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Germs of War
by Ketan Desai, 268 pp, paper, $21.95, ISBN 0-75140-988-7, London, England, Minerva Press, 1999.
JAMA. 2001;285:1221-1222.
We have become all too familiar with the many faces of terrorism. Images of savagery and carnage appear on our television screens with sickening regularity. For many people, Osama Bin Laden's name has become synonymous with death and destruction. Although the Cold War is over, there is a fear that weapons of mass destruction might be sold by rogue nations to other outlaws and vice versa.
There appears to be no dearth of disenchanted and disenfranchised individuals who seek to avenge indignities inflicted upon them by others on ideologic or religious grounds. Some of these men and women are willing to make the ultimate sacrifice. They are heroes to those who believe in the cause, terrorists in the minds of their victims. We fear blackmail by terrorists who might acquire nuclear weapons. We have seen the corpses of Kurds asphyxiated by Iraqi chemical warfare.
Bioterrorism has become a popular topic for seminars at national meetings. We are still debating the pros and cons of destroying the remaining stockpiles of the smallpox virus. In Biohazard: The Chilling True Story of the Largest Covert Biological Weapons Program in the World—Told From the Inside by the Man Who Ran It, Ken Alibek describes the clandestine biologic weapons program in Russia at a time when détente and glasnost were popular buzzwords. In 1984 near Antelope, Ore, followers of Rajneesh allegedly contaminated the water supply with salmonella, sickening many, in an attempt to wrest political control of town elections. Bioterrorism has become such a great concern that a consensus statement was published recently by a civilian biodefense working group.1 And in May 2000 a 3-day mock exercise was held in Denver, Colo, to simulate the crisis that would occur if the city were sprayed with a lethal dose of Yersinia pestis.
It is no surprise, then, that imaginative minds would create fictional accounts of the terror that might be unleashed upon us by our adversaries. Germs of War is an entertaining, fast-paced work of fiction, which capitalizes on the fears of many that what is now abstract could become a reality. The central figure is Dr Tariq Bukhari, a clumsy, ataxic, and uncouth man with a fiery temper who, as a child in Pakistan, is sold into slavery by his poverty-stricken family. The hardened boy learns to inflict unspeakable acts of cruelty upon his fellow slaves. This quality catches the eye of the sinister head of that country's intelligence service, and Bukhari is sent to a medical school in Lahore.
Dr Dan Howard, a professor at the Mayo Clinic in Rochester, Minn, recruits the young doctor for a research position in his laboratory. The professor is known to be inept and to do shoddy work. However, his tenure is guaranteed by huge grants from an outside agency (an alliance of Pakistan's Secret Service and Afghanistan's Taliban). Corrupt senators facilitate such activities. Bukhari's task is to create a biologic weapon of war and to confirm its efficacy. He manages to insert a toxin from Vibrio cholerae into the tubercle bacillus. Victims who inhale the bacillus would be expected to "drown" in their own secretions. The entire staff of an intensive care unit succumbs to a test of this lethal concoction.
Tracy Hopkins, a graduate student, stumbles upon a vial of the modified bacillus quite unexpectedly. What follows is a rather exciting and tense chase through the canyons of the western United States. The story, which seems so improbable, is quite absorbing—the sort of mayhem of which movie producers dream. This amalgam of science fiction, recombinant technology, and James Bond keeps us guessing. So how does it end? Well, the reader will need to get a copy of the book to find out!
Americans of Indian origin have recently distinguished themselves in the literary field. Ketan Desai, a physician and microbiologist, joins such well-known authors as Abraham Verghese (My Own Country, The Tennis Partner), 2000 Pulitzer prizewinner Jhumpa Lahiri (Interpreter of Maladies), Arundhati Roy (God of Small Things), Chitra Banerjee Divakaruni (Mistress of Spices, Arranged Marriage), and others. Desai writes vividly: "fired by faith and hate, the Mujahideen ripped open the belly of the Soviet War Machine" and "His prison, the Kharg Palace, had once graced Kabul in the manner of a beautiful lotus blooming in a sewage pond." He also has a perfect sense of timing: things happen when least expected.
Germs of War is a compelling story that commands attention not only as an entertaining thriller but also as a somber warning that biologic weapons pose a serious threat to our security. I enjoyed reading it and recommend it to all readers who still watch James Bond movies.
Anand P. Panwalker, MD, Reviewer
Wilmington Veterans Affairs Medical Center
Jefferson Medical College
Wilmington, Del
REFERENCES
1. Inglesby TV, Dennis DT, Henderson DA, et al. Plague as a biological weapon: medical and public health management. JAMA. 2000;283:2281-2290.
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Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor; adviser for new media, Robert Hogan, MD, San Diego.
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