Prescient is the right word for Laurie Garrett's Betrayal of Trust. It would be an understatement to say that the US response to anthrax deaths has left much to be desired. Worse yet, those deaths and the specter of bioterrorism have exposed all of the weaknesses in the public health system that Garrett has documented in her usual meticulous and intelligent style."
-- The Journal of the American Medical Association, by Dr. Tom Coates

"Garrett is a brave journalist, the Kate Adie or Christiane Amanpour of the germ world, and like Adie and Amanpour, she favors dramatic events. She rides a train into an Indian city stricken by plague as its citizens flee the other way. She visits a group of depressed young people in Ukraine and watches in a kitchen in Odessa as they inject themselves with a toxic form of heroin known as chorny. She describes flesh-eating, antibiotic-resistant bacteria devouring a patient in an American hospital. She recounts the frustrations and triumphs of the epidemiological SWAT teams that fly in from the Centers for Disease Control, the World Health Organization, and other institutions when outbreaks of such horrors as plague or Ebola occur. Everywhere Garrett encounters hospitals in chaos. When plague spread to several Indian states and killed some eighty people between August and October 1994, Garrett shows how the situation was exacerbated by a slow and lazy response from the Indian authorities and from the top officials of the World Health Organization, as well as by dilapidated, poorly equipped laboratories. Mass hysteria among panicky doctors and the residents of Surat made it even harder for the medical services both within and outside the country to respond efficiently. In 1995, 315 people contracted Ebola hemorrhagic fever and 244 people died in Kikwit, Zaire. This disease is caused by a virus, which is present in the bodily fluids of infected people. Health workers caring for sick and dying patients and relatives preparing the dead for burial tend to be most at risk for the disease. In Kikwit, two thirds of the dead were health workers who lacked such basic supplies as rubber gloves. In Russia's notoriously grimy hospitals, Garrett found that infection control was weak or nonexistent. Even US health care is undermined by doctors who overprescribe antibiotics, so that bacterial infections are increasingly resistant to the most widely used ones. If present trends continue, she writes, eventually few, or even none, of these drugs will work."
-- NEW YORK REVIEW OF BOOKS, April 12, 2001 By Helen Epstein

The Overseas Press Club of America gave BETRAYAL OF TRUST its most prestigious honor, the Madeliene Dane Ross Award for Reporting on the Human Condition. Awarded in a category in which books compete against reporting on TV, radio, in magazines and newspapers, BETRAYAL is the first book to ever receive this OPC recognition.

On January 29, 2001 it was announced that BETRAYAL OF TRUST is a finalist for the National Book Critics Circle award for nonfiction.'s "Editor's Choices 2000" named BETRAYAL OF TRUST one of the top ten works of non-fiction of the year--#4, in fact.

"On a par with Rachel Carson's SILENT SPRING, this chilling exploration of the decline of public health should be taken seriously by leaders and policy-makers around the world." 
--Publishers Weekly (July 31, 2000) (Full star review)

"Oh, what is the point of even going on! Newsday's health and science writer Laurie Garrett makes you sick with fear in BETRAYAL OF TRUST, an expose of public health catastrophes present and just waiting to happen." 
--Vanity Fair (August, 2000)

"A Health Alarm to Wake the World" --Anita Manning, USA Today (August 16, 2000) "A health alarm to wake the world the book warns of crumbling disease defenses, Laurie Garrett in her 1994 best seller, The Coming Plague, journalist Laurie Garrett used her reportorial skills..."
-- By Anita Manning, USA TODAY Author

"In our biotechnological age, this story may seem awfully quaint. But the world needs these simple public-health measures now more than ever--- and it needs them a lot more than a new genome. If you have any doubt that this is the case, Laurie Garrett's staggering new book, BETRAYAL OF TRUST, will obliterate it.....In BETRAYAL OF TRUST, Garrett investigates the state of the world's public health, and she's got some bad news: It's in free-fall." 
--Newsday (August 20, 2000)

