NATURE MEDICINE • VOLUME 8 • NUMBER 6 • JUNE 2002 551

BOOK REVIEW

At the Helm: A Laboratory Navigator

By Kathy BarkerCold Spring Harbor Laboratory Press,

$45.00, 352 pp, 2002

REVIEWED BY TARUN KAPOOR

Laboratory of Chemistry and Cell BiologyRockefeller University, New York, New York, USA

The lively, well-organized book, At theHelm: A Laboratory Navigator by KathyBarker is a valuable resource for newlyappointed principal investigators, whohave to recruit, motivate and managepeople, teach classes, carry out institu-tional responsibilitiesand compete forfunding while doingingenious research—the only thing thatthey have beentrained to do untilnow. Many principalinvestigators thusfeel overwhelmed bythe multitude oftheir new responsi-bilities. This bookclearly lays outguidelines for thosemaking the transition from their train-ing and bench work as graduate stu-dents and postdoctoral fellows torunning their own labs.

Written in a straightforward style,the book provides vital informationneeded to avoid common mistakes andget off to a good start. Barker inter-views several new and seasoned lableaders all around the United States,enlivening the text with their quotesand real life examples, while weavingin material from management sources.This presents a variety of opinions onany particular issue, so that there issomething that everyone can identifywith. By following the practical, easy-to-use rules and advice, Barker sug-gests, new faculty can learn to head alab with the highest levels of studentmotivation and creative research. Theycan also use its rule-based practices tobecome more productive and creative,write with greater ease, and socializemore successfully by learning aboutoften-misunderstood aspects of acade-mic and lab culture, including mentor-ing, she says.

The book starts with a fair compari-son of work as a scientist in the privatesector versus the academic world forpeople who are weighing career op-tions. For those choosing academic sci-ence, the book has tips on how to getthe job, negotiate start-up packagesand design lab space. She goes on fromthere to cover every imaginable aspectof setting up and running a lab. Amongthe topics covered in the book are hir-ing practices, time management, howto keep research central, lab organiza-tion, effective communication andhow to be a leader.

The chapter “Choose Your People”was particularly telling. Advice aboutthe hiring process is covered compre-hensively. As the author explains the

hiring protocol, she de-tails how to review re-sumes, check references,set up and conduct an ef-fective interview, evalu-ate the candidate andsell the job and whatyour lab has to offer. Shecautions on prejudicesthat we may not be cog-nizant of and adviseshow we should workpast first impressions.She also provides a use-ful primer on the differ-

ent visa types we may encounter whenhiring foreign researchers.

What surprised me most about thebook was that it was not just a list ofbasic management mantras. Each chap-ter in At the Helm includes anonymousvoices from many researchers aroundthe country expressing candid opin-ions, anecdotes and ideas. These quotesinclude real solutions to some of theunusual problems that one might en-counter as a new principal investigator.Clearly, many of these solutions havestood the test of time. In my first fewmonths heading a lab, I came across cir-cumstances that I thought were uniqueto my experience. It is comforting toknow that there are many others whohave been through similar situations,and can now look back and laugh!

As a new principal investigator, Ithink this book is necessary for every-one considering a scientific academiccareer to read before they start the trialand error of setting up their own labs. Ibelieve experienced managers will alsofind some useful advice in it to helpkeep their labs running smoothly.

Macroeconomics andHealth: Investing inHealth for Economic

Developmentpresented by Jeffrey D. Sachs

World Health Organization, GenevaAvailable online: http://www3.who.-

int/whosis/cmh/cmh_report/e/report.cfm$22.50, 200 pp, 2001

REVIEWED BY ADRIAN J. IVINSON

Harvard Center for Neurodegeneration and Repair

Harvard Medical SchoolBoston, Massachusetts, USA

The constitution of the World HealthOrganization (WHO) states, amongother things, “The objective of the WHOshall be the attainment by all peoples ofthe highest possible level of health”. It isalways the simple statements that get usin trouble, and bearing in mind their de-finition of health—“a state of completephysical, mental and social well-beingand not merely the absence of disease orinfirmity”—this one seems to committhe organization, a priori, to failure. Canwe ever contemplate “the highest possi-ble level of health” for every living per-son? Perhaps not, but a recentlypublished report presented by JeffreySachs, Macroeconomics and Health:Investing in Health for EconomicDevelopment, takes us a step in the rightdirection.

In a 1988 acceptance speech, the newlyelected Director-General of the WHO,Gro Harlem Brundtland, offered a some-what more practical mandate for theleading organization dedicated to globalhealth: to be “…the moral voice and thetechnical leader in improving health ofthe people of the world. Ready and ableto give advice on the key issues that canunleash development and alleviate suf-fering. I see our purpose to be combatingdisease and ill-health—promoting sus-tainable and equitable health systems inall countries.” Such a goal is a tad morepractical maybe, but still quite a task.

Brundtland is key here. She came tothe job from a background of publichealth and, thankfully, it shows. Publichealth, as the Oxford MedicalCompanion puts it, “…has its founda-tion not only in the biological and nat-ural sciences, but also in the realm of

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552 NATURE MEDICINE • VOLUME 8 • NUMBER 6 • JUNE 2002

BOOK REVIEW

social and political affairs.” In 1987, dur-ing her second stint as Prime Minister ofNorway, The World Commission onEnvironment and Development (thatshe chaired) presented ‘Our CommonFuture’, a report that boldly establishedthe link between environment and de-velopment. It showed that as long asthere is poverty—real abject, wretched,life-threatening poverty—the environ-ment cannot be safe. For who is going tolook to the needs of the environment be-fore caring for their own hour-to-hour,day-to-day survival needs?

