Epic Measures: One Doctor. Seven Billion Patients.

by Jeremy N. Smith

Moneyball meets medicine in this remarkable chronicle of one of the greatest scientific quests of our time—the groundbreaking program to answer the most essential question for humanity: how do we live and die?—and the visionary mastermind behind it.

Medical doctor and economist Christopher Murray began the Global Burden of Disease studies to gain a truer understanding of how we live and how we die. While it is one of the largest scientific projects ever attempted—as breathtaking as the first moon landing or the Human Genome Project—the questions it answers are meaningful for every one of us: What are the world’s health problems? Who do they hurt? How much? Where? Why?

Murray argues that the ideal existence isn’t simply the longest but the one lived well and with the least illness. Until we can accurately measure how people live and die, we cannot understand what makes us sick or do much to improve it. Challenging the accepted wisdom of the WHO and the UN, the charismatic and controversial health maverick has made enemies—and some influential friends, including Bill Gates who gave Murray a $100 million grant.

In Epic Measures, journalist Jeremy N. Smith offers an intimate look at Murray and his groundbreaking work. From ranking countries’ healthcare systems (the U.S. is 37th) to unearthing the shocking reality that world governments are funding developing countries at only 30% of the potential maximum efficiency when it comes to health, Epic Measures introduces a visionary leader whose unwavering determination to improve global health standards has already changed the way the world addresses issues of health and wellness, sets policy, and distributes funding.

Genres: Nonfiction, Science, Health, Medicine, Medical, Health Care, Biography

352 pages, Hardcover

First published April 7, 2015

Reviews

[Ernest · Rating 4 out of 5]

Epic Measures is a book simultaneously tells two stories. One story is about the importance of the data of disease in understanding how the world lives, what makes people sick where, which illnesses cause both the greatest individual and societal impact, with all its ramifications for global health policy. The other story is about Chris Murray, a doctor and economist singularly focussed, almost obsessed, with fulling documenting and understanding these questions with rigorous data not merely for its own sake but for the betterment of health policy and for improving people’s lives. These two stories interweave simultaneously in a book as eminently readable as it is profoundly important.

With so much money spent on health programmes and policies around the world, it would seem obvious to want to know how best to spend the money, on which programmes and on what methods. It was the disparate calculations, assumptions, methodologies and even governmental and non-governmental bureaucracies that frustrated Dr Murray such that to answer the question of how we live and die became his life’s work, with all the drive, working methods, view of the world and sheer mind that singularly focuses on one problem achieves.

This book does not paint Dr Murray as a perfect saviour of healthcare policy. It fairly seeks to understand what drives him to be so intense in this way, shares the problems faced when confronted by institutional systems and is candid in the tool his mission took on his family. Nor does this book’s theme of data driven analysis mean pages of pure numbers, formulas and dry statistics. Instead, the melding of Dr Murray’s life and a presentation of the vital importance of data-driven healthcare policy reads with the drive of a thriller, the insights of a biography, the adventure of trying to change the world and the overwhelming desire to want to save millions, if not billions, of lives.

This is a book that deserves to be read by more than just epidemiologists, medical doctors, policy makers or the intellectually curious. It challenges and inspires, and is bold in its ideas and ideals as it manages to reach them. It is a measure of how much this book feed, fuelled and gripped my intellect that I read it in one day.

[Vivek Jha · Rating 5 out of 5]

This book should be a required reading for all medical school students, especially those who thin the only way we can do good is by becoming super-specialists and practice high tech curative medicine. It tells the extraordinary story of Dr Chris Murray and his single minded quest to count the causes that cause premature death and disability around the world - the foot that led to the concept of DALYs and later the Global Burden of Disease.

As GBD "expert" (amongst hundreds others globally), I have been associated with the project in a very small way. We assume it just happened by itself, but the book tells the story of bureaucratic tussles, clash of egos and the problems of getting resources for the effort.

Most of all it is the story of how one driven person inspired a bunch of people to perform to the best of there abilities and come up with a measure that should define healthcare priorities of communities, and nations.

Makes you worry about much of the data that comes from so-called traditional authentic sources such as the WHO.

Does Dr Murray come out perfect? Certainly not- but the good that he and others have done will be of everlasting value, and this books documents it well. The writing style is fantastic, and if I and the time I would have finished it in one go!

[Diane · Rating 5 out of 5]

Given that Congress is in the process of deciding which health care bill will best serve Americans, Jeremy N. Smith's book Epic Measures One Doctor. Seven Billion Patients. is a most timely read.

