“The Hot Zone” and the mythos of Ebola

The Hot Zone was first released in 1994, the year I graduated high school. Like many readers, that book and Laurie Garrett’s The Coming Plague* really sparked my interest in infectious diseases. In some sense, I have those books to thank (or blame?) for my career.

But I’m still going to criticize The Hot Zone, because as a mature infectious disease epidemiologist and a science communicator in the midst of the biggest Ebola outbreak in history, The Hot Zone is now one of the banes of my existence. A recent article noted that the book is back on the bestseller list, going as high as #7 on the New York Times list recently, and #23 on Amazon. It’s sold over 3.5 million copies, and it’s reported as “a terrifying true story.” Many people have gotten almost all of their Ebola education from just The Hot Zone (as they’ve told me over, and over, and over in the comments to this blog and other sites).

Here’s why The Hot Zone is infuriating to so many of us in epidemiology and  infectious diseases.

First–the description of symptoms.Preston himself admits that these were exaggerated. Over and over, he uses words like “dissolving,” “liquefy,” “bleeding out” to describe patient pathology. (If I had been playing a drinking game while reading and did a shot every time Preston uses “liquefy” in the book, I’d be dead right now).

Of a Marburg patient, pseudonymously named Charles Monet, he describes him as

“…holding an airsickness bag over his mouth. He coughs a deep cough and regurgitates something into the bag. The bag swells up….you see that his lips are smeared with something slippery and red, mixed with black specks, as if he has been chewing coffee grounds. His eyes are the color of rubies, and his face is an expressionless mask of bruises. The red spots…have expanded and merged into huge, spontaneous purple shadows; his whole head is turning black-and-blue…The connective tissue of his face is dissolving, and his face appears to hang from the underlying bone, as if the face is detaching itself from the skull…The airsickness bag fills up to the brim with a substance known as the vomito negro, or black vomit. The black vomit is not really black; it is a speckled liquid of two colors, black and red, a stew of tarry granules mixed with fresh red arterial blood. It is hemorrhage, and smells like a slaughterhouse….It is highly infective, lethally hot, a liquid that would scare the daylights out of a military biohazard specialist…The airsickness bag is brimming with black vomit, so Monet closes the bag and rolls up the top. The bag is bulging and softening, threatening to leak, and he hands it to a flight attendant.

“…the body is partly transformed into virus particles…The transformation is not entirely successful, however, and the end result is a great deal of liquefying flesh mixed with virus…The intestinal muscles are beginning to die, and the intestines are starting to go slack…His personality is being wiped away by brain damage…He is becoming an automaton. Tiny spots in his brain are liquefying…Monet has been transformed into a human virus bomb.

“…The human virus bomb explodes…The victim has “crashed and bled out.”…He becomes dizzy and utterly weak, and his spine goes limp and nerveless and he loses all sense of balance….He leans over, head on his knees, and brings up an incredible quantity of blood from his stomach and spills it onto the floor with a gasping groan. He loses consciousness and pitches forward onto the floor. The only sound is a choking in his throat as he continues to vomit while unconscious. Then comes a sound like a bedsheet being torn in half, which is the sound of his bowels opening and venting blood from the anus. The blood is mixed with intestinal lining. He has sloughed his gut. The linings of his intestines have come off and are being expelled along with huge amounts of blood. Monet has crashed and is bleeding out.”

And later, at autopsy:

“His liver…was yellow, and parts of it had liquefied–it looked like the liver of a three-day-old cadaver. It was as if Monet had become a corpse before his death…Everything had gone wrong inside this man, absolutely everything, any one of which could have been fatal: the clotting, the massive hemorrhages, the liver turned into pudding, the intestines full of blood.”

And I didn’t even get to what Preston says about Ebola and testicles. Or pregnant women. Seriously, there’s pages upon pages upon pages of this stuff.

Throughout the book, Preston presents these types of symptoms as typical of Ebola. Not “in worst case, this is what Ebola could do,” but simply, “here’s what happens to you when you get Ebola.” It’s even beyond a worst case scenario, as he notes in part: “In the original ‘Hot Zone,’ I have a description of a nurse weeping tears of blood. That almost certainly didn’t happen.”

