Group Interview

Quotes

Stoney Stallones

And Stoney Stallones and Bill Reeves were two professors of epidemiology there. Talk about people who can bend your mind. I think of them… I don’t remember any information or facts I ever learned from them, but I was constantly entertained, constantly stimulated. They would ask you questions that had no answers. And it was just a delightful year.

This was the PhD program at Berkeley. Stoney was my and Dar’s advisor. You don’t appreciate it at the time, but he was the epidemiologist’s epidemiologist. He was the philosopher. He made you think about what we’re doing. I mean, what are the underlying principles of what we do? It’s not really love/hate. I mean, he was just a pleasure to be around, always stimulating. But he was a mean son-of-a-bitch at the same time. He just had this mean streak and he could just rip you apart if he felt like it in one way or another. Anyway, it was wonderful, glorious… Tough professor. But at the same time delightful. (pg. 6)

Off to the Epidemic Intelligence Service

So I got to the EIS officers recruiting meeting in the spring and we’re sitting around a big room – all the new recruits – and Alex [Langmuir] is basically assigning people to different tasks and he looked at me and said, “You’re going to be assigned to the Diarrhea Investigation group here in Atlanta, Georgia.” I said, “But I understand I am going to be working with Jacob Brody in Alaska.” He retorted: “Come to my office.”

It seems like 15, but it’s probably 5 minutes of just reaming me out by saying, “Listen, I’m in charge here and you come here and you do what we say or else you get up and walk out the door.” I said, “I guess I’d better walk out the door.” This is not a good way to start out. So I got up and I left.

[ed. He wouldn’t speak to me for about three or four meetings that he would show up after that. But finally, I gave a paper – I think it was on ALS in Guam or something and he finally came up and said, “That was good.”] (pg. 5)

I got back to Berkeley and I said, “Stoney, I don’t think I have a job anymore in the PHS.” “Wait a second, ” he said. He called Murray Goldstein who was the Associate Director of the Neurology Institute and Len Kurland was the Director of Epidemiology. And five minutes later I was a neuroepidemiologist. All this talk about planning your career! (pg. 7)

Shangheid in the South Pacific

We woke up the next morning [after a celebratory meal on Palau] and Stoney looked at Dar and me and says, “Really glad you two have signed up to go to Texas with me.” So somewhere in there we had been offered jobs at the new School of Public Health in Houston.

DL: And apparently had accepted.

DR: And accepted!

[Laughter]

HB: Shangheid I’d say.” (12)

Migrant Studies Era

DR: This was the period of strong interest in the effect of migration, especially from a low-risk to a high-risk or vice versa kind of thing. There were several studies going on at the same time along those lines – migrants to Australia and studying some of the South Pacific countries.

DL: Ian Prior was doing work in the Tokelau’s and the Cook Islands. John Cassel was very much interested in the work that was going on. There was a guy named Patrick who was with John Cassel.

DR: So that was the red hot item at the time, the influence or whatever you want to call it, migration and acculturation.

HB: And not the genes?

DR: Well, I think that was really one of the strongest things to come out of some of these studies, that whatever the genetic influence on this, the culture, environmental effects of what you eat and what you do are much stronger, two or three times. These have served as models and these papers, these reports, these data have been used over and over in lots of different ways in meetings that you’ve done and books. (pg. 14)

The Psychosocial Factors Era

DL: The meetings of the Council on Epidemiology around this time, the late Sixties and early Seventies, in my recollection frequently had reports from John Cassel, Len Syme, Leo Reeder, Larry Hinkle, others who were working on some of these ideas about social and cultural change and discontinuities. There was a whole litany of concepts of these things that to a large degree seems to have disappeared until the recent resurgence of the idea of population health and so on, which may be considered a rediscovery of exactly what was going on 30 years or more before. I don’t know how you perceive that.

