Customer Reviews

Betrayal Of Trust

5 star:		(20)
4 star:		(9)
3 star:		(4)
2 star:		(4)
1 star:		(3)

 

 

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.

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 through, and to discuss the minutia of politicking and health plans would have drowned the reader in prose outside the point of the book.

Now - to the story. Like The Coming Plague, this book does a wonderful job of pointing out the science of disease, how diseases emerge and re-emerge, and why everyone needs to care, whether it's in your country or not. I think this gives detail unavailable due to the mass of diseases covered in her first book; as a result, this one can do a more thorough job in getting the reader to understand the universal repurcussions of the decisions made on all levels about health care. It will also make you start to care about those countries you usually ignore.

Again, I think everyone would benefit from reading this book. It reads like a set of thrilling short stories, with the most compelling hook of all - they're true.

... 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.

Garrett was amazing in relaying all the relevant facts to the increasingly destabilizing realm of global public health. As you read, you can actually generate a picture of your own of all the problems and statistics compounding upon one another until at the end...well, we'll see. Definitely worth the time to read. Annotated to the fullest for anything that you could possibly want to consider or research for yourself.

'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 boring topic. It consists of six chapters, each an in-depth examination of a different public health concern. The first chapter investigates the pneumonic plague panic of 1994 in India. The second scrutinizes the Congolese Ebola epidemic of 1995. The third chapter documents the collapse of Soviet/Russian public health, with particular attention to drug-resistant tuberculosis. The fourth (and most controversial) describes the decline of public health efforts in the US under its 'managed care' and 'medicine for profit' health system. The fifth chapter, titled 'Biowar', is the most chilling (especially in light of recent events). And the last, and shortest, chapter is Garrett's epilogue. --- I found it unnerving to re-read the chapter about biological warfare. When I first read it many months ago it was documenting things almost no one (including me!) knew about. Today -- post Anthrax Scare -- most of the chapter is a summary of what 'we' (the public) have learned from the experts just in the past few weeks... What makes this book worth reading is that 'we' are still in our pre 9-11 stage of knowledge regarding the threats mapped out in her other chapters: drug resistance, virulent TB, tropical disease epidemics, the ever-widening impact of AIDS, the role of organized crime and corruption in the spread of lethal diseases, etc. Though these topics are not pleasant, they will be thrust onto public consciousness in the coming decades. Not without reason, Garrett's book has been compared to 'Silent Spring'. Incidentally, be sure to read the hundreds and hundreds of footnotes; they are not as much about documenting sources (though they often do so), as they are about expanding on the text. One thing I will assure you: You can disregard the cover blurb from the Washington Post stating that this book 'reads like a Robert Ludlum thriller'; 'Betrayal of Trust' is much too full of facts, names, places, and detailed history to be a Ludlum novel - moreover, it is NOT fiction.

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.

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 increasing microbial threat based on human arrogance, rapid increases in virulence, multiple drug resistance (MDR), and the appearance of entirely new viral entities, comes this articulate, literate, and extremely well researched investigation into the woeful state of the world's public health organizations. Earlier she had warned of the disrepair and dangerous lack of preparedness of public health agencies, and here she writes with cutting clarity as to just how irretrievably damaged they now are. Many international authorities are now openly worried because these national and international public health organizations constitute the only potentially effective line of defense for quick public health countermeasures to intervene and combat both the initial appearance of microbial threats (through inoculation, maintenance of public sanitation systems, and rapid response to perceived threats) as well as continuing support for stemming the effects of such outbreaks once they occur. Without such agencies the public is left literally to the mercies of fate.

This new work is an informative and fascinating decent into a terrifying world in crisis, and Ms. Garret quickly exposes the dark side of the highly vaunted globalization process. For even while Asian economies prosper under the new prosperity, dangerous new breakout of old microbial enemies such as pneumonic plague threaten the population with devastating new pandemics. Meanwhile, multiple drug resistant (MDR) forms of Tuberculosis have appeared in epidemic proportions in Russia, combining with the ravaging effects of drug addiction, alcoholism, and malnutrition (as well as the regional exposure to radiation poisoning connected to Chernobyl in the Ukraine) to exact a treble toll on life expectancy and quality of life in the struggling provinces. And this is just the most obvious tip of the iceberg.

Domestically we face new emerging threats from MDR Tuberculosis, West Nile virus, and other new "superstrains" of microbial entities we were arrogant enough to believe we had permanently vanquished. This phenomenon, when combined with the rapid and increasingly popular modes of international travel now threaten us with a Pandora's box of so-called "Third world diseases" for which we have little of no natural immunity. As Garret reveals the results of her detailed investigation into the nature of the threat, the reader must take pause. We have, she suggests quite eloquently, suffered from a betrayal of trust from both our national leaders and the various local, state, and national public health agencies, which have deteriorated to such an alarming degree that they are now virtually unable to stem the tide now confronting us.

