brian macmahon (1923-2007): founder of modern epidemiology

Brian MacMahon (1923-2007): Founder of Modern EpidemiologyAuthor(s): Dimitrios Trichopoulos, Philip Cole, E. Fran Cook, Manning Feinleib, RobertHoover, Chung-Cheng Hsieh, David Hunter, Richard Monson, Nancy Mueller, Mati Rahu, EricRimm, Kenneth J. Rothman, Meir Stampfer, Noel Weiss, Walter Willett and Hans-OlovAdamiSource: Cancer Causes & Control, Vol. 19, No. 4 (May, 2008), pp. 329-337Published by: SpringerStable URL: http://www.jstor.org/stable/40271871 .

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Cancer Causes Control (2008) 19:329-337

DOI 10.1007/s 10552-008-9 156-3

Brian MacMahon (1923-2007): founder of modern epidemiology

D. Trichopoulos • P. Cole • E. F. Cook • M. Feinleib • R. Hoover • C.-C. Hsieh •

D. Hunter * R. Monson * N. Mueller * M. Rahu * E. Rimm • K. Rothman *

M. Stampfer • N. Weiss • W. Willett • H. O. Adami

Published online: 15 April 2008 © Springer Science+Business Media B.V. 2008

Abstract Brian MacMahon was born in Sheffield, UK in 1923. He served as chair of the Department of Epidemi- ology at Harvard School of Public Health for more than 30 years. He was admired as a noble and generous man and

respected for his shining intellect, scientific integrity, and broad culture. He set the pace for modern epidemiology and led the way for a whole school of epidemiologists who are now spread around the nation and the world. He made

major scientific contributions, received several distin-

guished prizes and awards, and continued to publish insightful papers until the very end. Brian MacMahon was the first editor-in-chief of Cancer Causes and Control.

D. Trichopoulos (El) • E. F. Cook • C.-C.Hsieh • D. Hunter •

R. Monson • N. Mueller • E. Rimm • M. Stampfer •

W. Willett • H. O. Adami

Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 021 15, USA e-mail: [email protected]

P. Cole

University of Alabama, School of Public Health, Birmingham, AL, USA

M. Feinleib Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

R. Hoover National Institutes of Health, Bethesda, MD, USA

M. Rahu National Institute for Health Development, Tallinn, Estonia

K. Rothman Boston University School of Public Health, Boston, MA, USA

N. Weiss

University of Washington, School of Public Health, Seattle, WA, USA

Keywords Brian MacMahon • Epidemiology • Tribute • Biography

What follows is a collection of thoughts and memories by some of the students and colleagues of Brian MacMahon. To include contributions from all of them, would have been humanly impossible. The collection is introduced by his immediate successor as chair and concluded by the current chair of the Department of Epidemiology at Harvard School of Public Health.

Brian MacMahon through the years (by Dimitrios Trichopoulos)

I have known Brian MacMahon for more than 40 years, but I have interacted with him more than most of my colleagues and friends during the last few years of his life. During that period, Brian was as intellectually shining, thoughtful, and generous as always, and just as stubborn. His remarkable writing skills were better than ever and his insights in the field of epidemiology, the directions our discipline is taking, and the obstacles it is facing unique in their wisdom. One can only read his interview with Walt Willett in Epidemiology or his introductory chapter on the accomplishments in cancer epidemiology in a recently published textbook.

During the last few months he wanted us to work on a revision of his classical textbook, the second edition of which I had the privilege to co-author. He had indicated that he did not like my perspective, because I was too much influenced by the over-statisticalization of our discipline, but he could not get rid of me because of my involvement in the second edition. Whenever I disagreed with him - and I frequently did - he would challenge me by asking me to mention a

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330 Cancer Causes Control (2008) 19:329-337

major epidemiological finding which was not already evident in simple cross-tabulations. He proposed to involve in the revision of the book Pagona Lagiou, one of my closest collaborators who, nevertheless, quickly formed a strong alliance with him under his intellectual and cultural spell.

Brian was a towering figure in epidemiology, but he was also a man dedicated to his wonderful family and a deeply cultured person, with an unusual feeling for classical music. Once, I told him that, on account of my age, I have been losing my ability to identify the composer of a particular piece by listening to it. "Do not worry," he tried to comfort me, "you have never been particularly good at it."

