The Malaria Capers : More Tales of Parasites and People, Research and Reality [Paperback]

Robert S. Desowitz (Author)

Book Description

ISBN-10: 0393310086 | ISBN-13: 978-0393310085 | Publication Date: June 17, 1993

"Reads like a murder mystery. . . . [Desowitz] writes with uncommon lucidity and verse, leaving the reader with a vivid understanding of malaria and other tropical diseases, and the ways in which culture, climate and politics have affected their spread and containment."—New York Times

Why, Robert S. Desowitz asks, has biotechnical research on malaria produced so little when it had promised so much? An expert in tropical diseases, Desowtiz searches for answers in this provocative book.

Editorial Reviews

From Publishers Weekly

While biotechnology has taken great strides during the last 25 years, Desowitz, professor of tropical medicine at the University of Hawaii, reports that because of an "inbalance between research and reality," health and health systems--especially in the tropical Third World--have deteriorated. Although this ironically titled book concerns a tragic topic, Desowitz's accounts of unsung heroes in the battle against disease, coupled with his humanity and storyteller's skill, make for engrossing reading--as does, for instance, his speculation that kala-azarper web , like malaria an ancient, insect-borne plague, may have killed the dinosaurs. Malaria, he recalls, was known as Roman fever until Mussolini drained the Pontine marshes. The author asserts that a vaccine against malaria has not been found because of misrepresentation, misuse of funds and outright ineptitude. Soaring costs have further discouraged corporate research, especially for unprofitable drugs that mostly benefit the world's poor. Illustrations not seen by PW.
Copyright 1991 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.

From Library Journal

Desowitz (tropical medicine, Univ. of Hawaii) continues the gripping tales of parasites he began in New Guinea Tapeworms and Jewish Grandmothers ( LJ 10/1/81). Focusing on poor tropical nations "where health and health systems have deteriorated during the past twenty-five years," Desowitz describes how visceral leishmaniasis (kala-azar, the black sickness) has returned to the Indian subcontinent after being almost eradicated. He also discusses how malaria, despite years of research, still wreaks havoc in the tropics. Using these two insect-transmitted infections as examples of the tropical world's state of health, Desowitz engagingly narrates "the course of their natural history, human history, and the historical events surrounding their elucidation by sometimes great, sometimes petty, and sometimes venal scientists." For all medical collections.
- James Swanson, Albert Einstein Coll. of Medicine, New York
Copyright 1991 Reed Business Information, Inc. --This text refers to an out of print or unavailable edition of this title.

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Product Details

• Paperback: 288 pages
• Publisher: W. W. Norton & Company (June 17, 1993)
• Language: English
• ISBN-10: 0393310086
• ISBN-13: 978-0393310085
• Product Dimensions: 8.2 x 5.5 x 0.7 inches
• Shipping Weight: 8 ounces (View shipping rates and policies)
• Average Customer Review: 4.2 out of 5 stars  See all reviews (4 customer reviews)
• Amazon Best Sellers Rank: #136,128 in Books (See Top 100 in Books)

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9 of 9 people found the following review helpful:

3.0 out of 5 stars Thought-provoking study of Malaria and Kala Azar, March 28, 2001

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E. A. Lovitt "starmoth" (Gladwin, MI USA) - See all my reviews
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This review is from: The Malaria Capers : More Tales of Parasites and People, Research and Reality (Paperback)

Robert Desowitz leaves his readers with many 'cliff-hangers' in "The Malaria Capers". The version I read was published in 1991, so some of his unfinished stories may have endings by now---all except for the most important story of all, which is the search for an effective vaccine against the parasitic protozoans that cause malaria and kala azar (visceral leishmaniasis).

Immunization campaigns have eradicated smallpox and may be on the verge of eradicating polio, but the two diseases that this book focuses on cannot currently be prevented with vaccines. The danger of catching malaria or kala azar can be minimized---unfortunately the majority of the population at risk can't even afford the most effective preventive measure---a bed net soaked in insecticide (according to 2000 World Health Organization statistics this costs about $4, plus $1 per year for a supply of insecticide).

