Betrayal of Trust: The Collapse of Global Public Health | 
| Author: Laurie Garrett
Publisher: Hyperion
Category: Book
List Price: $18.95
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Avg. Customer Rating:  46 reviews
Sales Rank: 112493
Media: Paperback
Number Of Items: 1
Pages: 800
Shipping Weight (lbs): 2.1
Dimensions (in): 9 x 6.1 x 2
ISBN: 0786884401
Dewey Decimal Number: 362.1
EAN: 9780786884407
ASIN: 0786884401
Publication Date: August 2001
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What do Russia, Zaire, Los Angeles, and--most likely--your community have in common? Each is woefully unprepared to deal with a major epidemic, whether it's caused by bioterrorism or by new or reemerging diseases resistant to antibiotics. After the publication of her critically acclaimed The Coming Plague, which looked at the reemergence of infectious diseases, Laurie Garrett decided to turn her highly honed reportorial skills to what she saw as the only solution--not medical technology, but public health. However, what she found in her travels was the collapse of public-health systems around the world, no comfort to a species purportedly sitting on a powder keg of disease. In Betrayal of Trust, Garrett exposes the shocking weaknesses in our medical system and the ramifications of a world suddenly much smaller, yet still far apart when it comes to wealth and attention to health. With globalization, humans are more vulnerable to outbreaks from any part of the world; increasingly, the health of each nation depends on the health of all. Yet public health has been pushed down the list of priorities. In India, an outbreak of bubonic plague created international hysteria, ridiculous in an age when the plague can easily be treated with antibiotics--that is, if you have a public-health system in place. India, busy putting its newfound wealth elsewhere, didn't. In Zaire, the deadly Ebola virus broke out in a filthy and completely unequipped hospital, and would have kept up its rampage if the organization Doctors Without Borders hadn't stepped in, not with high-tech equipment or drugs, but with soap, protective gear, and clean water. Most of the world still doesn't have access to these basic public-health necessities. The 15 states of the former Soviet Union have seen the most astounding collapse in public health in the industrialized world. But during a cholera epidemic, officials refused to use the simple cure public-health workers have long relied on--oral rehydration therapy. Many of the problems in these nations can also be found in one degree or another in the U.S., where medical cures using expensive technology and drugs have been emphasized to the detriment of protecting human health. The result? More than 100,000 Americans die each year from infections caught in hospitals, and America has a disease safety net full of holes. A Pulitzer Prize-winning journalist (for Newsday and others), Garrett has deftly turned what could have been a very dry subject into dramatic reportage, beginning with the eerie silence on the streets of Surat, India, where half the city's population (including doctors) fled the plague, while a thick white layer of DDT powdered the ground. Fascinating, frightening, and well-documented, Betrayal of Trust should be read not only by medical professionals and policymakers but the general public, and should galvanize a change in thinking and priorities. --Lesley Reed
Product Description
What do Russia, Zaire, Los Angeles, and--most likely--your community have in common? Each is woefully unprepared to deal with a major epidemic, whether it's caused by bioterrorism or by new or reemerging diseases resistant to antibiotics. After the publication of her critically acclaimed The Coming Plague, which looked at the reemergence of infectious diseases, Laurie Garrett decided to turn her highly honed reportorial skills to what she saw as the only solution--not medical technology, but public health. However, what she found in her travels was the collapse of public-health systems around the world, no comfort to a species purportedly sitting on a powder keg of disease. In Betrayal of Trust, Garrett exposes the shocking weaknesses in our medical system and the ramifications of a world suddenly much smaller, yet still far apart when it comes to wealth and attention to health.With globalization, humans are more vulnerable to outbreaks from any part of the world; increasingly, the health of each nation depends on the health of all. Yet public health has been pushed down the list of priorities. In India, an outbreak of bubonic plague created international hysteria, ridiculous in an age when the plague can easily be treated with antibiotics--that is, if you have a public-health system in place. India, busy putting its newfound wealth elsewhere, didn't. In Zaire, the deadly Ebola virus broke out in a filthy and completely unequipped hospital, and would have kept up its rampage if the organization Doctors Without Borders hadn't stepped in, not with high-tech equipment or drugs, but with soap, protective gear, and clean water. Most of the world still doesn't have access to these basic public-health necessities. The 15 states of the former Soviet Union have seen the most astounding collapse in public health in the industrialized world. But during a cholera epidemic, officials refused to use the simple cure public-health workers have long relied on--oral rehydration therapy. Many of the problems in these nations can also be found in one degree or another in the U.S., where medical cures using expensive technology and drugs have been emphasized to the detriment of protecting human health. The result? More than 100,000 Americans die each year from infections caught in hospitals, and America has a disease safety net full of holes.A Pulitzer Prize-winning journalist (for Newsday and others), Garrett has deftly turned what could have been a very dry subject into dramatic reportage, beginning with the eerie silence on the streets of Surat, India, where half the city's population (including doctors) fled the plague, while a thick white layer of DDT powdered the ground. Fascinating, frightening, and well-documented, Betrayal of Trust should be read not only by medical professionals and policymakers but the general public, and should galvanize a change in thinking and priorities. --Lesley Reed
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| Customer Reviews: Read 41 more reviews...
