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13 of 13 people found the following review helpful
Format: Hardcover
The cover of the book suggests an "Indiana Jones" journey through exotic diseases, but instead this is a lengthy, more or less chronological set of case history vignettes, based on interviews with former EIS officers and some key CDC staff. The brief case histories make this good for reading in snipets, but the overall effect gets a bit mindnumbing and a lot of context and take home messages get lost in the process. It would have been better if the book had been thematically organized, for example, starting with the early years, explaining how people are trained and the basic methods they use, describing high profile or epidemiologically important cases, describing how EIS adjusted to CDC's new missions outside of infectious disease, describing epidemics that remain mysteries and then some integration and update. The growth and changes of CDC's mission are mentioned only in passing, although they have had profound effects on EIS, as well as the rest of CDC. Pendergrast repeatedly mentions budget issues but never explains why they occurred or how they have been remedied. At the end, Pendergrast mentions EIS officers who have made big splashes at CDC or elsewhere, but he gives little idea of less heralded outcomes. For example, he mentions an EIS beginning a long spiritual quest during a posting India, but never revisits this.

Pendergrast mentions fairly big concerns along the way, but never addresses them in depth. He questions whether CDC should have regulatory powers without understanding what that involves (e.g., new bureaucracy, long processes of review for regulations) or how it might affect CDC's other functions and its complex relationship with state and local health departments. A regulatory role might mean that CDC would have to reduce its relationship to local health departments and create firewalls that could, for example, prevent the posting of EIS officers or members of the commissioned corps to health departments, which would rob the agency of valuable field experience and knowledge. CDC already influences practice through guidelines and through conditions places on grants and contracts to health departments and other providers and the effect of these needs to be weighed against CDC taking a more formal regulatory role.

There are other odd omissions and limitations. I saw only one mention of Public Health Advisors, who are a corps of front line CDC staff who often have worked closely with EIS officers and historically played critical roles in collecting data and providing technical assistance in states and in foreign countries. These individuals usually have had longer postings than EIS officers and are trained at the bachelors or (more commonly now) masters level. They know how things work on a day to day basis and have made many EIS investigations possible. Among the areas where Pendergrast seems poorly informed, mental health topics particularly standout. He confuses hysteria and psychosomatic disorders, which are totally are totally different things, and neglects to mention that both tend arise out of circumstances that are troubling for the people involved. They aren't "in people's heads". He also neglects the complex potential causes and manifestations of confounding problems like Chronic Fatigue Syndrome and clusters of cancer diagnoses. In short, Pendergrast needed to do some more homework in places and perhaps should have sacrificed repetition for depth and context. This also might have allowed him to make the writing a bit more lively.
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24 of 29 people found the following review helpful
Format: HardcoverVine Customer Review of Free Product( What's this? )
When I saw a book about the EIS/CDC being offered on Vine, I was excited to see what was inside. Being a bit of an armchair pathologist, I find it absolutely fascinating that something as small as a virus can completely destroy a living organism. In "Inside the Outbreaks," I was hoping for either a "true-to-life" Outbreak (Snap Case) or Hot Zone. Unfortunately, "Inside the Outbreaks" is more like verbal time line composed of interviews from the various EIS/CDC members.

The chapters are composed of a small collection of short stories which resemble Blog entries in both their length and depth. Generally speaking, all of the stories are very formulaic and follow this pattern:
1 - CDC employee gets deployed to location with some sort of outbreak
2 - CDC employee investigates to find source of outbreak
3 - CDC employee finds source and recommends course of action
4 - Outbreak is contained

There are instances where the conclusion made by the CDC researcher causes a major impact in public health, however the impact is barely touched upon and explained away with one or two sentences.

The book itself is very easy to read as each chapter is composed of these short interview-stories which only span an average of one to three pages. Unfortunately you will probably find yourself putting the book down more and more often as the writing just isn't that engaging.
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11 of 12 people found the following review helpful
Format: HardcoverVine Customer Review of Free Product( What's this? )
Like other reviewers, I looked at the title and cover of the book thinking this would be about epidemics first and the Epidemic Intelligence Service (EIS) staff second. I was sort of expecting a book about really awesome doctors fighting diseases in an exciting manner. Sadly, I was wrong.