Although we live in the "Age of Big Data" as Smith states, where we all have Fitbits to track our every step, and you can pay $99 to have your DNA analyzed, it is remarkable that we don't have accurate statistics on what makes people ill and what they die from. In 147 of 192 countries, reliable death certificates do not exist.

Chad Murray, an Oxford graduate, came to believe that his life's mission was to "measure how we sicken and die in order to improve how we live". Murray is a physician and economist, and an extremely driven man. His interest in health care began when his family went to work at a hospital in Niger (he was ten years old).

The hospital had no electricity, water or supplies, but they had plenty of patients. Chad was the pharmacist, errand boy and assisted his father by holding the light so he could perform surgery. He learned how to persevere under difficult conditions.

Because Murray "combined the talents of a demographer and an epidemiologist, a biologist and a doctor, an economist and a policy expert", he was uniquely qualified to see the big picture of disease and mortality.

Murray's prickly personality hurt him when it came to working with others in the political arena. Worldwide organizations like the World Health Organization (WHO), UNICEF, and the UN led the way in working on health care issues, especially in the arena of childhood mortality.

Many people felt threatened by Murray's assertions that we must get accurate statistics on disease and disability in adults in order to objectively measure the health of the entire world. After working with many established organizations, Murray founded The Institute for Health Matrics and Evaluation, with the help of Bill Gates.

Murray and his staff of many around the world created a matrix that wanted to "turn information into evidence, evidence into action and action into results." They believed that global health is an instrument for social justice.

Epic Measures is not just a book that will interest statistic or math geeks, health care providers and politicians, it is a fascinating look at how the most basic human need- good health- can be achieved through getting accurate information, and once you had that, realistically finding solutions.

Fans of good narrative non-fiction, like The Immortal Life of Henrietta Lacks and Hidden Figures have found their next great read. And if you want to give your Congressperson a gift, a copy of Epic Measures would help everyone.

[Lydia · Rating 3 out of 5]

hmmmm full disclosure I tried to read this book a year ago but could not get past the "upbringing-in-Africa" chapter (the fact that I genuinely can't remember which African country it took place in tells you just how nonspecific it was, like Heart of Darkness but published in 2015)

I will say that the author is much more successful with the "drama in academia" portions of the book- these are interesting and informative, especially for those who may not have been exposed to health metrics previously. For that I do give credit-- however

The chapters that try to speak to the heart of public health as a discipline (inequality, injustice, any mention of colonialism) fail utterly because of the author's myopic and privileged perspective. He does include some criticism of the book's subject, but overall there is a fawning tone that glosses over any real issues in the field. The depiction of developing countries and policy-makers is really tired for a book published this recently, and there is no real investigation of power dynamics despite all of the research tea

I think the issues with this book are really tied to the archetype of the "underdog industry disruptor"-- usually an abrasive white man who is glorified for his singular competence. This is honestly an entire book genre and I understand the appeal, as we like to see people win. However I wonder how this trope apologizes for flaws, minimizes the importance of collaboration, and ultimately perpetuates colonial white savior narratives. This book alone was not gonna solve that but it deserves some thought, especially when we are talking about global health

Interesting to read a book about people you know (some more some less) so that is obviously going to bias my opinion but overall idk y'all

[Tracy Antol · Rating 2 out of 5]

I feel like an uneducated, uncultured heel for saying this book was "just ok". It was a true test of my patience to finish it. I appreciate the massive scale of the project - to truly and accurately measure global health. I am extremely impressed at the tenacity and grit of Chris Murray and his team. His findings are enlightening and helping world health organizations more accurately report and support health issues around the world.

I just felt like it could have been told in less pages. With less repetitive passages. And perhaps in the end I feel like a subpar human being because my job is nowhere near as meaningful as the Global Burden's. I'm not a math whiz. I don't have an insatiable drive for work and personal life.

If you're a student of medicine then this is probably a more amazing book.

[Nikhita Damaraju · Rating 5 out of 5]

This book introduces challenges with collecting data in the field of public health and tells the story of “The Global Burden of Disease” set of datasets. A large part of the book discusses how the burden of disease for a population was decided upon and accurately calculated. However, the part that really caught my attention was this line that talks about the differences between public health and personal health - “Safeguarding the health of the world depends as much on math as much as on medicine, and people who can gather and undestand big sets of numbers are essential to the workings of public, as opposed to personal, health”.

I recommend this book for anyone that is enjoys quantitative comparisons and is curious about public health.

[Leah K · Rating 3 out of 5]

Ok, so this book took me MONTHS to finish, which is not the norm for me. Maybe it was because I often picked it up late at night or maybe all the medical jargon made for insta-sleep (not an easy feat for someone with insomnia). But I finally got through it!

