Betrayal Of Trust The Collapse Of Global Public Health Public Health) [Hardcover]

 

 

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I found the book to be interesting, however I was constantly annoyed by the way the book jumped around from topic to topic. Neither the book as a whole nor the individual chapters rose to a climax, but was rather a jumble of information. Some of it was repetative, sometimes even verbatim. I was very dissapointed in the endnotes. Sometimes they listed sources, and other times they gave additional information. However, many times, I flipped back to the endnotes looking for a source and found just an anecdote instead. The general "The information for this section is from..." line does not satisfy me at all for citing sources. I think someone else could have taken the same information and written a much better book.

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 above...it 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. Sometimes I just have to put myself between children and odds bigger than they. It's the father instinct in me.

The book was written before 9/11 and I kept wondering, when reading the American chapter, what difference that would have made in her narrative. Oh, and I'll never doubt soldiers who complain of things like Gulf War Syndome again.

Remember when local health departments tested you for TB and other things before you could get a food handler's permit to be a waiter or a meat cutter or whatever, and they'd also trace one's sexual partners when one got treated for a sexually transmitted disease (note "old" reference once again)? They don't do that anymore. Our health department doesn't even care. I called them yesterday and asked them if I had an STD (not much chance of that anymore) should I tell all my sexual partners or would they. The answers? "Naw" and "NO." That's interesting, isn't it? One, it suggests that the author is correct in that the government is betraying us in matters of public health. Two, it suggests that I have way too much time on my hands.

It took me over a month to do justice to this book, and I have taken into account the thoughts of other reviewers. A book of this importance would indeed have benefited from an international advisory board of public health, medical, insurance, and policy experts; it would certainly have benefited from greater structure, firmer editing, and a foreword by someone like a former Surgeon General of the United States. As it is, it appears to have overcome these deficiencies with hyped-up marketing and sweetheart reviews, and this in some ways counterproductive because this book could have, should have, become a mainstream topic in the Presidential campaign. It failed to do so for several reasons, not least of which is the propensity of both candidates and their advisors to avoid serious thinking, but also because the book is not helpful to a popular understanding of the very real global and domestic threats to the health of our children today and in future generations. Having said all this, I commend the book for its content and do not recommend it as avocational reading. There are some very important points that the book brings out, and I will itemize these in order of importance: 1) Public health is about detection and prevention, medicine is about remediation. In the long run, investments in public health are vastly cheaper and more effective than after-the-fact medical intervention; 2) The insurance industry in the developing world has failed to support public health investments, and in a remarkable collusion with the pharmaceutical, hospital and managed health care industries, has created a very expensive and increasingly ineffective system focused on drugs (to which diseases are increasingly resistant) and hospitals; 3) Hospitals are no longer reliable in terms of protecting patients from both error and secondary infection from other patients. People are coming out of hospitals, in many cases, with more diseases than when they went in; 4) The health of our nation depends on the health of all other nations-not only does a collapse of public health in Africa lead to failed states and forced migrations, but it also is but an airline flight away from infecting Kansas; 5) Clean drinking water, uninfected food, and good environmental and occupational health conditions are at risk in many parts of the United States and Europe, not only in Russia and the rest of the world; 6) The United Nations, and the World Health Organization in particular, are in disarray and ineffective-in large part because of a lack of support from member nations-at dealing with the public health commons. There is no question but that the author has hit a "home run" in terms of describing the harsh reality of epidemics in India and Africa, the collapse of public health in Russia, the rapid migration of many diseases from Russia through Germany to the rest of Europe and the U.S., and the severe costs in the U.S. of a retreat from the collective good with respect to public health. Unfortunately, it is a home run hit in isolation, not a game-winning home run, because it fails to drive home, to the only audience that matters-the U.S. voter-exactly what political and economic initiatives are required to achieve three simple objectives: 1) re-establish the public health infrastructure in the U.S.; 2) redirect the entire health care industry toward preventive measures-including water and food quality controls-instead of remedial prescriptions; and 3) provide compelling incentives to the rest of the world for cleaning their own house (this presumes that we are able to clean our own first, a very questionable assumption at this point in time). This is a valuable book, a five in terms of intent, a three in terms of execution, and I am glad that I took the time to read it. It provides a wonderful foundation for enjoying, at an intellectual and policy level, the medical and public health novels by Robin Cook.

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4.0 out of 5 stars Another compelling, worthwhile read
I'll start with the bad - yes, there are areas of this book that I think an editor never saw. That said, I'm not sure it detracts so much from the quality - the point comes... Read more

Published on May 14 2003 by History Buff

5.0 out of 5 stars Informative, an excellent read
... this was and remains a remarkable book full of insight into the state of public health systems today, and the potential health threats faced by us all.

Published on April 9 2003

5.0 out of 5 stars Pick it up until you put it down.
Garrett was amazing in relaying all the relevant facts to the increasingly destabilizing realm of global public health. Read more

Published on Mar 14 2003

4.0 out of 5 stars Written for the public, but chock full of disturbing facts
'Betrayal of Trust' is an interesting follow-up to Laurie Garrett's first book, 'The Coming Plague.' This book brings a journalist's skills to what could otherwise be a somewhat... Read more

Published on Dec 27 2001 by Thomas J. Brucia

2.0 out of 5 stars Collapse of Garrett's fame!
FULL of factual errors (see Book review in British Medical Journal from late October 2001); way too long; way too repetitive. And completely devoid of ANY constructive suggestions.

Published on Nov 11 2001

5.0 out of 5 stars Prophetic Warning About Current State Of Public Health!
This is a truly prophetic warning from the acclaimed author of "The Coming Plague", which itself was an eloquent best-seller warning of the approaching debacle of... Read more

Published on Nov 10 2001 by Barron Laycock

4.0 out of 5 stars at times brilliant, prescient, inaccurate and frustrating
This is an excellent and yet deeply flawed book. It will (and should) frighten us all into action, and given recent events of Sept 11 and its aftermath - the imminent threat of... Read more

Published on Oct 1 2001 by Robert J. Crawford

5.0 out of 5 stars Perfidy in High and Low Places
Laurie Garret's writing is bigger than life but sometimes just as flawed. This dynamic superwoman occasionaly outruns her facts (penicillin is NOT a sulfa drug) but she has... Read more

Published on Sep 19 2001 by Cecil Fox

4.0 out of 5 stars Journalistic heart of darkness
"the horror!!! The horror..." Laurie Garrett has seen the horror and it is us. That is it is our worldwide failure to recognize the public health disasters that are... Read more

Published on Sep 8 2001 by RL

2.0 out of 5 stars Disorganized, rambling text weakens the message
(1)A sprawling, overly long, undisciplined transposition of research notes to 585 pages of text and 161 of notes. Chronology is erratic, organization and concision absent. Read more

Published on Aug 9 2001 by Peter Free

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