The Coming Plague

In The Coming Plague by Laurie Garrett we have a
terrific mixture of true-life medical fact
narrative such as the books by Richard Preston,
combined with in-depth analysis of the state
of public health in the world today.

Actually, since it was written in the early 90s,
the main weakness of this book is its relative
age. It forecasts a lot of dire emergencies to
occur by 2000 which did not.

(She has written a later book, which I plan to
read and review also.)

Not that things are a lot better than they were
when this book came out, but the outcomes
haven't been quite so dramatic -- yet.

For instance, we don't have mountains of dead
AIDS patients in Africa or Asia. Which is not
to be complacent, just to point out that despite
the tendency to panic while reading this book,
the human race is still muddling through.

One irritating part of this book is its occasional
criticisms of the can-do spirit of optimism that
medical authorities in the West had toward
infectious diseases in the 1950s and 1960s.

She criticizes the attitude that continued
economic development in the Third World would
bring about control of diseases there.

Seems to me that economic development is exactly
what such countries absolutely need. Without it,
how can they implement health programs. Clean
up their air, their water and their food? Put
up airtight housing with screened windows
to keep out mosquitoes carrying malaria?

She implies, without really saying so outright,
that all this ought to be paid for by wealthy
countries.

But wealthy countries have given huge amounts of
money to developing countries that has been
squandered and wasted.

Also, the infrastructure required would involve
huge amounts of wood, concrete, water -- and
labor. Most people reading this probably have no
idea how far from ideal -- even on a level of
rudimentary sanitation -- the average house in
rural Asia, Africa and South America is.

Furthermore, once the infrastructure is in place,
it must be maintained. Families must be willing
and able to repair screens -- or mosquitoes will
still fly in and spread malaria and dengue fever.

Big Daddy U.S. and E.U. can't be there every single
moment with a handout.

I applaud her telling of the stories of such
heroes as Frank Johnson of the CDC who -- among
many other accomplishments -- defeated Machupo
in Bolivia.

Although, from the Introduction, I was prepared
to criticize her for blaming AIDS on Reagan, I
have to admit that her overall account of the
beginnings of that crisis were broadly critical
of everyone, from Reagan to gays who fought to
keep bathhouses open.

Her overall analyses and pleadings to beef up
public health spending around the world are
overall reasonable.

I have one major criticism -- she seems to totally
discount the role of individual responsibility. She
obviously recognizes the health dangers of injecting
drugs, but refers to it as a health hazard of poverty --
as though drug addicts are FORCED (no doubt by Reagan,
despite his harsh antidrug policies) to be heroin
addicts.

She properly chastises New York City for letting
down its guard by reducing funding for its tuberculosis
program in the 1980s after it was apparently so
successful -- which allowed tuberculosis to come back
in a new, more drug resistant form.

But the city is not responsible for the irresponsibility
of many people with tuberculosis. She even dramatically
shows two of them at work, ignoring all advice to take
their meds as prescribed. They are responsible for
their own failures.

She outlined the problems quite well (on the whole),
then at the end quickly switches to the title, mentioning
the coming plague -- without really building an explicit
cause-effect relationship. She basically says -- we have
so many health problems around the world, we're going
to have another plague.

Maybe she's right. I'm certainly not complacent or
I wouldn't have written my book on bird flu.

But I keep thinking, what's the solution?

Monitoring?

Yes, fine. But who's going to pay for the infrastructure
throughout the developing world?

Every writer implies it should be the wealthy countries of
the world, but that leaves open all sorts of long term
problems. Every government will still demand to retain
sovereignty over the clinics in their countries -- so what
happens when disease detection conflicts with a despot or
with the need to keep tourists coming?

Poor countries have to start training doctors and nurses.

And what about alternative medicine? Garrett apparently
accepts all modern medicine such as vaccines, etc.

The fact of the matter is, we could not provide the
billions of poor in this world with the infrastructure
needed to reduce infectious diseases without greatly
overstressing the Earth's environment even more than
she laments in this book.

She makes occasional mention of how overcrowded
some megacities such as Rio, Calcutta etc are -- and
how so many people live in cramped, unsanitary
conditions. That when they lived on farms, they at
least had some food.

Again -- who forced them to move from the countryside
to those megacities? Nobody. They want the opportunity
to earn cash incomes. And if they stayed in the
countryside, they would help provide pressure to
clear out remaining rain forests.

Maybe, if certain members of the developing world were
not bent on destroying freedom around the world and
imposing their own religious beliefs on everybody,
the wealthy countries would agree to fund and
initially staff some sort of mega world health
program.

But the U.S. budget is now overstretched just dealing
with terrorists. And North Korea and Iran have made
it plain they want to use nuclear weapons. Tell THEM
that what the world really needs is to let the rain
forests alone!

So, I have no overall solutions. Just the hope that
humanity will continue to muddle through.

Though, it is possible that the viruses will eventually
win. Or maybe they will simply take back the rain
forests by killing off billions of us.

This book is highly recommended, despite my
philosophical differences with some of her
opinions, but don't start reading it
without a determination to retain your
optimism!