The book reads as a very well researched book about the staff of the EIS. In a way, it's like reading an indepth biography of any organization - sure, it's deep but not really exciting. Epidemics seemed more of a passing reference in the book and oddly, felt like a distraction. Sure, it's nice to know about a researcher's family but I want to know about the meat of their work, not so much their home life.

This book doesn't do the EIS staff justice. They're an unrecognized elite group in an underappreciated agency. After 50 pages, I got bored and felt bad about it because these fine folks are really doing amazing things and they deserve better.
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6 of 7 people found the following review helpful
VINE VOICEon April 5, 2010
Format: HardcoverVine Customer Review of Free Product( What's this? )
Disclaimer: A free copy of this book was received from Amazon Vine in exchange for an honest review.

Mark Pendergrast's book Inside the Outbreaks is about the Epidemic Intelligence Service (EIS) of the Centers for Disease Control. As such, the book tells about true heroes, men and women who go into some of the most dangerous places on earth and who expose themselves to killer pathogens on a daily basis in the interest of saving lives. One cannot read this book without feeling a sense of awe at the bravery of the physicians who have as their goal the eradication of infectious disease. It almost made me want to resurrect my medical school dreams so I could join their ranks, but I'm afraid I enjoy my creature comforts a little too much to do so.

However, the book is marred by poor organization and a lack of focus. The author chose to write the book in chronological order, seemingly detailing every case in the case files of the EIS from the year of its founding in 1951 to present day. As such there is little cohesion and little to hook one's interest. One wanders from one infectious disease outbreak to the next, from one doctor to the next, and often back again, with little to connect them. In one chapter some people will mysteriously die from an unknown cause, and then several chapters later an infectious disease will be identified and an asterisked note will refer the reader back to Chapter X to see the first appearance of the disease. I gave up trying to keep track of the various names of doctors mentioned in the book as there were just too many to remember-- and it didn't really matter anyway because other than a brief sentence about the individual's background, we never really get a chance to know anything about any of them or learn what makes them tick-- other than Alexander Langmuir, the founder of the program, who is mentioned frequently throughout.

This style of writing also led to a lot of repetition-- seemingly every time cholera is mentioned, for instance, the author mentions the holes cut in the cots of victims with buckets placed underneath to catch the continual flow of waste from the victim's body. It was a striking visual the first couple of times, but after a while it lost its impact. It got to the point where the book was a chore to finish-- and I LIKE reading medical books.

This book could have been so much more than it is-- rather than a clinical recitation of case files, I had hoped to get into the hearts and minds of the people involved in the EIS. Sadly, the main thing I came away with was a dry list of names and diseases.
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12 of 16 people found the following review helpful
TOP 1000 REVIEWERon March 18, 2010
Format: HardcoverVine Customer Review of Free Product( What's this? )
This is a fascinating story about a government agency I had never heard of, told in a dreary way. It tells the history of the EIS by means of two parallel themes:
- case notes of individual cases, generally 2/3 page to 1.5 pages each
- the organization, developing methodology and techniques of the EIS over time.

If you are looking for deep medical mysteries, such as Berton LaRouche's books, or the most excellent tv show Mystery Diagnosis, you will not find them here. Each case is so brief that, while it is interesting to see what the issues were and steps taken to deal with the incident, it is not like reading a medical thriller. It is almost like reading a list, and is sort of a dreary and choppy kind of organization. These are sort of Dragnet-style case notes, when this book could have been a Hot Zone style thriller. But the content is so interesting (to me) that I still enjoyed it, but I did feel that there were probably many more interesting aspects that were totally missed, such as the reasoning puzzles needed to understand an incident, or the curiosity and emotional involvement of the investigators, that was generally missed.

Additionally, I don't think the development of the EIS as an agency (whose officers frequently became part of the US Public Health Service Commissioned Corps, originally part of the Navy), or its methodology, were well chronicled or exposited. These tidbits were frequently buried inside individual case notes. It feels like the author has published notes which were collected from library research, but that he never took it to the next level of taking a step back and thinking like a historian, finding the greater story themes in all these disconnected tidbits. It almost reads like an in-house commemorative volume.