Compare that to just about any blog post by actual workers with Médecins Sans Frontières, healthcare workers on the front lines of this and many previous Ebola outbreaks. Stories are scary enough when the reality of the virus is exposed, and with it the dual affliction of poverty and the terrible health system conditions of affected countries. I interviewed MSF’s Armand Sprecher a few years back during a different Ebola outbreak, and he noted this about symptoms–quite different from the picture Preston paints:

The patients mostly look sick and weak. If there is blood, it is not a lot, usually in the vomit or diarrhea, occasionally from the gums or nose.

The clinical picture of Ebola that people take away from The Hot Zone just isn’t accurate, and with 3.5 million copies sold, is certainly driving some (much? most?) of the fear about this virus.

Second, airborne Ebola. Though this trope is often traced back to “Outbreak,” Preston clearly suggests that both Zaire Ebolavirus and Reston Ebolavirus can be airborne. What he never discusses nor clarifies is that the “evidence” for this potential airborne spread is really thin, and not even indicative of animal-to-animal or animal-to-person transmission.

Rather, it’s much more likely that if airborne spread was involved, it was aerosols generated by husbandry (such as spraying while cleaning cages), rather than ones which would have been generated by infected primate lungs (a necessary step for primate-to-primate transmission via a respiratory route). Indeed, this is the paper that Nancy Jaax et al. published on the findings Preston talks to Jaax about, 13 years after the fact (the experiment is marked as 1986 in The Hot Zone), and noting that transmission due to husbandry practices could not be completely ruled out. It’s unclear also that the Reston strain moved through the primate facility via air, rather than via spread due to caretakers, equipment, or husbandry. Nevertheless,  it’s frequently cited as fact and without any qualification that Reston is an airborne type of Ebola.

Instead, here is what Preston says about it:

“If a healthy person were placed on the other side of a room from a person who was sick with AIDS, the AIDS virus would not be able to drift across the room through the air and infect the healthy person. But Ebola had drifted across a room. It had moved quickly, decisively, and by an unknown route. Most likely the control monkeys inhaled it into their lungs. ‘It got there somehow,’ Nancy Jaax would say to me as she told me the story some years later. ‘Monkeys spit and throw stuff. An when the caretakers wash the cages down with water hoses, that can create an aerosol of droplets. It probably traveled through the air in aerosolized secretions. That was when I knew that Ebola can travel through the air.'”

He then comes back to “airborne Ebola” several times, based in part on this idea.

But here’s the thing. Just about any virus or bacterium could be aerosolized this way–via high pressure washing of cages, for example. If it can bind to lung cells and replicate there, as we already know Ebola can, it can cause an active infection.

But that’s not the same as saying “Ebola can drift across the room” from one sick person to a healthy person and cause an active infection, as Preston tries to parallel with HIV in the above paragraph. Even in Jaax’s experiment and others like it, there’s zero evidence that primates are expelling Ebola from their lungs in a high enough concentration to actively infect someone else. And that is the key to effective airborne transmission. Think of anthrax–if it’s released into the air, we can inhale it into our lungs. It can replicate and cause a deadly pneumonia. But anthrax isn’t spread person-to-person because we don’t exhale the bacteria–we’re dead ends when we breathe it in. This is what happens with primates as well who are experimentally infected with Ebola in a respiratory route, but Preston implies the opposite.

Third, if it wasn’t for points one and two, The Hot Zone really could be read as a “damn, Ebola really isn’t that dangerous or contagious so I have little to worry about” narrative. Preston describes many “near misses”–people who were exposed to huge amounts of “lethally hot” Ebola-laden body fluids, but never get sick–but doesn’t really bother to expose them as such. All 35 or so people on the little commuter plane Monet flies on between his plantation in western Kenya and Nairobi, deathly ill, vomiting his coffee grounds and dripping nasal blood into the airsickness bag he handed to a flight attendant–none of them come down with the disease.

The single secondary infection Monet causes is in a physician at the hospital where he’s treated, after his bowels “ripped open” like a bedsheet. That physician, Shem Musoke, not only swept out Monet’s mouth until “his hands became greasy with black curd” but also was “showered” with black vomit, striking him in the eyes and mouth. Monet’s blood covered Musoke’s “hands, wrists, and forearms,” because “he was not wearing rubber gloves.” Musoke developed Marburg virus disease, but survived–one of the few secondary cases of infection described in the book.

