Customer Reviews

The Fever: How Malaria Has Ruled Humankind for 500,000 Years

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I was excited when I saw the title of this book (one of my biggest problems with Guns, Germs, and Steel was how little focus Jared Diamond gave to the effects of malaria on societal development), but the more I read this book the more frustrated I become. Almost every page has at least one minor error, and many pages contain blatant errors regarding the fundamental biology that any competent editor should have discovered. My favorite howler: "Then again, 10 percent of the parasite's five thousand proteins retain their algaelike chemistry and remnant chloroplasts." A chloroplast is an organelle (large, complicated structure) in plant cells; to say that a protein contains "remnant chloroplasts" is utterly nonsensical.

The greatest misunderstanding comes from her "story of the evolution of malaria" in which P. falciparum (the most deadly of the 4 major plasmodium species) is presented as the latest evolutionary trick in a long line of a heavily-personified malaria species. If we take Ms. Shah's account, P. vivax emerged first, was defeated by the Duffy antigen in the African population and thereby forced into Europe to find new populations to destroy (such hyperbole is distressingly common in this book). Humans "invading the rain forest" (habitat destruction often results in contact with novel infectious diseases, but in this book serves as a trope in which habitat destruction inevitably leads to outbreaks of falciparum malaria and is a not so subtle way of pushing a particular viewpoint on her readership). In fact, P. falciparum has plagued humans since we split from the chimpanzee lineage, so it hardly qualifies as "new" - Ms. Shah implies that it has only been around for the last 4,000 years. The entire evolutionary history is an oversimplified war story with so much anthropomorphization that it is almost unreadable. Her use of the word "species" is similarly confused - it is sometimes used correctly but at other times seems merely to refer to strains, and there is no distinction in the text.

We are informed that the basic vocabulary of malaria research (gametocyte, schizont) is not merely "terms... whispered over cluttered lab benches by a few old-school malaria nerds..." but spoken by "...nearly everyone in the malaria world, from ponytailed Harvard undergrads to queenly Cameroonian researchers..." (not really sure where the adjectives came from...). Not to worry - after dabbling with these terms for little more than five pages, this brief foray with science gives way to wild historical speculation (the review below mine deals with these issues more comprehensively so I won't discuss them here).

I was profoundly disappointed by this book - I was hoping for something like "The Great Influenza" by John Barry but ended up with a randomly referenced (bold assertions are followed by a footnote, if you track these down they often have a tenuous relationship to the subject under discussion - we are even informed that finding references was complicated because the books she wanted weren't on interlibrary loan!), hyperbolic, and confused set of ramblings on a fascinating subject. For all her screeds about "exploitation" by "the West", it seems that Ms. Shah saw an opportunity to make a quick profit off of one of the world's deadliest diseases as it re-enters media prominence. The only problem was that she didn't bother to learn the basic facts of her subject first.

"Vivid" and "compelling" gushes E. Kolbert on the back jacket; "Fascinating... elegant... superbly well researched...poignant and important" intones N. Munk; "extremely well researched... gripping. Highly recommended" concludes malariologist B. Knols. With such lavish praise, this is a book to read: malaria after all IS a thoroughly fascinating subject.

Well, to me all adjectives sound in a way true, but as ironic commentary to a poorly written book. It's a shame, for Ms Shah's personality, as it shimmers through the text, is engaging. She is enthusiastic about her subject, and had certainly gone to great lengths to read up the material - alas, she appears overwhelmed by the task of synthesis, and she has been given thoroughly bad advice about how to approach her readership.