I succeeded Brian as chair of the Department of Epi- demiology and, on this account, I was asked by the current chair, Hans-Olov Adami, to coordinate this tribute and invite contributions by some of his former students and

colleagues. There are few better hallmarks of greatness than the quality of one's intellectual descendants. Just the list of those who were invited, and the many others who could not be invited for technical reasons, highlights the

greatness and the legacy of Brian MacMahon.

Dimitrios Trichopoulos Vincent L Gregory Professor of Cancer Prevention,

HSPH

Epidemiologist, scholar, gentleman (by Philip Cole)

I worked for and with Brian MacMahon for nearly 15 years as his student and colleague at Harvard. When I moved to Alabama we remained colleagues and collaborators for another 25 years, until his death. Throughout those 40 years, his character, integrity, ability, and productivity were the model of an academician that I emulated.

He was quick to praise but slow and reluctant to criticize. His honesty never wavered for expediency or any other rea- son. He tolerated our limitations and stimulated our abilities. He was that rarest of persons, both a fountainhead of ideas at the inception of a project and an overseer of detail through to its completion. He managed the administrative dross of a large department seemingly without effort. All the while he was

showing us that the principal, perhaps the only, duty of a

Department Head was to foster the growth and development of his students and faculty members.

Of course, he was a peerless epidemiologist. The 1960

publication of Epidemiologie Methods, the first textbook of modern epidemiology, assures that recognition. He also

originated and conducted many highly insightful and con-

vincing investigations into the etiology of cancer and other diseases. He was one of the greatest epidemiologists of the twentieth century. That is how our profession and the world of Public Health will remember him.

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Beyond that, all of us who knew him will remember him as the man who pointed the way, set the pace, and urged us to walk with him.

Philip Cole

Professor Emeritus, University of Alabama School of Public Health

A true giant in epidemiology (by Fran Cook)

Brian McMahon was a true giant in epidemiology, espe- cially in the field of cancer epidemiology. He became chairman of the Department of Epidemiology at the Harvard School of Public Health in 1958 and held that

position for 31 years. I came to the department in 1976 as a student, joined the department's faculty after completing my doctorate, and have never really left. Being primarily based at the hospital next door had given me the opportunity to follow the growth of the department over time and to observe the many influences of Brian. Clearly, the research accomplishments of the department can easily be measured though the numerous landmark projects and

papers of its faculty and students. Without doubt, he has had a strong influence on the research careers of many epidemiologists, all of whom can better speak of his role as an investigator and as a mentor. However, an over- looked aspect of his legacy was his dedication to the

teaching of epidemiology. Our current core curriculum at Harvard is based on the one that was developed during his tenure as chairman. I still begin my courses each year by reciting the definition of epidemiology from his 1970 text: "Epidemiology is the study of the distribution and determinants of disease frequency in man." In this way, his legacy will remain part of the teaching of epidemiology at Harvard and at many other institutions. I will be

always grateful to the opportunity that he gave me to teach epidemiology at Harvard. More importantly I will

always be thankful for the manner in which he treated

me, students, faculty, and staff. He had an open door and was a good listener. He always treated everyone with kindness and respect. Brian McMahon will be remembered by many as a gifted scientist, leader, and visionary in the field of epidemiology, but more importantly he will be remembered by me as a great guy.

Fran Cook

Professor of Epidemiology, HSPH

An appreciation (by Manning Feinleib)

Brian MacMahon and I first met in September 1956, when I

was a freshman medical student at SUNY Downstate. Eager



Cancer Causes Control (2008) 19:329-337 331

to use my background as a college mathematics major and an actuarial trainee, I asked my freshman advisor who would be the best contact at the medical school. He recommended a

"young professor" in the Department of Environmental and Community Health, Brian MacMahon. For the next two years I spent two afternoons a week assisting Brian compile data for his studies of survival of leukemia patients and a case-control study of parity and menopausal history in breast cancer. Late in 1958, Brian was appointed Chairman of the Epidemiology Department at the Harvard School of Public Health and left SUNY a few months later. Shortly thereafter, Duncan W. Clark, Chairman of the Department of Envi- ronmental and Community Health, extended a highly unusual invitation to me - to take a one-year leave of absence from medical school to teach Brian's courses and complete the research projects we had been working on. After considerable deliberation and help from my medical school colleagues, I accepted the offer. As the saying goes, the rest is history - I was committed to becoming an

epidemiologist. To have been appointed Chairman of a department at the

age of 35 is an example of the high esteem in which Brian was held by his academic colleagues. The publication of his text on Epidemiologie Methods, the first formal exposition on population-based research of chronic disease diseases, established him as one of the foremost epidemiologists in the world. His book gave a simple definition of epidemiology as "the study of the distribution and determinants of disease in human populations" which is still the basic definition presented in many introductory epidemiology texts. And his metaphor of the "web of causality" is still the basis for modern models of structural relations among multiple variables.

