Public Health 520: Artificial Epidemics and Changes in Human Culture
Fall 2015
Course Director:
Maureen Moran, MPH
Assistant Professor of Preventive Medicine
Time:
Location:
Credit:
0.5 units
Office Hours: By appointment
I.
Course Description
This course provides a close examination of how human behavior affects the development and
spread of so-called “artificial epidemics,” primarily covering non-communicable diseases
affecting adults. Diseases and conditions will be examined in order to discern the epidemiology
of the disease and how cultural influences can impact both the rise of diseases as public health
issues and their subsequent decline in incidence with a view toward prevention of future
outbreaks. The course is designed with a flipped classroom; students will review materials in
advance of the class session and come prepared to share and discuss the week’s topic in class.
Thus there is an exceptional long reading list each week and only 1 hour of classroom, rather
than 90 minutes, per week in this ½ unit class.
II.
Course Objectives:
The course will allow students to understand underlying causes for the growth in prevalence of
diseases and societal impacts of epidemics. The course will provide us with a relevant history of
public health events, and the reaction to these events by authorities, physicians, and the general
public. Students will have the opportunity to:
1. Acquire and review relevant literature pertaining to disease epidemics, in order to understand
epidemic characteristics and management
2. Define an epidemic, and identify the response from various stakeholders to these epidemics
3. List major effects of each epidemic (e.g. death toll, economic/disability costs), why these
effects are so substantial, and what long-term impact these effects have had
4. Describe research methods used to study epidemics
5. Explain underlying cultural influences that have driven the growth of each respective
disease/condition to epidemic proportions
6. Explain changes in culture as a result of these epidemics, including the effects of the
epidemics on human behavior and public policy
III. Grading Policies:
Course grades will be based upon:
Critical review of assigned material on a weekly basis and participation in discussion in the
tutorial session. (30%, 3 points for each class discussion)
Weekly short (2-3 page) commentary on the week’s assignment answering one or more of the
questions* shown below (40%, 5 points for each of 8 commentaries)
Final project (30%)
As a final project, students will select a disease not previously covered in the course and create a
folder of relevant sources (media, case reports, scientific research, etc.) to be used as teaching
aids in subsequent classes.
*Questions to be considered for each “Epidemic”
1. What is/was the impact of the epidemic on society? (Including health/death toll,
disability/economic costs, etc.)
2. What are the underlying risk factors for the disease in question? How were these risk factors
identified (i.e. by what research methods)? Why did these researchers focus on this particular
epidemic?
3. What changes in culture might have lead to this epidemic (including, for example, the context
of contemporary population dynamics, politics, economic situation, environment, and human
behavior)?
4. Is the disorder in question still a problem today? If so, why does it remain? If not, what
cultural influences have contributed to the decline in its incidence?
5. Can an epidemic of this disease reoccur (or become worse)? What has been done/should be
done to prevent this kind of epidemic?
7. Who were the investigators of these epidemics and what role did their prior experiences play
in the elucidation of the possible causes of the epidemic?
IV. Course Workload
Weekly attendance and participation in discussion, weekly preparation of cases, weekly writing
assignments, final project.
V. Course Evaluation
The MPH Program administers web-based course evaluations to students for each course near
the end of the quarter. Your completion of both the unit (course) and faculty evaluation
components is required; failure to complete either of the evaluations will result in an incomplete
grade until the evaluations are submitted. You will be sent the web link and instructions via
email later in the quarter. You will have about two weeks to complete the evaluations before
grades are submitted.
VI. Academic Integrity
Every Northwestern faculty member and student belongs to a community of scholars where
academic integrity is a fundamental commitment. The Program in Public Health abides by the
standards of academic conduct, procedures, and sanctions as set forth by The Graduate School at
Northwestern University. Students and faculty are responsible for knowledge of the information
provided by The Graduate School on their Web page at
http://www.tgs.northwestern.edu/about/policies/academic-integrity.html
Academic misconduct includes, but is not limited to
1.
Receiving or giving unauthorized aid on examinations or homework
2.
Plagiarism
3.
