Book Review

One World: The health and survival of the human species in the 21st century

N Engl J Med 1996; 334:1481May 30, 1996

Article

One World: The health and survival of the human species in the 21st century
Edited by Robert Lanza. 325 pp. Santa Fe, N.M., Health Press, 1996. $25. ISBN: 0-929173-16-3

This book is as bold and ambitious in scope as its title promises. It includes contributions from former president Jimmy Carter, former surgeon general C. Everett Koop, and 41 other world leaders, representing medical associations, the World Health Organization, other United Nations agencies, federal agencies in the United States and eight other nations, as well as stellar figures in medical research, such as Christiaan Barnard and Luc Montagnier. Some of the last works of Linus Pauling and Jonas Salk are published in this compendium. The editor, a well-known expert in transplantation biology, enlisted these leaders to provide “facts and possibly thoughts and suggestions for necessary changes for the new century, thus offering a multifaceted picture of where we stand and where we intend to go.” In most cases the intended audience is the medical profession itself — physicians and medical researchers.

The book is loosely organized: an introduction is followed by discussions of professional perspectives in medicine and public health; future advances in animal and plant genetics, reproductive medicine, AIDS, and vaccines; constraints and frustrations associated with innovation; the impact of war on health and the opportunities afforded by the ending of the Cold War; and limits on health imposed by environmental contamination and population pressures, as well as by interpretive essays that integrate certain issues and by statements from various ministries of health. A minor but pertinent criticism, given the ambitious, multidisciplinary nature of the work, is the omission of references.

A number of essays are gems in their own right. For example, two essays offer particularly thoughtful approaches to the questions raised by the editor. In “The Bottom Line,” W. Harding le Riche challenges medicine and science to consider how our mechanistic view of the world creates a “tremendous waste of energy that is, in the end, self-defeating” and presents a framework for a new medical-research perspective that respects environmental issues. Simone Veil, in drawing a sharp contrast between the French and American systems of health, challenges world medicine to adopt “a high degree of common purpose and mutual responsibility . . . and to maintain a strong commitment to the alleviation of the tragedies of poverty and inequality.”

The unequal distribution of wealth as the greatest threat to health in the 21st century is a unifying theme running through many of the essays, although few present ideas on how to reduce the gap between rich and poor. Another common theme is the need to reduce rapid population growth; the linkage between these goals becomes clear in the chapter by Nafis Sadik. However, one must look outside this book for a deep understanding of the forces behind continued rapid population growth, unintended pregnancy, and the means to effect needed change.

What can and should physicians do? Unfortunately, One World provides no clear-cut agenda — no next step or call to action. The editor lets the contributors speak for themselves, but does not provide a synthesis to help make sense of these many views, which are sometimes contradictory and seldom well integrated. In the children's book Seven Blind Mice, by Ed Young (New York: Philomel Books, 1991), the old tale of blind persons describing an elephant is retold. White Mouse, the seventh blind mouse, “ran up one side and she ran down the other. She ran across the top and from end to end.” With this global perspective, she finally puts together the accurate but incomplete descriptions of the other blind mice to determine that “the something” is an elephant. One could have wished for such a synthesis in this otherwise outstanding book.

Carol J. Rowland Hogue, Ph.D., M.P.H.
Rollins School of Public Health of Emory University, Atlanta, GA 30322