Stesheni kumi na moja

I'm a bit late to the "social science bloggers love Station Eleven" party. Chris Blattman put it in his 2014 favorite novels list, and Jay Ulfelder shared a nice excerpt. I loved it too, so I'll try to add something new. Station Eleven is a novel about what happens after - and just before, and during - a flu pandemic wipes out 99% of the human population. The survivors refer to that event as the Collapse, and mostly avoid talking about or thinking about the immediate aftermath when all was a fight for survival. But Station Eleven is not just derivative post-apocalyptica. The book avoids a garish focus on the period just after the Collapse, but instead focuses on the more relatable period just as things are beginning to unravel, and much later, as bands of survivors who made it through the roughest bits are starting to rebuild. The main characters are a band of musicians and thespians who are trying to retain some of the cultural heritage and pass it on to the next generation, who have no memory of the world before the Collapse.

It's also a novel about loss, both personal and societal. One of my favorite passages:

...No more ball games played out under floodlights. No more porch lights with moths fluttering on summer nights. No more trains running under the surface of cities on the dazzling power of the electric third rail. No more cities.… No more Internet. No more social media, no more scrolling through the litanies of dreams and nervous hopes and photographs of lunches, cries for help and expressions of contentment and relationship-status updates with heart icons whole or broken, plans to meet up later, pleas, complaints, desires, pictures of babies dressed as bears or peppers for Halloween. No more reading and commenting on the lives of others, and in so doing, feeling slightly less alone in the room. No more avatars.

Since I was reading this novel while traveling for work in Tanzania and Zimbabwe and Liberia, I was struck by its focus on Canada and the US. Nothing wrong with this: the author is Canadian* and the presumed audience is probably North American. But I kept wondering what the Collapse would have been like elsewhere. It was global, but would it have been equally catastrophic elsewhere? Urban centers like Manhattan are ludicrously unworkable in the absence of the electricity and cars and subways and other bits of the massive, distributed, and - to casual eyes - largely invisible infrastructure working to constantly feed them with supplies and people and information.

The novel implies that these urban centers fared worse, and focuses on suburbia and rural areas, where survivors re-learn how to farm, how to make things for themselves. We see nothing of the global "periphery" where the fall from wealth might be less great, where the collective psychological trauma of losing 99 out of 100 people might dominate the loss of technology. Of course, the periphery is defined by the observer and the writer, and isn't the periphery at all to those who live in it. Maybe things would fare better, or maybe not.

Imagine the same novel, but set in Tanzania, or some other country where the majority of people are small-holder subsistence farmers. Maybe it would use the device of following two relatives, one living 'upcountry' or in 'the village' (i.e., poor rural parts) and the other living in Dar es Salaam. Relationships are established in an early chapter when the successful urban relative visits the village, or the rural relative visits the big city, and both marvel at their differences.

Then the flu hits, and things start to break down. Narrative chapters are intersperse with transcripts of SMS (text message) exchanges, demands for mPesa transfers, the realization that money doesn't matter anymore, and finally the realization that the networks aren't getting anything through anymore. Some city dwellers flee for the countryside but find themselves shunned as bearers of contagion. The urban protagonist makes her way, over the course of months or years, to the rural area where her relative once lived, hoping to find things are better there. Her belief that the village will be the same mirrors the readers' belief - and common trope in writing about developing countries - that subsistence farmers today somehow live just as they did centuries or millenia ago. Bullshit, of course.

As the urbanite nears the village, her encounters reveal all the ways the modern fabric of village life was related to society and technology and has likewise broken down with the Collapse. Perhaps the power vacuum set off struggles amongst survivors and led to some new social order, where none of her skills are that useful. Nearing the village, she finds that the rural relative is now leader, revealing his situation has been reversed by the Collapse just as the once successful urbanite finds her way into his village with her last shilling.

Maybe this novel already exists. Or something else using the post-apocalyptic form to explore somewhere that's not Canada or the US or Europe and not reliant on mechanized agriculture. Pointers, please, as I'd love to read it.

*originally I wrote the author was American. Oops. Apologies, Canada!

