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Beating Back the Devil: On the Front Lines with the Disease Detectives of the Epidemic Intelligence Service
IN THE WAR AGAINST DISEASES, THEY ARE THE SPECIAL FORCES. They always keep a bag packed. They seldom have more than twenty-four hours' notice before they are dispatched. The phone calls that tell them to head to the airport, sometimes in the middle of the night, may give them no more information than the country they are traveling to and the epidemic they will tackle when they get there.
The universal human instinct is to run from an outbreak of disease. These doctors run toward it.
They are the disease detective corps of the U.S. Centers for Disease Control and Prevention (CDC), the federal agency that tracks and tries to prevent disease outbreaks and bioterrorist attacks around the world. They are formally called the Epidemic Intelligence Service (EIS) -- a group founded more than fifty years ago out of fear that the Korean War might bring the use of biological weapons -- and, like intelligence operatives in the traditional sense, they perform their work largely in anonymity. They are not household names, but over the years they were first to confront the outbreaks that became known as hantavirus, Ebola virus, and AIDS. Now they hunt down the deadly threats that dominate our headlines: West Nile virus, anthrax, and SARS.
In this riveting narrative, Maryn McKenna -- the only journalist ever given full access to the EIS in its fifty-three-year history -- follows the first class of disease detectives to come to the CDC after September 11, the first to confront not just naturally occurring outbreaks but the man-made threat of bioterrorism. They are talented researchers -- many with young families -- who trade two years of low pay and extremely long hours for the chance to be part of the group that has helped eradicate smallpox, push back polio, and solve the first major outbreaks of Legionnaires' disease, toxic shock syndrome, and "E. coli" O157.
Urgent, exhilarating, and compelling, "Beating Back the Devil" goes with the EIS as they try to stop epidemics -- before the epidemics stop us.
The universal human instinct is to run from an outbreak of disease. These doctors run toward it.
They are the disease detective corps of the U.S. Centers for Disease Control and Prevention (CDC), the federal agency that tracks and tries to prevent disease outbreaks and bioterrorist attacks around the world. They are formally called the Epidemic Intelligence Service (EIS) -- a group founded more than fifty years ago out of fear that the Korean War might bring the use of biological weapons -- and, like intelligence operatives in the traditional sense, they perform their work largely in anonymity. They are not household names, but over the years they were first to confront the outbreaks that became known as hantavirus, Ebola virus, and AIDS. Now they hunt down the deadly threats that dominate our headlines: West Nile virus, anthrax, and SARS.
In this riveting narrative, Maryn McKenna -- the only journalist ever given full access to the EIS in its fifty-three-year history -- follows the first class of disease detectives to come to the CDC after September 11, the first to confront not just naturally occurring outbreaks but the man-made threat of bioterrorism. They are talented researchers -- many with young families -- who trade two years of low pay and extremely long hours for the chance to be part of the group that has helped eradicate smallpox, push back polio, and solve the first major outbreaks of Legionnaires' disease, toxic shock syndrome, and "E. coli" O157.
Urgent, exhilarating, and compelling, "Beating Back the Devil" goes with the EIS as they try to stop epidemics -- before the epidemics stop us.
320 pages, Hardcover
First published August 31, 2004
About the author
Maryn McKenna
3 books109 followersMaryn McKenna is a journalist and author who specializes in public health, global health and food policy.
She has reported from epidemics and disasters, and farms and food production sites, on most of the continents, including a field hospital in New Orleans during Hurricane Katrina, a Thai village erased by the Indian Ocean tsunami, a bird-testing unit on the front lines of West Nile virus, an Arctic graveyard of the victims of the 1918 flu, an AIDS treatment center in Yunnan, a polio-eradication team in India, breweries in France, a “Matrix for chickens” in the Netherlands, and the Midwestern farms devastated by the 2015 epidemic of avian flu.
She writes about science and food for The New York Times Magazine, National Geographic, NPR, Newsweek, Vice, FiveThirtyEight, Wired, Scientific American, Slate, Modern Farmer, Nature, The Atlantic, and The Guardian. She is the author of the award-winning books SUPERBUG and BEATING BACK THE DEVIL, and is a Senior Fellow of the Schuster Institute for Investigative Journalism at Brandeis University and a frequent radio guest. Her 2015 TED talk, "What do we do when antibiotics don't work any more?", has been viewed more than 1.5 million times.
She has reported from epidemics and disasters, and farms and food production sites, on most of the continents, including a field hospital in New Orleans during Hurricane Katrina, a Thai village erased by the Indian Ocean tsunami, a bird-testing unit on the front lines of West Nile virus, an Arctic graveyard of the victims of the 1918 flu, an AIDS treatment center in Yunnan, a polio-eradication team in India, breweries in France, a “Matrix for chickens” in the Netherlands, and the Midwestern farms devastated by the 2015 epidemic of avian flu.
