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Betrayal of Trust: The Collapse of Global Public Health Hardcover – August 16, 2000

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Editorial Reviews Review

What do Russia, Zaire, Los Angeles, and--most likely--your community have in common? Each is woefully unprepared to deal with a major epidemic, whether it's caused by bioterrorism or by new or reemerging diseases resistant to antibiotics. After the publication of her critically acclaimed The Coming Plague, which looked at the reemergence of infectious diseases, Laurie Garrett decided to turn her highly honed reportorial skills to what she saw as the only solution--not medical technology, but public health. However, what she found in her travels was the collapse of public-health systems around the world, no comfort to a species purportedly sitting on a powder keg of disease. In Betrayal of Trust, Garrett exposes the shocking weaknesses in our medical system and the ramifications of a world suddenly much smaller, yet still far apart when it comes to wealth and attention to health.

With globalization, humans are more vulnerable to outbreaks from any part of the world; increasingly, the health of each nation depends on the health of all. Yet public health has been pushed down the list of priorities. In India, an outbreak of bubonic plague created international hysteria, ridiculous in an age when the plague can easily be treated with antibiotics--that is, if you have a public-health system in place. India, busy putting its newfound wealth elsewhere, didn't. In Zaire, the deadly Ebola virus broke out in a filthy and completely unequipped hospital, and would have kept up its rampage if the organization Doctors Without Borders hadn't stepped in, not with high-tech equipment or drugs, but with soap, protective gear, and clean water. Most of the world still doesn't have access to these basic public-health necessities. The 15 states of the former Soviet Union have seen the most astounding collapse in public health in the industrialized world. But during a cholera epidemic, officials refused to use the simple cure public-health workers have long relied on--oral rehydration therapy. Many of the problems in these nations can also be found in one degree or another in the U.S., where medical cures using expensive technology and drugs have been emphasized to the detriment of protecting human health. The result? More than 100,000 Americans die each year from infections caught in hospitals, and America has a disease safety net full of holes.

A Pulitzer Prize-winning journalist (for Newsday and others), Garrett has deftly turned what could have been a very dry subject into dramatic reportage, beginning with the eerie silence on the streets of Surat, India, where half the city's population (including doctors) fled the plague, while a thick white layer of DDT powdered the ground. Fascinating, frightening, and well-documented, Betrayal of Trust should be read not only by medical professionals and policymakers but the general public, and should galvanize a change in thinking and priorities. --Lesley Reed

From Publishers Weekly

On a par with Rachel Carson's Silent Spring, this chilling exploration of the decline of public health should be taken seriously by leaders and policymakers around the world. Garrett, a Pulitzer Prize-winning journalist for Newsday (The Coming Plague: Newly Emerging Diseases in a World Out of Balance), has written an accessible and prodigiously researched analysis of disaster in the making in a world with no functioning public health infrastructure. In India in 1994, neglect of public health for the poor led to an outbreak of pneumonic plague; the once-dreaded disease is now easily treatable with antibiotics, but the failure of Indian authorities to quickly reach a diagnosis and provide accurate information resulted in a worldwide panic. The former Soviet Union, for all its flaws, according to Garrett, assured every citizen access to health care. After the U.S.S.R.'s breakup, the Russian economy collapsed. With no funding left for health care, Russia was overwhelmed by a tuberculosis epidemic. Even the U.S., historically a pioneer in public health (this commitment was demonstrated by New York City's quick and successful response to an 1888 cholera epidemic, as well as the tenement reform movement of the early 1900s that helped eliminate diphtheria), is lagging today. During the Reagan administration, Garrett says, budget cuts dramatically weakened public health while also denying poor Americans access to medical care. The author believes that the medical challenges posed by the epidemic spread of AIDS in Africa, by drug-resistant microbes carried from one country to another and by the danger of biological warfare can be met only by a cooperative global movement dedicated to strengthening public health infrastructures. Garrett sounds the alarm with an articulate and carefully reasoned account. Author tour; NBC Today appearance. (Aug.)
Copyright 2000 Reed Business Information, Inc.

