•  Book Review: The Secret Life of Germs •  Food & Water Safety

Secret Agents: The Menace of Emerging Infections
By Madeline Drexler
Penguin Books
320 pp $15

The Demon in the Freezer
By Richard Preston
Ballantine Books
289 pp $7.99

In November 2003, federal investigators announced that contaminated scallions -- or green onions, as some people in parts of the United States call them -- had caused the largest outbreak of hepatitis A the country had ever seen. The scallions implicated in the outbreak, which afflicted more than 600 people in Pennsylvania and left three people dead, were traced to food producers in northern Mexico.

The fact that workers in another country could spawn a wave of disease simply by not washing their hands -- one theory about how the scallions became contaminated in the first place -- shocked many of those who heard about it. But anyone who'd read Madeline Drexler's book Secret Agents: The Menace of Emerging Infections would not have been surprised.

In recent years, the public health community has increasingly turned its attention to the dangers posed by what have been called "emerging infectious diseases." The term refers not just to totally new ailments like severe acute respiratory syndrome, or SARS, but also to those that have expanded their geographic range dramatically, such as West Nile virus and monkeypox, or have shown increased ability to cause severe sickness and death, like bacteria that have learned to evade antibiotics.

It wasn't supposed to be like this. For a brief window of time -- after the discovery of antibiotics in the 1940s and the polio vaccine the following decade, and before the advent of the AIDS epidemic in the 1980s -- many doctors and scientists believed that the era of infectious diseases was coming to an end. In the future, they predicted with a blend of confidence and arrogance, scientific advances would vanquish these plagues altogether, and the only major health threats would stem from chronic conditions like diabetes, cancer and cardiovascular ailments.

"By the mid-1960s, hundreds of new antibiotics were available to treat such afflictions as gonorrhea, syphilis, pneumonia, TB, bacterial meningitis, typhoid fever, even bubonic plague, while new vaccines prevented epidemics of measles, rubella, and polio," writes Drexler, a former medical reporter for The Boston Globe. "The study of infectious disease became unfashionable. Ambitious young doctors were advised not to specialize in it. ... Public health officials assumed that proper hygiene, sanitation, vaccination, antibiotic use, and good hospital care would keep the bugs at bay."

Drexler's book is as good a primer as any on why that assumption has turned out to be so wildly off the mark. It's a fascinating, prodigiously researched, and pretty terrifying exploration of a topic of enormous consequence to every human being. Drexler is not a scientist or doctor, but she knows how to explain complex medical concepts with great skill, and she writes with genuine urgency and grace. The plot here is no surprise -- infectious diseases will get us one way or another, as they have for millennia -- but the ingenious methods they use to surmount the obstacles humans construct make for riveting reading.

The pathogens that cause infectious diseases -- whether viral, bacterial, fungal, or parasitic -- threaten us from multiple directions. They're in the food we eat, the air we breathe, the water we drink, the people we love. And because they've been around for billions of years (far longer than we have), they're masters of the art of survival.

Each chapter in Secret Agents explores a particular facet of the problem: insect-borne diseases, food-borne illnesses, antibiotic resistance, pandemic influenza, the infectious agents behind chronic conditions, and bioterrorism. Drexler takes us from labs at the Centers for Disease Control and Prevention to meat-processing plants, from the Alaskan burial grounds of victims of the 1918 flu epidemic to hospitals where antibiotic-resistant infections run rampant. She's like a medical Scheherazade, spinning tale after tale after tale about wily pathogens.

While laying out a solid grounding in the mechanisms through which these bugs wreak their havoc, she never loses sight of the human side of the drama. She portrays both the tragic consequences of the diseases and the heroic exploits of the scientists who fight them. And in every section, she explains how changes in the modern world -- the astonishing ease of travel, the globalization of food production, the collapse of health care delivery systems, skyrocketing rates of antibiotic use -- have rendered us much more vulnerable to infectious diseases despite new treatments. If nothing else, Secret Agents makes it absolutely clear that the United States has reasons that extend far beyond altruism to care about health conditions in the rest of the world. As Drexler points out, microorganisms respect no boundaries, and deadly diseases in Asia or Africa will eventually make their way to the developed world.

Any pathogen can be virtually anywhere within 48 hours, she writes. In 1998, a Ukrainian émigré on a Paris-to-New York flight infected 13 other passengers with drug-resistant tuberculosis. In 2001, an Ontario hospital went on red alert when a Congolese woman arrived with what looked to be a hemorrhagic virus such as Ebola. Though she was eventually diagnosed with malaria, public health officials were once again reminded of the ticketless travel arrangements of exotic pathogens.

In Drexler's account, smallpox is one of a cast of dozens, if not hundreds, of diseases. But it has the starring role in The Demon in the Freezer, by Richard Preston, a long-time contributor to The New Yorker. Preston also wrote The Hot Zone, a best-selling medical thriller about an Ebola-like virus. In this book, he recounts the eradication of smallpox as a naturally occurring disease and explores its renewed life as one of the deadliest of the potential bioterrorism agents.

Preston is a gifted storyteller, and he has solid material in the tale of one of humanity's greatest medical triumphs -- its victory over the disease believed to have killed more people than any in history. The World Health Organization sponsored the campaign, which was coordinated with public health agencies in dozens of countries. Thousands of people in the developing world were deployed to vaccinate those in vulnerable and potentially exposed populations, trying to stem epidemics before they burst out of control.

By the end of the 1970s, the eradication campaign had accomplished its goal. The only two official smallpox repositories left were at the CDC in Atlanta and at a Russian virology institute, although many people remained convinced that clandestine stockpiles existed elsewhere.

Preston tells this story engagingly, but because we know the outcome there isn't much suspense. He tries to rev up the tension by framing the narrative within the context of the 2001 anthrax attacks, which revived concerns about bioterrorism and forced scientists and public health officials to focus renewed attention on smallpox.

The anthrax scare, as Preston recounts, also served the arguments of those seeking to unfreeze the CDCs long-dormant smallpox samples in an effort to develop better vaccines and treatments against the disease.

But this part of The Demon in the Freezer, which takes up much of the book, feels anticlimactic. Much of the anthrax story has been told elsewhere, and its connection to smallpox remains, at best, tangential. Moreover, the long-simmering policy debate between those who advocated the destruction of the remaining official smallpox stockpiles and scientists who insisted that the samples were needed for research purposes -- a dispute with far-reaching consequences -- never really comes alive.

As a result, Demon seems more like a pastiche designed to capitalize on Preston's earlier Hot Zone success than the page-turning medical thriller that it purports to be.

-- David Tuller reports regularly on health for The New York Times. A former staff writer for the San Francisco Chronicle, he has written for the Washington Post and Salon.com and is the author of "Cracks in the Iron Closet: Travels in Gay and Lesbian Russia" (Faber & Faber 1996).

First published December 12, 2003
Last updated October 30, 2008
Copyright © 2003 Consumer Health Interactive

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