Another “close call” was that of Nurse Mayinga N. She had been caring for one of the Ebola-infected nuns at Ngaliema Hospital in Kinshasa during the 1976 outbreak in Zaire, the first detected entry of Zaire Ebolavirus into the human population. Beginning to feel ill herself, she ditched her job and disappeared into the city for two days. She took a taxi to a different, larger, hospital in the city, but was sent away with a malaria shot. She’s examined at a third hospital and sent away. Finally she returns to Ngaliema hospital and is admitted, but by that time, had caused a panic. Preston says:

“When the story reached the offices of the World Health Organization in Geneva, the place went into full-scale alert…Nurse Mayinga seemed to be a vector for an explosive chain of lethal transmission in a crowded third-world city with a population of two million people. Officials at WHO began to fear that Nurse Mayinga would become the vector for a world-wide plague. European governments contemplated blocking flights from Kinshasa. The fact that one infected person had wandered around the city for two days when she should have been isolated in a hospital room began to look like a species-threatening event.”

How many secondary cases were the result of Mayinga N’s wanderings? That possibly “species-threatening” event? Preston again devotes several paragraphs to Mayinga’s gruesome illness and death, and notes that 37 people were identified as contacts of hers during her time wandering Kinshasa. He tells us they were quarantined “for a couple of weeks.”

The fact that exactly zero people were infected because of Mayinga’s time in Kinshasa merits half a paragraph, and not dramatic or memorable. “She had shared a bottle of soda pop with someone, and not even that person became ill. The crisis passed.” <–Yes, that is a direct quote and the end of the chapter on Mayinga. Contrast that to Preston’s language above.

Finally, beyond the science and the fear-mongering about Ebola, beyond everything and everyone in the story “liquefying” and “dissolving” and “bleeding out,” reading this book again as an adult, as a woman in a science career with a partner and kids, I was also left annoyed at the portrayal of the scientists. All of the major characters except one, Nancy Jaax, are men of course, ranging in age from late 20s to 50s-60sish. Understandable since this is in a mostly-male military institution and in a BLS4 setting to boot, but the one Preston focuses on for much of the narrative is Jaax.

While Preston may have been trying to portray Jaax as the having-it-all, tough-as-nails woman scientist, the fact that she’s the only one with any kind of home life is telling–mostly because he devotes more paragraphs to how she neglects both her children and her dying father than any success she has in her life outside of work. She is told early on by one of her colonels that “This work is not for a married female. You are either going to neglect your work or neglect your family.” This thought comes up repeatedly for Jaax, and in the end, while she was accepted and even honored by her colleagues and bosses, we hear over and over again how her children are left on their own to microwave meals and tend to their homework. How they desperately wait up for her to get home after work, often eventually falling asleep in her bed before she arrives. How she tells her father, dying of cancer back in Kansas and both knowing he only has a few hours to days to live, good-bye and “I’ll see you at Christmas” over the phone. How she barely arrives on time for his funeral after he passes.

We hear one paragraph about how another colleague, Thomas Geisbert, had a crumbling marriage with two small children, and how he left the children at his parents’ house for a weekend. Other than that, the personal lives of any other characters are practically absent, save for Jerry Jaax, Nancy’s husband. Even with him, much of the character development revolves around his fears of his wife working in a BSL4 lab.

The Hot Zone, for me, is unfortunately one of those books that you read as a young person and think is amazing, only to revisit years later and see it as much more shallow and contrived, the characters one-dimensional and the plot predictable. The problem is that The Hot Zone is not just a young adult novel–it’s still presented and defended as an absolutely true story, especially by huge Preston fans who seem to populate comment threads everywhere. And now it looks like there will be a sequel. At least it should be good for a drinking game.

 

*I’ll note that The Coming Plague is much more measured when it comes to Ebola–the two were grouped together because temporally, they were released close together, not because they display the same type of hype regarding the virus.

