Gabriele Amersbach
Finding out ways to keep people healthy has always been the ultimate goal for Meir Stampfer, the newly appointed chair of the School's Department of Epidemiology. Even as a medical student at the New York University School of Medicine, Stampfer points out, "My interests were always in preventive medicine, so initially I considered a career in ob/gyn, with its emphasis on keeping mothers and children healthy." Yet he soon found that every area in clinical medicine emphasized diagnosis and treatment. "My interest was in preventing disease in the first place, not patching things up when they're broken," he explains. "When I stumbled across epidemiology in my fourth year of medical school, it was clear that through this field I could learn more about how people can stay healthy in a scientific, rational, reasonable way--and it's still clear."
Stampfer's passionate interest for the field quickly grew. With reluctance, he entered a clinical internship but was greatly inspired during a year of training in Community Medicine at Mount Sinai School of Medicine in New York where he studied with Irving Selikoff, an expert in environmental hazards, especially asbestos. "I knew then that I needed formal training in public health," says Stampfer. As soon as his wife Claire finished her preliminary medical training (she is now a rheumatologist in private practice), they moved from New York to Boston so that he could study at the Harvard School of Public Health in what would become a long-term association.Stampfer received both his M.P.H. (1980) and his D.P.H. (1985) in epidemiology at the School and joined Harvard's medical school faculty in 1982. The timing was, in his words, "fortuitous since I had the opportunity to work with Frank Speizer and Walter Willett."
Stampfer would be able to play a pivotal role in four major longitudinal studies, conducted under the auspices of the School and the Channing Laboratory of Brigham and Women's Hospital, that have helped to transform America's diet and lifestyle choices. He is a co-investigator in the first Nurses' Health Study, which was begun in 1976 and enrolled 121,600; the second Nurses' Health Study, which enrolled an additional 116,100 nurses; the Physicians' Health Study of 22,000 U.S. doctors; and the Health Professionals Follow-Up Study, which enrolled 51,520 men from the health professions. In these studies, the promise of epidemiology he first glimpsed during his last year at medical school has been realized. "To prevent diseases," Stampfer emphasizes, "we have to distinguish what we really know from what we think might be--as well as from what we hope is true." He explains that the biggest strength of these studies is "the unmatched combination of large numbers of people enrolled with scrupulous attention to accuracy of the data, repeated measurement, and long-term follow-up." This rigorous research has led to concrete findings that have the potential to prevent disease in millions.
Stampfer is unabashedly enthusiastic about the potential impact of these findings: "We have enough information to make heart disease--the number one killer in America--a rare disease." The "capstone" of his research was the recently published "Primary Prevention of Coronary Heart Disease in Women through Diet and Lifestyle," (New England Journal of Medicine, July 6, 2000) that noted nurses who followed five moderate health guidelines had 82 percent less heart disease: they avoided smoking and obesity (body mass index under 25); ate a healthy diet; engaged in moderate-to-vigorous physical activity--like brisk walking--for at least half an hour per day; and drank at least half of an alcoholic beverage per day. Asked to elaborate on other findings from these studies, Stampfer is quick to cite the work of his colleagues--from Eric Rimm's work on the link between moderate alcohol consumption and lowered risk for heart disease and Lisa Hines's study of the impact of genetic variations on that link, to Francine Grodstein's work with cognitive decline as the nurses in the study reach their 70s. "There may be lifestyle patterns that can help people maintain cognitive function as they age--what could be more important and exciting than that?" he asks.
Stampfer emphasizes that this kind of rigorous research must be the basis for any national health recommendations. "In the past, well intentioned individuals rushed to offer simplistic sound bites often based on weak evidence. When nutrition specialists mistakenly recommend eating more fiber to prevent colon cancer or advocate reducing all fat consumption, it undermines our credibility and confuses consumers," he says. Stampfer sees the epidemiologists working with others to lead the charge to implement scientific findings. "One of the major strengths of the School of Public Health is that we don't have to stop with the findings from basic epidemiology," he explains. "We have outstanding Departments of Health and Social Behavior and Health Policy, for example, to help move findings into implementation, both on a community and a national level." Stampfer has already begun some "implementation" by requesting a shower for his floor. "It's in my contract," he quips, noting that it's essential to make it easy for people to adopt a healthy lifestyle--like exercising at lunchtime. A firm advocate of leading by example, Stampfer bikes to work and has already picked out the perfect spot in his office for a stationary bicycle.
Stampfer's quest for sound science as the foundation of all health recommendations has led to a prolific career. In 1999 the Institute for Scientific Information identified him among the "Most-Cited Researchers in Clinical Medicine 1981-98"--he is ranked #1 in epidemiology and #3 overall. He sits on numerous editorial boards and has won many awards and honors, including the 2000 John Snow Award from the American Public Health Association. In 1998 he was appointed to the U.S. Dietary Guidelines Committee and currently chairs the NIH's epidemiology and disease control study section. Yet, despite these achievements, his response to his appointment as chair is typically modest: "This wasn't something I planned for or sought out," he points out. "The epi department was extremely fortunate in its former chair, Alec Walker, who did a lot to boost morale and revitalize it."
In steering the department into the new century, Stampfer plans to "maintain the high standards Alec set" while he works to expand the department, especially in the areas of infectious disease epidemiology and neurological degenerative diseases--like Parkinson's, MS, and Alzheimer's--that are particularly hard to study in a case-control design. "You can't ask someone who's demented about their exercise pattern 20 years earlier. Now, with advances in basic science and genetics, we can learn more about the antecedents of these diseases," he explains. "These initiatives will supplement our traditional focus and strength in cardiovascular research and cancer epidemiology." Any expansion within the department must overcome the School's severe space limitation--a major challenge. As he contemplates his career, Stampfer acknowledges it offers a very different source of satisfaction than when one practices medicine: "You see single patients, they get better, they're happy, you're happy. In public health, we don't actually have the gratification of identifying the people whose disease we prevent, but there's enormous satisfaction in moving from basic discovery to seeing disease rates go down. Epidemiology is the first step in that transforming process."
Harvard Public Health Review Winter 2002/text version
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