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Summary: Thought-provoking study of Malaria and Kala Azar
Review: Robert Desowitz leaves his readers with many 'cliff-hangers' in "The Malaria Capers". The version I read was published in 1991, so some of his unfinished stories may have endings by now---all except for the most important story of all, which is the search for an effective vaccine against the parasitic protozoans that cause malaria and kala azar (visceral leishmaniasis).Immunization campaigns have eradicated smallpox and may be on the verge of eradicating polio, but the two diseases that this book focuses on cannot currently be prevented with vaccines. The danger of catching malaria or kala azar can be minimized---unfortunately the majority of the population at risk can't even afford the most effective preventive measure---a bed net soaked in insecticide (according to 2000 World Health Organization statistics this costs about $4, plus $1 per year for a supply of insecticide). No wonder Desowitz gets so mad and preachy in "The Malaria Capers". Malaria still kills over one million people a year (another 2000 WHO statistic) - most of them young children. None of the vaccines that scientists were working on when this book was written have proven to be effective, which is exactly what Desowitz predicted. In his last chapter, "The Vaccine Felonies", he excoriates the Malaria researchers who spent their AID grants on vaccines that were already proven to be ineffective and unsafe for humans. While doing so, they diverted funding from proven preventive measures such as bed nets, put Owl monkeys on the endangered species list, and (even more feloniously according to our laws) lavished the grant money on themselves and their office assistants. One of the stories that Desowitz couldn't finish in 1991 was whether these researchers were tried, convicted, and sent to prison. This book is more polemical and as a result, less interesting to the lay reader (myself) than his "New Guinea Tapeworms and Jewish Grandmothers", but it does have a few 'human interest' stories. The most haunting begins in a small Thai village: "...The school assembly bell, hanging by a rope from a limb of a mango tree, is the nose cone from an unexploded [Japanese] bomb. Next to the school, raised on pillars, is the wooden residence of a group of monks. On this late morning in June their prayers have ended; only the unceasing anguished cries of a monk dying from throat cancer break the subdued quiet of the village. In a one-room, wood-framed, tin pan-roofed house at the village edge, Amporn Punyagaputa, twenty-three years old and big with child, sits alone, feverish and confused by the searing pain in her head." Stories like this represent Desowitz at his best and most humane. I can almost guarantee that Amporn Punyagaputa will help you remember why Malaria is still such a killer, long after you've forgotten who misappropriated the AID funds. And you will definitely understand why Desowitz is so angry. You'll be angry, too.
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Summary: A "Must Read" for Infectious Disease & Public Health Folks
Review: Robert Desowitz's attempt to chronicle the successes and failures of man's quest to leash the ravages of tropical disease (especially malaria and leishmaniasis), results in a very engaging and easy to read book. Through his entertaining and at times, cynical approach, the author explains how throughout history, man's desire to rid himself of the pestilence of infectious disease has sometimes met with success (as in the case of smallpox), as well as with failure (as in the case of malaria). If for instance, we take the case of malaria, just in the figures utilized by the author in his accounting of the US Agency for International Development (USAID) effort to combat malaria, he chronicled over $100 million "thrown at" this disease, with the disease still flourishing today in many parts of the world! The author's method of "personalizing" or presenting the experiences and challenges faced by many people in this world at the individual level, succeeds in engaging the reader from the very first chapter. The opening account of the Indian woman, Susheela, who tries desperately to save her dying daughter from visceral leishmaniasis, only to discover that the medicine required to save her daughter is grossly unaffordable, rivets the reader's attention. Here is a personal account of a human tragedy, which could have been told from the perspective of too many families in developing countries even in today's modern world of globalized interdependence. Additionally, Mr. Desowitz does a good job of giving the reader a historical context in which many of the major events in the history of public health, actually took place. This helps the reader to develop a historical frame of reference and better understand the reasoning and motivations of key individuals and governments involved in tropical disease research during that particular period. Mr. Desowitz seeks to inform the reader as to why there currently exists either cures, treatments or vaccinations to only certain diseases, while other diseases seem to flourish with little to no concerted effort by any government, private or international agency to control them. "During the past two decades," states the author, "when biotechnology has made so many stunning advances, the health of tropical peoples has worsened. New, affordable, non-toxic chemotherapeutics have not been developed (because) the drugs-for-profit pharmaceutical industry gives low priority to the diseases of the poor people." Rarely, suggests the author, has human altruism towards his fellow man been the primary reason for the development of protective measures and cures from these diseases. Other more materialistic or self-serving reasons such as economic gain, protection of business, government or military interests, or the quest for recognition and notoriety (such as the Nobel Prize), have been the primary reasons for tropical disease research. The author posits that this motivation continues to this day with relatively little contemporary research effort going into the "poor people diseases" of malaria and tuberculosis. The author presents his main argument first by effectively painting a bleak picture of despair in recent-day India, followed by a detailed chronology of the historical events (and non-events) that lead up to it, and then concludes with an implicit warning. The fact that the health of tropical people has worsened over the past several decades is a physical manifestation of a perceived lack of international concern for certain regions of the globe. Mr. Desowitz cites numerous examples of national and international efforts to combat certain diseases throughout history, and dissects them in a manner by which the reader is left with a more thorough understanding of why the project failed or succeeded in accomplishing its objective. He presents to the reader the "rest of the story" which usually underlies the official version of a project or initiative and uncovers how the human factor of greed, self-service, and ulterior motivations have sometimes driven honest efforts into subversion. On the contrary however, he also very effectively describes how some of the earlier pioneers in the study of infectious disease persevered even in the face of adversity and defeat. A very good example of this is the case of Surgeon Captain Ronald Ross who after over three years of painstaking research and experimentation, discovered that malaria was transmitted by the bite of an infected female Anopheles mosquito through its salivary glands. Captain Ross' discovery was the culmination of not only his own personal work, but also the work of the countless researchers who came before him and contributed towards the building of the existing body of knowledge in malaria. There were many occasions in Captain Ross' quest for discovery that this author would have thought twice about turning my research efforts elsewhere! He was a true testament in perseverance and will. The Malaria Capers is a "must" read for all public health professionals and those aspiring to become one, as well as personnel entering the clinical research field. It is a fundamental book that prepares those seeking to enter the public health arena to face the challenges contained in the field of infectious diseases. It also sheds some light to the infectious disease researcher why research is only conducted on some diseases, and not others. A potential weakness of this book (which is also a strength!) is the author's perceived cynicism, especially when he describes many of the human blunders and indiscretions, which in his opinion may have set back the discoveries of potentially life-saving drugs and programs by many years. Mr. Desowitz appears to be an absolute subject matter expert in the field, and one who has "walked the walk" and not just "talked the talk." He does an absolutely superb job in capturing the reader's attention and instilling in him the knowledge acquired through years of working the business of infectious disease research. I highly recommend this book to anyone even remotely interested in the area of infectious disease. A "highly recommended" book!
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