For anyone who is inspired by the remarkable work Paul Farmer has engaged in over the years, this book offers a sound explanation of his guiding doctrine on human rights and healthcare for the poor.

It's a big world, but we Americans seem to reside in a small one, at least those of us fortunate enough to be insured and able to afford the health care we need. Many fellow US citizens cannot afford to be sick or ill at all, yet their needs may be tended only once they are so ill that emergency room care is required, but maybe not even then. Then there are the desperately poor of other nations and whole regions of the world that have virtually no care at all. This book is about those folks and medicine as it is currently practiced and dispensed here and abroad. Author Doctor Paul Farmer shows that modern medical practice violates the very ethos that spawned the impulse to heal in the first place.

This book has a lot of structural problems that, while off-putting, are easily ignored by the enormous contribution Farmer makes to our understanding of a set of topics that most of us have not thought about at all. This is an important and inspired book, one that is clear and easy to read, although marred by redundancy that a good editor might have helped eliminate. The thesis topic is that the desperately poor deserve more attention, not less as they now are accorded, because they are more vulnerable by definition. Farmer successfully questions the allocation of our resources toward corporate profits rather than treating the poor of the world.

Farmer's case studies based on his experience of working in Boston, Hattie, and the Russian Republic amply illustrate that our health care priorities are backward and unjust at best, pernicious and self defeating at worst. Every medical ethics course in the US ought to require this along with, or in place of, their existing textbooks that grind over the hoary issues of abortion and euthanasia, and a lot of other topics that are luxuries of a rich society that all but ignores those in greatest need.

Excellent - should be read by all medical people and politicians and any concerned about equality

This is a foundation book, if you have the time, money, and willingness to read broadly. If you want only one book on the cycle of health, human rights, poverty, and violence, buy Jeffrey Sachs' book on "The End of Poverty: Economic Possibilities for Our Time," in which this author, Paul Farmer, is praised, recognized, and clearly valued as a pioneer.

There are two bottom lines in this book:

1) Providing adequate low-cost health care for every human is the non-negotiable first step in eliminating human rights violations writ large (e.g. a year in a Russian prison could be an automatic death sentence from tuberculosis), poverty, and violence among the poor and between the poor and the more affluent.

2) Governments are failing. Here the author is in harmony with Philip Alcott, whose book "The Health of Nations" calls for the over-turning of the Treaty of Westphalia (no more respect for the sovereignty of dictators--as in America, when government become too destructive, the People have the right to abolish the government). The author believes that a larger non-governmental network, and public pressure to force governments to apply more money to health and less money to the military killing machine, will in fact not only end poverty, but unleash sustainable indigenous wealth.

His case studies are of necessity somewhat tedious and can be skimmed if one's mindset is inherently in agreement with his propositions--they do however provide deep documentation for the skeptical.

Another book that might be substituted for this one (especially if buying and reading Sachs) is the pioneering work of Laurie Garrett, "BETRAYAL OF TRUST," which documents the global collapse of public health. A very long book, my Amazon review of it is summative and may suffice.

Dr. Farmer also makes the rather helpful point that doctors doing good can go places where human rights inspectors would be considered intrusive. He praises Cuba, and rightly so. Any country that can put 10,000 medical practitioners into Venezuela, and thereby earn "first call" on Venezuelan oil, is operating at a strategic level of insight that the USA simply does not match today. Readers may not like hearing that the USA is slipping down into the middle ranks of "has been" nations, but that is the reality. On our present course, we are importing poverty, allowing pandemic disease to rear its ugly head through bird flu, mad cow disease and other mutations that will jump to humans, and we have also busted the national piggy bank with the double deficits (trade and debt).

When Dr. Farmer talks about the pathologies of power, he reminds me of Norman Cousin's book by the same title, but does so in a very practical personal way. If human beings are a primary source of national power, then having uneducated human beings subject to disease, poverty, crime, and terror has got to be the single dumbest thing any great power can allow to happen, at home or abroad. Lest anyone dispute my contention on this point, see my reviews of Barbara Ehrenreich, "Nickle and Dimed," and also David Shipler's "The Working Poor: Invisible in America." See my review of Sachs for more detail on the specific topic of global poverty and why it matters to every citizen.

the book is really intense and gets a little hatey sometimes, but is very illustrative of the problems that arise from oppression, poverty and structural violence.