Not trusting readers with complex matters Ms Shah foregoes a proper description of the parasites and their life cycle. Visual aids are eschewed. The spread of P. vivax and P. falciparum across the world has had a major impact on history - yet no map facilitates our understanding on the main thrusts. Readers are easily bored, she surmises, so words are qualified for effect: huts are dank, highlands are rugged, dreams are sad, ships are fine, particularly when it is a "flotilla of ships" (pg. 51) and natives... must be "local natives" (pg. 50). Anthropomorphic images are plentiful: "... malarial parasites munching on the hemoglobin" (pg. 44); parasites "rely on strategies..." (pg. 28); "malaria parasites teem with purpose inside the veins of the house sparrows" (pg. 19). Hyperbole is a stock of trade: "Once, the powerful men in the House of Parliament quaked in their boots at the thought of the mosquito's wrath" (pg. 172). And of course: "...desirable natural resources rest under prime malaria stomping grounds" (pg. 79). Alliterations abound: my favourite is "malarious masses". When all else fails, familiarity will do: " ...the parasite shtick fails..." (pg. 15), and the Atlantic Ocean is fondly called "the pond" (pg. 177). Ms Shah seems to fear the reader's short attention span, so she shorts the presentation for the telling anecdote, and gives inordinate amount of space e.g. to her visit to Blantyre and the fate of baby Duke.

One would like to sit down with her and go through the text, pointing out some howlers: "As human populations and the Plasmodium parasite in their veins collided during the age of exploration and conquest, malaria's differential killing power shuddered through the continents, altering the fate of nations." (pg. 37) or "In the closing months of the war, and overland evacuation route safe from German U-boats finally opened up" (pg. 79). And yes, she does have a thing about war at a distance: " Fifth-century Romans had to survive on shipments of food from North Africa, a thin thread that northern armies severed simply by holding up the grain ships at sea, plunging Rome into famine." (pg. 67). And the closing clause of Chapter 5: "Malarious embers smoulder on, awaiting their next spark." (pg. 120).

Hyperbole and mono-causality begins with the title: malaria has "ruled" humankind for 500'000 years. Well, Ms Shah asserts this on pg. 12 - no evidence given: just a "probable encounter at the time humankind discovered fire" - but her story really begins with Ice Age Africa, which is but a few thousand years ago. Republican (?) Rome's ascendancy was protected P. vivax, and felled by P. falciparum (pg. 63), and, yes, on pg. 58 she hints that malaria was destiny for the differential economic development of North and South in the US. She is probably right that malaria, like many other diseases, helped shape human history (see J. Diamond Guns, Germs, and Steel: The Fates of Human Societies - who did probably did not pay enough attention to malaria) - it is sad that she limits herself to sweeping innuendo, rather than going through the difficult task of summarising the scattered scientific and historical evidence so that the lay but literate reader is enlightened.

More annoying is her disorderly use of timelines: Ms Shah flips back and forth repeatedly through time. So at pg. 176 she quotes a 1929 UN report on malaria in India, followed, in the next sentence, by a quote from Florence Nightingale, who had never been to India, but written about the country'a rural health in 1890. This divergence matters, for knowledge about malaria increased immensely during that period. In discussing the IDAT program of the late `50s Ms Shah quotes in the same sentence Buddhist monks and Gandhi, who had died decades earlier (pg. 209). Ms Shah's poor control of numbers is exemplified by her tale of Darién, where the long-suffering Scots seem to multiply in order better to fall ill by the hundreds, die by the dozen, and abandon the place repeatedly. But of course - they could have captured "...dozens of turtles - enough to feed more than a thousand men" (a miracle of Christian proportions) - pg. 52. According to her quote, in Zambia two years of IMF prescribed restructuring programs caused "life expectancy to drop from fifty-four to forty years." (pg. 221). Wow, not even a war can do that!

Ms Shah is clearly bewildered by her subject. She is certainly right to show "the folly of treating malaria as a single disease with a single solution" (pg. 218). She spends 120 pages of her book proving that with examples from the past, replete with righteous finger wagging at the characters involved. Less than half would have sufficed: the subject is malaria, not human folly. As for the future, she seems to be despondent - the recent "top down" initiatives in her view equally misguided as all those of the past (I could agree with that).

