Infections and Inequalities: The Modern Plagues | 
| Author: Paul Farmer
Publisher: University of California Press
Category: Book
List Price: $21.95
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Avg. Customer Rating:  7 reviews
Sales Rank: 13759
Media: Paperback
Edition: 1
Number Of Items: 1
Pages: 419
Shipping Weight (lbs): 1.3
Dimensions (in): 8.9 x 6 x 1.1
ISBN: 0520229134
Dewey Decimal Number: 301
EAN: 9780520229136
ASIN: 0520229134
Publication Date: February 23, 2001
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Product Description
Paul Farmer has battled AIDS in rural Haiti and deadly strains of drug-resistant tuberculosis in the slums of Peru. A physician-anthropologist with more than fifteen years in the field, Farmer writes from the front lines of the war against these modern plagues and shows why, even more than those of history, they target the poor. This "peculiarly modern inequality" that permeates AIDS, TB, malaria, and typhoid in the modern world, and that feeds emerging (or re-emerging) infectious diseases such as Ebola and cholera, is laid bare in Farmer's harrowing stories of sickness and suffering.
Challenging the accepted methodologies of epidemiology and international health, he points out that most current explanatory strategies, from "cost-effectiveness" to patient "noncompliance," inevitably lead to blaming the victims. In reality, larger forces, global as well as local, determine why some people are sick and others are shielded from risk. Yet this moving account is far from a hopeless inventory of insoluble problems. Farmer writes of what can be done in the face of seemingly overwhelming odds, by physicians determined to treat those in need. Infections and Inequalities weds meticulous scholarship with a passion for solutions--remedies for the plagues of the poor and the social maladies that have sustained them.
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| Customer Reviews: Read 2 more reviews...
 Buy it. Read it. May 10, 2008
An enlightening and insightful book that passionately sets a higher standard for those involved in medicine or any type of humanitarian work. He is passionate about what he says, but careful not to make assumptions that have not been well documented and researched. The book challenged my thinking when it comes to health care, poverty, and our social duty to take action against injustices in the world.
 Infections & Inequalities by Paul Farmer November 9, 2007
3 out of 5 found this review helpful
Too long . Written with sientific dicipline & detail and burdened by too much specialized medical terminology for the popular reader . The idealism is admerable and the conclusion are justified but it speaks to the medical profession more than to the general public . A slow diffucult book to read . Sombody else should write the same book for the popular reader and for leaders in public policy .
careless errors, mediocre conclusion June 14, 2006
2 out of 33 found this review helpful
By claiming "social reform," Farmer contradicts his stance as an American citizen: Haiti has no money to support its own citizens, that's why the US and others are doing Haiti's job. But, the US has to care for its own citizens as well therefore has to first work on its own AIDS patients within its boundary. If the US does that as its social reform, Haiti instantly dries up.
Irritating mistakes somehow got through inspection: PAligre Dam? PEligre? (P. 174) PuertO Plata? PueltA? (P. 119)
Medical-anthropological approach to HIV & TB illuminates roles of inequality and poverty in spread of disease July 11, 2005
20 out of 21 found this review helpful
Farmer, a physician-anthropologist and activist, examines both the way that poverty and inequality result in the spread of HIV and TB today and the flawed justifications for inequitable access to treatment. His ethnographic analysis provides a powerful complement to standard epidemiological work, and this treatise on the danger as well as the immorality of inequity in medical care is largely convincing.
Farmer illustrates several broad themes effectively with case studies from Haiti and Peru. One is the idea that most studies overemphasize individual agency, failing to recognize serious "structural" factors, such as the pressure that extreme poverty exerts on people to engage in unhealthy behaviors and the problems introduced by economic inequality. (One example of the latter is that in unequal countries like Peru, second-line TB drugs are available because of demand by the rich, so doctors also prescribe them to the poor who can only afford them intermittently, which generates drug-resistant strains of the disease.) Another theme is that people in rich nations tend to place heavy weight on "strange" cultural beliefs and customs in explaining high disease prevalence, whereas actual epidemiological research tends to show that these factors carry little weight relative to poverty-related factors. While he uses AIDS in Haiti to illustrate this tendency, it applies perfectly to popular Western conceptions of AIDS in Africa: the popular media tend to emphasize cultural practices such as wife inheritance and a strong sex drive, whereas epidemiological research fails to support a major role for these.