No wonder Desowitz gets so mad and preachy in "The Malaria Capers". Malaria still kills over one million people a year (another 2000 WHO statistic) - most of them young children. None of the vaccines that scientists were working on when this book was written have proven to be effective, which is exactly what Desowitz predicted. In his last chapter, "The Vaccine Felonies", he excoriates the Malaria researchers who spent their AID grants on vaccines that were already proven to be ineffective and unsafe for humans. While doing so, they diverted funding from proven preventive measures such as bed nets, put Owl monkeys on the endangered species list, and (even more feloniously according to our laws) lavished the grant money on themselves and their office assistants. One of the stories that Desowitz couldn't finish in 1991 was whether these researchers were tried, convicted, and sent to prison.

This book is more polemical and as a result, less interesting to the lay reader (myself) than his "New Guinea Tapeworms and Jewish Grandmothers", but it does have a few 'human interest' stories. The most haunting begins in a small Thai village:

"...The school assembly bell, hanging by a rope from a limb of a mango tree, is the nose cone from an unexploded [Japanese] bomb. Next to the school, raised on pillars, is the wooden residence of a group of monks. On this late morning in June their prayers have ended; only the unceasing anguished cries of a monk dying from throat cancer break the subdued quiet of the village. In a one-room, wood-framed, tin pan-roofed house at the village edge, Amporn Punyagaputa, twenty-three years old and big with child, sits alone, feverish and confused by the searing pain in her head."

Stories like this represent Desowitz at his best and most humane. I can almost guarantee that Amporn Punyagaputa will help you remember why Malaria is still such a killer, long after you've forgotten who misappropriated the AID funds. And you will definitely understand why Desowitz is so angry. You'll be angry, too.

7 of 7 people found the following review helpful:

5.0 out of 5 stars A "Must Read" for Infectious Disease & Public Health Folks, September 26, 2000

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Jose & Mary Betancourt - See all my reviews

This review is from: The Malaria Capers : More Tales of Parasites and People, Research and Reality (Paperback)