Fabrication
4.
Falsification or manipulation of academic records
5.
Aiding or abetting any of the above
The PPH follows The Graduate School’s procedure for evaluating alleged academic misconduct,
as outlined on the TGS website. Faculty reserve the right to use the “TurnItIn” that is part of the
Course Management System to evaluate student assignments. Students agree that by taking this
course all required papers may be subject to submission for textual similarity review to
Turnitin.com for the detection of plagiarism. All submitted papers will be included as source
documents in the Turnitin.com reference database solely for the purpose of detecting plagiarism
of such papers. Use of the Turnitin.com service is subject to the Usage Policy posted on the
Turnitin.com site. Information about this tool can be found at
http://lmsblog.it.northwestern.edu/2014/09/29/turnitin-for-canvas/
VII. Course Outline
Week 1: Introduction to the course
Week 2: Lead Poisoning
Week 3: Jake Leg
Week 4: Parkinson’s Dementia Complex of Guam
Week 5: Lung Cancer
Week 6: Coronary Artery Disease
Week 7: Carpal Tunnel Syndrome
Week 8: Heat Wave Deaths
Week 9: HPV-positive head and neck cancers
Week 10: Student presentations of “new” epidemics
VIII. Course Materials (available to students for review on Canvas)
Week 1: Introduction
Gardner LI. Coronary heart disease: doing the “right things”. (letter to the editor) N Engl J Med
1985; 313: 642.
Week 2: Occupational Lead Poisoning
Hamilton, A. Lead-poisoning in Illinois JAMA 1911;LVI(17):1240-1244.
No author. Adult blood lead epidemiology and surveillance. JAMA 1993;269:1373.
Hamilton, A. Exploring the dangerous trades. Boston: Little, Brown and Company, 1943, pp. 311, 120-1, 123-6, 138-9.
No author. Lead hazard to bridge workers studied. Yale Medicine. Fall/Winter 1991-92. p 30.
Sicherman B. Alice Hamilton A life in letters. Cambridge, Massachusetts: Harvard University
Press, 1984, pp 254-57.
Sinclair, U. The Jungle. 1906, New York: Doubleday, Page & Co., selection from Chapter 9
Week 3: Jake Leg
Baum D. Jake Leg How the blues diagnoses a medical mystery. The New Yorker 2003,
September 15, 50-57.
Ballentine C. Sulfanilamide disaster Taste of raspberries, taste of death The 1937 elixir
sulfanilamide incident. FDA Consumer magazine June 1981. Accessed online 7/11/2011
Crandall FG. Paralysis – from spurious Jamaica ginger extract. Calif West Med 1931; 35:180182.
No author. Jamaica ginger legislation – A new California law. 1931;34:378-379
Gruen S. Water for elephants. Chapel Hill, NC: Algonquin books of Chapel Hill, 2006, pp 188192.
Kiley CE, Rich ML. An epidemic of motor neuritis in Cincinnati, Ohio due to drinking
adulterated Jamaica ginger. Pub Health Rep 1932;47 (42):2039-2052.
Morgan JP, Penovich P. Jamaica ginger paralysis Forty-seven year follow-up. Arch Neurol
1978;35:530-532.
Morgan JP, Tulloss TC. The jake walk blues A toxicologic tragedy mirrored in American
popular music. Ann Intern Med 1976;85:804-808.
Munsey C. Paralysis in a bottle (The “Jake Walk” Story) Bottles and Extras. Winter 2006, 7-12.
Parascandola, J. The Public Health Service and Jamaica ginger paralysis in the 1930s. Pub
Health Rep 1995;110:361-363.
No author. Medicine: United Jakers Time, October 26, 1931. Accessed November 30, 2011,
http://www.time.com/time/magazine/article/0,9171,742511,00.html
Musical selections inspired by Jake Leg:
https://www.youtube.com/playlist?list=PLkj9ptRXVI3XK2yAJ_rh_wFGPOv1G5Mna
Selection from the documentary, Prohibition Part 2. A Nation of Scofflaws a documentary by
Ken Burns and Lynn Novick, 2011.