Americanah

Americanah, the new novel by Chimamanda Ngozi Adichie is very good. I have a long list of Nigerian fiction on my to-read list, but Americanah got bumped to the top because it seemed like the perfect transition from Princeton to Nigeria: I heard Chimamanda speak in Princeton – where she, like Ifemelu, the main character, lived for a year on a fellowship – a month or so ago. Americanah starts with Ifemelu taking NJ Transit from Princeton to Trenton to get her hair braided, because Princeton is the sort of place with an “ice cream shop that had fifty different flavors including red pepper” but no one to braid black hair. Following her TED Talk advice, Americanah crams in many narratives. It’s set in Lagos and London, Brooklyn and Baltimore, New Haven and Philly, and it’s about migration from Lagos to America, from Lagos to London, and from everywhere back to Nigeria. One character, in London:

His eyes would follow them, with a lost longing, and he would think: You can work, you are legal, you are visible, and you don’t even know how fortunate you are.

It’s about dating across race, wealth, and cultures; academics and intellectuals and the many people who are only one or the other, not both; the London black market of arranged sham marriages and faked ID documents; accents real and faked; sex work; the constant burdens and exploitation and desperation of the undocumented; Barack Obama; the hope and opportunity that can come with an approved visa application; and hair. Lots of hair.

There are Americans who deny that racism is still a problem. Wealthy folks who, learning Ifemelu is from Nigeria, try to connect by mentioning their latest trip to Tanzania, their opinion of Ethiopian beauty, the charity they support in Malawi. Ifemelu thinks:

There was a certain luxury to charity that she could not identify with and did not have…. Ifemelu wanted, suddenly and desperately, to be from the country of people who gave and not those who received, to be one of those who had and could therefore bask in the grace of having given, to be among those who could afford copious pithy and empathy.

Another character is at a London dinner party, thinking:

Alexa, and the other guests, and perhaps even Georgina, all understood the fleeing from war, form the kind of poverty that crushed human souls, but they would not understand the need to escape form the oppressive lethargy of choicelessness. They would not understand why people like him, who were raised well fed and watered but mired in dissatisfaction, conditioned from birth to look towards somewhere else, eternally convinced that real lives happened in that somewhere else, were now resolved to do dangerous things, illegal things, so as to leave, none of them starving, or raped, or from burned villages, but merely hungry for choice and certainty.

Ifemelu is, for a while, a blogger who writes “Raceteenth or Various Observations About American Blacks (Those Formerly Known as Negroes) by a Non-American Black” which gives Adichie a venue to make observations, often hilarious and/or impolite. One post starts:

Dear Non-American Black, when you make the choice to come to America, you become black. Stop arguing. Stop saying I’m Jamaican or I’m Ghanaian. America doesn’t care. So what if you weren’t “black” in your country? You’re in America now….

Americanah never dwells on a single theme until it becomes tiresome The major characters are sympathetic but flawed, and the observations are constantly insightful – I wanted to quote much more here. So, highly recommended.

"As it had to fail"

My favorite line from the Anti-Politics Machine is a throwaway. The author, James Ferguson, an anthropologist, describes a World Bank agricultural development program in Lesotho, and also -- through that lens -- ends up describing development programs more generally. At one point he notes that the program failed "as it had to fail" -- not really due to bad intentions, or to lack of technical expertise, or lack of funds -- but because failure was written into the program from the beginning. Depressing? Yes, but valuable. I read in part because Chris Blattman keeps plugging it, and then shortly before leaving for Ethiopia I saw that a friend had a copy I could borrow. Somehow it didn't make it onto reading lists for any of my classes for either of my degrees, though it should be required for pretty much anyone wanting to work in another culture (or, for that matter, trying to foment change in your own). Here's Blattman's description:

People’s main assets [in Lesotho] — cattle — were dying in downturns for lack of a market to sell them on. Households on hard times couldn’t turn their cattle into cash for school fees and food. Unfortunately, the cure turned out to be worse than the disease.

It turns out that cattle were attractive investments precisely because they were hard to liquidate. With most men working away from home in South Africa, buying cattle was the best way to keep the family saving rather than spending. They were a means for men to wield power over their families from afar.

Ferguson’s point was that development organizations attempt to be apolitical at their own risk. What’s more, he argued that they are structured to remain ignorant of the historical, political and cultural context in which they operate.

