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Infections and Inequalities: The Modern Plagues
Paul Farmer has battled AIDS in rural Haiti and deadly strains of drug-resistant tuberculosis in the slums of Peru. A physician-anthropologist with more than fifteen years in the field, Farmer writes from the front lines of the war against these modern plagues and shows why, even more than those of history, they target the poor. This "peculiarly modern inequality" that permeates AIDS, TB, malaria, and typhoid in the modern world, and that feeds emerging (or re-emerging) infectious diseases such as Ebola and cholera, is laid bare in Farmer's harrowing memoir rife with stories about diseases and human suffering.
Farmer points out that most current explanatory strategies, from "cost-effective treatment" to patient "noncompliance," inevitably lead to blaming the victims. In reality, larger forces, global as well as local, determine why some people are sick and others are shielded from risk. Farmer writes of what can be done in the face of seemingly overwhelming odds, by physicians and medical students determined to treat those in whether in their home countries or through medical outreach programs like Doctors without Borders. Infections and Inequalities weds meticulous scholarship in medical anthropology with a passion for solutions—remedies for the plagues of the poor and the social illnesses that have sustained them.
Farmer points out that most current explanatory strategies, from "cost-effective treatment" to patient "noncompliance," inevitably lead to blaming the victims. In reality, larger forces, global as well as local, determine why some people are sick and others are shielded from risk. Farmer writes of what can be done in the face of seemingly overwhelming odds, by physicians and medical students determined to treat those in whether in their home countries or through medical outreach programs like Doctors without Borders. Infections and Inequalities weds meticulous scholarship in medical anthropology with a passion for solutions—remedies for the plagues of the poor and the social illnesses that have sustained them.
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First published January 1, 1999
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About the author
Paul Farmer
60 books665 followersPaul Farmer was an American medical anthropologist and physician. He was Professor of Medical Anthropology at Harvard Medical School and Founding Director of Partners In Health. Among his books are Infections and Inequalities: The Modern Plagues (1999), The Uses of Haiti (1994), and AIDS and Accusation: Haiti and the Geography of Blame (1992). Farmer was the recipient of numerous awards, including a MacArthur Foundation "genius" award and the Margaret Mead Award for his contributions to public anthropology.
Farmer was born in the U.S.A. in 1959. He married Didi Bertrand Farmer in 1996 and they had three children. He died in Rwanda in 2022, at the age of 62.
Farmer was born in the U.S.A. in 1959. He married Didi Bertrand Farmer in 1996 and they had three children. He died in Rwanda in 2022, at the age of 62.
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Displaying 1 - 30 of 117 reviews
December 12, 2010
This book, like all of Farmer's, is an excellent piece of scholarship. Much of the work is centered around the "pathogenicity of poverty," the idea that poverty, more than cultural or other anthropological factors, is crucial in examining the causes and transmission of infectious diseases. A medical anthropologist himself, Farmer frequently criticizes the anthropologist's obsession with "culture" -- in doing so, one often accuses voodoo, witchcraft, and animal sacrifice of being the instigator of HIV infection in Haiti. On the contrary, Farmer argues, culture and geographic location have much less to do with infectious disease than social inequality & the myriad factors that arise with such inequality. This argument is thoroughly supported with data of his own & others, and it is accompanied with practical, detailed solutions that alleviate the effects of poverty on infectious disease.
Just like the frequent co-morbidity of AIDS and TB, Farmer naturally focuses on these two diseases, providing data & case studies mostly from Haiti and Peru. With regards to TB, he gives many detailed examples of multi-drug-resistant (MDR) TB cases and allows for lengthy discussions of physician errors in dealing with those cases (labeling patients "noncompliant" for "refusing" to follow orders to eat well & drink clean water, for example).
I also commend Farmer's lengthy discussion of gender inequality; he devoted one chapter to the issue of how such inequality causes infection as well as significant sections of the rest of the book. This particular case successfully exemplified the ways in which inequality, as a whole, affects transmission of infectious disease.
Infectious and Inequalities is an eloquent, difficult, and painfully honest book. Though Farmer is clearly passionate about what he calls "the modern plagues," he avoids writing polemically and only occasionally drifts into sarcasm (when patient X was finally put on the proper treatment regimen, she improved..."almost as if she had a treatable infectious disease.") I would highly recommend this book to anyone who cares about dying people: it is essential.
-Eden
Just like the frequent co-morbidity of AIDS and TB, Farmer naturally focuses on these two diseases, providing data & case studies mostly from Haiti and Peru. With regards to TB, he gives many detailed examples of multi-drug-resistant (MDR) TB cases and allows for lengthy discussions of physician errors in dealing with those cases (labeling patients "noncompliant" for "refusing" to follow orders to eat well & drink clean water, for example).
I also commend Farmer's lengthy discussion of gender inequality; he devoted one chapter to the issue of how such inequality causes infection as well as significant sections of the rest of the book. This particular case successfully exemplified the ways in which inequality, as a whole, affects transmission of infectious disease.
Infectious and Inequalities is an eloquent, difficult, and painfully honest book. Though Farmer is clearly passionate about what he calls "the modern plagues," he avoids writing polemically and only occasionally drifts into sarcasm (when patient X was finally put on the proper treatment regimen, she improved..."almost as if she had a treatable infectious disease.") I would highly recommend this book to anyone who cares about dying people: it is essential.
-Eden
March 27, 2018
Were the microorganisms only longer than the people on earth or would they stay longer?
Please note that I put the original German text at the end of this review. Just if you might be interested.
I would like to focus on the theoretical part of the book. Paul Farmer is a shining example of with his commitment to the poorest and the weakest. His approaches and ideas for better medical care, more distributive justice and a restructuring of inefficient and corrupt systems are visionary. He describes the mistakes in the order, specifically the AIDS and tuberculosis epidemic in developing countries. However, back to the plagues.
Since the book is quite old, I include some of the newer developments.
One should not lose sight of the historical role models along with new scientific findings, despite all criticism of the events surrounding pork and avian flu hysteria. Above all, the pharmaceutical companies used the hyped crisis to sell more drugs and exaggeration was used to increase circulation of media.