Week 4: Parkinsonism-Dementia Complex of Guam
Duncan MW, Steele JC, Kopin IJ, Markey SP. 2-Amino-3-(methylamino)-propanoic acid
(BMAA) in cycad flour: An unlikely cause of amyotrophic lateral sclerosis and parkinsonism –
dementia of Guam. Neurology 1990; 40:767-772.
Hirano A, Kurland LT, Krooth RS, Lessell S. Parkinsonism-dementia complex, an endemic
disease on the island of Guam I. Clinical Features Brain 1961;84(4):642-661.
Monmaney T. This obscure malady. The New Yorker, October 29, 1990, pp 85-113.
Plato CC Garruto RM, Galasko D, Craig U-K, Plato M, Gamst A, Torres JM, Wiederholt W.
Amyotrophic lateral sclerosis and parkinsonism-dementia complex of Guam: Changing
incidence rates during the past 50 years. Am J Epidemiol 2003;147:149-157.
Snow BJ, Peppard RF, Guttman M, Okada J, Martin WRW, Steele J, Eisen A, Carr G,
Schoenberg B, Calne D. Positron emission tomographic scanning demonstrates a presynaptic
dopaminergic lesion in litico-bodig The amyotrophic lateral scleroiss-parkinsonism-dementia
complex of Guam. Arch Neurol 1990;47:870-874.
Spencer PS, Nunn PB, Hugon J, Ludoph A, Roy DN. Motorneurone disease on Guam: Possible
role of a food neurotoxin. 1986; 1(8487): 965.
Spencer PS, Nunn PB, Hugon J, Ludolph AC, Ross SM, Roy DN, Robertson RC. Guam
amyotrophic lateral sclerosis-parkinsonism-dementia linked to a plant excitant neurotoxin.
Science 1987; 237:517-522.
Steele JC. Parkinsonism-dementia complex of Guam. Movement Disorders 2005;20(12)S99S107.
THE ILLNESS & THE ODYSSEY a film by Berry Minott (may be available for viewing)
Week 5: Lung Cancer
Neyfakh L. How cigarettes became uncool on campus. Boston Globe Magazine December 8,
2013.
Age adjusted cancer death rates, females by site, US , 1930-2007. US Mortality Data 1960 to
2007, US Mortality Volumes 1930 to 959 National Center for Health Statistics, Centers for
Disease Control and Prevention.
Age adjusted cancer death rates, males by site, US , 1930-2007. US Mortality Data 1960 to
2007, US Mortality Volumes 1930 to 959 National Center for Health Statistics, Centers for
Disease Control and Prevention.
Turner R. Censors scissor frames to sanitize some classic cartoons. The Wall Street Journal,
Wednesday, July 29, 1992, p B1, B5.
Blum A, Rosenberg J. When “More doctors smoked Camels” Cigarette advertising in the
Journal. N York State J Med 1983; December, p 1347-1352.
Doll R, Peto R. Mortality in relation to smoking: 20 years’ observations on male British doctors.
Br Med J 1976;2:1524-1536.
Doll R, Hill AB. Lung cancer and other causes of death in relation to smoking A second report
on the mortality of British doctors. Br Med J 1956; 10 November: 1071-1081.
Doll R, Hill AB. The mortality of doctors in relation to their smoking habits A preliminary
report Br Med J 1954;26 June:1451-1455.
Samet JM, Speizer FE. Sir Richard Doll, 1912–2005. Am J Epidemiol. 2006; 164 (1): 95-100.
Sir Austin Bradford Hill, Obituary. Br Med J 1991; 302(27 April): 1017.
Hill AB, Doll R. Lung cancer and tobacco. Br Med J. 1956 May 19; 1(4976): 1160–1163.
Martin J. Miss Manner’s Guide to Excruciatingly Correct Behavior. New York: Atheneum,
1982, pp37-638.
Post, E. Chapter 40 Smoking in EtiquetteThe Blue Book of Social Usage. New York: Funk &
Wagnalls Company, 1950, pp 455-458. Also pp 365 and 400.