And here's a brief note from Foreign Affairs:

 The book comes to two main conclusions. First is that the distinctive discourse and conceptual apparatus of development experts, although good for keeping development agencies in business, screen out and ignore most of the political and historical facts that actually explain Third World poverty-since these realities suggest that little can be accomplished by apolitical "development" interventions. Second, although enormous schemes like Thaba-Tseka generally fail to achieve their planned goals, they do have the major unplanned effect of strengthening and expanding the power of politically self-serving state bureaucracies. Particularly good is the discussion of the "bovine mystique," in which the author contrasts development experts' misinterpretation of "traditional" attitudes toward uneconomic livestock with the complex calculus of gender, cash and power in the rural Lesotho family.

The reality was that Lesotho was not really an idyllically-rural-but-poor agricultural economy, but rather a labor reserve more or less set up by and controlled by apartheid South Africa. The gulf between the actual political situation and the situation as envisioned by the World Bank -- where the main problems were lack of markets and technical solutions -- at the time was enormous. This lets Ferguson have a lot of fun showing the absurdities of Bank reports from the era, and once you realize what's going on it's quite frustrating to read how the programs turned out, and to wonder how no one saw it coming.

This contrast between rhetoric and reality is the book's greatest strength: because the situation is absurd, it illustrates Ferguson's points very well, that aid is inherently political, and that projects that ignore that reality have their future failure baked in from the start. But that contrast is a weakness too, as because the situation is extreme you're left wondering just how representative the case of Lesotho really was (or is). The 1970s-80s era World Bank certainly makes a great buffoon (if not quite a villain) in the story, and one wonders if things aren't at least a bit better today.

Either way, this is one of the best books on development I've read, as I find myself mentally referring to it on a regular basis. Is the rhetoric I'm reading (or writing) really how it is? Is that technical, apolitical sounding intervention really going to work? It's made me think more critically about the role outside groups -- even seemingly benevolent, apolitical ones -- have on local politics. On the other hand, the Anti-Politics Machine does read a bit like it was adapted from an anthropology dissertation (it was); I wish it could get a new edition with more editing to make it more presentable. And a less ugly cover. But that's no excuse -- if you want to work in development or international health or any related field, it should be high on your reading list.

Hitch on Che

This is old ('97) but worth a read: Christopher Hitchens reviews John Lee Anderson's biography of  Che, along with Guevara's own Motorcycle Diaries.

New books

... that I wish I had time to read: 1) Laurie Garrett's first book since Betrayal of Trust (2000) is I Heard the Sirens Scream, which takes on 9/11, the anthrax attacks, and the US response to both. I'm most interested in the discussion of "the bizarre chemistry of The Plume that rose from the burning crushed World Trade center for four months." Alanna Shaikh interviews Garrett about the book in UN Dispatch.

2) The Other Barack, though it sounds depressing.

3) The Invention of Brownstone Brooklyn: Gentrification and the Search for Authenticity in Postwar New York. A review:

By 1982, Osman writes, the number of hardware stores in Park Slope was more than three times the per-capita average in the rest of the city, and surveys indicated that a majority of Park Slope residents were undertaking most improvements themselves. In the current age of multimillion-dollar brownstone sales, it’s easy to forget the more modest roots of these neighborhoods....New, politically savvy residents sometimes found common cause with local residents in lobbying for services and opposing large-scale development. In 1975, the Fort Greene Non-Profit Improvement Council was powerful enough to obtain a court injunction halting study of the construction of a new Giants Stadium on the Atlantic Terminal site. Such coalitions, however, don’t always hold together....

Sounds interesting throughout, especially now that I've been to Brooklyn. Yes, before this summer I had never really ventured outside of Manhattan on my few visits to New York. Also, the question of gentrification is one of those things I used to think was simple, when I first read of it. Surprisingly (or not?) it was talking through those issues in DC with several friends who are urban planners that made me realize that there generally aren't easy answers to any question involving old and new residents and changing economic fortunes in a neighborhood.

Not #4: After reading J's review, I think I'll pass on Inside the Everyday Lives of Development Workers.

