Reuel Arthur Stallones

Quotes

Psychosocial Variables

I looked up to him as a pioneer in this field [Len Syme] and I thought it was interesting stuff. Again, always looking for something different other than the standard risk factors for what’s going on. And that was great opportunities when you find them. I don’t know where the idea came from, but he proposed that we not only can look at individual measures, individual differences butat the ecological things. That whole concept. This is the true learning – that just blew me over in terms of understanding these kinds of complexities of epidemiology. Again, this was also very early in the psycho-social epidemiology stage and I don’t think there were any other prospective studies going on and so, again, we fit it into the cross-sectional.

But even our cross-sectional were the first negative studies. They would have said, “You can explain the major differences that you found based on the standard risk factors for cardiovascular disease.” And I think Len never quite forgave me for that. We certainly went on to the Nihonsan Studies in Hawaii that have continued to find negative results related to these psychosocial things. (24)

While this was going on Stony had gotten the funding for the ‘san’ part of Nihonsan. He had had much to do with the whole Nihonsan concept [the origins, the idea of such comparisons.]

His connections with Japan may have begun during his Korea time when he had periods of being either based in Japan or going back and forth. But before that he had been in Japan because of stroke. He had gone to Hisayama where the Hisayama Study was going on and he had been involved with Jim Tool and others in this questions about whether the strokes in Japan were all hemorrhagic because they have so much hypertension, and trying to improve the comparability of data on cost-specific mortality from stroke. Then he did a review of stroke epidemiology in the Journal of Chronic Diseases maybe ‘65ish. As far as I know it was one of the first if not the first epidemiologic effort to put together what was known….about stroke epidemiology.

[And I suppose that was part, at least, of how Nihonsan got underway.

The intertwining of all of these influences, those early origins of Nihonsan, migrants in Hawaii later on, getting involved with that, Len Syme coming over when Stony left. It’s incredible to sit down and try to figure all these things out. I know Abe talked about meetings taking place in Zukel’s office. Kagen was at Framingham. I think that Yano was somehow involved. Yano had come to visit Framingham and was totally amazed at seeing so much heart disease. There was some kind of influence from him and Stony there. He talked about Stony and I don’t know where the idea, “Let’s do a comparison of migrants” crossed.

I know Stony was very active in the origins of NIHONSAN and, of course we know he was very hurt when he went to Texas he was basically cut out of the ‘SAN’ part of that. And he carried that resentment with him, I think. So, again, some of his influence on some of these early studies, which have gone on for another 30 years after his initial involvement.(30)

We corresponded. I would send tapes from Guam about what we were working on. Actually Stony even came out. He knew nothing about ALS, but he was chosen for one of the site visits to come out and see what we were doing. And, again, his presence just crystallized things. We had different studies going and he was able to look at the raw data, graphs we had drawn up, and immediately just come up with, “Ok, have you thought about this, have you done this.” Key questions immediately supporting his ability. He’s clearly the smartest epidemiologist I’ve ever met.

DL: I was thinking about the most substantial epidemiologic studies that he was directly involved in. He certainly influenced many. He was directly involved in several. Among the things that stand out certainly Nihonsan was one. The work in the Seal Beach community was another. There was something called the King City Study which he had done early after arriving at Berkeley which was in King City, California. It involved a population sample, family studies of coronary risk factors.

D: It started off with high school students and then recruited their parents or something like that.

DL: I don’t know the details and I don’t know what the publications were from that study.

D: I don’t know if they ever published.

DL: There was a younger physician who was part of that team who was one of the people we had as a lecturer in Epidemiology 101 and his name escapes me at the moment, but it’s someone that I know Stony had intersections with off and on in his career.

D: Something was published because I remember the correlation between blood pressures, rank order of blood pressures in the students with the rank order blood pressure of their parents. Something like that.

DL: And then there was a guy at Berkeley he did some work with….early in the days of analysis of large datasets. This was Buechley and the one that stands out in my recollection is the correlation of coronary mortality by state with various state characteristics.

D: One of which was number of lynchings.

