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Winter 2009

INSIDE 2008 Annual Gift Report Lessons from the College Alcohol Study Boyhood chums reunite at HSPH Keys to heart disease Remembering an HSPH Nobel Laureate

Harvard Public Health Review

carrots and stIcKsEmployers

prod workers

to adopt

behaviors

that improve

health

HARVARD School of Public Health

Harvard The Harvard Public Health Review is published three times a year for supporters and alumni of the Harvard School of Public Health. Its readers share a commitment to the School’s mission: advancing the public’s health through learning, discovery, and communication.

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Dean of the Faculty Barry R. BloomJoan L. and Julius H. Jacobson II Professor of Public Health

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© 2008 President and Fellows of Harvard College

Dean of the facultyBarry R. Bloom

alumni council

officers Mark S. Clanton, MPH ’90President

Royce Moser, Jr., MPH ’65President-Elect

Elsbeth Kalenderian, MPH ’89 Secretary

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councilors2006-2009Anthony Dias, MPH ’04Ramona Lunt, MPH ’74Biba Nijjar, MPH ’07**

2007-2010Roderick King, MPH ’98Monisha Machado, SM ’07**Gloria Rudisch, MPH ‘70

2008-2011G. Rita Dudley-Grant, MPH ‘84Sean Dunbar, SM ‘08**Maxine Whittaker, MPH ‘86

Regional RepresentativeMyron Allukian, Jr., MPH ’67*

**Class Representative

* Harvard Alumni Association-appointed director

Visiting committee Steven A. SchroederChair

Ruth L. Berkelman Jo Ivey BouffordLouis W. CabotNils DaulaireNicholas N. EberstadtCutberto GarzaTore GodalJo HandelsmanGary KingJeffrey P. KoplanRisa Lavizzo-MoureyBancroft LittlefieldNancy T. LukitshVickie M. MaysMichael H. Merson Anne MillsKenneth OldenJohn W. RoweBernard SalickBurton SingerBryan Traubert

Dean’s councilGilbert ButlerWalter Channing, Jr.Barrie M. DamsonMitchell L. DongJohn H. FosterA. Alan FriedbergC. Boyden GrayRajat GuptaJulie E. Henry, MPH ’91Stephen B. KayRachel KingNancy T. LukitshBeth V. MartignettiDavid H. M. MathesonRichard L. MenschelAhmed MohiuddinAdeoye Y. Olukotun, MPH ’83Paul G. Rogers†

Jerome S. RubinKate W. SedgwickEliot I. SniderHoward H. StevensonRobert C. Waggoner

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†deceased

Public Health Review

10 Binge Drinking 101 College Alcohol Study calls for “environmental” changes at U.S. schools

16 Take Heart Five lifestyle choices cut heart disease risk for 80% of Americans. But what is the impact of stress and genetics?

20 Don’t I Know You From Chennai? Reunited childhood friends share a

passion for helping kids

22 A Man of Cultures Remembering HSPH Nobel Laureate Thomas Weller

Also in This Issue

25 Harvard School of Public Health Annual Gift Report 2008

26 The Year’s Events

The Gift Report

29 Volunteers

34 Founders Circle

36 Barry R. and Irene T. Bloom Fellowship

38 Tribute Gifts

39 Harvard School of Public Health AIDS Initiative

40 Annual Fund

44 Alumni

51 Friends

55 Faculty and Staff

56 Organizations

58 Financial Report

Back Cover: Continuing Professional Education Calendar

Winter 2009

20

Image credits: Top to bottom, Peter Horvath; Kent Dayton/HSPH; Kent Dayton/HSPH

4 Carrots and Sticks: Employers prod workers to adopt behaviors that improve health

16

4 Harvard Public Health Review

Health Policy|Health SystemsPeter H

orvath

A Massachusetts man lost his job at a Scotts

Miracle-Gro lawn and garden center in 2006 when

a routine drug test came back positive. The finding:

nicotine. Company leaders were cracking down on

smoking and other unhealthy behaviors they saw as bad

for the bottom line.

That same program saved another Scotts employee’s

life. In this case, the worker—following the advice of a

company-paid health coach—had some medical tests done

and discovered that he was likely just days away from a

massive heart attack. Two stents inserted into his coronary

arteries saved him from a life-threatening blockage.

These are just two examples of how U.S. employ-

ers are dangling “carrots” and swinging “sticks” to prod

workers to change their behavior and better their health.

Companies have long had an interest in keeping workers

healthy, productive, and satisfied while cutting health-

care and insurance costs. Increasingly, though, they are

carrots & stIcKs

Employers prod workers to adopt behaviors that improve health

continued

Winter 2009 5

using incentives—and disincentives—to rein in these

costs’ runaway growth.

So far, tobacco use and obesity are getting the most

attention. To prompt workers to stop smoking and lose

weight, employers are, among other things:

• adopting no-tobacco policies on and off the job

• offering cash-incentive payments and gift cards

• reimbursing workers for gym memberships

• providing free health coaching

• offering insurance-premium discounts to those who meet health standards—and surcharges to those who don’t

According to a 2008 national survey by Harris Interactive,

91 percent of employers “believed they could reduce their

health care costs by influencing employees to adopt health-

ier lifestyles,” wrote two Harvard School of Public Health

(HSPH) experts in the July 10, 2008 issue of the New

England Journal of Medicine. Michelle Mello, a professor of

law and public health in the Department of Health Policy

and Management, and colleague Meredith Rosenthal, an

HSPH associate professor of health economics and health

policy, spelled out the legal parameters of employer-spon-

sored wellness programs as they stand today.

According to surveys cited by Mello and Rosenthal, 19

percent of employers with 500 or more employees offered

wellness programs as of 2006. Almost 40 percent said they

planned to offer monetary rewards for healthy behaviors

within two years.

