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adamoe has commented on (3) products.

When She Woke by Hillary Jordan
When She Woke

adamoe, April 22, 2013

Very interesting and enjoyable. The protagonist's relationship with God and her awakening independence lacked a thorough exploration but the book provides a good story and a chilling possible future for our country.
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(1 of 2 readers found this comment helpful)

Flight Behavior by Barbara Kingsolver
Flight Behavior

adamoe, April 22, 2013

Similar to my favorite of her books, Prodigal Summer, in it's powerful intermingling of ecology and human interaction, each serving as a multifaceted metaphor for the other. Enjoy!
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The Imaginations of Unreasonable Men: Inspiration, Vision, and Purpose in the Quest to End Malaria by Bill Shore
The Imaginations of Unreasonable Men: Inspiration, Vision, and Purpose in the Quest to End Malaria

adamoe, April 21, 2013

The thesis of this book is that it takes someone a little crazy to solve big problems. It is a health science book, wrapped in biographical hero worship. To this end, Shore tells us the tale of the scientists working to save the children of Africa through the development of a vaccine against the malarial parasite. His point is made largely by repetition and he uses of multiple examples of the same thing, scientists who are working outside the establishment because they have big ideas and won’t take no for an answer. More than an attempt to understand the battle against malaria, the book is a tribute to the mad, loner scientist.

The author’s naïve enthusiasm and lack of medical or scientific background are apparent in his characterizations of the scientists and research projects involved in the fight against malaria. This is not necessarily a fatal flaw but does define the book’s audience as solidly not physicians, scientists or those actually engaged in the efforts to control or eliminate malaria in the developing world. In addition, this lack of expertise in the area in which he has chosen to illustrate his broad principle causes the author to miss many key aspects of the work and the application of his principles that leave large gaps in his overall theory and a number of questions that are left unanswered.

Many of the scientists profiled in this book are fighting to overcome, not the imagination gaps that the author claims are the problem, but simple production problems, the type of problem that they all share and might best be approached through teamwork and cooperation rather than competition. The author remarks that the business world’s spirit of competition would be a useful addition to the field of science and one that is demonstrated by Steve Hoffmann and the other scientists profiled in the book. However, these scientists would likely acknowledge that science has always involved a healthy competition for the latest discoveries, grants, public recognition. What is more difficult is to foster are meaningful collaborations across institutions and disciplines that are natural allies in their overall battles towards a cure or enhanced understanding. They do not require more incentive to compete with each other, that comes naturally and has been practiced throughout their academic and professional careers. What is lacking are the systems and tools that would help these researchers to put their heads together and share ideas and knowledge that could help to move the entire field forward.

Shore only briefly addresses the history of vector-borne disease elimination efforts as one dominated by successful vector-control campaigns without giving significant coverage to current efforts to combat malaria through bed nets and pesticides. Yellow fever in the U.S., for example, was wiped out largely by destroying mosquito habitats and not by the later vaccine development efforts that were ultimately also successful. What Shore does not address about these disease control efforts is that they were undertaken by public health officials, engineers, and volunteers with little or no connection to science or health care. The battles were waged in ditches with gasoline canisters, not in laboratories with pipettes. Shore and the scientists he profiles seem to believe that malaria can be fought like measles, when it clearly has much more in common with yellow fever and should be approached as such, with even less emphasis on vaccine development because malaria is caused by a parasite and there has never been a successful vaccine developed to protect against a parasite.

One reason for an approach to malaria control other than vaccine development is the nature of the disease itself. Malaria is a disease that people contract repeatedly throughout their lives. There is some level of immunity that develops because the severity of infection declines over the course of a lifetime, but much of this decline can be attributed more to overall disease-fighting capacity in adults versus children than to induced immunity from prior infections. The types of infections that people contract many times, the common cold, foodborne illnesses, “stomach viruses,” are not those that are readily protected against with vaccines. Even the flu, which has an effective and widely used vaccine, requires a different vaccine every year to prevent infection. While the need for innovation and thinking outside the box are essential to the struggle for control of malaria, it also makes sense to look to the history of infectious disease control efforts and to learn from the lessons of our past. This is directly contradictory to the message presented in this book and espoused by its hero, Steve Hoffman.

I was most interested to read Shore’s descriptions of the history of philanthropy and current social entrepreneurial trends, as this is a field in which he clearly understands the intricacies of the issues involved. Shore argues that over the last few decades, philanthropic institutions and leaders have begun to move away from the stopgap measures and multitudes of small, isolated projects model, “to go beyond good intentions to actually solving and eradicating neglected social diseases.” In many ways Bill Gates represents the best example of this shift, especially in the field of global public health. He and his foundation are not interested in supplying Band-Aids; their goal is to address the most pressing issues in a way that makes those Band-Aids unnecessary in the future. Shore seems much more thorough in his treatment of this topic in a few pages than he is in his treatment of malaria over the entire book. Then again, it is possible that he makes the same mistakes here but I cannot detect them because I have no training in business or experience investing in social entrepreneurship.

Beyond the basic ‘think outside the box’, ‘wackos do great things’ premise, Shore draws several lessons from his interactions with the scientists involved in this important struggle that are intended to be applied to a wide range of social enterprises. His first lesson, “Invest in Bringing Existing Solutions to Scale Rather Than in Discovering New Ones,” is perhaps most emblematic of his failure to comprehend the intricacies of the field from which his examples are drawn. In stating that the researchers in this book represent this type of investment, Shore demonstrates a deplorable lack of imagination. Vaccine development, especially for a vector borne, parasitic disease, is far from an existing solution. It is a lofty goal, a dream that may one day save a lot of people, or may be a gamble that never pays off. Vector control on the other hand, is a tried and true method for reducing malaria infections, one that could make good and immediate use of the large grant funds being poured into fancy labs in Maryland to save the lives of children in Africa. I am certainly not saying investing in science is a waste of money but it does represent the direct opposite of the ‘doing more of what we already know works’ principle.

The book was an interesting peak into the lives and motivations of some very passionate and driven individuals who each have different ideas about the best way to solve the problem of malaria. It also largely failed to draw the broader conclusions that the author was trying to make. I am left with the overall impression that Shore would have had greater success in illustrating his point had he drawn from his own field of expertise, perhaps business, law or the campaign to end childhood hunger, in his search for great minds doing things differently. His argument is severely weakened by the points he fails to address and the questions he does not ask because he does not adequately understand the fields of scientific inquiry and global public health.
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