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An explosion of pathogens, or perhaps just of fear

The New Killer Diseases: How the Alarming Evolution of Mutant Germs Threatens Us All, Elinor Levy and Mark Fischetti, Crown: 312 pp., $24.95

August 24, 2003|Claire Panosian Dunavan | Claire Panosian Dunavan is professor of medicine at UCLA school of medicine and a practicing infectious disease and tropical medicine specialist at UCLA Medical Center.

And what about the bigger picture? Since the late 1990s, for example, BSE and West Nile encephalitis have claimed no more than 600 European and American lives in total. In contrast, cerebral malaria (a condition that can be reversed with drugs that cost a dollar or two per patient) has silently killed several million African children, many of whom never got close to medical help. Now there's a killer disease.

A Washington postal worker who survived anthrax and now suffers from post-traumatic stress disorder (he suspects the anthrax mailings were a secret government experiment) is the book's segue into bioterrorism. A 3-year-old whose juicy bite of cantaloupe at a Milwaukee salad bar led to bloody diarrhea, kidney failure and death introduces E. coli 0157. In these and other poignant stories the authors describe the genetic, immunologic and vaccine development research that reveals the wondrous toolbox of modern microbiology. On the political side, arguments for better public health communication and interagency linkages (during the anthrax letter crisis, the FBI, CIA, EPA, FEMA and CDC shared turf rather clumsily) come through loud and clear, as does the case for stronger oversight of our domestic food supply.

In the United States alone, as Levy and Fischetti point out, food-borne germs cause 76 million illnesses and 325,000 hospitalizations a year. Fortunately, with 5,000-plus annual fatalities, the odds of death are low. That's not to downplay the casualties, economic costs or future threats of food-borne infection, however. In recent years, the global flow of fruits, vegetables and other exotic treats has brought some unhappy surprises: parasite-laden raspberries, cholera-carrying crabs, goat cheese laced with dangerous bacteria.

Do you remember your grandmother's old-fashioned meat grinder? It might be worth resurrecting. Today's ground meat often comes from supersized processing plants. As a result, a single patty at a supermarket may contain the commingled flora (salmonella, E. coli 0157, Campylobacter) of up to 1,000 head of cattle. No wonder so many restaurants refuse to serve a hamburger medium rare. (By the way, in addition to germs, most of us regularly consume industrial-strength antibiotics fed to American cows, pigs and poultry. These growth-promoting agents foster drug-resistant bacteria whose resistance genes eventually migrate from animal intestines to human guts to hospitals. In European Union countries, such antibiotic fortification is now banned, and Levy and Fischetti share that position.)

But is it realistic to expect Betty Crocker perfection with respect to food, even in privileged, industrialized societies? Reacting to several recent spates of diarrhea on cruise ships (the guilty party was an intestinal virus called the Norwalk agent), "The New Killer Diseases" complains: "Defiant germs are persisting in even the cleanest environments." It seems that "The New Killer Diseases" wants to cause a furor over a very basic fact: We're surrounded by microorganisms. From a purely evolutionary point of view, that's not a problem. There's plenty of evidence suggesting that an occasional cold or bout of diarrhea enhances lifelong immune defenses (assuming you're basically healthy to begin with).

Since I graduated from medical school in 1976, more than 30 new or resurgent infections have made newspaper headlines. In population terms, their effects have varied from minor to apocalyptic. In individual terms, as with all diseases, each one has brought human suffering and grief. But even the bona fide tragedies do not justify scaremongering. That's where "The New Killer Diseases" and I part ways. Looking back on recent medical history, perhaps the more sensible response to our environment is not Levy and Fischetti's but that of CDC chief Dr. Julie Gerberding. Emerging infections are "the new normal" in the world, she said in a speech earlier this year. So let's not waste energy decrying biologic adaptation and change, she suggested. Instead, use common sense, wash your hands, apply mosquito repellent and sign up for a flu shot.

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