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Review: Soap and Water & Common Sense, by Dr. Bonnie Henry

Looking for the perfect gift for the incorrigible germaphobes on your Christmas list? Try Bonnie Henry's Soap and Water & Common Sense. There's enough material here to frighten and titillate them until next Christmas. If the salmonella in this year's turkey doesn't get them first, that is.

The rest of us non-germaphobes may be less intrigued. Infectious diseases are not quite the threat to Canadians that Dr. Henry cracks them up to be. A person living in Canada in 2009 is less likely to die from an infectious disease than anyone ever before in the history of the human species. About 20 times as many otherwise healthy Canadians will be killed by cars this year than by the dreaded H1N1 influenza virus, for example. So, if you are concerned about protecting your health, a book on defensive driving would be far more useful.

Subtitled The Definitive Guide to Viruses, Bacteria, Parasites, and Disease, this book is really a quick and superficial guided tour covering virtually the gamut of human infectious diseases in about 250 pages. The book is generally well written, but it fails because it lacks focus.

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The reach of Soap and Water exceeds its grasp. The book tries to do too many things, and falls short on all of them. It lacks the precision and reliability of a reference book. While it's rich with interesting anecdote, it's not structured as a history book. It lacks the depth of a policy "think piece." It does not have the organization or detail of a how-to manual.

Admittedly, there are some great stories here. The dead flamingoes in the Bronx Zoo were the first North American victims of West Nile Virus. The emergency dog-sled relay across Alaska to bring antitoxin to fight a diphtheria outbreak in Nome gave birth to the annual Iditarod race. More storytelling would at least have added entertainment value.

We shouldn't be complacent about infectious diseases, but we shouldn't lie awake at night worrying about them either

It's hard to know the real audience for this book, but I have no doubt that it will find a readership. If nothing else, Henry's book enjoys an impeccable sense of timing. Driven by the hype over H1N1 influenza, infectious diseases are now the subject of almost unprecedented media attention.

The greatest failing of Soap and Water, as with much of the media coverage, is a lack of perspective. The age of infectious diseases may not be over, as a U.S. surgeon-general famously and prematurely declared in 1959. But the public-health importance of infectious diseases has dropped precipitously, particularly in developed countries such as Canada.

Henry would like us to believe that the threat of infectious diseases is increasing - a devil's brew of persisting threats (e.g. salmonella), new diseases (e.g. AIDS) and the re-emergence of old enemies (e.g. tuberculosis). The evidence speaks to the contrary. Death rates from infectious diseases have been declining steadily in this country for as long as we have kept vital statistics.

Tuberculosis makes a good case in point. In the 19th century, TB was the commonest cause of death in Canada, but rates have been dropping for 150 years. In the past two decades, this drop has levelled off, but at historically low levels - about 200 times less than a century ago. This improvement is due primarily to better living conditions and overall health. Antibiotics and improved medical care are only the icing on the cake.

Henry gets this all very wrong. She talks about TB being "temporarily thwarted in much of the Western world" but now undergoing a "dramatic resurgence" that is "decimating families." This is hardly an accurate picture of the risk in Canada today or realistic prospects for the future.

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Scientifically, Henry is well credentialed and generally reliable. There are, inevitably, a few errors. Jonas Salk used dead viruses in his polio vaccine, a very different technique from Edward Jenner's live cowpox virus vaccine against smallpox. Human rabies is almost unknown in North America, but not because of access to the human rabies vaccine. Rather, it is because we have eliminated wild dog packs. Tetanus is not a traveler's disease. There are plenty of tetanus spores right here at home. The Walkerton E. coli outbreak was a major tragedy, but it was not "the second-largest waterborne outbreak in history," not even remotely close.

Ultimately, the book's title tells it all. We shouldn't be complacent about infectious diseases, but we shouldn't lie awake at night worrying about them either. A little basic hygiene and a little common sense are all most Canadians need. Be careful with hazardous foods, judicious with your sex life and get the recommended vaccines, and chances are very good that you will live a long and healthy life until cancer, cardiovascular disease or diabetes call your number. Unless, of course, you get run over by a car on your way to get the H1N1 shot.

Richard Schabas is medical officer of health for Hastings and Prince Edward counties, and was Ontario's chief medical officer of health from 1987 to 1997.

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