Garrett has been tracking threats of disease for years. A native of Los Angeles, she did graduate work at UC-Berkeley in bacteriology and immunology before leaving academia for journalism. She worked as a freelance reporter and as a National Public Radio science correspondent before joining Newsday as a science writer in 1988. She won the 1996 Pulitzer Prize for explanatory journalism for her reporting on the Ebola virus. Over the years, Garrett has gained a reputation as a dogged reporter who backs up her arguments with an avalanche of data. That’s certainly true of her new book. “Betrayal of Trust” is thorough, detailed and meticulously documented, and its author clearly knows her subject backward and forward.

Salon caught up with Garrett by phone at her home in Brooklyn, N.Y.

What was your motivation for writing this book at this particular moment in history?

After I finished “The Coming Plague,” people were asking me, What’s the solution? How can we avoid having these massive epidemics overwhelm us? And the obvious answer is, you need a tough public health infrastructure that can spot the incursion of infectious diseases in the early stages and take appropriate steps to stop it before it becomes the next AIDS pandemic.

Here in the United States, I realized that for the last, say, 10 years of my career, without consciously focusing on it, I had been chronicling the collapse of our public health system. And that one thing after another that had been occurring in our country was a direct result of the fact that we had severely eroded … the very concept and the political power of public health.

What kind of events are we talking about?

In many states in the last decade, public health officials have tried to create such things as birth defect registries to track whether in some neighborhoods there’s a higher rate of birth defects. And if so, might there be something responsible for it? This has been refused by one legislature after another as if it were some Big Brother intrusion.

Another example is attempts to create a notification system for immunization … Many states were seeing that they were beginning to have resurgences of measles, resurgences of pertussis and other epidemics in children and thought, well, let’s just make it easy on families. Let’s create an immunization registration system. And then we can notify parents — your kid’s now 2, and it’s time for these shots. Virtually every time it’s been brought up in any state, the legislature has said no way. They see it as some kind of government intrusion in private life.

That’s one of the age-old questions of public health: How do you balance the individual’s rights with the health of the community?

We didn’t have any problem making those choices back when we had huge public health catastrophes all around us. In 1900, when waves of catastrophic epidemics would sweep through every city in this country, people didn’t have a whole lot of problems with the idea that the government had a job, and that the job, among others, was to prevent epidemics and to stop these catastrophes from occurring.

When I travel around the world I rarely encounter this notion of individual rights vs. public health as a serious impediment to the ability of public health to do its job. It’s a very American problem … It’s easy to be smug about it and to ignore the needs. The danger in a wealthy society is not as obvious as it was in your grandparents’ day or as when as you get in an airplane and travel overseas.

What about some of the places where the danger is more obvious?

India is this enormous sprawling nation of a billion people of virtually every religion on the planet and highly contested and occasionally volatile political forces … Several years ago, when the Congress Party was running India, the decision was made to relinquish virtually all responsibility for the public health of the people of India to the state level, but there was no increase in revenue streams to the states to cover that. As a result, public health virtually died overnight. When plague first broke out, it broke out in the state of Maharashtra. It went virtually unnoticed until some villages had bubonic plague rates exceeding 10 percent of the population.

When you arrive in Surat, you’re the only one getting off the train, because everyone else is leaving.

They all thought I was out of my mind … India has one of the highest illiteracy rates in the world … It’s very easy in such circumstances to have rumors take on a kind of life that exceeds anything we saw with the Monica Lewinsky episode in Washington.

The overreaction was stupendous. When [the disease] actually did appear in pneumonic airborne form, it was cause for a slight ratcheting up of concern, but certainly not to the degree that panic ensued. Instead of having government officials issuing proclamations that very clearly spelled out what was going on — this is what bacteria are, this is the antibiotic one should use, etc. — the state and federal governments freaked out and left everything to the wits of a handful of very dedicated civil servants in the town of Surat.

The global community totally overreacted. The World Health Organization totally failed to respond. And the result was that the Indian economy lost what was conservatively estimated to be about $2 billion in revenues and [experienced] a stock market collapse. [Indians] were placed under international boycotts for the most absurd possible reasons. Do you understand that the Gulf states banned Indian postage stamps? They banned food. They banned everything. Every country reacted absurdly.

Turning to the Ebola outbreak in the former Zaire: You were in Kikwit soon after the first cases were reported. At what point did you arrive on the scene, and what was going on?

