Ken Moore
To Raise Awareness, or to Plan a Solution?
Forgotten People, Forgotten Diseases.
By Peter J. Hotez. ASM Press; 215 Pages.
Take a stroll down a crumbling, rural road in Central Java. Gaze out your taxicab window onto the urban streets of New Delhi. What might you notice that each place has in common? Both are ravaged by the affects of disease and malnutrition. Through his humanitarian work in Angola – among other developing nations – Peter J. Hotez never ceases to be amazed that the approximate 600 million cases of hookworm in our global community could remain virtually unnoticed. Year-after-year these cases slip through the cracks and dip under the radar of our esteemed policy-makers, medical professionals, and health advocates. On the first page of Forgotten People, Forgotten Diseases, Hotez refers to a quote by Elie Wisel, “The age of hypocrisy has been succeeded by that of indifference…”
Neglected Tropical Diseases (NTDs) wage a war of attrition against one’s immune system, social life, and productivity. So, who is it that continues to be trounced by these debilitating infections? The answer is more than 40% of the world’s poor, over 1 billion people. About 37 forgotten diseases, including elephantitis, leprosy, and dengue fever, chronically impact the lives of the world’s most vulnerable. And perhaps the most ironic feature of these diseases is that almost every one is an ancient, heavily documented condition. Forgotten over time and overshadowed by the biggest emerging infections with high mortality rates – such as HIV/AIDS – NTDs continue to disable and disfigure millions of people across the globe. And those afflicted are doomed to become a burden to their society, unable to fully contribute to their families and their communities.
What evidence does Hotez give to support these morbid claims? After receiving an M.D.-Ph.D., and after having conducted extensive research, some of which has been funded by the Bill and Melinda Gates Foundation, Hotez asserts that “the cognitive and intellectual impairments resulting from hookworm-associated iron deficiency and anemia severely affect childhood education in terms of school performance and school attendance.” As a consequence, the wage-earning capacity of these afflicted individuals is significantly decreased. Additionally, infected agricultural workers in Africa, Asia, and the Americas have been shown to be far less productive than their healthy counterparts. His research-based conclusions leave very little doubt for the reader that his assertions are backed by solid fact.
Hotez highlights many societal consequences of NTDs over the course of the text, but as a respected pathologist, the majority of Forgotten People, Forgotten Diseases lies in its detailed descriptions of each NTD. The book is sprinkled with numerous text-book-like diagrams that illustrate how each of these infections is not only contracted, but also how they are perpetuated and spread. With this knowledge, Hotez intends to give the reader valuable insight on how these infections and diseases could be prevented if people were provided with an adequate education about them, or given the proper vaccinations.
The book, however, remains unbalanced. Although Hotez describes in detail how these forgotten diseases relentlessly impact the world’s forgotten people, his solutions are disappointingly empty. He brings up some innovative treatments and clinical strategies for fighting disease, but he only touches the surface on how to organize an effort to implement his suggested methods. It is always much easier to point out a problem than it is to map out a solution. Granted, Hotez briefly describes the benefits of public-private partnerships, and he lists a number of organizations working on the problem. But public-private partnerships come up as solutions in development literature to virtually every large-scale problem. Greater insight and more time spent on how to form these partnerships and how to sustain them would have been more helpful – rather than simply mentioning these concepts at the end of the book. What are some more incentives to establish these partnerships? If these incentives already exist, then why have they not already been capitalized on? What are current barriers to these partnerships? Why do the barriers remain strong, and how can we get around them? In development work, it is not about stating solutions – it is about conceptualizing strategies that lead to the implementation of those solutions, and then spending as much time planning an approach as analyzing the problem.
Despite this flaw, Forgotten People, Forgotten Diseases still serves its purpose. As Hotez emphasizes more than once, “the neglected tropical diseases are among the leading disabling conditions of humankind.” He intended to raise awareness about forgotten diseases, and he did this affectively. Additionally, Hotez did, in fact, make references to blanket solutions, and he affirmed that the problem of NTDs was not unsolvable. But as much as one mentions how inexpensive vaccination programs are, or as much as one advocates particular drug combinations to treat helminth infections, nothing will ever be done until we figure out why, exactly, these things have not already been done before.
In conclusion, Forgotten People, Forgotten Diseases is an informative read, but it is not the most appropriate book for a first-time, curious public health student to pick up and become immediately impassioned about the subject. Nevertheless, it does serve as a valuable tool that one could slip into his/her public health tool-belt for future reference. It is more engaging than a traditional textbook, but it does not flow as effortlessly as Jeffrey Sachs’ End of Poverty, Philip Hilts’ Rx for Survival, or Paul Farmer’s Infections and Inequalities. Peter Hotez lays out a wealth of information, but he does not include riveting anecdotes, perplexing case studies, or enough gripping examples to adequately invest the reader on a more human level. Instead, he provides beautifully concise summaries at the end of each somewhat disjointed chapter, so that any reader could easily pick up the book after a year, as a reference tool, to remind him/herself about whether dengue fever is spread by a mosquito or transmitted through soil.
