[ Winter 2011]
We asked this year’s winners James Dalen, Fernando Guerra, Lynn Rosenberg, and David Schottenfeld: What do you know now about improving the public’s health that you didn’t when you started out in your career?
“The people are ahead of their doctors.”
In 1970, I was an assistant professor at Harvard Medical School and director of the cardiac catheterization lab at the Peter Bent Brigham Hospital. I was doing all the things you’re supposed to do: writing papers, getting grants. But I was bored, because I was doing the same thing every day. I felt isolated from what was really going on in the world. I enrolled at HSPH.
The Harvard School of Public Health changed my whole orientation toward medicine. I continued to be a cardiologist, but instead of being an invasive cardiologist, I focused on preventive cardiology.
One of the reasons that U.S. health parameters are so poor is that we don’t emphasize prevention. That ties in with one of my strong interests: integrative medicine, which combines conventional allopathic medicine with some unconventional approaches. I’m a conventional physician. I’ve had conventional training, conventional schools. So why am I a supporter of integrative medicine? For two reasons. One is that integrative medicine is all about prevention. The second is that I have a master’s degree in psychology, and the mind/body connection is pretty obvious to me.
In the field of cardiology, we have recently discovered that people who are depressed are more likely to have heart attacks. Well, that’s not rocket science. Laymen figured out this kind of connection 20 years ago. Nearly 50 percent of all Americans now go to unconventional therapists—chiropractors, acupuncturists, nutrition therapists, massage therapists—in addition to their physicians. But they don’t tell their physicians about it, because they think their physicians will say, “Don’t do that.” The people are ahead of their doctors.
- Currently professor emeritus of medicine and public health at the University of Arizona.
- From 1988 to 2001, served as dean of the University of Arizona College of Medicine.
- Established MPH programs at the University of Massachusetts at Worcester and the University of Arizona, and helped establish a college of public health at the University of Arizona.
- In 1972, became Harvard’s principal investigator of the Multiple Risk Factor Intervention Trial, aimed at decreasing risk of coronary heart disease by controlling key risk factors for the disease.
- In 1999, helped found the Consortium of Academic Health Centers for Integrative Medicine.
“Be creative, be a risk-taker, be adventuresome.”
I was sent to Vietnam as a partially trained pediatrician. I became a battalion surgeon with one of the combat units. I was also responsible for working in the villages of the Vietnamese people—and I saw conditions that I thought I would never see again: plague, tuberculosis, any number of infectious diseases, and other life-threatening illnesses. Even at that time, I recognized that these conditions could have been prevented with investments in infrastructure, plumbing, indoor sanitary facilities, potable water, things like that.
I came back to my own community, San Antonio, in the early ’70s. And I saw cases of classical diphtheria—right here in San Antonio, not unlike what I had seen in the Republic of Vietnam. I thought: this just shouldn’t happen. Public health has to do better.
But public health cannot improve conditions by itself. Government policy, economic development, education are crucial. When you look at countries that have made incredible progress—Singapore, for example—they incorporate changes in the social welfare system, education, economic development, and political leadership.
A career in public health is an opportunity to be creative, to be a risk taker, to be adventuresome, to enjoy intellectual stimulation and curiosity. You start your day feeling good about what you hope to accomplish, and usually finish the day feeling pretty good, because maybe a little bit of what you’ve done has had some benefit. Would I do it again? Absolutely.
- Currently director of health for the San Antonio Metropolitan Health District (Metro Health), the largest public health agency in San Antonio, Texas.
- In 2008, oversaw an unprecedented merger of medicine and public health. Working with Metro Health and the county hospital, integrated prevention, early detection, and continuity of care into clinical care services.
- Focuses on improving health care access for infants, women, children, and the elderly; has overseen efforts to prevent HIV infection, teen pregnancy, and vaccine-preventable diseases; has worked to prevent domestic and child abuse.
- In 1971, as a practicing pediatrician, founded the Barrio Comprehensive Child and Family Health Care Center in San Antonio.
“Be skeptical of the conventional wisdom.”
Back in the very earliest days of my career, all the epidemiologic studies and randomized trials were of men. People finally realized that there were women as well, that effects might be different in women than in men, and that women should be studied.
There is always an accepted wisdom that people might be unaware of, but which is shaping their thinking. For example, back then, the common wisdom was that female hormone supplements were a good thing, based on the fact that women get heart disease later than men. People thought: What’s the main difference between men and women? It’s female hormones.
That was the mind-set. It wasn’t easy to get a study funded to look at female hormone supplements in relation to heart disease because belief in their benefits was so strong. Although there had been studies showing adverse effects of hormone supplements, it took the Women’s Health Initiative to turn those beliefs around. Thus, if I were to give advice to someone starting out in the field today, I would say: Be skeptical of the conventional wisdom.
My research is not on behavioral change, but increasingly I believe that this is where the action should be. We know how to prevent so many illnesses. For example, we know how to prevent a high proportion of diabetes and hypertension: get people to maintain a healthy weight.
But we don’t know how to get people to change their behaviors. Our society has become toxic in so many ways: Kids go to school all day and don’t have a recess where they can exercise, some areas are too unsafe for people to go out for a walk, and people live in neighborhoods where they don’t have access to decent foods or can’t afford to buy them (and some of the worst foods are subsidized by our government). In my view, more work should be done on how to effect institutional changes that would help rather than hinder individual behavioral changes.
- Currently associate director of the Slone Epidemiology Center and professor of epidemiology at the Boston University School of Public Health.
- Principal investigator of the Black Women’s Health Study, which aims to elucidate the causes of breast cancer, other cancers, diabetes, lupus, and other serious illnesses, many of which occur disproportionately in black women.
- Conducted studies that established a link between oral contraceptives and heart attacks in female smokers, suggested that alcohol consumption increases the incidence of breast cancer, and tied aspirin to decreased incidence of large bowel cancer.
“Never stop being a student.”
From my vantage point, I’ve always been very curious about disease mechanisms and understanding causal pathways. You can’t proceed on the basis of what you knew 20 years ago. I’ve come to appreciate how complicated human biology is, and how necessary it is for each of us to be well schooled in the fundamental disciplines of human biology, pathology, molecular sciences, human genetics, and of nutrition in health and disease.
The long-lasting thing that I learned at HSPH was to be a critical thinker. It was more of an attitude than a body of knowledge, because the body of knowledge was going to change dramatically over time. It was stimulating for me to take the knowledge that I had in medicine and human biology, and the attitude we have in medicine—which is really a one-on-one, Good Samaritan approach—and look at the impact I might have on the population burden of disease.
If I had to encapsulate what my life has been, it’s that — not to sound corny, but it’s been the joy of learning and never stopping being a student, while at the same time being a teacher, a mentor, and hopefully a leader. Even though you may reach retirement age or become emeritus, if you still have a passion for what you’re doing and the energy to pursue it, you shouldn’t stop.
- Currently John G. Searle Professor Emeritus of Epidemiology and professor emeritus of internal medicine at the University of Michigan School of Public Health.
- From 1959 to 1961, served as a commissioned officer in the Epidemic Intelligence Service at the Centers for Disease Control and Prevention.
- Research interests have included epidemiologic studies of breast, endometrial, prostate, testicular, colorectal, and lung cancers, and of the epidemiology of second primary cancers.
- In 2007, received the John Snow Award from the Epidemiology Section of the American Public Health Association.