Once I arrived I immediately discovered that there was such a sour taste in the mouth of these scientists from the previous gang of journalists. Some scientists, even the ones who knew me well and whom I had worked with in the past, were very hostile. The scientists themselves were sleep-deprived and strung out. They had witnessed a massive amount of death and real fear.

The community was gripped with a kind of terror that I’ve seen in civil wars, but it’s different … This is a terror that strikes when you really don’t understand; you don’t know how you can protect yourself; you don’t know whether the person you just hugged is a carrier.

One of the themes of the chapter on Kikwit is the connection between the spread of disease and poverty and corruption in government. How do those conditions amplify an outbreak?

People always talk about corrupt societies and bemoan the money that’s lost and the inability to get a school built or to get your business on track because of corruption. They forget that corruption actually kills people, that corruption is actually murder when it strikes your public health system.

In the case of Zaire, there’s no doubt whatsoever that that country experienced wave after wave of infectious diseases because of rampant corruption. Hospital systems and public health systems had been looted of everything. Doctors were performing surgery with instruments that were non-sterile — not because they were stupid but because they had no more fuel to run the generators and therefore to run the autoclave and therefore to sterilize the instruments. This epidemic never would have happened if an index case hadn’t shown up in one of these completely looted-to-the-bones hospitals, and the individual hadn’t gone in for surgery.

Once it got into the hospital, the explosion really claimed healthcare workers. The bulk of all that first wave of deaths was doctors and nurses and lab technicians and orderlies. They didn’t know what was killing them. It hadn’t been identified as Ebola. They didn’t know therefore how to protect themselves.

They had been coming to work every day. The vast majority never left their posts, even though most of them had gone unpaid for years. I’m not sure most American doctors would do that under similar circumstances.

When you’re talking about the American health system, you make more of a distinction between public health and individual medical care than you do when you talk about other countries.

Because it’s a clearer distinction in the U.S. We don’t have a national healthcare system. In Sweden, medical care and public health are all government functions and usually through the same agencies, so the lines get more blurred. But in the United States, public health is really a government function, usually at a fairly local level, and medicine is … an almost entirely private function, with some parts of it heavily government subsidized but in largely private facilities.

How is that bad for the health system?

We have given the bulk of health power to physicians and to organized medicine and most recently to the health management corporate structure, and we have allotted very little prestige and power to the practitioners of public health. They are paid far less; they are given dingy, lousy offices; and they’re treated like lesser beings. They rarely succeed in beating the AMA [American Medical Association] or any organized medicine on any issue.

Several times we have come very close in this country to voting for some form of national healthcare. Each time, public health has been completely left out of the discussion. What are the things that increase life expectancy in America? What are the things that can make sure children do not die in America? That’s never what we talk about … We always start the debate from the wrong place, which is an assumption that everything that anybody wants that’s called “medicine” should be paid for by government or not paid for by government.

You talk about the difference in what people spend on healthcare from age zero to 65 and age 65 and older, and the latter number is four times more than the former.

At least.

How do you shift some of those dollars from the end stages of life to the beginning stages of life, when the immediate benefits aren’t quite as clear, without looking like Dr. Kevorkian?

There are several answers to this. First of all, most of what determines how long one is going to live are events that occur in the first 12 years of life: how well you eat, how much you exercise, how well you brush your teeth. If you’re going to put a heavy investment, it makes a lot more sense to put it in childhood … I’m of the age group that when John F. Kennedy issued the president’s physical fitness exams, we all had to go out and prove we could do so many pushups and so many sit-ups. I can’t even imagine kids today managing to do it, with about half of the children in America physically obese.

The other part of that is, and I’ll put this to you in very personal terms: While I was hitting the finish line on this book, my father went into terminal illness and he was very ill. He had a strange form of autoimmunity that surfaced when he reached his 80s, in which his immune system was attacking his bone marrow and destroying his red blood cells … With constant transfusions of blood and injections of cortisones he could keep this vaguely in check and have some good days, some quality days, in between rounds of transfusion.

I was sent overseas on assignment to Africa for Newsday, and while I was in Africa my father made a decision. He decided that he never wanted to be in an ICU; he knew where this disease was going. And he decided that this transfusion was his last, this round of cortisones was his last and that he was going to die. I rushed back from Africa, and he died a few days later … I think he went with great courage. The whole family, we all feel so proud of him. I realize that some families would make a different choice. They would feel that any amount of money — any amount of hospitalization that could keep him alive another day, another two days — was warranted. But I don’t understand why. I can’t see it.