She writes about science and food for The New York Times Magazine, National Geographic, NPR, Newsweek, Vice, FiveThirtyEight, Wired, Scientific American, Slate, Modern Farmer, Nature, The Atlantic, and The Guardian. She is the author of the award-winning books SUPERBUG and BEATING BACK THE DEVIL, and is a Senior Fellow of the Schuster Institute for Investigative Journalism at Brandeis University and a frequent radio guest. Her 2015 TED talk, "What do we do when antibiotics don't work any more?", has been viewed more than 1.5 million times.
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Displaying 1 - 30 of 174 reviews
May 21, 2020
Update I am wondering how things have changed now corvid-19 infections is the prime preoccupation of the world? I am reading Wuhan Diary: Dispatches from the Original Epicenter and just came to where it is proposed that all Chinese people have to download an app and report every single day on their health so that they can be tracked. (People without cell phones are presumed to live in remote areas which a) probably don't have infections or b) are too unimportant to care about in any respect, life and death included). I wonder if it will come to that with us in the West? I believe they have something similar in South Korea and also maybe Germany, but I'm not sure.
___________________
For two days I have done very little except read this book. I thought it was going to be dry, but interesting talking objectively of the work of the Centers for Disease Control (CDC) and various other government organisations dealing with mass outbreaks of disease and germ warfare. But I was wrong! It was anything but dry. A fabulous read. Travel, adventure, humour, mystery, plot twists, interesting characters, it really had it all.
The best of the mystery stories was when four babies died of listeria, a gut disease that can take up to four weeks to show. The CDC had to track down how the babies caught it which involved finding the victims of the present infection typing this particular listeria so it could be differentiated from other outbreaks.
The next step was interviewing a massive number of people, both those who had it and a control group.. Then their fridges had to be gone through, stores and delis where they bought items that could be infected had to be inspected, the managers and buyers interviewed and this was in several different states.
Once the source had been narrowed down to pre-cooked, sliced turkey, the source had to be identified through interviews with the vendors and thence to the turkey meat manufacturers. They reacted really well recalling all possibly infected turkey at a great financial loss to themselves. It made me wonder if there isn't insurance for this kind of event.
Eventually, the source of infection was closed down and there were no more cases. The plot twist? The four babies who had died and started the investigation had not had this particular listeria at all!
The book ranged from 9/11 through anthrax, SARS, polio, tuberculosis, pneumonia, AIDS and more not just in the US, but Africa, South America and Asia. An interesting fact I learned was that although it is known that smallpox has been kept alive in both legal labs and in those who might wreak germ warfare on the world, only people who might have contact with it are vaccinated. This is because although there were very few major reactions to the vaccine - a sore arm and slight fever being common and only lasting a few days (I had them) - about 7 or 8 children per million vaccinations would die from complications. Now there was so little need for the vaccine, it's use was abandoned.
The book is a fantastic, fast-paced read. There is sparing use of adjectives and descriptions but there is the occasional lyrical sentence which points up the excellent writing that has no need of padding. Recommended to all who enjoy non-fiction and like engrossing books that require them to stop what they are doing and read!
___________________
For two days I have done very little except read this book. I thought it was going to be dry, but interesting talking objectively of the work of the Centers for Disease Control (CDC) and various other government organisations dealing with mass outbreaks of disease and germ warfare. But I was wrong! It was anything but dry. A fabulous read. Travel, adventure, humour, mystery, plot twists, interesting characters, it really had it all.
The best of the mystery stories was when four babies died of listeria, a gut disease that can take up to four weeks to show. The CDC had to track down how the babies caught it which involved finding the victims of the present infection typing this particular listeria so it could be differentiated from other outbreaks.
The next step was interviewing a massive number of people, both those who had it and a control group.. Then their fridges had to be gone through, stores and delis where they bought items that could be infected had to be inspected, the managers and buyers interviewed and this was in several different states.
Once the source had been narrowed down to pre-cooked, sliced turkey, the source had to be identified through interviews with the vendors and thence to the turkey meat manufacturers. They reacted really well recalling all possibly infected turkey at a great financial loss to themselves. It made me wonder if there isn't insurance for this kind of event.
Eventually, the source of infection was closed down and there were no more cases. The plot twist? The four babies who had died and started the investigation had not had this particular listeria at all!
The book ranged from 9/11 through anthrax, SARS, polio, tuberculosis, pneumonia, AIDS and more not just in the US, but Africa, South America and Asia. An interesting fact I learned was that although it is known that smallpox has been kept alive in both legal labs and in those who might wreak germ warfare on the world, only people who might have contact with it are vaccinated. This is because although there were very few major reactions to the vaccine - a sore arm and slight fever being common and only lasting a few days (I had them) - about 7 or 8 children per million vaccinations would die from complications. Now there was so little need for the vaccine, it's use was abandoned.
The book is a fantastic, fast-paced read. There is sparing use of adjectives and descriptions but there is the occasional lyrical sentence which points up the excellent writing that has no need of padding. Recommended to all who enjoy non-fiction and like engrossing books that require them to stop what they are doing and read!
