among themselves, pitching in and working on behalf of “the locals” when a governing body calls upon them to do so, but remain largely, perhaps deliberately, unaware of the predominant culture of the region. Wikipedia, a site frequented by regular Internet users who have graduated from college and, according to a Pew Charitable Trust report from 2007, tend to earn greater than $75,000 per year, lists the racial makeup of the city as over 90 percent White and less than 7 percent Latino. A local business site, however, perhaps more accurately suggests that Latinos make up almost 70 percent of the town and white non-Hispanics less than 30 percent.
In other words, what you believe to be true about Marfa entirely depends on where you stand in relation to what border. Still, the town smells the same no matter where you find yourself: like hot dust and a bit of hay, tones of wet concrete, maybe, after a rain, and a constant undernote of flat, stale beer.
The enigmatic price quoted turns out to refer to all as a group, and not all as in, all of them are the same price, so I happily hand over a dollar fifty to the yard sale proprietress without further consideration, explaining to the brown-skinned woman at the card table that my mother kept snake oil bottles over our kitchen sink.
She cheerfully pulls two more glass containers out from under the table and asks if I want them, too. They’re leaking and, she says, “the labels are getting all messed up.” I don’t catch her gist, considering that she
has clearly typed them up on the computer herself, made superfluous use of the modern fonts Old-Timey and Cowboy Narrow Condensed, and slapped them on whatever just-used glass bottles she could find lying around. Most are topped with a plastic not even available until the mid-1980s. The illusion of authentic snake oil isn’t maintaining itself in the first place, so there’s not really a lot here to “mess up.”
But she shows me: stuff has escaped the bottles, and the labels are becoming difficult to read. “They’re broken,” she says in a moment of laughing honesty. In a decision I now view as wholly arbitrary, I decide that the purchase of broken glass bottles filled with fake cures for real ailments goes an unreasonable step beyond the purchase of glass bottles that will still cure nothing but have remained, so far, intact.
“Better not try to cart them onto the plane back to Chicago,” I tell her.
“Oh, you’re from the Midwest?” She asks, my personal snake oil salesperson. I catch a whiff of her perfume; it is cheap and sharp, which I like. High-end perfumes tend to seduce, aiming to blend in as if a situation could exist in which a person’s neck might naturally have rubbed against a rare, out-of-season flower. “Be sure and tell all your friends back home that they really take these down in West Texas,” she tells me. “That they really work.”
She guffaws, but she’s not exactly joking. I suppose that going in on a laugh together at her region’s expense is preferable to what she may see as the alternative: that I will laugh at her expense later without her permission. In fact, I don’t think the collection of cures I’ve amassed is funny at all. They’re far more authentic than their creator seems even to realize, and I thank her for them profusely. This only seems to confuse her.
The master narrative about unlicensed medical practitioners is that they are fakers, liars, true capitalists. That they take nothing and spin it to their advantage, sucking in the trust and faith of the unwitting masses for personal, extravagant gain. That they do not discriminate, and are therefore not swindlers or standard con men, who will work a target over a stretch of time, twisting your personality quirks into their profit. They create instead a basic view of the world and its ills and your role therein. And they sell, simply, a tincture necessary to your survival within it, provided you are able to follow—or, less strenuously sometimes, simply trust in—the worldview they describe. There is nothing personal about what they do—their audience self-selects. They’re called charlatans or mountebanks, or sometimes chiropractors, witches, medicine men, doulas, yoga practitioners, naturopaths, faith healers, acupuncturists, Big Pharma. Snake oil salesmen. The crime they are charged with is valuing personal financial gain over the act of healing.
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