Tuesday, January 08, 2008

Handling Topical Subjects During Long Book Projects

Today, I interview Maryn McKenna. Her book, "SUPERBUG: The Death and Life of Drug-Resistant Staph and the Danger of a World without Antibiotics" will not be released until 2009. Maryn talks about medical writing, as well as handling a subject that's topical right now in a book that won't be released for another year.

Please tell us about yourself.
I'm a freelance print and Web journalist specializing in infectious disease, public health and health policy. I went freelance 18 months ago after spending 20 years as a medical and science writer at four newspapers, ending as the CDC reporter at the Atlanta Journal-Constitution. That experience fueled my first book, BEATING BACK THE DEVIL: On the Front Lines with the Disease Detectives of the Epidemic Intelligence Service (more on that below). Now I write for a variety of national magazines and journals (SELF, More, Annals of Emergency Medicine) and also for a well-read infectious-disease website, CIDRAP News (http://www.cidrap.umn.edu/), where I just completed a 10,000-word series on the obstacles to achieving a pandemic-flu vaccine. There is more about me at my personal website: http://www.marynmckenna.com/; and I am blogging my way through the MRSA book at http://drugresistantstaph.blogspot.com/.

Please tell us about your book, SUPERBUG: The Death and Life of Drug-Resistant Staph and the Danger of a World without Antibiotics.

The book grew out of a major feature I did last February for SELF Magazine <http://www.self.com/livingwell/articles/2007/01/0207bugdrugs_1_of_5>. As a medical reporter, I had been tracking and writing about drug-resistant staph (generally called MRSA, methicillin-resistant Staph aureus, after one drug from the class of drugs it is resistant to) for a while.
I had noticed that most of the MRSA community outbreaks that had been written up tended to skew male: football teams, high school athletes, jail inmates, and so on. I had the sense, based on my regular reads of medical journals, that the male identification was out of date. I met Sara Austin of SELF at the Association of Health Care Journalists (http://www.healthjournalism.org/) conference and proposed to her that I do a piece looking at MRSA as an under-appreciated threat to women and children. She agreed, we did the piece, and it got tremendous response plenty of reader letters, and also segments on the TODAY and Montel shows.
Based on that response, my agent Susan Raihofer and I thought there was a larger story here, and so we wrote up a quick proposal only about 20 pages, compared to the 80 pages that my first proposal took. Several publishers were interested and bid, but the book went in the end to Free Press, part of Simon & Schuster and publishers of my first book. It is due out in 2009.
The book is envisioned as a sort of biography of MRSA, something that will answer the questions: How did we get here?, How did this get so bad? and What are the obstacles to making this better? The classic form of a science book is the heroic investigator championing his discovery against all obstacles. This is not that book: There is no single hero though staph makes an intriguing villain.

My mother died last February 2007 from complications of MRSA, "The Super Bug." When she was diagnosed, we had never heard of it, although she probably contracted it as early as 2004. Is this why you felt it important to write the book?

I'm sorry for your loss, and I can say from even my preliminary research that there are many, many families in the same situation as yours, and so many of them feel isolated. I absolutely do feel that the staph story has been going on much longer than most people realize. The first reports of hospital-associated staph came out in the 1960s; the first medical-journal recognition that something odd and different was going on in the community came in 1999 with a small article in the CDC's Morbidity and Mortality Weekly Report, or MMWR, which is the best-read magazine you've never heard of. (It also carried the first report of the first AIDS cases to be recognized in the United States.)

Why do you think drug resistant staph didn't receive much press until late this year? My suspicions are that it was mainly only affecting elderly, but when it started showing up in schools, it garnered more attention. Do you think this had something to do with it?

Here's what I think is going on now. In many infectious-disease epidemics, there is a period of time when the disease is recognized, but considered a limited risk, usually because it affects only a discrete group. For some diseases, there comes a point where the risk group expands to the entire population and that expansion often comes as a significant shock that ripples through society. Much the same thing happened with AIDS: Originally it was thought of mainly as a disease of gay men and a few other risk groups, but in the late 1980s-early 1990s there was a moment when people realized it was also a heterosexual and broadly blood-borne risk, a sort of collective recognition of, "Oh my God, we're all in danger." I think much the same thing is happening now: People are realizing that MRSA potentially threatens themselves and their children. Not very many people cared about MRSA when it was affecting thousands of jail inmates, or causing grave skin infections in gay men who attended California sex clubs. Now that it has been shown to infect and occasionally kill average adults and children, concern and uncertainty are much more widespread.