To me, one of the things we’ve done by putting such emphasis on individualized medicine and ICU and disease treatment is that we’ve stripped all dignity from the individual. And I’m not sure that it’s the individual who wants $4 million spent on their care in two weeks to keep them alive, hooked up to machines, gasping in between pain-alleviating shots. I think it’s the family that cannot bear to see them go and a system that’s structured to keep spending money.

Do you see any political will or emotional will on the part of Americans to change that system?

Yeah. When you ask the right questions, the surveys show that Americans are thinking with wisdom about this. It’s simply that we’ve not had the debate start at the right point. If you start the debate from the point of who should pay for us to have absolutely everything we want done to us medically, you’re going to lose.

We’ve ended up with a terrible system full of injustice that leaves no one satisfied except the very, very rich … How can we pursue the sort of brave new world of medicine the Human Genome Project promises us and do so in a way that doesn’t result in, say, 2 or 3 percent of the global population having access to this grand scheme? And 94 to 97 percent not only don’t have access to this expensive medicine but actually lose access to older drugs that are no longer patentable but that used to protect them.

In a couple of places, you quote Paul de Kruif, who was a science writer in the 1930s. At one point, he says, “I don’t know why it took me so long to see that the strength and life-giving results of the toil of those searchers were for sale; that life was something you could have if you bought and paid for it.” How much of that reflects your own feelings, or are you more optimistic than that?

Certainly it reflects my opinion of the state of public health on a global level. I think we have made a decision for quite some time that if you’re in a poor country, your health is going to be worse, and if you’re in a rich country, your health is going to be better. And somehow that’s OK. We have no apparent moral or ethical problem with that. Which I personally find very troubling.

Herman believes that’s an unfair picture. If nothing else, it’s
an incomplete one because Americans had legitimate reasons to
fear Soviet infiltration in the immediate postwar years. The
United States and the Soviet Union were just about the only major
powers left standing, their interests were bound to clash and
there were nuclear weapons to worry about. Before and during the
war, a substantial number of leftist intellectuals and
institutions in the West were broadly supportive of the Soviet
Union; lured in by the dreamy, “let’s all share things” theory of
communism, they ended up countenancing purges, show trials,
political murders and intentional famines.

Herman certainly isn’t the first to point that failure out — or
to argue that the apparatus of the Communist Party of the United
States was basically under Stalin’s control. Simply put, there
was plenty of spying going on, and it seems that some of the
people offering foreign-policy advice to U.S. leaders were
willing to let parts of Europe and Asia fall under communist
control. That might come as a surprise to those who learned
everything they know about anti-communism from Arthur Miller,
Hollywood and the Nation, but scholars who have studied
declassified Soviet-bloc documents and other historical materials
have been saying it for years.

Obviously, that doesn’t mean that all or even most American
communists were spies or in any position to influence American
foreign policy, or that it was right to hound people because of
their political beliefs. Even among hardcore anti-communists, the
rap against McCarthy has always been that he was more interested
in grandstanding than in identifying actual infiltrators and
building strong, factual cases against them. Herman’s book
doesn’t do a whole lot to counter the charge. “Those who knew
McCarthy were constantly discovering to their astonishment how
little McCarthy knew about the theory or practice of communism
itself,” Herman says, and in so saying he makes the senator’s
supposedly principled anti-communist stance look more like a
free-floating xenophobia that just happened to home in on the
right target.

Make no mistake: Herman has exhaustively researched McCarthy’s
life and work, and he dutifully cites the countless mistakes and
outrages McCarthy committed. What’s bizarre is that none of them
seems to have provoked a flicker of indignation in the author.
For example, when Herman considers McCarthy’s vicious attack on
Gen. George Marshall in 1951, he refuses to take the senator’s
words at anything other than face value. “If Marshall were merely
stupid,” McCarthy lashed out, “the laws of probability would have
dictated that at least some of his decisions would have served
this country’s interest. … We have declined so precipitously in
relation to the Soviet Union in the last six years, how much
swifter may be our fall into disaster with Marshall’s policies
continuing to guide us?”

Ignoring the obvious implications of McCarthy’s statement, Herman
complains, “Critics bandied it about that McCarthy had called
Marshall a traitor (he had not), a secret Communist (he had not),
and even a coward.” Is Herman incredibly literal or just naive?
It’s certainly useful to try to understand, from the senator’s
point of view, why McCarthy did what he did. But at times Herman
simply takes leave of his own judgment. And some of the excuses
he offers for McCarthy’s conduct are astounding. McCarthy
“decided to lump where others took care to split,” Herman shrugs.
Oh, was that it?