Orday EB. The Etiquette of To-day New York: George Sully and Company 1920 pp 156, 171172.
Metropolitan Series Good Manners. New York: The Butterick Publishing Company (Limited),
1888, p. 361.
Week 6: Cardiovascular Disease
Herrick JB. Clinical features of sudden obstruction of the coronary arteries. J Am Med Assoc
1912; 59 (23):2015-2020.
Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of
premature death from coronary heart disease continuous and graded? Findings in 356 222
primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 1987;256
(20):2823-2828.
Sytkowski PA, Kannel WB, D’Agostino RB. Changes in risk factors and the decline in mortality
from cardiovascular disease. The Framingham heart study. N Engl J Med 1990;332:1634-1641.
White, PD The cardiologist enlists the epidemiologist. Am J Public Health 1957; 47 (4):1-3.
Chapman, CB. Foreward to Keys A. Seven Countries A multivariate analysis of death and
coronary artery disease. Cambridge, Massachusetts: Harvard University Press, 1980, i-viii.
Stamler J. Coronary heart disease: doing the “right things”. (editorial) N Engl J Med 1985;
312:1053-1055.
Levy D, Thom TJ. Death rates from coronary disease progress and a puzzling paradox.
(editorial) N Engl J Med 1998; 339: 915-917.
Paul O. Take Heart The Life and Prescription for Living of Dr. Paul Dudley White Boston:
Harvard University Press for the Francis A. Countway Library of Medicine, 1986, 109-111.
Gunby P. Cardiovascular diseases remain nation’s leading cause of death. JAMA 1992;267
(3):335-336.
Shah N. Milestones in public health: Discovering salt as a cardiovascular risk factor. An
interview with Dr. Jeremiah Stamler. Northwestern Public Health Rev 2013 (Fall), 8-11.
Gee K. America renews its love affair with butter. Wall Street Journal 2014; June 26, p B1-B2.
Kuklina EV, Carroll MD, Shaw KM, Hirsch R. Trends in high LDL cholesterol, cholesterollowering medication use, and dietary saturated fat intake: United States 1976-2010. NCHS data
brief, no. 117. Hyattsville, MD: National Center for Health Statistics, 2013.
Video Interview with Jeremiah Stamler, MD, the Father of Preventive Cardiology
https://www.youtube.com/watch?v=QL8nvKMoNdo
Week 7: Carpal Tunnel Syndrome
Arthritis Foundation, Carpal Tunnel Syndrome. Brochure, 1996.
Gelfman R, Melton LJ, Yawn BP, Wollan PC, Amadio PC, Stevens JC. Long-term trends in
carpal tunnel syndrome. Neurology 2009;72:33-41.
Goodman, RC. An aggressive return-to-work program in surgical treatment of carpal tunnel
syndrome: a comparison of costs. Plastic and Reconstructive Surgery 1992; 89:715-7.
Kleiman C. Carpal tunnel injury a big workplace issue. Chicago Tribune, Sunday, September
27, 1992, Section 8, page 1.
Kleiman C. John Deer gets a grip on repetitive stress injuries. Chicago Tribune, Sunday, June 6,
1993, Section 8, page 1.
OSHA, US Department of Labor. Success with Ergonomics. (undated report from perhaps 2002
describing a decrease in injury claims and costs associated with CTD-related repetitive strain
injuries in the insurance industry. )
OSHA, US Department of Labor. Ergonomics – Enforcement.
https://www.osha.gov/SLTC/ergonomics/faqs.html Accessed April 14 2015
OHSA Guidelines for Poultry Processing, pp 15-21.
Rignon JE. The Wrist Watch How a plant handles occupational hazard with common sense.
The Wall Street Journal, Monday, September 28, 1992, p A1, A4.
Sinclair, U. The Jungle New York: Signet Classic, 1906, final 2 paragraphs of Chapter 9.
Skrzycki, C. OSHA to propose ergonomic standards. Washington Post, Friday, February 19,
1999, page A1. www.washingtonpost.com accessed February 19, 1999.