Ms Shah frets: a new species of Plasmodium is adapting to the human host (P. knowlesi), and malaria could strike Europe again if "a blackout stalls the water pumps" (pg. 241), presumably flooding the Pontine Plains and other drained marshes. This, I'm afraid is plain nonsense. Yes, we'll have the occasional outbreak of malaria in developed countries, and treatment will promptly stomp it out. Malaria is unlikely to become endemic again. For malaria is a disease of poverty - as Jeffrey Sachs argues. There is a strong negative correlation between malaria and income: one speaks of the $ 4000 line, above which malaria seems to fade out (expect geographical, and cultural variations around this rule of thumb). This is no different from other tropical diseases, like sleeping sickness, which have receded in the face of the environmental transformation that mankind has wrought.

"The uncomfortable truth is that ending malaria over the long term will require much more difficult social and economic adjustments in African communities, just as it has elsewhere." (pg. 237) wails Ms Shah. "Uncomfortable?" here we have the likely (and desirable) outcome - and Ms Shah calls it "uncomfortable"! She fails to grasp the experience of Europe and North America in respect of malaria, as well as many other rapidly advancing countries. Difficult? Well we did it as we developed, did we not? G. Harding despaired of population control in 1968. Two generations of educated women later - the "difficult social and economic adjustments" needed to edge the world toward population stability have been accomplished - and yes, without agreeing on a target level beforehand, and at mighty little cost.

Malaria is firstly a matter of intelligent adaptation to the vector and the parasites. This process can be helped along by conscious efforts to understand the process, primarily at the local level. No silver bullets, no patent recipes, but simple programmes aiming to transfer experience can certainly help. Local knowledge and empowerment is the key, not cats or wisdom parachuted from on high. And if we keep on this adaptive process, well wake up one day and the problem has receded. After all: the US are the breadbasket of the world. By planning and silver bullets? No, the USDA extension service did it, one rural community at the time. "Malaria extension officers" might be what we need first and foremost.

Malaria is not something most of us think about in-depth unless traveling to an area where the disease is common. However, this incredible book makes an excellent argument for why we should. The author manages to magically transform volumes of scientific information into a riveting tale that just about anyone will enjoy.

Ms. Shah traces the very complex history of malaria from the beginning of human/mosquito interaction, and covers a range of related topics including the routes of infection and transmission; why certain areas and populations are more susceptible to malaria; the role of war, technology, and industry in sparking the disease; and why the efforts to control or at least contain it have not been universally successful. The book is meticulously sourced (at least 30% of the text consists of the references listed at the end of the book and footnoted within each chapter), but is not dry in the least.

The book reads like fiction, and it's too bad that it's not. The author leaves the reader with a very well-developed sense that the merest change in environmental conditions can leave us all susceptible to the next wave of malaria. I recommend this book strongly to just about anyone, but particularly for those who are interested in medical history and public health.

This was a great read... So insightful. It's the perfect book for people who love non-fiction, but may feel a bit overwhelmed by a book like Guns Germs and Steel. That is not to say that Diamond and those types doesn't have a place. However, someone who would never take a text book on vacation for personal reading, but still likes an informative educational book that is well written and light enough to keep your attention throughout may find 'The Fever' to be a good fit. It is definitely deep enough to educate and make you feel like you've learned and stretched your knowledge base. Even more so if you are a fan of medical history, or even just history in general.

Malaria has been a debilitating scourge of humanity for at least half a million years. In many parts of the world, not solely in the tropics, the disease ravages populations predictably, killing some, leaving the rest listless and incapable of significant occupation, either work or play.

Shah's documentary text reads like a detective story as humankind conjectures about and then discovers definitively that mosquitoes, immune themselves to the effects of the disease, spread the malaria parasite to other creatures, humans especially.

Fascinating in implication, Shah shows how human hubris, ignorance, superstition, intolerance and greed have played a part in this life-or-death engagement. She details the disease vector's adaptability, resilience, and sheer numbers as well as its necessity within the grand natural scheme of things.

Shah explores the success of modern technology including the development of powerful synthetic chemicals to contain and control malaria's spread. The use of treated mosquito nets is seen as, perhaps, "the best modern hope." But free distribution isn't enough by itself. Education about the why and how of using the nets is essential. And even at that, the measure may only be a temporary stopgap.

Read thoughtfully, reflect, then act --- many sources are supplied to spur even the most desultory reader to action.