In 1962, 1 joined Brian as an MPH/DrPH student at the Harvard School of Public Health. We had already published three papers together and I was eager to get on with formal training in epidemiology and biostatistics. I recall that Brian had a simple and direct way of looking at problems that was intuitively appealing and logical. This led to clarity of exposition that made his lectures stimu- lating, comprehensive, and thought provoking.

One of the most instructive aspects of the HSPH was the meeting of departmental faculty and students for lunch each day. Some of the regulars were George Hutchison, Jane Worcester, Tom Pugh, Ascher Segall, and Theo Ab- elin of the faculty, and graduate students Ralph Buncher, David Nitzberg, and Tornio Hirohata. Many of the conversations were about events at the school and in Boston but we also had informative discussions about substantive issues in which Brian was currently engaged. Aspects of case-control studies were hot topics at the time.

Brian served on many planning committees and advi- sory panels. I always admired the way he chaired these

sessions - weighing diverse arguments, reconciling differ- ences, and ever gracious. His dry humor often resolved contentious arguments that might have gone on endlessly.

Reflecting on my own career, I consider Brian to have been my prime mentor and role model. His early guidance and constant support were enduring influences throughout my professional life. I only hope that I have been able to pass on to my own students and colleagues some of the wisdom and confidence he instilled in me.

Manning Feinleib Professor of Epidemiology

Johns Hopkins Bloomberg School of Public Health

Reflections on a remarkable career (by Robert Hoover)

On the occasion of his retirement party, Brian was asked what he considered his most notable contribution over his long and illustrious career. He was asked essentially the same question a decade later for the VOICES series in the journal Epidemiology. In both instances, without hesita- tion, he had the same response: that there was no specific contribution of his own, but rather the large number of major figures in epidemiology around the world that had come from his training program at HSPH. This came from the epidemiologist whose numerous personal and seminal contributions are legendary, including altering the entire paradigm of our understanding of the endocrine etiology of breast cancer (ultimately recognized by the award of the General Motors Cancer Research Founda- tion's Mott Prize), laying the epidemiologie groundwork for our evolving understanding of lymphoma as an infectious disease, and the demonstration of the likely environmental nature of neural-tube birth defects and infantile pyloric stenosis, conditions long thought to be primarily genetic.

In my opinion, nothing captures better the essence of Brian's greatness than that response, in his own words. His total lack of any air of self-importance over his own august accomplishments was symptomatic of the humility that dominated his approach to science, and life in general. He truly believed that any important findings from his own work were a consequence of the entire team responsible for the study, as well as all of those who had laid the scientific groundwork leading up to the study - those on whose shoulders he believed we stood. He believed seeking personal recognition for such group efforts was absurd.

The other attribute of Brian's greatness conveyed by these words was his love for and nurturing of the epidemiologie method. He believed that epidemiology was not something you did, but rather it was a way of thinking

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that allowed you to do a lot of wonderful things in science and public health that would have been otherwise

impossible. He believed that our craft had been developed and nurtured by scientific giants in the past - Graunt, Fair, Snow, Hill, etc. - and that it was incumbent upon current

practitioners to continue to nurture and grow it, and to

bring this method to a new generation for them to love and nurture it. His joy was palpable when a current student "got" an important concept, or when a former student made an important observation via a unique application of the epidemiologie method. While always a

gentleman, he had little tolerance for lack of (or sloppy) epidemiologie thinking, particularly from the arrogant and

self-important. All of us who were privileged to have the opportunity to

learn from Brian how to think epidemiologically, and have

spent our careers trying to achieve the standard of every- thing that he exemplified, have lost a valued mentor and friend. I suspect that the honor we could pay to him that he would value most highly, would be for us to increase our efforts to bring his sound and insightful epidemiologie thinking into modern biomedicai and public health research and application. These fields have recently become the beneficiaries of a veritable tsunami of advances in molec- ular, biochemical, informatic and statistical science and

technology. In the process, many of the leaders in these fields have come to believe that these advances have obviated the need for sound epidemiologie thinking, rather than, as Brian would point out, actually making it more critical than ever.