DR: It kind of went from these kinds of broad principles of ecologic and individual influences then to specific psycho-social things. The social support, the Type A personalities… Len Syme was just one of these pioneer thinkers. To me it was one of those cases in which really brilliant ideas are never validated by data. When Stoney left, Len basically took over as my thesis advisor. And he didn’t like the results of the Guamanian Study. He just knew that they were wrong even though we had used some of his different kinds of measures to look at things. He also had used his questionnaire in the NIHONSAN Study. I’ve always believed these things were new, creative ideas. But every time I’ve looked at them they just never pan out. So the series of three or four papers out of the NIHONSAN Study, too, showed no influence, no effect on the Japanese. And there are many reasons. Maybe it’s something that’s important. But actually, all of Len’s early studies were cross-sectional studies. And all the things we did later were prospective and they found nothing.

DR: [And] again, [the Type A issue], that’s another example of something which under the juggernaut of time did not pan out. (16)

HB: Talk a little bit more about the Stoney/Texas era.

DR: This was Stoney’s “blossoming.” He spent so much time sitting back and saying, “What should a school of public health be? What shouldn’t it not be?” And he wrote some very nice papers along those lines that public health is not only taking care of poor people, the traditional ideas. I don’t know where he got the idea of a matrix – a university based on a matrix – rather than having specific courses (biostatistics, epidemiology, environmental health). To have those people with those talents and have those courses, but to have the focus of the school being problem areas. So you could have international health as a problem area. What are the major important aspects, problems? Urban health. What are the major health problems of people living in cities?

So he designed, you can fill in some of the five or six different major problem areas. The problems areas go this way in the matrix, disciplines going that way. So each problem area group, which would be the central way of organizing the school, would have an epidemiologist representative, a biostatistician, an environmental health person, a health administrator, a health promotion type. And this was immediately attractive and it was just so much fun coming into a new innovative situation like that. (17)

HB: Not directly relevant, but what would you say about the permanence and fragility of institutions [including Stoneys’ Texas]?

DR: What it gets down to is the idea if an organization is built around an idea versus the energy of an individual person. In which case, I think, the School of Public Health was Stoney’s genius and his energy and talking people into things that kept that going for all that time. But I don’t know, up until the time he died, I guess it was still strong.

DL: And, in fact, continued past the transition to a new dean who came with a very traditional view of academic organization and worked very hard to convert the school to his model and lost. The faculty was sufficiently wedded to the distinctive character of this academic program that the new dean was not able to make the change and that issue continues, basically on Stoney’s model. It, of course, is less than a perfect realization of the idea. There is a gravitation of the faculty in one discipline into one problem area. So it is no longer as balanced as it was when faculty were recruited to fill a niche in the matrix. But, basically the idea of a non-departmental organization as the ideal of professional training in public health has survived there despite transition to a dean who was very strongly opposed to it. How it will fare in the still longer term, I don’t know. But this is 35 years now since the start of the experiment. (18)

NIHONSAN

HB: We’ll get the story from Abe Kagan’s book and from Abe, but any particular insights you both have on NIHONSAN? I understand it might have been a senstive issue in Stoney’s life.

DR: Stoney was involved in that. A real brief description: When Abe Kagan was in Framingham, I don’t know if it was Yano, but some Japanese cardiovascular clinician, I think, came through there and was talking about how there was no heart disease in Japan. But he thought he had seen some people with heart disease in Hawaii. It was just some casual remark. Abe got together with Dawber. Who was the head of the epidemiology program at the Heart Institute? So we’re talking about probably ’62-63. I think it was Bill Zukel.

Anyway, there was a meeting and they were just talking about this remark and what does that mean? And Stoney was called in as an advisor for this little get-together. We’ll have to go back and look and see what Abe’s recollections are about where the original idea ….. Oh, I remember. A couple years earlier, probably ’59 or ’60…. What was his name? [Tavia Gordon] The biostatistician who worked at Framingham who published a paper looking at mortality rates due to cardiovascular disease, the broad category of cardiovascular disease in Japan.

