Non-Fiction Reviews

An evolving story

(2015) James Lyons-Weiler, World Scientific, £18 / US$28, pbk, xxvi +221pp, ISBN 978-9-814-67592-5


Unnervingly, this book particularly speaks to me. I had barely completed my postgraduate studies and started working for a learned professional clinicians' body in the pedestrian role of marketing and promotion, when AIDS emerged as a social issue. Indeed, a few years later when I moved to a biological society initially as its publications manager that the first book I took from commissioning through to publication was itself on AIDS education. For those who were young adults (20s – 30s) in the 1980s it was a harrowing time: many of us knew someone, or knew someone who knew someone who had been touched by HIV and remember that back I those days there was no cure. Indeed for many of Concatenation's site regulars, those of us scientists and engineers in Britain's SF community, our one chance of meeting the good doctor who was due to be GoH at the 1984 Eurocon had our hopes dashed as Isaac Asimov was for unable to attend due to a severe heart condition. Eight years later he died of HIV infection contracted during a blood transfusion as part of heart surgery in 1983. The point is that outbreaks of such novel (hence often hard to treat) and often lethal infections affect many.

Since then HIV has thankfully become treatable. But – and this is a BIG 'but' – since then we have also had bird flu, swine flu, and SARS and not to mention the problem of antibiotic (and indeed antiviral) resistance. Plus we must not forget non-human animal epidemics such as foot and mouth. The latest ebola outbreak is (other than flu variants) the most recent epidemic to cause an international stir, and certainly the one resulting in the most human deaths this decade. Indeed, those of you who follow Concatenation's seasonal science summary will have seen that it has covered the recent Ebola outbreak from early 2014 through to now (autumn 2015). And indeed in this century's first decade the Concatenation team had made some long-term predictions which included 'A microbiological pandemic either in humans or a major food crop'. In short, there will be other outbreaks of a highly contagious and lethal disease. And so James Lyons-Weiler has chosen a literally, critical topic for his book Ebola: An evolving story.

What James Lyons-Weiler has done is rush out, writing in just four months, a book that provides the basic science at an early undergraduate bioscience level, on Ebola with perhaps a twin focus on virus evolution and clinical aspects but also occasional looking up and around at the bigger picture of epidemic risk.

The book's plus points are that it is quite short and that it came out promptly once the epidemic had effectively been contained. As such it reminded me of Brian J. Ford's flash-written book on BSE (bovine spongiform encephalopathy or 'mad cow disease') which enabled folk to be brought up to speed early on before more considered and longer works could be written. Also, given that Ebola: An evolving story is written at a first year undergraduate level, it will be easily accessible to medical students as well as those in the biosciences and here (obviously) the biomedical sciences such as epidemiology, virology, immunology and to a certain extent pharmacology. Now, to be fair, there will undoubtedly in a year or so's time be better focussed books for each of these disciplines (indeed three ebola papers and three news/comment pieces in the 6th August 2015 edition of Nature – all open access – cover much of the ground), but what this book does is provide an early concise overview relevant to each of these specialisms and so biomedics will learn about the ebola basics of clinician concerns and vice-versa.

The book's negative points include that it came out promptly once the epidemic had effectively been contained. But this is a problem purely because we have not had time to properly digest the science lessons to be learned, but then that is exactly the point of this book, to blaze the trail. However I do wonder whether or not the rush to print (presumably for topicality) was at the expense of a copy edit: there were a few places where the order of the text made the reading a little confusing, but only a little and only in a few places. Nonetheless, had I been the publishers I would have forgone the expense of having some full colour figures (black & white would have easily sufficed) and gone for an addition editorial read through.  The book's other principal negative point is that its final chapter – sorry to say James – contains a useless decision-making model that is meant to be a tool for policy makers. I won't tear this apart line-by-line suffice to say that quantifying some of the model's values is pragmatically impossible. To take just one example the cost of 'lost work issues for people in quarantine' are variable and also variably perception-bound by stakeholders. For instance, a highly paid worker may incur a high cost but can afford it whereas a low-paid worker cannot, and then there are the public and private costs and benefits of the same, not to mention opportunity costs; all are different. And remember, even if one could derive a meaningfully quantitative decision algorithm for decision makers, this is the US we are talking about. On a purely quantitative basis that nation has decided on a most unsuitable healthcare system considering the US per capita healthcare spend versus longevity compared to nations with other systems such as the UK: here, our National Health Service problems – not that you'd think it given the standard of political rhetoric – are actually born of success given we have one of the lowest per capita healthcare spends among developed nations. (Incidentally, we also have one of the highest per capita economic gains from the pharmaceutical sector, while our biomedical science base is world-leading in terms of spend per paper weighted for impact factor!) So if, as it is, US policy-makers eschew an evidence-based approach for the basics of their healthcare system, one can't really expect them to change their modus operandi over narrower issues. cf. their dithering accepting anthropogenic climate change, or the value of therapeutic cloning, etc… But this is a moot point because I do not believe that the author has even begun to come close to provide a meaningful such algorithm.

But do not let this last put you off: this decision-making model is only three pages even if it does somewhat undermine the author's credibility for what otherwise seems a reasonable job of flash science writing. Many of the author's conclusions are sound and the journey he takes us on alerts us to very worrying moments of which future pandemic stakeholders do need to be aware. For instance, apparently research proposals relating to an earlier epidemic (involving a previous US President's science policy) saw all those that contained the word 'evolution' summarily dismissed, which is not useful if you want to find out how a pathogen errr… 'evolves' during the course of an outbreak as well as between them. Frightening stuff and almost hard (at least from a Brit science perspective) to believe. But then, and perhaps I should have mentioned this earlier, this book does look at ebola largely through a US-based prism.

All said and done, this is a reasonably useful book for those with a science background seeking an early insight to the latest ebola outbreak. With topicality being this book's big plus point, I can see this book finding a place on a number of university library shelves as well as on the 'further reading' list of a number of courses for 2015/6. That each chapter has a good academic reference list is also a plus for those wishing to study the issues more closely.

Jonathan Cowie

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