Miscellany: Epidemic City and life expectancy

In 8 days I'll be done with my first year of graduate studies and will have a chance to write a bit more. I've been keeping notes all year on things to write about when I have more time, so I should have no shortage of material! In the meantime, two links to share: 1) Just in time for my summer working with the New York City Department of Health comes Epidemic City: The Politics of Public Health in New York. The Amazon / publisher's blurb:

The first permanent Board of Health in the United States was created in response to a cholera outbreak in New York City in 1866. By the mid-twentieth century, thanks to landmark achievements in vaccinations, medical data collection, and community health, the NYC Department of Health had become the nation's gold standard for public health. However, as the city's population grew in number and diversity, new epidemics emerged, and the department struggled to balance its efforts between the treatment of diseases such as AIDS, multi-drug resistant tuberculosis, and West Nile Virus and the prevention of illness-causing factors like lead paint, heroin addiction, homelessness, smoking, and unhealthy foods. In Epidemic City, historian of public health James Colgrove chronicles the challenges faced by the health department in the four decades following New York City's mid-twentieth-century peak in public health provision.

This insightful volume draws on archival research and oral histories to examine how the provision of public health has adapted to the competing demands of diverse public needs, public perceptions, and political pressure.

Epidemic City delves beyond a simple narrative of the NYC Department of Health's decline and rebirth to analyze the perspectives and efforts of the people responsible for the city's public health from the 1960s to the present. The second half of the twentieth century brought new challenges, such as budget and staffing shortages, and new threats like bioterrorism. Faced with controversies such as needle exchange programs and AIDS reporting, the health department struggled to maintain a delicate balance between its primary focus on illness prevention and the need to ensure public and political support for its activities.

In the past decade, after the 9/11 attacks and bioterrorism scares partially diverted public health efforts from illness prevention to threat response, Mayor Michael Bloomberg and Department of Health Commissioner Thomas Frieden were still able to work together to pass New York's Clean Indoor Air Act restricting smoking and significant regulations on trans-fats used by restaurants. Because of Bloomberg's willingness to exert his political clout, both laws passed despite opposition from business owners fearing reduced revenues and activist groups who decried the laws' infringement upon personal freedoms. This legislation preventative in nature much like the 1960s lead paint laws and the department's original sanitary code reflects a return to the 19th century roots of public health, when public health measures were often overtly paternalistic. The assertive laws conceived by Frieden and executed by Bloomberg demonstrate how far the mandate of public health can extend when backed by committed government officials.

Epidemic City provides a compelling historical analysis of the individuals and groups tasked with negotiating the fine line between public health and political considerations during the latter half of the twentieth century. By examining the department's successes and failures during the ambitious social programs of the 1960s, the fiscal crisis of the 1970s, the struggles with poverty and homelessness in the 1980s and 1990s, and in the post-9/11 era, Epidemic City shows how the NYC Department of Health has defined the role and scope of public health services, not only in New York, but for the entire nation.

2) Aaron Carroll at the Incidental Economist writes about the subtleties of life expectancy. His main point is that infant mortality skews life expectancy figures so much that if you're talking about end-of-life expectations for adults who have already passed those (historically) most perilous times as a youngster, you really need to look at different data altogether.

The blue points on the graph below show life expectancy for all races in the US at birth, while the red line shows life expectancy amongst those who have reached the age of 65. Ie, if you're a 65-year-old who wants to know your chances of dying (on average!) in a certain period of time, it's best to consult a more complete life table rather than life expectancy at birth, because you've already dodged the bullet for 65 years.

(from the Incidental Economist)

The Tea Test

If you haven't been following it, there's currently a lot of controversy swirling around Greg Mortenson, co-author of Three Cups of Tea and co-founder of the Central Asia Institute. On Sunday 60 minutes aired accusations that Mortenson fabricated the 'creation myth' of the organization, a story about being kidnapped by the Taliban, and more. The blog Good Intentions Are Not Enough is compiling posts related to the emerging scandal, and the list is growing fast. If you haven't read it already, Jon Krakauer's mini-book, Three Cups of Deceit: How Greg Mortenson, Humanitarian Hero, Lost His Way, is really worth the read. Completely engrossing. It's a free download at byliner.com until April 20. It's about 90 pages, and Krakauer has obviously been researching it for a while -- in fact, my guess is that Krakauer turned 60 Minutes onto the story, rather than vice versa, which would help explain why he was featured so heavily in their piece. In the TV interview Krakauer quotes several former employees saying quite unflattering things about how CAI is run, so it's good to see that he gets many of those people on record in his ebook.