Because the Spanish flu killed not only millions of people but, what is even more terrifying, infected more than half of the then world population. It was a lucky coincidence that it just killed young and healthy people. Bird and swine flu, which may also have other intermediate owners as zoonoses, have the potential to be both incredibly deadly and contagious. So far it has not been, but the potential combinations of characteristics of Ebola and smallpox, AIDS and influenza or tuberculosis and hepatitis C give a foretaste of dystopian scenarios. These are in no way fictitious or unlikely.
As quickly and inaccurately mutating viruses such as HIV and Ebola are changing constantly and thus escape any vaccine and cure. They come in contact with new hosts and other viruses and bacteria and develop resistance.
In tuberculosis, hepatitis C, hospital germs and other pathogens, this has now led to the formation of multidrug-resistant bacteria.
The practice of evaluating the costs and financial potential of outbreaking diseases and disabilities after illnesses seems sick itself. Whether in hard currency or a lost, healthy life-year counted, these monsters are poor reports of bureaucratic withdrawal. One does not need to shun the comparison with the profit calculation of corporations.
They have no scruples about sitting on the patents, formulas and production sites of drugs and active ingredients. However, they keep them under wraps and thus prevent research and its healing by states or other companies. Not only are there no ambitions to produce drugs against diseases that are rampant in developing countries and therefore unprofitable. It is also systematically prevented that those affected resorts to self-help.
If they do, they will be sued for infringement of patent and copyright rights. However, these class action lawsuits by pharmaceutical companies against developing countries are not entirely in harmony with the code of conduct. They cause annoying cries of the press and usually have to be pulled back. Provided the world public learns about it. Good that there are still the lucrative civilization diseases in the first world.
The combination of unscrupulousness, greed and the postponement of action could, above all, make the industrialized countries regret their actions. Not only that they ensure a better exciter distribution through the developed infrastructure and many more people can be infected in a shorter time than in developing countries. What is also not considered are the extended consequences of a plague that is only rampant in developing countries due to the successful isolation of the West. The resulting lack of raw materials and food would also cause considerable damage in the North American and European economies.
Since research on drugs and vaccines is increasingly focusing on genetically modified organisms, consideration is required. We know nothing at all about the short-term, long-term or consequential effects of interfering with the genetic material of life forms. Except perhaps that the modification changes specific characteristics and results in desired directions. Often by accident or random. How this affects the further development, reproduction and the rest of the ecosystem is also under running and thus vanishes into insignificance.
Governments, corporations, and scientists now fully control their mental powers by combating some of the most adaptable, only partially explored and understood, mutant and hazardous forms of life using genetic engineering. It will be exciting to see what the viruses and bacteria can do with these extra, unnatural building blocks. Also, what a multidrug-resistant, genetically engineered pathogen knows how to start with the evolutionarily most successful properties of various diseases when it unites them.
In a slum in the third world, in a Chinese internment camp or an over-occupied prison of the industrialized countries.
Waren die Kleinstlebewesen nur länger als die Menschen auf der Erde oder werden sie es auch länger bleiben?
Ich möchte mich auf den theoretischen Teil des Buches konzentrieren. Paul Farmer ist mit seinem Engagement und Einsatz für Ärmsten und Schwächsten ein leuchtendes Vorbild. Seine Ansätze und Ideen für bessere medizinische Betreuung, mehr Verteilungsgerechtigkeit und eine Umstrukturierung der ineffizienten und korrupten Systeme sind visionär. Er beschreibt die Fehler im System, speziell anhand der AIDS und Tuberkulose Epidemie in Entwicklungsländern. Doch zurück zu den Seuchen.
Da das Buch recht alt ist, binde ich ein paar der neueren Entwicklungen mit ein.
Man sollte die historischen Vorbilder samt neuen, wissenschaftlichen Erkenntnissen, bei aller Kritik an den Vorgängen rund um die Schweine- und Vogelgrippehysterie, nicht aus den Augen verlieren. Vor allem die Geschäftemacherei von Pharmakonzernen und Übertreibung zwecks Auflagensteigerung von Medien.
Denn die spanische Grippe tötete nicht nur Millionen Menschen, sondern, was noch erschreckender ist, infizierte auch mehr als die halbe damalige Weltbevölkerung. Dass sie nur die jungen und gesunden Menschen dahinraffte, war ein glücklicher Zufall. Vogel- sowie Schweinegrippe, die als Zoonosen auch weitere Zwischenwirte haben können, bergen das Potential in sich sowohl überaus tödlich als auch ansteckend zu sein. Bisher war es noch nicht der Fall, aber die potentiellen Kombinationen aus Eigenschaften von Ebola und Pocken, Aids und Grippe oder Tuberkulose und Hepatitis C geben einen Vorgeschmack auf dystopische Szenarien. Diese sind in keiner Weise fiktiv oder unwahrscheinlich.
Gerade so schnell und ungenau mutierende Viren wie HIV und Ebola verändern sich stetig und entschlüpfen damit jeder Impf- und Heilungsmöglichkeit. Sie kommen mit immer neuen Wirten und anderen Viren und Bakterien in Kontakt und entwickeln Resistenzen.
Bei Tuberkulose, Hepatitis C, Krankenhauskeimen und anderen Erregern hat dies mittlerweile zur Bildung von multiresistenten Keimen geführt.
Pietätslos mutet die Praxis der Kostenermittlung von Krankheiten, Seuchenausbrüchen und durch Invalidität nach Erkrankung verkürzter Erwerbstätigkeit an. Egal ob in harter Währung oder verlorener, gesunder Lebenszeit gerechnet, sind diese Ausgeburten bürokratischer Abgehobenzeit Armutszeugnisse. Sie brauchen nicht den Vergleich mit der Gewinnkalkulation von Konzernen zu scheuen.
Diese haben keine Skrupel, auf den Patenten, Formeln und Produktionsstätten von Medikamenten und Wirkstoffen zu sitzen. Sie halten diese aber unter Verschluss und verhindern damit eine Forschung samt Heilung durch Staaten oder andere Firmen. Nicht nur, dass keine Ambitionen bestehen, Medikamente gegen nur in Entwicklungsländern grassierende und deshalb unrentable Krankheiten zu produzieren. Es wird auch noch systematisch verhindert, dass die Betroffenen zur Selbsthilfe greifen.