June 3, 2018
This is a well researched look inside the EIS. I am in disagreement over the first fatal bioterrorism attack on American soil. McKenna writes:
There were earlier fatal bioterrorism attacks in America. Smallpox was used as a bioweapon by British forces to subdue Native Americans during the French & Indian War (1754 - 1763). See Jeffrey Amherst and Smallpox Blankets and this New Scientist article, British used bioweapon in US war of independence.
According to Jonathan Tucker, former biodefence expert, the British also used smallpox against American troops during the American Revolutionary War (1775–1783). See Pox Americana: The Great Smallpox Epidemic of 1775-82 and the New Scientist article linked above.
If you liked this book, you might also enjoy:
✱ Virus Hunter: Thirty Years of Battling Hot Viruses - written by a virologist in the field
✱ Level 4: Virus Hunters of the CDC - written by Epidemiologists in the field
✱ The Coming Plague: Newly Emerging Diseases - written by a journalist with a BS in Immunology, Garrett is currently the Senior Fellow for Global Health
✱ Panic in Level 4 - written by Preston, a journalist, facts are sometimes exaggerated
✱ The Demon in the Freezer - written by Preston, a journalist, facts are sometimes exaggerated
It is ten months since two hijacked planes brought down New York City’s World Trade Center, and nine months since a set of mailed envelopes, loaded with finely milled anthrax, accomplished the first fatal bioterrorist attack in American history on American soil.
There were earlier fatal bioterrorism attacks in America. Smallpox was used as a bioweapon by British forces to subdue Native Americans during the French & Indian War (1754 - 1763). See Jeffrey Amherst and Smallpox Blankets and this New Scientist article, British used bioweapon in US war of independence.
According to Jonathan Tucker, former biodefence expert, the British also used smallpox against American troops during the American Revolutionary War (1775–1783). See Pox Americana: The Great Smallpox Epidemic of 1775-82 and the New Scientist article linked above.
If you liked this book, you might also enjoy:
✱ Virus Hunter: Thirty Years of Battling Hot Viruses - written by a virologist in the field
✱ Level 4: Virus Hunters of the CDC - written by Epidemiologists in the field
✱ The Coming Plague: Newly Emerging Diseases - written by a journalist with a BS in Immunology, Garrett is currently the Senior Fellow for Global Health
✱ Panic in Level 4 - written by Preston, a journalist, facts are sometimes exaggerated
✱ The Demon in the Freezer - written by Preston, a journalist, facts are sometimes exaggerated
March 26, 2012
I picked this book because my husband was an EIS officer for the last 2 years. He loved his time as one and I wanted to read more about other's experience. The author probably picked the 2 busiest years the CDC has had in a long time. They dealt with 9/ll, Anthrax and SARS on top of all of the normal stuff. It seems like those couple of years were pivotal when it came to the world and not only the USA getting it's act together to enable them to handle global public health threats. My husbands 2 years weren't nearly as exciting, although he did get to work on some interesting stuff and go to some very interesting places, it would have been crazier had the world not had it's act together. I think that is one thing that this book brings to light. It was an interesting read for me and is well written, but I don't know how interesting it would be for someone that didn't have a connection to EIS or had an interest in infectious disease.
September 9, 2019
Fascinating and terrifying.
July 21, 2009
This is a book about the Epidemic Intelligence Service, the "disease detective corps" of the Centers for Disease Control and Prevention. For three weeks, Ph.D.s, nurses, doctors, veterinarians, dentists, and even lawyers are trained in epidemiology and public health. They are put through a rigorous class schedule, frightening simulations, and even yanked out of classes to deal with disease outbreaks. Once they are fully trained, they spend two years working where-ever they are needed. Their work is multi-pronged: they go door-to-door, interviewing every contact of an infected person; they use molecular biology to pin down which cases of a disease are involved in an outbreak; they reassure the public. Sometimes they are assigned to work in a state, coordinating and investigating. But with only days or even hours notice, members of the EIS fly into war-torn countries to work with refugees, into politically charged anthrax investigations, to Listeria outbreaks afflicting a trailer park. They must be prepared for any situation.
This is a very exciting book! McKenna splits the chapters between the culture and training of the EIS (they have to wear full military uniform every Wednesday, for instance), and their investigation of disease outbreaks. Both are fascinating, but hampered because McKenna insists on writing a full paragraph about the family and professional life of every person mentioned, no matter how tangential. A better book would have focused on a few people, or cut out the sentences about their build and how many children they have.
I highly recommend this book to anyone interested in public health.
This is a very exciting book! McKenna splits the chapters between the culture and training of the EIS (they have to wear full military uniform every Wednesday, for instance), and their investigation of disease outbreaks. Both are fascinating, but hampered because McKenna insists on writing a full paragraph about the family and professional life of every person mentioned, no matter how tangential. A better book would have focused on a few people, or cut out the sentences about their build and how many children they have.
I highly recommend this book to anyone interested in public health.
December 3, 2013
The Center for Disease Control has been on the front lines fighting the effects of war, terrorism, and disease since 1946; this book recounts many of their most important cases.
Beating Back the Devil reads like a collection of true crime stories, rarely pausing to parse its technical terms or explain some of the statistical methods of epidemiologists, but galloping into the mystery of disease.
