Tuesday, April 7, 2015

Epic Measures by Jeremy N. Smith - Book Review



Epic Measures: One Doctor, Seven Billion Patients by Jeremy N. Smith (HarperWave, 2015, 352 pages, $26.99/13.59) explores and explains the importance of “big data” in analyzing the state of world health, discovering the actual causes and relative importance of death, disease, and examining the burden of disease at it affects people's quality of life. This important and illuminating book explores the causes of what it describes as the Global Burden of Disease, the accumulated knowledge of when, where, and how people are born and die, how disease affects not only lifespan, but quality of life. To accurately discover this information, it's necessary to collect, collate, compare data down to the level of small towns and villages. The development of the data base required for this program is perhaps the most complex and important compilation of information about the state of humankind ever attempted, let alone accomplished. Its implications for health care delivery and policy are world shaking. The opportunities are truly breathtaking. This exploration and accomplishment is told through the life and career of Chris Murray, a physician, PHD epidemiologist, world traveler, high risk skier, and first rate athlete who possesses the passion, energy, intelligence, and vision to conceive and complete the largest catalog of human health ever contemplated and achieved. This book is both inspiring as Murray the person is revealed and important as it explores the potential for solving many problems in world health.

Dr. Christopher J.L. Murray


Christopher Murray is the youngest child of Minnesota physicians who gloried in world adventure travel and rural medical practice. At the age of seven, he was made responsible for charting a route across the trackless north African dessert to a small medical clinic in South Sudan, where his parents had contracted to run a clinic. When they arrived they found a bare building with no equipment, staff, or patients. Within a few days there were plenty of patients, but no medicine or equipment. During their stay, young Christopher learned and watched, developing a lifelong passion for the needs of the poor. He later enrolled at Harvard College, spent a couple of years at Oxford on a Rhodes Scholarship, where he picked up a Ph.D. and, soon after his return to the U.S. Enrolled at Harvard Medical School, while simultaneously running a program dedicated to collecting health data. Everyone who knows Christopher Murray is impressed by his intelligence, energy, commitment, and likability. His drive and single-minded commitment to collecting and organizing an entire world's health data make him a challenging colleague, a demanding boss, and a problematic leader. His personality dominates this book, which is filled with able, dynamic people.

While still a relatively young man, Murray managed to be fired from institutions which lesser men strive to head or serve in for decades. Along the way, he developed metrics for creating a data base of the causes, losses, and risks of a number of diseases on a world-wide scale. Many of his studies were accepted and published in the world's most important health journal, Britain's The Lancet. He also conceived and helped develop a metric called Disability Adjusted Life Years (DALY) which recognizes the costs to quality of life and longevity of pain and suffering. He discovered that many of the heretofore intractable problems of obstetric disaster and child mortality had decreased loss at the level of early life, moving many diseases and issues of adolescence and early adulthood into a higher priority. Thus accidents, murder, HIV/AIDS, and diabetes forged into the forefront of causes of early death. Not surprisingly the inertia of national health agencies and world wide collectors of data were challenged for their hidebound and sloppy systems of collection, while private and public charities resisted Murray's findings because of the threat to their fund raising capability. It was only after the Bill & Melinda Gates Foundation discovered Murray's work and established the Institute for Health Metrics and Evaluation at the University of Washington, that Murray and his team found a base from which to begin completion (the data base will never, of course, be fully and finally complete) of the first global catalog of the Burden of Disease, a data base available to all for study, analysis, and data-based decision making. The interactive charts and diagnoses, made available free worldwide to researchers, health care decision makers, and private individuals, can provide hours (years) of fascinating reading and analysis for those interested in both general matters and specific risks of specific diseases and syndromes. Take a look!

The overall analysis can pinpoint issues and diseases for health care decision makers examining the cost effectiveness and efficacy of health care efforts at the global, national, and local levels. If the death panels that Sarah Pallin claimed would be a result of the Affordable Care Act (Obama care) existed, this is where they would exist. Instead, the Global Burden of Disease data base makes rational decision making about the efficacy and efficiency of health care decisions available and allows decision making based on available resources with the assumption that each life is as worthy as every other life. Playing with the data base is fun, too!

Jeremy N. Smith

Jeremy N. Smith has written for Discover, the Christian Science Monitor, and the Chicago Tribune, among many other publications. His first book, Growing a Garden City, was one of Booklist's top ten books on the environment for 2011. Born and raised in Evanston, Illinois, he is a graduate of Harvard College and the University of Montana. He lives in Missoula, Montana, with his wife and young daughter. (Publisher Profile)


Jeremy N. Smith's important book Epic Measures: One Doctor, Seven Billion Patients (HarperWave, 2015, 352 pages, $26.99/13.59) works well on two levels. It offers a fascinating portrait of Dr. Christopher Murray, a physician and epidemiologist, whose driven commitment to accumulating accurate data to catalog the state of world health in order to help develop policies and practices leading to its improvement led to the publication of the data in the Global Burden of Health. At the same time, Smith describes the turf wars and bureaucratic in-fighting of the health industry (for want of a better name) serving to maintain the status-quo and cater to parochial self-interest. The tension developed between Murray's drive against the lethargy and obfuscation of the world's health powers forms the central themes of this intriguing and illuminating tale. I recommend it highly to those who are interested in health care policy and maintaining personal health practices leading to longer, happier lifespans. Spending some time studying the web site linked to above and here can increase the power of this story. I read Epic Measures as an electronic galley provided by the publisher through Edelweiss. I read it on my Kindle app.