Rx for Survival: A Global Health Challenge (review)

In November 2005, public television stations across the country aired a six-part documentary series titled Rx for Survival: A Global Health Challenge. Produced by WGBH and Vulcan Productions, and funded by the Bill and Melinda Gates Foundation and the Merck Company Foundation, the series aims to raise awareness of the "greatest challenges in global health and the people meeting them." Each episode follows a set of seemingly intractable problems—smallpox, AIDS, river blindness, obesity, poor access to medical services, malaria, contaminated water . . .—and the difficult, but ultimately successful, struggles of ingenious scientists, public health administrators, and committed community health workers, past and present, to combat them.

The miniseries is a pricey affair, with extensive footage from far-flung locales, dozens of expert interviews and intimate firsthand accounts, fancy graphics depicting the immune system in action, and occasional fear-provoking subliminal messages. All the while, an ethno-techno musical score conveys a mood of alternating despair and hope. Of particular interest to historians are the numerous "historical" reenactments of health plights and triumphs, designed to reveal transportable lessons regarding global health developments over time.

Raising awareness of global health among the U.S. public and politicians is a worthy cause: with U.S. overseas development assistance at just 0.16% of gross national income, the country trails virtually every other OECD member in addressing global inequalities and their health consequences. The slick marketing campaign surrounding the documentary—including its narration by a decidedly perplexed Brad Pitt, a high-profile global health conference, a companion book and Web site, and the publication of a Gates Foundation–sponsored special issue of Time Magazine (followed, predictably, by Time's naming of Bill and Melinda Gates, together with rock star Bono, as its "persons of the year")—might be forgiven had Rx for Survival depicted global health in analytically sound terms. Instead, the series intersperses simplified narratives of health heroes and scientific ingenuity (Jenner, Snow, Pasteur, Yersin, Lazear, Goldberger, Fleming, etc.) with horror-flick accounts of superbugs (episode 2), "deadly messengers" (episode 4), and new threats (episode 6)—such as MDR tuberculosis, MRSA, West Nile Virus, SARS, avian influenza. In repeating these simplistic formulas to demonstrate the connections between disease problems of developing countries and emerging "risks" in the United States, the series misses the true challenge of global health: the importance of integrating technoscientific developments with sociopolitical improvements.

For example, as relentless polio vaccinators wend their way through open cesspools and extreme misery in Indian villages (episode 1), it is only delivering the vaccine that matters—no reference is made to the enormous local resources consumed by this campaign (the most expensive in world history) and its displacement of other, far more pressing, causes of childhood death and disability. We learn that crowded shantytowns in Lima provide ideal circumstances for the spread of tuberculosis, but Rx for Survival does not address the causes of or the solutions to the poor living conditions (a cornerstone of public health, past and present), focusing only on whether Partners in Health's Jim Kim will prove that it is possible to treat MDR tuberculosis with expensive, second-line drugs "borrowed" from Harvard hospitals and "smuggled" through Peruvian customs.

For classroom use, the series would work ideally for a critical media studies course—but as history of medicine, it is almost embarrassing: a hagiography long gone from the profession punctuates the narrative. History of medicine is stripped of context and serves only to justify technological breakthrough as the motor of history. Many of the complex arguments of interviewed historians—such as Howard Markel, Randall Packard, and Alan Kraut, among others—are selectively used to dramatize the role of individuals at the expense of the social, economic, and political imperatives that framed the emergence and implementation of public health innovations. Some of the reenactments are corny, such as Pasteur's interaction with a roomful of anticontagionists, or ophthalmologist Alfred Sommer's historical portrayal of himself as...