This is serious albeit absorbing reading, and is not recommended for squeamish or immature readers. It is a quite accurate and absolutely devastating look at the nature of a monumental public health threat that is emerging throughout the world even as we speak, one poised to cause catastrophic and tragic losses of life and irreparable social, political, and economic harm to the various nations in which it strikes, and one for which we have done amazingly little to prepare for. We now have the global village Marshall McLuhan warned about, and in such a community there is increasingly no place to hide from the frightening prospects of a wide range of microbial threats all too-naturally rising to confront us. This is a terrific book, a cogent, entertaining, and superbly documented foray into the horrifying realities of our looming public health disaster. I highly recommend it

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 terrorism that may be biological in nature - this book is extremely well timed.

The thesis of the book is that, for a variety of reasons (lack of political will in the US, economic deterioration in the former USSR, and poverty in Africa) public health infrastructures worldwide are in serious decline at the moment that horrible new diseases (Aids, ebola) and new strains of old ones (TB, whooping cough, diphtheria etc) are emerging. If these public health infrastructures are not repaired, she asserts, we are in for horrendous trouble. She may well be right and for this reason, we would do well to heed her plea for renewed investment throughout the world in preventive medicine, epidemiology, and other measures to promote collective, as opposed to the privatized (or "medicalised") health model.

It is easy to dismiss this argument as crypto-socialist,but to do so is a disservice both to the talents of Ms. Garrett and to the idea of public health itself. To prove her case, Garrett embarks on an historical tour of the public health systems of both the US and the USSR, both of which were pioneers. The US, in New York but also in Minnesota, developed science-based systems to recognize dangerous contagious agents and to stamp them out via quarantine and later vaccinations and for bacteria, antibiotic treatments. The statistics speak for themselves and are well documented in Garrett's book. Not surprisingly, the USSR developed a more coercive and less scientific system, which was in decline before the fall of communism in 1990; since then, it has declined so alarmingly that death rates in the former Soviet republics are twice as high as births!
What is needed, she says, is larger investments to maintain the fragile infrastructures of scientists, other health care professionals, and access facilities.

The wider landscape she describes - the context of this deterioration - is bleaker and more terrifying than I had imagined possible. It involves antibiotic-resistent strains of tuberculosis and other ancient scourges, an unprecedented Aids epidemic in Africa and Asia, and in the wake of the defunct Soviet biological warfare programs with 30,000 scientists who disappeared - some apparently into the Middle East - the specter of bioterrorism. (Indeed, some of the Sept 11 pilot-terrorists were getting trained with crop dusters, which could deliver small pox or anthrax to threaten millions.) We may be approaching the end of an era in which we believed science was triumphing over human disease. I now fear for my children. Developments in India (plague) and the Congo Republic (Ebola) are also covered in grim detail.

It is here that Garret's argument begins to run into trouble. What has emerged in the US, she says, is a hybrid of conservative ideology (blaming the victim with claims that health is the individual's responsibility) and a "medicalised" model whereby we seek high tech, individualized cures to ailments rather than the less expensive preventive cures that the collective public health model offers. I believe that this is a straw-man dichotomy that oversimplifies the problem, in effect setting up conservative budget cutters to blame for a failure of collective will. While this is certainly true to a degree, the political and economic dimensions of the problem are so complex that Garrett fails to do them justice. Moreover, the medical approach is complementary to the public health one. If the reader want a more realistic appraisal of these issues, (s)he must look elsewhere.

Furthermore, there are numerous inaccuracies and errors throughout the book, which damage its credibility. For example, at one point Garrett states that Crick worked at "Oxford University in Cambridge, England"! While this is trivial and an editor should have picked it up, it is symptomatic of the rushed feel to the book, which was obviously written too quickly and perhaps sloppily. Moreover, Garrett glosses over a number of issues that deserved far deeper scrutiny: she dismisses the demise of the Clinton health plan in one page (it was simply "overly complicated"), and rejects claims by the pharmaceutical industry that the cost of drug development is $500 million (because governments fund basic science). The list of these errors and omissions is indeed long.

SO in the end the book is a mixed bag. For me, it will serve as a treasure trove of information for my latest writing project, but I worry about the accuracy of many of her claims. It is a very good call to arms for a serious issue and a warning to us all.

REcommended with reservation.