Three HSPH graduates will receive Awards of Merit on Alumni Day, May 17. The awards are the highest honor presented to graduates and recognize leadership, community activities, contributions, accomplishments and commitments to public health that exemplify HSPH ideals. A peer nominated each winner.

This year’s winners are Robert Hoover, ScD ‘76, D.W. Chen, MPH ‘89 and JoAnn Manson, MPH ‘84, DrPH ‘87:

	Robert Hoover

Robert Hoover, ScD ‘76
Director, Epidemiology and Biostatistics Program, National Cancer Institute (NCI)

HSPH alumnus Robert Hoover was the first researcher to epidemiologically associate estrogen replacement therapy (ERT) with increased risk for breast cancer, a finding that emerged from Hoover’s HSPH thesis work.

ERT is part of a broader attempt called hormone replacement therapy to aid the health of peri- and postmenopausal women. Based on observations made during human studies, ERT was used to protect women against developing conditions such as osteoporosis. Lab evidence showed a more complicated story, though, suggesting that ERT may also promote cancer over time.

While still a doctoral student, Hoover analyzed hundreds of medical records of patients at an ob/gyn practice in the South under the guidance of Brian McMahon, former chair of the Department of Epidemiology. Hoover found that the longer a woman remained on ERT, the more her risk for breast cancer increased. He published his research, igniting heated discussions. Observational studies since then have consistently shown an increased risk for breast cancer when women use hormone replacement therapy for more than five years. The link has not yet been demonstrated in long-term randomized clinical trials because not enough time has elapsed for such trials to be concluded.

Hoover has continued to challenge conventional wisdom. In 1989, he was part of a team that first suggested that estrogen-progestin hormone replacement therapy, thought to be a safer alternative to ERT, actually increased risk for breast cancer more than ERT did. Hoover’s findings helped launch a series of hearings by the Food and Drug Administration, beaming a spotlight on the complexities of hormone replacement therapy.

"At this point, we have much more robust data about the risks of hormone replacement therapy than we do the benefits," said Hoover. "More research is needed."

For example, he said, hormone replacement therapy was long thought to help protect women against heart disease, but recent studies indicate that may not be the case.

Hoover’s interest in hormones and cancer encompasses more than replacement therapy. He recently was awarded the Distinguished Service Award by DES ACTION USA, a national non-profit consumer organization dedicated to informing the public about diethylstilbestrol or DES.

DES was a synthetic hormone given to thousands of pregnant Americans mostly in the 1940s and 50s to prevent miscarriages. The chemical turned out to cause congenital defects and a rare form of vaginal and cervical cancer called clear-cell adenocarcinoma in women who were exposed to DES in the womb. DES research has dropped off since the 1970s, but Hoover has followed many of the women who were given DES and their progeny.

Hoover has found that DES mothers are at higher risk for breast cancer and that DES daughters are at increased risk of squamous-cell cancer of the cervix. Sons, too, may be affected: male offspring of DES mothers may be at greater risk for testicular cancer. Now, Hoover is trying to quantify the association between DES exposure and other cancers and chronic diseases.

In addition to hormonal carcinogenesis, Hoover is delving into research about gene-environment interactions, and he has worked diligently to bring together data from nearly all of the world’s biggest cohort studies. The National Institutes of Health Cohort Consortium, created by Hoover, includes the Nurses’ Health Study and HSPH’s Health Professionals Follow-up Study.

As one of their first projects, consortium scientists will try to uncover potential gene-environment interactions by combining data from prospective cohort studies involving 7,490 cases of breast cancer and 7,130 cases of prostate cancer. Interactions between risk factors and genes associated with these cancers will be studied. The collaborative effort will serve as a model for efforts to take advantage of large population studies.

"I am so pleased that we are helping change the way in which science is shared," said Hoover. "This kind of cooperation will help us if we are to ever understand the way in which genetics and the environment together play roles in diseases."

D.W. Chen, MPH ‘89
Director, Division of Human Health Sciences, Food Safety and Inspection Service, US Department of Agriculture

When D.W. Chen looks at food, he sees more than his next meal. Chen has been charged with helping to protect US food supplies, a job that has taken on new importance after September 11th and the anthrax scares of 2001.