Tracking a small group of disease detectives in the Epidemic Intelligence Service's (EIS) class of 2002, the case histories range from the successful international efforts to eradicate smallpox, the spread of AIDS-related infections in minority drag queen communities, fighting cholera in Rwandan refugee camps, to tracking the post-9/11 anthrax letters.
There are surprising details here - for example, the U.S. government has a uniformed Commissioned Corps that has a military structure (to which the civilian doctors of the EIS struggle to conform).
My favorite chapter recounts the mystery of how West Nile virus contaminated donated organs, and it hints at the incredible amount of legwork required to come close to controlling an outbreak. There is also an interesting account of organizing a study of pregnant women in Malawi to fight malaria, and the story of efforts to prevent the spread of tuberculosis among the underground drag queens (whose extravagant balls are documented in the film Paris is Burning ). The specter of AIDS looms large over many of the stories in the book, since AIDS victims' compromised immune systems are especially vulnerable to infection.
The chapter entitled "War" tells the surprising story of EIS efforts in refugee camps after the Rwandan genocide: CDC doctors made sure relief workers knew how to treat cholera patients and used their research skills to verify food distribution and make sure that women and children were not overlooked. The CDC doctors witnessed the continuation of horrors of genocide (many of the refugees were the perpetrators of the Rwandan genocide), the children without parents, and the privations of an overcrowded refugee camp.
For those interested in the history of disease, be sure to check out Rabid: A Cultural History of the World's Most Diabolical Virus by Bill Wasik and Monica Murphy. There is also a free CDC Solve the Outbreak app for iPad that will teach you the basics of epidemiology, and the CDC Zombie outbreak guide, which is a light-hearted take on disaster preparedness. For more from the front lines of the CDC, check out Level 4: Virus Hunters of the CDC by Joseph B. McCormick.
Beating Back the Devil reads like a collection of true crime stories, rarely pausing to parse its technical terms or explain some of the statistical methods of epidemiologists, but galloping into the mystery of disease.
Tracking a small group of disease detectives in the Epidemic Intelligence Service's (EIS) class of 2002, the case histories range from the successful international efforts to eradicate smallpox, the spread of AIDS-related infections in minority drag queen communities, fighting cholera in Rwandan refugee camps, to tracking the post-9/11 anthrax letters.
There are surprising details here - for example, the U.S. government has a uniformed Commissioned Corps that has a military structure (to which the civilian doctors of the EIS struggle to conform).
My favorite chapter recounts the mystery of how West Nile virus contaminated donated organs, and it hints at the incredible amount of legwork required to come close to controlling an outbreak. There is also an interesting account of organizing a study of pregnant women in Malawi to fight malaria, and the story of efforts to prevent the spread of tuberculosis among the underground drag queens (whose extravagant balls are documented in the film Paris is Burning ). The specter of AIDS looms large over many of the stories in the book, since AIDS victims' compromised immune systems are especially vulnerable to infection.
The chapter entitled "War" tells the surprising story of EIS efforts in refugee camps after the Rwandan genocide: CDC doctors made sure relief workers knew how to treat cholera patients and used their research skills to verify food distribution and make sure that women and children were not overlooked. The CDC doctors witnessed the continuation of horrors of genocide (many of the refugees were the perpetrators of the Rwandan genocide), the children without parents, and the privations of an overcrowded refugee camp.
For those interested in the history of disease, be sure to check out Rabid: A Cultural History of the World's Most Diabolical Virus by Bill Wasik and Monica Murphy. There is also a free CDC Solve the Outbreak app for iPad that will teach you the basics of epidemiology, and the CDC Zombie outbreak guide, which is a light-hearted take on disaster preparedness. For more from the front lines of the CDC, check out Level 4: Virus Hunters of the CDC by Joseph B. McCormick.
June 20, 2019
This is essential reading, especially for anyone who has doubts about the public service. I knew of the CDC, but didn't realise their scope. McKenna has completed hundreds of interviews to give an intricate and in-depth view of the CDC response to multiple disease outbreaks. These include food poisoning, AIDS, Ebola, SARS, West Nile Virus, community MRSA, the 2001 anthrax attacks, polio, malaria and some more I cannot remember. Though the quality of these chapters varied quite a lot.
The highlights for me were food poisoning, which I did not realise was such a high-tech enterprise. Outbreaks are identified through DNA profiling, as they are now mostly sporadic due to high dispersal of modern foods. SARS was thorough and mostly covered the outbreak in Vietnam, which was a component I had heard essentially nothing about.
Unfortunately, AIDS was very poorly covered. I think I downloaded this book because I was interested in the CDC response to AIDS after a comment by Paul Monette in his AIDS memoir (which I can't recommend enough). However, the despite AIDS being one the largest epidemics in modern history, it was one of the shortest chapters. And it focused far too much on the people rather than the outbreak and the CDC response.
Which brings me to my major gripe. McKenna is obviously a people person, as she spends a huge amount of time describing the lives of the CDC members. Whilst I appreciate this, I think it becomes too much of the focus. At times minutia of their lives would overcome the story of a life-threatening disease. There was a chapter about the struggles of having to wear an army uniform to work once a week, and this chapter that was almost twice as long as the preceding chapter on the AIDS outbreak!
