Infections and Inequalities: The Modern Plagues, Updated Edition With a New Preface

Rating:
Summary: Wonderful etiological analysis, but unfounded conclusions.
Review: Anyone in the public health arena has heard (or even read) of Paul Farmer. The Harvard MD/PhD (Anthropolgy) is indeed a passionate and competant professional who has fresh drive and leads a commendable life in service to humanity. This book seems to be his most popular work (at least on campus of major public health colleges) and it deserves attention and analysis.

Farmer gives systematic treatment of HIV and TB etiology and prevalence in the US and Haiti. More importantly, how those diseases affect the poor in inequitable ways. Peppered with intimate anecdotes and cutting analysis, the book brings hard ideas with the immediacy of the individual plight. He debunks myth of AIDS early history and establishes perspetive for the disease to be viewed/studied in light of the poor and the strucutral violence that (he deems) causes the propensity of the disease in the lower levels of society. He offers solutions and pleas for attention to these 'new plagues' so that the effects can be mitigated for the sake of all humanity.

There are some issues with that perspective. Of course every author brings inherent bias to the writing (either intentional or not), but Farmer makes no apology for his worldview and dismisses opinions of others who are even within the sientific community as he. John Stuart Mill (in "On Liberty") would say that such an attitude is likened to assuming infallibility (which Farmer more or less accuses the attitude of the 'rich' toward the modern plagues). His neo-Marxist tendency completely undermines the state of the world and he therefore addresses his problems from a "the way it should be" approach. That is his prerogative, but taking such an attitude means that his ideas will remain just that: ideas. His lack of pragmatism borders a silent taint of militarism and that approach rarely attracts policy makers, even those on the left.

Farmer assumes that a preponderence of evidence precludes a serious analysis of personal aganecy. No one would argue the conflict of structural violence and the inherent effects on personal agency. Yet, the fact remains that it does exist and it at least needs to be addressed in a thorough matter in order to be a fair treatment of the subject matter.

Furthermore, he needed to address the distal factors (i.e etiology and biology of the diseases) with the proximate (i.e. socio-econimics, etc...) for the book to be of more interest to the lay person. Despite my reservations, it is still a great book to get the reader "out of the box" and see AIDS and TB with the urgency it deserves. Yet, this type of book needs to be in the hands of the lay, and this recommendation would help.

Lastly, Farmer claims on several occasions a foundation of political economy in the analysis of his subject. He is a physician and anthropologist, and without the concurrent opinions of a political-economist to back up his claims, the ideas therein are weak at best. His political-economic opinions may be in line with greats like Marx and Henry George, but he cannot assume the validity of his assumptions just by telling the readership he his resting on such evidence. Several other leading political-economic ideas stand in direct opposition to his conclusions of goverment fixing all health problems to his liking.

All in all, it is hard not to be moved by Farmer's compelling treatment of such horrendous plagues on humanikind. Yet, passion does not always equal pragmatic and working solutions. Therefore, his work will hopefully inspire those who can take his passion to offer clear and viable solutions in the war on these plagues.

Michael Jewell, MPH

Rating:
Summary: Paul Farmer-- the Cassandra Prophet
Review: Anyone who has traveled to a third world country and viewed the slums and abhorrent conditions millions of people live in,
with no basic sanitation or clean drinking water, will not be surprised by Dr. Paul Farmer's findings regarding the emergence of deadly pathogens in these countries. He ties the spread of AIDS in third world countries to the sex trade,an economic necessity for many young women,men and children, and the easier transmittal of the disease due to untreated STDs. His ethnographic studies of HIV positive women in Haiti, who are more likely to be partners of soldiers or truck drivers, two of the few paying professions in that country, provides another economic link to this disease. Most disturbing are his findings regarding multi-drug resistant tuberculosis,which is often a presenter disease of HIV. An estimated one third of tuberculosis cases in the US occur in someone born outside of the country, and Farmer feels that one third of the world's population harbors the tubercle bacillus, which easily emerges when someone's body is broken down by poor nutrition, other illness or a compromised immune system.
The vignettes of patients he has treated and saved, or was too late to save, place an unforgettable face on these diseases. He attacks arguments against treating third world tuberculosis and HIV as morally unsound and compares the costs of military campaigns against the pittance spent on
drugs that could save millions of lives. Another disturbing book- a worthy winner of the Magaret Mead Award.

Rating:
Summary: Shining a Light
Review: Dr. Farmer sums up what you can hear in his lectures (he is an amazing speaker), read in journals, and hear in his interviews: The "modern day plagues" result directly from Structural Violence. I read this book for my culture and health class and could not put it down. He writes with an eloquence unheard of in most anthropologists while at the same time with the passion of a deeply concerned physician. Although in some points the book can get repetitive (as case studies overlap) it is a spectacular, enlightening read that I would recommend to anyone, particularly potential (and current) medical anthropologists.

Rating:
Summary: Shining a Light
Review: Dr. Farmer sums up what you can hear in his lectures (he is an amazing speaker), read in journals, and hear in his interviews: The "modern day plagues" result directly from Structural Violence. I read this book for my culture and health class and could not put it down. He writes with an eloquence unheard of in most anthropologists while at the same time with the passion of a deeply concerned physician. Although in some points the book can get repetitive (as case studies overlap) it is a spectacular, enlightening read that I would recommend to anyone, particularly potential (and current) medical anthropologists.

Rating:
Summary: Complex causality: why people are really at risk for disease
Review: Finally Dr. Farmer couples his lucid historical, political and economic analyses of the conditions that put the poor at risk for bad health outcomes, with a plainly indignant calling out of healthcare professionals and healthcare organizations to make honest efforts to understand and remedy conditions which would never be tolerated among the well off in Western nations. In his goundbreaking, earlier books, "AIDS and Accusations," and "The Uses of Haiti," Dr. Farmer matter of factly discusses the global and local structural conditions and misrepresentations which led to the spread of disease and persistent, dismal health conditions in Haiti. In "Infections and Inequality," Dr. Farmer adds moral overtones to incisive, sociopolitical analysis and his characteristic accounts of individuals suffering from disease. The book consequently provides a powerful reflection from a man who has worked in some of the world's poorest regions on what the benefits of medical technology mean for people who have not traditionally had access to them. A powerful, informative read that clearly reflects the years of experience of a physician who has wrestled with the global responsibility of caring for the those who are worst off. An obligatory read for anyone even thinking of working for the impoverished of the world.