Tun sie das doch, werden sie auf die Verletzung von Patent- und Urheberrechten verklagt. Diese Sammelklagen von Pharmakonzernen gegen Entwicklungsländer sind aber nicht ganz mit dem code of conduct in Harmonie zu bringen. Sie verursachen lästige Aufschreie der Presse und müssen meist wieder zurück gezogen werden. Vorausgesetzt, die Weltöffentlichkeit erfährt davon. Gut, dass es da noch die einträglichen Zivilisationskrankheiten in der ersten Welt gibt.
Die Kombination aus Skrupellosigkeit, Gier und Handlungsaufschub könnte vor allem die Industrieländer noch teuer zu stehen kommen. Nicht nur, dass sie durch die ausgebaute Infrastruktur eine bessere Erregerverteilung gewährleisten und viel mehr Menschen in kürzerer Zeit angesteckt werden können als in Entwicklungsländern. Was zusätzlich nicht bedacht wird, sind die erweiterten Konsequenzen einer durch erfolgreiche Abschottung des Westens nur in Entwicklungsländern grassierenden Seuche. Denn das damit einhergehende Ausbleiben von Rohstoffen und Lebensmitteln würde auch in den nordamerikanischen und europäischen Volkswirtschaften beträchtlichen Schaden anrichten.
Da bei der Erforschung von Medikamenten und Impfungen vermehrt auf gentechnisch veränderte Organismen gesetzt wird, drängt sich eine Überlegung auf. Wir wissen nicht das Geringste über die Kurz-, Langzeit- oder Folgewirkungen von Eingriffen in das Erbgut von Lebensformen. Außer vielleicht, dass die Modifikation gewisse Eigenschaften verändert und daraus erwünschte Resultate erwachsen. Und das oftmals zufällig oder aus Versehen. Wie sich das auf die weitere Entwicklung, Fortpflanzung und das restliche Ökosystem auswirkt, läuft unter ferner liefen und entschwindet somit in die Bedeutungslosigkeit.
Nun bekämpfen Regierungen, Firmen und Wissenschaftler im Vollbesitz ihrer geistigen Kräfte einige der anpassungsfähigsten, nur teilweise erforschten und verstandenen, mutationswilligen und extrem gefährlichen Lebensformen mit Mitteln der Gentechnik. Es wird spannend sein zu beobachten, was die Viren und Bakterien mit diesen zusätzlichen, unnatürlichen Bausteinen anzufangen wissen. Und was so ein multiresistenter, gentechnisch verfeinerter Erreger mit den evolutionär erfolgreichsten Eigenschaften verschiedener Krankheiten anzufangen weiß, wenn er sie in sich vereinigt.
In einem Slum in der dritten Welt, in einem chinesischen Internierungslager oder in einem überbesetzten Gefängnis der Industriestaaten.
Please note that I put the original German text at the end of this review. Just if you might be interested.
I would like to focus on the theoretical part of the book. Paul Farmer is a shining example of with his commitment to the poorest and the weakest. His approaches and ideas for better medical care, more distributive justice and a restructuring of inefficient and corrupt systems are visionary. He describes the mistakes in the order, specifically the AIDS and tuberculosis epidemic in developing countries. However, back to the plagues.
Since the book is quite old, I include some of the newer developments.
One should not lose sight of the historical role models along with new scientific findings, despite all criticism of the events surrounding pork and avian flu hysteria. Above all, the pharmaceutical companies used the hyped crisis to sell more drugs and exaggeration was used to increase circulation of media.
Because the Spanish flu killed not only millions of people but, what is even more terrifying, infected more than half of the then world population. It was a lucky coincidence that it just killed young and healthy people. Bird and swine flu, which may also have other intermediate owners as zoonoses, have the potential to be both incredibly deadly and contagious. So far it has not been, but the potential combinations of characteristics of Ebola and smallpox, AIDS and influenza or tuberculosis and hepatitis C give a foretaste of dystopian scenarios. These are in no way fictitious or unlikely.
As quickly and inaccurately mutating viruses such as HIV and Ebola are changing constantly and thus escape any vaccine and cure. They come in contact with new hosts and other viruses and bacteria and develop resistance.
In tuberculosis, hepatitis C, hospital germs and other pathogens, this has now led to the formation of multidrug-resistant bacteria.
The practice of evaluating the costs and financial potential of outbreaking diseases and disabilities after illnesses seems sick itself. Whether in hard currency or a lost, healthy life-year counted, these monsters are poor reports of bureaucratic withdrawal. One does not need to shun the comparison with the profit calculation of corporations.
They have no scruples about sitting on the patents, formulas and production sites of drugs and active ingredients. However, they keep them under wraps and thus prevent research and its healing by states or other companies. Not only are there no ambitions to produce drugs against diseases that are rampant in developing countries and therefore unprofitable. It is also systematically prevented that those affected resorts to self-help.
If they do, they will be sued for infringement of patent and copyright rights. However, these class action lawsuits by pharmaceutical companies against developing countries are not entirely in harmony with the code of conduct. They cause annoying cries of the press and usually have to be pulled back. Provided the world public learns about it. Good that there are still the lucrative civilization diseases in the first world.
The combination of unscrupulousness, greed and the postponement of action could, above all, make the industrialized countries regret their actions. Not only that they ensure a better exciter distribution through the developed infrastructure and many more people can be infected in a shorter time than in developing countries. What is also not considered are the extended consequences of a plague that is only rampant in developing countries due to the successful isolation of the West. The resulting lack of raw materials and food would also cause considerable damage in the North American and European economies.
Since research on drugs and vaccines is increasingly focusing on genetically modified organisms, consideration is required. We know nothing at all about the short-term, long-term or consequential effects of interfering with the genetic material of life forms. Except perhaps that the modification changes specific characteristics and results in desired directions. Often by accident or random. How this affects the further development, reproduction and the rest of the ecosystem is also under running and thus vanishes into insignificance.
Governments, corporations, and scientists now fully control their mental powers by combating some of the most adaptable, only partially explored and understood, mutant and hazardous forms of life using genetic engineering. It will be exciting to see what the viruses and bacteria can do with these extra, unnatural building blocks. Also, what a multidrug-resistant, genetically engineered pathogen knows how to start with the evolutionarily most successful properties of various diseases when it unites them.