A few disclaimers: I think it's worth pointing out that a) as a one-time supporter and donor to CAI, Krakauer arguably has an axe to grind, b) several of Krakauer's previous books (Into Thin Air, Into the Wild, and Under the Banner of Heaven) have had sections disputed factually, though to me Into the Wild is the only case where he seems to have actually gotten things wrong, and c) I'm a big fan of him as a writer and thus am possibly a bit predisposed to believe him. Admitting by biases up front like good epidemiologist.

That said, it sounds like CAI has been very poorly led. Krakauer's book levels many damning claims about Mortenson and CIA's financial management that, while less emotionally shocking than the exaggerations about the 'creation myth,' should be much more troubling. CAI and Mortenson's responses to the accusations so far on 60 Minutes have seemed superficial, and I think it's safe to say that they will not come out of this looking squeaky clean.

I believe this episode raises two broader questions for the nonprofit community.

First, Krakauer chronicles a string of board members, employees, and consultants who came in, were shocked by how things were done and/or discovered discrepancies, and ended up leaving or resigning in protest. This section (pages 50-51) jumped out at me:

After Mortenson refused to comply with CFO Debbie Raynor's repeated requests to provide documentation for overseas programs, Raynor contacted Ghulam Parvi (the Pakistan program manager) directly, instructing him to provide her with documentation. For two or three months Parvi complied - until Mortenson found out what was going on and ordered Parvi to stop. Raynor resigned.

In 2007, Mortenson hired an accomplished consultant to periodically fly to Central Asia to supervise projects. When he discovered irregularities and shared them with Mortenson, Mortenson took no action to rectify the misconduct. In 2010, the consultant quit in frustration.

In September 2007, CAI hired a highly motivated, uncommonly capable woman to manage its international programs. Quickly, she demonstrated initiative and other leadership skills the Institute sorely needed. She had exceptional rapport with Pakistani women and girls. In 2008, she unearthed serious issues in Baltistan that contradicted what Mortenson had been reporting. After she told Mortenson about these problems, she assumed he would want her to address them. Instead, as she prepared to return to Pakistan in 2009, Mortenson ordered her to stay away from Baltistan. Disillusioned, she resigned in June 2010.

Seriously -- ff this has been going on for so long, how on earth is it just coming out now? Evidently a nationally known organization can have nearly its entire board resign and multiple employees quit, and it doesn't make the news until years later? Some of this (I'm speculating here) likely results from a hesitance on the part of those former employees to speak ill of CAI, whether because they still believed in its mission or because they were worried about being the sour grape person. Were they speaking out and nobody listened, or is there simply no good way to raise red flags about a nonprofit organization?

Second, while most organizations aren't guilty of fraud -- we hope -- there's at least one other take-away here. Another excerpt that jumped out at me:

On June 13, 2010, Parvi convened a meeting in Skardu to discuss Three Cups of Tea. Some thirty community leaders from throughout Baltistan participated, and most of them were outraged by the excerpts Parvi translated for them. Sheikh Muhammad Raza—chairman of the education committee at a refugee camp in Gultori village, where CAI has built a primary school for girls—angrily proposed charging Mortenson with the crime of fomenting sectarian unrest, and urged the District Administration to ban Mortenson and his books from Baltistan.

Based on Krakauer's footnotes, Parvi may be one of his less reliable sources, but this idea -- that the people portrayed in the book were outraged when it was translated to them because of how misleading it is -- comes up several times. Yes, fabricating stories is really bad. But how many other things do nonprofits say in their advertising that would be uncomfortable or downright offensive if you translated it for (and/or showed the accompanying pictures to) the recipients or beneficiaries or their services?

I propose a simple way to check this impulse -- to write about people as if they are victims or powerless -- and in honor of Three Cups of Tea, I call it the "Tea Test":

Step One: read the website content, blog posts, or email appeal you just got from your charity of choice. Or, if you work for a nonprofit organization, read your own stuff.

