The Return of Patriarchy

Across the globe, people are choosing to have fewer children or none at all. Governments are desperate to halt the trend, but their influence seems to stop at the bedroom door. Are some societies destined to become extinct? Hardly. It's more likely that conservatives will inherit the Earth. Like it or not, a growing proportion of the next generation will be born into families who believe that father knows best.

If we could survive without a wife, citizens of Rome, all of us would do without that nuisance.” So proclaimed the Roman general, statesman, and censor Quintus Caecilius Metellus Macedonicus, in 131 B.C. Still, he went on to plead, falling birthrates required that Roman men fulfill their duty to reproduce, no matter how irritating Roman women might have become. "Since nature has so decreed that we cannot manage comfortably with them, nor live in any way without them, we must plan for our lasting preservation rather than for our temporary pleasure."

With the number of human beings having increased more than six-fold in the past 200 years, the modern mind simply assumes that men and women, no matter how estranged, will always breed enough children to grow the population -- at least until plague or starvation sets in. It is an assumption that not only conforms to our long experience of a world growing ever more crowded, but which also enjoys the endorsement of such influential thinkers as Thomas Malthus and his many modern acolytes.

Yet, for more than a generation now, well-fed, healthy, peaceful populations around the world have been producing too few children to avoid population decline. That is true even though dramatic improvements in infant and child mortality mean that far fewer children are needed today (only about 2.1 per woman in modern societies) to avoid population loss. Birthrates are falling far below replacement levels in one country after the next -- from China, Japan, Singapore, and South Korea, to Canada, the Caribbean, all of Europe, Russia, and even parts of the Middle East.

Fearful of a future in which the elderly outnumber the young, many governments are doing whatever they can to encourage people to have children. Singapore has sponsored "speed dating" events, in hopes of bringing busy professionals together to marry and procreate. France offers generous tax incentives for those willing to start a family. In Sweden, the state finances day care to ease the tension between work and family life. Yet, though such explicitly pronatal policies may encourage people to have children at a younger age, there is little evidence they cause people to have more children than they otherwise would. As governments going as far back as imperial Rome have discovered, when cultural and economic conditions discourage parenthood, not even a dictator can force people to go forth and multiply.

Throughout the broad sweep of human history, there are many examples of people, or classes of people, who chose to avoid the costs of parenthood. Indeed, falling fertility is a recurring tendency of human civilization. Why then did humans not become extinct long ago? The short answer is patriarchy.

Patriarchy does not simply mean that men rule. Indeed, it is a particular value system that not only requires men to marry but to marry a woman of proper station. It competes with many other male visions of the good life, and for that reason alone is prone to come in cycles. Yet before it degenerates, it is a cultural regime that serves to keep birthrates high among the affluent, while also maximizing parents' investments in their children. No advanced civilization has yet learned how to endure without it.

Through a process of cultural evolution, societies that adopted this particular social system -- which involves far more than simple male domination -- maximized their population and therefore their power, whereas those that didn’t were either overrun or absorbed. This cycle in human history may be obnoxious to the enlightened, but it is set to make a comeback.


The historical relation between patriarchy, population, and power has deep implications for our own time. As the United States is discovering today in Iraq, population is still power. Smart bombs, laser-guided missiles, and unmanned drones may vastly extend the violent reach of a hegemonic power. But ultimately, it is often the number of boots on the ground that changes history. Even with a fertility rate near replacement level, the United States lacks the amount of people necessary to sustain an imperial role in the world, just as Britain lost its ability to do so after its birthrates collapsed in the early 20th century. For countries such as China, Germany, Italy, Japan, and Spain, in which one-child families are now the norm, the quality of human capital may be high, but it has literally become too rare to put at risk.

Falling fertility is also responsible for many financial and economic problems that dominate today's headlines. The long-term financing of social security schemes, private pension plans, and healthcare systems has little to do with people living longer. Gains in life expectancy at older ages have actually been quite modest, and the rate of improvement in the United States has diminished for each of the last three decades. Instead, the falling ratio of workers to retirees is overwhelmingly caused by workers who were never born. As governments raise taxes on a dwindling working-age population to cover the growing burdens of supporting the elderly, young couples may conclude they are even less able to afford children than their parents were, thereby setting off a new cycle of population aging and decline.

Declining birthrates also change national temperament. In the United States, for example, the percentage of women born in the late 1930s who remained childless was near 10 percent. By comparison, nearly 20 percent of women born in the late 1950s are reaching the end of their reproductive lives without having had children. The greatly expanded childless segment of contemporary society, whose members are drawn disproportionately from the feminist and countercultural movements of the 1960s and 70s, will leave no genetic legacy. Nor will their emotional or psychological influence on the next generation compare with that of their parents.

Meanwhile, single-child families are prone to extinction. A single child replaces one of his or her parents, but not both. Nor do single-child families contribute much to future population. The 17.4 percent of baby boomer women who had only one child account for a mere 7.8 percent of children born in the next generation. By contrast, nearly a quarter of the children of baby boomers descend from the mere 11 percent of baby boomer women who had four or more children. These circumstances are leading to the emergence of a new society whose members will disproportionately be descended from parents who rejected the social tendencies that once made childlessness and small families the norm. These values include an adherence to traditional, patriarchal religion, and a strong identification with one’s own folk or nation.