A third theme, which Farmer often trumpets but not as convincingly, is that many of the trade-offs voiced by policymakers are ultimately false. One example is the question of whether to treat tuberculosis with drugs or prevent it (e.g., by investing in economic development). He then uses the success of his clinic in Haiti as an example of both treating and preventing TB. The ultimate argument is that the wealthy have no right to withhold their wealth from the poor. However, he gives us no clear sense of how the resources to generalize this to the world at large should be marshaled. While the trade-off may be philosophically false, the practical application is unclear.
But even without a plan of action, Farmer illuminates key problems in the analysis of infectious disease spread and makes a convincing plea to share the wealth (and the technology).
 Wonderful etiological analysis, but unfounded conclusions. July 23, 2004
27 out of 54 found this review helpful
Anyone in the public health arena has heard (or even read) of Paul Farmer. The Harvard MD/PhD (Anthropolgy) is indeed a passionate and competant professional who has fresh drive and leads a commendable life in service to humanity. This book seems to be his most popular work (at least on campus of major public health colleges) and it deserves attention and analysis.
Farmer gives systematic treatment of HIV and TB etiology and prevalence in the US and Haiti. More importantly, how those diseases affect the poor in inequitable ways. Peppered with intimate anecdotes and cutting analysis, the book brings hard ideas with the immediacy of the individual plight. He debunks myth of AIDS early history and establishes perspetive for the disease to be viewed/studied in light of the poor and the strucutral violence that (he deems) causes the propensity of the disease in the lower levels of society. He offers solutions and pleas for attention to these 'new plagues' so that the effects can be mitigated for the sake of all humanity.
There are some issues with that perspective. Of course every author brings inherent bias to the writing (either intentional or not), but Farmer makes no apology for his worldview and dismisses opinions of others who are even within the sientific community as he. John Stuart Mill (in "On Liberty") would say that such an attitude is likened to assuming infallibility (which Farmer more or less accuses the attitude of the 'rich' toward the modern plagues). His neo-Marxist tendency completely undermines the state of the world and he therefore addresses his problems from a "the way it should be" approach. That is his prerogative, but taking such an attitude means that his ideas will remain just that: ideas. His lack of pragmatism borders a silent taint of militarism and that approach rarely attracts policy makers, even those on the left.
Farmer assumes that a preponderence of evidence precludes a serious analysis of personal aganecy. No one would argue the conflict of structural violence and the inherent effects on personal agency. Yet, the fact remains that it does exist and it at least needs to be addressed in a thorough matter in order to be a fair treatment of the subject matter.
Furthermore, he needed to address the distal factors (i.e etiology and biology of the diseases) with the proximate (i.e. socio-econimics, etc...) for the book to be of more interest to the lay person. Despite my reservations, it is still a great book to get the reader "out of the box" and see AIDS and TB with the urgency it deserves. Yet, this type of book needs to be in the hands of the lay, and this recommendation would help.
Lastly, Farmer claims on several occasions a foundation of political economy in the analysis of his subject. He is a physician and anthropologist, and without the concurrent opinions of a political-economist to back up his claims, the ideas therein are weak at best. His political-economic opinions may be in line with greats like Marx and Henry George, but he cannot assume the validity of his assumptions just by telling the readership he his resting on such evidence. Several other leading political-economic ideas stand in direct opposition to his conclusions of goverment fixing all health problems to his liking.
All in all, it is hard not to be moved by Farmer's compelling treatment of such horrendous plagues on humanikind. Yet, passion does not always equal pragmatic and working solutions. Therefore, his work will hopefully inspire those who can take his passion to offer clear and viable solutions in the war on these plagues.
Michael Jewell, MPH
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