It's not that it's a bad book. It's absolutely fascinating what Dr. Murray accomplished in his research over many years. The first comprehensive guide and continuously updated look into what causes diminished life and death in the entire world. No easy feat. Sure, we have WHO, the UN, and other nonprofit agencies but what happens when they all have very different answers? That's where Murray swoops in.

This book was published in 2015 and most of the studies in the book take place in 2012 or earlier. So I'd be curious to see an update on how the last few years were handled!

If you're deep into medicine, Epic Measures may be your thing. For me, it was a bit too much and repetitive to continuously keep my attention.

[Ann Fisher · Rating 3 out of 5]

This is said to be The Social Network but about important matters instead. It is. The important matter is nothing less than worldwide health and how we measure it and measure the impact our efforts have on it. The work is absolutely important and the story is told in detail. But it's such a hagiography, as even the subtitle "One Doctor. Seven Billion Patients" suggests. The author does admit that our protagonist, Christopher Murray, has antagonized a lot of people, but that's only because no one likes to be told that their work is worthless and he has more important things to do than make nice. Oh, and we learn, almost as an aside, that the courts no longer let him visit the children by his first marriage, but no hint why that might be. The book is so heavy-handed in this regard, that it makes it harder to trust the discussion of exactly what the work is and why it's so important.

[T · Rating 3 out of 5]

This book is probably one of those books that could've been a really long article instead. Nevertheless I gave it a decently-high rating, because it's on a really important topic: how we measure health outcomes has a dramatic impact on where we choose to allocate health resources. Measuring DALYs (disability-adjusted life years) might be such an obvious idea today, but this book tells the stories of challenges and institutional resistance to implementing these metrics across the board, ranging from lack of consistent, high-quality data to pure bureaucratic intransigence.

[Marshall · Rating 4 out of 5]

Health data is one of the most interesting big data out there. The question of “Who dies of what” leads to so many possible explorations. Yet, prior to global burden of study, the health data from WHO were fragmented and incorrect. Bad data leads to inefficient decisions, and it hurts development on global health.

“Epic Measure” tells the story of how Chris Murray develops Global Burden of Disease project, now published on healthdata.org. This book enhances my belief that good decision-making is backed up by good data and analysis. Collecting good data and good analysis is hard to do (it took Chris and Allen twenty years to realize the project). Plus, there’s always politics in global health, and the book show the struggle Chris and Allen have gone through while fulfilling their mission to measure “who dies of what”.

======================
Great quotes:

The “10/ 90 gap,” Murray called it. People in developing countries endured more than 90 percent of the world’s health problems. Those problems, however, received less than 10 percent of health-related research investments.

An estimated 93 percent of the world’s burden of preventable mortality . . . occurs in the developing world.

Not all poor people were the same. Yes, all had relatively little money. But reports repeatedly heralded residents of some low-income countries— China, Costa Rica, Sri Lanka— and the state of Kerala in India as healthier than others and, in terms of mortality rate improvement, doing even better than those in many wealthy Western nations. According to the World Bank, for example, China, Sri Lanka, and Kerala each had per capita incomes of, at most, $ 330 in the early 1980s. Nonetheless, in all of them life expectancy at birth approached seventy years. In Costa Rica, income per capita was $ 1,020, an order of magnitude less than in the United States. Yet the two countries’ infant and adult mortality rates were about equal.

But how could we say what would make people live better if we couldn’t even be certain when and how they were dying?

He realized that the broadest and best-funded initiatives to improve world health did not resemble individual efforts like those he’d participated in with his family or imagined with Culhane. They were about politics and diplomacy, promises and threats, secrets and handshakes.

Choices between competing health priorities are made every day by decision-makers in the public and private sectors,” they would write. “These choices reflect each decision-maker’s implicit understanding of a population’s epidemiological profile, as well as opportunities for intervention. We believe that it is preferable to make an informed estimate of disability due to a particular condition than to have no estimate at all.” Better to push epidemiology to its limits— and then improve it— than to hold back, waiting for more information, and let the pain and suffering of billions remain ignored.

In bureaucracies, it is said, nothing is allowed, but there’s a way around every rule. Murray, the skeptic and debater, now had to master the more subtle art of office politics. Anything sensitive, for example, had to be said in person, not in writing, or it might be used against you.

Working with Frenk, he defined national health system performance not just by how healthy or unhealthy a country’s people were, but also by how much health was improving or declining, how small or large the gaps were between the best and worst off in a country, and how well services matched demand.