Interview with “Warm Bodies” author Isaac Marion

And now for something a bit different. I’ve mentioned before that I’m a big fan of zombies. So, I was intrigued when I started seeing press for Warm Bodies, a book by Isaac Marion about a zombie who is, well, not your typical zombie. Recently released as a feature film, I read the book a few weeks ago, and last weekend took my 13-year-old daughter to see the movie. I enjoyed both (as did my daughter), and asked Isaac if he’d be willing to answer a few questions for the blog. His interview is below (a few spoilers, take note):

Tara: Your take on zombies is a bit different than most stories. Obviously there’s the central idea that they can be “cured”–and they also talk and have friends. I saw in a previous interview that you said you’d kind of “stumbled” into the zombie genre and were not always a zombie geek. Can you describe your experience emerging as a bona fide zombie author, and what has the reaction to the book/movie been from the hard-core zombie community?

Isaac: The reaction has been pretty much split between two camps. Camp 1 is people who understand that a zombie is a fictional creature that has been portrayed differently, with different origins and different behavior, in pretty much every iteration and remains open to interpretation depending on the goals of the story in which it appears. That camp thinks its a great new idea and welcomes the unexpected shift in perspective that explores a lot of the unaddressed questions in zombie lore, while using the mythology to explore other, more human themes. Camp 2 is people who I don’t understand at all, who seem to think that zombies are real creatures that have been studied and defined by science, and that there are immutable “rules” to how they should function in fiction. These people tend to ignore the fact that every major work in the canon of zombie mythology has redefined what zombies are. First, they were regular people brainwashed by Haitian voodoo powder. (White Zombie.) Then they were corpses reanimated by mysterious cosmic radiation. (Night of the Living Dead.) Then they were regular people driven insane by a virus. (28 Days Later and onward.) In the midst of all this, we saw zombies with lingering consciousness who responded to music and speech (“Bub” in Day of the Dead) self-aware zombies capable of independent thought and even leadership (Land of the Dead) and yes, zombies who fall in love. (Fido.) I don’t really know what it means to be part of a “zombie community” but I’m certainly well familiar with the “genre” if all stories about a certain creature can be lumped into one genre. (Why is “Dragon” not a genre? Why is there no “Robot genre”? I don’t even think “Vampire” is considered its own genre.) My roots run pretty deep into geekdom, so it’s not like I just decided “I think I’ll write a zombie novel” and then had to research what the fuss was all about.

Tara: Each zombie story also seems to come up with their own terminology for zombies: “walkers,” “skels,” “Z’s,” “stragglers,” “biters,” etc. Yours are “corpses”, “the Dead,” and “Boneys,” though you do occasionally break the unwritten rule and refer to them as zombies. Was it important to you to try to differentiate your Dead from those that had come before in other movies/books?

Isaac: I think Warm Bodies is kind of a mashup of all the zombie fiction that came before it. I wasn’t trying to create a new “version” of zombies to add to the canon, I was trying to use all the tropes of that canon for satirical and metaphorical purposes. So I just combined everything–R doesn’t know where zombies came from, but he references every well known origin story in his musings. One of the unusual things about Warm Bodies’ universe is that it’s actually our universe. These people knew about zombies in fiction before they became reality. They’ve seen the George Romero films. So when zombies first started to appear, it wasn’t just “Oh my God there are corpses coming to life!” it was, “Oh my God, our collective cultural nightmares are becoming reality!” This is only briefly referenced in the movie (Julie holds up a copy of the 1979 film “Zombie” next to R’s face at one point) but it’s a little more explicit in the book and will be explored further in the sequel.

Tara: Zombie stories run the spectrum from trying to create very scientifically legitimate zombies (“Neuropathology of Zombies,“The Zombie Autopsies”–even “Zombieland” suggested the outbreak had resulted from a mutated “mad cow” infection) to not even trying to justify them scientifically. In the book, R can’t remember anything about how the world ended or the zombie plague may have begun, while Julie muses that it started when humans “buried themselves under greed and hate” until they hit the bottom of the universe, and then kept on digging–an idea more along the lines of a curse rather than an infection. And of course, The Dead eat the brains of the living and by doing so, gain their memories–so yours swings pretty far to the “not even trying” end of the spectrum. Were you worried about how that would be received when so many recent zombie stories have tried to be a bit more rooted in reality?

