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Summary: Journalistic heart of darkness
Review: "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 knocking at our doorsteps in the name of Ebola, TB and antibiotic resistent germs.Her book is less of a medical or epidemiology text than it is a social-political criticism of governments and bureaucracies that care more about their own interests than the interests of those they serve. Written in a journalistic, narrative style; Garrett humanizes the tragedy of crumbling infrastructures and uncaring governments that have resulted in the mutation of deading bacteria and viruses. Her research is impressive and conclusions are strongly opinionated. I highly recommend this book....
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Summary: Written for the public, but chock full of disturbing facts
Review: '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.
Rating: 
Summary: Disorganized, rambling text weakens the message
Review: (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. Key ideas are lost in an overwhelming mass of unnecessary, often pointless detail. Because Garrett fails to come up with a workable definition of public health, she writes about virtually everything conceivably related to it in an almost stream-of-consciousness framework. This flaw is best illustrated in the chapters on Russia and the United States. (2)Garrett has a genius for anecdotal storytelling about life and death. This is well illustrated in The Coming Plague and in the Ebola chapter of Betrayal of Trust. Her style lends itself to the wrenching and motivating portrayal of human suffering in discrete epidemiological events. But serial anecdotes ad nauseum are not well suited to clarity or to persuasive analysis of sweeping social issues. (3)Betrayal of Trust would have been much improved with severe editing. The addition of an analytically-trained co-writer to list summary points at the beginning or end of each chapter would have strengthened the policy-making function of the book. Such a framework would have allowed Garrett to more sensibly sort and select from her voluminous notes. (4) Visibly tighter editing would also have bolstered one's confidence that many attibutions of fact and quotation were confirmed before being published. As it is, publisher Hyperion comes away with a black eye for failing its talented author.
Rating: 
Summary: Informative, an excellent read
Review: ... 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.
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Summary: Another great effort by Laurie Garrett
Review: After Laurie Garrett's classic book "The Coming Plague" I've been waiting anxiously for an update and was overjoyed to find another work of this magnitude; "Betrayal of Trust" Laurie combines statistics and dramatic story telling to convey what may be the most urgent message of the 21st Century. The Health Care System is broken, its a global problem and its victims are the poor and disenfranchised first but the whole of society will suffer if steps aren't eventually taken. Christians, especially readers of the "Left Behind" series will enjoy this compelling description of the fourth horseman. Lauries backs up her claims with anecdotal examples, clear logic and lots of numbers. World class reporting meets world class story telling. Scary stuff, more so than anything else you might read in horror because its happening now!. For more about Laurie Garret check out www.npr.org and search for Laurie Garret http://search.npr.org/cf/cmn/cmnvs03fm.cfm Its a big book, 740 pages including the very detailed end notes. Its "The Hot Zone" and "The Stand" brought into present day. I've love to know if Stephen King reads Lauries work. That would really scare him...
Rating: 
Summary: An expert opinion
Review: Although this book is easy to read and manages to often convey some important concepts, that critique is on target in noting tha t the facts are often not quite right. Many other critiques fail to acknowledge this limitation in a book purporting to at least in part represent scholarship. T he hundreds of references obfuscate this problem, as it requires expertise to und erstand whether or not the references are indeed the latest and most accurate. Es pecially in a highly referenced book purporting to set forward accurate scientific information, it is regrettable that not infrequently the finer details are just plain wrong. The devil is in the details . There are entire sections where the book manages to misunderstand where the field really is "at" and the citations are to out-dated or discredited work. It would appear that there has been a failure to seek out a spectrum of top experts who might have filtered the wheat from the chaff. In other sections of the book, the reverse is true - it is perfectly on target, and has clearly gotten it absolutely right. The problem is: very few readers will be able to discern which portions are junk, and which superb. Get a pound, not a pinch, of salt if you read this. And read it solely for "fun" and not as the serious work you might erroneously suspect it was. There are som e marvelous kernels. And beware of quoting it as a reference!
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Summary: at last, a book about health that makes common sense
Review: for many years during my training in medical school and afterwards I kept thinking about the many problems facing healthcare and how those problems could be addressed in a way that could solve the issues and not add to them. I am extatic to realize that Laurie Garrett, using her no nonesense approach, has done a superb job in bringing to open the same issues that I thought were culprits of the chaotic status quo in healthcare. Kudos
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Summary: Collapse of Garrett's fame!
Review: 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.
Rating:
Summary: Overgeneralizations marr on-target basic message
Review: Garrett has spent most of her career following the medical and public health beat, and her work has been awarded for it. Unfortunately, this magnum opus continues her treat of taking reportage, and packaging it like a scholarly work. The inclusion of 100 of footnotes implies a scholarly focus that is not there. As reporting, this is perfect. The collapse of health in the former Soviet Union, the HIV/AIDS devastation of Africa, and the challenges to the minimal public health systems of China and India are all correct. The book tries too hard, however, to make the case that you can find the seeds of similar decay in the state of the various US public health systems reviewed - NYC, LA, and Minnesota - and that there is a betrayal of trust going on in the US, also. The fact is, there has never been more cash available for public health PREVENTION as there is today. The problem in the US is not a failure of the public health system, but of the health CARE system, that foists the provision of health services off on the prevention programs. In LA, the governmental system has to provide both public health protection AND services. In that case, the need for immediate services almost always trumps the long term view of public health protection. A further indication of the distance between reportage and scholarly work is when you get the facts wrong. For example, the author states that one of the 'heroes' of the piece, Hermann Biggs, left the NY City Dept of Health in 1923, dispirited from the Tammany regime. In fact, Biggs left the NYCDOH in 1913, and was Commissioner of Health of the NY State DOH from 1914-1923, where many of his key public health innovations occurred. Omissions are also common. While the NYC DOH is highlighted as an exemplar of 1990's public health, no mention is made of the fact that, during this period, mosquito and rodent control were markedly cut back. The connection to NYC's difficulty in controlling rats, and its playing catch up on mosquito control, should be obvious to as skilled a reporter as Garrett. Summary, read the book, not as history, but rather as a clarification of just how fragile civilization's hold on health is, and will remain.
Rating: 
Summary: Betrayal of Trust: Good book, badly written.
Review: Garrett has written a massively researched book on the decline of public health. The topic is very important and I enjoyed reading the book, but Garrett needs to take a remedial math course. Statements like "Per-capita health spending, having plummeted in the middle of the Great Depression by 120 percent..." or "Between 1940 and 1945 the population of California grew 135 percent from 6,982,000 to 9,491,000," cause the reader to pause. That's just on one page. Errors of this sort detract from her point. Other errors upset the reader even more. For example: (p. 245) (referring to hospitals) "Most were staffed by personnel who rarely-- if ever-- were paid." And one page later: "More than 80 percent of the annual 1997 Russian state health care spending, for example, went to hospitals, which used it largely to maintain their inefficient, overly large staffs." This book needed careful editing and proof-reading. It could have been several hundred pages shorter and made a more powerful statement. Even though I was keenly interested in the topic, I was upset with the errors, making me doubt her other conclusions. Still worth reading, but don't quote her numbers.
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