Friday, November 15, 2013

A Pop Health Book Review of "Deadly Outbreaks"

I was always a fan of "House, MD", a medical TV drama that followed a team of physicians tasked with diagnosing patients with mystery symptoms that stumped every other doctor.  I loved the twists and turns, the hypotheses, the puzzles.

I kept being reminded of House as I read Dr. Alexandra Levitt's new book, "Deadly Outbreaks".  She profiles seven cases where real life medical detectives (aka: field epidemiologists) solve mysteries involving exotic viruses, unexplained deaths, and occupational safety (just to name a few!)

As I thought about the relevance of "Deadly Outbreaks" to Pop Health, I kept coming back to the role of communication between these medical detectives and the public.  This communication is heavily impacted by the media (which can help or hurt an investigation!)  I was fascinated to read about this relationship in the cases presented (from 1976-2007) and think about how it will evolve in the future along with our health communication channels.

Several cases offered particularly striking lessons in health communication:

Lesson 1:  The Role of Communication in Promoting Fear or Stigma

Chapter #4:  Obsession or Inspiration
This case (1976) chronicled the discovery of what would later be named "Legionnaires Disease". With U.S. citizens already worried about a possible influenza epidemic (due to a suspicious death earlier in the year), the medical detectives had to contend with media coverage that fueled public fear:

"The U.S. public, bombarded by daily news stories, was disturbed and frightened by the outbreak in Philadelphia, even though swine flu was quickly ruled out as a possible cause."
(Page 84)

"The public was primed and ready to believe that something big and scary was about to arrive, and it had."
(Page 84)

Chapter #7: A Normal Spring
This case (1993) followed the trail of a virus affecting people in New Mexico (later discovered to affect people in the four corners (New Mexico, Arizona, Colorado, and Utah). This case was interesting because it presented the challenge of managing the intersection of media coverage and local culture (Navajo people were disproportionately impacted by the condition).

"The Navajos were also unhappy at being linked to the disease in Four Corners. The newspapers not only printed the names of dead relatives, but also referred to the disease as the "Navajo flu," stigmatizing an entire people."
(Page 174)

Lesson 2: The Role of Communication in Promoting Health and Safety

Chapter #5: Deadly Desserts
This case (1994) which involved a Salmonella outbreak, highlighted a successful public awareness campaign! After Salmonella was linked to their products, the Schwan Company conducted a recall and asked customers to discard or return all uneaten products that may be affected.

"Schwan's even sent their trucks door-to-door to retrieve ice cream from each household."
(Page 124)

"Schwan's public awareness campaign- advising its customers not to eat its ice cream -was unprecedented and has been praised and studied as a model of good corporate citizenship."
(Page 124)

Lesson 3:  What's In A Name?  The Importance of Language

Chapter #4: Obsession or Inspiration
The newspapers called it "Legionnaires Disease" first. This popular name would later become official (and was approved by the American Legion).

"It was named Legionella pneumophila ("lung-loving"), in honor of the American Legionnaires.  Although many affected groups do not want the stigma of having an organism or a disease named after them, the leaders of the American Legion decided that the name would honor their fallen colleagues."
(Page 111)

Chapter #7: A Normal Spring
It is customary to name a newly isolated animal-borne pathogen after a geographic feature around the place it was discovered.  Therefore, names such as the "Four Corners virus", "San Juan virus", and "Muerto Canyon" were proposed.

"...the Navajo community was uncomfortable with names that would tie them to the new disease..."
(Page 181)

In response to this concern, scientists settled on a neutral name for the pathogen: Sin Nombre, the No Name Virus.

Overall Thoughts

I highly recommend this book. While I highlighted some of the health communication lessons here, there are lessons for a variety of public health disciplines. It is a great resource for public health students:  Dr. Levitt does a wonderful job of defining key public health terms (e.g., case control study) and providing lots of practical examples. It is a great resource for current public health practitioners who should re-visit lessons from past outbreaks as we tackle the challenges of disease surveillance, domestic/international outbreaks, and the disturbing anti-vaccine movement. This book gives us a good idea of the diverse skill set needed by today's public health workers....and I believe communication skills are at the top of the list. We need scientists who can do the work and also negotiate the media and the challenges of communicating risk to the public. As online news and social media become ubiquitous, I'm curious to see how public health handles the challenges of the 24-hour news cycle where health myths or facts can be spread in the blink of an eye.

What Do You Think? Would love to hear from others who have read the book!

Disclaimer: I was invited to review "Deadly Outbreaks" by the Council of State and Territorial Epidemiologists (CSTE) and provided with a copy of the book.

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