Step Two: imagine arriving in the recipient city or village, with a translated copy of that text. Would you be uncomfortable reading that website or blog or email to the people you met? Would it require tortured explanations, or would it instantly make sense and leave them feeling dignified?

That's it: if Step Two didn't make you cringe, then you passed the Tea Test. If it made you uncomfortable, made them feel ashamed, or got you attacked -- re-draft your copy and try again. Or find another organization to support.

I think there are many organizations that pass the Tea Test, but probably many more that fail. These organizations don't necessarily share all the faults of CAI as laid out by Krakauer and others, but they wouldn't fare much better in this situation, because they say something for one audience that was never intended to get back to the others.

I hope the idea of the Tea Test -- reading a translated copy of that material to the people it's describing -- will be helpful for donors and nonprofiteers alike. As a former online fundraiser I know I've broken this rule, and as a donor I've found things appealing that I probably should have reacted strongly against. I'm going to try to do better.

Update: I've posted a slightly revised (and I hope easier to remember) version of the Tea Test on a permanent page here.

Atlas Shrugged

My oldest brother, Drew, is a professional oboist, reedmaker, and composer. He also writes witty things on Facebook which don't get out the wider world, like the bullet-point review of Atlas Shrugged below. While I still haven't gotten around to reading anything by Ayn Rand (shocking!), this hits the high points of pretty much everything I've heard of her, so I'm re-posting it here (with his permission). With a new movie coming soon we're all going to be inundated with a new generation of Objectivists, so it's time to read up. His review:

Atlas Shrugged is 50% story and 50% sermon. It would've been a better book had it been half as long, or at least half a venomous.

Atlas Shrugged is an eloquent expression of a beautiful idea that (like all beautiful ideas) becomes grotesque when unchecked by counterbalancing forces.

Atlas Shrugged is a fantasy novel. The real world is not powered exclusively by a dozen productive geniuses who all happen to agree on everything. Elves and dwarves are more believable.

In the real world, businessmen are not demigods, and politicians are not devils.

In the real world, wealth is inherited by George W Bush, not Francisco d'Anconia.

Ivy Starnes says, "The plan was a noble ideal, but human nature was not good enough for it." Sadly, Rand does not realize that her villain's words apply equally to her own ideology.

At first it's confusing that an author capable of such brilliantly concise dialogue so often launches into long-winded and half-baked rambles. But there's a reason for it: outrageous ideas seem less outrageous with repetition. Partisan media understand this. You don't have to justify a claim if you repeat it often enough. I laughed out loud when Rand first referred to the "looters." But by the end of the book, that peculiar usage seemed almost normal.

Not since Zen and the Art of Motorcycle Maintenance has a book so clearly shown that brilliant novelists often make lousy philosophers. Of course, brilliant philosphers often make lousy philosophers, too.

Review: "The Panic Virus"

Review of The Panic Virus, by Seth Mnookin. Simon & Schuster Jan 2011 (Available at Amazon) [Disclosure: I got a free copy of the Panic Virus from a friend who has a friend that works at the publisher -- I wasn't given the copy specifically to write a review, but it's still probably better to disclose I didn't pay for the book.]

Seth Mnookin's The Panic Virus starts and ends with two stories of parents whose seemingly normal children come down with a serious illness. He describes their children before the episodes, and then their dread as they go downhill, are hospitalized, and fight for their lives. These stories intentionally parallel the narrative of the vaccines-cause-autism movement -- "our child was normal, then he got the vaccine, and then he got autism, so it must have been the vaccine." However, Mnookin's carefully chosen stories don't support the anti-vaccine movement; they do just the opposite and make you feel heartsick for the children affected by vaccine-preventable diseases.

Mnookin knows how to tug on heart strings, and how to get his readers riled up, so it's a good thing that he comes down strongly pro-vaccine. His case studies are selected for emotional value, and they illustrate how a thoughtfully written narrative can humanize statistics about disease outbreaks and the danger of the anti-vaccine movement. But I approve of Mnookin's tactics ultimately because his stories are true -- vaccines save lives, and much harm has been done by the spread of unfounded fear.