This dynamic helps explain, for example, the gradual drift of American culture away from secular individualism and toward religious fundamentalism. Among states that voted for President George W. Bush in 2004, fertility rates are 12 percent higher than in states that voted for Sen. John Kerry. It may also help to explain the increasing popular resistance among rank-and-file Europeans to such crown jewels of secular liberalism as the European Union. It turns out that Europeans who are most likely to identify themselves as "world citizens" are also those least likely to have children.

Does this mean that today's enlightened but slow-breeding societies face extinction? Probably not, but only because they face a dramatic, demographically driven transformation of their cultures. As has happened many times before in history, it is a transformation that occurs as secular and libertarian elements in society fail to reproduce, and as people adhering to more traditional, patriarchal values inherit society by default.

At least as long ago as ancient Greek and Roman times, many sophisticated members of society concluded that investing in children brought no advantage. Rather, children came to be seen as a costly impediment to self-fulfillment and worldly achievement. But, though these attitudes led to the extinction of many individual families, they did not lead to the extinction of society as a whole. Instead, through a process of cultural evolution, a set of values and norms that can roughly be described as patriarchy reemerged.


In the primordial past, to be sure, most societies did not coerce reproduction, because they had to avoid breeding faster than the wild game on which they fed. Indeed, in almost all the hunter-gatherer societies that survived long enough to be studied by anthropologists, such as the Eskimos and Tasmanian Bushmen, one finds customs that in one way or another discouraged population growth. In various combinations, these have included late marriage, genital mutilation, abortion, and infanticide. Some early hunter-gatherer societies may have also limited population growth by giving women high-status positions. Allowing at least some number of females to take on roles such as priestess, sorcerer, oracle, artist, and even warrior would have provided meaningful alternatives to motherhood and thereby reduced overall fertility to within sustainable limits.

During the eons before agriculture emerged, there was little or no military reason to promote high fertility. War and conquests could bring little advantage to society. There were no granaries to raid, no livestock to steal, no use for slaves except rape. But with the coming of the Neolithic agricultural revolution, starting about 11,000 years ago, everything changed. The domestication of plants and animals led to vastly increased food supplies. Surplus food allowed cities to emerge, and freed more people to work on projects such as building pyramids and developing a written language to record history. But the most fateful change rendered by the agricultural revolution was the way it turned population into power. Because of the relative abundance of food, more and more societies discovered that the greatest demographic threat to their survival was no longer overpopulation, but underpopulation.

At that point, instead of dying of starvation, societies with high fertility grew in strength and number and began menacing those with lower fertility. In more and more places in the world, fast-breeding tribes morphed into nations and empires and swept away any remaining, slow-breeding hunters and gatherers. It mattered that your warriors were fierce and valiant in battle; it mattered more that there were lots of them.

That was the lesson King Pyrrhus learned in the third century B.C., when he marched his Greek armies into the Italian peninsula and tried to take on the Romans. Pyrrhus initially prevailed at a great battle at Asculum. But it was, as they say, "a Pyrrhic victory," and Pyrrhus could only conclude that "another such victory over the Romans and we are undone." The Romans, who by then were procreating far more rapidly than were the Greeks, kept pouring in reinforcements -- "as from a fountain continually flowing out of the city," the Greek historian Plutarch tells us. Hopelessly outnumbered, Pyrrhus went on to lose the war, and Greece, after falling into a long era of population decline, eventually became a looted colony of Rome.

Like today's modern, well-fed nations, both ancient Greece and Rome eventually found that their elites had lost interest in the often dreary chores of family life. "In our time all Greece was visited by a dearth of children and a general decay of population," lamented the Greek historian Polybius around 140 B.C., just as Greece was giving in to Roman domination. "This evil grew upon us rapidly, and without attracting attention, by our men becoming perverted to a passion for show and money and the pleasures of an idle life." But, as with civilizations around the globe, patriarchy, for as long as it could be sustained, was the key to maintaining population and, therefore, power.


Patriarchal societies come in many varieties and evolve through different stages. What they have in common are customs and attitudes that collectively serve to maximize fertility and parental investment in the next generation. Of these, among the most important is the stigmatization of "illegitimate" children. One measure of the degree to which patriarchy has diminished in advanced societies is the growing acceptance of out-of-wedlock births, which have now become the norm in Scandinavian countries, for example.

Under patriarchy, "bastards" and single mothers cannot be tolerated because they undermine male investment in the next generation. Illegitimate children do not take their fathers' name, and so their fathers, even if known, tend not to take any responsibility for them. By contrast, “legitimate” children become a source of either honor or shame to their fathers and the family line. The notion that legitimate children belong to their fathers’ family, and not to their mothers', which has no basis in biology, gives many men powerful emotional reasons to want children, and to want their children to succeed in passing on their legacy. Patriarchy also leads men to keep having children until they produce at least one son.

Another key to patriarchy's evolutionary advantage is the way it penalizes women who do not marry and have children. Just decades ago in the English-speaking world, such women were referred to, even by their own mothers, as spinsters or old maids, to be pitied for their barrenness or condemned for their selfishness. Patriarchy made the incentive of taking a husband and becoming a full-time mother very high because it offered women few desirable alternatives.

To be sure, a society organized on such principles may well degenerate over time into misogyny, and eventually sterility, as occurred in both ancient Greece and Rome. In more recent times, the patriarchal family has also proved vulnerable to the rise of capitalism, which profits from the diversion of female labor from the house to the workplace. But as long as the patriarchal system avoids succumbing to these threats, it will produce a greater quantity of children, and arguably children of higher quality, than do societies organized by other principles, which is all that evolution cares about.