The highlights for me were food poisoning, which I did not realise was such a high-tech enterprise. Outbreaks are identified through DNA profiling, as they are now mostly sporadic due to high dispersal of modern foods. SARS was thorough and mostly covered the outbreak in Vietnam, which was a component I had heard essentially nothing about.
Unfortunately, AIDS was very poorly covered. I think I downloaded this book because I was interested in the CDC response to AIDS after a comment by Paul Monette in his AIDS memoir (which I can't recommend enough). However, the despite AIDS being one the largest epidemics in modern history, it was one of the shortest chapters. And it focused far too much on the people rather than the outbreak and the CDC response.
Which brings me to my major gripe. McKenna is obviously a people person, as she spends a huge amount of time describing the lives of the CDC members. Whilst I appreciate this, I think it becomes too much of the focus. At times minutia of their lives would overcome the story of a life-threatening disease. There was a chapter about the struggles of having to wear an army uniform to work once a week, and this chapter that was almost twice as long as the preceding chapter on the AIDS outbreak!
April 16, 2019
This short book is poorly written, choppy, and although it tells great stories, over all a bad read. One thing it does do is set a start date for the decline of the CDC and the Epidemic Intelligence Service (EIS) as Late 2004/5. This is when both services started to be driven by Washington politics than by what the nation needed from it's leading doctors, biologists, virologists, and disease hunters. This down grade of the CDC is a direct result of GOP politicians who do NOT understand science and choose NOT to learn. The best example is the 2014 Ebola outbreak in West Africa where a U.S. missionary was left for days while friends and family got enough cash to rent a private jet to be rigged as a containment unit and bring the man back to Atlanta and Emory U. In the late 90's and early 2000"s the CDC had an old trailer from NASA that was used as astronaut containment post Apollo missions. This trailer fit nicely into any USAF cargo plane for immediate deployment any where a U.S. citizen was infected. Roll off plane, tow to hospital, load patient, tow back to plane and patient is on the way back to the U.S. Not any more. The fact that CDC personnel had to travel on an Australian cargo plane to get to N.Y. the day after 9/11 shows how far down the priority scale epidemiological surveillance and the stoppage of disease has fallen. This is one thing this book shows. We used to do good research, we used to do good health reports, we used to care about upcoming diseases and how they will affect U.S. citizens: We NO LONGER DO!! and that lack of capability WILL affect some, if not ALL of us at some point in our lives. Even to the point of our deaths.
April 27, 2021
Read for Public Health 🥰 Very informative. And I like that it’s from the perspective of the workers who deal with these cases, going into more detail than just what the disease is. Shows how we respond to epidemics, pandemics, so on. My teacher picked a very good book as our one for the semester. She’s my favorite so I’m also noting down her suggestions for other informative reads.
May 1, 2018
Eye-opening and informative.
July 24, 2018
This is a fascinating look at the work done by the CDC's disease detectives.
December 27, 2022
McKenna is very evidently a newer writer here, darting all over the map as she covers many major cases of disease outbreak: polio, West Nile, Listeria, AIDS, malaria, tuberculosis, drug-resistant staphylococcus, SARS. All of these are covered in more detail elsewhere, in works by David Quammen, David France, and so on, but McKenna's angle is to focus on the Epidemic Intelligence Service (EIS), a quasi-military public health outfit within the CDC. The group has had many successes, including development of a rapid test for West Nile virus, and one of the first studies of AIDS.
But how does the one success relate to the other? We get a general impression that members of the EIS are young, brilliant, risk-taking doctors, nurses and scientists, that they adapt one way or another to the heavy demands of a frontline government job requiring military-level discipline. We are offered a peek into the growth of this bureaucratic arm of the federal government from the 1950s forward, though most of the book focuses on the "class of 2002," many members of whom agreed to be interviewed by McKenna. What is missing is any sense of the total effects of the institution on the larger context of epidemiology, or indeed, the world, with its complex situation of economic development in an era of postcolonialism.
Chapters that take us to Africa particularly lack the larger perspective that help us form any conclusoins. EIS workers save single humans, orphans and soldiers, in Malawi and Rwanda, but what effect did the USA have -- what effect did it fail to have that it might have had -- on the ground in Africa? And in what ways did work in Africa aid epidemic prevention in the USA?
Lurking behind the 2022 reading of this 2004 book is a larger question, one which the author of course cannot answer: how and why did the CDC fail as an institution during the 2020 COVID-19 pandemic? In what ways did it do well? McKenna in 2004 might have been more helpful for us today if she had tried to evaluate the EIS against the larger world of pandemic threats. But, at the very least, we readers are now thirsty for more books covering the institutional histories of 2020.
