Content of this lecture
This is a shortened version of J Hanley's 1-hour lecture
in the McGill Minimed Series on Epidemiology
in the Fall of 2014. It skips quickly over smallpox and cholera,
focuses on 20th-century research and ends with a 21st century
research study JH was directly involved in (his career started out in
1973 in clinical
trials of cancer therapies.)
JH's (mostly collaborative) research since coming to McGill
relies less on randomized trials,
and more on indirect and unplanned (non-experimental)
evidence. But that in part is what has made his work more
interesting and challenging. As you will see
from the
Reprints section of his website, and
from his
cv, he has worked with many researchers,
from pediatrics to geriatrics, and on some big-ticket
public health topics such as cancer screening.
Today, the scope of epidemiology research,
and the work in our very large department, is very broad.
So it was difficult to choose a title for the Minimed
series that captured this breadth. We
went with a narrow definition that suggests
we are just disease detectives, but if you look
at the titles, or the actual videos, of the other
5 lectures in the Minimed series, you will get a sense of
the breadth.
A few words about the
RESOURCES on JH's MiniMed page:
The advance material gives a sampling of
epidemiology.
The Minimed presentation by J Hanley
is in several formats: the 'slides'
(today's students think 'slides' were invented
for Powerpoint!) are the visuals, and the
'transcript' gives the words JH calls them the lyrics!).
You get both together in the Canal Savoir video
[Also given is is link to the 'raw' (unedited)
video recorded by McGill -- they edited it to fit the
1 hour for Canal Savoir, but took out the audience solving the
'Medical Mystery' -- more on these
medical mysteries later!
The links from the BOOK 'Disease:
the extraordinary stories behind history's deadliest killers'
include some diseases beyond
smallpox and cholera. [Don't 'peek' at the
puerperal (childbed) fever chapter until
you have tried to solve the mystery!]
The book itself is a stunning production.
The online and freely available
LECTURE SERIES on EPIDEMICS
from Yale University is excellent.
The SMALLPOX movie by our National
Filem board is also excellent. It is
half fact (from 1885), half fiction (a
possible future epidemic), and --like
the smallpox outbreak, which JH's lecture
touches on --is based in
Montreal.
For those of you who are JH's age
(born in the 1940s) the material on the
1954 TRIAL OF SALK POLIO VACCINE
will bring back strong memories.
In his Minimed lecture, JH played the first
several minutes of the
Movie:The Last Mile (15min)
and ended the lecture by playing the announcement
of the results of the trial. Each year,
the material
in the link is 'must' viewing/reading for his
students in Biostatistics. He usually starts with
The short article for high school mathematics students:
The Biggest Public Experiment Ever: The 1954 Field
Trial of the Salk Poliomyelitis Vaccine.
If you become interested in the cholera
story, you should start with the world
maps of the 7 cholera pandemics. Cholera
is still endemic today in the same place
it seems to have originated from. [see also the
'cholera in Haiti' (21st century)
link further down. The websites on John Snow
[one of epidemiology's heroes] are impressive,
and another good starting point.
No history of epidemiology' lecture is
complete without a mention of John Snow.
All 5 items under
'BOOKS, VIDEOS, AUDIO:' deal with
cholera. The prize for the
best and shortest telling of John Snow's
contribution is the dramatization in the BBC
video on the building of the sewers of London.
Unfortunately, Youtube seems to have taken
down its link.
[All 7 programs in that BBC series are very good,
and the series was availabe on Netflix recently].
The 'Ghost Map' -- and the search for
the 'index' (first case) is a good read. JH mentions
Ebola 'case 0' (CNN terminology) in his lecture.
Under 'Private ICU Rooms' you will
find the full report of the 21st century study
on infections that JH refers to in his lecture.
JH took the 'humans in test-tubes' cartoon
from the NY Times
ARTICLE
Do We Really Know What Makes Us Healthy?
by the Science writer Gary Taubes. His topic
in that article was HRT
(hormone replacement therapy). His book
'Good Calories, Bad Calories'
is very thorough.
He has recently taken on the sugar industry, and its
efforts to 'blame' fat'.
The links in the MYSTERIES section
allow you to play detective.
In the MiniMed
lecture, the audience figured out the 'childbed fever'
or 'puerperal fever' case -- if
you get stuck, you can always Google the answer,
or look it up in Wikipedia, or
wok your way through the Powerpoint presentation.
Hint: even though
the case is from almost 200 years ago, the
underlying issue (failure of health professionals to
do something very simple and effective)
is still revelant.
The 'Mystery Dataset:
What happened to these people?'
has been used by epidemiology teachers
for many years to get students to
reason it out. One clue: why are
there children' in the 'other' social class
(maybe its not a social class, but an
occupational class!). By the way, some of the
early guesses (quickly ruled out by the data)
were an earthquake, a war, a famine, etc.
One other clue: the 'event' happened
just over 100 years ago. One question
from the MiniMed audience (on
what continent did this event happen?)
was quite helpful, especially when
the answer had to be 'none of them'.
The event that made for the striking time
pattern in water consumption
(Why this pattern on this specific
afternoon in 2010?) is not to do
with health, but with a popular human activity
(or one that humans like others to be active in!).
It has a USA connection.
Incidentally, JH uses the Million litres (ML)
scale to ask his students: is that ML per minute,
or per hour, or per day? Given how many
people live in Edmonton, and how many litres
of water per person are 'used' by Canadians,
it is possible to figure out the missing
time dimension -- and the example
helps explain to calculus
students that one does not have to
travel for an hour to calculate how
fast (in Km/Hour) one is going!
The puzzle
'What events were these?
was also featured as the "On the web" (last page) item in
the April 2017 version of the popular statistics magazine
Significance, which the Royal Statistical
Society aims at a general audience. JH's
website provides a series of clues.
The bottom of the webpage gives some other links,
as well as one to the entire series
of 6 MiniMed lectures on Canal Savoir. [the lectures rotate,
but one can also search for a specific one -- and they are
all available in 'raw' form on this
McGill site ]
Feel free to contact
James.Hanleyjames.hanley@McGill.Ca
if you have any questions,
or if any of the links break.