Way to Go, Ohio 38:49

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Hello, hello, Revisionist History listeners. I'm excited to announce that this season, I'm offering a bunch of perks from my most loyal listeners, the ones who subscribe to Pushkin Plus. For those who just can't get enough, we're giving every episode to our subscribers one week early. Plus, we've created many episodes, released weekly, and I'm calling them tangents. And of course, you'll never hear any ads.

Subscribe to Pushkin Plus on the Revisionist History Show page in Apple Podcasts or at pushkin.fm. Deep into the preparation of Season 7 of Revisionist History, one bitterly cold day, I sent my producers, Lehman Gistu and Eloise Linton, on special assignment. Fly to Detroit. Rent a car.

This is a dumb question. Is it like high security? Oh, no. Well, it's not high security, but we did have to really put on a lot of gear to get in there for food safety reasons. You're wearing like hard hats, reflective jackets,

Were you wearing, like, industrial footwear? Not footwear, but we had to wear gloves. So we were wearing gloves, caps for our hair. That didn't really work for either of us. Not at all. I wanted to understand an experiment. One of the most important experiments of our modern era. One that's been all but forgotten. And, crucially, for my own selfish purposes, I wanted them to take a taste test. I'm going to close my eyes. Yes.

So we had a couple of paper plates in front of us and then a spoon and then we would spoon a little bit of it into our hands and then taste it from there. I will say that I took way too much. It was overwhelming for sure. Okay. I guess I'll put two little... Okay. This one first. Oh. That's strong. Yeah. Wow. Yeah, right. Okay.

You weren't blinded. But you didn't know which was which. So you have two little plates in front of you. Could they tell the difference? Yes. The insiders at the factory know the difference. The rest of us, not so much.

My name is Malcolm Gladwell. You're listening to Revisionist History, my podcast about things overlooked and misunderstood. This is part two of our investigation of magic wand experiments, impossible experiments that could only be done if we waved a magic wand. In this episode, you'll hear my magic wand by way of a journey from the banks of the St. Clair River to the tallest mountains in Europe, on to India, and then...

This episode is going to require a fair amount of digression. Patience, Grasshopper. We begin our story over a century ago, a time when you could go many places in the world and find some portion of the local population severely disfigured. If I'm walking around a remote village in the Swiss Alps in 1800, what do I see? High up in the Swiss Alps in the mid-1800s, you probably, probably about

half the population would have a visible goiter. I'm talking with Michael Zimmerman, University of Zurich, about goiters, a swelling on the neck right in front of the larynx. Describe these goiters. How large could they be? Well, I mean, in a child, it's about the size of maybe a lemon. But the older women, particularly the ones who'd had repeated pregnancies, you know, and would have large multinodular goiters, they can be the size of a

A volleyball. I mean, they can... A volleyball? Yeah, sure. They can compress the trachea, make it difficult to breathe or swallow. They can really be massive. Some portion of the population with goiters had a related condition, what used to be called cretinism.

So in children, for example, they don't grow normally. So they're very short. They have characteristic facial features. They have very dry skin, very dry hair. They move very slowly. Their temperature regulation is very poor. They become cold very easily. And then classically, it's associated with cognitive impairment and also deaf mutism. And it's not reversible. It's not.

For the longest time, no one knew the explanation for cretinism or for goiters. It would be one thing if they appeared everywhere. Then you could say, "This is just what human beings look like." But this wasn't everywhere. It was confined to very specific regions of the world.

I mean, it was famous back in the 1800s for British and American tourists to go up in the Swiss Alps, not only to see the beautiful alpine scenery, but also to see goiter and cretinism. I mean, Mark Twain, very famous quote, I've seen the two things I wanted to see in Switzerland, Mount Blanc and the goiter, and now I'm going home. It wasn't until the 19th century that scientists started to figure out what might be the culprit.

Iodine. Or rather, a lack of iodine in the diet. Iodine is a trace element found largely in seawater. There's a lot of iodine in seaweed and in the livers of fish like cod. If you live in a coastal area, you'll get iodine in your diet naturally because the wind and rain blowing off the ocean will deposit iodine in the soil and water. If a cow near the coast drinks water with iodine in it, then that iodine gets into your milk and meat.