In January 2000, Brundtland launchedthe Commission on Macroeconomicsand Health, again emphasizing thebroader social and political componentsof health. “…issues such as debt relief,trade negotiations, the AIDS crisis, essen-tial drug availability and the spiraling ofhealth-care costs have left no doubt thathealth has a central role in the worldeconomy. Yet, few finance officials anddevelopment economists have so far ex-plored the potential importance ofhealth investment as an instrument forreducing poverty.” And in a statementthat seemed to reflect her frustrationwith those finance officials, she added,“The goal of this Commission and itspre-eminent thinkers is to show onceand for all that health must be at theheart of development.”

I would guess that she is pleased withthe resulting report, Macroeconomics andHealth. It makes a compelling case that astrong economy is the best guarantee ofa good health-care system and that a na-tion’s good health is the best guaranteeof a strong economy.

That this simple loop is at the heart ofa nation’s well-being seems obvious.Countries at either end of thehealth/economic spectrum and at allpoints in between provide ample evi-dence of the link. Nonetheless, skepticsare served up a feast of evidence that im-provements in either one of thesebarometers (medical and economic) pro-vide a lift to the other and put the coun-try on an upward spiral of well-being.Conversely, weakness or negativegrowth in either one will undermine ef-forts to improve the other, creating adownward spiral. Some of the evidence isindirect, but poignant. Malnourished orotherwise sickly children do not grow astall as well-fed, healthy children. Inpoorer countries, the economic impactof this is seen in the positive correlationbetween adult height and earnings.

Whereas the bottom of the health/eco-nomic spiral is characterized by high in-fant mortality, poor life expectancy andlow per capita income, the report warnsus against allowing this bleak picture togive way to a feeling of hopelessness. It isnot some sort of natural state that thepeople of those countries are destined tosuffer. Most of the dis-ease burden can betraced back to just a fewdiseases for which effec-tive medical interven-tions do exist. Theproblem is that we havefailed to make these in-terventions available toall who need them. Thereason for this failure issimple—money.

If we had the financialresources to effectivelytackle HIV/AIDS,malaria, tuberculosis, diarrhea and ahandful of other diseases on a globalbasis, a huge health burden would belifted. The evidence of a few examples—reduced HIV prevalence in Thailand andUganda; oral rehydration in Mexico;fewer malaria deaths due to mosquitonets in Viet Nam—even allows us to cal-culate what it would cost. By defining abasic level of medical intervention andpopulation coverage, and applying thesetargets to all of sub-Saharan Africa andother poor countries (defined as thosewith an annual income of less than$1,200 dollars per person) the authorscalculate that they would need just $34per person to reach their goals.

Although $34 per person per yearseems very modest, when it is applied tothe entire population of global poor itturns into a daunting number. Goodbasic health care (and the necessary ad-ministration and supervision to ensurethat it is delivered effectively) for the 2.7billion neediest people would cost $57billion per year by 2007. Consideringthat the international community is cur-rently donating just $2 billion per yearfor health, this seems almost unattain-able. But one of this report’s manystrengths is putting numbers in context.

All but the poorest of the poor coun-tries could contribute significant healthdollars to these new programs. By 2007,just $22 billion would need to comefrom donor countries. The $2 billion cur-rently donated by these countries (theUnited States, Canada, Australia, NewZealand, Japan and most of Europe) rep-

resents less than 0.01% of their gross na-tional product (GNP). All that is beingproposed is an increase to 0.1% of GNP.

Of course, government finance wonkswould offer a slack-jawed response to arequest for such an increase. But that isonly because the current culture is notone of significant support. It is only be-

cause we are used to suchlow levels of health aid that0.1% of GNP seems a lot.And here perhaps this oth-erwise inspiring report is atits weakest. It makes astrong case for a major in-crease in aid, explains theimpact such an increasecould have, describes howthe new funds would beused, and quantifies thenumber of lives that wouldbe saved and the number ofcountries that could be set

on their own two feet as a result; how-ever, it does not venture to suggest howwe change the current culture of limitedglobal health aid. All the report reallysays on the subject is, to paraphrase,‘where there’s a will, there’s a way’. Thegood news is that the trend in healthaid is in the right direction, both interms of percentage of GNP and ab-solute dollars.

Jeffrey Sachs, the famous Harvardeconomist, chaired the commission thatproduced this excellent report. Sachs is acharismatic, energetic and convincingcharacter. We must hope that he and agroup of like-minded and similarly per-suasive and talented individuals will hitthe international circuit and not restuntil they have persuaded a few of themore significant GNP countries to getthe ball rolling and to commit to real in-creases in health financial aid. There isprobably no greater calling.

In summing up his report, Sachs of-fered this simple truth: “There is no ex-cuse in today’s world for millions ofpeople to suffer and die each year for lackof $34 per person needed to cover essen-tial health services. A just and far-sightedworld will not let this tragedy continue.”

Global health leaders, and the rest ofus, must shout this message from therooftops. And if we, the wealthy globalcommunity, do not respond appropri-ately then we must either demonstratethat the central tenet of this book iswrong, or we must come clean and an-nounce that we have decided that $34 istoo much to pay for a life.

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