Jan 28, 1999

Selin Somersan

Disease and Discrimination, Spring 1999

Book Review

I will be reviewing a book called " Emerging Infections, Biomedical Research Reports". The book overall is 513 pages. It contains 17 different sections, all of which are written by different authors. The editor of the book is Richard M. Krause, who also wrote the first chapter as an introduction as a way to create a connection between all the other chapters. Krause himself selected the other authors to write about the different types of infectious diseases with an emphasis on molecular and evolutionary epidemiology and population biology. Since they were written independently, each chapter can be read independently of the rest of the book.

The book is more like a source book. It can be considered as a scientific text rather than a social justice text in terms of the information it gives. However I think this information provided will be very useful when discussing social justice issues. The first two chapters are looking at general concepts of infectious diseases. I want to write about these two chapters and a sample from the rest of the chapters( each of which addresses a different infectious disease)

Ch.1- Introducing to emerging Infectious Diseases; Stemming the Tide.-Richard M. Krause : The first chapter is presented in two sections : I) Emerging Infections and II) The Dynamics of Microbial Emergence. I felt that this was the most subjective chapter of the book. The author reflects his feelings and opinions through his experiences about the scientific, politic and social factors effecting the emergence/reemergence of infectious diseases. In some sections of his writing, it actually surprised me to feel a tone of resentment towards the society. Some of this resentment rises from the fact that in the 1970-75, ‘ " end of infectious disease" was the popular idea’(pg. 3). One result of this was that the budget of National Institute of Allergy and Infectious Diseases (NIAID) was reduced (Here it is important to note that Krause was the director of NIAID at that time, which may also be a cause of his resentment). He states in several places that he had always warned the society and the US government about the persisting threat of the epidemics, and was not recognized or at some points was criticized for being too cautious. One place where I felt his anger the most was where he said " No matter what you do, you will be criticized. But as President Truman said, ‘If you can’t stand the heat, stay out of the kitchen’ "(pg. 13) . The rest of the chapter Kauser talks about biological and social factors that effect the spreading of infectious diseases. He also points out some diseases which differ in these factors. He suggests that to be able cope with future epidemics like AIDS these factors need to be considered. Although subjective and angry in some places, I think the chapter does give a good introduction to the rest of the book where certain infectious diseases that are currently emerging are discussed in detail.

Ch.2 -Analytical Theory of Epidemics-Roy M. Anderson This chapter discusses mathematical models for host infection, including variables such as population variables, rate parameters, genetic and behavioral heterogeneity. The author also accepts that the actual event is far more complex than the model, however by creating models like this, we can understand and even predict certain characteristics and patterns of emergence of infectious diseases. Chapter two is interesting but very limited in the audience it relates to, even more so than the other chapters are. This is because in addition to biological concepts; there are equations and some mathematical concepts that are used.

In the rest of the book each chapter talks about a specific epidemic, written by different people. Each author/authors have his/her/their own tone of voice and style. However unlike Kraus's chapter, these are mostly very objective chapters. The epidemics that are considered here are tuberculosis (Ch. 3), cholera (Ch. 4) , diseases caused by E. coli (Ch. 5 ), streptococcal diseases-Staphylococcal toxic shock syndrome (Ch. 6 ) , Lyme disease (Ch. 7) , influenza (Ch. 9) , dengue (Ch. 10 ), AIDS (Ch. 11) Hantaviral diseases (Korean hemorrhagic fever and Hantavirus pulmonary syndrome) (Ch. 12), Ebola virus (Ch. 13) , diseases caused by anthropod-borne pathogens (Ch. 14), , intestinal parasitic protozoa (Ch. 15), transmissible spongiform encephalopathies(TSE) (Ch. 16) and malaria (Ch. 17).

The chapters are not designed/organized exactly the same way, but they cover similar concepts about the individual diseases. The organization depends on the specificity of the disease and there is a focus on the most problematic aspect of the disease. Generally these chapters look at the biology and evolution of the specific epidemic in relation to the population. I think they do a good job of explaining the past, present and the probable future of the particular disease. The chapters also discuss social events that might have effected the burst of the epidemics (such as World War II's effects on the rising of tuberculosis epidemic). Where known, the pathogenesis of the disease, how it is transmitted, how it acquires resistance and the main biochemistry associated with it is also given. The scientific fight against that disease, the precautions that have been taken and that need to be taken are other issues which are usually addressed.

It is impossible to discuss all the chapters in this review.So I have chosen one of the chapters to discuss in detail here:

Ch.11-"The AIDS epidemic: Demographic aspects, population Biology and virus evolution" by Thomas C. Quinn and Anthony Fauci. The chapter starts with the history of the disease; where it emerged and how it was identified. Later the authors talk about the rate at which the epidemic spreads differently with respect to location. I think it is very interesting to see how in different parts of the world HIV epidemic show different rates and different means of transmission. One striking example they talk about is that in Poland 70% of HIV infected people are IDUs (injection drug users) , in Czech an Slovak republics 2/3rd of infections are due to homosexual transmission and in Bulgaria 75% are due to heterosexual transmission. The authors state that this is due to the differences in social relations, culture, sexual networks, mobility of the people within the region and the government’s attitude about the AIDS control programs. Although these facts are stated and these differences are acknowledged, no deep discussion about these issues takes place in the chapter. There is also a section that talks about how this epidemic is going to effect the young population in communities, and what this might lead to. However when talking about these effects, the author uses a very materialistic and factious tone, referring to this population as "the productive population" instead of as "people, individuals". This example represents the general tone the chapter is written in. More information about the virus itself, how it evolved and its biological background is given. The section ends with suggested precautions and prevention ways.

I think overall the book was useful in that it provided a lot of background information about the historical, social, economic, political and biological aspects of different epidemics. However I think it was more scientific and facts oriented. At some parts of the text the data was overwhelming, and thus it became hard to follow. The audience for these chapters are people that have some background or familiarity with scientific terminology and which are interested in the factual aspects of the issues. The main missing part was discussion on human justice issues, sociological problems and personal experiences these diseases lead to (the patient’s points of view and his psychology). On the other hand, there were a lot of facts which would help to analyze the disease and the way the disease is dealt with. Although the social justice aspect of the book is missing I think this book gives a good basis to create a social justice discussion.

Emerging Infections: Biomedical Research Reports, edited by Krause, Richard M. Academic Press, 1998.

The cover photograph shows the Seattle Police during the 1918 influenza epidemic, and is taken from the National Archives in Washington, DC. There are four other figures/tables in the book, taken from different places:

1) Figure 3 in Ch. 6 is a figure of streptococcal infections that is taken from the book "Bacterial infections of humans", A.S. Evans and H.A. Feldman, Plenum Publishing, NY. (1982) p 525-552.

2)Table V in Ch6 is reprinted with permission from Holm, et.al. Volume 166. The university Chicago Press. (1989) p31-37

3) Fig.1 in Ch.6 is taken from the following article: Davies, J. Inactivation of antibiotics and the dissemination of resistance genes, Science 264 , 375-382

4)Fig.2 from Ch.2 is taken from the following article: Bissonnette, L and Roy, P.H. Characterization of the InO of Pseudomonas aerugisona plasmid pVSI, an ancestor of integrons of multi-resistance plasmids and transposons of Gram-Negative Bacteria. J. Bacteriol. 174, 1248-1257.