The chronicle of the nation's ills Medicine: It lacks flair, but a weekly report published by the U.S. Centers for Disease Control and Prevention is consistently the first with articles about outbreaks and oddities that bear watching.

Sun Journal

October 14, 1997|By Jonathan Bor | Jonathan Bor,SUN STAFF

The most intriguing magazine you've never heard of is printed in black and white, lacks photographs, measures a scant 6 1/2 -by-8 inches and contains about as many numbers as words.

Even its title -- Morbidity and Mortality Weekly Report -- promises less than it delivers.

Almost proudly lacking in flair, the magazine published by the U.S. Centers for Disease Control and Prevention in Atlanta is a ticket to the mystery and drama of epidemiology -- the branch of medicine that deals with the causes, spread and taming of illness. Each issue is a report card on the nation's well-being, with narratives about outbreaks and oddities that bear watching.

Readers who have followed MMWR over the years remember this headline from 1981: "Pneumocystis pneumonia in homosexual men -- Los Angeles." It was the first reporting on a rare infection, evidenced in five young males, that would turn out to be a hallmark of AIDS -- the epidemic of our age.

Subsequent issues carried more pieces of the puzzle: a rapidly increasing death toll, the first transfusion-related case, the first hemophiliac case, the spread among intravenous drug users.

In similar fashion, the booklet reported unfolding stories of conventioneers who were stricken by a deadly respiratory illness in a Philadelphia hotel (Legionnaire's disease); the women who became horribly ill after using the same brand of tampon (toxic shock syndrome); and the Navajos who were felled by a strange infection spread by mice (hanta virus).

Dr. Richard A. Goodman, MMWR's editor since 1988, says with pride that the bulletin occupies a key link in the process by which public health problems are observed, investigated and -- in many cases -- solved.

Articles often originate in the towns and counties of America, where health officers observe medical phenomena and report them to the CDC. MMWR's small staff of editors and writers publishes the observations so others in the field can draw connections to what they've seen. This peculiar brand of journalism turns disease investigations into a national affair -- involving readers in an evolving process of detection.

"We give surveillance data back to those who collected the data and back to those who need to know," Goodman says. "It's almost like an arc or a circle. If one part is missing, the whole thing breaks down."

Goodman recalls, for example, a mystery that arose in 1979 when a group of New Mexico doctors started talking about the alarming cases they were seeing -- patients suffering a blood condition that caused painful muscles, joints and skin. People were dying, and nobody knew why.

They reported their findings to the state health department, which passed them along to the CDC.

Across the country, doctors reading a preliminary account in MMWR realized that they were seeing similar symptoms. Case reports came flooding in. Soon, health officials realized that the patients had one thing in common. They had taken L-tryptophan, a dietary supplement that was supposed to improve sleep, ease pain and elevate mood.

The Food and Drug Administration recalled the offending batch, produced by a Japanese company that had introduced a contaminant when it changed its production.

With this, the outbreak ended.

"All the pieces were put together," says Goodman. "It's a beautiful story of the way public health works in this country, a real collaboration between several state health departments and the CDC and the FDA."

MMWR's roots can be traced to 1878, when the surgeon general's office began publishing an equally unassuming report called "Bulletins." It was the government's chief means of informing states about deadly diseases that were arriving in U.S. ports aboard cargo and immigrant ships.

"Two cases of yellow fever have occurred in the harbor of Key West, one on the Norwegian ship 'Marie Frederike' and one on the Spanish bark 'Dona Talefora.' The city is reported healthy," declared Bulletin No. 1.

The bulletin changed hands over the years and appeared under different names, including "Abstract" and "Public Health Reports," before the CDC published its first MMWR in 1961. Over the years, it has traced influenza outbreaks, documented the worldwide eradication of smallpox and, more recently, tracked an international effort to wipe out polio.

"I think the best stories are infectious or communicable diseases that are occurring virtually as we report, and that are unsolved but clearly solvable," says Dr. Michael B. Gregg, who as editor for 21 years saw MMWR through the emergence of toxic shock, Legionnaire's and AIDS. "It's a showcase for how good epidemiology is -- of our ability to prevent, detect and control disease."

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