But go inland, and iodine gets harder to find in nature. Fresh water flushes iodine out of the soil. Worst off are places that used to be covered with glaciers. Because when the glaciers retreated, they took topsoil and natural iodine with them.

No iodine in the soil, no iodine in plants. No iodine in plants, not enough iodine in the people eating those plants. And when people don't get enough iodine in their diets, their thyroid glands have to work overtime to compensate. So the thyroid becomes huge, like an oversized heart.

Think about the Swiss Alps, an inland mountain chain with lots of glaciers, no iodine in the soil. And so people living there have historically been afflicted with goiter. Norway also had a huge goiter problem. So did mountainous parts of China, Russia. And goiter was a problem in the United States, of course, because there are plenty of inland areas in America once home to glaciers.

There's a book published in the 1920s called Defects Found in Drafted Men, which is simply a compendium of the physicals conducted by the U.S. Army on draftees during the First World War. So basically, we're looking at the entire reasonably healthy male population, young male population of the United States gets examined by a doctor and their health condition is noted in this book. Correct. It must be a massive book. It's a big, thick book, yeah.

That's the economist Jim Fierer, who published a study based on that data. This is pre-computerized, shaded maps showing where some diseases were common and where some weren't. And this led to the discovery of what's known as the goiter belt, which is the place where goiter was endemic, which is the upper Midwest. The goiter belt.

Just to give you a sense of the problem, in Houghton County, which is Michigan's Upper Peninsula, 538 young men were brought before the draft board. A third of those draftees showed, quote, a demonstrable enlargement of the thyroid. In some cases, the goiters were so large, the men were turned away from the army because they couldn't button up the collars of their uniforms.

Fierer estimates the lack of iodine in places like Houghton County caused significant cognitive impairment, as much as a standard deviation in IQ, which is a lot. A standard deviation can be the difference between being able to handle college and not being able to handle college. So what's so weird about this? There is literally a part of the country where people are not as smart in aggregate as other parts.

Certainly they are not as smart as they could have been in the absence of being iodine deficient. Yes, I think that's right. So you have people in various parts of the world who don't get enough iodine. What do you do about it?

Michael Zimmerman says some of the earliest attempts to fix the problem were a disaster. The dose of iodine that they were applying in these initial studies was extremely high, you know, a thousand-fold higher than what was needed to eliminate goiter. And iodine, like any nutrient, is poisonous at high doses.

So a lot of people developed hyperthyroidism and actually cardiac arrhythmias and died from excess iodine ingestion. So it was seen kind of as a double-edged sword and people saw it as a poison as well as a potential remedy. There was an iodine backlash and a lot of confusion.

Like, was iodine a treatment for goiter, the way aspirin is a treatment for headache, something you gave once and it solved the problem? Or was it a supplement? Was iodine something that people with goiter needed on a continuous basis? And if so, how much iodine would you need to give to people? How often? Starting at what age? And how would you give it to them? Did it matter? What the world needed was a proper experiment. Careful, rigorous, controlled. And where did salvation finally come from?

Akron, Ohio. Surely, at least if you are as old as I am, you remember the classic 1983 hit from Chrissy Hynde and the Pretenders, My City Was Gone? What city is she talking about? Not Cleveland. Not swanky Columbus. Not stuffy, well-fed Cincinnati. Akron.

Because Chrissie Hynde grew up in Akron. South Howard is the historic center of old Akron. It got gutted in the 70s for an empty urban plaza. How many cities get dissed at such a high level by one of their favorite daughters? My friends, we're finally getting close to revealing my magic wand.

Very close. And let me make one more promise. My magic wand will give Akron a shot at redemption. Before we go any further, a few words about my magic wand experiment. In the last episode, I gave several scientists a chance to wave a magic wand to create any experiment they wanted, without regard for the laws of nature or ethics. And then I pounded my chest and said that my magic wand would be the best of all.

Why did I say that? Well, I'll tell you. Because all of the other magic wanders I spoke to were trying to solve big, weighty questions, existential questions, global questions. Me? I'm being super practical. Mine is news you can use. Mine is a subtle tweak on an experiment that already happened. An experiment conducted early in the 20th century by a brilliant young physician named David Moreen.

