The future for humanity looks decidedly bleak in these two books. Take your pick: a pandemic or two looming on the horizon and a pharmaceutical industry beyond redemption.
David Quammen is an accomplished storyteller and his book weaves a comprehensive tale of zoonoses and ‘spillover’: when those infections lurch across species into homo sapiens. Infections, such as the one due to the Hendra virus, may, at first, seem distant and exotic diseases far removed from the purview of general practice, but this view can be neatly reversed when considering just one zoonosis: Ebola. It has been flaring intermittently since its first recorded emergence in 1976 and Quammen travels to Central Africa to explore the origins of Ebola. The chapter on SARS is just as eye-opening and the author finishes by unpicking the HIV tale, detailing the wounded hunter hypothesis, and exposing the trade in bush meat en route. HIV is traced back to the early 20th century and turns out to be, terrifyingly, not just one spillover, but multiple spillovers.
At first glance the global and governmental mechanisms to manage pandemics can seem fuzzy and over-elaborate; some may feel they are plain self-serving. Spillover brings the risk from zoonoses into sharp focus. Perhaps the Ebola virus will be the one to sweep away a significant proportion of humanity. Probably not, but Quammen’s book is compelling and shows that there are many candidates out there vying to be the next pandemic.
One of the players to dig us out of our pandemic hole and perhaps save us from an early death will be the pharmaceutical industry. What hope? Not much if one looks at the Tamiflu® saga. And absolutely no hope if Peter C Gøtzsche’s book is anything to go by. When it comes to passion, nothing can trump a dose of Gøtzsche rage. He lays it out in thick dramatic strokes. The detail in this book is almost overwhelming and the case against pharma exhaustive. Gøtzsche makes no bones about it: the deceit, the anti-trust cases, the outright criminal, and the immoral.
The overall tone is nothing short of apoplectic. It’s almost too much. This book needed to be written but most people, understandably, won’t stray beyond Goldacre’s Bad Pharma for the concise version. The inescapable conclusion is that the pharmaceutical industry is appallingly misaligned with individual and global health needs. In Gøtzsche’s words: ‘Our drugs kill us on a horrific scale. This is unequivocal proof that we have created a system that is out of control.’
- © British Journal of General Practice 2014