Questioning our enchantment with high technology

[Fall 2013 Centennial issue]

After spending more than 25 years as a doctor—eventually becoming physician in-chief at Boston’s Beth Israel Hospital— Howard Hiatt knew firsthand the limitations of U.S. health care: a penchant for expensive, high-tech treatments, lack of rigorous evaluation of new clinical procedures, growing numbers of patients excluded from the system, and a failure to emphasize prevention.

When Hiatt became dean of Harvard School of Public Health in 1972, he saw an opportunity to address those shortcomings. Transforming the School’s Departments of Biostatistics and of Health Policy and Management, he made public health the conscience of medicine. Immediately after his appointment, Hiatt founded the Faculty Seminar in Health and Medicine, a biweekly group of more than 100 researchers who looked at public health through an interdisciplinary lens. And through a series of faculty appointments, he imported powerful new research tools and methodologies of molecular biology and the quantitative social sciences into the School’s traditionally strong research on tropical diseases, cancer, toxicology, and environmental disease.

“Many [health care] problems had not only biological and clinical basis, but political and economic … and historic underpinnings,” Hiatt told the Harvard Public Health Review in 1997. Hiatt’s efforts to broaden the School’s research portfolio—to include assessment of medical procedures, clinical trials of treatment drugs, and analysis of the economics of health care systems in the U.S. and abroad—are now seen as visionary. But some faculty members at the time resisted what they viewed as an unwelcome departure from the School’s historic trajectory. Among other issues, they didn’t think public health should be the “watchdog” of medicine. In 1978, they called for Hiatt’s resignation, in a letter to Harvard’s then-president Derek Bok.

But Bok strongly supported Hiatt, who continued to reshape the School’s focus until stepping down in 1984. Hiatt currently serves as associate chief of Brigham and Women’s Hospital’s Division of Global Health Equity.

Madeline Drexler