David Marine was born in Maryland and studied at Johns Hopkins School of Medicine. Then he went to do his residency at Lakeside Hospital in Cleveland in 1905. Cleveland, on the banks of Lake Erie, freshwater Lake Erie, one of the great lakes created by the Laurentide Ice Sheet 20,000 years ago. Cleveland, built on a landscape shaped by glaciers, which stripped away the iodine as they retreated. Goiter Country.

According to the legend, he was walking to his first day of work and noticed that many of the women in the neighborhood and all of the dogs had a big goiter. That's Michael Zimmerman again. He studied David Marine's career. So when he went to work and he was asked, like, what would you like to work on in terms of your research focus here? He said, well, maybe I should work on the thyroid because it seems like there's a lot of thyroid disease around.

In 1909, Maureen gets called in by a local trout hatchery that's convinced their fish are suffering from a strange outbreak of cancer. All of the farmed fish have a big bulge right near their thyroid. Maureen tells them, that's not cancer. Your problem is you're feeding your fish chopped up pigs' hearts and livers. And the pigs of Ohio, which eat the iodine-deficient feedstocks of Ohio, have no iodine in them.

Marine tells them, feed the fish chopped up sea fish. The hatcheries follow his advice, and the fish goiters go away. In Ohio, David Marine is Dr. Goiter. He spends a decade gathering evidence in the laboratory. Then, in 1917, Marine goes to the Cleveland School Board and says, I'd like to do an experiment. Let me feed some iodine to your school children to see if I can get rid of goiter.

And Cleveland says, "No." Of course they say no. I mean, can you imagine this scenario? Iodine is, at this point, still considered a poison. The Food and Drug Administration wanted manufacturers of iodine to put a skull and crossbones on the package. And Marine decides he only wants to dose girls with iodine, fifth grade and up, which surely must have seemed a little shady at the time.

Imagine that your 12-year-old daughter comes home from school one day with a note from the teacher asking for your permission to let little Janie take part in an experiment involving repeated doses of something widely considered a poison. But no worries, because it'll be done under the supervision of some guy from out east who's done a lot of work with trout. Let me just read to you from the instructions Maureen wrote out to teachers. Quote,

So, little Janie's going to come back home with a head cold and covered in pimples and a rash after being fed generous doses of a mysterious liquid. I mean, what would you say? You would say no thanks.

Cleveland says, no thanks. But Dr. Goiter has come too far to give up. So he drives 40 miles south to Akron and proposes the same idea to the Akron school board. And Akron doesn't say no. Akron says yes. And it is in Akron that we get the first definitive proof that if you give iodine to people, Goiter vanishes. How quickly did he see that improvement?

He saw it in a matter of weeks. Wow. So Akron is this weirdly open-minded place and Cleveland is this weirdly closed-minded place when it comes to one of the most significant scientific findings of the 20th century. I think what happened is he went over to Akron because the president of the Akron School District was also an alum of Johns Hopkins and said, what do you think? Should we do this together? And the guy said, yeah, I trust you.

The Akron Iodine Experiment changes the world. It's up there on the list of greatest public health breakthroughs in history. But that was more than a century ago. When I said I'd give Akron another shot at redemption, I was talking about now. This whole thing started one day when I was salting my pasta water. A light bulb went off inside my head, and I realized I too have a magic wand. First thing I did with my magic wand idea?

I called up Sema Segeyer, who runs a data analytics nonprofit called Sergo Ventures. Lots of very smart people using data to solve public health problems. What do we not know about vaccine hesitancy? I think one interesting thing that we do not know is whether an injection actually matters. So I looked at a number of studies and none of them actually explored

whether the form of the vaccine matters. What she means by form is that there are plenty of ways to deliver a vaccine. One is by needle in a doctor's office, but you can give yourself a flu shot through an inhaler. And the same thing is being developed for a COVID vaccine. If we'd had the choice from day one of the pandemic to go needle or inhaler, which would have made the most sense? We don't know.

Does the person who doesn't want to get vaccinated object to the concept of the vaccination or just the form?

Sagayar said that her firm once did research in India, looking at why people were skeptical about certain kinds of medical treatments. And so while this is in India, and I'm not suggesting that this may be true in the US, but it's some really interesting results in that in India, for example, anything in the form of a powder is least value from a medicinal perspective, whereas a pill is of higher value, an injection even higher value, and an IV even higher value. Are Westerners like Indians?

