book review, Volume 4 number 10, November 2003 Bugs This summer’s biblical swarm of mosquitoes prompted plenty of grumbling from Interior Alaskans. Bugs are so ubiquitous to our lives that you’d think we’d know as much about them as we do about the larger, far less populous creatures we live with. There’s a glut of books about the life cycles of caribou and the predatory habits of bears. But what about that pesky skeeter? Into this void steps biologist Andrew Spielman, who has spent fifty years studying the miniature terrorists, distilling his knowledge into a brief, highly readable little book called Mosquito: A Natural History of Our Most Persistent and Deadly Foe (co-written with journalist Michael D’Antonio). Spielman provides gives a good overview of the brief existence of your average mosquito (old-timers may last six months, most never get beyond the larval stage). His descriptions are almost loving in their attention to detail. His fascination with his topic shows. My only complaint is that he spends too little time on this part of his story. The bulk of the book concerns the diseases mosquitoes spread, and the vast impact the little hummers have had on the course of history, from Rome to the Panama Canal. To this day, mosquito-borne illness is a leading cause of death worldwide. Spielman advocates carefully monitored insecticide use to ease the suffering, making an interesting argument for the spraying of the much-despised DDT. It’s been decades since Americans viewed mosquitoes as more than a nuisance, but with the 1999 emergence of West Nile virus in New York, the telltale itch and swelling once again became something to fear. As Madeline Drexler demonstrates in Secret Agents: The Menace of Emerging Infections, this represents the dark side of our highly mobile lifestyle. The same strain of West Nile now spreading rapidly across North America was first noted in Israel in 1998. An infected mosquito likely hitched a ride on a plane from Tel Aviv, and a plague was born. Drexler explores the multitude of new infections ranging over this country: incurable staph in the nation’s hospitals, new food-borne threats, the ever-evolving flu viruses, and the emerging theory that germs are the cause of heart disease and many cancers. She also delves into the risks resulting from our excessive dependence on broad-spectrum antibiotics which, while often effective against disease, have the perverse effect of breeding new, drug-resistant strains of previously manageable infections (like the above-mentioned staph, or the particularly virulent strains of tuberculosis now circulating). It’s the clearest example of evolution in progress. Germs possess an endless capacity for getting around our defenses. Whatever we throw at them only makes them stronger in the end. All this will be familiar territory to readers of Laurie Garrett’s landmark 1994 bestseller, The Coming Plague. Drexler picks up where Garrett left off, echoing her call for an enhanced public health system. Garrett herself has explored that theme in her 2000 follow-up, Betrayal Of Trust: The Collapse of Global Public Health. It’s a grim story. After detailing the failure of efforts to deal with mid-nineties outbreaks of Ebola in Africa and Plague in India, Garrett turns her attention to the complete breakdown of health care in the former Soviet Union, and explores the rise and fall of public health in America. It was the public health movement, not the medical profession, that brought the steep rise in life expectancies Americans enjoyed in the twentieth century. Unfortunately, people are only willing to pay for a perceived need. By the 1980s, with the population in good health, public health budgets were slashed to bone. At precisely this point opportunistic infections like AIDS and multiple drug-resistant TB broke out. The spread of both could have been slowed dramatically, and countless lives saved, if local health departments had had the resources to meet the challenge. The deaths of thousands are in part the result of political shortsightedness. And then there’s the threat of biological terror. Both Drexler and Garrett devote entire chapters to this issue, Drexler with the advantage of hindsight after last year’s anthrax attacks. The nation, as was seen, is woefully under-prepared to deal with the threat. The deliberate release of deadly diseases may go initially undetected if only a few isolated cases emerge at first. There is no effective central data bank for reporting medical anomalies. Even the most vile diseases likely to be used in weaponized forms initially appear as flu symptoms, only to turn lethal later. A disease could spread far and wide before potentially infected persons would even be aware of their condition. Hospitals are not prepared to handle a massive outbreak. The Bush administration is stockpiling smallpox vaccine, but distribution in an emergency would be a nightmare. One might think, then, that we would be bolstering our public health infrastructure. Billions are being dumped into a missile defense system to guard against an all but nonexistent threat. Meanwhile we have already seen one well publicized bioterror attack. Other acts—from the dumping of botulism on a salad bar by the Oregon-based Rajneeshee cult in the 1980s, to more recent, generally botched efforts by tax protesters and right-wing Christians—have enjoyed less publicity. Yet little is being done. Perhaps the most vital element of our national defense is being shortchanged. No surprise in an era when health advocates are all but penniless and defense contractors routinely purchase presidents.
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