Book Review

Quiet Killers: The Fall and Rise of Deadly Diseases

N Engl J Med 2007; 357:1784-1785October 25, 2007

Article

Quiet Killers: The Fall and Rise of Deadly Diseases
By Robert Baker. 256 pp., illustrated. Thrupp, England, Sutton Publishing, 2007. $29.95. ISBN: 978-0-750-94108-2

The tubercle bacillus has quite a vendetta against the arts, having been associated with the deaths of Jane Austen, Frédéric Chopin, Fyodor Dostoevsky, Edgar Allan Poe, Franz Kafka, Alexander Pope, and Molière. And as Robert Baker points out in his book, “consumption” still kills and is one of the “weary litany of diseases that are treatable or preventable by simple measures, yet persist in the developing world.” These diseases — including tetanus, measles, malaria, sandfly fever, Chagas' disease, Ebola virus infection, cholera, rabies, sleeping sickness, West Nile virus infection, and infection with human immunodeficiency virus (HIV) or AIDS — continue to ravage poorer nations.

In Quiet Killers, Baker elegantly traces the history of infectious agents from the Roman era to the present day. He references Shakespeare's Henry V on malaria (“he is so shaked of a burning quotidian tertian that it is most lamentable to behold”) and Boccaccio on the plague (“the stench of their putrefying corpses carried the tidings”). He recounts how Oliver Cromwell played a key role in the spread of yellow fever worldwide by shipping slaves from West Africa to the Caribbean to be put to work clearing vast tracts of mosquito-infested rain forest.

This is not a prurient foray into the world of flesh-eating worms and nose-rotting parasites — although these creatures do put in memorably sickening appearances. Baker may have dispensed with the appurtenances of an academic study, but he retains the objectivity of such a study. There is a powerful and uncluttered narrative at work here: for thousands of years, humans and the quiet killers have lived in uneasy equilibrium, and this balance has been tipped one way by wars, famine, and the disruption of local ecology and the other way by improvements in hygiene and scientific awareness.

Baker compares the struggle to “an ungloved boxing match between two prize-fighters . . .both have exchanged near-killer blows but neither has quite had the other out for the count.” Humankind, he contends, has squandered the opportunity to usher in a “Golden Age of protection from disease” and may even be facing a resurgent enemy. Baker writes, “Drug-resistant HIV disease, TB [tuberculosis], MRSA [methicillin-resistant Staphylococcus aureus], malaria — each is a real hazard; the further dangers of new emerging diseases such as Nipah, and Influenza A. . . are ever with us.”

This statement is a little harsh. Microbes have proved capable of an acrobatic adaptability that few could have predicted. The massive advances in medical science since the invention of the microscope, which are carefully outlined by Baker, should not be overshadowed by the follies of the past century. Besides, it is not the fault of the field of microbiology that malaria continues its noxious reign over sub-Saharan Africa and that the British public remains skittish of the measles, mumps, and rubella vaccine.

Still, Baker remains quietly optimistic. He brings us up-to-date on the latest developments in the field, including “designer” antibiotics, antimicrobial peptides that are derived from the human body, and proteomics, the use of advanced computers for the virtually instantaneous analysis of thousands of proteins. As always, the science is addressed in clear and lucid terms.

Nor does Baker lose his poise when tackling emotive geopolitical issues. His discussion of the pharmaceutical industry is one example. Baker draws our attention to the possible ramifications of a company freely distributing a much-needed drug to an impoverished part of the world. What would be the legal consequences if someone became ill as a result of the medication? And where would the decision leave the state of research by pharmaceutical companies into new, more effective treatments if the profit margin became severely squeezed? For Baker, the real problem lies in the lack of funding available to universities. He notes that in Britain, this has led to professorial chairs in microbiology going unfilled. “Being a chair with no research money,” he quips, “is like being a eunuch in charge of a harem; and one which hasn't even got any women in it.”

Talha Khan Burki, B.Sc.
1 Ravensfield Gardens, Ewell, Epsom, Surrey KT19 0ST, United Kingdom
t_burki@yahoo.co.uk