Do we have an implied hierarchy when it comes to the form a medicine takes? We don't know. So it could be that for some people, a vaccine in the form of an inhaler may not be as valuable or perhaps as robust as an injection, for example. It's perception. Like, I don't want to use it because I can't imagine that inhaling a vaccine is going to work. That's the thinking. And I can actually sort of understand that.

that intuitively there will be a lot of people, particularly enthusiasts, who will be like, no, no, no, give me the real, I want a little bit of pain, I want the real deal. Who knows where it's going if I'm just sniffing it?

I mean, I'll be very honest. That's how I feel personally, despite being a scientist and knowing that inhalers work. I would be like, I'd rather get an injection because my mental model of vaccinations are injections, right? That's how vaccines have always been given. So this is what we know. We know that 24% of Americans are fearful of needles. That's an astonishingly high number, Zemma. It is, yeah. ♪

So, are the hardcore vaccine skeptics, the people jumping up and down and saying COVID doesn't exist, really just scared of needles? Like, really scared of needles and don't want to admit it? Maybe. I mean, we see world-class athletes giving up millions of dollars in income because they refuse to get vaccinated.

How on earth would a macho, testosterone-driven manly man at the top of their sport admit that they just don't like the needle, even if they're given a lollipop afterwards? And even if the doctor distracts them with a puppet and says, look at the puppet, is this what it's really all about? We don't know. We don't know anything. And when you're faced with this many I don't knows, what do you do? An experiment. That's what.

When David Marine did his experiment on the schoolgirls of Akron, he made them drink a little iodine suspended in solution. But that obviously isn't practical if your goal is to give iodine to everyone in Akron on a continuous basis. Besides, there were lots of iodine skeptics around. Were they going to drink iodine straight up day in, day out? Probably not. He needed a better solution.

Why does everyone settle on salt as the appropriate agent for delivering iodine to the population? Yeah. Well, salt is, you know, in a way it's a very good food fortification vehicle, period. I mean, it's consumed by everybody in the population. Michael Zimmerman again. It's consumed in moderation. I mean, we eat too much salt, but no one can eat like 20 or 30 grams of salt in a day, right?

It's a good vehicle for iodine because iodine is such a trace essential element where we just need micrograms per day. You can easily add it into a few grams of salt. So it just disappears in there and it's very stable. So if added to reasonable quality salt, it's stable as well. And it's very cheap, right? So most places salt is a very cheap commodity and even the poor can afford it.

Maureen has a colleague, David Cowie, who starts writing letters to the big salt companies of the Midwest, pitching the iodine idea. I'm desirous of getting in communication with the proper person in your company with whom to take up the question of the iodization of all salt used as food in Michigan. He writes to Morton Salt in Chicago, owned by Mr. Morton. He writes to Diamond Crystal Salt in St. Clair, just up the river from Detroit.

Before carrying our work any further, we are anxious to counsel with the salt manufacturers and distributors in Michigan, acquaint them with our plan, give them all the information we have, and get their ideas on the question, particularly as to whether there would be any objection from their viewpoint. It works! And soon enough, every salt company in the country has agreed to add a dash of iodine to their salt.

And that's why there's no goiter to speak of in Cleveland or Akron or anywhere else in the goiter belt. Why the IQs of the people in the Upper Peninsula of Michigan are no longer a standard deviation lower than everyone else's. Why the salt you buy in the supermarket today has a label on the bottom. Iodized salt.

That's why I sent my producers Lee and Eloise to Michigan on a cold winter's day. To the St. Clair facility of the Diamond Crystal Salt Company. The company that said yes to David Cowie and David Marine a century ago. A big, rugged, ancient, iconic factory shimmering in white dust. Salt. Salt everywhere. A temple of salt.

So iodine looks very similar to salt. It looks almost identical to salt. Okay. I had no idea. Lee and Eloise saw the sacks of iodine waiting to be added to mountains of salt, and then they went to a small conference room to answer the crucial question. Is salt the kind of miraculous substance where you can sneak all kinds of stuff into it and no one will be the wiser? Wait, so where did the taste test take place?

You're in what? What kind of room? Just a general meeting room in the back. We had lunch all together. We had burgers and fries. And then we did the taste test after that. And wait, did the fries come salted or did you salt them? It came catered. So neither.