DL: Lynchings was one. The greater the number of lynchings reported in whatever time period, the greater the rate of coronary mortality. And there was also a direct association between numbers of psychiatrists per state and the coronary mortality. And a number of other like observations.

D: I remember that it had to do with physicians per capita directly related to the number of coronary deaths, cardiovascular deaths, and I think of hospital deaths, too. All these kinds of things. Yes. That was fun stuff. I don’t know if it ever really changed the world, but just wonderful fun ideas that they would come up with. Was it the hardness of the water? Maybe that didn’t come out of that one. I’m not sure. (35)

The New UT Houston

When the Texas opportunity came up I don’t know what all the details were at Berkeley at that time, but Chuck Smith had died suddenly. There was a vacancy in the Berkeley deanship. My impression is that Stony had anticipated that he would become the dean.

D: And he wanted it.

DL: Wanted to be the dean and Bill Reeves was selected instead. Maybe by that time it was already apparent that the ‘san’ part of Nihonsan was not going to be renewed.

D: I don’t think so.

DL: Or that came about shortly after because I had always thought that was part of the equation.

D: It was quite a bit later. When I left Houston two years after going there I went to NINDB, Len Syme wrote me saying that they had been badly treated by the review committee for continuing the ‘san’ part. So this must have been ’71 and could I do anything about it. They had made the mistake I think of going to the Neurology Institute for the grant rather than Heart. This is the renewal we’re talking about now.

DL: Well, the original application I think as I recall had been for the baseline survey and there was never funding for a longitudinal component. There was the possibility of doing some mortality follow-up maybe of the survey participants. I think it never had the same kind of financial security that Honolulu did.

D: Honolulu was supported by contract from the Heart Institute, whereas the ‘san’ part – I don’t know when it went to Neurology. I don’t know Stony’s participation in the first phase of it. But whatever, it was either a renewal or going to a different institute that Len had contacted me and this is after the first, I think, the baseline exam was done.

DL: I remember Bill Zukel being mentioned in all this and I’m wondering if it was perhaps a renewal application had gone to what was then NHLI and was not favorably reviewed and maybe Len was pursuing the possibility of NINDB.

D: Maybe so. I don’t know. That was always sad. Not only that, but all of the baseline data were lost because at one point I wanted to do a comparison of … I can’t remember what it was. It was a follow-up based on some of their stuff and contacted Len and it was stored in some basement or gone or lost or flooded or who knows what. Lost. So that was a sad aspect of that beyond the baseline exam. And only two years of mortality follow-up.

My feeling is that part of Stony’s decision to take the deanship in Houston is based on the fact that he didn’t get the deanship in Berkeley.

DL: Yeah, that must have been so. And then his maybe liberation from the Berkeley tradition he had the opportunity to think about how a school of public health should really be organized and that led to the sort of radical idea of a school without walls and a school without departments.

D: Yes, again, a totally new pioneering concept of education in public health and developing a matrix approach to course work or to organization. (43)

Academic Innovation

If you read some of these, again part of searching out the things, some of those papers on what is a school of public health or how to start a school of public health, things along that line, these are totally new ideas, innovative concepts. Where did he get them? He wasn’t trained in this in any way either in education or this kind of administration, but he just fell into it naturally and, again, with his creative capacity just began to put together these wonderful ideas.

DL: His approach to faculty recruitment was to recruit good people and let them go. There was very little direction.

D: Dick Remington being at that meeting at Coronado Island and then showing up as the head of statistics. I guess you and I should feel very proud that we were considered in that group to be enlisted.

DL: That’s true. And maybe the earliest years of the school and for quite a while what became of the school was most satisfying to Stony.

D: Every once in a while you get an opportunity. Somebody says, “It’s all yours. Do with it what you will.” And here was his chance. Every detail – designing a building that’s going to do this, designing educational concepts. How are you going to teach public health? What is public health, community health? Thinking those things through it’s just amazing to me this guy’s creativity. I have done a lot of looking at epidemiology theory and I don’t think he copied these ideas from somebody else. Nobody had talked about these kinds of things that I’ve seen anyway. (47)