464 Book Reviews
eat a "reasonable amount of protein"—
whatever that means—and "balance the
amount of food you eat with the amount of
exercise to maintain appropriate body
weight" (my italics). The nine unremarkable
guidelines set out in the modern gibberish of
scientific compromise are then accompa-
nied by a rather general page or two on each
which gives a very general scientific justi-
fication. The eighth commandment of
avoiding excess micronutrient supplements
is clearly important in a society where a sub-
stantial proportion of adults pop mineral and
vitamin pills. Then follow technical tables to
prove the consistency of modern guidelines
and an attempt to explain interindividual
variation in the population.
In chapters 3-9, the book provides a
simple introduction to nutrition from fats
with the chemical formula of cholesterol
displayed, nomograms for calculating the
body mass index, a rather poor section on
Infectious Diseases of Humans: Dynamics and Control
By Roy M. Anderson and Robert M. May
Paperback ISBN 0-19-854040-X, Oxford University Press, New York, 1991, 757 pp., $47.50
This book discusses the dynamics and
control of infectious diseases in terms of
mathematical models, and much of the dis-
cussion has a mathematical flavor. As in all
sciences, a discussion in mathematical terms
helps to make the discussion precise and re-
duces ambiguities, but it means that an abil-
ity to interpret mathematical equations is re-
quired to gain a full appreciation of the
material. The authors attempt to make the
material accessible to readers who are less
mathematically minded. Particularly useful
in this regard are the large number of infor-
mative graphs, diagrams, and tables. The
more technical mathematics has been rel-
egated to eight appendices. The authors
sometimes help the non-mathematical
reader by expressing even quite simple as-
sumptions both algebraically and in dia-
grams. However, the book is not consistent
fiber, and a good simple summary of food
additives. Only by chapter 10 are we al-
lowed to know fully what to do and here the
fear of being explicit, quantitative, and
meaningful in relation to varying energy
needs becomes apparent. The book ends by
recognizing that there are facts and figures
in abundance, but what is needed is under-
standable, practical advice. With this book,
the intelligent reader will indeed be edu-
cated and the experts will have gained from
the experience. What is still needed, how-
ever, is an illuminating, original and physi-
ologically relevant way of translating popu-
lation statistics into individualized practical
help for the average consumer.
Philip James
Rowett Research Institute
Greenburn Road
Bucksburn, Aberdeen AB2 9SB
United Kingdom
in this regard. It contains quite a few equa-
tions that involve summation notation, de-
rivatives, integrals, or determinants without
adequate explanation of what these equa-
tions mean. More verbal explanations for
such equations and an introductory section
to explain some of the mathematical con-
cepts and notation would have helped the
less mathematically minded readers consid-
erably.
The dynamics and control of infectious
diseases are studied by individuals of vari-
ous backgrounds, including epidemiolo-
gists, public health officers, social scien-
tists, geographers, and mathematicians. It
is natural that individuals are often less fa-
miliar with the work of colleagues from
other professions. This is particularly true
of the work on mathematical models,
which is often passed over by individuals

