- Email: [email protected]
The sea is full of sharks
Perspectives
Book The sea is full of sharks As a child of the 1950s growing up in the Flemish village of Keerbergen, Peter Piot dreamed of two Belgian characters that would shape his life: Tintin and Father Damien. From Tintin, Piot gained a carnivorous hunger for adventure and travel. But Father Damien’s great sacrifice for the 19thcentury Hawaiian victims of leprosy held a special resonance for the young Catholic boy, as the missionary came from nearby Tremelo, where Piot would stare at Damien’s town square statue. The part of Piot’s character that devoured Tintin spawned a 27-year-old doctor, still in training in microbiology, who eagerly flew to Zaire without a valid passport and little support from his own country to jump into a mysterious 1976 epidemic. But the soul that was enthralled with Father Damien pushed adventure aside in favour of outrage over the conditions he found in a Catholic mission in Yambuku, where the terrifying epidemic of what would be dubbed Ebola was spawned. The ideals of adventure, travel, and medicine form a thread that weaves through Piot’s No Time To Lose: A Life in Pursuit of Deadly Viruses, making it a riveting read. But the sobriety and sacrifice of Damien form a second, more interesting arc from 1976 Zaire to Dec 26, 2008, when Piot stepped for the last time out of his office as Executive Director of the United Nations AIDS Programme (UNAIDS): a coupling of indignation and discovery. Whether it came from staring at the Tremelo statue, the natural proclivities of small town Flemish folk, his father’s economist pragmatism, or his mother’s no-nonsense office management skills, Piot seems to have approached every issue in his life, first, with a recognition of a basis for his indignation; and, second, with concrete, logical problemsolving. That paired indignation and problem-solving has made his journey through life have meaning, not only www.thelancet.com Vol 379 May 26, 2012
for Piot, but ultimately for millions of people infected with HIV. Throughout No Time to Lose, Piot devours so energetically opportunities, meals, wine, and instant friendships, from beers drunk in the humid heat of Yambuku with Father Carlos to mojitos sipped with Fidel Castro, that the reader savours the moments, and insights, alongside him. But the reader is also at Piot’s side when he watches Ukrainian intravenous drug users inject heroin between their toes or listens in astonishment to whiskey-sipping South African President Thabo Mbeki, as he weaves a dark conspiracy in which western pharmaceutical companies invent a false disease (AIDS) to force poor countries to buy their drugs.
“Piot denounces the idea that amounts of money raised should serve as the primary metric of global health achievement…” Ultimately the hunger for adventure is also one for knowledge, and Piot’s fervour to learn, grow, and adapt consistently served him. I suspect students of science and public health will benefit from the methods Piot deployed in analysing and solving problems, from the epidemiological features of AIDS during the 1980s to the Chinese Government’s refusal to confront HIV 15 years later. By the time the final page is reached Piot has, to name but a few deeds, been on a plane captured by terrorists; spent 2 days inside Renaissance hallways of the Vatican arguing about condoms; isolated a new form of penicillinresistant gonorrhoea; carried the bloated, redolent bodies of dead helicopter pilots through the jungles of Zaire; treated what was probably the first case of AIDS in Belgium; run successfully for election to leadership of UNAIDS and unsuccessfully for Director-General of WHO; confronted
the President of Zambia when Chiluba asserted AIDS was “punishment for fornication”; berated Fidel Castro for imposing mandatory quarantine on Cubans infected with HIV; sneered at Suzanne Mubarak, First Lady of Egypt, when she stated that no tree is high enough to hang all homosexuals; and survived dozens of death threats, mostly from AIDS activists. His Flemish grandmother berated young Peter that, “your ass can’t sit still”, and several times in his memoir Piot says he was, “basically running around like crazy”. Indeed, the pace of this life seems impossibly fast. And when Jonathan Mann, the original leader of the global fight against HIV/ AIDS, died in a Swissair crash in 1998, Piot found alarming reason to work even harder: “It gave me an incredible sense of urgency: I need to do so much before that happens to me too.” By the time Piot walks out of his UNAIDS office, all he can do (at Kofi Annan’s suggestion, no less) is sleep, as “every cell in my body had accumulated a decade of regular lack of sleep and constant jet lag”. His admiration for former UN Secretary-General Annan began in 1995 when he pulled the new UNAIDS leader aside and whispered, “The sea is full of sharks.” It’s the apt kick-off to Piot’s years at the UN, fighting off bureaucrats, donors, activists, bigoted world leaders, incompetent global health maestros, and what he characterises as troublesome journalists. (Piot’s disdain for the media is surprisingly tough. Conversely, his praise for well over 300 colleagues will send readers to the index to look themselves up. Here’s a clue: if Piot liked working with you, your name is preceded by positive adjectives. If not, well, it’s just your name.) Piot’s analysis of inherent failures in the UN system will resonate with anybody who has ever worked for a UN agency. Of wealthy-nation donors