Unlike the first 2 reviewers, who sound like they have a scientific or medical background, I am just a regular, ordinary person. I heard about this book from someone who had heard the author being interviewed on NPR, and it sounded like something I would like to read. I had enjoyed reading Richard Preston's books on ebola and smallpox (The Demon in the Freezer was particulary good), so I checked this out and had the sample sent to my Kindle. I could not stop reading! The book is fascinating! You do not have to have a scientific or medical background to enjoy this. The author's style is accessible, easy to read, and immediately captured my interest. I can't wait to read the full book.

The drawback? The $12.99 kindle price. I am in agreement with the boycott of books priced over $9.99, so I will wait for the price to come down, or hope to find a good used print copy. For $13 I want a print copy I can hold in my hands. It is too much to pay for a kindle book. That being said, I repeat that I found the sample fascinating, and am extremely eager to read the whole book!

I think this book would have benefitted tremendously from better editing. It was way too wordy and repetitive. Instead of telling a story in a straight-forward and concise way, this book rambled around its points and had no discernible narrative structure. The subject is fascinating, but the book is dull.

The author begins the book with a look at how malaria developed and how the transmission cycle occurs in the Anopheles mosquito. Tracing it roots in Africa thousands of years ago, the author follows malarias spread around the world and explains why it is endemic in some areas while rarely found in others. She also delves into the issues of eradication and why it has failed to control, let alone conquer, the spread of the disease. From spraying to medications to netting, the author details why each has failed and how the malarial parasite has managed to survive most attempts to control it.

Most Americans rarely, if ever, think about malaria, and if they do, they think about it as it relates to poor African and South American countries which have not been able to eradicate malaria. I doubt many Americans are aware that we are precariously close to having malaria return to this country. Most mosquito experts will admit that we are potentially one infected person away from having malaria return to this country, and with globalization and easy travel available, it is inevitable that we will develop pockets of malaria. It really is just a matter of time.

The book is very well written, translating difficult technical information into very readable material that does not require scientific training to understand. As a board member of a mosquito control district, I am quite aware of how difficult it is to transmit readable, understandable information to the public, and the author has done an amazing job of doing just that. It should act as a wake up call to Americans about the dangers of malaria and why we need to be vigilant. I would recommend it to all, specifically those people living in areas where malaria is most likely to return.

For someone with no medical or scientific background, a book about disease and the micro organisms that cause it can be daunting, dizzying, disorienting. Ms. Shah's book, however, meshes science, history, sociology, and medicine seamlessly so that those of us who are scientifically dense can understand and enjoy her account.

Judging by the nearly fifty pages of notes at the book's end, Ms. Shah did her homework and some exhaustive research. Some reviewers here criticize Shah for what they perceive as factual errors and for some literary embellishments. I rather like her style and for me the extra adjectives and figurative language only heightened my interest. The Fever is not intended as a text for professionals so it should not be held to the same standards.

Sonia Shah's account of malaria reads like a human tragedy, fed by ignorance, greed and self serving conflicts of ego and politics. I've now read two books by this author and enjoyed this book so much that I'll probably seek out a third.

If you're looking for the ultimate, authoritative malaria text, browse your nearest college book store.
If you want a book that the layman can digest and appreciate, seek out "The Fever."

"The Fever" destroys the myths of humans being able to employ scienfic approaches to end disease as effectively as the financial meltdown of 2008 destroyed the myth of the efficiency of the marketplace. Ms. Shah's book is a revelation. She creates a mostly convincing case that malaria shaped a great deal of cultural history in the world, and that attempts to eradicate it have been largely unsuccessful.

The main problem with malaria, Shah convincingly argues, is its frightening ability to quickly nullify all strategies used to destroy it. From quinine tablets to DDT, all preventative measures have, at best, reduced its malignancy. But only temporarily. New resistant strains of both the malaria parasite and the mosquito species that carry them always emerge, and malaria outbreaks always come back.

