New book warns of hard times ahead dealing with disease
by Seth Rogovoy

(GREAT BARRINGTON, Mass., July 17, 2003) -- I woke up one morning a few years ago and when I got out of bed and put my foot down to stand up my knee hurt. I didn’t recall having injured it in any way the previous day, but when I started to walk down the hall it hurt to put any weight on it.

Within a few hours I was flat on my back on the living room couch, unable to stand up under my own power, my knee red and swollen and with pain so severe I was screaming in agony. Ibuprofen did nothing to ease the pain; it took a shot of morphine at the emergency room at Fairview Hospital to stop the feeling that my knee was on fire.

But the knee kept swelling and sickly red lines began to radiate down my leg and up my thigh. After several more visits to the emergency room, where doctors variously puzzled and conjectured over the cause of my symptoms – spider bite? Lyme disease? -- I wound up in an ambulance on an after-midnight ride to Berkshire Medical Center in Pittsfield, where I was promptly assigned to the critical care unit with what I eventually learned was a life-threatening bacterial infection.

What I had, in simplistic terms, was strep throat in my knee – a virulent case that could have cost me my leg or a lot more had I delayed seeking treatment. And if not for the concerned and concerted efforts of a few doctors who rightly suspected that I had fallen victim to invasive Group A streptococcus infection and begun immediately pumping me full of intravenous antibiotics, my case might have provided Lenox author Mark Fischetti with one of the medical horror stories in his terrific new book, “The New Killer Diseases: How the Alarming Evolution of Mutant Germs Threatens Us All” (Crown Publishers, N.Y., 288 pages, $24.95), instead of the happy ending it supplies in the final chapter of the book, co-written by Boston University microbiologist Elinor Levy.

As it turns out, mine was just one of thousands of similar stories happening every day throughout the nation and around the world. In spite of the tremendous advances made by modern medicine in taming harmful disease-bearing pathogens, threatening bacteria and viruses are evolving at an alarming rate. Since the 1970s, researchers have discovered more than 30 new infectious diseases, including AIDS, Lyme disease, West Nile virus, and most recently SARS.

With the taut, gripping prose of a thriller, Fischetti’s brand-new book – so freshly written that it’s the first book to cover the story of the recent outbreak of SARS – recounts the emergence and re-emergence of several of the diseases threatening not only the health of individuals but potentially the safety of our nation and the survival of the human race. Through the stories of victims and survivors of anthrax, mad cow disease, E. coli 0157 bacteria, tuberculosis, West Nile virus and (gulp!) invasive group A strep, the authors examine how infectious diseases and viruses are mutating more rapidly than scientists can keep up with, and how experts are trying to cope with the spread of species-jumping, antibiotic-resistant pathogens.

“We both wanted to teach people how infectious diseases operate and how the immune system works, so if you read through the book you learn a fair amount about all that and hopefully don’t realize you’re learning it,” said Fischetti in a recent phone interview from his office in downtown Great Barrington, where he works as a freelance writer and editor for a wide range of publications, specializing in science, technology and business.

A contributing editor to Scientific American and the author of numerous books, including “Weaving the Web,” which recounts the invention of the World Wide Web by Tim Berners-Lee, Fischetti had written about medicine, diseases and genetics before, when he began noticing that within a short walk from his office, several people he knew had been hit by strange, extraordinary diseases.

In these cases, the people lived, although life is never the same once you’ve had, say, a heart infection or a bout of listeria.

“Most people who feel sick blow it off, deal with it, and go to work,” said Fischetti. “But a lot of people wait too long, especially when symptoms are not common. They just put up with it. That’s a dangerous way to be.

“But you can’t just tell that to someone. You have to convey it in a way they understand. That was my motivation: to teach people to learn about what really goes on with diseases in your body. Maybe then they’d be a lot more attuned to it and get help sooner if they are really in a bad way.”

Indeed, “The New Killer Diseases” does double duty as illustrative case study in the need for preemptive action on the part of patients, doctors, researchers and public health officials, and as basic textbook on microbiology and immunology. Fischetti’s skill as a popular science writer – he’s written for the Smithsonian, the New York Times, Science, Omni and the New York Times, among others – holds the reader in good stead in “The New Killer Diseases,” as he seamlessly weaves the educational component and scientific explanations into the narrative. A reader who can’t tell a macrophage from a phagosome or a cytokine from a lysosome hardly even realizes he’s “learning science.”

Levy originally wanted to write a book explaining how the immune system works. The two writers were paired by an agent who realized there was a bigger story here than a mere explanation of immunology – the riveting story of these accelerating diseases that are challenging our immune systems -- and one that could entice the general public.

“First, I have to understand the science, and that’s where Elinor was most obviously helpful,” said Fischetti, who has an undergraduate degree in physics from SUNY-Albany. “It’s kind of cool working with an expert one-on-one for a long project. You have one of the best tutors in the world all to yourself.

“Each chapter, the first step for me is to learn about it and talk through it all with Elinor, and make sure I understand it. She also wrote for me two or three single-page tutorials, and I would essentially translate that into what I thought was common language, and send it back to her and she’d correct it.

“Once we had that kernel, if we were going to tell a story like mad cow I could work the science in. Sometimes we have a page here or there, a couple of paragraphs, about bacteria or macrophages. We just kind of sneak it in. That’s the storytelling part, which is fun.”

Fischetti began work on the book in the fall of 2000 and completed the manuscript about a year and a half later. Did 18 months immersed in the world of evolving and mutating infectious diseases have an emotional effect on the author?

“It didn’t get depressing, but I did notice I started washing my hands a lot
more frequently,” said Fischetti, who lives in Lenox with his wife, JoAnne Redding, and their children, Nicholas, 15, and Megan, 12. “I did change our family’s practices in the kitchen. Basic stuff like washing utensils and cutting boards, cooking food thoroughly.

“Sometimes I would come home and start talking about these diseases at the dinner table and they wouldn’t want to hear it. Once you’re writing something it’s an exercise and you have distance. But talking it over at the dinner table, they’d say, ‘We don’t really want to know this now.’”

[This article originally appeared in the Berkshire Eagle on July 17, 2003. Copyright Seth Rogovoy 2003. All rights reserved.]

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