Isaac: The stories that root it in reality do so because they aren’t really about the zombies themselves, they aren’t using zombies for any thematic purpose beyond maybe some light social commentary, they’re mostly just props to menace the characters and create action. Obviously, with a zombie narrator, Warm Bodies is much more about the Dead themselves, and what it means to be in that state vs. fully alive. I didn’t use any science because this is a metaphorical story. In the sequel I’m writing now, it will go deeper into the actual metaphysical causes of the plague and the way human consciousness influences reality, but it definitely won’t reveal some random virus to explain everything. Most zombie stories use something like that because it’s quick and easily understood and clears the field for all the action and visceral thrills. That’s not really what these books are about.

Tara: When I first read the description of “Warm Bodies,” I admittedly cringed a bit. Like many others, I was a bit apprehensive that it was going to be a “Twilight” for zombies. Thankfully, R wasn’t sparkly like Edward and Julie wasn’t a pathetic wimp like Bella, and I was pleasantly surprised with how much I liked the book and the movie. Like much great zombie fiction, your book is entertaining but also has a bigger message about the state of society–very Romero-esque, even if your zombies are much different than his. How did the novel evolve from your initial short story, just musing about what a zombie might think about, to the richer allegory of the finished product?

Isaac: It had a lot to do with the state of my own life at the time I was inventing this story. I had moved from my small hometown to Seattle a couple years before and had left behind my conservative religious upbringing in the process. It was a weird moment in life, where I was trying to understand who I was and what my purpose was outside of this very small-minded, limiting, ultimately pessimistic worldview that I had grown up with. And beyond that, I was getting older, feeling the loss of energy and passion that comes with age and experience and trying to find a way to fight it off. So I started to notice a lot of parallels between my life and this unhappy corpse living in the wreckage of civilization, and my transformation started to connect with his. The story kind of just exploded out of me in a short period. I think it was a therapeutic experience for me as a person. Writing it helped me figure out some of my own struggles.

Tara: Still, it is a romance, complete with “R and Julie” and even a balcony scene. Like the play, R and Julie brought about change and a healing in their respective populations, even if that was not their intent. Why did you decide to incorporate that story and those references into your novel?

Isaac: It kind of just happened by accident, actually. I was fairly deep into plotting it when I noticed the ways my story had assembled itself around that classical arc, and I decided to run with it. To me, the Shakespeare allusions are just another layer, not really the central theme of the story, although people are quick to call it “Romeo and Juliet with Zombies.”

Tara: There seems to be a rash of first-person zombie stories lately–Hugh Howey’s “I, Zombie”, “Brains” by Robin Becker, or “Zombie, Ohio” by Scott Kenemore, in addition to “Warm Bodies.” Do you see this as a new trend–a humanization of the zombie?

Isaac: I’m not familiar with any of those. I would imagine people probably have similar thoughts to the one that first inspired my short story: “Why hasn’t this been done yet?” Villains are almost always more interesting than heroes. It’s always fascinating to get inside the mind of the bad guy and try to understand them. For thousands of years we’ve been watching the pure white knight slay the monster, and it’s getting old. People are starting to understand that morality and motives are complex and we want to know more about what goes on in the darker half that’s been hidden away from us for most of the history of fiction. I think as society becomes more and more comfortable with moral ambiguity, these kinds of perspective swaps will become more and more common.

Tara: Can you tell readers a bit about “The New Hunger” and your anticipated sequel to “Warm Bodies”? Any other writing projects you’re kicking around?

Isaac: “The New Hunger” is a novella that takes place seven years before Warm Bodies, involving a formative early encounter between Julie, Nora, and a newly undead R. It illuminates their histories and expands the scope of the world a bit, while foreshadowing a lot of what’s going to happen in the sequel. The sequel is going to be a lot bigger and more complex than Warm Bodies, less about zombies than death itself and the forces, human and inhuman, that make our world a dark place when it doesn’t have to be. It will explore some more metaphysical, even cosmic themes, and veer more toward modern fantasy than zombie horror. I’m pretty excited about it.

Many thanks to Isaac for participating! You can find out more about him via his website, or follow him on Twitter.

