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Inside the Outbreaks: The Elite Medical Detectives of the Epidemic Intelligence Service 1st Edition

3.8 out of 5 stars 40 customer reviews
ISBN-13: 978-0151011209
ISBN-10: 0151011206
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Product Description
Since its founding in 1951, the Epidemic Intelligence Service has waged war on every imaginable ailment. When an epidemic hits, the EIS will be there to crack the case, however mysterious or deadly, saving countless lives in the process. Over the years they have successfully battled polio, cholera, and smallpox, to name a few, and in recent years have turned to the epidemics killing us now--smoking, obesity, and gun violence among them.

The successful EIS model has spread internationally: former EIS officers on the staff of the Centers for Disease Control have helped to establish nearly thirty similar programs around the world. EIS veterans have gone on to become leaders in the world of public health in organizations such as the World Health Organization.Inside the Outbreaks takes readers on a riveting journey through the history of this remarkable organization, following Epidemic Intelligence Service officers on their globetrotting quest to eliminate the most lethal and widespread threats to the world's health.

An Amazon Exclusive Essay by Mark Pendergrast, Author of Inside the Outbreaks

I first heard about the Epidemic Intelligence Service when an old high school friend, Andy Vernon, e-mailed me in 2004 to say that he thought I should write a history of the EIS. I had never heard of it. Andy had been an EIS officer in the late 1970s and had gone on to a career at the Centers for Disease Control, where he still works, studying tuberculosis. I was intrigued to find that this organization sent disease detectives all over the world as first responders. I knew little about microbes or epidemiology, although I had written about the epi of caffeine in two of my previous books (For God, Country & Coca-Cola and Uncommon Grounds). My lack of knowledge was not a deterrent. Rather, it was an enticement. I like to learn new things, in new areas. Every area of human endeavor has its own special way of looking at the world, its own vocabulary and culture. But we're all humans, so it isn’t that hard to learn.

I also like to write about things that matter. I am not naïve enough to think that what I write will change the world in any huge way, but I like to think that my books challenge people to look at the world in a more nuanced, in-depth way. Or to put it another way, I hope that my books make people more curious, more informed. In this case, I was intrigued when I discovered that the EIS was founded in 1951 because of fears about bioterrorism during the Korean War. The founder of the service, Alexander Langmuir, was a towering, somewhat intimidating presence, and the EIS officers had been involved in just about every major public health threat in the post-World War II era. Each investigation was a kind of mystery story. In other words, it looked like a lot of fun, and it would give me an excuse to travel to Africa, a continent I had never visited. Plus, I grew up in Atlanta and had never heard of the EIS, which is based there. That made it all the more intriguing.

As I conducted research for a book proposal and began to interview EIS alums (it is a two-year program, so there are more than three thousand of them), I was impressed with their thoughtfulness, clarity, and dedication to the people's welfare. I had never really thought about what "public health" meant, but I came to realize that in trying to halt the spread of epidemics, they were in a sense “treating” the general public the same way a clinical physician treats an individual patient. And EIS officers could have a far greater impact on far more people. Yet such epidemiologists are underappreciated because their work is largely invisible. They may have saved my life, or yours, but we wouldn't know it. So writing Inside the Outbreaks would, I hoped, educate people about the importance of such work and the importance of funding it properly. It will come as no surprise to anyone that public health has always been (and still is) very poorly funded, even though a good public health approach--involving surveillance, prevention, intervention, and planning--ultimately saves millions of dollars as well as lives.

(Photo © Betty Molnar)

A Q&A with Mark Pendergrast

Q: What is the EIS and why have we never heard of it?

A: The Epidemic Intelligence Service is a two-year service and training program of the Centers for Disease Control & Prevention, the CDC. It began in 1951, during the height of Cold War paranoia over possible biological warfare during the Korean War--hence the name, which implied a sort of medical equivalent to the Central Intelligence Agency. It is indeed the most important (and effective) government agency of which you have never heard. EIS officers have investigated many famous epidemics, but they generally maintain a low profile.

Q: What is the significance of the EIS logo, with the damaged shoe?

A: The logo features the world globe with a shoe superimposed on it, a hole prominent in the shoe's sole. EIS officers call themselves "shoeleather epidemiologists" because during investigations they get out into the field, right into the middle of an outbreak. Hence the worn-out shoe, though they have also traveled by dogsled, elephant, camel, dugout canoe, and helicopter, to mention a few modes of transportation.

Q: How big is the Epidemic Intelligence Service? Can you tell us a little about how it operates?

A: In recent years about 80 new EIS officers enter the program for July training in Atlanta. There are now over 3,000 EIS veterans, most of whom have gone on to careers in public health, either at the CDC, state health departments, the World Health Organization, the Gates Foundation, or schools of public health.