Despite its flaws, Herman’s book is fascinating, and it visits a
lot of interesting territory: McCarthy’s friendship with the
Kennedys, his strong political support among Catholic voters, the
tactical mistakes that led to his eventual downfall. And Herman
makes a strong argument that the grounds on which the Senate
censured McCarthy were tenuous at best. But even then, Herman
takes his own argument one step too far. He compares McCarthy to
the victims of Stalin’s show trials, who, after their convictions
for nonexistent crimes, were hauled off and executed. For all of
Herman’s efforts to explain McCarthy’s excesses, the resulting
book is not at all flattering — to its author or to its subject.

Dyson is right about one thing: Few Americans these days know much more about King’s thinking than what they remember of that speech. In Dyson’s view, King has been transformed into a “safe Negro,” a romantic dreamer who doesn’t make white people uncomfortable. So in “I May Not Get There With You,” he sets out to describe a King far more radical than the one trotted out for mainstream consumption on the third Monday of every January. “We must rebel,” he writes, “against the varieties of amnesia that compete to reduce King to an icon for the status quo or a puppet of civil and social order … King as he truly was is enough for us now, perhaps even too much — a fact that drives us to sanitize his image with soapy tales of how he wanted us to like each other very much.”

For most of his adult life, King did try to appeal to white people’s consciences and to basic American ideals. That strategy worked brilliantly when he and his followers braved attack dogs, fire hoses and Southern sheriffs who were benighted to the point of caricature. But King’s views changed in the mid-1960s, when he took his crusade against racism to Chicago. To hear Dyson tell it, the civil rights leader was bewildered by what he found: intense hostility among whites, demoralization among blacks and indifference all around to the “huge morality plays” like the ones he staged in the South.

Afterward, King showed much more reluctance to stake black people’s future on white goodwill. Rather than demanding reforms in existing institutions, he talked about “restructuring the whole of society.” By 1968, he was questioning whether black Americans could rightly celebrate the Bicentennial. He talked, at least privately, about the need for a democratic form of socialism. While his whole career reflected a desire for what Dyson calls “substantive, not just procedural, justice,” that theme became more pronounced in the last three years of his life.

Painting a truer picture of that life takes more than just rereading the speeches, though, and Dyson feels obligated to address King’s less honorable behavior. Critics have accused King of plagiarizing much of his academic writing, cheating on his wife and succumbing to sexism. Dyson concludes that King is guilty as charged; he thinks, though, that the man’s achievements outweigh his sins.

That’s a perfectly sensible judgment, but Dyson can’t leave well enough alone. He tries to place King’s plagiarism within a supposed black tradition of borrowing and expanding upon other people’s ideas — the same tradition, he suggests, that led to sampling on hip-hop records. He also hypothesizes that “King’s plagiarism at school is perhaps a sad symptom of his response to the racial times in which he matured.” Dyson tries to make a larger point out of King’s infidelity as well, declaring that his “relationship with Coretta symbolizes the difficulty faced by black leaders who attempted to forge a healthy life with their loved ones while the government aimed its huge resources at destroying their families, a sure metaphor for how the state has often abandoned or abused the black family with cruel social policies.” It’s awfully presumptuous to speculate on what lay inside a long-dead person’s heart. And it’s intellectually sloppy to extrapolate a whole critique of society from it.

Unlike critics who bemoan the shift in King’s tone from major key to minor, Dyson wants to revive and extend the work of the civil rights leader’s later years. Yet he blurs the difference between his own views and what King might have thought if he were still alive now. When Dyson urges the black church to work for class solidarity, stronger labor unions and other goals familiar to readers of the Nation, he describes it all as what “King might say.” When Dyson disagrees with King’s opinions — e.g., King “took too readily to the language of pathology to describe black ghetto families” — he dismisses those opinions as “serious mistakes.” That’s too bad. Dyson’s passion is evident, his writing is powerful and he’s right to fret about people who use King to suit their own purposes. If only the writer could practice what he preaches.

Actually, “The Crisis of Desire” is only half of the book Hardy intended to write, according to the lengthy introduction by his friend David Groff. Hardy died in a hiking accident in 1995 but left behind a lengthy book proposal, drafts of a few chapters and extensive notes. Groff, a freelance writer and former editor for Crown, tried to stitch them together. And in the book that emerged, Hardy urges gay men to take control of their health, their sex lives and their fates.