“Spillover” by David Quammen

Regular readers don’t need to be told that I’m a bit obsessed with zoonotic disease. It’s what I study, and it’s a big part of what I teach. I run a Center devoted to the investigation of emerging diseases, and the vast majority of all emerging diseases are zoonotic. I have an ongoing series of posts collecting my writings on emerging diseases, and far too many papers in electronic or paper format in my office to count. Why the fascination? Zoonotic diseases have been responsible for many of mankind’s great plagues–the Black Death, the 1918 “Spanish” flu pandemic, or more recently, HIV/AIDS. So you can imagine my delight when I read about Spillover, a new book by David Quammen on zoonotic diseases.

I’ve previously highlighted some of Quammen’s work on this site. That link goes to a 2007 story he wrote for National Geographic on “infectious animals,” which really serves as a preview to “Spillover,” introducing some of the concepts and stories that Quammen elaborates on in the book.

“Spillover” is wide-ranging, tackling a number of different infectious agents, including viruses like Nipah, Hendra, and Ebola; bacteria including Coxiella burnetii and Chlamydia psittaci; and parasites such as Plasmodium knowlesi, a zoonotic cause of malaria. HIV is a big part of the story; Quammen devotes the last quarter or so of the book to tracing the discovery and transmission of HIV from primates to humans, and from 1900 to present-day. He even takes the time to explain the basic reproductive number–something that’s not always a page-turner, but Quammen manages to do it well and without being too tangential to the rest of the story; much more of a Kate-Winslet-in-Contagion than Ben-Stein-in-Ferris Bueller delivery.

Indeed, “Spillover” is somewhat unique in that it doesn’t read quite like your typical pop science book. It’s really part basic infectious disease, part history, part travelogue. Quammen has spent a number of years as a correspondent for National Geographic, and it shows. The book is filled with not only well-documented research findings and interviews with scientists, but also with Quammen’s own experience in the field, which gives the book a bit of an Indiana Jones quality. In one chapter, he details his adventure tagging along with a research team to capture bats in China, entering a cave that “felt a little like being swallowed through the multiple stomachs of a cow.” This was after an earlier dinner in which he describes his encounters with the an appetizer of the “world’s stinkiest fruit” (I’ll keep the description of the smell to myself) with congealed pig’s blood for a main dish (bringing to mind the scooping out of monkey’s brains in “Temple of Doom”–and the various zoonotic diseases that could be associated with those, come to think of it).

Quammen’s book is an excellent, and entertaining, overview of the issues of zoonotic disease–why do they emerge? Where have they come from? How do they spread? The only thing that’s missing is more of a cohesive discussion about what to do about them. However, that’s rather understandable, as we certainly have less of a grasp of this question than we do about the others (and even with some of those, our knowledge is spotty at best). I hope “Spillover” will inspire another generation of future germ-chasers, as “The Coming Plague” did almost 20 years ago.

“Fool Me Twice” by Shawn Lawrence Otto

Science denial, I fear, is here to stay. Almost half of Americans believe in creationism. Anti-vaccination sentiment is going strong, despite record pertussis outbreaks. Academics are even leaving their jobs, in part, because of the terrible anti-intellectual attitude in this country. It’s depressing and demoralizing–so what does one do about it? Shawn Lawrence Otto’s “Fool Me Twice” offers an analysis.

Otto’s book is good stuff. He devotes the first quarter or so of the book to understanding how we got to where we are regarding science denial and anti-science attitudes. It’s a nice introduction, moving from Galileo up to modern day, and covering the intersections of science and religion, as well as the “two cultures” thinking. He uses these chapters to argue that science is inherently political, and that scientists need to engage in the public like in the good ol’ days past. Otto argues that today, partisan politics and shock jocks have pushed us further away from valuing science, and scientists are left wondering what they can do to compete against the money and influence that industry wields.

To do this, Otto creates something of a roadmap. It’s probably suggestions many of us in the field have heard before in publications such as Unscientific America and elsewhere, but it never hurts to hear it again. Engage. Talk to churches and other community organizations. Run for office. Be inclusive and avoid identity politics. Don’t be alarmist. Frame your message. Talk about *how* one does science rather than just the findings and the facts. While this is great stuff, he spends less time discussing the difficulties of actually, y’know, *doing* this as a scientist (though he does talk a bit about the Sagan effect early in the book, and so doesn’t completely ignore the problems that scientists can have when they do more communication and outreach).

