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Title: Betrayal of Trust : The Collapse of Global Public Health by Laurie Garrett ISBN: 0-7868-8440-1 Publisher: Hyperion Pub. Date: 15 August, 2001 Format: Paperback Volumes: 1 List Price(USD): $17.95 |
Average Customer Rating: 3.88 (40 reviews)
Rating: 3
Summary: Good ideas, flawed execution
Comment: The message of this book is clear, vitally important, and well driven home: public health is in bad trouble worldwide, due to failure of public and governmental will. One might call that "civic culture," or just plain old-fashioned morality. In any case, the world's governments are not spending nearly enough on public health. Garrett deals first with what may be the world's worst cases--Zaire/Congo and the former Soviet Union--and then shows that the same problems, in much less virulent form so far, exist in the United States. All this is true. However, I must agree with several other reviewers that the book is full of errors. The scientific name of the common rat, _Rattus rattus_, is misspelled "_Ratus ratus_" throughout. In the Zaire chapter, footnote 113 was obviously intended to correct and replace the inaccurate #114, but both were left in. And so on. More serious is the extremely cursory and misleading treatment of food, nutrition, and the results of failure in that area. Garrett loves the romance of new diseases, and tends to ignore problems that are not new or infectious. She treats nutrition as if nothing of much value were known and as if there were few (if any) problems beyond just getting enough food. Diabetes is mentioned a few times, but is not in the index. Yet diabetes is a vastly more important public health problem than Ebola virus, and may soon rival TB and AIDS worldwide, as genetically susceptible individuals consume more and more sugar, alcohol, and the like. (By contrast, her section on drugs and the failed "War on Drugs" is outstanding.) But most serious of all is the lack of a coherent plan for solving the world's problems. Garrett's major recommendation is more spending; necessary, surely, but not a plan in itself. What should we do first? What next? How can we be maximally cost-effective? How do we balance needs when funding is short--for instance, how should a Third World country balance providing clean water against building new hospitals? Above all, how do we get back the unique morality that brought us public health (as well as public education, conservation, and other public goods) in the early 20th century? The idea of aggressively acting for the comprehensive benefit of the entire citizenry is really quite rare in history. As Garrett points out, it is in desperate shape in the US today. Garrett could have made a much stronger case if she had focused on clear proposals.
Rating: 4
Summary: at times brilliant, prescient, inaccurate and frustrating
Comment: This is an excellent and yet deeply flawed book. It will (and should) frighten us all into action, and given recent events of Sept 11 and its aftermath - the imminent threat of terrorism that may be biological in nature - this book is extremely well timed.
The thesis of the book is that, for a variety of reasons (lack of political will in the US, economic deterioration in the former USSR, and poverty in Africa) public health infrastructures worldwide are in serious decline at the moment that horrible new diseases (Aids, ebola) and new strains of old ones (TB, whooping cough, diphtheria etc) are emerging. If these public health infrastructures are not repaired, she asserts, we are in for horrendous trouble. She may well be right and for this reason, we would do well to heed her plea for renewed investment throughout the world in preventive medicine, epidemiology, and other measures to promote collective, as opposed to the privatized (or "medicalised") health model.
It is easy to dismiss this argument as crypto-socialist,but to do so is a disservice both to the talents of Ms. Garrett and to the idea of public health itself. To prove her case, Garrett embarks on an historical tour of the public health systems of both the US and the USSR, both of which were pioneers. The US, in New York but also in Minnesota, developed science-based systems to recognize dangerous contagious agents and to stamp them out via quarantine and later vaccinations and for bacteria, antibiotic treatments. The statistics speak for themselves and are well documented in Garrett's book. Not surprisingly, the USSR developed a more coercive and less scientific system, which was in decline before the fall of communism in 1990; since then, it has declined so alarmingly that death rates in the former Soviet republics are twice as high as births!
What is needed, she says, is larger investments to maintain the fragile infrastructures of scientists, other health care professionals, and access facilities.