Stevens JC, Beard CM, O’Fallon WM, Kurland LT. Carpal tunnel syndrome in Rochester,
Minnesota, 1961 to 1980. Neurology 1988; 38:134-138.
Stevens K. The carpal tunnel syndrome in cardiologists. Ann Intern Med 1990;112:796.
Van J. Crusade for workplace comfort resumes. Chicago Tribune, Monday, January 13, 1997,
Section 4, pp 1-2.
Surgical repair of carpal tunnel syndrome
https://www.youtube.com/watch?v=4vYiqeeUWNU
Week 8: Heat Wave
Anonymous. From the Centers for Disease Control and Prevention. Heat-related deaths-Philadelphia and United States, 1993-1994. JAMA. 1994;272(3):197.
Gladwell M. Political heat. The New Yorker. August 12, 2002, pp 76-80.
Keaten J. In France, about 3,000 die in the heat. Chicago Tribune online. August 14, 2003.,
accessed August 14, 2003.
Kiernan L, Zielinski G. Casualties of heat just like most of us. Chicago Tribune, July 23, 2000,
Sec. 1, p 1,6.
Klinenberg E. Heat wave A social autopsy of a disaster in Chicago. Chicago: University of
Chicago Press, 2002.
Manier J. Deadly lessons. Chicago Tribune, August 20, 2006, sec. 2, p.1, 3.
Press Release. “The 1995 Heat Wave: Autopsy of a Disaster.” Northwestern University Media
Relations. July 9, 2002.
Reardon PT. A metaphor with a roof. Chicago Tribune Magazine, February 2, 1997, p 20-22.
Royko M. Killer heat wave or a media event? Chicago Tribune, July 18, 1995, Sec. 1, p 3.
Rubin BM. Summer of sadness. Chicago Tribune, July 23, 2000, Metro section p 1-2.
Schreuder C, Gorner P. Coroners don’t always agree on when heat kills. Chicago Tribune, July
18, 1995, Sec. 1, p 1, 6.
Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL. Heatrelated deaths during the July 1995 heat wave in Chicago. N Engl J Med 1996;335:84-90.
Srikameswaran A. Heat-related illnesses can unexpectedly turn into killers. . Chicago Tribune,
July 18, 1995, Sec. 1, p 6.
Whitman S, Good G, Donoghue ER, Benbow N, Shou W, Mou S. Mortality in Chicago
attributed to the July 1995 heat wave. Am J Public Health 1997;87:1515-1518.
CBS TV 6 pm news, special report on the heat wave, July 1995
https://www.youtube.com/watch?v=lCWJsgeFUe4
Week 9: HPV-positive Head and Neck Cancer
Scudellari M. Sex, cancer and a virus. Nature 2013;503 (21 November):330-332.
Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, et al. Human
papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol
2011; 29:4294-4301
Mroz EA. Forastiere AA, Rocco JW. Implications of the oropharyngeal cancer epidemic. J Clin
Oncol 2011; 29:4294-4301
Sanders SA, Reinisch JM. Would you say you “had sex” if…? JAMA 1999;281:275-277.
Herrero R, Quint W, Hildesheim A, Gonzalez P, Struijk L, et al. Reduced Prevalence of Oral
Human Papillomavirus (HPV) 4 Years after Bivalent HPV Vaccination in a Randomized Clinical
Trial in Costa Rica. PLoS ONE 2013; 8(7): e68329. doi:10.1371/journal.pone.0068329
Szabo L. Treatment for throat cancers like Dimon’s improving. USA Today July 2, 2014.
http://usat.ly/1lzkAyA
Harris G. Can Oral Sex Cause Cancer? Men’s Journal March 2012
http://www.mensjournal.com/magazine/can-oral-sex-cause-cancer-20120809
No author. The man’s guide to HPV. Men’s Journal.
http://www.mensjournal.com/health-fitness/health/the-mans-guide-to-hpv-20130607
CBS news Study: HPV linked to head, neck cancers in men
http://www.cbsnews.com/news/oral-sex-and-throat-cancer-michael-douglas-hpv-reportspotlights-epidemic/