In a slum in the third world, in a Chinese internment camp or an over-occupied prison of the industrialized countries.
Waren die Kleinstlebewesen nur länger als die Menschen auf der Erde oder werden sie es auch länger bleiben?
Ich möchte mich auf den theoretischen Teil des Buches konzentrieren. Paul Farmer ist mit seinem Engagement und Einsatz für Ärmsten und Schwächsten ein leuchtendes Vorbild. Seine Ansätze und Ideen für bessere medizinische Betreuung, mehr Verteilungsgerechtigkeit und eine Umstrukturierung der ineffizienten und korrupten Systeme sind visionär. Er beschreibt die Fehler im System, speziell anhand der AIDS und Tuberkulose Epidemie in Entwicklungsländern. Doch zurück zu den Seuchen.
Da das Buch recht alt ist, binde ich ein paar der neueren Entwicklungen mit ein.
Man sollte die historischen Vorbilder samt neuen, wissenschaftlichen Erkenntnissen, bei aller Kritik an den Vorgängen rund um die Schweine- und Vogelgrippehysterie, nicht aus den Augen verlieren. Vor allem die Geschäftemacherei von Pharmakonzernen und Übertreibung zwecks Auflagensteigerung von Medien.
Denn die spanische Grippe tötete nicht nur Millionen Menschen, sondern, was noch erschreckender ist, infizierte auch mehr als die halbe damalige Weltbevölkerung. Dass sie nur die jungen und gesunden Menschen dahinraffte, war ein glücklicher Zufall. Vogel- sowie Schweinegrippe, die als Zoonosen auch weitere Zwischenwirte haben können, bergen das Potential in sich sowohl überaus tödlich als auch ansteckend zu sein. Bisher war es noch nicht der Fall, aber die potentiellen Kombinationen aus Eigenschaften von Ebola und Pocken, Aids und Grippe oder Tuberkulose und Hepatitis C geben einen Vorgeschmack auf dystopische Szenarien. Diese sind in keiner Weise fiktiv oder unwahrscheinlich.
Gerade so schnell und ungenau mutierende Viren wie HIV und Ebola verändern sich stetig und entschlüpfen damit jeder Impf- und Heilungsmöglichkeit. Sie kommen mit immer neuen Wirten und anderen Viren und Bakterien in Kontakt und entwickeln Resistenzen.
Bei Tuberkulose, Hepatitis C, Krankenhauskeimen und anderen Erregern hat dies mittlerweile zur Bildung von multiresistenten Keimen geführt.
Pietätslos mutet die Praxis der Kostenermittlung von Krankheiten, Seuchenausbrüchen und durch Invalidität nach Erkrankung verkürzter Erwerbstätigkeit an. Egal ob in harter Währung oder verlorener, gesunder Lebenszeit gerechnet, sind diese Ausgeburten bürokratischer Abgehobenzeit Armutszeugnisse. Sie brauchen nicht den Vergleich mit der Gewinnkalkulation von Konzernen zu scheuen.
Diese haben keine Skrupel, auf den Patenten, Formeln und Produktionsstätten von Medikamenten und Wirkstoffen zu sitzen. Sie halten diese aber unter Verschluss und verhindern damit eine Forschung samt Heilung durch Staaten oder andere Firmen. Nicht nur, dass keine Ambitionen bestehen, Medikamente gegen nur in Entwicklungsländern grassierende und deshalb unrentable Krankheiten zu produzieren. Es wird auch noch systematisch verhindert, dass die Betroffenen zur Selbsthilfe greifen.
Tun sie das doch, werden sie auf die Verletzung von Patent- und Urheberrechten verklagt. Diese Sammelklagen von Pharmakonzernen gegen Entwicklungsländer sind aber nicht ganz mit dem code of conduct in Harmonie zu bringen. Sie verursachen lästige Aufschreie der Presse und müssen meist wieder zurück gezogen werden. Vorausgesetzt, die Weltöffentlichkeit erfährt davon. Gut, dass es da noch die einträglichen Zivilisationskrankheiten in der ersten Welt gibt.
Die Kombination aus Skrupellosigkeit, Gier und Handlungsaufschub könnte vor allem die Industrieländer noch teuer zu stehen kommen. Nicht nur, dass sie durch die ausgebaute Infrastruktur eine bessere Erregerverteilung gewährleisten und viel mehr Menschen in kürzerer Zeit angesteckt werden können als in Entwicklungsländern. Was zusätzlich nicht bedacht wird, sind die erweiterten Konsequenzen einer durch erfolgreiche Abschottung des Westens nur in Entwicklungsländern grassierenden Seuche. Denn das damit einhergehende Ausbleiben von Rohstoffen und Lebensmitteln würde auch in den nordamerikanischen und europäischen Volkswirtschaften beträchtlichen Schaden anrichten.
Da bei der Erforschung von Medikamenten und Impfungen vermehrt auf gentechnisch veränderte Organismen gesetzt wird, drängt sich eine Überlegung auf. Wir wissen nicht das Geringste über die Kurz-, Langzeit- oder Folgewirkungen von Eingriffen in das Erbgut von Lebensformen. Außer vielleicht, dass die Modifikation gewisse Eigenschaften verändert und daraus erwünschte Resultate erwachsen. Und das oftmals zufällig oder aus Versehen. Wie sich das auf die weitere Entwicklung, Fortpflanzung und das restliche Ökosystem auswirkt, läuft unter ferner liefen und entschwindet somit in die Bedeutungslosigkeit.
Nun bekämpfen Regierungen, Firmen und Wissenschaftler im Vollbesitz ihrer geistigen Kräfte einige der anpassungsfähigsten, nur teilweise erforschten und verstandenen, mutationswilligen und extrem gefährlichen Lebensformen mit Mitteln der Gentechnik. Es wird spannend sein zu beobachten, was die Viren und Bakterien mit diesen zusätzlichen, unnatürlichen Bausteinen anzufangen wissen. Und was so ein multiresistenter, gentechnisch verfeinerter Erreger mit den evolutionär erfolgreichsten Eigenschaften verschiedener Krankheiten anzufangen weiß, wenn er sie in sich vereinigt.
In einem Slum in der dritten Welt, in einem chinesischen Internierungslager oder in einem überbesetzten Gefängnis der Industriestaaten.