Robert Hoover Division of Cancer Epidemiology & Genetics, N1H

Shining intellect, kindness, and humor

(by Chung-Cheng Hsieh)

I would like to recall fond memories of Dr. MacMahon's humor. As my thesis advisor, he would edit the manu-

scripts drafted by a novice student, tirelessly providing comments and re-writes, revision after revision. On one of them, I had mistyped sex "ratio" of the incidence rate of a cancer as "ration." Besides noting the typo, he asked on the margin: "What do you have in mind?" I also remember the annual fall picnic at his New Hampshire farm, where he would offer a "nickel tour" or a "dime tour" to walk down to the river at the edge of the farm, although it was not clear if there would be any difference between the two. His kindness and humor will always be remembered.

Chung-Cheng Hsieh

Adjunct Professor of Epidemiology, HSPH

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Enduring memories (by David Hunter)

I first met Brian while I was a Master's student at Harvard, with few clues about how to pursue a career in Epidemi- ology. As Department Chair, Brian was very generous with his time, giving advice on the implications of various

options, and helping me in the search for funding. When I feel overcommitted and wonder whether I have time for a

needy student, I remember that Brian somehow found the

time, and it made a difference. He would muse somewhat about the start to his own career, and point out there were

many roads to the same place. Few contemporary epidemiologists, and I suspect fewer future epidemiologists, have spent time as a ship's surgeon, or had equivalent experiences. He will be remembered not only as the inventor of many aspects of our field, but also as a caring mentor and guide.

David Hunter Vincent L Gregory Professor in Cancer Prevention,

HSPH

A dinner with Brian (by Richard Monson)

My dinner with Brian was a feast of ideas. In 1965, I was a medical officer in the Army in

Germany, pondering my future. By chance, I came across a

catalog from the Harvard School of Public Health. Having never heard of the place, I was surprised to learn that it was in the backyard of the Medical School that I had attended.

I wrote a letter to the Chairman of the Department of

Epidemiology indicating that I was interested in training in

epidemiology, biostatistics, or mathematical biology. I also asked about the availability of stipend and tuition support. Dr. Brian MacMahon responded that he was "fascinated by your statement of interests." I found this to be an odd

response, in that at the time I had no interests. I later came to realize that this was part of Brian's persona - he

encouraged many of us who had only a vague notion what

epidemiology was and helped shape our own ideas. I knew only that I wanted to do research; at the start of

the second semester of my master's year I sought Brian's advice. He responded that he had always wanted to send a

questionnaire to Massachusetts' physicians asking about

peptic ulcer. I stated pursuing this issue, intending that this be a master's project. At the end of the semester, having been accepted into the doctoral program, I again sought Brian's advice as to a doctoral thesis. He responded that he considered my ulcer project to be my thesis project. Brian was always one step ahead of me.

After I joined the faculty in 1969, Brian suggested that I

complete the second round of data collection on a study of




the relationship between prenatal X-ray and childhood cancer. The first round provided data that were similar to those from the Oxford Childhood Cancer Survey, i.e., that there was a relative risk of about 1.5 for both leukemia and solid tumors. Brian warned me that in the new data "there was something fishy." It turned out that in the study extension there was no association with solid tumors.

Several years later, when I had completed the data collection and analysis, I wrote two outstanding papers and

gave them to Brian to read. There was no response. I combined them into one paper. Still no response. After several years I asked Brian when he was going to get around to reading my papers. He looked uncomfortable and indicated that he did not consider them to be of any scientific value because they did not clarify what had already been published. I disagreed but no longer brought up the

subject. My view was and is that well-done studies should be published irrespective of results. Eventually, the truth will come out.

This tale of papers languishing on Brian's desk was shared by Phil Cole, whose words were more golden than mine. Phil and I were locked in a contest as to who could accumulate the most paper-years of unpublished manu-

scripts that gathered dust on Brian's desk. On the other hand all of the papers that we published were greatly improved by Brian's encouragement and editing. His point of view yielded the desired results - readable writing and

counting. I last saw Brian in the summer of 2007, when Nancy

Mueller and I had lunch with him. I was bloviating about

my editorial experiences as chair of a radiation committee that produced a 700-page report. I indicated that there were three phases to editing that could not be done at the same time: editing for content, editing for style, and editing for errors. Brian agreed and said: "You know where you learned that, don't you?" So much for my brilliant career.

