With recent news blurbs concerning the possible threat from strains of the West Nile virus in the northeastern part of the country this summer, the urgent importance of this book is quietly being reinforced. This important effort by journalist Laurie Garrett is a whopper; a long, carefully documented and quite readable text giving an overview of the worldwide efforts of the "insect fighters' at the Center for Disease Control (CDC) of the U.S. Public Health Service and other agencies ranging from the U.N to state, university and local agencies to combat a panoply of both new biological agents like HIV, Ebola, and the West Nile virus as well as new and much more virulent and drug-resistant strains of old enemies like tuberculosis, bubonic plague, a number of venereal diseases, and complex new public health concerns like Toxic Shock Syndrome. Ms Garrett's highly detailed and exhaustively documented thesis, written while on a graduate fellowship at Harvard, is both frightening and hard to ignore. She posits that through our environmental arrogance and stupidity, the general medical strategies of the western societies, and our consistent overuse of antibiotics, we are quickly losing the continuing fight to keep the general public of both the postindustrial nations and the less developed world safe from the wild panoply of microbiological agents that are out there in the environment, and we are, through our encroachment on wilderness areas never before populated by humans, unnecessarily introducing segments of the population to new microbiological agents who then find a vector or path into human habitation and resultant infection. Moreover, the increasing levels of world commerce and concomitant travel among the nations of the world mean that someone infected in the jungles of South America or equatorial Africa can be in a restaurant in New York City or at the beach on Martha's Vineyard several days later as the agent starts its formidable and often highly contagious microbiological attack. This is truly scary stuff. One becomes increasingly concerned about the safety of the general public and for our relative lack of public health preparedness as one winds through the pages of this long book. The approach is one of individual story telling, and while this makes the book much more readable and entertaining, it also tends to repeat a lot of information that one could otherwise avoid. Yet this is truly a minor quibble with a facintaing and fact-packed book that often made me feel like I was taking a graduate seminar in "Current Issues in Infectious Epidemiology". It's tone is both approachable and yet scholarly, a rare treat to enjoy, and Ms Garrett's obvious intelligence and ability to communicate shines here, as she makes complex environmental, infectious disease, and human issues converge in an understandable and compelling way. Finally, she makes an excellent case for increased public awareness as well as immediate political action to restore and reinvigorate the vitality and capability of our local, state, and national public health agencies, and certainly has increased my own awareness and concern for the ongoing scientific effort to battle the microbes. If her argument that many of the gains of the 20th century in public health (and the healthy longevity we enjoy as a result) are increasingly at risk is correct, we must take action to combat the wide range of problems she discusses to avoid a serious long-term breakdown in our public health system. This is an important book that has sparked a serious national and international public debate about some critically important issues that could literally potentially affect billions of people across the globe. I recommend it, hope it will be even more widely read, and hope you read it, too.
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