It May Not Be Pretty, but This Magazine Is a Lifesaver

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 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 curious headline in 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 (Legionnaires’ 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 the bulletin occupies a key link in the process by which public health problems are observed, investigated and--in many cases--solved.

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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 publish 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 patients. 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 U.S. 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.”

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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 the 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.

Bulletins 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, Legionnaires’ and AIDS. “It’s a showcase for how good epidemiology is--of our ability to prevent, detect and control disease.”

Until 1982, the CDC provided free subscriptions to about 120,000 people around the world--principally physicians, nurses, dentists, academics and public health officials. Since then, the agency has reduced the number to about one-tenth of that figure--but anyone can read the bulletin on a free Web site (https://www.cdc.gov), which features a powerful search engine linked to past issues. (For those interested in hard copies, the Massachusetts Medical Society sells subscriptions.)

Each issue contains several pages of tables providing state-by-state breakdowns of diseases recorded in the previous week. On the penultimate page, you always find “Deaths in 122 U.S. Cities”--weekly death totals, in a list that begins with Albany, N.Y., and ends with Wilmington, Del. Public health officials know to look for secrets in the numbers.

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Lead stories focus either on emerging outbreaks or older investigations that deserve recognition. In July, MMWR featured this report: “Fatal Human Plague--Arizona and Colorado, 1996.”

The first of two case reports began with the ominous words: “On Aug. 2, 1996, an 18-year-old resident of Flagstaff, Ariz., was taken to a local outpatient clinic because of a two-day history of fever, pain in his left groin and diarrhea.” The next day, the patient was transferred to a hospital emergency room, where he soon died.

Although the account was nearly a year old, it contained the important public health message: Although rare, human plague still exists. It is spread by ticks that feed off infected prairie dogs in the Southwest. People venturing into rodent habitats should avoid sick and dead animals; they should wear repellents, insecticides and protective clothing.

Tucked inside the magazine are enticing tidbits of epidemiology: Farm accidents are still a major problem across rural America, but tractor roll bars save lives. Firearms, strangulation and overdose are the leading causes of suicide, surpassing inhalation, cutting and drowning.

Last May, readers learned that dog attacks killed 304 people between 1979 and 1996. A map of the United States showed the geographic distribution of deaths.

“Almost all the stories have a message,” says Gregg. “Some don’t have a great message. It might simply be, ‘Thank god there are doctors out there reporting unusual events.’ ”