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BOOK REVIEW

These detectives solve medical mysteries

By Dennis Rosen
Globe Correspondent / May 3, 2010

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Consider a group of highly motivated and dedicated physicians, fanning out across the globe to track down sickness, identify its cause, and prevent it from occurring again. Like modern-day superheroes, the doctors of the Epidemic Intelligence Service, or EIS, have been doing just that for the last 59 years.

“Inside the Outbreaks’’ tells the story of the EIS and of the men and women who served as investigators in its ranks and helped bring about some of the biggest medical triumphs of the last century.

The service was established in 1951 by Alexander Langmuir as a subdivision of the Centers for Disease Control. From the outset, signing on with the EIS involved willingness to accept great personal sacrifices. Investigators often spent weeks and sometimes months away from home in some of the most dangerous places on earth. Whether investigating outbreaks of cholera in Bangladesh, smallpox in Brazil, or food poisoning in the United States, they risked their own health as well as their safety as their work sometimes put them in the midst of military hostilities. They also often faced resistance from skeptical local populations who needed to be convinced that the group’s intentions were good — they were accused, for example, of secretly spreading AIDS under the guise of vaccinating against polio.

Instead of being made up of chapters devoted to specific topics, such as the eradication of smallpox or the difficulties in conducting mass vaccination campaigns, this book tells the history of the service chronologically. This is the book’s central weakness and makes what the group did seem more like a jumble of separate projects that somehow, almost accidentally, resulted in great outcomes, rather than the fruition of well-coordinated efforts. By choosing to write it this way, the author makes it difficult to appreciate just how impressive these accomplishments are. However, it does offer an interesting perspective on how the ethical standards of our society have changed during this relatively short period.

For example, in the quest to find vaccines for hepatitis A and B — which can be fatal or lead to chronic liver disease and cirrhosis — both the viruses and the experimental vaccines were injected into “mentally disabled’’ children at the Willowbrook State School in Staten Island during the 1950s, all of whom lacked the ability to give informed consent or assent to participate.

Another example provided is the response of the authorities to reports of cases of paralytic polio that occurred in some people following their inoculation with the polio vaccine in 1955, which was being given to prevent this. While the cases were ultimately traced back to a faulty batch made by one manufacturer, Langmuir suppressed this information, fearing lawsuits and a public backlash against a mass vaccination campaign that was meeting severe resistance from various groups, including the American Medical Association, which viewed it as socialized medicine.

The doctors of the EIS also had to deal with political pressure from special interest groups, such as big business, which were threatened by their findings.

Author Mark Pendergrast tells of a case in 1980 when the connection between tampon use and toxic shock syndrome, a sometimes fatal disease triggered by the poison produced by staphylococcus bacteria, was discovered. It turned out that this bug was able to breed especially well within a certain brand of tampons produced by Procter & Gamble.

Despite the strength of the evidence (the investigators found that 71 percent of those who developed toxic shock had used that particular brand of tampons), when meeting with P&G executives prior to its publication one of the executives said to the investigators, “You realize what this means to Procter & Gamble? What if you’re wrong?’’ Their response was: “What if you’re wrong? What if it were your daughter?’’ The EIS prevailed, the findings were published, and three days later Procter & Gamble withdrew the tampons from the market.

Dr. Dennis Rosen is a pediatric lung and sleep specialist at Children’s Hospital Boston and an instructor in pediatrics at Harvard Medical School.

INSIDE THE OUTBREAKS:
The Elite Medical Detectives of the Epidemic Intelligence Service
By Mark Pendergrast
Houghton Mifflin Harcourt, 432 pp., $28