The best description of Brian's style came in the mid 1970s from a comment that Shields Warren made to John Boice. Shields noted that those fellows in epidemiology at HSPH (meaning Brian and George Hutchison) are pretty smart - they don't tell you what to do, only what not to do.

Brian taught all of us what not to do. The rest was up to us as individuals and as students of Brian.

Richard Monson

Professor of Epidemiology, HSPH

Father of us all (by Nancy Mueller)

All modern epidemiologists are in someway "children" of Brian. His impact on our discipline is extraordinary. But for those of us who were fortunate enough to serve on his

faculty, he fathered us indeed. He fiercely protected us from the harsh winds of attack from hostile deans, indif- ferent study sections, and outside critics. He carried our worries on his shoulders - perhaps explaining his sometimes hunched posture. In fact, on an unforgettable departmental canoe trip in the Adirondacks in the late 1970s, he portaged more than his share of canoes despite the best efforts of John Boice to out-run him on the trail.

He fed us with clippings from journals to nudge our science. My favorite was a letter-to-the-editor of the Lancet that he placed in my box early in the AIDS epidemic. The letter contained a convoluted and highly speculative dis- cussion of certain salacious sexual practices that were proposed to account for the new pandemic. His note said, "Nancy, wait till you see this!" I walked into his office and after some laughter, we discussed the challenges implicit in untangling the behavioral risk factors for AIDS. Such dialogues often continued at lunch.

Brian was slow to criticize or to overly praise, but was consistently careful in his conversations. When appropriate, he offered pithy advice. My first such memory concerned a draft letter to an editor I had written in a fury to rebuff the proposal that Hodgkin's lymphoma was itself infectious. This proposal by a competitor in the field had been widely reported in the lay press frightening patients and their families and was based solely on his own suspect studies. Brian's advice; "Don't get into pissing contests with skunks." (Subsequent research by Peter Smith, Sey- mour Grufferman, and Paul Scherr refuted the claim.)

Brian's fatherliness was also evident in his loving care of his family. The MacMahons often spent their weekends at their farm in New Hampshire. It was their custom to take along their two cats on the two-hour trip. The cats would spend the weekend in the barn and fields, and on Sunday late afternoon, return to the house for the drive home. As I remember the story, one weekend Kathleen and Mary had been invited to a birthday party back in Needham, neces- sitating an earlier departure. After searching and many tears, only one cat was found. Brian drove his family and cat home, dropped the girls off for the party, drove back up to the farm, located the missing cat, and drove home again late at night. At that point, he won my heart.

Nancy Mueller Professor of Epidemiology, HSPH

Rare but memorable meetings (by Mati Rahu)

The political climate of the 1970s encouraged Soviet and US epidemiologists to collaborate. In October 1975, a delegation of US epidemiologists visited my home institute in Tallinn, Estonia. Never had my tiny homeland seen such

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a cluster of top epidemiologists - Brian himself, George Hutchison, David Levin, Noel Weiss, and Ken Rothman. When you live in the USSR where infectious disease epidemiologists protest fiercely against the use of the word "cancer" in combination with "epidemiology," and where the fundamentals of modern epidemiology can be acquired only through autodidactic learning, even a brief talk with a

prominent scientist filled you with optimism and motiva- tion. The material legacies of this visit - two red hardcovers entitled Epidemiology: Principles and Methods with historic signatures from 9 October 1975 on the title

page - adorn the bookshelves of Estonian epidemiologists. Four years further on, my Moscow colleague Zoya and I

were ending an epidemiologie US tour. As its duration had

suddenly been reduced half by our authorities, we were in Boston for three days instead of the planned 19. Brian waited in the airport, drove us to The Children's Inn, and in 10 min we continued toward his home. We met there Heidi, Mary (at 15), and George. Soon, by my travel notes, Brian started to carve up the turkey.

The next day, 1 1 November, is burned into my mem-

ory. In the morning we visited the Department of

Epidemiology where (besides other highlights) Ken sup- plied me with the publication Epidemiologie Analysis with a Programmable Calculator. After dinner at the Harvard Club, Brian guided a trip in the autumn colored area of the birth of the American Revolution. Afterwards at his

home, Brian handed me a royal gift - the HP-67. I could not believe that it was 1979 and I had a sophisticated calculator for computing adjusted ratios and, iteratively, confidence intervals!

