The politics of the microbe soup

The Coming Plague — Newly emerging diseases in a world out of balance
By Laurie Garrett
Virago, 1995. $29.95
Reviewed by Dot Tumney "Ultimately, humanity will have to change its perspective on its place in Earth's ecology if the species hopes to stave off or survive the next plague. "Microbes, and their vectors, recognise none of the artificial boundaries erected by human beings. Theirs is a world of natural limitations, temperature, pH, ultraviolet light, the presence of vulnerable hosts, and mobile vectors." Well there you have it. Worse, both your digestive system and your favourite yoghurt won't work without microbes. The balancing act is not simple. The Coming Plague describes in detail the successes and failures of attempts to control infectious diseases over the last 30 years. Infections spread best among humans living in poverty, crowding and ignorance. The Black Death in the middle ages was so devastating because no one realised the cure was to kill off the rats. That plague spread widely but slowly because it had to go on foot. HIV/AIDS spread, however, benefited from a long latency period, a highly mobile human population and idiotically repressive policies that left it free to grow in marginalised groups and provide a reservoir for wider distribution. Nothing works as well for a microbe than to get into poorly equipped medical facilities run by well meaning missionaries with no medical skills, vitamins and drugs to be injected, and reused needles. The potential for disaster when invasive methods are employed in the absence of effective hygiene is astronomical. Microbes entering a body directly into the blood bypass much of the normal defence mechanisms of the skin, respiratory system and gut processes. Since the 1970s, expensive medical technology, drugs and methods have been exported in bits and pieces to everywhere. The results are a few good hospitals here and there, and a dog's breakfast of useless equipment and wrongly used drugs in between. Garrett points out that diseases which exist in a low toxicity among an isolated population may take on a totally different character when given a previously unexposed set of hosts. Organisms may also adapt in response to a changed environment. Microbes which are dangerous but hard to transmit may arrive the easy way by blood to blood transmission. Simple and effective disease control methods are mainly labour intensive (nursing time, cleaning and disinfection); low technology (involving isolation and protective clothing); unprofitable; and unspectacular, therefore not useful for either corporate PR or fundraising. Garrett's book contains a wealth of detail on how to confront infectious disease. She follows several researchers and particular investigations to illustrate the ineffectiveness of regulators and managements, the lack of political savvy among (rich) researchers — research in poor countries leads one to a clear understanding of politics if not the possibility of good working equipment, libraries or fax machines. When research is complicated by politics, the implementation of public health policies becomes a minefield since "A major threat" is one of those "in the eye of the beholder" concepts. In addition the sizeable chunks of unreasoning belief that has shifted from religion to medicine in recent decades has given, not only individuals, but also institutional thinking a severe case of magic bullet syndrome. The emergence of drug resistance in common, previously controlled diseases came as a rude shock to recent generations of "curative" physicians. Rich people were no longer safe — even if you could afford fancy pills there mightn't be one that worked. And you couldn't even take the damn bug to court. Magic bullet type thinking is tailor made for market medicine, thus the mad rush of pharmaceutical companies to the new wonders to be found in rainforests. The microbe population (forgive the imagery) is sitting back laughing its head off — swap a few bits of DNA with the bug next door and off we go again. It's not that magic bullets aren't useful, it's just that too narrow a focus is deadly. Vaccination programs must be carried out completely. Blood products must be cleaned up. Reusing needles must be totally eliminated. Proper use of antibiotics is essential both for patient treatment to be effective and to prevent loss of effect. Of course money is hard to find. But all the research funding recently invested in cancers and lifestyle problems had better be balanced by efforts to keep tabs on microbes. Besides, the more work you do on cancers and degenerative diseases the more likely you are to find a virus helping things degenerate or mutate. If money is hard to find, rational social planning planet-wide, equally essential, is even harder. For example, all basic health advances on a large scale necessitate the education and empowerment of women the world over. In the end, capitalism's much worshipped market forces don't stand a chance in competition with the inhabitants of the microbial soup — microbes engage in competition and growth on a scale that leaves BHP looking like a little woolly lamb. We more complex life forms had better find another way. This engaging book is a good start.