How do they operate? An EIS officer is usually pretty young (average age around 34, and more than half are women, though at the onset most were men). About 20% are minorities, with a substantial international component. They are on call 24 hours a day. Many stay at the CDC and specialize in a particular area, such as foodborne/diarrheal diseases or influenza. Others are stationed within state health departments and serve as "general practitioners" of public health, chasing any kind of outbreak. All are subject to being sent at a moment's notice to an emergency anywhere in the world.

Q: Is the EIS program unique to the United States?

A: No. The EIS program has spawned clones and imitators around the world. There are now 36 such programs serving 82 countries, with plans to develop eight new programs to serve 11 additional countries. EIS alums have helped to start all of them.

Q: Your stories of EIS exploits are really amazing, particularly how they helped to identify new diseases and their causes. Can you name some of them?

A: There are so many! Let's see. EIS officers started the first poison control program in the United States, saved the polio vaccine program by identifying which vaccines contained live instead of killed virus, pioneered the identification and control of hospital infections, learned that people could contract rabies from bats without being bitten, helped to eradicate smallpox, realized that even unbroken eggs could carry Salmonella, first identified E. coli O157:H7 as a lethal pathogen, were pivotal in testing oral rehydration therapy for cholera, started the first surveillance system of birth defects and helped to identify folic acid as a prevention for Spina bifida, proved that aspirin caused Reye syndrome, that toxic shock syndrome was caused by super-absorbent tampons, and that Lyme disease came from ticks.

They pioneered effective disaster relief, blew the whistle on lead poisoning from smelters, and identified vinyl chloride in PVC factories as the cause of a rare, lethal liver cancer. They first identified Lassa fever, Ebola, Legionnaires' disease, and Hantavirus Pulmonary Syndrome. They investigated mass hysteria in schools, sick building syndrome, the Dalkon Shield, forced sterilizations, homicidal nurses, and terrorist anthrax letters. Do you want me to go on? I haven't mentioned solving listeriosis, identifying AIDS, finding Cryptosporidium in drinking water, battling rotavirus, multiple-drug-resistant tuberculosis, botulism, yellow fever, parasites, pesticides--

Q: Do EIS officers combat only infectious diseases?

A: No, they try to study and prevent virtually every threat to public health. I already talked about lead poisoning and other environmental problems, as well as psychological problems and criminal activity. EIS officers have also studied tobacco, cancer clusters, obesity, heat waves, binge drinking, violence, suicides, and injuries (they don't like the word "accident"). Unfortunately, problems stemming primarily from human behavior are harder to combat and solve than threats from microbes--even though microbes are also devious and opportunistic.

From Publishers Weekly

Plucky epidemiologists track the world's ailments in this hectic public health saga. Pendergrast (For God, Country and Coca-Cola) chronicles the exploits of the doctors, nurses, statisticians, and sociologists of the Centers for Disease Control's Epidemic Intelligence Service, who jet around investigating the causes and remedies of disease outbreaks from Alabama to Zaire. Looming large is the ever-present, life-threatening problem of diarrhea, whose outbreaks they trace variously to contaminated water, iffy tofu, and Oregon cultists who in 1984 sprinkled salmonella into restaurant salad bars. The investigators also take on more exotic cases, including Ebola outbreaks, the post-9/11 anthrax letters, and a grade-school itching epidemic that turned out to be mass hysteria. These epidemiologists have also led long campaigns to eradicate smallpox—in Pendergrast's telling, an epic struggle against both germs and cultural prejudices—and tried to abate social ills like smoking, obesity, and gun violence. There's not much story-telling frippery in Pendergrast's episodic six-decade narrative, just bare-bones accounts of barely individuated sleuths busting one microbial perp after another by collecting samples and conducting surveys. Still the scientific fight against these cunning, deadly pathogens makes for an often engrossing browse. Photos. (Apr. 13)
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

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Product Details

  • Hardcover: 432 pages
  • Publisher: Houghton Mifflin Harcourt; 1 edition (April 13, 2010)
  • Language: English
  • ISBN-10: 0151011206
  • ISBN-13: 978-0151011209
  • Product Dimensions: 9.3 x 6.6 x 1.2 inches
  • Shipping Weight: 1.4 pounds
  • Average Customer Review: 3.8 out of 5 stars  See all reviews (40 customer reviews)
  • Amazon Best Sellers Rank: #1,092,388 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

By Richard A. Jenkins on July 12, 2010
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.
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Format: Hardcover Vine 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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Format: Hardcover Vine 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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Format: Hardcover Vine 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.
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