Rating: 
Summary: I've been talking about it and noweveryone wants to read it
Review: 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.
Rating: 
Summary: Surgical Intervention Necessary
Review: I bought this book Betrayal of Trust after hearing a very compelling interview with the author Laurie Garrett and NPR's Noah Adams. The first three chapters of eyewitness, investigative reporting on a plague pandemonium in India, media hysteria and government ineptitude at the second major outbreak of the Ebola virus in Zaire, and the sinking of the flagship of the Soviet state, the submarine Kurtz...excuse me, the model health care system for all citizens are very well presented reads. The presentation of the history of public health in the United States with all its gaffes, successes, pursuit by the evil empire of the AMA, is a muddled mess. I was impressed with the attempted scope of over three hundred years of historical evidence. The story line developed chronologicly and thematically, such that with relief I discover I have made it to the 1920's in a treatment of the Golden Days of Public Health only to find that to develop the narrative for certain resistance to Public Health we need to skip back. I don't feel that the author can bring her storytelling to this section which with its footnotes represents over a quarter of the book.There are way to many subthemes to keep track of and are not necessary for the concluding part of her book, where we stand now on the global preparation for threats to the Public Health. There is a woefully lacking index for the book which makes the hundreds of footnotes basically irrelevant. In the panorama of American Public Health the author gives pages to the issue of tobacco and the knowledge of its harm to the Public Health. Not a single line in the index. I think that if the author had found some American stories to report that I would have connected with her presentation and she would have more effectivally made her points. So skip the section on the United States and the footneotes and read the rest of the book.
Rating:
Summary: Good material, poor presentation
Review: 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.
Rating:
Summary: Good material, poor presentation
Review: 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.
Rating: 
Summary: Not a quick read, but thought provoking
Review: I love Laurie Garrett's work and have read both this book and _The Coming Plague_. And I am ready for her next treatise whenever she may print it.
What reviewers say about the lengthiness and sometimes meandering style is true. When I read her first book, I was reminded of a joke I heard when attending an exhaustive, three day long training about HIV/AIDS counseling and testing. One of the presenters quipped that you might feel like you were dying of AIDS even though you never had it.
Reading this book, you can feel wearied and overcome by the problems. But, if you go with her style, where she interweaves facts with stories of real pepole impacted by the very trends she cites, you get a greater sense of the dimensions of the problems and the reality of the issues.
As we watch our president dismantle so many care systems, I think the chapters on what happened to Russia when they did the same have extreme relevance.
The publish date of this fine book means that some of its data is aging but the representation of the problems and trend remain timely.
Read it.
Rating:
Summary: Another compelling, worthwhile read
Review: 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.
Rating:
Summary: Paperback Primer Invaluable to the Public
Review: 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.
Rating:
Summary: Good ideas, flawed execution
Review: The message of this book is clear, vitally important, and well driven home: public health is in bad trouble worldwide, due to failure of public and governmental will. One might call that "civic culture," or just plain old-fashioned morality. In any case, the world's governments are not spending nearly enough on public health. Garrett deals first with what may be the world's worst cases--Zaire/Congo and the former Soviet Union--and then shows that the same problems, in much less virulent form so far, exist in the United States. All this is true. However, I must agree with several other reviewers that the book is full of errors. The scientific name of the common rat, _Rattus rattus_, is misspelled "_Ratus ratus_" throughout. In the Zaire chapter, footnote 113 was obviously intended to correct and replace the inaccurate #114, but both were left in. And so on. More serious is the extremely cursory and misleading treatment of food, nutrition, and the results of failure in that area. Garrett loves the romance of new diseases, and tends to ignore problems that are not new or infectious. She treats nutrition as if nothing of much value were known and as if there were few (if any) problems beyond just getting enough food. Diabetes is mentioned a few times, but is not in the index. Yet diabetes is a vastly more important public health problem than Ebola virus, and may soon rival TB and AIDS worldwide, as genetically susceptible individuals consume more and more sugar, alcohol, and the like. (By contrast, her section on drugs and the failed "War on Drugs" is outstanding.) But most serious of all is the lack of a coherent plan for solving the world's problems. Garrett's major recommendation is more spending; necessary, surely, but not a plan in itself. What should we do first? What next? How can we be maximally cost-effective? How do we balance needs when funding is short--for instance, how should a Third World country balance providing clean water against building new hospitals? Above all, how do we get back the unique morality that brought us public health (as well as public education, conservation, and other public goods) in the early 20th century? The idea of aggressively acting for the comprehensive benefit of the entire citizenry is really quite rare in history. As Garrett points out, it is in desperate shape in the US today. Garrett could have made a much stronger case if she had focused on clear proposals.
Rating: 
Summary: Collapse of Garrett's fame!
Review: 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
Rating:
Summary: at times brilliant, prescient, inaccurate and frustrating
Review: 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.
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