Product Details

  • Hardcover: 624 pages
  • Publisher: Hyperion; First Edition edition (August 16, 2000)
  • Language: English
  • ISBN-10: 0786865229
  • ISBN-13: 978-0786865222
  • Product Dimensions: 6.5 x 2.2 x 9.5 inches
  • Shipping Weight: 2.7 pounds
  • Average Customer Review: 4.2 out of 5 stars  See all reviews (58 customer reviews)
  • Amazon Best Sellers Rank: #1,082,466 in Books (See Top 100 in Books)

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More About the Author

Laurie Garrett is the only writer ever to have been awarded all three of the Big "Ps" of journalism: the Peabody, the Polk, and the Pulitzer.

LATEST BOOK: I HEARD THE SIRENS SCREAM: How Americans Responded to the 9/11 and Anthrax Attacks, available exclusively as an e-book.

Her journalistic efforts at KPFA-FM radio in northern California garnered the 1977 George Foster Peabody broadcast journalism award, for a series called "Science Story." In 1996 Garrett received the Pulitzer Prize for her coverage of the 1995 Ebola virus epidemic in Kikwit, Zaire. The following year she was awarded the George C. Polk award for a series of more than 30 articles she published in Newsday, documenting the collapse of health and rise of HIV, tuberculosis, diphtheria, and dozens of other diseases in the former Soviet countries. Her second Polk Award was given in recognition of the reporting in BETRAYAL OF TRUST: The Collapse of Global Public Health.

Laurie Garrett was in graduate school studying immunology when she started reporting, as a sideline, on Berkley radio station KPFA-FM. After a year of this hobby, including the co-production of a radio series, "Science Story," Garrett and colleague Adi Gevins were awarded the George Foster Peabody Award for Broadcasting, the highest such honor for radio. Garrett continued working at KPFA, in multiple jobs including management, reporting, documentary production, and disc jockey. She received multiple awards during this period, including the so-called "Major Award" in broadcasting from the Edwin Howard Armstrong Foundation.

In 1979 Garrett spent a year covering a variety of stories overseas, including the SALT-II nuclear disarmament negotiations between the US and USSR, the World Food Summit in Rome, civil war in Rhodesia (now Zimbabwe), the anti-apartheid activities in the African frontline states, and a long list of outbreaks and disease issues across sub-Saharan Africa. During this period she resided primarily in Lusaka, Zambia, reporting for a variety of news outlets, from Pacifica Radio to the BBC.

From 1980-88 Garrett worked as a Science Correspondent for National Public Radio, based first in San Francisco and then Los Angeles. Her work at NPR, which featured detailed coverage of the unfolding HIV/AIDS epidemic in the US and Africa, was honored with a long list of awards and recognition. Garrett began covering the AIDS epidemic in June 1981, and continuously chronicled the horrible spread of the disease and its toll for more than 20 years.

In mid-1988 Garrett left NPR to join the science writing and foreign desk staffs of Newsday, then the third largest daily newspaper in America. Garrett covered a diverse range of stories all over the world, including: the spread of HIV around Lake Victoria, plague in India, Chernobyl radiation illness in Ukraine, toxic waste in El Salvador, discovery of ancient tombs in the Egyptian desserts, and SARS in Beijing.

In 1996 Garrett was awarded the Pulitzer Prize for Explanatory Journalism for her coverage of the 1995 Ebola virus epidemic in Zaire. In addition to the "three P's of Journalism" Garrett's work at Newsday was honored with four awards from the Overseas Press Club of America, and a long list of recognitions from a variety of professional journalism societies. In 2000 Garrett shared with the New York Times' Larry Altman the first Victor Cohn Award for Medical Science Reporting, from the National Association of Science Writers (NASW). Garrett served as President of NASW for two years while at Newsday.

