J of Canadian medical Association 1995
1466 CAN MED ASSOC J * 15 NOV. 1995; 153 (10)
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THE COMING PLAGUE:
NEWLY EMERGING DISEASES
IN A WORLD OUT OF BALANCE
Laurie Garrett. 1994.
750 pp. lIlust. Farrar, Straus and Giroux,
New York.
1994. $27.50. ISBN 0-374-12646-1
Overall rating: Excellent
Strengths: Thoroughly researched; provides an
urgent message for the 21st century
Weaknesses: Sheer size; attempts to cover too
many events in too much detail
Audience: Anyone interested in how infectious
diseases may influence modern-day
civilization
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1his remarkable book lies somewhere between a textbook of
microbial ecology and a sciencefiction novel. The subtitle -Newly
Emerging Diseases in a World Out of Balance - is the theme in an account of
changing patterns of infection during the last 50 years.
Subjects include Legionnaires' disease, toxic
shock syndrome and hantavirus pulmonary syndrome in the United
States, as well as exotic "new" diseases caused by Machupo, Marburg,
Lassa and Ebola viruses.
Garrett also
describes the increasing threat from
"older" diseases, such as malaria and
tuberculosis, that have taken on new importance because of the emergence of multiple-drug-resistant organisms.
Much of the story is told through the personal experiences of
the "disease cowboys," a term Garrett uses for the front-line scientists
and field epidemiologists who piece together the puzzles of various disease outbreaks, often at serious risk to their own health.
Garrett ascribes much of the growing imbalance in the struggle between microorganisms and Homo sapiens to
- man's destruction of the
- world's rainforests,
- social upheavals,
- population shifts and jet travel,
all of which provide unprecedented opportunity for new encounters in a
shrinking global village.
The first sentence of the book recounts the
childhood recollections of the author's uncle, a physician, about the
great influenza pandemic of 1918 and 1919, which claimed nearly 22
million lives worldwide.
Garrett tabulates this and other serious influenza pandemics dating back to
1510, but fails to put these massive tolls of human life in years long past
into the context of her perception of a world that has only recently fallen
out of balance. The swine flu threat of 1976 may have fizzled, but a new
strain of influenza, with an airborne route of transmission and an incubation period of only 1 to 3 days, is more likely to cause millions of
deaths around the world in a short time frame than any of the fearsome,
exotic diseases from distant jungles.
The lengthy chapter on human immunodeficiency virus (HIV) is
particularly informative. It is backed up by 18 pages of notes, including
detailed tables and diagrams as well as numerous references to scientific
publications. For people interested in the emergence of HIV types 1
and 2 as human pathogens and their relation to primate viruses, the book
presents a more readable and authoritative account than I have found
elsewhere.
Each chapter has extensive endnotes, more than 1300 in total, contained in a section at the end of the
book. Although the endnotes add
immeasurably to the usefulness and
interest of this book, the headings of
this section do not include the name
of the corresponding chapter. The
reader is obliged to flip back and
forth through the notes, searching
for the beginning of each numbered
section.
The theme of this book is best captured in the chapter entitled
'Thirdworldization: the interactions of poverty, poor housing, and social
despair with disease."
This chapter contains a powerful message for
politicians bent on dismantling, in the name of health care reform and
economic restraint, the existing networks of public health surveillance and communicable disease control established over many years.
Garrett points to worldwide vigilance as our best hope for spotting the next microbial "hot zone" in time to minimize its effect.
Bryce Larke, MD, DCISc
Professor
Department of Pediatrics and Department
of Medical Microbiology
and Infectious Diseases
University of Alberta
Medical Director
Provincial AIDS Program
Alberta Health
Edmonton, Alta.