June 14, 2013
I have some mixed feelings about this book. First of all, I've been spoiled recently by some good, readable non-fiction, and this missed that mark. He does sprinkle in personal stories to his dense discussion of health initiatives, but even those come off as clinical. I also had a hard time with his complete disregard of making these programs financially feasible, and it occurs to me that this is because he has plenty of donors to his work. He is setting an impossible standard for the rest of the global health community. I consider myself to be quite the dreamer myself and do not like to be financially restrained, but even I found Dr. Farmer to be overly-idealistic. Don't get me wrong, he is a very intelligent, very admirable man, but he is more of an outlier than a trail-blazer.
August 18, 2012
This is an odd book. One of the bizarre aspects is a running diatribe about the way that global health money is spent on prevention instead of on treatment. First of all, it's not either/or. Secondly, if you had to choose, why not overweight prevention, which would save more lives than treatment? Thirdly, what is he talking about? In AIDS, for example, the global health money has been disproportionately spent on treating people with anti-retrovirals vs. preventing infection with condoms, etc. The overall point that more should be done to help poor people is a good one, but I am not sure what his idiosyncratic arguments add.
May 29, 2013
While I was aware at the drastic healthcare disparities that exist between nations, this book put a face and a name to those people and really quantified the magnitude of the disparity. We know that many diseases are treatable, even preventable with the proper infrastructure and medicine, but we don't want to spend money to help treat other people, even when it would help us in the long run. Let's just spend the money and deal with it all and be better off for it.
September 2, 2007
I put this in my "read" section, only because I'm never going to finish it. It's terribly written and pretentious. I'm more interested in the biography of Paul Farmer than I am of actually have to slog through his overwritten prose.
August 10, 2008
Farmer does an excellent job discussing some of the sheer complexities related to infectious disease (particularly HIV and TB) prevention and the role that inequalities have in such prevention. A must read for anyone interested in thinking about social issues and public health.
December 17, 2025
Despite being written at the turn of the millennium, Farmer's words are impactful today. In a time when there is chaos in the world order (to include the gutting of USAID), his analysis reminds us to re-center the lives and narratives of those most affected by structural violence and to reject the "immodest claims of causality" that lead people facing insurmountable poverty, gendered violence, and other stark inequities receiving the additional insult of being labeled as "noncompliant" or otherwise responsible for treatment failure. His anthropological analysis and insights, weaved into the local history and epidemiology of the HIV and TB epidemics of his interest, keep the reader feeling engaged and invested in understanding how siloed science - siloed by specialty and by patient population - has failed to help the people and communities who need its insight the most.
While many of Farmer's critiques of epidemiology have been addressed by the rising popularity of assessing social determinants of health in modern epidemiological research, this book added to a growing call within the field to go the extra step -- understanding inequities exist is only the first phase of understanding the health problem. How do we improve the health of these communities? Farmer's answer is surprisingly - to me - elegant in both its optimism and practicality: just like we can walk and chew gum, so can we (and should we) use the technology we have in addition to focusing on the structural drivers of inequity.
In sum, this was a thought-provoking, well-written piece with calls to action and a gentle scolding that ring true even today. With the threat of the world's first trillionaire looming above us all, Farmer reminds us that, with the persistence of poverty, so will we see a persistence of these deadly "plagues," which can easily spread beyond borders and become more costly to treat than to prevent.
While many of Farmer's critiques of epidemiology have been addressed by the rising popularity of assessing social determinants of health in modern epidemiological research, this book added to a growing call within the field to go the extra step -- understanding inequities exist is only the first phase of understanding the health problem. How do we improve the health of these communities? Farmer's answer is surprisingly - to me - elegant in both its optimism and practicality: just like we can walk and chew gum, so can we (and should we) use the technology we have in addition to focusing on the structural drivers of inequity.
In sum, this was a thought-provoking, well-written piece with calls to action and a gentle scolding that ring true even today. With the threat of the world's first trillionaire looming above us all, Farmer reminds us that, with the persistence of poverty, so will we see a persistence of these deadly "plagues," which can easily spread beyond borders and become more costly to treat than to prevent.
March 18, 2023
“But as skeptical as one might be about the efficacy of the sociological message, we cannot dismiss the effect it can have by allowing sufferers to discover the possible social causes of their suffering and, thus,
to be relieved of blame “
I f*ing BAWLED. Each page illustrates “the pathogenic role of inequality”. Ky at times gw baper bgt and helpless even at how all of this is systemically rooted. Im glad finally abis juga setelah dianggurin setahun lebih. Rip paul farmer
to be relieved of blame “
I f*ing BAWLED. Each page illustrates “the pathogenic role of inequality”. Ky at times gw baper bgt and helpless even at how all of this is systemically rooted. Im glad finally abis juga setelah dianggurin setahun lebih. Rip paul farmer
May 18, 2012
This book goes into painstaking detail. The book is summed up as wealth equals health. I was thrilled during the intro, and less thrilled as I finished it.
We are tossing ineffective or inappropriate drugs at populations, or no treatment at all, that don't have the money. It's called "cost effective". It wouldn't be cost effective to treat everyone the same. Which is a sick joke. At the same time we are all sharing the same micobacteria. Politics, poverty, lower standard of living, war, ineffective or lack of health care, disasters, all increase the risk hundreds fold. We are missing the opportunity to study disease by not including them in the research mix. Nor, sharing knowledge and treatment.
The world draws an imaginary line between them and "us" and aggressively identifies and treats one side, while letting the other side languish. Imagining all along there is really a wall separating us. There is not. Infectious disease doesn't respect imaginary lines.
Even in 1st world USA there is a giant percent difference in risk for disease, and dying of disease we can cure. Worse not having adequate care universally we have a petri dish situation to parasites, virus, bacteria. An open one, in plain sight. Not locked away somewhere, but mixing with all other populations. "micobacteria" (parasites, viruses) "do not respect national borders" or wealth, politics, ignorance, or insurance coverage.
People are not sicker because they are not knowledgeable, or have less morals, they are sicker because they have not social care.
