Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and Their Impact on Global Health and Development.
Dr. Peter Hotez, M.D. Ph.D. Washington D.C: ASM Press, 2008. 215 pp. Special Features (13 Color Plates). US $39.95, ISBN 978-1-55581-440-3.
In Forgotten People, Forgotten Diseases, Dr. Peter Hotez (M.D., Ph.D.) presents a insightful summary of the major tropical diseases and argues that they have such significant poverty-promoting features and health burdens (physical and mental) that they deserve the same attention, energy, and funding that the public health world has given to such publicized infections as malaria and HIV/AIDS. Dr. Hotez’s purpose is to make a moral plea for the infected people and does so by pairing harrowing statistics with the personal qualifications of an expert immunologist and microbiologist on the ground, that the reader has no option but to be moved by such a strong advocate. However, Dr. Hotez leaves the reader wondering whether solutions exist for such a significant problem. Though the reader will find the scientific complexities of these diseases often strenuous and the moral narrative overreaching at times, Hotez manages to speak about the reality on ground and about the possibilities with eradication. Forgotten People, Forgotten Diseases is a compelling read for anyone interested in keeping a well rounded view of today’s crises.
Forgotten People, Forgotten Diseases introduces the list of pathogens that are among the most common infections of the world’s poorest people by describing the health and socioeconomic effects of the thirteen major Neglected Tropical Diseases (NTDs). Dr. Hotez discusses the high prevalence of NTDs in developing countries and the unending cycle between NTDs and poverty, going into detail about the poverty contributing factors which NTDs produce, including chronic disability and disfigurement, and social stigmatization. Dr. Hotez constantly compares the social and health impacts of NTDs to the other more publicized members of the “gang of four”, consisting of HIV/AIDS, Malaria, and Tuberculosis, to highlight the significant discrepancy in funding and public attention between the NTDs and the other three members. Disability-adjusted life years (DALYs) are used to fully assess the health impact of the NTDs, which are only second to HIV/AIDS in DALYs and sixth overall. The socioeconomic impact is most clearly presented when one considers that the seven most common pathogens burden the people who live on US $2 or less a day with chronic features, resulting in 52.1 million DALYs lost annually for the 40% of people who live on less than US $2 per day. The pathogens prohibit adult productivity and often affect the youngest members of a community with problems in cognition, memory, school performance, and school attendance, contributing to losses in population productivity as adults. Using these facts, Dr. Hotez makes an argument as to why populations living in developing parts of the world, such as in Africa, Asia, and Central and South America get caught in within a cycle of poverty and hopelessness that urgently needs attention.
Dr. Peter Hotez’s strength lies in greatly clarifying a subject with a voice of needed urgency that the NTDs deserve and he strengthens his reach to different levels of readers by effectively appealing on both moral and scientific grounds. He often simplifies complex scientific and economic ideas with helpful diagrams and illustrations that fill in when the confusion of the written scientific explanation becomes strenuous. This includes the diagrams showing the life cycles of pathogens and the effects of NTDs using the DALYs and prevalence tables. The moral narrative never loses its beat as Dr. Hotez presents pictures of those infected, especially the ones of children, and puts a face to the deforming and stigmatizing diseases, leaving a lasting impression on the reader. Dr. Hotez’s is also a strong and talented researcher as he is able to effectively identify for the reader and public health student the existence of natural problems that can’t be changed through man’s influence versus conditions that can be worked with. For example, the rain will continue to create moist breeding grounds, but plans for sanitization and housing can change the transmission of infection. One is educated with past and current projects, with much insight into specific organizations and their collaborations and ventures, and Dr. Hotez discusses the flaws and benefits of each as a remedy for future projects. It is also the writer’s own work and enthusiasm, including producing a low cost vaccine with HHVI-Sabin which could provide a framework for future developments in global access, that makes the reader much more interested since the author is not only writing about what can be done but is also heavily involved himself.
However, Dr. Hotez’s writing does include rare moments in which his rationale for the moral and scientific importance of the NTDs seems to be overreaching. Yes, the average cost of popular western procedures might be higher compared to treatments for the NTDs, but Dr. Hotez’s explanation on how that is a direct correlation to the prices of drugs and treatments for the NTDs is lacking. This serves primarily as a technique to produce angst among the readers, something he is very fond of. Why should the level of cost and the different medical practices in the west, where there is a different prevalence of diseases, be compared to tropical diseases? He continues to do this when he makes the assertion that the NTDs can serve as predisposing factors for violence and unrest, but neither continues this theory up with much detail or considers that most of the people he has described so far suffer from such strong disabilities that it’s more likely that they will seclude themselves from society than engage in violence. While attention needs to be brought to NTDs, it does not seem as surprising or illogical as Dr. Hotez makes it seem that more attention has been paid to HIV/AIDS, TB, and Malaria because individually over time, none of the seven most prevalent NTDs reach the magnitude of the least funded of the three (Malaria) in terms of DALYs. They are part of a category that includes them all of them because they were neglected and tropical and is subject to an increase in group membership if a supposedly eliminated infection comes back while the category of Malaria will always just include Malaria and have a much clearer identification with the public as a single enemy. It was frustrating as Dr. Hotez kept calling the noble cry for battle against the NTDs, making it seem as if eradication was within reach. He would identify some past and present treatments used for the various NTDs and conclude by dismissing these treatments for various reasons, including cost, toxicity, or resistance without often offering clear solutions for battle.
Dr. Hotez’s Forgotten People, Forgotten Diseases is an informative introduction to a series of diseases that most of us have either never heard of or understood the full impact of. His strength in strongly appealing on both scientific and moral grounds also highlights the book’s weaknesses, moments in which the reader feels the writer’s rational for the importance of his cause may be overreaching. Overall, this is a compelling subject and Dr. Hotez’s book is necessary for the public health student interested in keeping a well rounded view of world health problems |