The book is not scheduled to be released until 2009. Are you afraid some of the information may be irrelevant at that point - is this one of the major challenges facing medical journalists who write books on timely topics?

Absolutely it concerns me. This happens all the time to journalists: You start work on something, hoping that you have spotted a trend before it crests, and then events scoop you. This actually happened with my first book also: I was writing a narrative and history of the federal government's disease-detective SWAT teams, ferreting out the stories of outbreaks on which they had deployed, and in the midst of my research the international SARS epidemic sent the teams on the largest deployment in their history. I despaired at first, thinking that there would be nothing else to say when the book came out, but as it happened, that epidemic and then the spread of avian flu later that year kept the concept of "disease detectives" alive in the public mind and increased interest when the book came out. I hope the same thing will happen this time. I feel pretty confident that MRSA is not going to become a less important problem in the next 18 months.

How did you conduct your research for this book?

I work on two tracks, medical and personal. For the medical, I do my best to find every medical-journal article ever written on the topic, both past ones (using the PubMed interface to the National Library of Medicine, http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed) and new ones (using a �My NCBI� alert through PubMed). Then I try to figure out who are the most important or innovative researchers, and I try to interview them and to visit them if they'll let me. For the personal, I look for victims and victims' families. I set up Google Alerts to catch things in local newspapers, and post notices in every relevant electronic bulletin board I can find.
I have post-graduate training (through the Knight-Wallace Journalism Fellowships at University of Michigan, http://www.mjfellows.org/) in the social history of epidemics. I�m always looking, when I tell the story of a disease, for historical background that allows me to set the outbreak within the context of the time. Here's an example: While reporting the series on pandemic vaccines that I recently finished, I discovered that independent authorities had been calling for vast ramp-ups in flu-research funding since 1986. But what else was happening in 1986? It was the earliest days of US government response to AIDS: Rock Hudson, the celebrity who made the disease real to much of America, died in October 1985. Figuring out that context made it easier to understand why calls for expanded flu research - research that could have protected us against the current pandemic threat - had been ignored.
I also accept that I am going to run up against something totally foreign to me that I am going to have to learn in depth pretty quickly. That's happened in every big project I've done as a journalist, and I'm facing it right now with this book. It's forcing me to delve into drug development and microbiology, two subjects on which I am weak and need to get up to speed quickly!

What was the most interesting medical story you've done?

Hmm, wow. There have been so many that I both was intellectually intrigued by and also felt deeply about. Just in the past few years, there was the scientist who recognized the first cases of AIDS in America, but didn't get to put his name to the observations until many years later; a woman who suffered the first described case of West Nile Virus paralysis, and who five years later is still struggling to regain her health; the World Health Organization physician who first warned the West of the dangers of the SARS epidemic and then lost his own life to the disease; the Thai village that was nearly wiped out by the 2004 tsunami but that recreated itself in a refugee camp with immense dignity and bravery.
Right now, aside from MRSA, the story that most engages me is the ongoing recovery of New Orleans. I reported from the city for the Atlanta Journal-Constitution during Hurricane Katrina and as a freelancer have gone back roughly every 6 months since. Right now I am writing about the linked crises of emergency-room capacity and mental-health care.

How do you make medical and scientific topics interesting and readable for the general public?

Two things are essential. The first thing is, you have to really understand the science in order to be able to explain it in simple language without making mistakes. This does not require scientific training; it does require being willing to ask questions very patiently and thoroughly and often, at the risk of feeling stupid, until you are sure you have it right.
The second thing is, the story cannot be about the science! The story must be about people, and their experience of the problem or challenge or disease, with the science secondary. Readers are not engaged by data. Narrative is what touches their hearts.

Tell us about your awards for Beating Back the Devil: On the Front Lines with the Disease Detectives of the Epidemic Intelligence Service

I've been fortunate to receive awards from both sides of the aisle, as it were. The book was named a "Best Science Book of the Year" by Amazon and a "Best Book" by the NPR program Science Friday, and an "Outstanding Academic Title" by the American Library Association. Also, I was named "Georgia Author of the Year."

Where can people find your award winning book?

Amazon! It has the deepest discount. Search for the title, or use the "Books" page on my website.


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