That said, this book has real value. There is a peculiar style applied here, what might called epidemiological thriller, reminiscent of the "Diagnosis" column in the New York Times, where we follow along as doctors try to understand a problem. Cases of food-borne illness in the USA are a great example, though they also expose the problem with the approach: we find the listeria turkeys, but miss evaluating prevention efforts in the era of global-scale trade agreements. Another feature of the book is to interview the frontline EIS scientists. As a teacher, I very much want my students to know about jobs like this. I'll be clipping passages and lining them up with other such profiles to use in seminars to come.
But how does the one success relate to the other? We get a general impression that members of the EIS are young, brilliant, risk-taking doctors, nurses and scientists, that they adapt one way or another to the heavy demands of a frontline government job requiring military-level discipline. We are offered a peek into the growth of this bureaucratic arm of the federal government from the 1950s forward, though most of the book focuses on the "class of 2002," many members of whom agreed to be interviewed by McKenna. What is missing is any sense of the total effects of the institution on the larger context of epidemiology, or indeed, the world, with its complex situation of economic development in an era of postcolonialism.
Chapters that take us to Africa particularly lack the larger perspective that help us form any conclusoins. EIS workers save single humans, orphans and soldiers, in Malawi and Rwanda, but what effect did the USA have -- what effect did it fail to have that it might have had -- on the ground in Africa? And in what ways did work in Africa aid epidemic prevention in the USA?
Lurking behind the 2022 reading of this 2004 book is a larger question, one which the author of course cannot answer: how and why did the CDC fail as an institution during the 2020 COVID-19 pandemic? In what ways did it do well? McKenna in 2004 might have been more helpful for us today if she had tried to evaluate the EIS against the larger world of pandemic threats. But, at the very least, we readers are now thirsty for more books covering the institutional histories of 2020.
That said, this book has real value. There is a peculiar style applied here, what might called epidemiological thriller, reminiscent of the "Diagnosis" column in the New York Times, where we follow along as doctors try to understand a problem. Cases of food-borne illness in the USA are a great example, though they also expose the problem with the approach: we find the listeria turkeys, but miss evaluating prevention efforts in the era of global-scale trade agreements. Another feature of the book is to interview the frontline EIS scientists. As a teacher, I very much want my students to know about jobs like this. I'll be clipping passages and lining them up with other such profiles to use in seminars to come.
April 13, 2018
OK, now I'm not quite sure how any of us ever live past 35. This book was fascinating, terrifying, informative, etc. Pretty amazing to hear about the experiences of CDC officers and the projects they work on and how. It was a little bit difficult to keep track of all the different people mentioned and followed in the book, but I kind of just didn't worry about exactly who everyone was and tried to focus on the rest of what was going on.
Also, it was kinda mindblowing how many of these epidemics I remember, but not very strongly - many of the big outbreaks discussed in this book happened between my late teens and when I finished college. Obviously, I remember the anthrax thing with the postal system - anyone who lived through 9/11 likely remembers that one. I remember when everyone was talking about the bird flu. I remember hearing about West Nile and MRSA and SARS, and I remember knowing they were serious and knowing there were travel or blood donation restrictions and that kind of thing, but I never knew 90% of what this book describes about each one. The one I felt I knew the most about was listeria, which I really didn't know much beyond pregnancy restrictions associated with listeria - I knew it was foodborne and I knew which foods it travels in because they're the pregnancy restrictions, so the listeria chapter was kind of a "pregnancy restrictions extended version." I guess if the book had been written later, it would probably have had a chapter on zika, too. I felt awfully grateful that smallpox is gone, after hearing the descriptions of that. Yikes.
Anyway, I enjoyed this one and felt a lot more educated by the end.
Also, it was kinda mindblowing how many of these epidemics I remember, but not very strongly - many of the big outbreaks discussed in this book happened between my late teens and when I finished college. Obviously, I remember the anthrax thing with the postal system - anyone who lived through 9/11 likely remembers that one. I remember when everyone was talking about the bird flu. I remember hearing about West Nile and MRSA and SARS, and I remember knowing they were serious and knowing there were travel or blood donation restrictions and that kind of thing, but I never knew 90% of what this book describes about each one. The one I felt I knew the most about was listeria, which I really didn't know much beyond pregnancy restrictions associated with listeria - I knew it was foodborne and I knew which foods it travels in because they're the pregnancy restrictions, so the listeria chapter was kind of a "pregnancy restrictions extended version." I guess if the book had been written later, it would probably have had a chapter on zika, too. I felt awfully grateful that smallpox is gone, after hearing the descriptions of that. Yikes.
Anyway, I enjoyed this one and felt a lot more educated by the end.
Read
March 14, 2019 I did not finish this book so these are my thoughts only about two-thirds of it.
Parts of it were really interesting, and parts were rather boring. It was interesting to read about the struggles these doctors faced while living in India and struggling to eradicate smallpox. It wasn’t so interesting reading about the rather mundane struggles they faced living in Atlanta and trying to balance careers and parenting. It was interesting reading about their learning to dress safely at a contaminated scene. It was not so interesting being told about their learning to adjust to a uniform.
