public health
sb admin | 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…
terrasig | July 7, 2010Yesterday, the ScienceBlogs arm of Seed Media Group announced that they would be hosting a blog written by members of PepsiCo's research and development leadership team. From the Food Frontiers blog:
PepsiCo's R&D Leadership Team discusses the science behind the food industry's role in addressing global public health challenges. This is an extension of PepsiCo's own Food Frontiers blog. All editorial content on the blog is overseen by ScienceBlogs editors.
The opening post was written by ScienceBlogs "editor" Evan Lerner:
As part of this partnership, we'll hear from a wide range of…
sb admin | July 6, 2010Liz Borkowski writes: I wrote last week about how federal agencies can solve the problems that create conditions for disease outbreaks - or fail to solve them, as is too often the case. This week, I wanted to focus on the role Congress plays in public health agencies' effectiveness, because that's another angle that crops up repeatedly in Inside the Outbreaks.
Congress's creation of federal agencies is clearly a huge achievement, and they've also periodically given new powers to already existing agencies. For instance, Mark Pendergrast tells the story of the Dalkon Shield, an IUD that turned…
lborkowski | July 6, 2010Liz Borkowski writes: I wrote last week about how federal agencies can solve the problems that create conditions for disease outbreaks - or fail to solve them, as is too often the case. This week, I wanted to focus on the role Congress plays in public health agencies' effectiveness, because that's another angle that crops up repeatedly in Inside the Outbreaks.
Congress's creation of federal agencies is clearly a huge achievement, and they've also periodically given new powers to already existing agencies. For instance, Mark Pendergrast tells the story of the Dalkon Shield, an IUD that turned…
sb admin | 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…
sb admin | 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…
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…
sb admin | June 29, 2010Liz Borkowski writes: Mark Pendergrast wrote yesterday about how politics plays into the work of the EIS, and it's something that I kept noticing as I read Inside the Outbreaks. As he points out, my post last week highlighted the solution to the Reye's Syndrome puzzle - which was solved by Karen Starko, who's also one of the Book Club bloggers! - but didn't get into the larger issue: there can be a big difference between solving the puzzle and solving the problem. In yesterday's post, Mark writes:
Although Karen's and subsequent CDC studies clearly demonstrated that giving children aspirin…
lborkowski | June 29, 2010Liz Borkowski writes: Mark Pendergrast wrote yesterday about how politics plays into the work of the EIS, and it's something that I kept noticing as I read Inside the Outbreaks. As he points out, my post last week highlighted the solution to the Reye's Syndrome puzzle - which was solved by Karen Starko, who's also one of the Book Club bloggers! - but didn't get into the larger issue: there can be a big difference between solving the puzzle and solving the problem. In yesterday's post, Mark writes:
Although Karen's and subsequent CDC studies clearly demonstrated that giving children aspirin…
sb admin | 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…
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…
mmckenna | June 28, 2010In the winter of 1999, I stood in an outpatient clinic in a pediatric hospital in New Delhi and listened to a father sobbing over the paralysis of his only son. He was a farmer and lived in Uttar Pradesh; counting walks, minibuses and trains, it had taken him 24 hours to get to the hospital. He had carried the toddler the entire way.
His son had gotten the drops, he insisted: Every time the teams came to his neighborhood -- which they did three, four times each year -- he or his wife had lined up all their children, the boy and his older sisters. His son had had 11, 12 doses, the man said.…
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…
mmckenna | June 24, 2010There's a troubling item in this afternoon's issue of the CDC's Morbidity and Mortality Weekly Report or MMWR: The first report in the United States of a novel resistance mechanism that renders gram-negative bacteria extremely drug-resistant and that has been linked to medical care carried out in India or Pakistan.
The short item describes three isolates (E. coli, Klebsiella pneumoniae and Enterobacter cloacae) found in three patients in three states between January and June of this year. All three isolates produced New Delhi metallo-beta-lactamase (NDM-1), which has never been recorded in…
lborkowski | June 22, 2010Liz Borkowski writes: Mark Pendergrast's Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service is a fast-paced tour through nearly six decades of epidemiology achievements by this relatively small program of the Centers for Disease Control and Prevention. It's a fast and fascinating read, and its episodic structure makes it an easy book to carry around and dip into whenever you've a got a few minutes of free time.
The public-health professionals who join the EIS - usually for two-year stints, though some stay longer - are often young and willing to take risks…
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…
mikethemadbiologist | June 21, 2010This post might put me at odds with much of the science bloggysphere, but I think a lot of the concern over congressional and FDA hearings over whether 'over-the-counter' genetic screening and genome sequencing should be regulated is overblown. Maybe my feelings are influenced by my concerns about the misuse of antibiotics--in the case of cefquinome, the FDA did the right thing (and I only wish they had acted sooner).
Consider this article which was recommended by a ScienceBloging, the crux of which is:
The controversy here rests on a single assumption: That the typical Walgreen's customer,…
mikethemadbiologist | June 18, 2010Or more precisely, why do some patients not follow their doctors' orders even when it is blindingly obvious that they should do so? In Monday's NY Times there was an interesting article about patients who are being paid to take their medicine in a reliable manner. I was going to write about the payment issue as it raises all sorts of questions, but I've become fixated on something in the article: ignoring obvious incentives to take care of yourself.
For example, once a juvenile diabetic (someone who can't manufacture his or her own insulin) takes a lot of insulin before eating a meal,…
terrasig | June 18, 2010Reuters Health Executive Editor and proprietor of the excellent Embargo Watch blog, Ivan Oransky, was kind to alert me to this topical paper that appeared in Monday's issue of Annals of Internal Medicine entitled, The Social Mission of Medical Education: Ranking the Schools.
To the credit of the Annals, the full text of the primary article is currently free. An accompanying editorial is behind the subscription wall.
The study was conducted led by Fitzhugh Mullan with Candice Chen, MD, Gretchen Kolsky, and Michael Spagnola from the Department of Health Policy at the George Washington…
mmckenna | June 17, 2010A set of papers published this month in two journals provide an unsettling glimpse into the rocketing incidence and complex epidemiology of one really scary pathogen, Acinetobacter baumanii.
In the all-star annuals of resistant bugs, A. baumanii is an underappreciated player. If people -- other than, you know, disease geeks -- recognize it, that is because it's become known in the past few years for its propensity to attack wounded veterans shipped to military hospitals from Iraq and Afghanistan, earning it the nickname "Iraqibacter." (Important note: Steve Silberman of Wired magazine took an…