This claim is contentious. Today, after all, we associate patriarchy with the hideous abuse of women and children, with poverty and failed states. Taliban rebels or Muslim fanatics in Nigeria stoning an adulteress to death come to mind. Yet these are examples of insecure societies that have degenerated into male tyrannies, and they do not represent the form of patriarchy that has achieved evolutionary advantage in human history. Under a true patriarchal system, such as in early Rome or 17th-century Protestant Europe, fathers have strong reason to take an active interest in the children their wives bear. That is because, when men come to see themselves, and are seen by others, as upholders of a patriarchal line, how those children turn out directly affects their own rank and honor.

Under patriarchy, maternal investment in children also increases. As feminist economist Nancy Folbre has observed, "Patriarchal control over women tends to increase their specialization in reproductive labor, with important consequences for both the quantity and the quality of their investments in the next generation." Those consequences arguably include: more children receiving more attention from their mothers, who, having few other ways of finding meaning in their lives, become more skilled at keeping their children safe and healthy. Without implying any endorsement for the strategy, one must observe that a society that presents women with essentially three options -- be a nun, be a prostitute, or marry a man and bear children -- has stumbled upon a highly effective way to reduce the risk of demographic decline.


Patriarchy may enjoy evolutionary advantages, but nothing has ensured the survival of any particular patriarchal society. One reason is that men can grow weary of patriarchy's demands. Roman aristocrats, for example, eventually became so reluctant to accept the burdens of heading a family that Caesar Augustus felt compelled to enact steep "bachelor taxes" and otherwise punish those who remained unwed and childless. Patriarchy may have its privileges, but they may pale in comparison to the joys of bachelorhood in a luxurious society -- nights spent enjoyably at banquets with friends discussing sports, war stories, or philosophy, or with alluring mistresses, flute girls, or clever courtesans.

Women, of course, also have reason to grow weary of patriarchy, particularly when men themselves are no longer upholding their patriarchal duties. Historian Suzanne Cross notes that during the decades of Rome's civil wars, Roman women of all classes had to learn how to do without men for prolonged periods, and accordingly developed a new sense of individuality and independence. Few women in the upper classes would agree to a marriage to an abusive husband. Adultery and divorce became rampant.

Often, all that sustains the patriarchal family is the idea that its members are upholding the honor of a long and noble line. Yet, once a society grows cosmopolitan, fast-paced, and filled with new ideas, new peoples, and new luxuries, this sense of honor and connection to one’s ancestors begins to fade, and with it, any sense of the necessity of reproduction. "When the ordinary thought of a highly cultivated people begins to regard 'having children' as a question of pro’s and con's," Oswald Spengler, the German historian and philosopher, once observed, "the great turning point has come."


Yet that turning point does not necessarily mean the death of a civilization, only its transformation. Eventually, for example, the sterile, secular, noble families of imperial Rome died off, and with them, their ancestors' idea of Rome. But what was once the Roman Empire remained populated. Only the composition of the population changed. Nearly by default, it became composed of new, highly patriarchal family units, hostile to the secular world and enjoined by faith either to go forth and multiply or join a monastery. With these changes came a feudal Europe, but not the end of Europe, nor the end of Western Civilization.

We may witness a similar transformation during this century. In Europe today, for example, how many children different people have, and under what circumstances, correlates strongly with their beliefs on a wide range of political and cultural attitudes. For instance, do you distrust the army? Then, according to polling data assembled by demographers Ronny Lesthaeghe and Johan Surkyn, you are less likely to be married and have kids -- or ever to get married and have kids -- than those who say they have no objection to the military. Or again, do you find soft drugs, homosexuality, and euthanasia acceptable? Do you seldom, if ever, attend church? For whatever reason, people answering affirmatively to such questions are far more likely to live alone, or in childless, cohabitating unions, than those who answer negatively.

The great difference in fertility rates between secular individualists and religious or cultural conservatives augurs a vast, demographically driven change in modern societies. Consider the demographics of France, for example. Among French women born in the early 1960s, less than a third have three or more children. But this distinct minority of French women (most of them presumably practicing Catholics and Muslims) produced more than 50 percent of all children born to their generation, in large measure because so many of their contemporaries had one child or none at all.

Many childless, middle-aged people may regret the life choices that are leading to the extinction of their family lines, and yet they have no sons or daughters with whom to share their newfound wisdom. The plurality of citizens who have only one child may be able to invest lavishly in that child's education, but a single child will only replace one parent, not both. Meanwhile, the descendants of parents who have three or more children will be hugely overrepresented in subsequent generations, and so will the values and ideas that led their parents to have large families.

One could argue that history, and particularly Western history, is full of revolts of children against parents. Couldn't tomorrow's Europeans, even if they are disproportionately raised in patriarchal, religiously minded households, turn out to be another generation of '68?

The key difference is that during the post-World War II era, nearly all segments of modern societies married and had children. Some had more than others, but the disparity in family size between the religious and the secular was not so large, and childlessness was rare. Today, by contrast, childlessness is common, and even couples who have children typically have just one. Tomorrow's children, therefore, unlike members of the postwar baby boom generation, will be for the most part descendants of a comparatively narrow and culturally conservative segment of society. To be sure, some members of the rising generation may reject their parents' values, as always happens. But when they look around for fellow secularists and counterculturalists with whom to make common cause, they will find that most of their would-be fellow travelers were quite literally never born.