Still, an amazing chronicle of a group that I was completely unaware of, and a very interesting read if you like these topics. But it could have been so much better. [My 4-star rating reflects my basic interest in this previously unheard-of topic, rather than the quality of the writing.]
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2 of 2 people found the following review helpful
on December 18, 2010
Format: Hardcover
This book is a concise history of the EIS and will be a useful introduction for many people, probably from a beginning high school student looking for accurate information in fast a moving presentation, up to a general physician wishing to learn some history of public health in the US. MP has done justice to epidemiology for the general reader, simplifying a complex history of a subject which everyone, no matter what occupation, should be familiar with because of its continuing importance to society.

Curiosity about medicine as well as government policy and ethics may be stirred by the episodes reported. Certainly one may like to learn more about the people and diseases that are touched upon in the book depending on ones interests. This book mentions even some of the smallest outbreaks that were investigated by EIS and CDC, including many unsolved ones, which I was happy to know about. Things we heard, depending on one's age, in the news growing up are discussed as well like toxic shock syndrome, legionnaires disease, swine flu and the like. You might learn something about small pox and TB and malaria as well that you did not know before. And you will learn about AIDS epidemic, Marburg and Ebola and Hanta viruses, as well as Salmonella and E Coli and Staph bacteria. Botulism, lead and mercury and much more before you are finished.

Reading this books makes it very apparent that much more is yet to be discovered. Yet, even for one who does not pursue epidemiology any further, it seems to me to be a highly accurate history, and it is satisfying reading on its own.

In summary, I dont think I have ever read such a concise presentation of the material in this work. More fun to read this book than an issue of MMWR. The story of disease and its investigators is incredible even without adding drama. The biographical bits given us about the investigators are somewhat understated and undramatic, but enjoyable. Most importantly, the ability to sum up complex facts, issues and ideas involving biology and policies in a couple of sentences that retain accuracy as well as interest, is a quality achieved by the author numerous times in this book, an admirable accomplishment deserving high praise.
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2 of 2 people found the following review helpful
Format: HardcoverVine Customer Review of Free Product( What's this? )
Inside the Outbreaks - much substance but little style

Inside the Outbreaks is the most recent of the fact based techno thrillers like "The Hot Zone", "Ebola", "The Coming Plague",and "Dr Mary's Monkey". As the exquisitely researched history of the Center for the Disease Control people and case studies, it fulfills its function. As a fascinating, cant put it down, story of human drama, it stops short of its goal. You cant quite decide what Mark Pendegrast intended more, although the introduction rings passionate about the people, it also raises a plaintive note of how vastly unnapreciated and underfunded the service is.

The book traces the roots of CDC from the viewpoint of its creator, Dr Langmuir, but does so in a backhanded complimentary sort of way. While we are told that not much would have happened without Dr Langmuirs constant perseverance at the helm, every other page also implies that his megalomaniacal, paranoid tendencies hampered the efforts of his teams on many occasions. Oh well, seems that he had to play a delicate balance between the political needs to keep the effort going and to encourage bright minds to enlist and stay on.

There are countless medical detective stories here, but they are laid out like a transcript of a court case, not as fascinating stories of survival that they deserve to be. I truly hope that someday the History Channel will have a series based on this book. And a series it needs to be, because there is so much packed into the book, you have to read many paragraphs over and over to comprehend what is going on.

I kept thinking that some books have ghost writers for exactly this reason. It is not enough to have compelling facts, you need to tell a compelling story as well. I would have easily given up half the stories in exchange for more in depth explanations. Its OK to have a bit of emotions mixed in with the science.

