BOOK REVIEW

of Caesarean sections. You learn that nuances of the global epidemiology of retreat and eventual elimination of Marc Chagall was thought to be dead at malaria and modern approaches to con- malaria as an endemic disease in the birth, but revived when he was dropped trol programs. The book relates a dismal 1950s. The first 250 years of malaria in into a bucket of ice water. The chapter tale of how malaria control efforts have the USA are covered in Chapters 1 and 2, and book end with a lively presentation failed globally and how, “No new con- whereas most of the remainder of the of aspects of being a new mother, and trol strategy has emerged in recent years book details the social and medical im- the final word is directed at the future to replace the faulty DDT spraying pro- pact of malaria in the southern states of human pregnancy in the context gram…Malariologists in developing during the first half of the 20th century. of contemporary reproductive tech- countries are turning increasingly to In Chapter 4, there is an interesting nology. low-technology solutions such as insec- analysis of the effective ‘malaria tax’ im- Bainbridge has written a highly infor- ticide-treated bed nets, as nothing else is posed on industry and how the realiza- mative, enlightening and amusing book available.” tion of this economic impact led to on human pregnancy. It certainly will be True, malaria contin- the mobilization of re- appreciated by a wide audience. ues to kill huge numbers sources to control the of children, to sicken a disease, a topic of con- high proportion of the siderable importance in world’s population and current malaria-control Malaria: Poverty, Race, to impose major direct programs. A highlight of and indirect economic the book is the anecdotal and Public Health in burdens on the dev- but relevant insight into eloping world, but there knowledge, attitudes and the United States have been successes since practices toward provi- DDT. The near elimina- sion of health services in by Margaret Humphreys tion of malaria in China general and malaria in Johns Hopkins University Press from a peak of tens of particular, through the $41.50, 256 pp, 2001 millions of cases annually unique documentation in the 1970s is one such generated in the 1930s REVIEWED BY ALLAN SAUL success. Other steady, al- by the Federal Writers’ Malaria Vaccine Development Unit, National beit less spectacular, gains in specific Project. These accounts chronicle a sys- Institutes of Health, Rockville, Maryland, USA programs in Southeast Asia, South Asia, tem in transition from old beliefs of Central and South America also come to malaria as an environmental hazard I eagerly started Malaria: Poverty, Race, mind. Increasingly, new control strate- (contracted by ‘bad water’), to more and Public Health in the United States, gies in endemic areas, such as those pro- modern ideas of malaria as a contagion © http://medicine.nature.com Group 2002 Nature Publishing looking forward to the insights into moted under the umbrella of the WHO carried from person to person by mos- malaria control that could be gained Roll Back Malaria Program, rely on inte- quitoes; the impact of the education sys- from the successful experience of the grated programs to empower communi- tem in the introduction of new ideas; United States. I wanted to see what ties to provide access to better health and the constraints imposed by poverty lessons could be applied to the develop- care, better health education, early diag- on the ability to act on the information ment of malaria-control programs in nosis and treatment, wealth-generation even when understood. similarly rural, poor and relatively low schemes so people can afford health care These are topics with an uncanny rele- endemic areas and how these compared and lifestyle changes to reduce risk, as vance to contemporary control pro- to my own experiences in developing well as anti-mosquito measures such as grams tailored to low-to-moderate sustainable malaria control programs in bed nets and spraying. These are low- endemic areas. These efforts face similar The Philippines. However, my expec- technology perhaps, but increasingly so- obstacles with regard to economics, tations were quickly lowered by read- phisticated in their development of health-seeking practices and beliefs, as ing, in the Introduction, Margaret multifactor and sustainable programs. well as the more technical issues of vec- Humphreys’ rationale for this book: “I Apart from the pessimistic big picture tor control and treatment of patients. had once hoped that this research pro- of this story, there are also numerous, Even if the only lesson to be learnt from ject might result in more than an histor- usually trivial, but annoying errors. For the US is that malaria can be beaten, ical narrative, that it might actually example, in describing the lifecycle of then this alone is important. bear relevance for the beleaguered inter- malaria parasites, there are at least six Humphreys poses the question, “Who national malaria community”. Instead significant errors in one paragraph. killed malaria [in the USA]?” and pro- she conveys her disappointment that, These do not inspire confidence in the poses a novel, but plausible, explanation “The history of malaria’s disappearance scholarship behind this book. for the coup de grace, which I won’t spoil from the United States has few lessons If one accepts that Malaria is simply by disclosing here. However, even in un- to offer for those struggling to combat “an historical narrative” and ignores the raveling this mystery she warns, “that the disease in its contemporary tropical minutiae, then it offers a fascinating you may be wiser at the end, but still not homes.” story of the spread of malaria through sure.” My advice for readers of this book: After having read the book, I disagree. the USA following its introduction in Don’t let the limits imposed by the au- The difference of opinion may relate to the 17th century, through its greatest thor spoil a good story of considerable the author’s limited knowledge of the geographical coverage in the 19th cen- relevance for contemporary malaria- biology of the parasite and its host, the tury. The story culminates in the steady control programs.

104 NATURE MEDICINE • VOLUME 8 • NUMBER 2 • FEBRUARY 2002