Advanced societies are growing more patriarchal, whether they like it or not. In addition to the greater fertility of conservative segments of society, the rollback of the welfare state forced by population aging and decline will give these elements an additional survival advantage, and therefore spur even higher fertility. As governments hand back functions they once appropriated from the family, notably support in old age, people will find that they need more children to insure their golden years, and they will seek to bind their children to them through inculcating traditional religious values akin to the Bible's injunction to honor thy mother and father.

Societies that are today the most secular and the most generous with their underfunded welfare states will be the most prone to religious revivals and a rebirth of the patriarchal family. The absolute population of Europe and Japan may fall dramatically, but the remaining population will, by a process similar to survival of the fittest, be adapted to a new environment in which no one can rely on government to replace the family, and in which a patriarchal God commands family members to suppress their individualism and submit to father.


The Virus Hunters

When the deadly SARS virus struck China three years ago, Beijing responded with a massive coverup. If it weren’t for the persistence of two young reporters and one doctor who had seen enough, SARS might have killed thousands more. There's no guarantee the world will be so lucky next time.

In April 2003, as thousands of Chinese were infected and the dying were quarantined in squalid hospital wards, the Chinese government covered up the SARS outbreak, allowing the killer virus to spread around the world. That was hardly surprising. The first response to an epidemic is usually denial. From the perspective of a head of state, a mayor, a governor, or any ruling body, infectious disease remains among the hardest issues to manage. There is almost no calamity, save starvation or siege, that can so quickly reduce a city to panic and despair. Why should China’s mandarins behave any differently? When confronted with a new infectious disease caused by the SARS virus, they initially downplayed the danger and assumed a tacit policy of wishing the microbe back into whatever species from which it had jumped. What did they really have to go on at first?

A few hundred cases? In a nation of more than a billion? Indeed, with infectious disease outbreaks a far more common occurrence in China than in, say, the United States, it is on one level understandable how China's minister of health, Zhang Wenkang, could have initially downplayed the threat posed by a respiratory infection thousands of miles from the capital. If it hadn't jumped international borders, then the outbreak might have remained a minor medical curiosity.

Yet the SARS epidemic of 2003 now appears a useful blueprint of how the next pandemic might begin. As the planet struggles to deflect another imminent viral emergence, the lessons learned from SARS are more relevant than ever. Although the work of virologists, physicians, nurses, and public health officials was instrumental in beating back the virus, it is frightening to consider that if it weren't for the courage of one iconoclastic Chinese physician who came forward to tell the truth at enormous personal risk, the SARS epidemic would have been even more devastating.


Hong Kong was among the first major cities hit hard, with more than 1,000 infected and dozens dead by early April. Yet there was also growing awareness among those of us in Hong Kong that the true extent of this newly identified virus was still a mystery. I had become the editor of Time Asia, Time magazine's sister publication, a year earlier. My own office, on the 37th floor of a high-rise in Quarry Bay, Hong Kong, had a panoramic view of Victoria Harbor, Kowloon beyond that, and, in the distance, the lush mountains dividing Kowloon from the New Territories. Just past that, out of sight, was China.

If Hong Kong, Toronto, and Singapore, with modern hospitals and first-rate medical treatment, could be brought to a standstill by scores of fatalities, then how must the interior of China be coping with SARS? There, the medical infrastructure in some provinces was still at developing-world levels. How would the armies of poorly trained, so-called barefoot doctors cope with a viral killer for which there was no antidote? The poorer provinces, such as Shanxi or Hebei, could have been entering into another plague-induced Dark Age. The Chinese government was still clinging to the impossibly low numbers released in February: 305 infected and 5 dead. China's recalcitrance made it seem that the central government was surely dissembling, and what would compel it to lie but a cataclysm unfolding somewhere in the vast interior? How could the world come to grips with this disease and achieve the World Health Organization's (WHO) goal of containment if the virus were spreading unhindered in China? Could the 10-15 percent death rate for SARS now being spoken of in Hong Kong become a global epidemic of biblical proportions? In Hong Kong, we became steadily more concerned as the cases continued to mount.

The burden of uncovering the extent -- and coverup -- of the SARS crisis in Beijing would fall to two young reporters. Huang Yong was a 34-year-old correspondent for Time Asia. With his shaved head and large, round, brown eyes, he came across as so boyish that few would have guessed that he was on his second marriage and had just fathered his second child. Although he had grown up in Oakland, California, he returned to China when he was 17. In 1989, when students gathered in Tiananmen Square, he spent two weeks there, standing alongside his father, earnestly believing that a new China was being born right before his eyes. On the June day the tanks rolled into the square, he was home nursing a cold. The young boy who happened to be standing beside Huang's father was killed by a soldier's bullet. He was left feeling heartbroken, estranged from the country he loved.

Huang's fellow correspondent in Beijing, 27-year-old Susan Jakes, had curly brown hair that she often wore in a ponytail, squinting brown eyes, and an easygoing smile. Susie was a native New Yorker, grew up on Manhattan's Upper East Side, attended the Trinity School there, and learned Chinese during her time at Yale University, where she graduated with honors. It would be a phone call from Susie to a friend of hers in Hong Kong that would eventually lead to the purging of some of the highest officials in China.


