The Malaria Capers: More Tales of Parasites and People - Research and Reality Hardcover – 29 Jan 1992
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Like such eminent science writers as Stephen Jay Gould and Lewis Thomas, Mr. Desowitz manages to make the basic principles of his subject immediately comprehensible to the general reader. He has also succeeded in giving us a profound appreciation of the ways in which scientific and medical knowledge advances, through hypothesis, error and experiment, through serendipity, dedication, and perseverance. --Michiko Kakutani"
Like a novelist, [Desowitz] draws the reader into the human tragedy of disease. . . . Rich in historical-medical detective stories. --Betty Ann Kevles"
A gripping account of how a one-celled protozoan has triumphed over modern science. "
Just as it was not necessary to be an astrophysicist to feel the grandeur and scope of Stephen Hawking's "A Brief History of Time," it is not necessary to be a parasitologist or specialist in tropical medicine to relate to the drama, tragedy and even romance of Desowitz's fascinating and provocative story. . . . Interesting and important. " --This text refers to the Paperback edition.
From the Back Cover
Like such eminent science writers as Stephen Jay Gould and Lewis Thomas, Mr. Desowitz manages to make the basic principles of his subject immediately comprehensible to the general reader. He has also succeeded in giving us a profound appreciation of the ways in which scientific and medical knowledge advances, through hypothesis, error and experiment, through serendipity, dedication, and perseverance. --This text refers to the Paperback edition.See all Product Description
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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.
The biggest disease threat in the world is not AIDS. Not lung cancer. Not heart disease. It's malaria, which kills more people every year than AIDS has killed altogether. (2007 update: No longer true; AIDS now kills about as many people as malaria each year.)
Most of them are young children, with pregnant mothers also a prime target. Almost all are poor, powerless and colored.
And their situation today is worse, considerably worse, than when the rich countries amassed their advanced medical and public health techniques to attack malaria a couple of generations ago.
In this angry book, Robert Desowitz, a (now retired) professor of tropical medicine, medical microbiology and public health at the University of Hawaii, says it did not have to be, and, as he has in past books, he points the finger of blame when other commentators are too scared to.
True, malaria is a tough foe. Of several kinds, only one, caused by a parasite called Plasmodium falciparum, is often fatal, but it is a fearsome predator. Where falciparum reigns, the infant mortality rate runs 40 to 50 percent.
And its imperium is spreading. Malaria used to be relatively uncommon in the cities of black Africa, which, bleak as they were, were inhospitable to mosquitoes. The cities have grown enormously, and failed attempts to eradicate the principal mosquito vector merely bred mosquitoes with urban tastes.
Malaria, however, is not only a tropical disease. Rich countries tend to control their mosquitoes -- by destroying their wetlands, if nothing else -- but as recently as the 1890s, the coast of Georgia was depopulated by malaria, and when Desowitz was studying in London there was malaria there, too. But most of us think seldom of malaria; no one gives dance benefits to raise money for malaria.
To reinforce the difference between the rich and healthy and the poor and diseased, Desowitz also traces the story of another killer of the poor in the tropics, a disease most Americans have never even heard of, visceral leishmaniasis. It is a parasite, too, but spread by a sandfly.
It is nearly as deadly a killer as plague, and where it reigns -- Bangladesh, Bengal, Nepal -- it has the same name, kala azar, the black sickness.
Desowitz, no sensationalist, describes one death from each disease, just to show what it's like, in chapters of relentless horror.
Then he turns to equally relentless analysis. Things get complicated. For example, the leishmania organism has been around as long as man (and undoubtedly a lot longer), but accounts of the disease start only in 1824. Early recorded epidemics apparently spread thanks to the improved transportation system the British brought to India. (Which might seem a bad bargain, but economic historians think that system, especially the railways, ended famine in India, with the exception of one last hunger engineered by Mohandas Gandhi -- yes, the Mahatma, the only lawyer besides Thomas More ever to make saint.)
Complications pile on complications. "Kala azar is not a Stars and Stripes disease like cancer, coronaries, stroke and allergies," writes Desowitz. "No American president is going to introduce a bill for Congress to fund a War on Visceral Leishmaniasis," yet western experts and western money have explained the central problems of the disease, as they did of malaria.
They even found a moderately effective treatment, but it costs $15 (1992 price), which is far beyond the means of the citizens of the empire of kala azar.
So, like malaria, no one, especially in the rich countries, pays much attention to kala azar now. "No major efforts have been made to find an antimalarial to replace chloroquinine," a miracle drug against malaria until the plasmodium adapted to it. Modern medical research has "made the development of drugs to treat the diseases of poor people uneconomical." (2007 update: In testimony before Congress in 2004, Desowitz blamed U.S. AID for continuing to buy chloroquinine, which, he now says, is not only not a cure but in some circumstances is actually harmful.)
But there are even more complications. Skipping over some, we come to the Agency for International Development, which for over 20 years (2007 update: 35 years) has been spending millions to develop a malaria vaccine.
Never mind that "there has never been a vaccine to protect or cure any parasitical disease of humans," or that AID is not normally a medical research bureau. The program was, Desowitz says, in the hands of incompetents, some of whom are already in prison, other awaiting trial for peculations. (2007 update: 5 convictions)
Within its own empire, AID is circulating a self-serving description of this disaster, claiming that despite thievery, the program has made great strides. Desowitz says it has accomplished nothing significant, and I accept his version. (2007 update: no change)
His track record is superb. When all we got was happy talk from the medical community, Desowitz explained (in "The Thorn and the Starfish") why an AIDS vaccine is unlikely; when the rest of the medical community was nearly silent about the feminist attack on Bendectin, the only drug useful against morning sickness, Desowitz told us that was hogwash, and in 1991, in a widely unreported decision, the U.S. Supreme Court concluded that the so-called evidence against Bendectin was worthless. But by then it was too late; nobody makes Bendectin any more.
Desowitz is one of my few heroes. Of the AID malaria criminals he says, "It is possible that the villains were not the indicted, but the respectable, established and honored scientists. These were the men and women who said not a word in public protest when their opinions were . . . manipulated into falsifications. These were the men and women who said in private that the AID-sponsored research was of doubtful quality. These were the men and women who disregarded their responsibilities as leaders of their profession. Their silence may have caused irreparable harm . . . ."
In the 19th century, Henrik Ibsen wrote a play whose hero was "An Enemy of the People" because he spoke out when everyone else thought it best to keep quiet. That is exactly the kind of hero Dr. Robert Desowitz is.
Unfortunately, the writing is not memorable, and I found the author often a bit patronizing and trying too hard to be funny or witty where good, serious prose would have been more welcome. Also, sometimes technical concepts are mentioned without giving the reader sufficient background to fully appreciate their meaning and implications (unlike, for instance, in most of Stephen J Gould's writing, to mention an outstanding example of science essayist).
From this perspective, I think Harrison's "Mosquitoes, malaria and men" is a much better book on the history of the interaction between malaria and men, even if it does have the drawback of being about 30 years old, and hence misses almost all of the post 70s fight against malaria history. Friends tell me that Honigsbaum's "The Fever Trail" is also very good and more up to date, but I have not read it so I have no personal opinion about that.
So, let us put it this way, I found Desowitz to be an intelligent, very competent and compassionate writer, but I also found him a bit condescending, and his balance between clarity (for the layman) and completeness is a bit too tilted towards the former. Still, a good read, and I thank the author for his effort and for the resulting book!
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