One thought about the organization of this book. I found it a little odd. It discusses numerous disease outbreaks from about the 1920s on. But instead of going chronologically, it jumps back and forth. So she will tell us about something that happened in 2001 and then jump back to 1950, then in 2005 and jump back to the 1960s, and so on. She gives us enough history about each outbreak to not really be lost in the timeline, but it was unusual.
Because of the nature of work needed to be done by these epidemiologists, and the diseases they had to combat, several chapters discussed the homosexual lifestyle. It was done as delicately as possible but was more than I was comfortable reading. Because I was just reading it for my own information, and not from a need to know, that was the reason I quit reading.
Parts of it were really interesting, and parts were rather boring. It was interesting to read about the struggles these doctors faced while living in India and struggling to eradicate smallpox. It wasn’t so interesting reading about the rather mundane struggles they faced living in Atlanta and trying to balance careers and parenting. It was interesting reading about their learning to dress safely at a contaminated scene. It was not so interesting being told about their learning to adjust to a uniform.
One thought about the organization of this book. I found it a little odd. It discusses numerous disease outbreaks from about the 1920s on. But instead of going chronologically, it jumps back and forth. So she will tell us about something that happened in 2001 and then jump back to 1950, then in 2005 and jump back to the 1960s, and so on. She gives us enough history about each outbreak to not really be lost in the timeline, but it was unusual.
Because of the nature of work needed to be done by these epidemiologists, and the diseases they had to combat, several chapters discussed the homosexual lifestyle. It was done as delicately as possible but was more than I was comfortable reading. Because I was just reading it for my own information, and not from a need to know, that was the reason I quit reading.
January 21, 2021
While a little dated, written in 2004, this is a fascinating history of the EIS (Epidemic Intelligence Service), a branch of the CDC. Each chapter is devoted to a disease that was recognized and then tracked down and studied by the CDC, such as West Nile, Smallpox, AIDS, TB, anthrax, and SARS. These teams leave at a moment's notice for places all over the world and live in sometimes dangerous and unsavory places while they check contacts and chart symptoms. A very interesting book which leads up to our current viral epidemic.
January 18, 2021
This book is well written and researched! I particularly enjoyed the layout of the book, where each chapter was a particular disease outbreak and what the EIS and CDC’s responses were to each of those. I learned a lot about public health initiatives in this book revolving around disease control, which I am specifically interested in and enjoyed. I also loved how human it was, and it combined history, epidemiology, and humanness in each chapter. I hope to see a book by this author in the future that is more modern and includes more recent outbreaks in history, like Ebola, Zika, and COVID-19.
February 26, 2020
Good epidemiology studies. Especially timely due to corona virus
April 14, 2020
Interesting and a little scary.
July 27, 2020
I really liked the way this was laid out. Normally I don’t like time jumps, but I enjoyed going from story to story.
January 10, 2021
TW for the TB chapter for the use of the word transsexual as well as using both male and female pronouns for transgender people. General confusion over dressing in drag vs being transgender. And the phrase "transgender lifestyle" which just so much smh.
October 4, 2020
The only thing I was beating back was sleep every time I cracked open this v boring book
May 29, 2020
Reading this 2004 book now is spooky and not a little disheartening. It describes the front-line "disease detectives" of the CDC, the sorts of people played by the ravishing Marion Cotillard in the 'Contagion' movie. What's more, it describes them in the context of an apolitical, well-staffed and well-funded agency that is dedicated to preserving the safety of American citizens, and to a lesser extent the rest of the world. These people are smart, dedicated and selfless, at least as presented here.
This is all a giant smack in the face given the dismal performance by this once-admirable agency during our current epidemic. And there are doubtless a great many ex-members of this group, pushed out by politics, who couldn't agree more.
This is all a giant smack in the face given the dismal performance by this once-admirable agency during our current epidemic. And there are doubtless a great many ex-members of this group, pushed out by politics, who couldn't agree more.
November 2, 2018
Good summary of previous outbreak investigations conducted by EIS officers. I learned a lot. However, it was written in quite a sensational nature. I don't think that public health work is ever quite as flashy!
January 17, 2018
Absolutely incredible book.
May 2, 2020
A really enjoyable read. I though that the book might be dated, but a lot of the information is historical anyway (e.g. about fighting polio and smallpox). Its end point is the anthrax bioterror attack that occurred right after the September 11 attacks. I learned a lot about how disease tracing is done as well as about the nature of disease. I also appreciated the emphasis on the need for multiple methodologies, including talking to the people affected (not just relying on statistical modeling), in order to find the truth. Some of the key people she profiles get a bit lost in the back and forth of the storyline, but overall well worthwhile.
March 7, 2018
I will admit, at the start of this book it had trouble grabbing my attention but that quickly changed. Once I got to "polio" I couldn't stop reading. From the training methods the CDC put their EIS members through to the everlasting threat of Terrorism, this book is a great read. Especially if you are trying to learn more about different strains of diseases (which was my reasoning for reading this book), or if you want a book that gives you a different perspective on civilizations around the world and how they deal with diseases. Overall I give "Beating Back the Devil: On The Front Lines with the Diseases Detectives of the Epidemic Intelligence Service" by Maryn McKenna a 4/5 stars. My reasoning for the 4 is because it was indeed a great book but the fact that it wasn't always able to drag my attention right off the bat just kept it away from that fifth star.