He had watched this before, 71-year-old Dr. Jiang Yanyong recalled. He had seen the best and brightest brought down because of a lie, for the government's prevarications, recalcitrance, and duplicity. Jiang had been on duty the evening of June 3, 1989, when the People's Liberation Army (PLA) massacred the students in Tiananmen Square. As the director of the 301 Hospital’s department of routine surgery, he was resting in his dormitory room when he heard a series of gunshots coming from the north. A few minutes later, his beeper paged, summoning him to the emergency room. "We are a big city hospital," he remembers. "We were not used to seeing young people coming in with this level of trauma." Seven students were dragged in by their compatriots, fellow protesters carrying red banners. Who would kill children? Jiang wondered. "The army," the students shouted, their faces a curious mixture of fear and rage. "It's a bloody massacre."

"Lying before me were my own people," Jiang would later write, "killed by children of the Chinese people, with weapons given to them by the people." That night, however, Jiang didn't have time to reflect. There was another salvo of gunshots, followed, a few minutes later, by another delivery of the wounded. Jiang was a surgeon who usually performed intricate cancer and tumor procedures; he had not seen patients as severely injured as these since he had worked with a PLA engineering unit during the construction of the Chengdu-Kunming railway during the 1960s. Back in 1989, 301 Hospital had 18 operating theaters in which doctors, working in shifts, spent the entire night performing emergency trauma procedures, attempting to save, according to Jiang, "those who could be saved."

Eighty-nine students would be rushed to 301 Hospital that night. Seven would die.

Jiang was so busy trying to stop the bleeding, reinflate lungs, and transfuse blood that he could not stop to wonder why he was called upon to perform these tasks. It was the bloodiest night of his long and storied medical career, and one that would leave him wondering why and how this had happened. Tiananmen Square was no abstraction for Jiang, nor was it a political struggle or counterrevolution or culmination of an era of reform. It was blood. Up to his elbows, staining his gown, coating his galoshes. Every surface of each article of clothing was tinged with students' blood. Although it was figuratively on Deng Xiaoping’s hands, it was literally on Jiang's.

Today, Jiang holds a military rank equivalent to general because of his title as chief of surgery at the hospital. For a moment, when you first see him, you think he must be in his 50s -- his hair is an unnatural crow black -- but there is an aged droop to his eyes, as if the ocular muscles themselves have worn out from squinting into so many surgical incisions.

Throughout March 2003, Jiang had been spending more time indoors, like many people around the world, watching television for news of the war in Iraq. The SARS virus was only a crawl on China Central Television (CCTV), a glowing proclamation that "SARS is under control and there has never been a better time to visit Guangdong Province." The SARS outbreak had so far been reported as primarily a Hong Kong problem; the disease, if it were in China at all, had probably been brought in by foreigners, the official Chinese media were reporting.

Among international public health officials, of course, there was increasing consensus that the outbreak in China was far worse than the Chinese government was admitting. The State Council Information Office was reporting 12 SARS cases and 3 fatalities in Beijing. It seemed impossible: There were thousands of cases in Guangdong and Hong Kong, and hundreds in provinces throughout China. How could Beijing have just 12 cases? Jiang found that discrepancy curious but gave it little thought.

But near the end of that month, a good friend of Jiang’s fell ill with lung cancer and, naturally, Jiang was brought in to consult on the case. The patient, a medical professor, was brought to 301 Hospital. Surprisingly, he developed a high fever and a spot was found on his lung. After another specialist was brought in, Jiang's friend was diagnosed with SARS and transferred to the intensive care unit before he was removed and sent to 309 Hospital, deemed the official SARS Control and Prevention Center for the People's Liberation Army. Jiang, checking on the treatment his friend might receive, phoned respiratory specialists at 309 who were former students of his from Beijing University Medical College. "They sounded very upset," Jiang recalls. "I didn’t understand why. There were just a few cases and that was such a big hospital."

There were 60 cases, Jiang was told, dozens of them medical staff themselves. Seven patients had already died of the disease. He called other colleagues and found that there were similar outbreaks occurring at 302 Hospital, which had 40 cases, and even at his own 301 Hospital, which had 46 SARS cases. "This is a terrible disease," one of his colleagues told him. "It acts so quickly. I've never seen any disease progress this fast. You go from breathing normally to intubation in three days. You die in a week."

Why, then, did the health minister, Zhang Wenkang, appear on television on April 3 to reassure the public that there were only 12 cases in all of Beijing, when there were 60 in just one hospital? The health minister even chastised a foreign reporter for wearing a gauze surgical mask, telling him, "You are safe here whether you wear the mask or not." Jiang, watching the press conference on TV, could not believe what he was hearing. The health minister was either lying or misinformed. Either scenario was unacceptable, considering the nature of a highly contagious, infectious disease.

Later, while taking a late-afternoon walk in the courtyard behind his apartment complex, he came upon two fellow retired senior PLA officers. They discussed the fact that there were far more cases than Health Minister Zhang was admitting.

"There must be something wrong with the health information system," one of the officers said.

"You need to talk to the health minister," said the other officer. "He's a doctor. He should know better."

Jiang agreed. If this disease were as deadly as reports indicated, then the health minister should be making every preparation to ensure the safety of Beijing rather than appearing on television assuring the citizenry there was no risk. He now speculated that if he just told the health minister about these hundreds of cases in Beijing, about this outbreak, then appropriate action would be taken. Perhaps if he came forward and told the truth, the Communist Party would see the light.

His wife told him, "Don't do it, you will get yourself in trouble, why are you sticking your neck out?"

And then he cried, tears welling in his eyes, "This is bigger than me, or you, or China. This could be a disaster for all of mankind."