[The paper was about] Deaths in Japan, Japanese men in Hawaii, and Japanese men in the U.S. This neat step down. The highest rates in the U.S., the middle in Hawaii, and lowest in Japan. Japan has always had the lowest mortality for cardiovascular disease of any country in the world, probably even today but certainly back in the Sixties. And it was decided to have a Framingham-like contract. Not a grant, but a contract to set up a study to look at this. So they would fund a survey and I believe they were going to be Framingham models from the very beginning of prospective studies. But at least they were going to look at cross-sectional studies.

They chose at that time the ABCC population within the 100,000 or so people who were being watched by ABCC for radiation effects of the atom bomb. They had a healthy adult group of people who were more than two kilometers away from ground zero and actually most of them further than that. It was kind of a comparison group. They would choose a sample of those people – same age – and they had 2,000 people there. They would get a sample of Japanese men in Hawaii and Japanese men in the San Francisco Bay Area.

Stoney designed a lot of this beginning stage but about the time he left. . . I guess the original surveys had just been started here. . Len Syme took over. And Abe Kagan went to Hawaii to start that one. The ABCC always had an American director and a Japanese director . . . It started in 1965 through ’68. I started about a year later here in the Bay Area. . .with the same protocol; the questionnaire was translated into Japanese and every place could have their choice. We were just going over some of the things today of Framingham – smoking, alcohol, physical activity – all these things, standard Rose chest pain questionnaire. Pretty much everything was the same [as Framingham]. So Abe was there and he ran that . . from about ’65 to ’79 until he retired. In’79 I joined. Michael Marmot’s PhD thesis was to look at data sitting in Berkeley. He just took the existing data and analyzed it. (pg. 19)

The first series of [NIHONSAN] papers – Stoney’s important role was designing and getting these things started – his name was not on any of the first five papers in the American Journal of Epidemiology.

DL: 1976. There were five or six papers. There was the basic methodology and the initial survey findings.

HB: But why?

DR: Who knows? But it was a major breach of friendships and etiquette.

DL: He was very bitter about that.

HB: That was inexcusable behavior. Nobody is ever hurt by giving everybody credit due. (pg. 21)

A Sense of History

This is one of the reasons that I think this [CVD Epi history] project is so important. I think there is a genuine loss of the sense of history without which much of the joy and pleasure in what we do is lost and it’s not transmitted or propagated by the people who are coming along behind us. (pg. 27)

Some of the Joy is Gone (as Director of the Hawaii Heart Study)

DL: Not only the experience he had [Abe Kagan] as director of that program for what must have been 12 or 13 years – the Honolulu Heart Program—but he also in that position had a transition in his relationship with NHLBI in whose employ he took that position. And as the administrative organization changed, the degree of latitude he had as director and investigator and so on was… progressively narrowed in ways that made it, I would guess, just impossible for him to stay in that position because of changes in the Institute policy and personnel.

HB: Darwin and I have particularly felt the damage to the spirit of the field, if not to its substance, of the increasing control from federal staff… Could you just say a word about that in terms of your ability to be a PI in Honolulu and how they do it and how they justify it?

DR: …I was a contract officer. I was an employee of the Institute.

HB: That’s fine, but still you are the PI…

DR: Just like Framingham.

HB: Still, loss of control in a lot of decisions?

DR: It was the best job I ever had. First of all, 5000 miles or maybe almost 6000 miles, makes a lot of difference. From Bethesda. The first few years, four years, I had a most wonderful boss, Manning Feinleib. I first met Manning before I moved. He was a neighbor of Jake’s and we would sit and we’d have Stoney-style conversations about what are the principles of epidemiology. And Manning was just brilliant interacting along these kinds of lines. But Manning was a terrible administrator. He would do things like say, “Wouldn’t it be fun if we knew something about stroke in blacks?” And there would be people sitting around a room and he’d come back a week later and say, “Where is that report I asked you for on strokes?” People were unhappy because his communication was on the intellectual level.

