mpendergrast | July 21, 2010Mark Pendergrast writes: It's time to wrap up this ScienceBlog Book Club on my book, Inside the Outbreaks. I want to thank Liz Borkowski, Steve Schoenbaum, and Karen Starko for their excellent, insightful commentaries, and thanks too to those who commented here. I assume that you can continue to do so, and you can also contact me through my website at www.markpendergrast.com. While you're there, on the Outbreaks page, take a look at the YouTube link to the children of Niger singing. It's quite wonderful, and it also has an important message at the end.
I don't regard this as the end of…
sschoenbaum | July 9, 2010In this post I want to address disease control opportunities for EIS officers, many of which are detailed in "Inside the Outbreaks: One of the first things we learned about on joining the EIS was John Snow's determination that an outbreak of cholera in London was attributable to contamination of the water from the Broad St. pump and his stopping the epidemic by removing the pump handle. On reading "Inside the Outbreaks" one is struck with the number of EIS officers whose efforts have removed pump handles....
The efforts of Jeff Koplan, subsequently director of CDC, and Mark Rosenberg,…
mpendergrast | July 8, 2010Mark Pendergrast writes: Instead of responding to last week's commentaries on this book club blog about my book, Inside the Outbreaks, I want to throw out a controversial idea that runs counter to what many public health commentators apparently believe. So I expect some disagreement here. (I will post responses to the commentaries as "comments" on each commentary. So go back and take a look at what I wrote there, please.)
Fears of bioterrorism are overblown. We should be spending much more money, time, effort, and print (including e-print) on naturally occurring outbreaks, epidemics,…
kstarko | July 7, 2010Karen Starko writes: Several basic questions related to Reye's syndrome (RS) have come to me from readers of Mark's book, Inside the Outbreaks. These show the importance of continued education on health issues. (For example, some physicians thought that fever was essential to getting RS). Again, thanks to Mark Pendergrast for a wonderful addition to our public health knowledge.
Is an influenza or chickenpox infection necessary to acquire RS?
The answer is no. RS generally has two phases: the antecedent illness and usually, within a few days of this, the syndrome of vomiting and…
sschoenbaum | July 2, 2010Steve Schoenbaum writes: In his blog this week, Mark Pendergrast challenges someone/anyone to take on explaining the differences between case-control studies vs. cohort studies. As an EIS officer, back in late May/early June 1968, I did a case-control study as part of the investigation of a common source outbreak of hepatitis in Ogemaw County, Michigan, so I will try to pick up the challenge. I believe it was only the second time case-control methods were used in a CDC epidemic investigation. In using this method I learned about the power of comparison, not just that numerators need…
kstarko | June 30, 2010Karen Starko writes: When the "financial crisis" started and the news media started throwing around numbers in the trillions and projected fixes in the billions, I realized I just didn't get it. So I got a little yellow post-it, labeled it "understanding trillions," and started a list of examples. And when I learned that the US GDP in 2006 was 13T and the derivative market, estimated in June 2007, was valued at 500T, I quickly got a sense of the potential drain of the derivative market (in which money is spent on items without real value...my definition, please correct me if I am wrong). I…
mpendergrast | June 28, 2010Mark Pendergrast writes: Thanks to commentators Liz Borkowski, Karen Starko, Steve Schoenbaum, and Mark Rosenberg for their thoughtful posts, though it appears that Mark Rosenberg's post got cut off after his first-paragraph query asking why anyone would go into the field of public health. I will wait to respond to his post once I see him answer his own question! In the meantime, there is much to talk about. I (Mark Pendergrast) will respond to parts of what Liz, Karen, and Steve wrote in order, along with other blogger comments.
Let me respond first to a blog comment from John Willis, who…
sschoenbaum | June 24, 2010Steve Schoenbaum writes: "Inside the Outbreaks", Mark Pendergrast's wonderful history of the Centers for Disease Control's Epidemic Intelligence Service (EIS), can be read on many levels. I confess that as a former EIS officer (1967-1969), personally familiar with most of the "elite medical detectives" of the first few decades, I tended to read it "between the lines". I found myself recalling many personal incidents, interactions with others, and themes mentioned but not necessarily fully developed in the book. I'd like to consider a couple of those here:
Early on in "Inside the Outbreaks…
mrosenberg | June 24, 2010What is it that drives people to public health in general and to EIS in particular? Public health is notorious for being the lowest paid medical specialty of all. In addiiton, when you work to prevent diseases and injuries you don't have identified patients the way you do when you are treating patients. So why would anyone do this?
kstarko | June 22, 2010Karen Starko writes: Even though I am a former EIS officer I am still amazed by the many successes of the EIS that Mark Pendergrast so clearly details in Inside the Outbreaks, The Elite Medical Detectives of the Epidemic Intelligence Service. As I reflect on the outbreaks and epidemics described in the book and my own experience, I realize that the case study method employed in the training course and the two-year hands-on program plays a critical role in the success of the EIS program.
Picture this: young doctors, nurses, veterinarians, and other health professionals, many barely out of…
mpendergrast | June 21, 2010Mark Pendergrast writes: To kick off this book club discussion of Inside the Outbreaks, I thought I would explain briefly how I came to write the book and then suggest some possible topics for discussion.
