American Plagues

Starred review from April 25, 2016
The term plague is no longer limited to bacterial or viral infections, but is expanding to include heart disease and cancer in this updated edition of a popular textbook. Gehlbach (Interpreting the Medical Literature), dean emeritus of the School of Public Health at the University of Massachusetts, Amherst, leads a thoroughly engrossing exploration of American medical history across 12 chapters, which range from a Boston smallpox outbreak in 1721 to a measles outbreak at Disneyland in 2014. Gehlbach describes how devastating epidemic diseases have been encountered, misunderstood, understood, and then conquered (smallpox, yellow fever, tuberculosis, polio) or ameliorated (heart disease, AIDS). He also addresses the deadly new problem of multiply antibiotic-resistant infections as well as contemporary medicine’s disastrous bête noire: the anti-vaccine movement. In addition to lauding fine accounts of the great historical studies (the Framingham study of heart disease, the Wynder and Graham study of lung cancer), Gehlbach warns that plenty of research turns up nonsense, and he delivers a painless primer on how to tell good studies from bad. Readers will have little trouble understanding his explanations of bias, contamination, true positives versus false positives, and meta-analysis. Gehlbach’s book is often assigned reading for college-level public health classes, and all textbooks should be as entertaining.