Garrett was born in Los Angeles, a 5th generation Los Angeleno. Garrett is a proud product of public education, having attended public schools and universities in California. She graduated with honors in biology from the University of California, Santa Cruz. Garrett attended graduate school in the Department of Bacteriology and Immunology at UC Berkeley and did research at Stanford University in the laboratory of Dr. Leonard Herzenberg. Her PhD studies, mentored by Dr. Leon Wofsy, focused on measuring T cell responses to variable stimuli.

Garrett did not complete her PhD studies, as her reporting "hobby" in local radio proved far more compelling. Laurie Garrett never attended a school of journalism, though she served on the faculty of the Schools of Journalism at UC Berkeley (academic year 1997-98) and Columbia University (2001).

In academic year 1992-3 Garrett was a Fellow in the Harvard School of Public Health, where she learned a tremendous amount of health science that continues to guide her work today.

In 1995 Garrett received the University of California Alumni Achievement Award.
In 1998 Laurie Garrett was awarded a PhD by Illinois Wesleyan University, Doctor of Humane Letters, honoris causa.
In 2002 Garrett was awarded a second PhD from the University of Massachusetts, Lowell: Doctor of Humane Letters, honoris causa.
In 2007 the University of Minnesota named Laurie Garrett a member of the Delta Omega Society, an honorary public health society.
In 2009 Garrett was awarded a PhD from Georgetown University, Scientiae Doctorum, honoris causa.
In 2011 Laurie Garrett was named one of the "45 Greatest Alumni" of the University of California in Santa Cruz, on the 45th anniversary of the school's creation.

In 2004 Laurie Garrett left Newsday to join the think tank staff of the Council on Foreign Relations in New York. She now runs the Council's Global Health Program, and serves as the Senior Fellow for Global Health. Garrett has written several reports and articles including: HIV and National Security: Where are the Links?, A Council Report (Council on Foreign Relations Press, 2005), 'The Next Pandemic?' (Foreign Affairs, July/August 2005), 'The Lessons of HIV/AIDS' (Foreign Affairs, July/August 2005), 'The Challenge of Global Health' (Foreign Affairs, January/February 2007), The Future of Foreign Assistance Amid Global Economic and Financial Crisis, A Council on Foreign Relations Action Plan (2009),and CastroCare in Crisis (Foreign Affairs July/August 2010).

AND FINALLY (in the first person)

I am an avid urban cyclist, using a 25 year old Specialized Crossroads for commuting and errands, and a custom titanium Merlin road bike for the real rides. I avidly support the greening of NYC, expansion of bike paths and lowering Brooklyn's carbon footprint.

For several years I was a partner with Havens Wines, located in the Napa Valley. The wines were magnificent, and being in the wine biz -- even merely as one of 14 partners --- was loads of fun. Sadly, we sold Havens Wines a few years ago, and the buyers couldn't make a go of it: Havens no longer exists. But I retain great admiration for skilled wine makers, and love of gourmet meals lubricated with fantastic wines and shared with great friends.

For more than 20 years I have been a strong supporter of the arts in New York, especially performances at BAM. As a BAM patron, I attend as many of the Brooklyn Academy of Music concerts, plays, dances and performances as my schedule will allow.

Brooklyn rules.

