Betrayal of Trust: The Collapse of Global Public Health by Laurie Garrett.
Publishers Weekly, starred review
"On a par with Rachel Carson's Silent Spring . . . Garrett sounds the alarm with an articulate and carefully reasoned account." --This text refers to the paperback edition of this title
Los Angeles Times
"Displaying masterly craftsmanship . . . assiduously researched . . . Garrett's message is loud, clear and convincing." --This text refers to the paperback edition of this title
". . . traces public health through an engaging series of events and personal experiences -- her own and others' . . ." --This text refers to the paperback edition of this title
In her surprise best-seller The Coming Plague (1994), Pulitzer Prize^-winning Newsday reporter and former NPR science correspondent Garrett drew readers' attention to emerging, antibiotic-resistant diseases. Her primary recommendations were more (and more effective) public-health fieldwork, research, and preventive medicine. In Betrayal of Trust, Garrett's subject is public health itself: the desperate inadequacy of public-health infrastructure in much of the developing world and the shocking neglect of that infrastructure in "developed" nations. Garrett moves from the relatively simple inadequacies revealed by the 1994 pneumonic plague outbreak in India and the 1994 Ebola epidemic in Zaire to a nuanced analysis of the issues involved in the near-total collapse of public health in the former USSR and the years-long underfunding and lack of respect for this key government responsibility in the U.S. (Her U.S. chapter pays special attention to public health in New York City, Los Angeles County, and the state of Minnesota.) Garrett's "biowar" chapter makes clear that the threat of biological terrorism has gained the attention of world (and U.S.) leaders, but their responses to date have been dominated by a military (rather than public-health) mind-set. Dramatic changes in attitudes as well as resource allocation will be needed to construct a public-health infrastructure capable of coping with the myriad challenges of globalization. Mary Carroll
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"One of the Best Sci Tech Books of 2000... Argues that protecting its citizens' health is the responsibility of...government."
Foreign Affairs March/April 2001
..a twin... of the author's best-selling The Coming Plague- interesting, sprawling, heavily anecdotal, and amply footnoted... a useful warning
Dr. James Orbinski, president, Médecins Sans Frontières, winner of the Nobel Peace Prize
"Bravo to Garrett for a diagnosis and wake-up call that is both brilliant and prescient."
In this meticulously researched and ultimately explosive new book by the Pulitzer Prize-winning author of the New York Times bestseller The Coming Plague, Laurie Garrett takes readers across the globe to reveal how a series of potential and present public health catastrophes together form a terrifying portrait of real global disaster in the making. --This text refers to the paperback edition of this title
The author, Laurie Garrett , April 18, 2000
Globalization and the threat to global public health systems
When THE COMING PLAGUE was a bestseller in 1995, readers convinced of the terrible crisis of newly emerging diseases, wanted more - especially solutions. The problem was that I could only reflect what scientists in the field were saying at the time: it was vague, even a bit desperate.
That propelled me on a quest. I had to know why genuine solutions weren't at hand, and where they might be found.
The result is BETRAYAL OF TRUST: THE COLLPASE OF GLOBAL PUBLIC HEALTH, due to be published this August by Hyperion. I hope that you will not only read this book, but spread the word. The issues are, quite literally, matters of life and death to us all.
BETRAYAL OF TRUST is about globalization, not of the Web or of rock and roll, but of microbes and disease risks. The telltale stories are already there. A wedding banquet in wealthy Westchester County, New York sickens all in attendance, thanks to cyclospora parasites on the raspberries served atop the wedding cake: raspberries grown in Guatamala. Schools all over Japan are shut down because something the children are eating gives them deadly E. Coli infections: that "something" turns out to be daikon sprouts (a staple of the Japanese diet) grown in Idaho downstream from contaminated cattle. The entire world becoems hysterical over an Ebola virus outbreak in Zaire: an outbreak fueled by clinics so starved for medical supplies that doctors and nurses spread the disease to their patients because they lack protective gloves or sterile equipment. HIV and hepatitis viruses become epidemic throughout Siberia because alienated post-Communist youngsters drown their sorrows in opiate fogs, administered via contaminated syringes filled with virally infected heroin.
Wherever the millions of people who cross an international border daily go, their microbial hitchhikers follow. Similarly, the globalized food production system means worldwide risks of bacterial and parasitic diseases. Global misuse of antibiotics signals emergence of completely drug-resistant, untreatable forms of tuberculosis, strep pneumonia, malaria and dozens of other diseases. A global marketplace for the 21st Century may look like Minneapolis' Mall of America; or, horribly, it may more closely resemble the outdoor produce marts of central Africa.
My search led me to India in late 1994, during that country's pneumonic plague epidemic. And to Zaire in 1995, during the Ebola virus outbreak in Kikwit. In 1997 I spent several months traveling across the former Soviet Union nations, witnessing the complete collapse of their health systems, and the resulant epidemics and abysmal declines in life expectancies. Throughout 1998 and 1999 I dug through the history of public health in the United States, trying to understand what went wrong: why did the greatest public health system in the entire world lose its way? And I traveled all over Europe and the U.S. looking for ways to bridge the widening gap between what sorts of drugs and vaccines the world actually -- desperately -- needs, versus what is in the research and development pipeline at the largest pharmaceutical companies.
The future is now, and it demands globalized public health that can match the new globalized threats. But the trend is in the opposite direction, as governments trim public health spending, medical care consumes precious remaining health dollars and profit drives all pharmaceutical innovations. Today the issue of emerging diseases has been elevated to official U.S. government status as a threat to National Security, and is receiving attention at the highest levels of the governments of the U.S., Canada, the European Community and within the United Nations system. That's all well and good, but it's hardly enough. No protective plans can be executed in the absence of a strong public health system in the United States and throughout the world. And, sadly, such a system no longer exists.
BETRAYAL OF TRUST has consumed five years of my life, and exhausted me. If you read the book, however, all the pain and agony will have been well spent.
Thanks for reading this,
About the Author
Laurie Garrett is a Pulitzer Prize-winning reporter who has been a health and science writer for Newsday since 1988, and a contributor to such publications as Vanity Fair, Esquire, the Los Angeles Times, and Foreign Affairs. Previously, she was science correspondent for NPR. She is the only person to have received all of the top four awards in American journalism: the Pulitzer Prize (for which she has three times been a finalist); the George Foster Peabody Broadcasting Award; the George C. Polk Award; and three times honored by the Overseas Press Club of America. Her book The Coming Plague (1994) was named "one of the best books of 1994" by both the New York Times Book Review and Library Journal, and was a national bestseller. Garrett lives in Brooklyn, New York.