Knowing the burden by disease told you the scope of a region’s health problems— who was sick and dying where, and what they suffered from. Knowing the burden by consequence across the full range of disabilities told you what programs were required to help people get better.

One of the increasingly important functions of public health programs is prevention, reaching healthy people who need help knowing how to stay that way.

“Women from ten to sixty have a survival advantage, but a disadvantage in living with disability,” Murray concluded. The disadvantage was significant, and not limited to injuries and illnesses related to having children. Women needed more and better care in a variety of areas.

Low back pain, sixth on the list, was so prevalent and so painful it now caused more years of healthy life lost than murder, malnutrition, lung cancer, or tuberculosis. “As the world is aging, the burden shifts,”

the stresses of unemployment or a general condition of powerlessness that drive many people to drink or drugs— are beyond the ability of the ordinary individual to change.

“A lot of strange ideas people pursue come from a misperception of what priorities are,” Murray said. In 2010, for example, rabies killed 50 percent more people than all acts of war, according to IHME numbers. Nearly three times more people died from falls than from brain cancer.

Most economists believe that if the average wealth of a country increases, its populace will be able to afford better health care, and become healthier as a result. However, IHME data shows that this is true only up to a certain point. A much stronger correlation exists between health and education.

Educating women is an especially wise health investment on two fronts: first, it makes them better advocates and decision makers for themselves and their families during times of medical need; second, it leads women to delay the onset of motherhood and have fewer life-risking pregnancies overall.

[Angie · Rating 4 out of 5]

This is only the first paragraph of the review. I thought it was much too long and looked a lot better on my blog. Here is the link: Readaholic Zone I hope you go check out the rest of the review.

As an individual who is obsessed with medicine this book keep me mesmerized due to the brilliant and distinct new way, Chris Murray looked at the world's health problems by formulating the Global Burden of Disease Study. Why had I not heard of this ingenious scientific study before I kept asking myself as I indulged in the book’s abundant supply of facts, figures, and Murray’s distinct calculations that are used in the Study? One of the most interesting aspects of the study to me is the number of disability-adjusted life years or DALYs which entails taking the quality years a person lost due to a disability (YLDs) from the years they actually lived ending up with how many years a person lived a healthy life. Therefore, this is just a simplified version of how the book explains it, but being disabled myself this concept blew my mind, even though it is a simple calculation I felt as if Murray understood not being able to live life to its fullest. Whereas, Murray has endless energy doing everything at an extreme level from work to fun.

"Thanks, TLC Book Tours, for letting me give an honest review of this book"

[Matt McGough · Rating 3 out of 5]

kinda self-indulgent and repetitive despite being on an interesting topic that is personal to me

[Ted Lehmann · Rating 5 out of 5]

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.

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! Read the remainder of my review on my blog and please consider ordering it from the Amazon portal there.

[BradMD · Rating 3 out of 5]

"...Murray's salary was $488,000..."

[Lee Richardson · Rating 5 out of 5]

Disclaimer: I worked at IHME on the Global Burden of Disease (GBD) for one year between undergraduate and graduate school.

I recently wrote a "research statement" for job applications, and was surprised by how influential the Global Burden of Disease study was. When I worked at the IHME, I was a lot younger, so I didn't quite understand how significance and revolutionary spirit of the place was until I left. The truth is, from a pure scientific perspective, I don't know of, or haven't encountered many projects that match the scope and ambition of the GBD. From my experience, most scientific research is incremental gains, and doesn't operate at higher levels of abstraction such as "measure all of the worlds health issues".

The reason the GBD impacted my research statement so much is that, at the GBD, I saw the power of a simple goal: Collect and organize all of the health data we can onto our servers, synthesize it, and determine ways to produce estimates at higher and higher levels of granularity. What was very interesting, from a statistical perspective, was seeing the importance of the **other** parts of research, not just the statistical modeling itself. We had teams and teams of people whose only goal was collecting hard-to-get pieces of data, managing the databases, building the visualizations, fitting the statistical models, and more.

But I also saw how useful and rare hardcore statistical skills could be. The folks involved in statistical modeling, such as Abie Flaxman, were so impressive. While I already was already leaning towards a PhD in statistics, seeing the role that statisticians had at the GBD further reinforced my decision.

The GBD helped me understand how a large team could be organized around building a data product, and how the components of a data product fit together to produce a common goal. Conceptualizing a project in this way, and actually pulling the entire thing off, it both genius and a testament to persistence.

As for the book, very well written, and very engaging. Chris Murray is a fascinating character, and I could easily see this book being made into a movie. It could be a movie because it has all of the components, the interesting character, the rise, the many challenges along the way (for example, when Larry Ellison dropped the funding), and finally, the triumph of releasing the GBD at the IHME. Great book, glad Smith wrote it!