"THE COLLAPSE OF GLOBAL PUBLIC HEALTH, IN 'BETRAYAL OF TRUST:' by Laurie Garrett (2000, NY: Hyperion), builds on Garrett's earlier 'The Coming Plague,' this time telling blow-by-blow the story of recent infectious disease crises, including Russia, Ebola in Zaire, plague in India (1994). Garrett argues passionately that govts have forgotten the lessons of how public health (& population preventive action) changed the world's health situation over the centuries; she calls for renewed attention to the "basic factors essential to population health: clear water, plentiful food; housing; waste disposal; social & medical control of epidemics; widespread, universal access to maternal & child health care; & a health care system." Garrett observes that the World Bank has become the biggest funder of public health in the world. Garrett concludes with the prediction shared with many experts that within a few decades, 'viruses, bacteria & fungi will have evolved complete resistance to the human pharmaceutical arsenal.' "
-- The Humanitarian Times (January 26, 2001) TOP TEN BOOKS OF 2000, YEAR-END RECAP

"It was in Zambia's copper belt in 1979 that Laurie Garrett first laid eyes on a dead infant. The young journalist had journeyed to Africa in search of experience and adventure, and one day found herself in a ramshackle clinic. A mother suddenly appeared with a baby that was "beyond crying. The doctor quickly offered his diagnosis: "This child is ..."
--Publishers Weekly, by Scott Sherman (08/21/2000)

"Her tour through the slums of India and the tundra of Russia is both stunning in its breadth of detail and heartbreaking in the misery it reveals." --Ryan Sager, Wall St. Journal (August 29, 2000) "The author shows clearly that successful public health programs require a fragile bond of trust between the people and their government, and she details the critical effects of politics and economics on public health infrastructures. Her endnotes, which might constitute a book in themselves, offer a tremendous resource for additional research. Completely readable for general readers and experts alike, this reasonably priced book is highly recommended for all libraries." 
--Library Journal (September 1, 2000) (A full star review)

"What do Russia, Zaire, Los Angeles, and--most likely--your community have in common? Each is woefully unprepared to deal with a major epidemic, whether it's caused by bioterrorism or by new or reemerging diseases resistant to antibiotics. After the publication of her critically acclaimed The Coming Plague, which looked at the reemergence of infectious diseases, Laurie Garrett decided to turn her highly honed reportorial skills to what she saw as the only solution--not medical technology, but public health. However, what she found in her travels was the collapse of public-health systems around the world, no comfort to a species purportedly sitting on a powder keg of disease.
In "Betrayal of Trust", Garrett exposes the shocking weaknesses in our medical system and the ramifications of a world suddenly much smaller, yet still far apart when it comes to wealth and attention to health. With globalization, humans are more vulnerable to outbreaks from any part of the world; increasingly, the health of each nation depends on the health of all. Yet public health has been pushed down the list of priorities. In India, an outbreak of bubonic plague created international hysteria, ridiculous in an age when the plague can easily be treated with antibiotics--that is, if you have a public-health system in place. India, busy putting its newfound wealth elsewhere, didn't.
In Zaire, the deadly Ebola virus broke out in a filthy and completely unequipped hospital, and would have kept up its rampage if the organization Doctors Without Borders hadn't stepped in, not with high-tech equipment or drugs, but with soap, protective gear, and clean water. 
Most of the world still doesn't have access to these basic public-health necessities. The 15 states of the former Soviet Union have seen the most astounding collapse in public health in the industrialized world. But during a cholera epidemic, officials refused to use the simple cure public-health workers have long relied on - oral rehydration therapy. Many of the problems in these nations can also be found in one degree or another in the U.S., where medical cures using expensive technology and drugs have been emphasized to the detriment of protecting human health. The result? More than 100,000 Americans die each year from infections caught in hospitals, and America has a disease safety net full of holes. 
A Pulitzer Prize-winning journalist (for Newsday and others), Garrett has deftly turned what could have been a very dry subject into dramatic reportage, beginning with the eerie silence on the streets of Surat, India, where half the city's population (including doctors) fled the plague, while a thick white layer of DDT powdered the ground. Fascinating, frightening, and well-documented, "Betrayal of Trust" should be read not only by medical professionals and policymakers but the general public, and should galvanize a change in thinking and priorities." 
--Lesley Reed - Sept. 5, 2000