On Christmas Eve, Kabul was occupied and for some

years the dark political sky weakened face-to-face contacts between epidemiologists of the two superpowers. Thanks to Brian's understanding, diplomacy, and influential words, we were able to meet in the lobby of the familiar hotel on

Longwood Avenue on a chilly morning of 7 March 1983. Brian then gave me a tour of a large library. During the

following three weeks his wisdom, warmth, and hospitality were all around.

Mati Rahu

Professor of Epidemiology, National Institute for Health

Development, Estonia

A giant among public health immortals

(by Eric Rimm)

I came to the Department of Epidemiology as a doctoral student in 1986 with three other new students in the ScD/DrPH program (the typical size for new doctoral

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cohorts at the time) and 15-20 other students from other

programs. I distinctly remember meeting Dr. MacMahon for the first time on orientation day. He was stately and forceful with his introduction to the new students, yet, still

gave off a sense of warmth. Later in the day he met only with the four doctoral students, and I recall his pointing directly at me and exclaiming, "So you are Rimm." As a

young inexperienced new student on my first day at Harvard sitting in front of a man for whom I had read and was told was the father of chronic disease epidemiology, my immediate thought was, "Why didn't I wear my depends today?" Subsequent to this were flashes from the movie Paper Chase, where John Hausman, playing the classic role of a Law School Professor, intimidates and humiliates new first year students. I am sure it was only a few seconds (that seemed like minutes) before he gave me a wry smile, welcomed me again and noted that he had read

my single published paper and remembered my application and reference letters. A true relief from my exaggerated imagination and a thoughtful personal welcome.

The timing of my training coincided with the transition from artist-designed 2x2 slides and transparencies to PC- based graphics programs. Word leaked that I was one of the local trainees with a working knowledge of Harvard

Graphics 3.0. Initially, he asked if I could make a few

graphs for a talk and also for an upcoming book he was

writing. I mocked up first drafts and he would sit at my desk and make simple edits and formatting tweaks. This new technology was like eye candy for our esteemed Chair. At some point it dawned on him that maybe an old dog could be taught new tricks, and he called me to make an

appointment to teach him the ropes. This led to calls from his home to help with software installation and a few occasional calls on weeknights and weekends for assistance with data entry and graphing. He was always perfectly respectful of my time, but he would not be deterred, much like how he lived his life and built his career. A final

positive note from this story was his insistence that the

Publishing company reimburse me $500 (a windfall for a doctoral student on a $8,600 a year training grant stipend) for my help with "graphic design" on his book. They thought this preposterous since big publishing companies had whole departments created for this service, but in the

end, "The Chair" prevailed. My glass is raised to the man who created a field, trained

a generation of public health professionals, and as a passing thought made it possible for me to start a career in epidemiology in his department.

Eric Rimm Associate Professor of Nutrition and Epidemiology,

HSPH




Parenting is by example rather than dictum

(by Ken Rothman)

I met Brian 40 years ago, when I applied to enter the doctoral

program in epidemiology at Harvard. He somehow sounded

encouraging as he explained to me that I would need a Masters' degree first before we could discuss the doctoral

program. Three years later, with the Masters' behind me and as I neared completion of my doctoral training, he offered me

my first professional job, as an assistant professor, and we became colleagues. We were already friends. To work in the

company of such a man was a privilege that only seems

greater with the passage of time. Some say the best parenting is by example rather than

dictum. In that way Brian was the perfect intellectual

parent to a long stream of epidemiologists who came

through Harvard. He provided direction to a department and research funding to faculty and students when it was needed; he delivered lectures that were models of inspiration; he conducted scientific studies with his characteristic bent toward elegant simplicity and skepticism; and he lived

by the principles of honesty, fairness, and compassion. What lesson could be more valuable? He was also a lively raconteur. His tales animated daily brown-bag lunches for

faculty and students in the department conference room over many years.

In 1975 Brian invited me to join a small scientific del-

egation to the Soviet Union. The scientific mission was part of a larger effort of scientific and cultural exchange that was intended to bridge the great political divide between the US and the USSR. Noel Weiss and George Hutchison were also part of the delegation. We spent two weeks in Moscow, Tallinn, and Tbilisi, learning about Soviet science, making contacts, proposing collaborative research, and toasting endlessly at long banquets. Brian seemed very much at home being the diplomat-scientist, crafting plans for research collaboration with the giants of Soviet medicine, and trying to keep a straight face as the Soviets toasted to Nixon, out of office after Watergate, but still

worthy of Soviet toasts for starting the "war on cancer" that had ultimately brought us there. The plans for collaboration nearly fell victim to bureaucratic obstacles at the end of the visit, but Brian met one-on-one with his Soviet

counterpart and we came home with an agreement that carried the program of cooperation forward for a long spell.