 compelling and frightening December 12, 2007
i went into this book a bit skeptical at first. I work in a big city hospital and i thought: what can i really learn from some third world nation i've never been too? A lot apparently. I was shaken to the core by this book, because when an author comes out and really puts all the pieces together, a horrific picture is painted of just how close we are to crisis.
if you care at all about your health, read this book. if you are entering the field of medicine (I will be finishing my RN degree next month) then you HAVE to read this book. Infectous diseases are not a sexy field, but the far reaching affects of a microscopic virus are vast. the ease that someone could make a "dirty bomb" and set off a widespread panic is very, very real. The total absence of a system to isolate and prevent disease is mind boggling.
Laurie Garrett has written a riveting book that doesn't pull the punches. she makes public health an issue that should matter to everyone, everywhere. i will be passing this book on to my mom, she's a NICU nurse.
Good- too US-centric September 25, 2007
Very interesting book, however the last chapter focuses extensively on the US healthcare system, something that wasn't of much interest to me.
 Informative But Practically Unreadable February 7, 2007
1 out of 1 found this review helpful
Laurie Garrett's researchers have compiled for her an enormous amount of data which clearly shows that health care infrastructures around the world are no longer in any condition to prepare or protect people from the next terrible plague let alone maintain the status quo among diseases that were once thought to have been all but eradicated from the planet. Garrett threads her way through health-care crises around the world, from Africa to India to Russia, but it is the state of American health care that makes up the largest chapter in the book, and it is the demise of American health care that should be the most startling. We have all known for a long time that something was terribly amiss with health care in the United States, but "Betrayal of Trust" reveals that the problems are much, much deeper than many of us realized, almost to the point of absolute despair. Health care may be tenuous at best in third-world countries and the former Soviet Union, but this is mostly because those countries are impoverished or cash strapped, whereas in the United States, although we are rich, we have allowed our health care to degrade through conservatism, politics, and greed.
All public responsibilities and services that have been privatized or deregulated have suffered similarly, driving up costs while lowering quality--private contractors must, after all, make a profit; they must get their little bite, their "mordida", and they must stifle competition and pay off politicians in order to maintain hegemony in their fields--but in the realm of health care this means that someone (or lots of someones, usually poor someones) will suffer or die needlessly. It also means that while no one is immune from contagion, the public health system is now too complex, with too many competing interests, to adequately direct any consistent policy of public health. Franklin Delano Roosevelt understood that government exists only to serve the people, and he took extraordinary (and quite successful) measures which demonstrated that government could improve the lives of its citizens. For the last several decades, we have lived under a government that believes it exists to serve business, that in this way, indirectly, the people's lot will improve. But all of those little "mordidas" add up, and so costs and debt have gone up also.
This is all made very clear in "Betrayal of Trust", through timelines of indomitable men and women who took the reins and made things happen; who found cures for polio and eradicated smallpox; who created a generation of Americans with no memory of the sadness of all-too-common childhood diseases and death. But while this evolution from greatness to complacency becomes clear as the reader progresses through the book, Garrett's style of writing is so poor that it is a struggle to get from page to page. Basic grammar and punctuation may not be her strong suit, but at least her editor should have corrected her redundancies (how many times must we read that the doctors in Zaire had no gloves? One...two...three...four...five...six...). And why do academic writers refuse to set off their introductory prepositional phrases with commas? Sentence after sentence runs on such that the reader must stop, back up, re-read the sentence, mentally place the comma, and then go on. Graduate students cringe when they are assigned this book, but the information remains important. Garrett's researchers did their jobs well.