[Katie · Rating 4 out of 5]

Today, the idea of being able to rank countries based on their healthcare and to know the main causes of death around the world seems normal to me. Amazingly, this was nearly impossible a decade ago. Chris Murray was shocked to find that WHO estimates of deaths from different causes added to more than the total of deaths. Many countries didn't officially track births and deaths and many records reported immediate cause of death but not the ultimate cause of death (head injury, but not that it was from a car crash, for example). Murray's intensity and expertise equipped him to solve this technical challenge, but his sometimes abrasive personality made the politics of getting his results adopted equally challenging.

This book was such an enjoyable read! I loved hearing about the different challenges Murray and his collaborators faced and how they overcame them. Both the technical challenges and the political maneuvering necessary to have their results accepted made for some fascinating reading. I thought the author did a great job including just enough detail (technical and political) to keep me interested without getting bogged down. The amount of personal information he included about the different people involved with the project was a similarly successful balancing act. I was invested in every aspect of this story.

Personally, I enjoy doing science in large part because of the opportunity it provides to make a difference in the world. Perhaps as a result, I found this account moving even though it wasn't written particularly emotionally. I empathized with and admired Murray's drive to get the right numbers because they could be used to improve people's lives. I loved hearing about the actions that were taken as a result of his work. If you enjoy statistics, definitely pick this up. If you're interested in health care and equality of access to health care around the world, but not statistics, pick it up anyway! It's an accessible read full of interesting and surprising information.This review was originally posted on Doing Dewey

[Mayur Bhanarkar · Rating 5 out of 5]

A masterpiece emphasising on the bigger picture of health care. A must read for each and every medical student in India aspiring to become specialised doctors and all they think about this profession is having a superspeciality degree. There's more beyond saving one life being a specialist. The tagline ,'ONE DOCTOR SEVEN BILLION PATIENTS' is a true inspirational justification to the book.How it tells that spending the most of their GDP doesn't give you the topmost rank amongst all the countries with respect to their Health care standards. How one, crazy, dedicated doctor striving to change the entire picture of global health and how one should have a real adventure untill and unless you've reached your physical and intellectual limits. Being in a medical school we often do not emphasize more on statistics but this helped me realise the importance of statistics and how one can execute and modify health care policies for specific regions and countries. I wonder how Bill Gates realised the importance of statistics posed by Dr Murray and sponsored IHME and at the same time WHO failed to recognise it. Or were they in a state of denial? Quite strange.

"Everybody does a better jobs when they have a notion of being in a competitive world"

[Carine · Rating 5 out of 5]

Fantastic read for anyone interested in global health. The story of Chris Murray, the single-minded health economist's journey to create a map of global health problems -- what kills us, what ails us --in a way that can unequivocally translate into policy and impact. Reads like a novel.

[Paul Comeau · Rating 5 out of 5]

Good read overall... nice mix of both Christopher Murray's background, what he set out to do, and how he did it...

[Heather · Rating 5 out of 5]

Dr. Christopher Murray had an unusual upbringing. At 10 years of age, he was living in Diffa, Niger where his missionary parents were running a clinic. Chris and his sister Megan and brother Nigel were all put to work at the clinic, where 10-year-old Chris found himself working as pharmacist and errand boy.

While there, the family made the discovery that the malnourished seemed almost entirely free of "malaria and common viral illnesses", yet days after being given food and medicine these same people would become horribly ill from those same illnesses they appeared free of just days before. The family theorized that the virus was as dependent on iron as humans, and the fact that these malnourished people had anemia left the virus starved and spent. Once they were on a healthy diet, including iron, the virus thrived. So food and vitamins could kill these people, if the virus was left untreated!

The family (minus young Chris, who was too young to have participated in the study) published an article about their findings in The Lancet on March 22, 1975.

It was experiences like this that led Chris Murray to conclude: "Conventional wisdom can kill."

Murray went on to attend Harvard in 1980, and was chosen as a Rhodes scholar his senior year. It was while on tour of the World Health Organization (WHO) in 1985 that he found himself awed by the same organization he would one day challenge. Murray would later introduce himself to Alan Lopez of WHO and tell him that "...everything you've written about mortality in Africa is wrong". Murray and Lopez would go on to become friends and co-founders of the Global Burden of Disease Study, which would turn the world of epidemiology on its head.

The author first met Chris Murray in 2012, and he describes him as "blunt, often abrasive, hyperenergetic, supremely confident, yet fiercely collaborative", and overall just plain fascinating. He notes that Murray was argumentative and loved an open dialogue; "the push and pull of other people's ideas and willing to listen to any serious proposition, no matter the source".