Not surprisingly, he also brings up the importance of Science Debate, of which Otto is the CEO. Otto notes that candidates are questioned much more on religious issues than on scientific ones, and Science Debate can serve as a non-partisan platform to get important science questions answered by candidates. In 2008, both candidates did respond to a list of 14 questions. How much did it matter in the long run? Probably not a lot, but at least it did get candidates to think about important scientific issues and put ideas down in writing for the public.

In the end, I found “Fool Me Twice” a thought-provoking but dense book. I also wonder who Otto’s intended audience was. One back-of-the-book blurb reads “Before you vote in the next election, read Shawn Lawrence Otto’s “Fool Me Twice.” Bill Nye’s blurb also enthuses, “Here’s hoping some voters and Congress members take [Otto] seriously–soon.” Nice thought, but I can’t see the average voter picking up this book. There are portions within where even I found difficult to get through–his discussion of post-modernism, for example, probably would be fine for those with more grounding in philosophy and familiarity with its terminology, but again it got me thinking about target audience and how many would be able to connect the dots without giving up on the book at that point (and thereby missing out on a lot of the good stuff to come in later chapters). Maybe I’m too cynical. I do hope, however, that at least a number of scientists–especially those just wading into the waters of communication and science politics–do pick up the book, and dog-ear some of the important pages and suggestions as I have done. Otto has hope for a more scientific American future. I hope he is right.

Climate change and public health

I rarely write about climate change. As much as it’s been hashed out amongst climate scientists, and even many of the former “climate skeptics” have now changed their tune, I readily accept that climate change is happening, and is happening largely due to human activities. More importantly for my field, climate change is also having effects on human health in a number of different ways, from the movement of insect vectors into new areas, to warming of the seas leading to more extreme weather conditions, to the loss of coral reefs and the freshwater that these reefs protect from the surrounding oceans. It’s an immense field, and it seems that every time I turn around, another paper is published detailing the public health effects of climate change.

Luckily for me, many of these examples have been carefully documented in a recent book by Paul Epstein and Dan Ferber, Changing Planet, Changing Health. Epstein was a maverick in this field, trained as a physician who had carried out global health research in several African countries. In his previous position helping to run the Center for Health and the Global Environment at Harvard, he led research into a variety of areas in tropical medicine, including the role of climate in disease epidemiology. Unfortunately, as I was finishing up this book last night, the New York Times reported that Dr. Epstein passed away at the age of 67. This is a huge loss to the field, but work in this area will certainly continue, and we’re likely to only see more connections between disease and global warming in the coming years and validation of his passions and ideas.

“Changing Planet, Changing Health” is deceptively expansive. It’s a mere 300 pages before notes and index, but it takes you on a journey investigating the movement of mosquitoes in Africa, cyanide in Honduras, soybean rust in Illinois, pine beetles in Colorado, and even flooding in Cedar Rapids, Iowa. And yet, the book never felt disconnected to me–Epstein & Ferber manage to draw the myriad climate-associated threads together into a well-woven tapestry, and fluidly move from one topic to another. They also discuss what needs to be done to curb this destruction in the last chapter.

Of course, the last chapter is also one of the toughest. While climate change is harming our health in a thousand different ways every day, there’s still denial in many circles that it’s even happening, and none of the solutions to curb it are easy. Furthermore, too many people still see it as “just a polar bear problem” rather than something that actually makes a difference in their lives. This needs to change. Epstein and Ferber succeed in making climate change personal: something everyone who eats and breathes should be concerned about.

“The Fever” by Sonia Shah

Malaria is one of mankind’s most ancient scourges. A century after the discovery of its cause, various species of the parasite Plasmodium, humanity still remains in its deadly grip in many areas of the world. Malaria is estimated to have caused 225 million illnesses and almost 800,000 deaths in 2009, making it one of the top infectious disease killers. Many of these deaths occurred in children under the age of five.

Shah traces the history of malaria from the introduction of the parasite into the human population to modern-day controversies about malaria treatment, research, and funding. It’s a fast-paced read; informative but never dry. Indeed, Shah makes much use of metaphor; sometimes, to the detriment of the scientific narrative, in my opinion. However, that’s more of a minor issue to me.