The origin of the book goes back to an email I got in 2004 from my old high school and college friend, Andy Vernon, who wrote that I should consider writing the history of the EIS. I emailed back to say that I was honored, but what was the EIS? I had never heard of it. I knew Andy worked on tuberculosis at the CDC, but I didn't know that he had been a state-based EIS officer from 1978…
kevleitch | October 9, 2008Dr. Offit has never been shy about coming out with his opinions about vaccines and their lack of association to autism. Good. I genuinely thank him for doing so. He has been willing to put himself in the line of fire for what he believes is the right thing to do. In the course of doing this he - and his children - have been subjected to threats and abuse.
He knows that this can be the price you pay for becoming entangled with anti-vaccinationists. But he also knows that this is a subject that must be tackled.
He knows that this is not just a local issue. It is international. Non-vaccinators…
autismvox | October 9, 2008On the last day of the Science Blogs Book Club discussion about Dr. Paul A. Offit's recently published Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure, I'll start by quoting the last paragraph of the book:
The science is largely complete. Ten epidemiological studies have shown MMR vaccine doesn't cause autism; six have shown thimerosal doesn't cause autism; three have shown thimerosal doesn't cause subtle neurological problems; a growing body of evidence now points to the genes that are linked to autism; and despite the removal of thimerosal from vaccines in…
pauloffit | October 7, 2008I want to thank all of those who have commented on this blog for their thoughtfulness and reason. In answer to some of your questions:
Regarding the scope of the book: One commenter asked if I had considered including material in the book that was not directly related to the vaccine-autism debate. Yes. The one area that I didn't address was the history, scope, and impact of the anti-vaccine movement in the United States. There is probably no more powerful influence on how many parents make decisions about vaccines than that of the cynically named National Vaccine Information Center. This…
autismvox | October 7, 2008
I'm teaching a course on Greek and Roman mythology this semester and last week we tackled this question:
Did the Greeks believe their myths?
That is indeed the title of a 1988 book by French historian Paul Veyne. He writes in his Introduction:
Did the Greeks believe in their mythology? The answer is difficult, for "believe" means so many things. Not everyone believed that Minos, after his death, continued being a judge in Hell or that Theseus fought the MInotaur, and they knew that poets "lie." However, their way of not believing these things is disturbing to us. For in the minds of the…
autismvox | October 6, 2008I apologize that this post is not really a review of Dr. Offit's book (I don't know how your Monday has been going but mine has included a boy with a bad cold who had to stay home resulting in immediate rearrangement of my schedule of classes etc., and my needing to meet the deadline for an important document). Much of the exchange here at the Science Blogs Book Club has been about science, vaccines, and the media's role in keeping public discussions of autism overly focused on vaccines. Dr. Offit also devotes a chapter of Autism's False Prophets: Bad Science, Risky Medicine, and the Search…
pauloffit | October 6, 2008Thanks again for all of your comments. I'll try to address a few of your excellent suggestions and criticisms.
Regarding my characterization of children with autism: I think one of my limitations in writing this book is that I'm not a neurologist, psychologist, or developmentalist. I'm an infectious diseases specialist with an expertise in vaccines. So I don't come in contact with many children with autism. As a consequence, my characterization of children with autism in AUTISM'S FALSE PROPHETS came exclusively from what I read in newspapers, which no doubt slants descriptions to more extreme…
autismvox | October 4, 2008Orac wrote about the need to devise frames that can "combat the likes of Jenny McCarthy" and to counter the highly misleading frames that are out there about vaccines, namely:
1) Autism as vaccine injury.
2) Vaccination as an assault on personal freedom.
3) "Green Our Vaccines" and its variant, "We are not 'antivaccine'; we're pro-safe vaccine."
4) Too many too soon.
As the parent of an autistic son, and as someone who communicates regularly with lots of parents of autistic children and with lots of parents period, these are some reasons why people these days seem drawn to such misinformation…
pauloffit | October 3, 2008I'll try to address some of the excellent questions that were asked and points that were raised.
Regarding Jennifer's comment that the stated previous incidence of autism of 1 in 10,000 children is inaccurate: You're right. I'll make sure not to use that statistic in the future. Thanks for pointing that out. As you note, the incidence is closer to 1 in 2,500.
Regarding the financial impact of vaccines: The CDC always performs a cost-benefit analysis to determine whether the anticipated savings in healthcare costs and indirect costs (i.e., lost time from work) justifies the price of a vaccine…
pauloffit | October 3, 2008As the hypotheses shift...
It's now been about ten years since vaccines were first blamed to be the cause of autism. First, it was the MMR vaccine. The mechanism by which this vaccine was supposed to cause autism was ill conceived. Measles vaccine virus was proposed to replicate in the intestine causing chronic inflammation and loss of intestinal barrier function allowing for entrance into the bloodstream of encephalopathic proteins causing autism. However, there was no evidence that attenuated measles virus damaged the intestine and no evidence that specific encephalopathic proteins caused…