In summary, I liked the book. I liked the topic. I had to put it down many times before finishing it because its like reading a textbook though. Mr Pendegrast, please mix in a little cherry flavoring into the medicine?
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1 of 1 people found the following review helpful
Format: HardcoverVine Customer Review of Free Product( What's this? )
I was personally somewhat familiar with two of the cases described in this book, and have an interest in Intelligence and Scientific topics. Thus I expected an exciting read on the real-time reportage of investigations of the Epidemic Intelligence Service (EIS). Alas, the brief factual but past-tense dry reportage of epidemics and medical situations was described from the point of view of an uninterested reporter giving brief vignettes of "incidents" in the past histories and case files of the EIS. In each case a 2-3 page summary of the chronological findings in that case was given without either the level of scientific detail, or first-person present tense point of view that could have made the incremental discoveries and "red-herrings" exciting. I was an undergraduate student in Philadelphia during the 1974 incident of Legionnaires disease at the Bellevue Stratford Hotel and can readily recall the engaging and scary reporting on the daily television news of mysterious illness and death at a Philadelphia landmark and while the dry facts of this investigation are reported they yield none of the excitement of the ongoing partially reported investigation at the time. I had been taking L-tryptophan as a non-prescription over the counter sleep aid when it was taken off the market around 1990 and expected an exciting story that led to the discovery of contaminants in Showa Denko's manufacturing process but learned little more than the symptoms found in a victim and the cooperative nature of the Japanese manufacturing firm in the investigation.

In general this book, reveals the surface facts of many investigations from the files of the EIS in chronological order and reported in past tense third-person perspective and makes what could have been interesting stories of scientific/medical investigations told in terms of the individual scientific tests performed and false-hypotheses tested by an investigator and reported in first-person by the investigator as the case developed a set of dry historical case files.

--Ira Laefsky
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1 of 1 people found the following review helpful
TOP 1000 REVIEWERon April 18, 2010
Format: HardcoverVine Customer Review of Free Product( What's this? )
Inside the Outbreaks tells the story and history of the EIS (Epidemic Intelligence Service), a group of "disease dectives" based in the CDC (Centers for Disease Control). Through this program, many fantastic health outcomes have been derived: the essential eradication of polio and smallpox, as two examples.

Epidemiology is essentially the study of diseases in people, over place and time. It's a constantly developing field, and new disease agents and vectors are still being discovered. As someone who has a background in epidemiology, there was a lot of great information in this book that I actually didn't know.

The stories are easily digestible; rarely do they run more than 3 pages of text. Some of them are quite interesting, and it runs the gamut of time from the beginning of the EIS to present day. If you like epidemiology, or want to understand a basic primer of how disease investigations occur, this book is worth reading.

What I did not like about the book, and why I'm giving it 3 stars, is that the writing was piecemeal and not cohesive. I understand that the source of the information was from interviews of the EIS officers as well as note review, but I felt the stories could be much more compelling. It really leaves off the human interest piece.

The formula for many of the stories:
CDC found out about some pathologic agent/odd disease; there was some sort of infighting (about ~30% of the time); someone gets sent out to study the population/disease; discovery was made (about 80% of the time); course of action is set out; resolution (about 80% of the time).

Another thing that I found interesting and a bit disturbing was the lack of discussion of ethics around human subject testing. Tuskegee is one of the well-known epidemiology studies that put egg on science's face, but at least people acknowledged the harm. In the book, EIS officers report (paraphrase)"inoculated prisoners with various doses of Shigella to see the dose-response (how little one must ingest before one gets sick)." A few times, there is a nod to the fact the studies weren't handled well with the particpant's best interests in mind: "We didn't have human subject review" "Things were done that way at that time", etc.

Even in cases where the investigation lead to significant public health shifts in attitude, practice change, or improved health outcomes, Pendergrast's style is very nonplussed. A reader could easily miss the importance of the result.

There is a lot of great information in this book, but it could've been packaged and presented in a way that was more digestible and representative of the EIS' work.
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1 of 1 people found the following review helpful
on June 9, 2010
Format: Hardcover
I find public health people remarkable heroes and I have long believed epidemiology is addressing medical issues better than conventional physicians. Also far more cost effective for both the remote poor and the industrialized affluent. I could not put down this book. Only a good writer could have told this story so successfully, however, because, yes, it is a bit dorky and sadly for many Americans, the problems these heroes solve are often abstract and dismissable. Food safety issues should make this a three-meal a day concern for all humans but what can you do about the disinterest of most people. If one could scare one's friends who may be in various kinds of denial about the fragility of everything and the plight of most of the inhabitants of earth, they would find this book a revelation and an inspiration. Other wiser and worried friends just need a gift copy. I am grateful to the work of epidemiologists and appreciate this record of their remarkable work in the EIS.
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