Way scary, but a really good read. January 17, 2007
I read this for a University course. I kept it. The public is woefully undereducated about public health and by definition it affects us all. I highly recommend this book.
promising start but poor finish October 1, 2005
12 out of 15 found this review helpful
If horror writer Stephen King ever suffers from writer's block, he should read this book's opening chapter, where Pulitzer Prize winner Laurie Garrett describes traveling into the plague ravished Indian city of Surat. The description, which belongs more in the Book of Revelations than in a chronicle of modern day health care, is stomach churning. Irula tribesmen are paid to catch the plague carrying rats - and are encouraged to eat their prey. The rats, being the breeding grounds for all conceivable types of plagues and pestilences that they are, quickly turn the Irula predators into their prey. Even as the yesinia pestis bacterium and its bubonic plague cousin were devastating the city, Surat's Aids-racked prostitutes continued to ply their trade. Life goes on, even in the midst of death.
So, of course, do HIV and other killer microbes in environments like Surat where ignorance reigns supreme. The description of Surat's Ved Road is like something out of Dante's lowest circles or the Pharaoh's Egypt after God's plagues had done their worst. If you can imagine legions of bloated sewer rats letting loose billions of plague carrying fleas, you can begin to imagine Surat.
Surat is not even the scariest place she describes. Although, for example, Mobutu and his ilk let loose the dogs of war, they also unleashed Africa's most lethal microbes as well. Mobutu's Zaire gave us several outbreaks of Ebola, which with lassa, yellow fever and Marburg disease ranks as among the most fatal diseases currently stalking Africa. Although Ebola has inspired Hollywood to make "Outbreak" and a few other B-grade movies that may be soon coming to a movie house near you, the trouble is that our globalized village means that Ebola and its killer cousins may also soon be coming to a slum town near you. Garrett tells us to beware of the coming deluge.
For Russia, it may be too late. If Garrett is to be believed, Mother Russia's failure to provide healthcare for her children is on a par with Europe's Black Death of the fourteenth century. The collapse of the evil empire has unleashed epidemics of diphtheria, flu, typhoid, cholera, dysentery, TB, syphilis, gonorrhea and Aids. Alcoholism and drug abuse compound the situation. Radiation is also endemic - buildings made from waste products produced by Soviet nuclear facilities speckle the landscape of her major cities. Pollution, radiation, and malnutrition are gnawing away at the people's immune systems and Russians' life expectancy continues to fall as a result. Not even the epidemics of antiquity come close to the apocalypse now plaguing that blighted and thoroughly polluted land.
Soviet surgeons, if Garrett is to be believed, never even learned to scrub their hands - even Groucho Marx knew that much. And even if they now know what to do, they can no longer be bothered. Russia's sanitation standards are now worse than Africa's. Because Russia's sewage pipes are mixed, almost as a matter of course, with water pipes, her tenements are breeding grounds for today's super bugs, which are resistant to all known forms of penicillin and its derivatives. As if all of that was not bad enough, Aids and TB - Ebola with wings, as Garrett describes it - is endemic in today's Russia. Russia's hospitals are so unhygienic that being a patient or a worker there is like playing Russian roulette - with a fully loaded chamber.
Nor is that the end of it. Russia has 2 million IV drug users. Ten to 15 per cent of the Russian population has some experience with IV drug use. Welcome to Hell. And to a hitherto largely ignored major Aids epidemic. Mother Russia is at the forefront of the globalized sex industry and of the plagues of globalized sexually transmitted diseases, which are such an integral part of that booming industry. Not only are child prostitutes plying their trade directly in front of the Russian parliament but, with the rest of Russia's lost generation, they are literally giving the world a more virulent form of Aids. Russia more resembles Dante than Dostoyevsky.
There is, in all of this, a great and urgent story to be told. Unfortunately, Garrett does not tell it. After informing us how tiny Estonia rescued itself from Russia's fate with the help of the Swedish Academy of Science, Garrett's book just goes downhill. She spends over 200 pages giving us a potted history of America's health care system from Christopher Columbus and Typhoid Mary up to Hilary Clinton and beyond. Then, for those of her readers who are determined to see the book through to the finish, she spends another 60 pages crying Wolf about biological warfare before giving us 70 pages of largely superfluous notes. Stephen King does not make those mistakes. He sticks to his plot and terrifies his readers. Garrett should have done the same. In trying to put several books under one cover, she trivializes the traumas of India, Africa and Russia and fails to scare us out of our complacency. So even though Bill Clinton and a clutch of Nobel Prize winners endorse the book's fly cover, a smaller book packing a more lethal punch would have served her purpose better.
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