That said, Mnookin's book isn't at all a fearmongering tale of what will happen if you don't vaccinate your child -- the bookend stories are just that, and he could probably have included a few more narratives throughout without stretching it. For the most part his book is a sober narrative of a social movement that goes back to the earliest vaccines, but has only come to nationwide fruition with the rise of the Internet.

Mnookin chronicles the development of early vaccines, and, to his credit, spends a good deal of time on what was done badly by the scientists and advocates. The Cutter Incident is there,  along with the 1976 swine flu vaccine. Mnookin doesn't mince words in describing injuries that have been caused by vaccines, and at many times I found myself cringing and thinking "why weren't better systems in place earlier?" and "they really should have done more".

This willingness to confront unpleasant truths is a strong point for the Panic Virus, and it also gives Mnookin an opportunity to introduce the safety innovations that stemmed from each incident, all while setting the stage for the anti-vaccine movement. Another strength is that The Panic Virus also offers compelling humanizations of many of the parents of autistic children who have been involved in the anti-vaccine movement. Their despair at seeing their children suffer, their ostracization in a society where autism is not accepted, their occasionally callous treatment by physicians who have no easy answers to offer -- all of this makes it impossible not to sympathize with them.

For the most part, Mnookin doesn't present parents as the villains of his story. That role is reserved for shoddy physicians, scientists and pseuodoscientists, and most of all for journalists. Andrew Wakefield, Mark and David Geier, and journalist/author David Kirby all come in for harsh reckonings, along with many other "expert witnesses" for anti-vaccine lawsuits. This book left me quite depressed regarding the role of journalists and TV personalities in the whole fiasco. There has been so much bad reporting, and so little good.

While reading The Panic Virus, I kept thinking that its major shortcoming is a lingering uncertainty about its target audience. Is Mnookin writing for the uninitiated who want an introduction to where the anti-vaccine movement? Or is he writing a broadside for those already staunchly in the pro-vaccine community? There are sections where the rhetoric made me think it was the latter, while the majority of the book seems to be for those with little outside knowledge of vaccine science. Since Mnookin cautions so much against being led astray by charlatans who peddle fear with a thin veneer of scientific-sounding verbiage, I wish he had done a bit more to explain the science done in recent years on vaccine safety, thiomersal, MMR, and autism. I understand why an author writing a popular narrative would avoid trying to describe these subjects: they are incredibly complicated and divert the reader from the narrative. [Note that I haven't read Paul Offit's Autism's False Prophets, which I understand might have a bit more of that.] And it's not like good science writing is entirely missing from The Panic Virus. Some things are explained well, but overall there's just a bit too much deference to the authority of  science and scientists for my tastes, especially for a book intended for lay audiences. It's a good book, but not a great book.

I also wish Mnookin had provided a better counter-narrative in the second half of the book. Broadly speaking, the first half follows the development of vaccines and early vaccine injury scares (founded and unfounded), and the second half explores the rise of the anti-vaccine social movement. The second half is missing strong pro-vaccine characters, such as one or two scientists or policymakers who have been working to combat the anti-vaccine crowd. A lot of good research has been done to disprove fallacious claims, and to look for policy solutions aimed at decreasing opt-out rates on a state level, but none of that is here.

To date the anti-vaccine crowd has really won the narrative war: their message is simpler, and scarier, and has the added perk of being anti-establishment in appealing ways. The Panic Virus didn't give me much hope that that would change soon -- although the book itself is mostly a step in the right direction, combining a pro-science view with a few emotional narratives about vaccine-preventable diseases.

Our best hope is that eventually our scientific explanations of autism etiology will solidify a bit more, and coupled with much more demonstrably effective treatments, the snake oil appeal of the "cures" sold by the anti-vaccine movement will lose their charm. One theme of the Panic Virus is that the anti-vaccine movement arose because parents of autistic children weren't getting the sympathy, explanations, and help they needed. Many factors including a lack of understanding by doctors and communities, isolation, weak scientific explanations, and a lack of viable treatments all created a situation like a field of dry grass. When a powerful idea -- "vaccines cause autism" -- arose and was amplified by the echo chambers of Internet communities, it ripped through the dry field like a wildfire, sowing panic and fear. And the fire still hasn't been put out.