from other disciplines. One reason for this
is the technical nature of work concerned
with mathematical models. It is also true
that a lot of the mathematical work does
more to advance mathematics than it does
to help our understanding of the spread of
diseases. Researchers from other disci-
plines and individuals engaged in develop-
ing public health policy will naturally
wonder whether it is worth the trouble to
follow the technical mathematical litera-
ture in order to extract what is useful to
them. This book focuses on discussion that
is directly relevant to public health issues
and should help to convince most readers
that the study of mathematical models for
the spread of diseases helps significantly
in our understanding of disease spread and
is crucial for assessing the consequences
of intervention.
Some readers may remain skeptical,
claiming that the models are oversimpli-
fied to the point of doubtful relevance to
the practical problems of public health. It's
true that insights are usually demonstrated
from consideration of oversimplified mod-
els, but conclusions derived from simple
models gain credibility when they remain
valid for a variety of more general settings
and sound explanations can be found to
support them. This is easily illustrated
with the concept of herd immunity, for
example. A formal meaning is usually
given to the concept of herd immunity
from a consideration of simple models, but
the concept holds up under more general
settings, although its precise description
may change a little, and the explanation
for it in terms of the mean number of "off-
spring" produced by each infective makes
good sense.
While mathematical models describing
the spread of infectious diseases provide
some very useful insights, their most impor-
tant role is as a tool for helping to decide on
suitable strategies for the control of infec-
tious diseases. It is not possible to use
planned experiments in communities to as-
sess the impact of vaccination schedules on
Book Reviews 465
the spread of diseases. It is necessary to
predict the likely consequences. Here, epi-
demic models are absolutely essential, be-
cause it is not possible to keep track of all
variables and interactions over time without
a formal mathematical description. This is
especially true as we increasingly use vac-
cines, such as the measles, mumps, and ru-
bella vaccine, to protect simultaneously
against more than one disease. There are
many subtle consequences of mass immu-
nization that change over time. For example,
high levels of childhood vaccination against
measles increase the average age of the sus-
ceptibles, eventually leading to considerable
variation in the duration of maternally ac-
quired immunity of infants, and limiting the
opportunity for having immunity boosted by
exposure to disease. Some, or all, of these
factors may affect the best choice of vacci-
nation strategy. Considerations based on
mathematical models can help to determine
whether this is so.
Two-thirds of this book deals with models
for diseases spread by what the authors call
microparasites (such as viruses, bacteria,
and protozoa). Part II discusses models for
diseases spread by macroparasites (hel-
minths and arthropods). This partition of the
material arises because these two types of
diseases have characteristics that require
different types of models.
In each part, the biologic characteristics
are introduced and the type of data that are
typically available is discussed. The discus-
sion of models begins with the simplest
models, and uses them to introduce the con-
cepts and type of results that they lead to.
The authors then consider how various gen-
eralizations affect the results.
There is a considerable amount of discus-
sion about the steady state solution to the
model equations; in other words, the even-
tual outcome of an intervention. It is clearly
of interest whether or not eradication is pos-
sible. The steady state solution is of less in-
terest when eradication is not indicated,
because it takes a long time, typically a life-
time, to approach the steady state, which
466 Book Reviews

means that vaccines, the community, and be-
havior are likely to have changed in the
meantime. The dynamics over time are also
considered. It is this aspect, perhaps up to
10-15 years, that is of greater interest to
public health questions.
After detailed discussion of the simpler
models, the authors consider how various
generalizations, such as age-specific trans-
mission rates and other heterogeneity, affect
the results. Specific attention is given to en-
demic infectious diseases in developing
countries.
The strengths of the book lie in the wide
ranging coverage of different types of in-
fectious diseases, as well as the biologic mo-
tivation given for the models and its many
references to relevant data. With its large
number of references (about 750), the book
is a valuable key to the literature on relevant
data, models, and control strategies for in-
fectious diseases.
A serious weakness of the book is its fail-
ure to specify the precision of estimates ob-
tained from data, and also of predictions
arising from models. At a time when editors
of the leading international journals in the
health sciences are at pains to promote good
scientific practice by insisting that research-
ers associate confidence intervals with es-
timates, it is very disappointing to see that
the authors of this important book fail to use
confidence intervals and standard errors. A
related point is that there is little discussion
of probability models. Probability models
are not needed for diseases in communities
with many susceptibles and many cases.
However, with mass immunization, these
numbers become small and the elements of
chance play a central role and have to be
considered.
The book is recommended as a refer-
ence book for all people concerned with
public health issues arising from infectious
diseases. The range of applications is very
broad and most people will find substan-
tial parts of the material to be of interest to
them.
Niels G. Becker
Department of Statistics
La Trobe University,
Bundoora, Victoria 3083
Australia

BOOKS RECEIVED

Menopause: A Midlife Passage. By Joan C. Callahan. ISBN 0-253-20817-3 paperback,

0-253-31312-0 hardback, Indiana University Press, Bloomington, Indiana, 1993, 220 pp.,
$29.95 hardback, $12.95 paperback
Iron and Human Disease. Edited by Randall B. Lauffer. ISBN 0-8493-6779-4, CRC
Press, Boca Raton, Florida, 1992, 534 pp., $198.00 US, $240.00 outside US, hardback
Health Economics Research in Developing Countries. Edited by Anne Mills and Kenneth
Lee. ISBN 0-19-261620-X hardback, Oxford University Press, New York, 1993, 363 pp.,
$59.95
Diseases of Infection: An Illustrated Textbook. By Norman Grist, Darrel O. Ho-Yen, Eric
Walker, et al. ISBN 0-19-262308-7 hardback, 0-19-262307-9 paperback, Oxford Uni-
versity Press, New York, 1993, 453 pp., $73.50 hardback, $37.50 paperback
Indoor Allergens: Assessing and Controlling Adverse Health Effects. Edited by Andrew
M. Pope, Roy Patterson, and Harriet Burge. ISBN 0-309-04831-1, National Academy Press,
Washington, DC, 1993, 308 pp., hardback