Monday, June 15, 2009

Book Review - Smallpox: The Fight to Eradicate a Global Scourge

Smallpox: The Fight to Eradicate a Global Scourge by David Koplow
Book review by Cooper Lloyd

David Koplow’s Smallpox: The Fight to Eradicated a Global Scourge is a perfect read for the newcomer to the study of smallpox. Koplow sets out to provide a basic overview of the disease and its surrounding debates, and he successfully realizes this goal. Extremely detailed discussions are left for other writers; Koplow’s aim is to appeal to reader who has little scientific knowledge or background in the issues surrounding smallpox, and to leave him or her equipped to understand the virus’ continuing significance and engage in the debates surrounding its extinction.

Koplow structures Smallpox in chapters that, one-by-one, build up a multi-disciplinary understanding of smallpox. Koplow begins by discussing the history and biology of smallpox – the bread and butter, really – but then adds additional layers of understanding while ultimately crescendoing to a debate of sorts over whether smallpox should be exterminated from the planet. In terms of chapter content, the book moves from the history, biology, and use of smallpox as a biological weapon, to some related background in environmental law and policy, to the role of the WHO and the morality of extermination, and finally to the arguments both for and against extermination.
In the first two thirds of the book, Koplow provides a well-rounded, if cursory, understanding of the disease and the fundamental issues at stake in its continued existence. Koplow’s treatment of the history of smallpox is compressed into only a few pages, yet he mentions most of the important points, touching on the origins of the disease, its role in ancient history, past treatment regimes such as inoculation, and the global eradication program. In the following chapter on biology, Koplow describes viruses from ground zero, also treating topics such as genetic engineering, genetic alteration of smallpox, and the goals of smallpox research. Koplow next discusses smallpox as a biological weapon, moving chronologically through history to situate the current situation within the context of policies that have evolved over time. The chapter on Environmental Law and Policy raises issues that are often neglected in the study of smallpox, such as biological diversity and the bearing of both US and international law in the debate over the extermination of smallpox. Finally, the chapter on the WHO discusses smallpox within the context of the organization that has been such a major player in its eradication, while also answering the readers’ questions about where the current variola stocks reside and why the extermination of the virus is taking so long; the chapter on morality treats the philosophical debates about the role of man in the manipulation of nature.

Koplow uses all of these chapters bring up various points to which he will return in the last two chapters, the first of which treats the case for extermination and the second the case against extermination. These two chapters synthesize the arguments from various disciplines, allowing the reader to understand how several lines of argument apply to this complex question. While some arguments may at first appear to repeat points brought up earlier in the book, the reader ultimately emerges appreciative of Koplow’s attempt to draw together all of the information presented in the preceding chapters. Furthermore, Koplow organizes these final chapters in terms of numbered arguments and rebuttals, which provide a clear framework and allow the reader to move back and forth constantly, considering both sides of the arguments. The arguments themselves are written in non-technical language – the kind of arguments that one might encounter when talking to a friend (for example, Argument 1 in The Case for Extinction: It costs more money to continue to store and work on this stuff). The clarity of these arguments helps draw the new scholar of smallpox into the debates at the very heart of the disease.

In his conclusion, Koplow offers 12 recommendations for the future, including his own take on whether or not to retain the stocks of variola (you’ll have to read the book to find out his opinion); having taken us through the arguments on both sides of the debate, it only seems appropriate that Koplow allow the reader to understand in the end where he comes down on these issues. Appropriately, however, he reserves this injection of personal belief for the very end of the book and thus spends the majority of his time presenting the arguments and rebuttals quite impartially. Koplow’s policy prescriptions are insightful if controversial, but one wonders whether anyone besides the casual reader will ever see them. Furthermore, they are often too general to be very helpful; for example, Recommendation 7 states that we should, “Address the burgeoning bioterrorism threat directly.” The two paragraphs that follow provide no clear vision of how this should come about.

Ultimately, Smallpox is an accessible read and one that fills a gap in the smallpox literature by addressing the debates over the extermination of smallpox in a simplified way that the general public can understand and take part in; however, to a reader more educated in the issues surrounding smallpox, Smallpox will surely be too simplistic to be of much use. One of Koplow’s best devices throughout the book is the structuring of his chapters using questions as headings; for example, a biology section is entitled, “Is a virus alive?”. Throughout the book, Koplow anticipates the readers’ questions, but in the end, the reader is left with a million unanswered questions. Perhaps, however, this is Koplow’s great achievement; he provides the reader with a base knowledge that equips him or her to ask questions with a new level of sophistication, to tackle more detailed works about smallpox, and to engage constructively in the ongoing debate.

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