Many others entered Murray's orbit and played a part in the change that came about in the world of epidemiology and continues to this day. One of those people is Bill Gates, who was impressed with Chris Murray's vision and funded the Institute for Health Metrics and Evaluation with $105 million in 2007.

I could go on and on. Chris Murray is my new imaginary boyfriend. What he does with "Big Data" makes me weak in the knees. He was behind the creation of the GBDx, which was a software platform for compiling, organizing and displaying all of the data regarding the health of the world. They can click on a country and instantly see a visual representation of all of the conditions and diseases impacting the health of the people of that country, This is exactly the type of thing I would do, if I had Murray's skills! My brain naturally wants to organize data in this manner and make sense of it. This is the type of project that I would find "fun".

My final word: I was concerned going into this that I would find this book and/or the material boring. No worries! I loved this book! I think Chris Murray is a fascinating character. He has a brilliant mind, and a knack for seeing (and convincing others) that spending some money on world health can save the world billions in the long run. Unhealthy people are a drag on society, and healthcare for all should be a priority!

The author does a great job of making this information readable. Knowing how ornery Murray can be only makes him more human to me. The author takes what could have been a very dry and boring read full of data and turns it into what almost feels like a thriller as you follow along with Murray's endeavors. Especially fitting for this day and age, I strongly suggest everyone read this one. It brings forth an important message-- and my imaginary boyfriend is fantastic in it!

[Jaina Rose · Rating 4 out of 5]

This review is also available on my blog, Read Till Dawn.

First, full disclaimer: as the daughter of a doctor and a physician-scientist, I came into this book probably with more inherent interest and familiarity with the world of research than the average reader will. I found the book very interesting (if slow and overly-detailed at times); you might just find it boring.

But honestly, I don't know how anyone could find it completely boring. It's a book about the development of a universal health measurement resource! Chris Murray's research has so much potential for helping us pack the greatest punches against illness with the most efficiency, and I think it's awesome. Is it the be all and end all of such rankings? No, as Murray himself points out, the study is too new to have all the bugs worked out. It needs competition to keep it as fresh and relevant as possible, and it needs critical eyes to find any flaws hidden in the data. But it's amazing nonetheless, leaps and bounds above any other measurements that have been attempted. Kudos to all the amazing researchers who pulled it off, and to Bill Gates for funding such crucial research.

Setting aside the amazing stuff that Murray and his peers accomplished, what of the book itself? It does struggle at times to stay interesting–especially when going through all the meetings Murray attended, all the jobs he had, all the research he did before he got funding for this main project, etc. I do think seeing the journey Murray took to publishing the Global Burden of Disease is important, though, because it gives us more insight into who he is as a person and as a researcher.

And Murray truly is a genius. He's extraordinarily passionate about his work, extremely gifted intellectually, and full of seemingly boundless energy. I think his dedication to his research is good, when it comes to the research itself and all the people it will help, but I do struggle a little bit to empathize with him much. As I said, I know lots of scientists. I've seen how wrapped up they can get in their work. Murray's wife divorced him and took custody of their three children, and they don't say why but I can only guess that a lot of that tension stemmed from him never being home. It's great that he could accomplish so much for all the sick people on the planet, and to the world he's a hero for his dedication to the cause, but I'd be willing to bet that his kids' opinions of him are far less glowing.

Ah, well, who wants to focus on the negatives? Epic Measures is an interesting, important, and well-researched book about an interesting, important, and well-researched project that has great potential to change the world. Definitely check this book out if you're interested in learning about the struggle to end human suffering around the globe.

Disclaimer: I received a complimentary copy of this book in order to participate in a TLC book tour.

[Joan Leung · Rating 5 out of 5]

While I was reading this book, I can't stop it! It is the best book in public health I have read so far!

This book is a biography of Chris Murphy, he has changed epidemiology and has influenced the life of seven billions of people. No doubt he is a public health researcher with entrepreneurship. He is a kind of crazy energy and commitment guy which you usually see in startup founders. I especially love his child life story in Africa with his family, marvellous! Chris Murray is originally from New Zealand but he grew up around the world. His parents ran a clinic in West Africa for a year. The clinic was so understaffed when they got there that Chris and his siblings had to do a lot of the work. During their time there the family noticed that malnourished people who were fed got sick from malaria. They found out that the virus requires iron to thrive. When people are starving they don't have the iron stores for their bodies to support the virus. When they are refed, they are again good hosts for the disease. The family published their findings in Lancet. This led to Chris' lifelong interest in scientific research - especially research into whether or not conventional wisdom is correct. Chris's parents gave him a very different childhood and changed his life.