No Time to Lose: A Life in Pursuit of Deadly Viruses Peter Piot. W W Norton & Company Ltd, 2012. Pp 304. US$28·95. ISBN 9780393063165
1939
Perspectives
Piot summarises: “I preferred by far the tough love of the UK and the US to the lip service of some other countries who were long on words, but short on cash.” Parsimonious France, he tells us, was “always pushing to recruit French nationals”, and when Piot ran for leadership of WHO, the Italians “unashamedly gave me the CVs of five fairly junior Italian officials as a condition for their vote for me”. He reserves special disdain for western AIDS advocates, noting there was “simply zero tolerance among some for anything other than advocating
for more money”, and pushing policies that blurred, “the lines between scientific evidence, professional institutional loyalty, and activism”. Piot denounces the idea that amounts of money raised should serve as the primary metric of global health achievement: “The only real measure of our success would be in lives saved.” Ultimately reflecting on the emphasis placed on HIV treatment, versus the controversies that have shrouded every infection prevention effort, he sadly concludes, “Even if we could stop AIDS today—stop it cold—in terms of
new transmissions, it would still have a massive impact on generations to come.” By 2008 Piot can justifiably claim at least partial credit for the nearly 7 million people outside of the wealthy world receiving HIV treatment and the huge global health enterprise that arose during his tenure at UNAIDS, but he remains wistful. More than once he reflects “The question that haunts me until today is whether we could have done it earlier, faster.”
Laurie Garrett [email protected]
In brief Exhibition Reading bones
Laurence Clarke/UCL
The discovery of human bones is always newsworthy. But when the bones of at least 84 individuals are found under the main quad of the oldest college of the University of London, UK, it is bound to raise questions. This is what happened in March, 2010, during construction work at University College London. After a visit from the police had ruled out any suspicion of foul play, UCL’s forensic anatomist Wendy Birch, assisted by forensic anthropologist Christine King, were left to excavate, examine, and attempt to reassemble a collection of well over 7000 bone fragments, almost all of them human. Buried on Campus, a tantalising exhibition set among the magnificent Victorian display cases at UCL’s Grant Museum of Zoology, is the result of their 2-year investigation. According
Buried on Campus Grant Museum of Zoology, University College London, London, UK, until July 13, 2012
Laurence Clarke/UCL
http://www.ucl.ac.uk/museums/ zoology/whats-on
1940
to Jack Ashby, Manager of the Grant Museum, “The display and treatment of human tissues is always considered very sensitively in museums today. The disposal of this material in the manner it was disposed of would certainly never happen now.” His comment begs the question of how old the bones are and when they were buried. Before UCL’s foundations were laid in 1826, the site off Gower Street had a history as a rubbish pit, a duelling spot, and the exhibition ground of a steam railway track built by the engineer Richard Trevithick. There is no record of a plague pit—an idea initially put forward to account for the bones. Moreover, a glass Bovril jar found with the bones has been dated to between 1886 and 1920. The bones themselves may, however, be significantly older. Most likely, they are the remains of a Victorian anatomical teaching collection. Some of the bones have been written on, and many show cut marks, for example on a vertebra, a femur, and a skull, consistent with a modern post mortem or anatomical dissection. There is also evidence of a range of diseases—the curvature caused by rickets, the smoothness resulting from arthritis, and
the roughness from osteomyelitis— typical of a teaching collection. If so, then which institution threw out the bones? Here, the curators can only speculate. The prime suspect seems to be UCL’s own anatomy department: it moved about since its founding in the 1820s, and now no longer exists. Instead, anatomists are spread between the Medical School and three other departments. Ashby explains how, with the rise of genetics, many university zoology teaching collections were regarded as outdated, and literally put into skips. Fortunately, says Ashby, UCL had the vision “that a mix of genetics and organisms is what students really needed”, and today the Grant Museum is used in teaching. Birch sees the same potential for the exhumed discovery. “Not only is this a fascinating glimpse into the history of medical teaching at UCL”, she says, “but this collection is being used again to teach current medical, forensic and science students.” Everyone likes a mystery, so perhaps one of the current crop of students at UCL, intrigued by this find, will help to resolve its outstanding puzzles.