Customer Reviews

Most Helpful Customer Reviews

42 of 42 people found the following review helpful By Donna VINE VOICE on December 8, 2000
Format: Hardcover
Yes, Laurie Garrett's books are lengthy, but what's does that have to do with the enormously valuable information she imparts to her readers. READ her books over time if you would rather. READ her books while you read another novel but READ them. I did enjoy The Coming Plague more but that was strictly due to my personal interest in that narrow topic. Betrayal of Trust covers Public Health and Medicine and its failings, setbacks, and the immediate future of our health. Betrayal of Trust is the result of her investigation of Public Health worldwide.
Ms. Garrett utilizes fascinating examples and historical data to demonstrate among other things that we have a limited community of researchers, doctors, and other health related professionals around the world that try to contain and remedy extremely serious threats and potential threats to our health and well-being.
Ms. Garrett sounds a major wake up call that the risk of a major epidemic or health crisis could strike at anytime and that we are absolutely not prepared to tackle the problem (for the many reasons she details throughout the book). We, Americans, go through our days feeling secure that the system is working when that is not reality. To merely say that the unavailability of financial support and treatment resources here and all over the world for containment and prevention of disease is an understatement of vast proportion. The spread of disease is a major problem that accompanies growing mobility of people and the unique illnesses they carry with them to other parts of the world.
I wholeheartedly recommend Ms. Garrett's books now and anxiously await her next publication - regardless of the topic.
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38 of 42 people found the following review helpful By John P Moore, PhD on October 15, 2000
Format: Hardcover
Laurie Garrett does not write short books. But it's worth the effort ploughing through Betrayal of Trust if you care about Public Health and what its decline could mean for our children and grandchildren if due care and attention is not given to this important part of contemporary life. The frightening problems caused by the collapse of the Public Health system in Russia are a potential lesson to us all who live in the USA; Garrett chillingly portrays the grim situation now faced by the Russian people. If such problems can happen in a relatively sophisticated country, then we need to think of the problems of less well developed countries. And again Garrett brings the message home with her writing. Nowadays, infectious diseases know no borders, and their spread can occur with frightening rapidity. Garrett documents this with her own observations of Plague in India and Ebola in Zaire. Add in a chapter on bioterrorism and it becomes clear that this is a book that can have a real impact on one's thinking. Sure, there are probably some factual errors here and there, which is probably not surprising in a book of this length. But look at the big picture - which is what this book is very much about.
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23 of 25 people found the following review helpful By Amazon Customer on October 29, 2003
Format: Paperback Verified Purchase
Here are a few cautions about the book:
The book is 550 pages with 230 pages of footnotes. I note this because sometimes, including this time, I order a book without looking at how many pages it is. This one was a surprise for me when I opened the box from Amazon.
The print is very small. I had to go out and buy magnifying glasses. It was either that or use arm extensions. I am very old though. The footnotes are even smaller, and the numbers of the footnotes are impossibly small. You don't have to read all of the footnotes. Some of them are just ibid's and idem's. But there is more interesting detail in some of them.
By quoting similar statistics about the same issue in the same paragraph, she seems to contradict herself until you figure it out and can move on, slowing down your pace. Note the "old" reference may simply be me.
Other than that I found the book very interesting. As I talked about it with others, many asked to "borrow" it after I completed it. I find this a little bothersome sometimes, don't you? You get the book back about half the time.
The chapters on Russia and America were the most interesting. The ones on Kitwik and India were the least. By far, the Russian chapter was the scariest. Had I read this book before going there last year I might not have gone. DON'T DRINK THE WATER, including ice cubes (giardia). I never drink water when I'm in another country. I find it safest to stick with beer, and bottled water to brush my teeth. Anyway, this was her best chapter by far (it's very long) giving a more human element than any other chapter and far more interesting detail about everyday life for some. It was the chapter that made me want to send money to someone, especially that woman and her ill son.
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28 of 31 people found the following review helpful By on August 18, 2000
Format: Hardcover
In this masterful work of reportage, Newsday Science correspondent Laurie Garrett accounts for the present disarray of public health and makes a convincing case for the interdependancy among the disease prevention and control infrastructures of both rich and poor nations. Using examples from the commomplace (HIV/AIDS, water borne bacterial infections) to the extreme (biological terrorism) Garrett copiously documents the centuary-long decline of public health systems, in the U.S. and among other countries (with special attention to Russia and the CIS). A worthy sequal to her previous work on emerging disease ecology ("The Comming Plague").
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