After he was graduated from Harvard and Oxford, he started his career in analysis of public health data. At the World Health Organization, he found that a lot of the health data used to make policy decisions was based on numbers that were made up. He worked with another researcher to develop a genius formula that figured out the true cost of the disease in each country. He also took into consideration, not just the deaths from that disease but the damage done from a disease-causing less than optimal health in the population. I also appreciated his focus on adult health statistics and not just childhood disease. And he is also the first person considered mental health in millennium development goals.

As we all know, public health investment is also difficult and not easy to predict. In the past, most governments and NGOs using wrong/limited data decide where the most effective places to put their money are. Does it help more people to treat malaria or diarrhoea? If you can only vaccinate for one is it better to give polio vaccine or measles? Measles kills more people but if you survive it you are fine. Polio doesn't kill as many people but survivors have more disability. These are the kinds of questions that they try to answer. I found the subject matter interesting but the book got bogged down in a lot of interdepartmental politics in the middle. It picks up again at the end with ideas for living a better life based on the findings of the Global Burden of Disease study.

I loved reading it and highly recommended read for everyone remotely interested in public health, statistics and policy.

[Steve · Rating 5 out of 5]

The fascinating story of how Chris Murray – doctor, economist, adventurer, obsessive workhorse – created the Global Burden of Disease research program, mapping the causes of injury, illness and death for every person in every country in the world.

The fragmented nature of global health advocacy creates a strong tendency for aid dollars to be misspent. As examples, take malaria and, say, lower back pain. Aid groups for both have an incentive to overstate the importance of their cause, fearing an under-allocation of funds if they didn’t. In this case, malaria would likely attract more donor attention (when was the last time the sight of a pot-bellied 50-year old clutching his back and wincing brought a tear to your eye?). The achievement of the Global Burden of Disease effort was to quantify the relative severity of different ailments – to answer questions like whether it’s preferable to live 10 years with lower back pain or have your life cut 1 year short by malaria. Armed with this common unit of measurement, Murray and his team painstakingly – over many years and in the face of resistance from the global health establishment – compiled a near-exhaustive database on which ailments cause how much suffering, where, and to whom. Today, aid groups and public health departments can focus their efforts using this database as an objective guide. Turns out lower back pain is the world’s 6th largest cause of suffering (malaria is 7th).

Epic Measures is a truly inspiring tale of how an individual’s faith in and obsession with a singular, unwavering vision can change the lives of millions. It seems tragically unfair (though predictable) that Murray himself has lost so much along the way, divorcing his first wife and losing custody of their three children.

[Aaron Shulman · Rating 5 out of 5]

What if we the cause of death for every single person on the planet, as well as the health problems they experienced throughout life? What if we were able to process all that information into big data computational models in search of macro-insights that have the potential to change human health as we know it? I had never considered either of these questions before reading journalist Jeremy N. Smith’s Epic Measures: One Doctor. Seven Billion Patients. Now I can’t stop thinking about them.

Epic Measures tells the story of Christopher Murray, a brilliant, zealously driven doctor whose life mission is to track how every person on the planet lives and dies. In doing so, he has shaken up global health, making enemies in powerful institutions like the World Health Organization while at the same time winning the respect of many public health leaders, not to mention the admiration (and funding) of people like Bill Gates. His Global Burden of Disease (GBD) studies have already changed the way countries approach the health of their citizens. In the early aughts, using nation-specific GBD research based on Murray’s “belief that to know anything, you have to study everything,” Mexico was able to dramatically reform its entire healthcare system. Fifty-two million people who were uninsured now have coverage. Just as essential, illnesses that health officials previously considered unimportant have become priorities for treatment and prevention. As a result, in the span of 10 years the country nearly halved its child mortality rate.

Smith has a gift for bending complex public policy debates, statistical sciences, and global medicine into a thumping narrative about trends shaping the future.

[Liz · Rating 3 out of 5]

This book gives a nice bird's-eye view of global health. It follows physician Christopher Murray as he pioneers the worldwide tracking of not only causes of death but also causes of suffering among the living. His work culminated in the establishment of the Institute for Health Metrics and Evaluation, which does have a pretty cool interactive website. I was sort of perversely happy to see neck pain acknowledged because I’d been feeling pretty alone in that, and apparently I’m far from it. It’s pretty mind-boggling that until a couple decades ago, no one investigated worldwide ailments or even kept reliable records on cause of death.