The wider landscape she describes - the context of this deterioration - is bleaker and more terrifying than I had imagined possible. It involves antibiotic-resistent strains of tuberculosis and other ancient scourges, an unprecedented Aids epidemic in Africa and Asia, and in the wake of the defunct Soviet biological warfare programs with 30,000 scientists who disappeared - some apparently into the Middle East - the specter of bioterrorism. (Indeed, some of the Sept 11 pilot-terrorists were getting trained with crop dusters, which could deliver small pox or anthrax to threaten millions.) We may be approaching the end of an era in which we believed science was triumphing over human disease. I now fear for my children. Developments in India (plague) and the Congo Republic (Ebola) are also covered in grim detail.
It is here that Garret's argument begins to run into trouble. What has emerged in the US, she says, is a hybrid of conservative ideology (blaming the victim with claims that health is the individual's responsibility) and a "medicalised" model whereby we seek high tech, individualized cures to ailments rather than the less expensive preventive cures that the collective public health model offers. I believe that this is a straw-man dichotomy that oversimplifies the problem, in effect setting up conservative budget cutters to blame for a failure of collective will. While this is certainly true to a degree, the political and economic dimensions of the problem are so complex that Garrett fails to do them justice. Moreover, the medical approach is complementary to the public health one. If the reader want a more realistic appraisal of these issues, (s)he must look elsewhere.
Furthermore, there are numerous inaccuracies and errors throughout the book, which damage its credibility. For example, at one point Garrett states that Crick worked at "Oxford University in Cambridge, England"! While this is trivial and an editor should have picked it up, it is symptomatic of the rushed feel to the book, which was obviously written too quickly and perhaps sloppily. Moreover, Garrett glosses over a number of issues that deserved far deeper scrutiny: she dismisses the demise of the Clinton health plan in one page (it was simply "overly complicated"), and rejects claims by the pharmaceutical industry that the cost of drug development is $500 million (because governments fund basic science). The list of these errors and omissions is indeed long.
SO in the end the book is a mixed bag. For me, it will serve as a treasure trove of information for my latest writing project, but I worry about the accuracy of many of her claims. It is a very good call to arms for a serious issue and a warning to us all.
REcommended with reservation.
Rating: 3
Summary: Good material, poor presentation
Comment: I found the book to be interesting, however I was constantly annoyed by the way the book jumped around from topic to topic. Neither the book as a whole nor the individual chapters rose to a climax, but was rather a jumble of information. Some of it was repetative, sometimes even verbatim. I was very dissapointed in the endnotes. Sometimes they listed sources, and other times they gave additional information. However, many times, I flipped back to the endnotes looking for a source and found just an anecdote instead. The general "The information for this section is from..." line does not satisfy me at all for citing sources. I think someone else could have taken the same information and written a much better book.
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Title: The Coming Plague: Newly Emerging Diseases in a World Out of Balance by Laurie Garrett ISBN: 0140250913 Publisher: Penguin USA (Paper) Pub. Date: October, 1995 List Price(USD): $15.95 |
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Title: Global AIDS: Myths and Facts, Tools for Fighting the AIDS Pandemic by Alexander Irwin, Joyce Millen ISBN: 0896086739 Publisher: South End Press Pub. Date: 01 November, 2002 List Price(USD): $19.00 |
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Title: Infections and Inequalities: The Modern Plagues, Updated Edition With a New Preface by Paul Farmer ISBN: 0520229134 Publisher: University of California Press Pub. Date: 05 February, 2001 List Price(USD): $19.95 |
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Title: Pathologies of Power: Health, Human Rights, and the New War on the Poor by Paul Farmer ISBN: 0520235509 Publisher: University of California Press Pub. Date: 01 April, 2003 List Price(USD): $27.50 |
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Title: AIDS: Science and Society, Fourth Edition by Ross F. Conner, Luis P. Villarreal, Hung Y. Fan ISBN: 076370086X Publisher: Jones & Bartlett Pub Pub. Date: February, 2004 List Price(USD): $39.95 |
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