Nandini Jayarajan

Elizabeth Pisani

The Wisdom of Whores

New York: W.W. Norton & Company, 2009

400pp. $16.95

0393337650

From her unique perspective and experience, Elizabeth Pisani in her book, The Wisdom of Whores, reveals the dirty underbelly of epidemiological research and international efforts to stymie the global prevalence of HIV/AIDS. With 10 plus years of working as an epidemiologist and policy advisor for major players like WHO, UNAIDS, the World Bank, and committing extensive field research and surveillance throughout Asia, she describes how science has successfully informed public health, where it has failed, and why it has failed in those areas. She argues that epidemiologists have done well in focusing attention on the right problems and informing where to allocate money, but have been unsuccessful in persuading governments and interest groups to fund the right programs that benefit the people who need it the most. She attributes these failings to ideology and money, particularly western ideology and money.

Her compelling story, wit, and passion arrest her audience from start to finish, educating thoroughly even the uninitiated to the management of the HIV/AIDS crisis. Her only shortcoming, ironically, stems from the same intimacy between the author and reader, as by the end of the book the audience is exhausted by the wins and losses of her career and disgusted by the current state of the situation, and threatens to instill indifference rather than action.
Pisani presents her story chronologically from the beginning of her career, which conveniently coincides with early days of the AIDS epidemic. Her technique of punctuating milestones in HIV prevention with personal anecdotes becomes powerfully persuasive later when she focuses more on her opinions and interpretations of global efforts.

A particular message that reveals itself through this organization is that while research and surveillance is necessarily tedious hard work, the biggest revelations are more from chance, circumstance, and a bit of luck. For instance, her ‘beating up’ data in Geneva (p 18), filling up ‘the honesty box’ with many, many research errors (Ch. 3), and discovering that junkies aren’t often the best peer educators are some memorable events that stays with the reader. When she later shifts focus on the practices of other organizations and interest groups, those earlier anecdotes help the reader understand how similar experiences have informed such a wide range of ideology and opinions on best practices.

Pisani’s ultimate success in sustaining audience engagement is in her honest, and affable voice. Interchangeably shifting between first person ‘I’ and second person ‘you’, she treats the reader like her best friend divulging the outrageous fun they had making other colleagues and guests at dinner parties feel uncomfortable with their wild stories of sex, condoms, and foreskin soup (p12) over beer and cigarettes back in the old days. She reveals how she, a scientist, an epidemiologist, was shocked to tears by the results of her research indicating that 1 out of 4 of her hundred new waria friends (an Indonesian sub-culture of transvestites) would be dead within a decade (p 57). Her ability to speak frankly with a sense of humor about these subjects, and her ability to translate the numbers to real people help the audience to relate to the subject matter.
In the second half of the book Pisani provides her opinion on why current international efforts is in short, exhausting and discouraging. Her list of reasons are endless: religion obstructing condom distribution, activism trying to be politically correct shifts focus away from HIV, politicians ignore good science for fear of losing votes, voters lack compassion, money being allocated incorrectly, money not even reaching the country and intended programs, no empathy for the junkies, interest groups interpret data to suit their own platforms, and on and on and on. While this does effectively prove her point that ideology and money get in the way of good work, it also makes the audience wonder why it should even care. At least Pisani is aware of this effect, and concedes that she has bored and discouraged even herself in the past by this same exposition. She does end on an optimistic note, though for many readers it may come too late.
Overall, Pisani presents an engaging account on the HIV epidemic from its early days to its current state. Through it, she makes epidemiology and science approachable and shows how it is relevant in the larger global public health arena in informing policy and programming. It is a thoughtful and clear, though highly biased perspective on how far we have progressed on this issue and how we well we will fair in the future.