In a few places, Hardy’s book is downright heart-rending. He writes achingly of his Dutch friend Hans, who chose to “quit” rather than keep struggling against HIV. Physician-assisted suicide is legal in the Netherlands, and Hardy was in Amsterdam when Hans was tidying up his affairs. “The pages of his daily agenda for the year 1991 were filled with notes of what he had yet to do up to a certain day — and then abruptly blank for the rest of the year,” Hardy reports. Hans died comfortably at home among friends after drinking a poison under a doctor’s supervision. Hardy can’t help but compare him with other terminally ill friends whose lives ended in madness or with guns or handfuls of pills. “Beyond sorrow and my loss, I saw a victory against a virus that knows no love,” Hardy writes. “In the final stages of his illness, Hans wrested control back from the disease, refusing to give it any more of the suffering and trials that it demanded. Of all the deaths I have seen — and I have seen too many — only his had dignity.”

Yet while Hardy is adept at sifting through the intricacies of loss and bereavement, his attempts at activist sociology often miss the mark. Consider his argument that gay men need to bring friendship and eroticism back into their lives: “Bound through our sex together and our histories, suffused with anger and ever-transforming desire, planted in different landscapes but fed by the same underground streams, we could find in fraternal love a paradigm we might healthily embrace.” It’s an odd point to dwell on, not because there’s anything wrong with friendship or eroticism but because modern gay America has plenty of both. (Ever been to a gay bar on a weekend night?) Yet Hardy is wistful — even nostalgic — for the political activism and easy sexual intimacy of the 1970s, and only by the standards of that era does gay life today seem sterile and tame.

Before the epidemic, Hardy was part of a revolution that was going to create alternatives to monogamy and heterosexual marriage. Gay politics in the 1990s is nowhere near as momentous. The gays-in-the-military debate, his book argues, is merely a distraction from the plague; same-sex marriage, when justified on the grounds that it would domesticate gay men, is “anathema to the historic truths of gay liberation.” And because gay men tried before AIDS to create a “new ideology of relationships,” Hardy even gets worked up over men who succumb to “unconsidered notions of love and marriage.” His bitterness is sad, and it’s also ironic. What’s the use of a liberation movement if people can’t make choices that the liberators dislike?

Can the American public really be so callous? “Why, despite the haunting nature of many of these images, do we seem to care less and less about the world around us?” asks Moeller, a professor at Brandeis University. The premise of “Compassion Fatigue” is that it isn’t the public’s fault. Moeller suggests that Americans are plumb worn out from lousy coverage of world events and are tuning it out entirely — and that some news organizations are responding by reporting only the most salacious foreign news.

As evidence, Moeller lists crises during which news outlets disserved their audiences with reductive or overly graphic coverage. For instance, the Ebola virus and flesh-eating bacteria captivated reporters; meningitis and sleeping sickness kill far more people but aren’t shocking enough to get much ink, Moeller says. She has a point. It can’t be healthy when dozens of newspapers and three 24-hour cable news channels reduce complex international crises to melodrama again and again. But Moeller’s long catalogue of overheated quotes and desperate situations is likely, on its own, to drive most readers to compassion fatigue (and also to “Compassion Fatigue” fatigue, since the book is often as repetitive as the news reports it criticizes).

Moeller views Americans’ disengagement from foreign affairs as a new problem, and she finds a new culprit: profit-minded media giants and the substitution of readership surveys for news judgment. It’s a reasonable hypothesis. In Hollywood, marketing techniques produced “Batman Forever”; in Washington, they produced Dick Morris and the Contract With America.

Though Moeller notices that the media have put less emphasis on world news since the collapse of the Soviet Union, she refuses to entertain the idea that Americans actually are less interested in world affairs. She overlooks one of our most ancient traditions: Except during wartime, Americans have unfortunately heeded George Washington’s warning against foreign entanglements. It’s no coincidence that, like the new isolationism of Pat Buchanan and Ross Perot, compassion fatigue became rampant when the Cold War ended.

Take another look at Somalia: People there had been starving to death for a year — and living in political anarchy for longer — by the time American cameras arrived in 1992. Media pictures convinced George Bush to send the Marines to Mogadishu with humanitarian aid, but most Americans were surprised when a warlord’s forces started killing U.S. soldiers. Suddenly, images of a Somali mob jeering at a dead serviceman flooded American TV. “And so was born the ‘Somali doctrine,’” Moeller writes, “the inheritor to the ‘Vietnam syndrome’ that argued that the United States should not get involved in faraway crises when its own security is not in danger.” But that doctrine has nothing to do with tuning out news coverage and everything to do with bad old American isolationism.