Huang Yong had been sent by Time Asia's Beijing bureau chief, Matthew Forney, to drop into a few local hospitals and discreetly see if any of the doctors, nurses, or support staff would talk about atypical pneumonia cases. He walked straight into one hospital -- our staff would come to call this legally and medically risky practice "bombing" hospitals -- and strolled up and down the hallways. The physicians and nurses, he immediately noticed, were all wearing masks. On later bombing runs, he would carry a bouquet of flowers as a prop. For this trip, he simply began strolling around and asking different doctors if they had any of these dreaded pneumonia cases in the wards. He was told, sure, they had a few. And they had referred a few cases to 309 Hospital as well.

"How many patients do you have?" Huang asked.

"About 15," a doctor told him.

That was strange. Fifteen cases. In this one hospital? In all of Beijing, according to the Ministry of Health, there were only a dozen cases.

If a reporter working for a foreign magazine could stumble upon evidence contradictory to what a government minister was probably saying at this exact moment at a press conference somewhere in Beijing, then the lie had to be big. Which meant the truth had to be so terrifying, it necessitated a lie that had no chance of actually succeeding. Huang walked back to his little hatchback and pulled out onto the 4th Ring Road, sipping his beer. He followed this train of thought to its logical conclusion: The disease was already here, and not only was it here, it was doing so much damage that the leadership was panicking. He pulled into the parking lot at Ditan Hospital. He slipped on his gauze mask, walked up to the registration desk, and asked, "Do you have a respiratory department here?"

"What's your problem?" asked the nurse standing behind the counter.

"Lung disease," he answered.

She jumped back a full meter and covered her mouth and nose with her hand. "Go to the emergency ward."

Huang laughed and went to the elevator bank. At the emergency ward, he strolled toward the nurses’ station in the middle of an open suite of intensive care units. There were dozens of patients in critical condition. The nurses wore masks and appeared to be busy behind the counter.

"I think my mother is here," Huang said.

"Who is she?" asked a nurse seated behind a desk.

"We call her Granny Hu," he said. "She has atypical pneumonia."

"She's one of a dozen," the nurse said.

By the time Huang returned to the bureau, he had visited one more hospital, where he heard of about 10 more cases. That made at least 37 cases, though the official tally was still only a dozen.

Huang called me, and we talked about what he had seen. I was eager to get the story onto our Web site, and I pointed out that if, in the first three hospitals Huang walked into, we had found dozens of infected patients, then who knew how many more there were throughout Beijing?

Matt, our Beijing bureau chief, agreed, but then raised a valid point: Huang was not a doctor, and our criteria of what constitutes a SARS case could be different than the government's.

It was a legitimate issue. If we ran a story about Beijing’s hiding cases, and it turned out these were not SARS cases but some other pneumonia -- or, more likely, the government came out and said we were wrong -- how could we disprove them? We didn't have the virus growing in cell lines. We didn't have a doctor backing up our story.

"We need a whistle-blower," Matt said.


What he was hearing sounded so farfetched that Jiang turned up the volume on his television. Minister of Health Zhang Wenkang, seated behind the microphone tree, was proclaiming that the Chinese government was already dealing diligently with the problem of SARS and that the spread of the disease was under control. Zhang was a graduate of the Second Military Medical University, perhaps the most sophisticated medical school in the country. And he was now rejecting the most basic personal principles of the medical profession.

Jiang later told me he thought a long time about what he should do. When he had once come forward during the Cultural Revolution to denounce a corrupt hospital administration, he had been detained and beaten. After Tiananmen, he kept quiet. But now, he felt he was in a different position. He had more stature than he had during the Cultural Revolution or Tiananmen; he was now a party member. And he was virtually retired, a respected elder who had treated many of the top brass and had saved several important generals' lives. Many of the senior military command requested him when they needed surgery. Perhaps his rank and connections offered him some protection. This was an opportunity to make up for the guilt he felt about never coming forward and stating what he saw the night of the massacre at Tiananmen. By keeping silent now, was he again participating in a great and terrible lie? Only this time, the consequences were incalculable.

Jiang decided to pen a note, explaining who he was and the facts about the number of SARS cases in the No. 301, No. 302, and No. 309 hospitals. "As a doctor who cares about people's lives and health, I have a responsibility to aid international and local efforts to prevent the spread of SARS." He faxed it to the government-controlled CCTV-4 and Hong Kong’s Phoenix-TV, two of China's biggest networks, using the fax number for viewer comments and suggestions. He assumed they would quickly get in touch with him to check his credentials before airing it. They never called.


Our Beijing correspondent, Susan Jakes, was asked to prepare a file about the general state of the Chinese healthcare system. She had no contacts in the Ministry of Health. Trying to think of a way into the subject, she decided to call a political source. Susie's connections in the dissident community had been useful in the past, but it was unlikely those connections would extend into the Chinese medical community. Still, desperate, Susie called one of her political contacts, Harold, who had ties to party officials.

She asked him if he knew anything about SARS in Beijing.

There was silence on the line. "Call me back from a safe phone."

Often, in China, we suspected our land lines and even our cell phones were bugged. When we needed to talk specifics about sensitive subjects, Matt or Susie would switch the SIM cards in their phones from a local Beijing number to an international exchange that was billed through a foreign phone company we believed was far less likely to be tapped. Or, even safer, the reporter would find a pay phone -- which are still common in China -- and call from there.

Susie threw on her denim jacket, walked out of the bureau, and hurried to a nearby pay phone.

