Subject: Death, Here is Thy Sting 
Date: Published: 12/13/91 (109 lines)
Source:  Wall Street Journal.  Copyright Dow Jones & Co. Inc. 

    LEISURE & ARTS -- Bookshelf:
    Death, Here is Thy Sting
    ----
    By David Burns

    In the 1950s and 1960s, it looked as if a one-two punch
 against malaria -- insecticides to kill the mosquitoes that
 transmit it, drugs to kill the parasites that cause it --
 would control, perhaps even eradicate, one of humankind's
 most ancient diseases.
    But a report issued a few weeks ago by the Institute of
 Medicine (IOM) in Washington says malaria has made a dramatic
 resurgence.  Sickness and death "are at almost unprecedented
 levels" and increasing rapidly.  "The outlook for malaria
 control is grim ...we are slipping behind the parasites .
 .  .  we are down to our last drugs ...new tools are
 desperately needed."
    What went wrong?  Robert S. Desowitz, professor of tropical
 medicine and medical microbiology at the University of
 Hawaii, blames bureaucratic bumbling and scientific hubris.
 His book, "The Malaria Capers:  More Tales of Parasites and
 People, Research and Reality" (Norton, 288 pages, $21.95), is
 a gripping account of how a one-celled protozoan has
 triumphed over modern science.
    "In 1990 -- in this age of rocket ships and genetic
 engineering -- 250 million people will get malaria and at
 least 2.5 million people will die" of it, he writes, twice as
 many as only a decade ago.  "In regions of intense
 transmission, 40 percent of the toddlers may die of acute
 malaria."  The disease is found in 102 countries.  In warm
 climates favorable for mosquitoes, hundreds of millions are
 infected more or less constantly.
    Man and malaria go back a long time.  "The cuneiform
 medical writings of the Sumerians repeatedly describe the
 typical fevers of malaria," writes Dr. Desowitz, "the Chinese
 medical classic of 2700 B. C., the Nei Ching, also gives an
 accurate description."  Hippocrates thought "a dank effluvium
 rising from the marshes caused an imbalance of the bodily
 humors."  Malaria is mentioned in the writings of Aristotle,
 Plato, Horace, Chaucer, and Shakespeare, and it killed Dante.
 Horace Walpole introduced the modern word when he wrote from
 Rome in 1740 of "A horrid thing called mal'aria {bad air}
 that comes to Rome every summer and kills one."
    The first sighting of the protozoan was made in 1880 by a
 French army physician in Algeria.  In 1897, British surgeon
 Ronald Ross, working in India, demonstrated that the disease
 was transmitted by the bite of a mosquito.  Italian
 investigators led by Giovanni Battista Grassi were the first
 to show in 1898 that human malaria is transmitted by
 anopheline mosquitoes.
    Ross advocated attacking the mosquito where it bred.  But
 the eminent German bacteriologist Robert Koch disdained
 "swatting flies"; his dictum was "treat the patient, not the
 mosquito."  These two "stubborn, opinionated men," writes Dr. 
 Desowitz, "so permanently polarized the approach to malaria
 control that integrated, multifaceted campaigns have never
 been carried out except for some rather half-hearted pilot
 projects."
    Ross's vector strategy resulted in the draining of swamps
 and other mosquito breeding grounds.  It also prompted
 widespread use of insecticides -- which ultimately made the
 current generation of anophelines resistant:  DDT doesn't faze
 them.  "No amount of DDT alone could ever cause the
 interruption of transmission," notes Dr. Desowitz.
    Koch thought the parasite could be drugged into
 submission.  Chloroquine (Aralen) was the kind of agent he
 sought.  "However," notes Dr. Desowitz, "over the years the
 widespread use of chloroquine led to the selection of
 resistant strains" of the parasites.  Today, multi-drug
 resistant strains are found throughout the world and
 treatment is "a therapeutic challenge."  In severely afflicted
 Africa, infected patients -- if they reach a hospital at all
 -- run the risk of receiving AIDS through unscreened blood
 transfusions.
    What about a vaccine to create immunity?  Unfortunately,
 the malaria parasite undergoes a dozen stages of development
 and "all stages are different; each would require its own
 vaccine ...There are notable exceptions to protection by
 vaccine -- the common cold, and AIDS.  And malaria," he
 writes.  But this has not stopped the U. S. Agency for
 International Development (AID) of looking "for a quick fix,"
 claims Dr. Desowitz.
    Part of his book is an attack on AID "amateurs" who have
 spent $100 million on vaccine research that has little hope
 of success.  In a final chapter, "The Vaccine Felonies," he
 describes how a few scientists were corrupted by all that
 money:  "One is in jail.  One is about to go on trial, indicted
 for theft, criminal solicitation, and conspiracy.  Two others
 have been indicted for theft.  Others are under
 investigation."
    Today, there is no more talk of eradication, nor of a
 "magic bullet."  Disillusioned health authorities pursue the
 more modest goal of reducing sickness and death to tolerable
 levels.  Research continues (though the IOM report notes that
 "anti-malarial drug discovery and development is of little
 interest to pharmaceutical firms").  But control, cure or
 prevention all require sustained funding -- precisely what
 the poor, tropical countries where malaria is endemic do not
 have.
    ---
    Mr. Burns is a free-lance writer in Washington, D. C. 

[This article is made available here by Dow Jones Co. for the
 personal and non-commercial use of callers to this bbs, in the
 hope that it will be of some help to those who are suffering
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