Superbug: The Fatal Menace of MRSA (review)

There are instances where science fact is far more insidious and scary than science fiction. One such instance is chronicled by Maryn McKenna in her book Superbug: The Fatal Menace of MRSA. This is the description, in McKenna's free-flowing prose, of a modern-day biological success story (or horror story depending on your perspective), that is, the emergence and spread of community-associated methicillin-resistant Staphylococcus aureus, otherwise known in scientific literature as CA-MRSA. It is an ancient human foe, colloquially known as the "staph germ," which through genetic mutation, acquisition of new genetic information from other bacteria, and unknown selective forces has risen to epidemic status in the United States. The term epidemic is not applied glibly. Indeed, the spread, particularly of wound infections and pneumonia caused by CA-MRSA strains across the United States, has been concisely documented in the medical and public health literature as a true epidemic. Ironically, it is a semisilent epidemic since most people in the lay public have only a fleeting acquaintance with this modern-day plague. McKenna's book delves into the horrific effects that CA-MRSA brings to the lives of those with whom it makes acquaintance—individuals, families, football teams, school systems, indeed entire communities. It is a sobering read, in the tradition of Richard Preston's The Hot Zone. It is in turn captivating, gruesome, melancholy, and aggravating. Why didn't the medical community do something, you may find yourself asking yourself. What if that were my child—what would I have done, you may wonder. No one can read this book as an outsider; you will be drawn into this drama.

The book has its fair share of heroes. For the most part they are physicians and scientists who attempt to sound the alarm about CA-MRSA, though few listen. They are the doctors who struggle at the bedside of their patients to bring healing, or ultimately attempt to bring solace to those who are left behind in the wake of this microbiologic serial killer. This is a book well worth reading. True, it is focused on the problem of staphylococcal infections, but underlying this gripping story is the broader issue of how the medical and public health communities, not just in the United States but globally, recognize and respond to new biological threats. Readers of this book will likely never take the occasional pimple for granted any longer or may think twice about that swollen abrasion before simply slathering it with over-the-counter "triple antibiotics." Perhaps that is a good thing. McKenna's book indicates how slow the medical and public health communities can be when confronted with something new and the need for each of us to be our own health advocates in times of crisis. There are several compelling stories of love, compassion, faith, and fortitude that punctuate this drama. The slowness of the medical community to grasp the significance of the emergence of CA-MRSA has been paralleled time and time again over the years with Legionnaires' disease, toxic shock syndrome, hantavirus infections in the southwestern United States, and SARS. In each case, bright people, armed often with serendipitous findings, sounded an alarm that went unheeded until it was devastatingly obvious that something was wrong and people were dying. McKenna's book will educate you, fascinate you, overwhelm you, and more than likely make you reconsider your own state of health as well as the health of our medical and public health establishments. These too are good things. In the end, one must take to heart the words of the noted microbiologist Alexander Tomasz of the Rockefeller University, who once noted to his peers, "We must never underestimate a life form that is 3.5 billion years older than we humans are." Certainly McKenna would agree with this sentiment.