It's a medical protest book. Unfortunately the people that read this book won't be the ones that can make a lot of change nationally or world wide. It's not fun reading, but important reading. I'd like to think it matters, still. It is important stuff relevant to everyone. I picked it up because I liked Laurie Garretts books and thought it would be like them. It's not nearly as readable. It reads like a drum beat to wake up to inequalities, not like an action thriller that sucks you in. More studies and results to prove the point. Less story like. Very readable, as those things go. More about one point, instead of all encompassing.
We are tossing ineffective or inappropriate drugs at populations, or no treatment at all, that don't have the money. It's called "cost effective". It wouldn't be cost effective to treat everyone the same. Which is a sick joke. At the same time we are all sharing the same micobacteria. Politics, poverty, lower standard of living, war, ineffective or lack of health care, disasters, all increase the risk hundreds fold. We are missing the opportunity to study disease by not including them in the research mix. Nor, sharing knowledge and treatment.
The world draws an imaginary line between them and "us" and aggressively identifies and treats one side, while letting the other side languish. Imagining all along there is really a wall separating us. There is not. Infectious disease doesn't respect imaginary lines.
Even in 1st world USA there is a giant percent difference in risk for disease, and dying of disease we can cure. Worse not having adequate care universally we have a petri dish situation to parasites, virus, bacteria. An open one, in plain sight. Not locked away somewhere, but mixing with all other populations. "micobacteria" (parasites, viruses) "do not respect national borders" or wealth, politics, ignorance, or insurance coverage.
People are not sicker because they are not knowledgeable, or have less morals, they are sicker because they have not social care.
It's a medical protest book. Unfortunately the people that read this book won't be the ones that can make a lot of change nationally or world wide. It's not fun reading, but important reading. I'd like to think it matters, still. It is important stuff relevant to everyone. I picked it up because I liked Laurie Garretts books and thought it would be like them. It's not nearly as readable. It reads like a drum beat to wake up to inequalities, not like an action thriller that sucks you in. More studies and results to prove the point. Less story like. Very readable, as those things go. More about one point, instead of all encompassing.
November 16, 2014
Fascinating book blowing many poverty and disease myths out of the water. Found this book on the Bill Gates reading list and glad I picked it up. As other reviews have stated, it might be a tad academic and scattered, but an excellent, illuminating read. I am very interested in his other books since I learned so much with this one.
Not only is it the ethical thing to help all the world's people deal with treatable, deadly diseases, it's enlightened self interest to do so as boundaries and borders are fluid; we protect ourselves. As Dr. William Budd writes about typhoid fever in Victorian England and applicable today:
"This disease not seldom attacks the rich, but it thrives among the poor. But by reason of our common humanity we are all, whether rich or poor, more nearly related here than we are apt to think. The members of the great human family are, in fact, bound together by a thousand secret ties, of whose existence the world in general little dreams. And he that was never yet connected with his poorer neighbour, by deeds of charity or love, may one day find, when it is too late, that he is connected with him by a bond which may bring them both, at once, to a common grave."
Fav quote:
"There is nothing wrong with underlining personal agency, but there is something unfair about using personal responsibility as a basis for assigning blame while simultaneously denying those who are being blamed the opportunity to exert agency in their lives."
Not only is it the ethical thing to help all the world's people deal with treatable, deadly diseases, it's enlightened self interest to do so as boundaries and borders are fluid; we protect ourselves. As Dr. William Budd writes about typhoid fever in Victorian England and applicable today:
"This disease not seldom attacks the rich, but it thrives among the poor. But by reason of our common humanity we are all, whether rich or poor, more nearly related here than we are apt to think. The members of the great human family are, in fact, bound together by a thousand secret ties, of whose existence the world in general little dreams. And he that was never yet connected with his poorer neighbour, by deeds of charity or love, may one day find, when it is too late, that he is connected with him by a bond which may bring them both, at once, to a common grave."
Fav quote:
"There is nothing wrong with underlining personal agency, but there is something unfair about using personal responsibility as a basis for assigning blame while simultaneously denying those who are being blamed the opportunity to exert agency in their lives."
April 26, 2013
Jake suggested it although he did not get through it.
Stories were interesting the first time, but they get rehashed to make the same point repeatedly. I would have been good after maybe 50 pages. That may be the result of this being a compilation of essays.
Disease treatment is disease prevention, for Infectious Disease.
If current best treatments are too expensive for use in developing countries, what does that mean about the value we place on life?
MDRTB needs to be treated as well as simple tuberculosis.
Stories were interesting the first time, but they get rehashed to make the same point repeatedly. I would have been good after maybe 50 pages. That may be the result of this being a compilation of essays.
Disease treatment is disease prevention, for Infectious Disease.
If current best treatments are too expensive for use in developing countries, what does that mean about the value we place on life?
MDRTB needs to be treated as well as simple tuberculosis.
April 29, 2020
Farmer argues against the logic that it is too expensive to treat infectious disease among the poor, and that they themselves are to blame for their bad treatment outcomes. Yes, that is an actual argument. As climate change also illustrates, some people are willing to risk the health of the world to make a buck.
August 10, 2023
“Show us the data to suggest that declining HIV incidence and declining AIDS deaths in wealthy countries will not be followed by decreasing investment in the basic research necessary for new drug and vaccine development. No such data exist. If they did, new antituberculous agents, also sorely needed, could not be termed "orphan drugs" a great irony, since TB remains, along with AIDS, the leading infectious cause of adult death in the world today.”
“After a decade of medical practice in the same village, I was accustomed to ferreting out accusations of sorcery and had previously spent some years trying to make sense of them. And that, paradoxically, is the primary function of such accusations: to make sense of suffering.”
“We live in a world where infections pass easily across borders social and geographic - while resources, including cumulative scientific knowledge, are blocked at customs.”
“(…) educational strategies will not change rates of typhoid when basic sanitation does not exist.”
“Efforts on her behalf may ultimately fail, but they will not have failed to call into question the cynical calculus by which some lives are considered valuable and others expendable.”
“After a decade of medical practice in the same village, I was accustomed to ferreting out accusations of sorcery and had previously spent some years trying to make sense of them. And that, paradoxically, is the primary function of such accusations: to make sense of suffering.”
“We live in a world where infections pass easily across borders social and geographic - while resources, including cumulative scientific knowledge, are blocked at customs.”
“(…) educational strategies will not change rates of typhoid when basic sanitation does not exist.”
“Efforts on her behalf may ultimately fail, but they will not have failed to call into question the cynical calculus by which some lives are considered valuable and others expendable.”