Andrew Robinson
www.thelancet.com Vol 379 May 26, 2012
Book The sea is full of sharks As a child of the 1950s growing up in the Flemish village of Keerbergen, Peter Piot dreamed of two Belgian characters that would shape his life: Tintin and Father Damien. From Tintin, Piot gained a carnivorous hunger for adventure and travel. But Father Damien’s great sacrifice for the 19thcentury Hawaiian victims of leprosy held a special resonance for the young Catholic boy, as the missionary came from nearby Tremelo, where Piot would stare at Damien’s town square statue. The part of Piot’s character that devoured Tintin spawned a 27-year-old doctor, still in training in microbiology, who eagerly flew to Zaire without a valid passport and little support from his own country to jump into a mysterious 1976 epidemic. But the soul that was enthralled with Father Damien pushed adventure aside in favour of outrage over the conditions he found in a Catholic mission in Yambuku, where the terrifying epidemic of what would be dubbed Ebola was spawned. The ideals of adventure, travel, and medicine form a thread that weaves through Piot’s No Time To Lose: A Life in Pursuit of Deadly Viruses, making it a riveting read. But the sobriety and sacrifice of Damien form a second, more interesting arc from 1976 Zaire to Dec 26, 2008, when Piot stepped for the last time out of his office as Executive Director of the United Nations AIDS Programme (UNAIDS): a coupling of indignation and discovery. Whether it came from staring at the Tremelo statue, the natural proclivities of small town Flemish folk, his father’s economist pragmatism, or his mother’s no-nonsense office management skills, Piot seems to have approached every issue in his life, first, with a recognition of a basis for his indignation; and, second, with concrete, logical problemsolving. That paired indignation and problem-solving has made his journey through life have meaning, not only www.thelancet.com Vol 379 May 26, 2012
for Piot, but ultimately for millions of people infected with HIV. Throughout No Time to Lose, Piot devours so energetically opportunities, meals, wine, and instant friendships, from beers drunk in the humid heat of Yambuku with Father Carlos to mojitos sipped with Fidel Castro, that the reader savours the moments, and insights, alongside him. But the reader is also at Piot’s side when he watches Ukrainian intravenous drug users inject heroin between their toes or listens in astonishment to whiskey-sipping South African President Thabo Mbeki, as he weaves a dark conspiracy in which western pharmaceutical companies invent a false disease (AIDS) to force poor countries to buy their drugs.
“Piot denounces the idea that amounts of money raised should serve as the primary metric of global health achievement…” Ultimately the hunger for adventure is also one for knowledge, and Piot’s fervour to learn, grow, and adapt consistently served him. I suspect students of science and public health will benefit from the methods Piot deployed in analysing and solving problems, from the epidemiological features of AIDS during the 1980s to the Chinese Government’s refusal to confront HIV 15 years later. By the time the final page is reached Piot has, to name but a few deeds, been on a plane captured by terrorists; spent 2 days inside Renaissance hallways of the Vatican arguing about condoms; isolated a new form of penicillinresistant gonorrhoea; carried the bloated, redolent bodies of dead helicopter pilots through the jungles of Zaire; treated what was probably the first case of AIDS in Belgium; run successfully for election to leadership of UNAIDS and unsuccessfully for Director-General of WHO; confronted
the President of Zambia when Chiluba asserted AIDS was “punishment for fornication”; berated Fidel Castro for imposing mandatory quarantine on Cubans infected with HIV; sneered at Suzanne Mubarak, First Lady of Egypt, when she stated that no tree is high enough to hang all homosexuals; and survived dozens of death threats, mostly from AIDS activists. His Flemish grandmother berated young Peter that, “your ass can’t sit still”, and several times in his memoir Piot says he was, “basically running around like crazy”. Indeed, the pace of this life seems impossibly fast. And when Jonathan Mann, the original leader of the global fight against HIV/ AIDS, died in a Swissair crash in 1998, Piot found alarming reason to work even harder: “It gave me an incredible sense of urgency: I need to do so much before that happens to me too.” By the time Piot walks out of his UNAIDS office, all he can do (at Kofi Annan’s suggestion, no less) is sleep, as “every cell in my body had accumulated a decade of regular lack of sleep and constant jet lag”. His admiration for former UN Secretary-General Annan began in 1995 when he pulled the new UNAIDS leader aside and whispered, “The sea is full of sharks.” It’s the apt kick-off to Piot’s years at the UN, fighting off bureaucrats, donors, activists, bigoted world leaders, incompetent global health maestros, and what he characterises as troublesome journalists. (Piot’s disdain for the media is surprisingly tough. Conversely, his praise for well over 300 colleagues will send readers to the index to look themselves up. Here’s a clue: if Piot liked working with you, your name is preceded by positive adjectives. If not, well, it’s just your name.) Piot’s analysis of inherent failures in the UN system will resonate with anybody who has ever worked for a UN agency. Of wealthy-nation donors