But he’s a brilliant guy and we just worked wonderfully together. He may have made two requests during that four year period. One, he wanted to have a Pacific-wide meeting on cardiovascular disease in the Pacific Basin. We had a wonderful meeting on Kona, the big island, just to kind of bring us all the information on what’s going on – trends, current levels, things like that. So he requested that. Did he request anything else? He wanted to give emphasis to some of these psycho-social studies, which I did when I was first there. I enjoyed that. It was a hobby. So that was wonderful. Another nice thing about it is that Hawaii was five hours different… So by 12:00 in Hawaii it was like 5:00 in Bethesda so everybody is going home. So if they had busy mornings, you just never had to talk to anybody.

My basic interaction was that twice a year I would go back to Bethesda. This was during Manning’s time and we would have once a year, either in Bethesda or in Hawaii, a peer-review group. We’d just talk about general plans. What are the priorities? When are you going to do another exam? What are the hypotheses? And he just worked with me. Then Paul Leaverton took over for a couple years after Manning. And the same thing, just a delight. Then Millicent came along and she wanted to know everything that was going and how do you decide this and things like that. But again, the combination of distance and time changes, it was still not that bad. She wanted more frequent interactions about what’s going on and she wanted to have a list of papers published in the last year and that kind of stuff.

HB: Nothing wrong with that.

DR: It was really interesting. When I accepted this job I was talking to Stoney and he said, “This will be great because you need an opportunity to be a boss of something. Just let yourself go and see what happens. It’s going to be a great experience for you.”

And so I kind of watched myself. How do I operate in terms of being in charge of whatever, 20 some people. I decided I’m really a loose kind of administrator. I basically would say, “Here’s some things we have to accomplish within this time period. How are we going to get it done?” And somebody would say, “I’ll take the lead on this.” And I’d say, “The rest of the time, think of something you’d really like to do. Something that you think is fun to look at and let’s interact on it.” And we did.

So I would try to recruit PhD students from the school, faculty from the school. And somebody at Bethesda would say, “What about this thing? Come on, let’s work on it.” So it was a rich experience of working with people, very loose, very informal. Anybody who had a good idea was welcome. We had people on sabbatical, actually at least one person a year on sabbatical. I’d always have one, maybe two PhD students working on their thesis. And half of all the publications were from those kinds of leads. And the nice thing about that is there were people who had interests totally different from mine, who’d come in and we’d work together on them. We did a series of papers on risk factors in the elderly that I probably wouldn’t have thought of if not for one of these people coming in and saying, “What about this? Look what Framingham says.” So it was just perfect. It was just wonderful. No complaints whatsoever.

DL: But it changed.

DR: Oh, it changed. Millicent changed it and then Claude got interested in things. I mean, they didn’t come in with ideas, they came in with control. We want to do this, we want to do that, sort of thing. I don’t know what happened. I guess I got island fever after 14 years or so of it and just wanted to get off and see broader views and go more than 40 miles an hour and things like that.

HB: Any specific way they interfered with your freedom of thought and actions? Or was it just their presence?

DR: We always had to fight for money. We were in competition with Framingham at that time and things like that. We would prepare for each contract renewal more rigorously than any grant application. I learned later that I was breaking the law because I would sit there and do these applications. I’m an employee of the government, working with the PI, you know. It just got to where we would have to spend more time satisfying the whims of the administrators as opposed to letting our minds wander and doing what we wanted to in terms of ideas. Again, I can’t remember one hypothesis from Central.

What I remember is that somebody on Millicent’s staff would say, “Hey, how about doing this?” I said, “That’s good. We can do that. Let’s do it.” And they would come out and we’d interact. I demanded that anyone who wanted to study something has to come out and do things. The latest and probably one of the nicest ones was Irribarin. Carlos came out and worked on this low cholesterol thing and just took it step after step. It was a wonderful experience. And again, something I wouldn’t have done by myself. So that combination of kind of having an open door, no real strong rules and restrictions of how things are done, it was to me immensely pleasant, and I think productive. We did a lot of stuff, we put out a lot of things that I feel good about.

When they were searching to replace Manning, I was offered a job to come back. . . And it was clear, I would not function well at all in Washington. (pg. 32)