A lucid and controversial study of infections, infectiousness, and chronic illness.
Many of the chronic ailments we think of as genetic are really, in Ewald’s (Biology/Amherst Coll.) view, the result of “stealth” infections we don’t entirely understand; our models for combating them are badly outdated, like attempts to fight this century’s war with last century’s weapons. For many of these infections, the solutions are simple (use insect-proof window screens, don’t administer the same antibiotics to animals and humans, provide clean drinking water, and teach hygiene in the schools)—but remarkably difficult to enact. We worry about acute infections like influenza, Ebola, and Nile River encephalitis because they kill dramatically, quickly, and exotically, but most acute infections are neutralized by our immune system: if they don’t kill us, they will bother us no more. Or will they? Chicken pox can resurface as shingles; other herpes viruses also reemerge. In addition to providing a fascinating history of our combat with microbes (and an excellent, readable explanation of the immune system), the author exposes us, so to speak, to a host of viruses and bacteria that can live for years without displaying the smallest symptom. Heliobacter pylori, for example, is responsible for most peptic ulcers and may cause certain cancers; the papillomavirus causes genital warts in its acute phase and cervical and penile cancers in its chronic phase. Both kill widely, but neither results in the high alert that more foreign-sounding infections arouse. This is why, Ewald argues, we are far behind in the search for cures to most chronic illnesses. Although the arrival of retroviruses like HIV and HTLV has forced us to rethink the mechanism of infection, we are still largely in the dark as far as treatment is concerned. The bad news is that inoculation as we know it simply may not be possible—or, if it is, may have only a limited role in prevention and cure.
A frightening alarm whose many suggestions—starting with simple hygiene—will be ignored at our own peril.