- Hardcover: 320 pages
- Publisher: Sarah Crichton Books; 1 edition (July 6, 2010)
- Language: English
- ISBN-10: 0374230013
- ISBN-13: 978-0374230012
- Product Dimensions: 6 x 1.1 x 9 inches
- Shipping Weight: 1.2 pounds
- Average Customer Review: 4.3 out of 5 stars See all reviews (41 customer reviews)
- Amazon Best Sellers Rank: #772,853 in Books (See Top 100 in Books)
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The Fever: How Malaria Has Ruled Humankind for 500,000 Years Hardcover – July 6, 2010
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From Publishers Weekly
This fascinating, mordant pop-sci account tells us why malaria is one of the world™s greatest scourges, killing a million people every year and debilitating another 300 million, and why we have remained complacent about it. Journalist Shah (The Body Hunters: Testing New Drugs in the World™s Poorest Patients) shows how the Plasmodium parasite, entering through a mosquito™s bite and feasting on human red blood cells, has altered human history by destroying armies, undermining empires, and driving changes in our very genome. We™ve learned to fight back with antimalarial drugs and insecticides, but malaria™s adaptability and its buzzing vector, Shah notes, give it the upper hand. Shah provides an intricate and lucid rundown of the biology and ecology of malaria, but her most original insights concern the ways in which human society accommodates and abets the parasite. (The impoverished denizens of Africa™s malaria belt, she observes, would sometimes rather use the pesticide-laced bed nets sent by Western aid groups to catch fish.) Shah™s is an absorbing account of human ingenuity and progress, and of their heartbreaking limitations. 16 pages of b&w illus.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
Investigative journalist Shah maintains her signature pattern (Crude, 2004; The Body Hunters, 2006) here, exposing both the seemly and not-so-seemly aspects of the subject under review. As Shah demonstrates, when it comes to taming, never mind eradicating, malaria, the disease is cannily able to keep the ball in humankind's court. Notwithstanding, people in tropical climes who live with its ubiquitous presence have over time come to uneasy terms with the fever. That is not to say they would not benefit from a cure. Indeed, their need is most critical. It's just that when Western nontropical humans are exposed to malaria, they suffer its worst effects, then tackle the problem in largely ineffectual ways. And it is not for want of money (think Bill and Melinda Gates). But Shah takes no prisoners, blasting everyone, including the World Health Organization. Even Harvard's state-of-the art Malaria Initiative takes it on the chin for eschewing unglamorous but effectual grunt work in favor of “lavishly funded . . . economy building technology.” Malaria may rule humankind, but Shah rules the in-depth investigative report. --Donna Chavez
Top Customer Reviews
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.
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.
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.