Thursday, December 25, 2014

Book Review: Epidemiologists saving the world

If you are fascinated by TV dramas like "House" or simply real-life medical mysteries like SARS and swine flu, Alexandra Levitt's "Deadly Outbreaks" might just hit the spot.

Book Review: Epidemiologists saving the world

For those who are fascinated by House, Contagion, or simply real-life medical mysteries like SARS and swine flu, the new book Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic Viruses, and Drug-Resistant Parasites might just hit the spot. Written by Alexandra Levitt, a scientist at the Centers for Disease Control and Prevention,  it describes the suspenseful, intriguing, and often dangerous work of “medical detectives” — the epidemiologists who solve conundrums that threaten the public’s health. Levitt’s clear and simple writing makes the book accessible and interesting for non-scientists as well as those well-versed in the field.

In each of the seven chapters, Levitt chronicles a real epidemic that both mystified and challenged public health professionals. She profiles the medical detectives who were instrumental in leading the search for a solution, or at the very least, an explanation for the issue at hand.

If you thought epidemiology was all about lab coats and microscopes, think again. Levitt highlights the importance of cross-discipline collaboration in solving public health challenges and shows that answers may remain hidden without outside perspectives. Often these collaborations are with predictable partners, such as epidemiologists consulting with primary care providers during a suspected hantavirus epidemic in New Mexico. Other times, the cooperation between epidemiologists and business leaders is the crucial link, as was the case with a Salmonella outbreak in a Minnesota ice cream factory. More broadly, Levitt argues that collaboration is required between public and private sectors and between the local, state, and national levels. After all, medical detective work—just like crime scene forensics—does not occur in a vacuum.

Of local interest is the chapter on the infamous Legionnaire’s disease (a potentially fatal pneumonia) outbreak of 1976, which terrified Pennsylvania residents and eventually led to the closure of the Bellevue-Stratford Hotel in Philadelphia, site of the American Legion convention that supplied the name of the disease. Also of note is a chapter profiling  James Buehler, a longtime CDC leader who recently retired from the agency and is now a  professor of health and management at the Drexel University School of Public Health. Levitt describes Buehler’s involvement in a heart-wrenching case of infant deaths in the cardiology ward of a Toronto hospital. By using “epi curves” (graphs plotting deaths against time, deaths on each nurse’s watch, etc.), Buehler and his CDC colleague helped solve the case. Regrettably, the epidemiologists were also subjected to a torrent of brutal cross-examinations by lawyers defending individual nurses or other parties, and justice was never dealt. Levitt depicts such stories with the suspense of a Law and Order episode, widening the book’s appeal.

Levitt also demonstrates that public health workers often need to make decisions without having all the information they would like. For example, in a bizarre epidemic of polyneuropathy (a neurologic disorder involving damage to multiple peripheral nerves) among employees at a meatpacking plant in Texas, the epidemiologist on the case deduced that the cause was most likely the “brain mist” produced from processing hog brains. She had no proof, but she decided to act on the theory and cut off workers’ exposure to the mist immediately. Because of this decisive action in the face of uncertainty, the team of epidemiologists was able to prevent more employees from getting sick while they investigated the case. The book is especially adaptable for classroom use since Levitt re-defines and describes complex terms and scientific processes in case the reader has not read the preceding chapters. This may feel repetitive to the attentive reader who recalls the terms from earlier in the book. But it allows academics to use excerpts of single chapters that are relevant to their syllabus.

Deadly Outbreaks also provides critical take-away messages for the practice of public health in general. Levitt notes the necessity of collaboration between the fields of veterinary medicine/animal health and public health. Most emerging infectious diseases  that threaten human health originated in animals, and the welfare, health, and industrial use of animal populations have an enormous impact on our own health. This notion of collaboration has been widely recognized by organizations such as the One Health Initiative, which promotes uniting human, animal, and environmental health to achieve advancements in health care. The concept’s “worldwide strategy” calls for synergy among physicians, osteopaths, nurses, veterinarians, dentists, and other health professionals to achieve things like “biomedical research discoveries, enhancing public health efficiency, expanding the scientific knowledge base, and improving medical education and clinical care.” As the public health community should be well aware, Levitt argues that it will take more than a tunnel-vision approach to improve health in our society, particularly with the increased threat of animal-borne illness.

The author also highlights the importance of flexibility in public health preparedness. Specifically, there are times when it is necessary to divert resources from one division (e.g., bioterrorism) to another division (infectious disease control) as unexpected crises arise. Levitt and others have noted that the overemphasis on bioterrorism prevention after 9/11 may have contributed to the lack of preparedness in responding to SARS, H1N1 (swine flu), and other incidents not related to bioterrorism. In contrast, Levitt praises public health leaders who have quickly agreed to divert resources from one division to another in times of need. This type of adaptability is crucial, especially in a field where the biggest threats often come as a surprise. Levitt also recognizes the public health workers’ challenge in addressing outbreaks without causing further panic. A delicate balance is required to inform people of what they should to do protect themselves without mobilizing the “worried well” — those who are healthy but fear becoming sick, flocking to medical providers and tying up services for those who need them.

Levitt succeeds in portraying epidemiologists as ordinary people who are sometimes faced with remarkable challenges to their consciences, such as the dilemma of serving an individual’s interest versus protecting the population’s health. These challenges are indeed real, and Levitt’s work hopefully will bring further admiration for the public health leaders who overcome them on a daily basis. With any luck, Levitt’s book might also inspire the next generation of young scientists to pursue the exciting field of epidemiology.

Phoebe Jones, a second-year graduate student in Health Policy and Management at Drexel’s School of Public Health, is focusing on aging, autism, and ethics.To suggest a book for review that is broadly related to public health, send her an email.

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About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, DrPH, MSc Assistant Professor, Drexel University School of Public Health
Janet Golden, PhD Professor of history, Rutgers University-Camden
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