November 5, 2008
The true stories themselves are fascinating, following people connected to the Epidemic Intelligence Service, an organization founded some sixty years ago to combat biological warfare and disease epidemics. That means that for decades they have been deployed to deal with small pox, SARS, and a mysterious immune disorder striking gay men that became the nightmare of HIV/AIDS. They were in charge during the post-9/11 anthrax scare, and were deployed on desperate missions to fight primitive diseases in third world countries. Every anecdote-driven chapter is worth reading for its information, though McKenna does the book few favors with a dry, highly procedural writing style that turns life-threatening situations dull. In particular her style of providing unhelpful miniature biographies of many people who rapidly become faceless casts in epidemics slows things down, and she has a habit of throwing a paragraph of false information at you only to dispel it in the next that seriously grates. The writing itself is well worth overcoming, though, to learn about an amazing service most readers will never have heard of before.
July 30, 2015
I'm a little shocked that McKenna can take such fascinating subject matter and turn it into a book that's Sahara dry. If you are interested in the subject matter, a brief selective history of the CDC, like me, its 4 star subject matter, but its 2 star writing. I'd recommend reading the book if you're also fascinated, but be warned it reads like an EIS 101 text book... here are the salient facts you should memorize for the test...
My biggest pet peeve is there's too much detail about people that show up for two pages, then are never heard from again (so and so was married last week, so and so just had a baby, etc) and very little about people that are instrumental in the book.. Here's their CV and one personal nugget, the end. I feel like I just came to work in the mail room and am getting the office tour from a half-hearted HR lackey that can't be bothered with the new intern and isn't all that concerned about whether or not its obvious to me they'd rather be doing ANYTHING else besides showing me around. Its just badly done, all around.
My biggest pet peeve is there's too much detail about people that show up for two pages, then are never heard from again (so and so was married last week, so and so just had a baby, etc) and very little about people that are instrumental in the book.. Here's their CV and one personal nugget, the end. I feel like I just came to work in the mail room and am getting the office tour from a half-hearted HR lackey that can't be bothered with the new intern and isn't all that concerned about whether or not its obvious to me they'd rather be doing ANYTHING else besides showing me around. Its just badly done, all around.
May 15, 2016
I'm a medical interpreter so this book is right in my sweet spot - disease! International locales! Shoe-leather epidemiology, oh my!
The officers of the EIS track down diseases, figuring out where they hide and what makes them spread. It can be exciting but a lot of it is good ol' detective work - gathering data, analyzing trends, tracking down leads. We watch the officers do their thing in LA, Malawi, and beyond.
A wide range of diseases are covered, from malaria to SARS. I was drawn to outbreaks that I knew existed but had only a basic idea how they started - polio, AIDS, West Nile. The medical information is easily digestible and relatively jargon free.
I listened on audio and I'm not sure it was the best way to enjoy this book. I didn't click with the narrator (weird pauses, mispronouncing some medical terms) and would have probably enjoyed the words more if they were on a page. The library only had the audio version though, so whatevs.
An easy recommendation to medical nuts everywhere.
The officers of the EIS track down diseases, figuring out where they hide and what makes them spread. It can be exciting but a lot of it is good ol' detective work - gathering data, analyzing trends, tracking down leads. We watch the officers do their thing in LA, Malawi, and beyond.
A wide range of diseases are covered, from malaria to SARS. I was drawn to outbreaks that I knew existed but had only a basic idea how they started - polio, AIDS, West Nile. The medical information is easily digestible and relatively jargon free.
I listened on audio and I'm not sure it was the best way to enjoy this book. I didn't click with the narrator (weird pauses, mispronouncing some medical terms) and would have probably enjoyed the words more if they were on a page. The library only had the audio version though, so whatevs.
An easy recommendation to medical nuts everywhere.
February 18, 2012
A very informative account of the work of the EIS division of the CDC. It describes several major health crises where the CDC stepped in and goes into illuminating detail about what its investigators do.
Most of these were epidemics that appeared in the press but you'll learn a lot more about them here.
The author also documents the way that the US Public Health Service was militarized by a Bush appointee in a way that makes no sense at all. The scientists were forced to wear uniforms at all times and were rejected from serving if they couldn't meet military physical fitness standards.
I don't know about you, but if an epidemic hit my region I'd want the smartest, not the fittest epidemiologists working on it. And ones who were independent thinkers, NOT people who feel more comfortable blending in with a crowd and following orders.
Most of these were epidemics that appeared in the press but you'll learn a lot more about them here.
The author also documents the way that the US Public Health Service was militarized by a Bush appointee in a way that makes no sense at all. The scientists were forced to wear uniforms at all times and were rejected from serving if they couldn't meet military physical fitness standards.
I don't know about you, but if an epidemic hit my region I'd want the smartest, not the fittest epidemiologists working on it. And ones who were independent thinkers, NOT people who feel more comfortable blending in with a crowd and following orders.
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