They didn't need salt, but there was salt on the table. Of course there was. They were in the bosom of the Diamond Crystal Salt Company, one of the nation's premier salt-making facilities. The entree is going to be perfectly salted. So, the real taste test. Diamond Crystal flew in its top salt specialists for the occasion. Lee and Eloise were presented with two paper plates of salt, one pure, one adulterated.

Eloise and Lee each take a big breath, then a quick drink of water to cleanse the palate. I'm gonna guess this one's iodine. The first one? What do you think? No, no, no. I have no idea. They taste exactly the same. Extremely salty. I still taste it. It's extremely salty, both of them. Well, this one looks like it's a different density.

And maybe they added more stuff to it. Oh, they're so tiny though. How can you even see what's bigger? I'd say this looks bigger. Oh, this is smaller. Oh, I need glasses. That's what the issue is. So which was which is which? This one was the iodized. Oh! Got it! They taste exactly the same.

Turns out you can put just about whatever you want in salt and no one's going to notice. I think you can see where I'm going with this. My magic wand. Well, Ma, you know my idea. The reason I called you is that I was curious about putting it in salt along with iodine. By it, I mean the COVID vaccine.

Now, I realize that given the present limits of science, that's an impossibility. We don't know how to make a vaccine so stable that you could stick it in a condiment. Maybe someday. Not today. But that's why this is a magic wand experiment. The things that we would love to do but can't because of the laws of nature. But I have explained the rules of the game to Semma Segeyer, and she has agreed to play. I put it in salt, and I call it something different.

I say it's the anti-COVID supplement that I'm sticking in your salt. So we've now, we're not using the word vaccine at all. Because vaccine for most people is associated with the thing that you get in a needle, right? So now we're saying, actually, no, no, no. It's just like iodine or the niacin in your weed or whatever. Is it niacin in weed? I forget. It's a nutritional supplement that we're putting in salt, which we think will help fight

My question is, does moving the COVID vaccine from the vaccine category to the nutritional supplement category help us with the skeptic? So you're not calling it a vaccine. You're still tricking them in some ways, right? Because you're not giving them the full information. Yeah, let's take it for granted here. There's going to be some trickery. But I'm calling it, I'm just saying it's a supplement and it just helps you fight COVID. Accurate, right? Yeah.

Sure, you've reframed, you've essentially reframed the product in a way that doesn't play into their beliefs that, you know, the vaccine has microchips that are following them, is doing X. Yeah, I think it could. So in other words, the threshold of resistance for something that you eat as part of your regular diet, we would, this is what we'd like to find out,

Is that lower than your threshold of resistance for something that is framed as a medical intervention? Is there a category of person who...

who is a COVID skeptic, whose skepticism would translate as indifference to some kind of intervention. So it's hard to be indifferent about a shot, particularly when you have to go to the doctor, register, wait in line, blah, blah, blah. But maybe it's so easy to be indifferent to, I'm in McDonald's and it's on my fries.

So it's like, and if I don't believe that COVID exists in the first place, what I would do is roll my eyes at the people who think that by eating fries, they're protecting themselves. But I'm not going to not eat the fries. Right, because I care about the fries. I care about the fries. That's my hope. Listeners may remember one of my favorite all-time revisionist history episodes, season two, McDonald's broke my heart. We take fries very seriously here. Fries can change the world.

No, it's true. I mean, you don't always have to change someone's belief or their mental model to get them to do a behavior. Yeah. Right? You can make it very easy. You can make the thing that you want them to do an impediment for something they really care about, as you said, like eating the fries. On the other hand, maybe this whole COVID-fighting salt idea might be a bust. Remember the whole brouhaha over fluoride?

The powers that be put fluoride in the water supply back in the 1950s as a simple way to fight tooth decay. And some people are still upset about it. To this day, Portland, Oregon refuses to fluoridate its water. Go to Portland. Ask people there how many cavities they have. They would rather sit in a dentist chair, all numbed up, and get drilled for an hour than have the government slip something harmless in their drinking water.

To paraphrase the old cliche, the people of Portland will cut off their teeth despite their mouths. There's a scenario where putting the vaccine in salt is every bit as insidious or maybe even more insidious than putting it in a vaccine, right? In the same way that fluoride was considered to be insidious by virtue of the fact that it was ubiquitous. It was unavoidable and everywhere. We're still going to get a skeptic group with the salt, right?