February 15, 2024
3.5/5
“it’s almost like [he/she/they] had a treatable infectious disease” - super interesting read on how inequality plays a role in the spread of infectious diseases. given that it was written more than 20 years ago, it’s also interesting to reflect on how covid now plays a role in infectious diseases and local epidemics, especially in resource poor areas of the world. though TB and AIDS are still rampant, i feel like you could replace either with covid/ebola/any other infectious disease and see similar trends and stories.
this was a slower read for sure because anthropology is hard to read (at least for me), especially in the context of medical anthropology and all of his citations/meta analyses to prove his multiple theses. eye-opening and gripping, but also dense and repetitive at times (for good reason). it’s also making me want to do medical anthropology
paul farmer is of course a god/role model for many and may he rest in peace! he is incredible and amazing and shows how justice and compassion are needed in this world to protect the poor and mitigate the effects of inequality. definitely a good read for someone interested in global health
“it’s almost like [he/she/they] had a treatable infectious disease” - super interesting read on how inequality plays a role in the spread of infectious diseases. given that it was written more than 20 years ago, it’s also interesting to reflect on how covid now plays a role in infectious diseases and local epidemics, especially in resource poor areas of the world. though TB and AIDS are still rampant, i feel like you could replace either with covid/ebola/any other infectious disease and see similar trends and stories.
this was a slower read for sure because anthropology is hard to read (at least for me), especially in the context of medical anthropology and all of his citations/meta analyses to prove his multiple theses. eye-opening and gripping, but also dense and repetitive at times (for good reason). it’s also making me want to do medical anthropology
paul farmer is of course a god/role model for many and may he rest in peace! he is incredible and amazing and shows how justice and compassion are needed in this world to protect the poor and mitigate the effects of inequality. definitely a good read for someone interested in global health
August 3, 2019
One of my favorite quotes from this book: "There is something unfair about using personal responsibility as a basis for assigning blame while simultaneously denying those who are blamed the opportunity to exert agency in their lives. A patronage that simultaneously grants 'victims' powerlessness and then assigns them blame for that powerlessness is nothing new."
It was enlightening but also disturbing to read this exposition about the nature of infectious diseases in the world. According to the WHO, tuberculosis remains the world's leading infectious cause of preventable deaths. Meaning the treatment exists, but a large majority of the victims do not have access. There were countless stories recounted about individuals who used up all their famiy's wealth and sold all the family's assets in order to pay for treatment yet it still wan not enough to keep them alive. Their inability to afford or physically access the entirety of the treatment was logged as "non-compliance." As if they had any agency in their lives to comply in the first place.
It was enlightening but also disturbing to read this exposition about the nature of infectious diseases in the world. According to the WHO, tuberculosis remains the world's leading infectious cause of preventable deaths. Meaning the treatment exists, but a large majority of the victims do not have access. There were countless stories recounted about individuals who used up all their famiy's wealth and sold all the family's assets in order to pay for treatment yet it still wan not enough to keep them alive. Their inability to afford or physically access the entirety of the treatment was logged as "non-compliance." As if they had any agency in their lives to comply in the first place.
March 8, 2021
I enjoyed reading this (like I do any Dr. Farmer book) but as it was written in the 90s, it is definitely less relevant than his more current writings on AIDS and tuberculosis. Yet, I still enjoyed seeing where and how the circumstances and analyses have changed or stayed largely the same since then.
He critiques cost-effectiveness models and the values which inform them (cost effective to whom? not those dying of these preventable and treatable diseases?), warns about the conflation of structural violence and cultural difference, and reminds us that even though the most common unit of analysis in public health is the nation-state, this is often irrelevant because organisms do not respect national boundaries.
Some of his statements definitely seem unfortunately prescient in light of the fact that suffering from the current COVID-19 pandemic has been disproportionately distributed:
“we live in a world where infections pass easily across borders—social and geographic—while resources, including cumulative scientific knowledge, are blocked at customs" (p. 54).
He critiques cost-effectiveness models and the values which inform them (cost effective to whom? not those dying of these preventable and treatable diseases?), warns about the conflation of structural violence and cultural difference, and reminds us that even though the most common unit of analysis in public health is the nation-state, this is often irrelevant because organisms do not respect national boundaries.
Some of his statements definitely seem unfortunately prescient in light of the fact that suffering from the current COVID-19 pandemic has been disproportionately distributed:
“we live in a world where infections pass easily across borders—social and geographic—while resources, including cumulative scientific knowledge, are blocked at customs" (p. 54).
August 10, 2019
It really made me rethink how the world is treating people from developing countries. I have never known that so many NTDs are still making people suffered in developing countries. For instance, TB is a signature disease as poor people. It has very high cure rate if they get earlier and proper treatment, however, things are not that straightforward. People from developed countries are ignorant and treat people from developing countries as if they are invisible and forgotten people. They stop coping up with new antibiotics for those NTDs because they cannot make profit out of that. Since those medicines are in need in developing countries, they gave up making new antibiotics which fight against MDR-TB, for instance. The real stories of patients from those poor countries made me heartbroken and at the same time made me frustrated. It only affects poor people and this book highlights discrepancy between rich and poor. Really nice book to recommend to anyone.
April 18, 2022
very interesting book. I learned so much about social determinants of health, HIV/AIDS, and TB through reading this book (also likely because I knew minimally about these areas before reading this book). The book is quite dense, mirroring some of the scientific articles I had to read for class. However, many incredibly profound statements in the book. I read a copy of the book at the UNC library that was previously annotated to follow the train of thought within long sentences and highlight important statements.
I think one of Farmer's other books, Pathologies of Power, speaks on social determinants of health in a manner from the perspective of health as a human right, but Infections and Inequalities more specifically focuses on HIV/AIDS and TB.
I think one of Farmer's other books, Pathologies of Power, speaks on social determinants of health in a manner from the perspective of health as a human right, but Infections and Inequalities more specifically focuses on HIV/AIDS and TB.