"While most journalists contentedly fill their newspapers with virtual breads and sexual circuses these days, Laurie Garrett stands out as something of a traditionalist. In spare, no-nonsense prose, the Pulitzer Prize-winning New Yorker writes big articles about the importance of clean water, the demise of antibiotics and the perils of imported food. And God bless her for it."
-- The Globe & Mail, Toronto (Saturday, September 16, 2000) - By Andrew Nikiforuk

"Garrett's message is loud, clear and convincing. Be it India, Africa, Russia or the United States, securing basic public health standards should pose no insuperable problems; all it requires is sufficient political will and a modicum of funding. At the very least, it requires adequate nutrition, clean water, good drainage, proper hygiene and sound medical management. Rich nations should help the poor and in the process put their own houses into order. Political disintegration, get-rich-quick multinational capitalism, mass migrations of refugees and other phenomena of our globalization times are providing magnificent new opportunities for disease. And in "Betrayal of Trust," Garrett has delivered a sober warning for the new century."
-- Los Angeles Times (Sunday, September 17, 2000) by Roy Porter, author of "The Greatest Benefit to Mankind: A Medical History of Humanity.

"The central message of this blockbuster of a book is simple and stark: Public health, Laurie Garrett tells us, must become global if local populations in the U.S. or anywhere else are to be spared exposure to lethal epidemics old or new. But administrative arrangements to safeguard public health are grossly inadequate everywhere and are decaying dangerously even in countries like ours, where antibiotics and other early 20th Century triumphs once promised to eliminate infectious disease as a serious threat to human life."
-- The Chicago Tribune, By William H. McNeill. (October 1, 2000) William H. McNeill is a University of Chicago professor of history emeritus.

"Garrett has done a masterful job of laying out the near-crisis state of public health. After finishing Betrayal of Trust, the reader isn't likely to escape the feeling that something must be done urgently. But a book this long will simply not win enough of those readers to create the public outcry that this issue needs. Garrett has convinced me that public health needs a Silent Spring, Rachel Carson's much shorter book that awoke the public to the dangers of insecticides. One hopes that Garrett or someone equally talented will write it before another epidemic hits."
-- BUSINESS WEEK (Oct. 2, 2000) By Catherine Arnst

"Throughout the book, Garrett reminds us that public health is fragile. Where there is a choice, societies choose curative medicine over prevention. Sadly, I agree and I believe the reader will be convinced by her arguments. 

Garrett devotes a third of the book to a lengthy discussion of public health deterioration in the United States in the context of diminishing federal funding for health. This is a detailed, annotated, well-researched indictment of what the author terms "antigovernmentalism." In addition, she maintains, the nation has succumbed to the concept that in health matters the rights of the individual trump the rights of the community. The book details for the United States many of the same problems that are found in developing countries, including AIDS, multidrug-resistant tuberculosis, and bacterial resistance to antibiotics. 

I also found the chapter on biowarfare to be an accurate account of the current risks. It presents the useful perspective that any countermeasure will depend on and require a strong public health infrastructure for surveillance and response. 

Garrett is an outstanding investigative reporter. Betrayal of Trust is a reflection of her meticulous research and her ability to write an engaging, scientifically credible text that can be understood by scientist and nonscientist alike. Antigovernmentalists will not be pleased, but Garrett has traveled the world to gather her material and has a message that we should all take seriously."
-- SCIENCE magazine, January 2001. A review by Robert E. Shope

"Rarely has a journalist with such experience conveyed so dire a message with such writerly skill. Destined to be classic (as its predecessor already is), Betrayal of Trust is a book you can't afford not to read."

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