"I'm going to send you an e-mail," Harold said when she called him back. "In that e-mail, there will be a URL to a secure Web site. At that Web site, you'll need a password. Type in your old Hong Kong phone number and you will be able to download a Word file. Read that and call me back."

Susie ran back to the office to check her e-mail. Harold's message had already arrived. Following his instructions, she downloaded the Word document. At the top, it read Jiang Yanyong, Doctor, and said that he was a longtime Chinese Communist Party member. It also gave his phone number. She read the note. The letter indicated that the number of patients infected with SARS was significantly higher than the official statistics from China's Ministry of Health. It went on to describe at least 60 patients at one Beijing hospital. Most amazing, this letter was signed by this doctor.

She went back to the pay phone and called Harold.

"Who is this guy?"

"He is who he says he is. A doctor. A party member."

Susie was nervous this letter would be difficult to verify. "Can I call this guy? Will he talk to me?"

"Call him," Harold assured her. "He's at home."

Susie knew what she now had. A big story about a big lie.

Still using the pay phone, Susie called the number on the letter. Dr. Jiang Yanyong answered.

When she identified herself, Jiang told her, "Everything I want to say is in the letter."

"But I need to ask you some more questions," Susie pleaded, "to flesh this out a little bit."

He paused for a moment, and then, speaking in a lower voice, said, "Okay, let's meet at the teahouse at 4 o'clock in the Ruicheng Hotel, in the western part of Beijing, near the 301 Military Hospital."

But, when Susie returned to the bureau, she received another call, this one from a labor lawyer she had called the day before asking if he knew anyone who knew anything about SARS.

"Why don't you come to my office right now," he suggested. "I think I might have something you want to hear."

When Susie returned from the bureau, she took a taxi to his offices, on the fourth floor of a modern office building, and when she walked in, after he closed the door, he told her that he had a cousin who is a doctor at the Military Academy of Sciences.

"Will she talk to me?" Susie asked.

"No," the lawyer explained, "But I can call her and you can listen while we speak."

Susie would later realize that this had been prearranged by the lawyer and his cousin to screen them from any possible accusations of talking to a foreign reporter and violating a gag order that was handed down on March 7 forbidding doctors and public health officials from talking to the media about SARS. As for the veracity of the source, we had worked with this lawyer before on several stories, and found him to be reliable.

The lawyer dialed his cousin's cell phone.

"Tell me again what you told me before," he said, handing the phone to Susie.

Susie listened as the doctor spoke of a situation even more terrifying than that described in Jiang's letter. She described the first case to come to Beijing -- a woman who had driven from Shanxi and seeded the Beijing outbreak. To Susie's surprise, that had been in early March, during the National People's Congress. The hospital director at the Military Academy of Sciences had told his staff that there was SARS in Beijing, but that no one was to mention a word of it outside the hospital, so as not to interfere with the National People's Congress and leadership transition.

Since then, the woman continued, there were numerous cases at several hospitals. No. 1 and No. 2 hospitals each had dozens of cases. "They are practically filled," the woman said. And 309 Hospital, specifically mentioned in Jiang's letter, had 40 new cases in just the last week. 301 and 302 hospitals were also being overwhelmed.

The official numbers were lies.

Susie arrived at the Ruicheng Hotel in Western Beijing at 2:45 that afternoon. With each Chinese businessman entering, Susie would glance up, wondering if he were Jiang. When he finally walked in, he paused for a moment and then, seeing Susie, the only foreigner, he gestured for her with a quick wave to follow him. She took off after him as he headed for a corner of the lobby. He led her through a service entrance, up an elevator, and down a hall, where he asked a hotel employee for directions. Susie realized he didn't know where he was going as he walked into a cafeteria, which, it being the mid-afternoon, was closed. Finally, he found the teahouse and took a seat in a booth partitioned from the restaurant by wooden screens. Around them, they heard the clatter of mah-jongg tiles, which, besides clandestine business meetings, was the primary purpose for these little teahouse rooms. Susie's first impression was that he was nervous. But once they ordered and began to chat, he calmed down. He talked about his work as a surgeon, spoke in very clear Chinese, and gave the names of medical procedures in very good English. He was, Susie quickly deduced, exactly who he said he was in the letter.

Finally, Susie asked, "Why did you write this?"

He paused. "As a doctor, I cannot stand by while there is a terrible disease threatening the people and they are not hearing the truth about it."

Jiang didn't resemble the dissidents Susie had known. Those fellows had an agitated quality that came across almost as a twisted sense of entitlement. They had been through so much that they no longer felt it necessary to consider the feelings of those who hadn’t suffered as they had. Jiang was different. He was an elder, and like a teacher, was coming forward because he was disappointed at how his students were behaving. He emphasized that he was a party member, that he felt, as a member of the leadership, he had an obligation to state the truth. As they pored through his letter sentence by sentence, Susie felt increasingly comfortable that the material was journalistically sound. Her listening in on the phone call from the female doctor had essentially confirmed everything Jiang had written.

"Are you sure you want to sign your name to this?" Susie asked him.


"Aren't you afraid this will get you into trouble?"

"Everything I have said is true," he said, nodding.

"That doesn't mean you won't get in trouble."

"I have constitutional protection."

Susie shook her head. She can take on an almost haughty demeanor when she feels someone is making a mistake. So far, she had remained deferential; Jiang was, after all, an elder accustomed to being treated respectfully. Now, however, Susie felt she needed to be understood clearly. Susie had worked with numerous Chinese who should have been protected by the constitution yet were sentenced to reeducation, put through the psychiatric hospital system that is often used in lieu of prison, or forced to flee. The truth provided no sanctuary.