Shah begins the book with an anecdote about her own childhood as an American visiting her relatives in India; sleeping under a bed net while her cousins sleep in the open, fearing mosquitoes, and India, and being ashamed of her fears. She notes later that, when her family hears she is writing a book about malaria, they ask her why–to them, it seems as silly as writing a book about the common cold. Shah notes this several times throughout the book–for example, explaining that many in malaria-endemic regions, people would rather use their bednets for fishing than to protect from mosquitoes, so while programs which deliver such nets can tout high numbers of bednets distributed it doesn’t necessarily mean that everyone who receives one is using them correctly.

Indeed, much of the book is spent discussing the limitations and missteps of anti-malarial programs, past and present, from issues of mosquito resistance to pesticides, to parasite resistance to chemotherapy. Another repeated thread is political will, or lack thereof, in anti-malarial programs, and the ping-pong that is played by many funding agencies. When programs demonstrate success and malaria is reduced, there is little will to continue such programs–which may be hampered in any case by the emergence of resistant mosquitoes or parasites. It’s a messy business, and today’s programs don’t seem to be much better off than those carried out in the previous century.

Shah’s book is a thoughtful read for anyone interested in global health–not only for the history of Plasmodium‘s detection and eventual proof as the cause of malaria (after many false starts), but also for the thoughtful descriptions of global health programs carried out by outsiders throughout the decades, and possible ways to change these and avoid repeating the mistakes already made by predecessors.

“Pox” by Michael Willrich

Next to Ebola, my favorite virus would probably be smallpox (Variola virus). I mean, now that it’s eradicated in nature, what’s not to love about the mysteries it’s left us–where it came from, why it was so deadly (or, not so deadly, as in the emergence of the “mild” form, variola minor), and will a new poxvirus emerge to take its place? The topic is particularly germane since the debate still rages on about the fate of the world’s smallpox stocks. Smallpox has killed untold millions and influenced the destiny of societies; and as Michael Willrich details in his new book, Pox: An American History, the legacy smallpox has left us is still alive and well today.
Continue reading ““Pox” by Michael Willrich”

Science and the media: three new books

There has been a surge of interest recently in science denial, particularly revolving around the issue of vaccines. Last year saw the release of Michael Specter’s Denialism; in the last few months, three others have been released: Seth Mnookin’s Panic Virus, Robert Goldberg’s Tabloid Medicine, and Paul Offit’s “Deadly Choices.” More about each of them after the jump.
Continue reading “Science and the media: three new books”

Summer reading 3: Good Germs, Bad Germs by Jessica Snyder Sachs

Balance is a tricky thing to find in area, and medicine is notorious for its trade-offs. A drug that may make you well in the long run may also have side effects that make taking the medicine difficult. Even drugs that we often think of as typically innocuous, such as antibiotics, can have an enormous cost associated with their use, both at the individual and the population level. Sachs covers our love-hate relationship with antibiotics and germs in general in her book, Good Germs, Bad Germs. More after the jump…
Continue reading “Summer reading 3: Good Germs, Bad Germs by Jessica Snyder Sachs”

Summer reading 2: Richard Preston’s “Panic in Level 4”

I had ended up with a ratty old piece of Army gear, a space suit that belonged to nobody A little voice started speaking in my head. What are you doing here? the voice said. You’re in an Ebola lab in a fucking defective space suit. I started to feel giddy. It was an intoxicating rush of fear, a sensation that all I needed to do was relax and let the fear take hold, and I could drift away on waves of panic, screaming for help.

Martha was looking into my eyes again.

The little voice went on: You’re headed for the Slammer.

Richard Preston opens his new publication, a collection of essays titled Panic in Level 4: Cannibals, killer viruses, and other journeys to the edge of science, with a quotation: “In order to know soup, it is not necessary to climb into a pot and be boiled.” Preston disagrees with the sentiment, expressed by English mathematician and physicist Oliver Heaviside. Preston discusses how he, as a journalist, has created a living by jumping into the soup–even though it’s sometimes scared the piss out of him, as described in the excerpt above (the “panic” described in the title). However, Preston fans should be cautioned that this all isn’t typical Preston fare. More after the jump…

Continue reading “Summer reading 2: Richard Preston’s “Panic in Level 4””