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Beating Back the Devil:
On the Front Lines with the Disease Detectives of the Epidemic Intelligence Service

by Maryn McKenna

Reviewed by
Cheryl Simon Silver

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If you thrive on danger, stress, unpredictability, and near-certain exposure to the planet’s most virulent bio-toxins, consider a career as an epidemiologist in the Centers for Disease Control’s Epidemic Intelligence Service (EIS). That is one message a reader might take home after perusing Maryn McKenna’s unsettling and immensely readable book, Beating Back the Devil.

McKenna, a journalist given extensive access to the EIS, uses her insider’s status to good advantage. She bases her story on interviews with members of the service and on some written accounts by the EIS founder Alexander Langmuir. By melding descriptions of the day-to-day work with tidbits about the histories and personal lives of individual epidemiologists, the book is simultaneously about the EIS, its members, and the diseases they race to contain.

Some laboratory scientists studying disease have one kind of goal—to sort out how diseases work and how to cure or prevent them. The EIS folks approach disease from the other side, trying to figure out the source of infections, how they are spreading, and then how to nip them while they can still be contained.

In a series of outbreak-focused anecdotes, the author churns it all together to convey what life is like for members of the continually renewing corps of epidemiologists. Her skills as a reporter imbue her prose with a breathless, on-the-brink-of-emergency air:

“They were the newest cadre of recruits to the Epidemic Intelligence Service, the fifty-first entering class of the CDC’s rapid-reaction force. They had agreed to trade two years of their careers for two years of intensive training in real-time disease detection. They had accepted, along with the training, a commitment to leave at a moment’s notice for whatever outbreak needed them, whether it was a deadly new encephalitis on the far side of the planet or a church-supper attack of diarrhea one state away. “

The CDC’s corps of epidemiologists is revered world over for its rapid response and ability to figure out why outbreaks are occurring and then contain them. The author is clearly enamored by their skills and their bravery, and why shouldn’t the reader be as well?

This is a special breed of scientist. They may bridle at the requirement to wear the military-style uniform of the Public Health Service in Washington, D.C., but in McKenna’s portrayal they are militant in their dedication to duty and their determination to succeed in stopping the disease of the day.

The EIS traces its genesis to Langmuir’s fear during the KoreanWar that soldiers were deliberately infected with the “epidemic hemorrhagic fever” that sickened three thousand troops and killed two hundred of them. In an eerie forecast of today’s bioterrorism threat, Langmuir worried that the soldiers might unknowingly serve as human weapons who would bring the deadly illness back to the states.

The EIS was conceived as a two-year stint doing disease surveillance for the CDC. Then, Muir hoped, successive groups of trained epidemiologists would fan out into the field, taking jobs with the country’s state and local public health services. The vision worked.

A modern reader immediately sees the dramatic and “reality” potential of the stories told in Beating Back the Devil. Indeed, The Medical Detectives by Berton Roueche provided the inspiration for the new NBC dramatic series, “Medical Investigation,” and the program is based on the efforts of CDC’s elite cadre of epidemiologists.

The stories add up to more than cliff-hangers, however. Some scourges described in the book—polio and West Nile virus, for instance—hit close to home. Developing countries struggle with chronic epidemics like malaria, compounded by AIDS and hunger. Some maladies, like tuberculosis, are entrenched in our society, and others, like smallpox, seem vanquished yet retain their power to alarm and to kill.

At the very least, the stamina of the EIS members who reel from crisis to crisis is impressive. One vignette describes a corps member who solved an outbreak of bacterial infections in a Cairo, Egypt, neonatal intensive care nursery, then raced to New York to take over in autumn 2001 just as anthrax made its ominous and deadly foray into America.

Beating Back the Devil may come to an end, but its story does not. In the last chapter, the SARS outbreak of 2003 has abated, and both reader and presumably scientist breathe a sigh of relief. But the respite is temporary. The EIS, and the world, has its eye on a troubling and lethal bird influenza brewing in Asia, hoping it doesn’t make its dreaded global jump into the human cauldron.

Maryn McKenna, Beating Back the Devil. Simon & Schuster, New York, 2004.

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