Beating Back the Devil
Simon & Schuster, 2004
On call 24 hours a day for two years, the members of the Epidemic Intelligence Service (EIS) belong to an elite group of physicians, epidemiologists and PhDs in related fields who serve as the CDC's front-line agents. Beating Back the Devil (2003) is the first book to look inside the agency, describing both its history and cases up to the present day. Although I was a bit disappointed that statisticians didn't play a bigger role in the narrative (they were certainly behind the scenes), I was fascinated by the stories the EIS agents had to tell.
In particular, the two stories that really grabbed my interest were about eradicating Polio two generations ago, and fighting Malaria in Malawi right before the book went to print. The vaccine against Polio developed by Jonas Salk and John Enders was the third attempt tested on humans, the first having proven ineffective and the second actually propagating the disease. Though Salk went down in history for having found an effective treatment, the initial distribution of the vaccine in 26 states in 1955 saw an increase of cases and sent the CDC scrambling to investigate. The EIS took quick action in both mapping the outbreaks and tracking them to a few batches of contaminated vaccine, which allowed the national innoculation program to come back online within a month of a precautionary shutdown.
Unlike the long-dead Polio, Malaria afflicts 300 million people annually and kills one in 300. Because women who have immunity lose it during pregnancy, and because a lack of technology in remote villages makes it difficult for pregnant women to take properly, the WHO, CDC and Malawian Ministry of Health coordinated a study to test the effectiveness of the drug when administered correctly. Although the logistics of coordinating and executing a good study were a herculean task for EIS agent Scott Filler, there was yet another struggle in getting the mothers in his study to give birth in the study's hospital rather than in the villages with local midwives. With the help of a powerful local leader, Filler was able to convince enough mothers to deliver in his hospital while protecting the status and welfare of midwives who lost business.
From a statistician's point of view, I enjoyed the Polio story because it was an important, pressing problem with a relatively straightforward solution. Conversely, the Malaria story was compelling for the opposite reason: what on paper looked like a simple study turned out to have a great deal of complication that could not be expressed in a model.