Profile: Health detective’s daily duties not for the squeamish

A page of a “Far Side” calendar is thumb-tacked onto the bulletin board in Craig Roberts’ University Health Services office.

On it, a large group of bacteria is lined up outside a movie theater, waiting to buy tickets to see “It’s a Mad, Mad, Mad, Mad, Mad, Mad Intestinal Tract.”

For most people, the cartoon is good for a laugh. For Roberts, it’s a living.

As an epidemiologist serving as UHS’s chief expert on public health and sexually transmitted diseases, he routinely deals with illnesses and outbreaks that bring out all of the worst parts of the intestinal tract — not to mention various other unpleasant fluids secreted by the human body.

A conversation about his job can wander from the dangerous and exotic — the possible ways that UW–Madison tailgaters contracted E. coli O:157 from animal feces — to the routine, such as how a spike in a certain strain of genital herpes among students seems to be related to oral sex. Needless to say, some of the topics aren’t for the squeamish.

Unlike television shows such as the old “Quincy, M.E.” or more recently “CSI: Crime Scene Investigation,” it’s relatively rare that Roberts goes out in the field to scrape up traces of bacteria. Although he spends time each week providing clinical services to students with concerns about STDs, the bulk of his epidemiology work is conducted through computer data research or “shoe leather” investigation on the phone.

“He’s not exactly wading through stuff in hip boots,” says Scott Spear, director of clinical services and Roberts’ supervisor. “He’s one step removed from that. But to Craig, everything’s like a puzzle. He’s always looking at what caused (a particular disease) and how it all might be linked together.”

A Madison native, Roberts attended UW–Madison and graduated in 1981 with a bachelor’s degree as a physician assistant. A P.A., as the job is known, sees patients and handles roughly 80 percent of a typical doctor’s duties.

Stints at a clinic for migrant workers in Wild Rose, Wis., and at the former Madison General Hospital (now Meriter), directed Roberts’ career toward public health. In 1983, he began working in the famed Blue Bus STD clinic, duties he still holds today.

“Today’s climate (for STDs) is a lot different than when I started,” he says, noting that “there’s hardly a party I go to when someone doesn’t ask me about STDs.”

“Things aren’t perfect, but this generation has grown up in the age of AIDS, and there’s a lot more condom use,” he adds.

His interest in disease led him to enroll in the Department of Population Health Sciences master’s program in epidemiology, essentially the study and tracking of community health and illnesses.

These days, the bulk of his work relates to crunching UHS data and statistics, searching for patterns that could indicate the presence of a disease or health trend. But that’s not the work that’s splashed Roberts on the front pages of newspapers or the opening of newscasts.

In a dozen major cases since 1990, he’s been the first to receive the news that students have become seriously ill as a result of diseases such as meningitis or gastroenteritis caused by salmonella or E. coli.

Typically, a serious situation unfolds with Roberts being tipped to a suspicious case. He works with primary-care providers and city and county officials to confirm it, and then assesses the scope of the outbreak. Soon after, he begins the process of trying to find out how the victim was exposed and who else might be at risk.

Meningitis, which has claimed the lives of two UW–Madison students in the last decade, is one of the most serious diseases because research still hasn’t shown why some people seem to be at greater risk. Although the nature of the disease tends to cause a fearful reaction on campus, meningitis is less communicable than many other illnesses, he says.

The most recent “drop everything” case took place last fall, when it became apparent that E. coli O:157 had infected a number of people attending a football tailgate party at the UW Stock Pavilion. With 35 people experiencing abdominal pain and bloody diarrhea, Roberts says it was the most important case he’s handled.

Spear says Roberts’ low-key demeanor helps him excel at the public information aspect of his job, making sure that students and the community receive accurate information that doesn’t exacerbate a difficult situation.

“In dealing with a number of public health crises, and the accompanying media hysteria, Craig has been always been a calming influence,” Spear says. “He’s a good spokesman, and he doesn’t inflame a situation. These cases can be extremely serious, but they’re not usually issues the entire public needs to get excited about.”

Some of his detective work yields important findings. For example, an article about the investigation of a 1999 campus outbreak of Norwalk-like viral gastroenteritis was published by the Centers for Disease Control and Prevention. But other cases don’t always wrap into a neat package with clear-cut answers.

Although the university is taking steps to prevent a future instance of E. coli infection, the ultimate cause of the recent cases will probably never be known, Roberts says. Victims came in contact with bacteria on the Stock Pavilion floor, but neither the source, nor the method of transfer, can be determined, he says.

“We don’t always find out how a particular bug got into a body,” Roberts says. “Like detective work, there are unsolved cases. But we do learn enough to know what to do to prevent something from happening again in the future.”

Roberts has one piece of free health advice: Wash your hands frequently. Hand washing is the single most important preventive behavior for the transmission of many infectious diseases.

“Maybe a dozen times a day,” he says of his own hand-washing habits. “But don’t write that.”