Still, I’m not totally convinced there was enough material for a full book here. The opening chapter about Murray as a child helping out his parents in a clinic in Africa was not only engrossing but also effectively illustrated the points the author wanted to make about the gulf between philanthropist’s visions and actual reality. Unfortunately, it was the most concrete section by far. Most of the rest dealt with very macro stuff like dealing with bureaucracy, funding, and politics. I guess it was inevitable that Murray was going to have less one-on-one work as time went by, but it doesn’t really make for a good story.

There was enough to keep me reading, though. Maybe I’m just nosey, but seeing which afflictions plague which countries is interesting. Once Murray’s numbers started getting published, countries’ reactions were also interesting – some got defensive, some pushed for reform, some did nothing. Murray himself was also one of those tactless obsessive dynamos, so his interpersonal relationships, both professional and personal, were fun to follow as well.

So yeah, solid 3 stars.

[Nicolas Name · Rating 4 out of 5]

The main point in this book is that Dr. Chris Murray, a doctor and economist who specialized in global statistics on health data, who created a new metric called the “burdens of disease”, which looked at years of life lived without disability, with each disability coded for how disabling it is. It essentially tried to mathematically figure out how best to improve the healthcare system of the entire world, with region specific recommendations, from what the United States, Cuba, Canada, Angola, and so on can do to better improve their respective healthcare system, in particular their policies, and what their current main health issues are, and what their potential fixed could be.

It was funded by Bill Gates through a grant from his foundation. The work itself seemed very interesting, but I think the book wasted too much time trying to talk about how cool and interesting Dr. Murray was and is. That’s not relevant to the story and it’s not what makes his work important. The book could have been a perhaps 1/5 shorter without those passages, that get repetitive after a certain point.

That said, it’s an important book, and knowing more about international healthcare metrics is a topic that I didn’t expect to be as intellectually intriguing as it seems. It’s a topic I’m interested in exploring further in more detail, if the opportunity ever arises.

[Jeet · Rating 4 out of 5]

"This book is the story of a huge independent effort, years in preparation, to do nothing less than chart everything that threatens the health of everyone on Earth."

A profile of Dr. Chris Murray, who made it his mission to count the diseases that afflict humans and figure out what are the greatest causes of illness and death.

In the vein of Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World, this is equally the story of a physician-scientist as it is the mission he undertakes. It chronicles Dr. Murray's background in global health to his ultimate health measurement work, supported by the Gates Foundation. I had never heard of the Global Burden of Disease project, but now learning about it makes it seem like one of the most important projects humanity could undertake. I felt excited while reading this book because of how it makes the seemingly insurmountable obstacle of beating death more tangible.

[Nandita Damaraju · Rating 5 out of 5]

A great read about a phenomenal effort to quantify the health of the world. To actually accurately represent the health of the world in numbers is a not only daunting task, but is extremely crucial for policy makers and agencies for appropriately allocating resources. A country could be spending billions of dollars treating cancers, when lower back pain probably causes the largest burden on the population. I think this quote accurately sums up the book. “You could solve humanity’s most pressing problems, Murray believed, once you recognized them.” I am in complete awe of the efforts that led to the Global Burden of Disease Project by Chris Murray and his team at the Institute for Health Metrics and Evaluation. A highly recommended read for everyone remotely interested in healthcare, numbers and policy.

[Romain MARQUER · Rating 5 out of 5]

Health is about living a long and healthy life. The best health indicator is “Healthy Life Expectancy”, not just “Life expectancy”. Public health decisions require a targeted understanding of illnesses that cause years of life lost (early deaths) and years of life with disability. The book tells the story of how one comprehensive study on public health data - directed by Chris Murray - saved millions of lives and redirected billions in public health investments. It challenged and defeated bureaucratic headwinds and other partisan interests that stood in the way of truth and science. The book made me realise public health policy isn’t always driven by accurate information. It also shows that one man and the hard work of a team of dedicated researchers can stand their ground against some of the world's most powerful health institutions, and change the world for the better.

[Jonathan · Rating 4 out of 5]

If, like me, you studied public health in the last 15 years, you might take it for granted that many of the ways that we think about measuring and setting targets for health globally are actually quite new! These include the MDGs/SDGs, the global burden of disease, QALYs/DALYs. That also means that many of the people in this book are our contemporaries, like Chris Murray, Julio Frenk, Bill Gates, etc.
Recommend this book for anyone who wants to understand how politics impacts measurement/reporting of disease -- better reporting means more efficient allocation of funds, which means some groups will lose money and therefore influence. Also highly recommend this for recent public health graduates that want to take a deeper dive into the recent history of monitoring and evaluation.