Robert Desowitz's attempt to chronicle the successes and failures of man's quest to leash the ravages of tropical disease (especially malaria and leishmaniasis), results in a very engaging and easy to read book. Through his entertaining and at times, cynical approach, the author explains how throughout history, man's desire to rid himself of the pestilence of infectious disease has sometimes met with success (as in the case of smallpox), as well as with failure (as in the case of malaria). If for instance, we take the case of malaria, just in the figures utilized by the author in his accounting of the US Agency for International Development (USAID) effort to combat malaria, he chronicled over $100 million "thrown at" this disease, with the disease still flourishing today in many parts of the world! The author's method of "personalizing" or presenting the experiences and challenges faced by many people in this world at the individual level, succeeds in engaging the reader from the very first chapter. The opening account of the Indian woman, Susheela, who tries desperately to save her dying daughter from visceral leishmaniasis, only to discover that the medicine required to save her daughter is grossly unaffordable, rivets the reader's attention. Here is a personal account of a human tragedy, which could have been told from the perspective of too many families in developing countries even in today's modern world of globalized interdependence. Additionally, Mr. Desowitz does a good job of giving the reader a historical context in which many of the major events in the history of public health, actually took place. This helps the reader to develop a historical frame of reference and better understand the reasoning and motivations of key individuals and governments involved in tropical disease research during that particular period. Mr. Desowitz seeks to inform the reader as to why there currently exists either cures, treatments or vaccinations to only certain diseases, while other diseases seem to flourish with little to no concerted effort by any government, private or international agency to control them. "During the past two decades," states the author, "when biotechnology has made so many stunning advances, the health of tropical peoples has worsened. New, affordable, non-toxic chemotherapeutics have not been developed (because) the drugs-for-profit pharmaceutical industry gives low priority to the diseases of the poor people." Rarely, suggests the author, has human altruism towards his fellow man been the primary reason for the development of protective measures and cures from these diseases. Other more materialistic or self-serving reasons such as economic gain, protection of business, government or military interests, or the quest for recognition and notoriety (such as the Nobel Prize), have been the primary reasons for tropical disease research. The author posits that this motivation continues to this day with relatively little contemporary research effort going into the "poor people diseases" of malaria and tuberculosis. The author presents his main argument first by effectively painting a bleak picture of despair in recent-day India, followed by a detailed chronology of the historical events (and non-events) that lead up to it, and then concludes with an implicit warning. The fact that the health of tropical people has worsened over the past several decades is a physical manifestation of a perceived lack of international concern for certain regions of the globe. Mr. Desowitz cites numerous examples of national and international efforts to combat certain diseases throughout history, and dissects them in a manner by which the reader is left with a more thorough understanding of why the project failed or succeeded in accomplishing its objective. He presents to the reader the "rest of the story" which usually underlies the official version of a project or initiative and uncovers how the human factor of greed, self-service, and ulterior motivations have sometimes driven honest efforts into subversion. On the contrary however, he also very effectively describes how some of the earlier pioneers in the study of infectious disease persevered even in the face of adversity and defeat. A very good example of this is the case of Surgeon Captain Ronald Ross who after over three years of painstaking research and experimentation, discovered that malaria was transmitted by the bite of an infected female Anopheles mosquito through its salivary glands. Captain Ross' discovery was the culmination of not only his own personal work, but also the work of the countless researchers who came before him and contributed towards the building of the existing body of knowledge in malaria. There were many occasions in Captain Ross' quest for discovery that this author would have thought twice about turning my research efforts elsewhere! He was a true testament in perseverance and will. The Malaria Capers is a "must" read for all public health professionals and those aspiring to become one, as well as personnel entering the clinical research field. It is a fundamental book that prepares those seeking to enter the public health arena to face the challenges contained in the field of infectious diseases. It also sheds some light to the infectious disease researcher why research is only conducted on some diseases, and not others. A potential weakness of this book (which is also a strength!) is the author's perceived cynicism, especially when he describes many of the human blunders and indiscretions, which in his opinion may have set back the discoveries of potentially life-saving drugs and programs by many years. Mr. Desowitz appears to be an absolute subject matter expert in the field, and one who has "walked the walk" and not just "talked the talk." He does an absolutely superb job in capturing the reader's attention and instilling in him the knowledge acquired through years of working the business of infectious disease research. I highly recommend this book to anyone even remotely interested in the area of infectious disease. A "highly recommended" book!

2 of 2 people found the following review helpful:

5.0 out of 5 stars 15 years later, the situation's still just as bad, January 8, 2007

By 

Harry Eagar (Maui) - See all my reviews
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This review is from: The Malaria Capers : More Tales of Parasites and People, Research and Reality (Paperback)

I published this review in 1992. Little has changed since, but for Amazon I have updated a few points.