The past few years we exchanged frequent e-mails and

telephone calls, and also went out to lunch regularly. He

published five first-authored papers in the two years before his death, and in the same period he traveled to Lyon to

give a lecture at the invitation of Peter Boyle. We discussed the content of these papers as well as the lecture. We also traded views on many other topics small and large, seeking

advice from one another on matters of work and family. It was my good fortune to have this time with the man who loomed so large in my life, and whose friendship meant so much.

Kenneth J. Rothman Professor of Epidemiology, Boston University School of

Public Health

A role model for all times (by Meir Stampfer)

One of my favorite memories of Brian MacMahon was when I was a student, and looking for my first job. I applied to the Epidemiology Department, as there was an opening, but was turned down by Dr. MacMahon, the department chair. He did this with such quiet grace and charm, and with such encouragement for me, that it actually felt like a positive experience. He then supported my later appointment at HMS, and subsequently back to HSPH in his last year as chair. The casual gathering at his summer home in the Fall was a yearly ritual that faculty and students always looked forward to. He greeted each person, whether senior professor or brand new first year masters student, with warmth and respect. Thus, he was a role model not only for his intellectual achievements, but even more so for his decency and humanity.

Meir Stampfer Professor of Nutrition and Epidemiology, HSPH

A letter to Brian (by Noel Weiss)

When he retired in 1989, Brian MacMahon forbade Har- vard's Department of Epidemiology from holding a formal occasion that would honor him and his work. So, the Department suggested to colleagues and former students that they simply write to Brian to express their appreciation. In response to this suggestion, I sent the letter below, which I'd like now to share with others. Eighteen years later, the only change I'd make is to one part of the footnote: Brian's lecture on retrolental fibroplasia served as the stimulus not only for a lecture here at the University of Washington, but for the entire first chapter of the book that Tom Koepsell and I published in 2003, Epidemiologie Methods. I'm confident, though, that indirectly and not quite so explicitly, his influence can be found throughout the book.

Noel Weiss Professor of Epidemiology,

University of Washington School of Public Health

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April 24, 1989 Brian MacMahon Harvard University School of Public Health 677 Huntington Avenue Boston, Massachusetts 02115

Dear Brian:

You may not remember that when I came to Harvard 21 years ago, it was to receive training as a health care administrator. I had considered a number of careers in clin- ical practice and even academic medicine during my years in medical school and house staff training, but none ever seemed right for me. Then, after the big plunge into a school of public health 3000 miles from home, I was confronted by a heavily social science curriculum in my major field (Health Services) and by an advisor who, despite her name (Weiss), was not inspiring: Health services and health care adminis- tration now didn't seem right, either. It turns out there was an

enjoyable and productive career in public health awaiting me as an epidemiologist, but I had no crystal ball, and thus I had no way of knowing it was there. You and a very few others at Harvard provided the crystal ball, enabling me to get a

glimpse of that future. You in particular offered first-rate

training in epidemiology, but of even greater importance you provided, by your example, a role model. I saw what it was like to be a capable and respected epidemiologist in a school of public health, and I liked what I saw. And, even without

really intending to, I mimicked what I saw. So, when I look at the style with which I conduct my work now - from class- room teaching*, to advising, to approaching a research

question, to chairing a department - I can see ample evi- dence of your influence. I receive lots of praise for my performance, but rarely do I get a chance to give appropriate recognition to those behind the scenes. I'm enjoying this

opportunity right now - I hope you're not too embarrassed to

enjoy it with me.

Yours truly, Noel S. Weiss

*I gather that it's been a long time since you presented an

introductory course in epidemiology. That's a loss for those cohorts of HSPH students who were taught by someone else;

they'll never know what they missed. The course I took from

you in 1968 made an indelible impression. The early session on retrolental fibroplasia, in which the deployment of the full

range of epidemiologie approaches was illustrated, was a tour de force and had a particularly great impact on me. I

actually gave a watered-down version of that lecture at the

University of Washington several times (I had carefully retained your handouts), during which time it was attended

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by Tom Koepsell who was getting an MPH degree here. When he later joined our faculty and began to teach, he also

recognized the potential of that example as a means of providing an overview. Tom spent a lot of effort augmenting what he had heard from me, and now gives a lecture each year on this subject that actually does justice to yours of two decades ago. It really is true: A teacher never knows where his/her influence ends.

