Labor Day weekend 2011 marks thirty years since I ventured from Brisbane, Australia and arrived in Boston to begin my studies towards a Master of Public Health, and hopefully gain admission to the doctoral program at the Harvard School of Public Health. Mentors in the Department of Social and Preventive Medicine at the University of Queensland counseled me to pursue this training and to do so at Harvard as this would give me strong grounding in methods and approaches to prevention at the population level. The population level of health had been a strong influence on my thinking as a medical student with such Australian leaders as Douglas Gordon teaching on principles of community education to advance the uptake of Pap smears. His seminal book was published while I was a medical student and emphasized the need for precision and critical thinking in public health epidemiology. (see: Health, sickness and society: theoretical concepts in social and preventive medicine Gordon, Douglas St. Lucia, QLD: University of Queensland Press, ) With support from mentors I obtained a Knox Fellowship to study at Harvard and a Fulbright Postgraduate Student Award (covering my air fare).
Summer research projects during medical school allowed me to have hands on experience in data analysis, writing and presenting research findings. Projects included analysis of data on hypertension and response to surgery for renovascular hypertension (Professors Richard Gordon and Gordon Clunie); and analysis of pathology records with Dr J. J. Sullivan to document age and gender trends and incidence of keratoacanthoma in renal transplant patients who show more aggressive forms of this premalignant skin lesion. 1
Medical education was a topic of substantial interest leading to engagement in national and local student politics and curriculum committee activity within the medical school.2-4 I also served on the Committee to Review Future Needs and Medical Education in Queensland, Australia, convened by the Medical Board of Queensland.
Boston 1981 onwards
Early contacts in Boston included Fred Mosteller, who included me in the New England Journal of Medicine related project (Statistics in Medicine) leading to numerous collaborations and an early NEJM paper with John Emerson.5 Subsequent collaboration with Fred Mosteller included studies of design in medical research and the gain of innovation over standard therapy 6-8; meta-analysis (including teaching a course at HSPH)9-12 and our final major contribution, the analysis of BCG vaccine and its efficacy in protecting against tuberculosis (in collaboration with Harvey Fineberg, Mary Wilson, Cathy Berkey, Elizabeth Burdick and Tim Brewer).13,14
Upon arrival in the Epidemiology Department at Harvard School of Public Health, I indicated to my professors that I was interested in the application of epidemiologic data to policy and public health practice. Subsequently, I was referred to a group of health economists in the fall of 1981 and began work applying epidemiologic data to estimating the costs of smoking and benefits of quitting with Nancy Kelly and Gerry Oster.15 Continuing collaborations included analysis of prophylaxis against DVT,16,17 cost effectiveness of nicotine replacement gum as an adjunct to smoking cessation, 18,19 and costs of diabetes20 and subsequently of obesity. 21-24 This research allowed me to apply principles of meta-analysis and of decision sciences taught by Weinstein and Fineberg during my doctoral training.
My doctoral dissertation research focused on cardiovascular disease in women 25 and included participation in the Nurses’ Health Study research group led by Dr. Frank Speizer. This offered opportunities to gain hands on experience in epidemiologic studies, contribute to the study through understanding self-report 26-32, and opened the door to studies of diabetes33,34, stroke 35, fractures 36-38, and cancer 39,40