Chen’s office provides epidemiologic and medical support to the USDA’s food safety programs and works in partnership with an array of federal and state public health and regulatory agencies to investigate and prevent foodborne diseases. Among his targets are bacteria such as E. coli, which has a potentially deadly strain called O157 H7, and emerging threats such as Bovine Spongiform Encephalopathy or "mad cow disease."

Chen also has the responsibility of planning damage control in the event of a biological or chemical attack against US food supplies. He is working with other groups to assess the country’s preparedness and emergency response capabilities in case of attack. The groups are looking at every step of the food chain, from "farm to table," examining areas of animal slaughter, processing, transportation and distribution that could be exploited.

"Our department is doing everything we can to take steps we need to prepare for events perpetrated by people with ill intent," said Chen.

Chen and his colleagues are working on surveillance systems that would help detect emerging food-related illnesses at the population level, providing officials with a heads-up that something may be amiss in the food supply. They are also working to enhance surveillance at processing plants and ports of entry and to provide coordination among various government labs to improve the ability to diagnose problems rapidly.

Prior to working at the USDA, Chen directed an office at the Health Resources and Services Administration (HRSA), US Department of Health and Human Services, which provides federal oversight of the nation’s organ procurement and transplantation system. While there, he worked with other government agencies, patient groups, physicians and hospitals to protect the fairness of organ allocation across the country. He also tackled issues such as increasing awareness of organ and tissue donation options and preventing the spread of diseases through organs and animal tissues.

Chen is a vocal advocate of linking academia and public health practice. Before his involvement in transplantation policy, he served as a deputy director in a division at HRSA’s Bureau of Health Professions that worked closely with the Association of Schools of Public Health and academia to create federal funding grants for public health practice initiatives.

He helped to draft The Public Health Workforce: An Agenda for the 21st Century, a report by the US Public Health Functions Project. The report was a milestone, developing a standardized taxonomy for describing public health occupations and changing the way in which the Department of Labor classifies the public health profession, as well as identifying training/education needs for strengthening the public health workforce.

"The diversity and richness of public health is one of its greatest attributes," said Chen, "and all in the field share the common goal of improving our nation’s health. There is no more important mission."

	JoAnn Manson

JoAnn Manson, MPH ‘84, DrPH ‘87
Chief, Division of Preventive Medicine and Co-director of the Connors Center for Women’s Health and Gender Biology, Brigham and Women’s Hospital; Professor, Department of Epidemiology, HSPH; Professor, Harvard Medical School

Two years ago, the Ladies’ Home Journal named HSPH alumna JoAnn Manson as one of the top 10 "Champions of Women’s Health" in the US, a fitting recognition for a researcher and clinician who has dedicated her career to women’s health issues.

Manson is a lead investigator of the Women’s Health Initiative (WHI), an initiative of the National Institutes of Health and the National Heart, Lung, and Blood Institute. The WHI is one of the largest intervention studies of its kind in the US, focusing on the major causes of death, disability and frailty among 160,000 postmenopausal women. Postmenopausal women today find themselves in relatively uncharted water. It is not uncommon for a woman to live 30 years or more after menopause. Manson is the principal investigator of the WHI clinical center in Boston. She has helped create the design and protocol of WHI.

Manson has been a leading advocate of the benefits of moderate-intensity exercise, such as walking, in preventing coronary heart disease and type 2 (adult-onset) diabetes, both major killers of women. She has written a book called The 30-Minute Fitness Solution: A Four-Step Plan for Women of All Ages to help women overcome obstacles to regular exercise.

She has helped pinpoint the role of body weight and weight gain in heart disease, diabetes and stroke, and she is either leading or collaborating on clinical trials testing the effects of hormone replacement therapy, antioxidant vitamins, folic acid, low-fat diet, calcium/vitamin D supplements and low-dose aspirin.

A practicing physician and endocrinologist, Manson sees patients weekly.

She has offered her clinical skills to neglected populations, having volunteered as a physician at a homeless shelter in Lynn, MA for several years.

Manson sees community efforts as key to providing lifelong health for the public and applauds measures such as providing healthier food choices in school cafeterias and creating bike and walking paths.

"Knowledge is power," said Manson. "If we can get reliable information to the public about lifestyle modifications, they can make more informed decisions about their health."