The question is whether the skeptic group with the salt is smaller than the skeptic group with the needle. Or now you get another skeptic on top of the existing skeptic. You know, I mean, yes, this will be like a massive government intervention, right? People who really don't want the government interfering in their lives. This is that, right? This is like the government now telling me I can't avoid because I have to have the salt with the vaccine. What if the geniuses at Moderna came up with COVID vaccine 2.0?

which was so incredibly ingenious that we could just throw it in with the iodine in our table salt. Well, we have no idea whether that would help our struggle to get everyone vaccinated. Hence, my magic wand, Akron versus Cleveland. Just like old times, Akron gets COVID salt, Cleveland gets the needle. I'll let Sama wave the magic wand. So tell me what the experiment should look like.

Okay, so I would actually have three arms of the experiment. So I'd have obviously one arm of the experiment, which is like people have to go and get their needle, the regular today. I would have one arm of the experiment where all the salt that a group of people in this place are consuming actually already has the vaccine, right? They cannot choose. And then I would have another arm where the packages that you call in the supermarket are actually labeled. You know, some of them have

The COVID, what did you call it? It's the anti-COVID supplement. Anti-COVID supplement. So some of the packages would have the anti-COVID supplement and some won't. So you give them a choice, essentially. No choice salt. Choice salt. Needle. That's our magic wand experiment. Cleveland gets it in the arm. Akron gets it in the salt. And someone else has to choose between salts. Let's make that, I don't know, Toledo. Three arms. Three arms. Three arms.

We run the experiment for six months, an experiment in how the form of a vaccine affects hesitancy. We kind of know what happens in Cleveland. Most people get their vaccine shots, but there'll still be a big group who don't. But what about Toledo, where you get to choose whether or not you want anti-COVID salt supplement? We don't know. But the bigger unknown.

is Akron. You can't live in Akron and not get vaccinated unless you systematically remove all salt from your diet. Never eat out. Consume flavorless pasta and soup. Suffer. So do people leave Akron in a panic? Or do they say, I'm an Akronite, inheritor of a grand tradition of using my salt shaker to solve the greater problems of the world. F it, I'm in.

In which case, within days, Akron is the shining city on a hill. Masks come off, the hospitals empty, strangers give each other hugs and big sloppy kisses. A convoy of angry long-haul truckers chanting, "My body, my choice," starts out in Cincinnati and heads for Akron, only to turn back in frustration when they stop for lunch in McDonald's in downtown Akron and inadvertently vaccinate themselves.

And soon people across this great country, from California to the New York Island, from the Redwood Forest to the Gulf Stream waters, would rise up and say with one voice, I'll have Akron salt with my fries. Salt that tastes like freedom. Back to Ohio, all my fears were gone. There were no mask mandates. Restaurants downtown.

SARS-CoV-2 has disappeared Even from unventilated places Salt shakers everywhere Reducing hospital cases A-O, way to go, Ohio Revisionist History is produced by Eloise Linton, Lee Magistu, and Jacob Smith with Tali Emlin and Harrison B.J. Choi.

Our editor is Julia Barton. Our executive producer is Mia LaBelle. Original scoring by Luis Guerra. Mastering by Flan Williams and engineering by Nina Lawrence. Fact-checking by Keyshell Williams. Oh, and special thanks to Dave Hill on vocals and guitar. Additional engineering by Eamon Drum and Yorosh Jovanovich at The Bridge Studios. Our voice actor was David Glover.

Thanks also to the University Hospitals of Cleveland Archive and the folks who make Diamond Crystal Salt at the Cargill Salt Plant. I'm Malcolm Blabaugh. I went to Ohio and the goiter was gone. There were no unsightly masses on people's necks downtown.

A-O way to go Ohio.

I'm Malcolm Gladwell, and I'd like to take a moment to talk about an amazing new podcast I'm hosting called Medal of Honor. It's a moving podcast series celebrating the untold stories of those who protect our country. And it's brought to you by LifeLock, the leader in identity theft protection. Your personal info is in a lot of places that can accidentally expose you to identity theft.

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I will not stop until he is destroyed. Every soul is in peril. Shall we begin? The Lord of the Rings. The Rings of Power. New season, August 29th. Only on Prime Video.