"The constitution doesn’t protect everybody," Susie said. "It will not protect you."

He smiled. "I am 71 years old, and I have lived in this country a long time." He knew exactly what was at stake.

She sent the story to me at 9 p.m. We had it up on our Web site an hour later. Almost immediately, the story was picked up by media all over the world.


Huang Yong chugged down a bottle of Beijing Spring beer and lit a cigarette. He had decided to finish his brew before bombing another croak house. Huang had shrugged when asked whether he thought these bombing runs were dangerous. He would pull on his black leather car coat and say, "Oh, I think I'll be fine." And fortified by a few beers, he didn’t hesitate to venture into what would turn out to be some of the most dangerous hospital wards in Beijing.

Still, nothing could have prepared him for what he found. In an aged and run-down hospital ward were dozens of patients, "every single one of us in this building," a nurse infected with SARS named Zhang would tell him, "is a SARS patient." The patients were sprawled on dirty sheets, catatonic, fighting for their lives. "There are at least 100 SARS patients here, if not several hundred," said the nurse. "We're not allowed out of this room. We piss in this room, crap in this room, and eat in this room. At least half the patients here are doctors and nurses from other hospitals." This was the charnel house that we had all feared was out there. Huang steeled himself and continued walking through the wards. He regretted not wearing a surgical mask, yet felt obligated to continue his journalistic rounds. Another nurse in a surgical mask and gown stopped him.

"Look, I'm not pushing you away. I do this for your own good," she explained. "No place is safe in this hospital. All of these wards are full of SARS patients, there are over 100 at least. Don’t believe the government -- they never tell the truth. They say it's a deadly disease with 4 percent mortality? Are you kidding me? The death rate is at least 25 percent."

Huang would crack open another brew back in his car and chug down almost half of it before driving back to the bureau. When he arrived, he walked into Susie’s office to report what he had seen. He had a smile on his face.

It was all true, every one of those awful rumors. Huang had not only confirmed them; he had seen it for himself.

And, he would tell me later, he had never felt so alive.


Huang had already tapped out his most obvious contacts. He began calling friends and asking if they knew anyone who worked in Beijing's hospitals or public health sectors, not really expecting to come up with a source. Yet a friend of his suggested a doctor from the China-Japan Friendship Hospital whom he vaguely knew and gave Huang his mobile phone number.

Huang called and quickly explained who he was and that they shared a mutual friend, and what we had learned about the coverup.

The doctor was silent.

Fearing he would hang up, Huang added that what they knew was going to be published anyway, and this was merely an attempt to make sure they had the facts correct.

Huang listened as the doctor took a deep breath and sighed, "It's true."

The doctor then recounted to Huang the story of the WHO’s April visit to the China-Japan Friendship Hospital. The hospital had 56 SARS patients, 31 of whom were doctors, nurses, and other medical workers. A few minutes before the WHO team arrived, a fleet of ambulances pulled into the horseshoe driveway in front of the hospital. The hospital director ordered the stricken healthcare workers loaded onto gurneys, and staff scrambled to move these patients into the waiting ambulances. As the team of WHO experts inspected the hospital, the fleet of white vans took a leisurely tour around Beijing, keeping its deadly cargo of 31 coughing health workers a secret from the world.

The doctor was now confirming with Huang that this was more than a "hole"; it was a pattern of deception the scope and scale of which were hard to imagine.

Huang asked him, "How could you do this?"

The doctor said softly, "We are ashamed."


On April 20, Hong Kong felt a little like those scenes of post-virus London in 28 Days Later -- I was the only shopper on the entire fourth floor of the Landmark Building, one of Hong Kong's most popular malls. There had been nearly 100 deaths in Hong Kong due to SARS, but the city was so abandoned you would have guessed the body count was a thousand times more.

As I was leaving, my cell phone rang. It was Susie calling from Beijing. China's Minister of Health Zhang Wenkang and Beijing Mayor Meng Xuenong had just been ousted. It was the highest-level Chinese government purge since the uprising at Tiananmen Square in 1989.

"It's unbelievable," Susie said. She described the press conference that morning at which Gao Qiang, the deputy minister of health, had revised the number of SARS cases in Beijing upward by a factor of 9, from 37 to 339. There were 402 additional suspected cases in the capital, he said. In Shanxi, there were 108 cases; in Guanxi, 12; Hunan, 6; and on and on through each province for which the government had even the sketchiest of statistics. Nearly 2,200 SARS cases in China, up from 350 just the day before.

The first phase of response to the outbreak, government denial, had officially ended.

I had to stop. Right there on Queen's Road. The Chinese government had just admitted it was wrong, catastrophically so, to the point where it had just held a public, nationally televised mea culpa. And then it canceled May Day. And it was due, in part, to the work of Susie and Huang, and the courage of one very brave doctor. Standing there next to the Dunhill boutique in my light-blue surgical mask with a Nokia pressed to my ear, I was proud of our reporters and, most of all, of Dr. Jiang Yanyong.

Jiang had become an international hero because of the courage he showed in exposing the SARS coverup, so renowned that the Chinese government didn't dare detain him. Yet.

His next act of insubordination, however -- a February 2004 open letter to the National People's Congress that questioned the party line that the Tiananmen massacre had been a counterrevolutionary rebellion -- prompted his and his wife's arrest and reeducation later that year. He has not issued a public comment since.

Who will be so brave next time?