No Time to Lose: A Life in Pursuit of Deadly Viruses Peter Piot. W W Norton & Company Ltd, 2012. Pp 304. US$28·95. ISBN 9780393063165
1939
Perspectives
Piot summarises: “I preferred by far the tough love of the UK and the US to the lip service of some other countries who were long on words, but short on cash.” Parsimonious France, he tells us, was “always pushing to recruit French nationals”, and when Piot ran for leadership of WHO, the Italians “unashamedly gave me the CVs of five fairly junior Italian officials as a condition for their vote for me”. He reserves special disdain for western AIDS advocates, noting there was “simply zero tolerance among some for anything other than advocating
for more money”, and pushing policies that blurred, “the lines between scientific evidence, professional institutional loyalty, and activism”. Piot denounces the idea that amounts of money raised should serve as the primary metric of global health achievement: “The only real measure of our success would be in lives saved.” Ultimately reflecting on the emphasis placed on HIV treatment, versus the controversies that have shrouded every infection prevention effort, he sadly concludes, “Even if we could stop AIDS today—stop it cold—in terms of
new transmissions, it would still have a massive impact on generations to come.” By 2008 Piot can justifiably claim at least partial credit for the nearly 7 million people outside of the wealthy world receiving HIV treatment and the huge global health enterprise that arose during his tenure at UNAIDS, but he remains wistful. More than once he reflects “The question that haunts me until today is whether we could have done it earlier, faster.”
Laurie Garrett [email protected]
In brief Exhibition Reading bones
Laurence Clarke/UCL
The discovery of human bones is always newsworthy. But when the bones of at least 84 individuals are found under the main quad of the oldest college of the University of London, UK, it is bound to raise questions. This is what happened in March, 2010, during construction work at University College London. After a visit from the police had ruled out any suspicion of foul play, UCL’s forensic anatomist Wendy Birch, assisted by forensic anthropologist Christine King, were left to excavate, examine, and attempt to reassemble a collection of well over 7000 bone fragments, almost all of them human. Buried on Campus, a tantalising exhibition set among the magnificent Victorian display cases at UCL’s Grant Museum of Zoology, is the result of their 2-year investigation. According
Buried on Campus Grant Museum of Zoology, University College London, London, UK, until July 13, 2012
Laurence Clarke/UCL
http://www.ucl.ac.uk/museums/ zoology/whats-on
1940
to Jack Ashby, Manager of the Grant Museum, “The display and treatment of human tissues is always considered very sensitively in museums today. The disposal of this material in the manner it was disposed of would certainly never happen now.” His comment begs the question of how old the bones are and when they were buried. Before UCL’s foundations were laid in 1826, the site off Gower Street had a history as a rubbish pit, a duelling spot, and the exhibition ground of a steam railway track built by the engineer Richard Trevithick. There is no record of a plague pit—an idea initially put forward to account for the bones. Moreover, a glass Bovril jar found with the bones has been dated to between 1886 and 1920. The bones themselves may, however, be significantly older. Most likely, they are the remains of a Victorian anatomical teaching collection. Some of the bones have been written on, and many show cut marks, for example on a vertebra, a femur, and a skull, consistent with a modern post mortem or anatomical dissection. There is also evidence of a range of diseases—the curvature caused by rickets, the smoothness resulting from arthritis, and
the roughness from osteomyelitis— typical of a teaching collection. If so, then which institution threw out the bones? Here, the curators can only speculate. The prime suspect seems to be UCL’s own anatomy department: it moved about since its founding in the 1820s, and now no longer exists. Instead, anatomists are spread between the Medical School and three other departments. Ashby explains how, with the rise of genetics, many university zoology teaching collections were regarded as outdated, and literally put into skips. Fortunately, says Ashby, UCL had the vision “that a mix of genetics and organisms is what students really needed”, and today the Grant Museum is used in teaching. Birch sees the same potential for the exhumed discovery. “Not only is this a fascinating glimpse into the history of medical teaching at UCL”, she says, “but this collection is being used again to teach current medical, forensic and science students.” Everyone likes a mystery, so perhaps one of the current crop of students at UCL, intrigued by this find, will help to resolve its outstanding puzzles.
Andrew Robinson
www.thelancet.com Vol 379 May 26, 2012