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The Coming Plague

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The Coming Plague. Newly Emerging Diseases in a World Out of Balance. By Laurie Garrett. (Penguin: 1995. Pg. 768.) ISBN: 0140250913.

Reviewed by Rochelle Caviness - September 23, 2001

Humans are relatively fragile creatures. Many of the things that can damage or kill us are easily observed. But perhaps the most scary are those dangers that we cannot easily see and which, until recently, we did not even know existed - such as microbes and the ubiquitous viruses that have plagued mankind since the beginning of time. In this chilling book, Laurie Garrett, Pulitzer Prize-winning investigative journalist, examines the potentially catastrophic dangers presented by viruses and mans attempts to control the uncontrollable. In The Coming Plague, Garrett introduces the reader to a smorgasbord of viral diseases such as Ebola, Hanta Virus, Cholorea, Toxic Shock Syndrome, Lassa Fever, HIV, Tuberculosis, and many more. She also introduces us to the many individuals who have identified, and studied the various diseases, offering personal glimpses into their lives, and their work.

HIV is often presented as the paramount indicator of the wonders of science. When this virus was newly emergent is was fairly rapidly identified, and new drugs where found to slow down the course of the disease, AIDS, which is caused by the HIV virus. As Garrett points out, we where lucky this time. She explicitly details just how lucky we where by offering a few, pointed questions. What would have happened it the virus spread more easily? What would have happened if it remained undetectable, yet contagious, in an infected person for decades? What would have happened it had killed it's victims rapidly? And what will happen if the disease mutates into something more virulent? When Garrett posed these questions, back in 1994, scientist thought that they were getting a handle on the disease, and that a cure, and vaccine, were only a few years away. It is now 2001. We still lack a cure, and a vaccine. Worse, the virus is learning to cope with the cocktail of drugs taken by its victims in order to suppress the disease. As the virus becomes more drug resistance, will it also become more virulent, or will it mutate in a yet unanticipated direction?

It is little wonder that The Coming Plague has been called the modern day Silent Springs. Just like Rachel Carson, Garrett, in this thoughtful and thought provoking book, has clearly shown that we, as a species, are in peril. In this haunting book, Garrett explains that new and mutated viruses emerge everyday. Some follow natural progressions, while others are aided by the very victims that they are programed to attack - humans! For instance, legionaries diseases, is a by-product of efficient, air conditioned buildings, with the virus growing in the cool, moist recesses of central cooling systems. Other disease are primarily opportunistic. They are most efficient when they come across a population weakened by war or famine. As well, other disease, such as the flu, are with us all the time. But they are also constantly changing. Some years, the flu virus will merely cause you to get 'sick', in other years, it becomes universal deadly, such as it did during the pandemic flu outbreak in 1914 when over twenty million people died. Yet even in those years when the flu is viewed as being benign, it still manages to kills thousands.

Another, extremely important point that Garrett brings to light is that the global population has grown to enormous proportions. Not only does this increase in population make for an ideal breeding ground for pestilent, but it is also putting stresses upon the environment never before experienced. How will the earth react? Will new, and more deadly virus emerge to protect the Earth from this human infection that has the potential of destroying the biosphere, just as surely as the bubonic plague might kill its victim? As well, the large, and mobile, human population makes it unbelievably easy for a virus to spread around the world in a matter of hours. In addition, as we encroach into areas that were previously untouched, we are bringing ourselves into contact with potential virus reservoirs that, in the past, did not represent a threat to humans. For instance, in the American Midwest, great prairie dog colonies inhabit the plains. Periodically, these colonies are decimate by bubonic plague. In the past, these plague outbreaks where not a major public health concern because humans seldom came into contact with the prairie dogs, and the disease carrying fleas that infest them. But now, entire subdivisions have been built upon or near many prairie dog colonies. How long will it be before these healthy suburbanites begin sicken with the plague?

Garrett, an investigative journalist, brought the full force of her journalistic skills to the writing of this book. Her sources of information are well document, and accurate. She not only offers the reader an overview of the state of medicine in the old days - i.e., the 1930 and 40's, but also a complete overview of the epic struggle between man and microbe, from our earliest bouts to our latest skirmishes. She also shows how the discoveries of such wonder drugs as penicillin has altered the course of modern medicine - and how such drugs have served as a panacea, making us think that we would always be safe. In truth these drugs, and their over use, were actually causing us to be placed in grave danger as more and more virus become drug resistant, such a the new, and virulent forms of drug-resistant tuberculosis. She also offers insights into modern virology and the attempts being made to protect mankind.

While Garrett is clearly trumpeting a global warning, she does not think that we are necessarily doomed. She offers this book as a wake-up call. Just as disease has become globalized, so to must the efforts to identify, and ameliorate, the causes of such ailments. By unifying against this common foe, we have a chance to protect ourselves. And she justifiably chides our public health officials for not taking the threat of viral epidemics seriously. There are many simple steps that we can take to retard the spread of these diseases, steps as simple as merely washing our hands regularly or to ensuring that everyone has a clean source of drinking water. She also discusses how social and political activities help to spread diseases, as well as offering suggestions of how to counter these negative influences. By taking preventive steps now, by being constantly vigilant for emerging infectious diseases, and by taking pro-active steps once a new disease or outbreak is identified, and by educating ourselves to what viruses are and how they can be combated, we might just survive.

The Coming Plague may be off-putting to some readers because it is a long, and very detailed book. Don't let its size or subject matter intimidate you. This is a phenomenal book. It is a compelling and well-written book that I whole-heartily recommend. It will be of extreme interest to anyone interested in virology, public health, or simply the history of man. The Coming Plague helps put into perspective the causes and spread of viral illnesses. She examines the impact that these diseases can have, not only on the human body, but also the social, political, and economic repercussions from these illness. She also offers a pointed example of the impact that these illness can have on the viability of our species, and the steps we can take to help protect ourselves.

Related Reviews:

How the Cows Turned Mad, by Maxime Schwartz.
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Public Health Law: Power, Duty, Restraint, 2nd Edition, by Lawrence O. Gostin.
Newly revised and expanded, this is a comprehensive introduction to the field of public health law, and the role that the government does, and should play in protecting the health of its citizens.

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