She also reveals an incredibly important fact that we in the relatively malaria-free industrialized west--including many of us who initially supported malaria control programs sponsored by the Gates Foundation and endorsed by the self-serving Bono types of the world--fail to understand: Most people who live in heavily malaria-infested areas don't consider it to be a serious disease, because those who survive it are the products of natural selection that long ago killed off those who had no natural defenses against it. Survivors have inherited malarial defenses and pass these on their children. That's why African slaves brought to America were better able to deal with the malarial-infested swamps of the south (and because of this were assigned to labor in these areas) than the Europeans who immigrated here.

Thus, in sub-saharan, Africa, according to Shah, most Africans consider malaria infections to be something they live with--the equivalent of a really bad flu in America. They get infected, they get knocked out for a few weeks as their bodies neutralize the latest infection, and then they're okay until they're infected again. Since death is always a way of life in impoverished areas--whether it's malaria, AIDs, famine, or war--death by malaria isn't considered as significant an event as it is in the west.

According to Shah, when mankind tries to eradicate malaria, it simply makes matters worse. Those born without malaria defenses survive and pass on these 'non-survivor' defenses to their progeny. When malaria once again reasserts itself, often in new mutated forms that survived the latest chemical onslaught, fatal epidemics break out because newer generations no longer have the 'defenses' to cope with it.

Shah also makes the point that the well-meaning but misguided attempts of Bono and Gates to control malaria simply don't work because those who received mosquito nets and pills don't consider the issue important enough to use them. Top-down approaches simply don't work; if malaria is to defeated, it has be done at the local level, with commitments from everyone. But again, mosquito nets won't stop it; mosquitos bite during the day as well. Pills don't stop it; natural selection quickly produces new strains of malarial parasites spread new infections.

And, contrary to what Sachs and others say, malaria is NOT an economic issue. It's a GEOGRAPHICAL issue. Building rows and rows of beautiful houses and setting up factories and businesses in villages bordered malaria-infested swamps won't stop the outbreaks. To kill the disease, one must destroy the habitats where the malarial mosquitos lived. Malaria was largely eradicated in the U.S. and western Europe because we bulldozed over most of nature in these countries, drying out and building cities upon the wetlands where these mosquitos thrived.

Adopting a similar approach in Africa, central and south America and Asia would require clearcutting and draining of all the rainforests and wetlands in these countries. Is that what we want? Even if this were to happen, malaria would probably resurface again, since global warming and increased CO2 resulting from the elimination of rainforests would create an envirnonment for malaria-infected mosquitos to thrive in cisterns, puddles, fountains and fishing ponds.

With the except of a few conjectural theories (for example, her theory that the establishment of Rome was driven by malarial concerns), Shah makes a very convincing case for the idea that malaria had a greater influence on the cultures of peoples coping with it and in thwarting the attempts of empire-builders than nearly any other disease or concern.

The only hole in her argument is her assertion that, in spite of increasing cases of malaria in the U.S. after Hurricane Katrina leveled New Orleans, malaria is unlikely to resurface as a major issue in the U.S. It's hard to understand this, since great portions of Louisiana, Mississippi, Florida and other parts of the south are covered with swamps that provide the ideal environment for malaria to thrive. It's quite likely that malarial mosquitos live in these areas, but since they're generally not permanently inhabited by large populations of humans or cattle, the disease simply doesn't have an opportunity to spread very far. However, a new, drug and insecticide-resistant strain that emerged from the bayous would have the potential to level generations of Americans who were never born with anti-malarial genes. It doesn't even need to emerge on its own; a super-resistant-malaria-infected tourist from another country who got bitten by a malaria-worthy mosquito in New Orleans could create a whole new generation of mosquitos carrying this new strain. It's not a matter of if; it's only a matter of when.

Shah's point: The only way that malaria can be stopped is to totally destroy every mosquito in the world. Doing this would require methods that would be so environmentally harmful that the cure would be worse than the disease. Malaria's continuing existence presents humbling proof that man is not even close to being the master of this planet, and that when humanity finally kills itself off, malarial mosquitos will emerge from their hidden underground pools and find other life to feast on.