Creating Camelot (by Walter Willett)

The world knows well of Brian's enormously visible contributions to epidemiology, including the textbook that codified and defined our field and his many fundamental

insights on the etiology of breast cancer. I would therefore like to describe a few small episodes that represent the

ways in which he helped me and so many other colleagues, and in doing created the Camelot of academia.

My first encounters with Brian were in the early 1970s, the Vietnam years. As I was a conscientious objector when

my draft number came up, I worked mainly evenings as an adult medicine physician in East Boston Neighborhood Health Center. As this gave me some free time during the

day, as a Harvard employee I signed up to audit the basic courses in biostatistics and epidemiology, then taught by Dick Monson, Phil Cole, Tom Mack, and Brian MacMa- hon. Hearing Brian describe in person the origins of the international case-control study of breast cancer and the

findings that emerged was an amazing experience. I man-

aged to ask a few questions during and after class. Toward the end of the course, Brian stopped me after a class and said he had checked with the Registrar's office and found that as a Harvard employee, I could convert these audited courses to credits toward an MPH degree. I was amazed that this international giant in epidemiology, who barely knew me and without my request, had taken the time to clear a path for me. Of course, this was impossible to

ignore, so I formally enrolled as a student and over two

years obtained my MPH degree. For me this was career

defining as the MPH allowed me to switch from teaching internal medicine to community medicine while working in

Tanzania, and thereafter, to enroll in the epidemiology doctoral program at Harvard.

Again as a student, Brian encouraged me to consider the

possibility that nutrition might have something to do with

cancer, a radical thought that had never occurred to me

before. I was later privileged to be a faculty member in Brian's department, and again I benefited frequently from his

support, such as being invited to a meeting, to co-author a

review, and in many other small and quiet ways. Of course, we all benefited from his critiques that were unvarnished, direct, and almost always directly on target. Most




importantly, he created an academic shelter that minimized

bureaucracy and formality to let us pursue our ideas. Until

today, Brian serves as the inspiration for the teacher, inves-

tigator, and department chair that I hope to be.

Walter Willen Chair, Department of Nutrition, HSPH

A scientific symphony (by Hans-Olov Adami)

Although my meetings with Brian MacMahon were limited in number and brief for the most part, I have three memories unlikely to fade. During my first visit to Boston in 1991, 1 was lodged at the Harvard Club and Brian came to see me over breakfast. For a former surgeon from Sweden who was largely self-taught and just recently entered the realm of epidemiology , meeting the author of the Textbook that had become my professional compass was an almost unreal event. During our serene conversation, Brian claimed "I hate words" - a surprising statement for someone who had just recently started a scientific journal. Always ringing in my ears, this claim has influenced my writing ever since.

In recent years, Dimitrios Trichopoulos took me to Brian's home on several occasions. The interior of his house was hardly sumptuous but rather a casual enclave for

a true intellectual. Books, computers, scientific papers, magazines, manuscripts, and sagging armchairs were the essential ingredients in this little universe, habituated for decades. Our conversation was quiet, sometimes fumbling with moments of relaxed silence.

Brian's remarks were sharp and friendly but never conciliatory. When we left after an hour or two, a man with impeccable integrity was waiving his hands for farewell on his vestibule.

My final memories are from a couple of weekend lunches in a gloomy Bostonian fish restaurant. The core team was constant: Brian, Dimitrios Trichopoulos and Ken Rothman. Being a member of the group was a treat. Based on deep personal friendship dating back to the 1970s, this team behaved like a remarkably integrated chamber orchestra, a string trio with perfect coordination of three uniquely distinct personalities. The conversation was an andante played with precision, dry humor and no unnec- essary tones. Sadly do I realize that these intellectual lunch concerts will never take place anymore because the first violinist is no longer among us.

Hans-Olov Adami Chair, Department of Epidemiology, HSPH

Acknowledgments The authors are grateful to Mr. David Havelick and Ms. Rebecca Cantor for their editorial assistance.

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brian macmahon (1923-2007): founder of modern epidemiology

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