Reviewed by: John S. Marr, MD, MPH

By Madeline Drexler
Joseph Henry Press
Copyright 2002
316 pages
ISBN: 0-309-07638-2
$24.95 hardcover

Secret Agents, the most recent addition to a decade-long list of books devoted to emerging infections, deserves special praise. The book offers us not only a pleasant review but also a scholarly overview of the scores of new pathogens, many of which have become household words and/or concerns. It discusses key bugs (and some lesser-known microbes) and gives up-to-date analyses of events post-September 11 (anthrax and other bioterrorism agents). All observations are accurate, original, and infectiously insightful. Indeed, this book is a most enjoyable read; it should be informative for infectious diseases cognoscenti as well as an excellent introduction for an initiative audience wishing to learn about the newest health threats.

The Acknowledgements are filled with familiar authorities in infectious diseases and epidemiology, and author Madeline Drexler skillfully uses their insights, drawing on them for expert opinion when needed. Drexler, an experienced health journalist and former medical columnist for the Boston Globe, also interviewed scores of other lesser-known troops from the trenches of clinical medicine, public health, and research whom she graciously credits for their own seminal contributions regarding the discovery and elucidation of new diseases/epidemics. Her use of attributions and quotations is never distracting, but only adds to multivariant, fact-filled narratives. These hard-hitting/next-day accounts are written with a sharply pointed pen, creating Abe Hirschfeld-like character sketches with whimsical views and an occasional amusing epiphany.

Each of the 8 chapters of Secret Agents covers a logical grouping of pathogens or pathologies: a brief overview of the history of microbial diseases; arthropod-borne diseases; food-borne illnesses; antibiotic-resistant organisms; influenza; suggested infectious etiologies of chronic diseases; bioterrorism; and auguries and hopes of new things to come.

Each chapter has clever subchapter headings allowing for synaptic changes in thought or idea: for example, a discussion of the 1918 flu pandemic morphs into "The Barnyard Theory" (about drifts and shifts in influenza A), and then to a discussion of the recent H5N1 strain. An overview of Escherichia coli 0157 leads into a section entitled "Animal Farms" about the recent dissemination of microbe-tainted meat and poultry products, thence to a mini-essay on Campylobacter, followed by the discussion of prions, "Mad Cows and Englishmen." Through use of these subchapter headings, the reader knows what is about to be discussed and relishes the change in course.

Chapter 6 ("Infections Unmasked") rightfully lauds Barry Marshall as a "patron saint" for his discovery of an infectious etiology for the age-old, noninfectious disease theory of ulcers. Some 20-odd years ago, Marshall challenged the dogma of gastric ulcer causation, much to the surprise of physicians, surgeons, and pharmaceutical companies, who expected to treat patient for ulcers with Sippy diets, gastric resections, and antacid concoctions for decades to come. This chapter also touches on recent proven causal associations between infectious agent and disease (eg, Kaposi's sarcoma) and other alleged noninfectious diseases.

In this reviewer's opinion, the latter is a bit light on discussions on theories of possible infectious etiologies of multiple sclerosis, rheumatoid arthritis, Crohn's disease, coronary heart disease, and affective disorders. Notably missing is a mention of the Borna virus for the latter affliction: a recent PubMed search shows more than 500 citations for this neurotropic viral zoonosis. (Just think about the implications to medicine that a virus may be one (of many) causes of manic depression and schizophrenia!) One hopes that Drexler's skills as a medical journalist could expand upon the subject of many other alleged "noninfectious diseases."

There must be other entities in the research pipeline, aside from ulcers and the previously known "atypical juvenile arthritis" (now known as Lyme disease), that we are missing and to which we need to be alerted. Given the long history of obstipationary thought on disease causation, there must be a new Koch (or Marshall) hoping for his/her 15 minutes or more of fame. The lay and scientific communities deserve a responsible and accurate spokesperson like Drexler to evaluate and popularize their claims.

Although the chapters of Secret Agents compliment each other, each could appear as a free-standing essay. The book reads like a perfect multicourse meal, attractively presented and served with the right amount of clinically correct, surprisingly up-to-date information on dozens of conditions. Drexler's Dorothy Parker-like bon mots and asides are the perfect sauces to compliment the feast.

The last chapter, "Think Locally, Act Globally" is surprisingly upbeat but also realistic. Drexler suggests that, in the past and present, individuals and organizations have always come to the fore, and others will continue to do so in the future to address what other nay-sayers have predicted to be a bleak future. This chapter gives us an alternative hope in and justified praise to present-day scientists and benefactors in their largely unsung efforts to make the world a possibly better place -- even when other secret agent disease agents were to emerge from unforeseen nidi. The chapter is a well-deserved dessert served after a most satisfying meal. Secret Agents is a most delightful read, and, like other very special treats, it should be read slowly, savored, and remembered.