The biggest disease threat in the world is not AIDS. Not lung cancer. Not heart disease. It's malaria, which kills more people every year than AIDS has killed altogether. (2007 update: No longer true; AIDS now kills about as many people as malaria each year.)
Most of them are young children, with pregnant mothers also a prime target. Almost all are poor, powerless and colored.
And their situation today is worse, considerably worse, than when the rich countries amassed their advanced medical and public health techniques to attack malaria a couple of generations ago.
In this angry book, Robert Desowitz, a (now retired) professor of tropical medicine, medical microbiology and public health at the University of Hawaii, says it did not have to be, and, as he has in past books, he points the finger of blame when other commentators are too scared to.
True, malaria is a tough foe. Of several kinds, only one, caused by a parasite called Plasmodium falciparum, is often fatal, but it is a fearsome predator. Where falciparum reigns, the infant mortality rate runs 40 to 50 percent.
And its imperium is spreading. Malaria used to be relatively uncommon in the cities of black Africa, which, bleak as they were, were inhospitable to mosquitoes. The cities have grown enormously, and failed attempts to eradicate the principal mosquito vector merely bred mosquitoes with urban tastes.
Malaria, however, is not only a tropical disease. Rich countries tend to control their mosquitoes -- by destroying their wetlands, if nothing else -- but as recently as the 1890s, the coast of Georgia was depopulated by malaria, and when Desowitz was studying in London there was malaria there, too. But most of us think seldom of malaria; no one gives dance benefits to raise money for malaria.
To reinforce the difference between the rich and healthy and the poor and diseased, Desowitz also traces the story of another killer of the poor in the tropics, a disease most Americans have never even heard of, visceral leishmaniasis. It is a parasite, too, but spread by a sandfly.
It is nearly as deadly a killer as plague, and where it reigns -- Bangladesh, Bengal, Nepal -- it has the same name, kala azar, the black sickness.
Desowitz, no sensationalist, describes one death from each disease, just to show what it's like, in chapters of relentless horror.
Then he turns to equally relentless analysis. Things get complicated. For example, the leishmania organism has been around as long as man (and undoubtedly a lot longer), but accounts of the disease start only in 1824. Early recorded epidemics apparently spread thanks to the improved transportation system the British brought to India. (Which might seem a bad bargain, but economic historians think that system, especially the railways, ended famine in India, with the exception of one last hunger engineered by Mohandas Gandhi -- yes, the Mahatma, the only lawyer besides Thomas More ever to make saint.)
Complications pile on complications. "Kala azar is not a Stars and Stripes disease like cancer, coronaries, stroke and allergies," writes Desowitz. "No American president is going to introduce a bill for Congress to fund a War on Visceral Leishmaniasis," yet western experts and western money have explained the central problems of the disease, as they did of malaria.
They even found a moderately effective treatment, but it costs $15 (1992 price), which is far beyond the means of the citizens of the empire of kala azar.
So, like malaria, no one, especially in the rich countries, pays much attention to kala azar now. "No major efforts have been made to find an antimalarial to replace chloroquinine," a miracle drug against malaria until the plasmodium adapted to it. Modern medical research has "made the development of drugs to treat the diseases of poor people uneconomical." (2007 update: In testimony before Congress in 2004, Desowitz blamed U.S. AID for continuing to buy chloroquinine, which, he now says, is not only not a cure but in some circumstances is actually harmful.)
But there are even more complications. Skipping over some, we come to the Agency for International Development, which for over 20 years (2007 update: 35 years) has been spending millions to develop a malaria vaccine.
Never mind that "there has never been a vaccine to protect or cure any parasitical disease of humans," or that AID is not normally a medical research bureau. The program was, Desowitz says, in the hands of incompetents, some of whom are already in prison, other awaiting trial for peculations. (2007 update: 5 convictions)
Within its own empire, AID is circulating a self-serving description of this disaster, claiming that despite thievery, the program has made great strides. Desowitz says it has accomplished nothing significant, and I accept his version. (2007 update: no change)
His track record is superb. When all we got was happy talk from the medical community, Desowitz explained (in "The Thorn and the Starfish") why an AIDS vaccine is unlikely; when the rest of the medical community was nearly silent about the feminist attack on Bendectin, the only drug useful against morning sickness, Desowitz told us that was hogwash, and in 1991, in a widely unreported decision, the U.S. Supreme Court concluded that the so-called evidence against Bendectin was worthless. But by then it was too late; nobody makes Bendectin any more.
Desowitz is one of my few heroes. Of the AID malaria criminals he says, "It is possible that the villains were not the indicted, but the respectable, established and honored scientists. These were the men and women who said not a word in public protest when their opinions were . . . manipulated into falsifications. These were the men and women who said in private that the AID-sponsored research was of doubtful quality. These were the men and women who disregarded their responsibilities as leaders of their profession. Their silence may have caused irreparable harm . . . ."
In the 19th century, Henrik Ibsen wrote a play whose hero was "An Enemy of the People" because he spoke out when everyone else thought it best to keep quiet. That is exactly the kind of hero Dr. Robert Desowitz is.