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June 3, 2019Dr. Farmer's central argument in this book is that social inequalities lead to inequalities in outcomes among people who have infectious disease such as AIDS or tuberculosis, and indeed social inequality levels could be considered a pathogenic contributor. Therefore, infectious treatment must not be limited to medical intervention but a 'biosocial' intervention-- a holistic combination of medical and social assistance. He draws from his formidable decades-long experience as a clinician in Haiti , where he shows that poverty is a relentless constraint on every factor of life and an inhibitor to the health of the population.
July 20, 2019
I got a lot out of this book. It is While a bit dry, this is a very logical and sometimes passionate treatise and indictment on our society's ineffective approach to treating global epidemics of tuberculosis and HIV, particularly for the poor. There are so many fundamental "take aways" and lessons that I always felt like I was learning and that my thinking/precepts were being challenged. Farmer's incredible experience and dedication to the fields of infectious disease and medical anthropology/sociology are clear and accessible. If you are interested in public health and/or income inequality, you will appreciate this book. If not, then it may not be a great fit.
November 25, 2022
I expected a book about medicine. Most of it was about Farmer's underlying rage at a system that condemns nations to poverty and citizens to death by TB. I'd feel the same way, if I had seen what he had. But granted that I live in an ivory tower, I have to ask, what does he want? It is probably truer to say the system made some countries rich out of a world of poor countries. More international aid, that's usually a good idea. But not even economists really understand what makes countries rich. It's certainly not an easier problem to solve than medicine.
I appreciate his anger, though. May we all desire justice so much.
I appreciate his anger, though. May we all desire justice so much.
October 21, 2024
A study of how poverty creates more risk for infections and worse healthcare outcomes.
Dr. Farmer an anthropologist-physician (who co-founded Partners in Health) shows, through the study of AIDS and TB, the idea that poverty, more than cultural or other anthropological factors, is crucial in examining the causes and transmission of infectious diseases.
He also breaks down common myths that the world uses to excuse why impoverished areas are more likely to have higher case load of infections.
It was a bit dry, and a little over my head, but the overall message was really well put together.
Dr. Farmer an anthropologist-physician (who co-founded Partners in Health) shows, through the study of AIDS and TB, the idea that poverty, more than cultural or other anthropological factors, is crucial in examining the causes and transmission of infectious diseases.
He also breaks down common myths that the world uses to excuse why impoverished areas are more likely to have higher case load of infections.
It was a bit dry, and a little over my head, but the overall message was really well put together.
April 9, 2025
I've read afew other books on anthropology and related nonfiction, and this was the best hands down. Remined me of "Manufacturing Consent" but about global health rather than mass media.
The big takeway is that the poor will die worse and more often than the people who are partial to leaving books reviews and twiddling their thumbs in the first world worrying about what liberal arts college they're going to attend.
If you reading this, or just some guy from Massachusetts for that matter, somehow contracts TB or HIV, medical and mortal fate will be determined not by the pathogen contracted the but by two needlessly simple things: location and money.
A sick world we live in indeed.
The big takeway is that the poor will die worse and more often than the people who are partial to leaving books reviews and twiddling their thumbs in the first world worrying about what liberal arts college they're going to attend.
If you reading this, or just some guy from Massachusetts for that matter, somehow contracts TB or HIV, medical and mortal fate will be determined not by the pathogen contracted the but by two needlessly simple things: location and money.
A sick world we live in indeed.
May 26, 2020
Read over several years. Started a bit before med school. Now finished amidst the hopeful downslope of the first wave of Covid--a devastating illustration of many of the concepts laid out years ago in this book.
This quote has always stayed with me:
"There is nothing wrong with underlining personal agency, but there is something unfair about using personal responsibility as a basis for assigning blame while simultaneously denying those who are being blamed the opportunity to exert agency over their lives."
We have to figure out a way to do better.
This quote has always stayed with me:
"There is nothing wrong with underlining personal agency, but there is something unfair about using personal responsibility as a basis for assigning blame while simultaneously denying those who are being blamed the opportunity to exert agency over their lives."
We have to figure out a way to do better.
February 3, 2026
Favorite part: While including a broad scope of the then-current literature, this book is grounded in Farmer's own clinical experience and that really adds a grounding element to the heavy topics and statistics.
Didn't love: The age! There's sort of nothing to be done about it, contemporary non-fiction has a shelf life and this book made me so curious about what has changed (or stayed the same) on this topic since the nineties. I got to here through John Green's Everything is Tuberculosis, so I guess I have some idea.
Didn't love: The age! There's sort of nothing to be done about it, contemporary non-fiction has a shelf life and this book made me so curious about what has changed (or stayed the same) on this topic since the nineties. I got to here through John Green's Everything is Tuberculosis, so I guess I have some idea.
May 15, 2018
Paul Farmer writes like a PhD. Not a teacher, not a public health advocate, but a PhD, steeped in theory and fifty cent words that make his text pretty hard to engage with. I’m normally really interested in the subject of public health and inequalities but this book made my eyes glaze over. I disliked it more than I’ve ever disliked a book like this, mostly because of how hard it was to read. Not because the material was challenging but because Paul Farmer is that bad of a writer.
January 3, 2019
Although repetitive and agenda-oriented, Infections and Inequalities is certainly a worthwhile read. Life will never be "utopian" here on earth. I frequently ponder why I was given so much when others barely exist. I strive to live my life with the maxim "to whom much is given, much is expected" at my spiritual core. We can provide health care world-wide if it becomes a global priority. Meanwhile we can each do our part. We don't have to live in a Marxist society to reach out to those in need.
April 3, 2020
beyond the solid evidence consistently provided throughout the ethnography (although the author defies that the book is actually one), farmer's tenacity in addressing global health inequities through addressing the structural determinants of infectious diseases permeates through the pages and can definitely be felt as the reader. required reading for anyone in global health... definitely made me rethink some of my own misconceptions about the intersections around med anthropology and epidemiology, and expanded my thinking of the social dets of health. thanks for the push to read this, d!
January 10, 2024
‘Access to medical care is a more important predictor of survival than are sex, race, and income level.’ “In other words, ensuring equal access to effective medical interventions can efface the biological expression of social inequalities.”
The challenge of the present—-will we as a society take the necessary steps to eradicate tuberculosis and (until a cure for AIDS is found) facilitate access to AIDS treatment?
The challenge of the present—-will we as a society take the necessary steps to eradicate tuberculosis and (until a cure for AIDS is found) facilitate access to AIDS treatment?
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