BY THE RULES

Employee wellness programs have been around for decades.

But one likely impetus for these programs to offer a new

round of health incentives was the issuing, in December of

2006, of final rules on group health plans under the Health

Insurance Portability and Accountability Act (HIPAA).

These rules reduced the uncertainty about what was legally


permissible, which was probably holding some insurers back

from moving in this direction, Mello says.

Among other things, HIPAA limits the value of in-

centives that group health plans can offer to less than 20

percent of the total cost of health insurance (meaning

premiums paid by both employer and employee). This rule

allows for up to $2,420 for a family insurance policy cost-

ing $12,100 a year. HIPAA rules also distinguish between

incentives based on participation in a program and incen-

tives based on achieving certain health standards, such as

quitting smoking or attaining a healthier weight as reflected

by the body mass index (BMI).*

There are caveats, however. “If the reward is tied to

achieving a health standard but there’s no alternative stan-

dard available to people who can’t reasonably be expected to

meet that standard, it would violate HIPAA,” Mello notes.

Assume, then, by way of example, that “Company X” re-

quires its employees to be nonsmokers and have a BMI under

30. The company’s rationale, backed by the medical literature,

would be that (a) people who smoke are more likely to develop

heart disease, lung cancer, and other costly and debilitating dis-

eases and (b) those with a higher BMI are likely to develop these

as well as other problems, such as diabetes, all of which could

erode their productivity and ratchet up their and the company’s

health care costs. HIPAA might allow the incentive to help

slightly obese workers reach a BMI under 30; however, the law

would also require that morbidly obese workers receive the same

incentive to meet a less drastic and more realistic target BMI.

All of this is perfectly legal, as long as group health

plans abide by HIPAA and insurers and employers abide by

the Americans with Disabilities Act, plus other applicable

federal and state laws. “It’s rare for courts to find that obesity

constitutes a disability under the Americans with Disabilities

Act,” Mello says. “Courts have also consistently found that

nicotine or tobacco use does not constitute a ‘disability.’” She

and Rosenthal point out, however, some courts have ruled

“morbid obesity” to be an “impairment” if it can be linked to

a “physiological cause.”

Still other federal laws governing health incentive plans

include civil rights laws, pay and age discrimination laws, the

Employee Retirement Income Security Act (ERISA), and the

tax code. State laws may also limit a company’s ability to im-

pose health standards. Several states have statutes that explicitly

disallow hiring or firing workers based on their tobacco use.

STEP ONE: HEALTH SCREENING

To screen employees for unhealthy behaviors, many well-

ness programs use a health risk appraisal as a first step.

“Health risk appraisals tend to be broad instruments that

collect information about clinical conditions, health-related

behaviors, and medical history,” says HSPH’s Rosenthal.

“Most include questions related to tobacco and alcohol use,

even to things like seat-belt use. Some are more tailored

than others.”

IBM: carrots only

IBM offers employees up to two $150 payments a

year if they complete Internet-based assessments

organized around healthy eating, exercise, overall

health, and children’s health. To earn payments,

employees must meet specific requirements such as

weight loss, diet change, or attainment of physical

fitness goals, with each option.

Carrots• Healthy Eating Option: food tracking, meal planning,

goal setting

• Physical Activity Option: walking, running, swimming, aerobics

• Preventive Care Option: preventive care recommen-dations and maintenance of personal health records

• Children’s Health Rebate: educational resources for employees to establish healthy eating and exercise routines for their children

• New Hire Rebate: new employees complete an on-line health assessment and visit Web-based health resources

* To calculate your BMI, divide your weight by your height in inches squared. Multiply that by 703. A BMI of 25 to 29.9 is overweight, while 30+ is obese. A BMI calculator is available at www.findmybmi.org.

“It’s rare for courts to find that obesity constitutes a disability under the americans with Disabilities act.”

—Michelle Mello, HSPH professor of law and public health

continued

Winter 2009 7

alabama: targeting Highest-risk Workers

Starting in January 2010, the state of Alabama

will charge current employees a $50-a-month

health insurance premium (no premium is

charged now, except for tobacco users).

Incentives will kick in for employees who choose

to participate.

Carrots• $25 premium discount to employees who don’t

use tobacco

• $25 “wellness premium discount” for employees who meet standards for blood pressure, choles-terol, glucose, and BMI

• Anyone whose results fall outside certain bound-aries receives a voucher that covers the co-pay-ment for a doctor’s visit.

• Beginning in 2011, employees can receive the dis-count if they have shown that they are within set boundaries, or are taking steps to get healthier.

StiCkS • $25 monthly premium for tobacco users rises to

$50 in 2011

• No wellness premium discount for employees who don’t take health risk assessments and/or steps to reduce their health risks

Such tools also reflect medical standards for health in-

dicators such as blood pressure and cholesterol, established

by clinical experts based on evidence from patient studies.

Disease-specific organizations, such as the American Heart

Association (AHA) and American Diabetes Association

(ADA), post benchmarks on their Web sites.

For example, the AHA puts the high end of normal

blood pressure at 120/80. ADA describes blood glucose

levels of 70 to 130 mg/dl before meals as normal. Some

doctors urge people to take action if their total cholesterol

level is above 200, for example, or when their BMI reaches

the overweight and obese range.

In August of 2008, the state of Alabama—which

already charges tobacco users $25 per month in insurance

premiums—announced that as of 2010 it would charge

additional monthly premiums for employees who choose

not to participate in the state’s wellness program. The

state employs more than 37,500 people. (See “Alabama:

Targeting Highest-Risk Workers,” left).

Alabama’s chief goal is to identify the people most

at risk first, because their levels for BMI, cholesterol, and

blood pressure are far above what is considered healthy.

“We try to identify people who are at highest risk so they

can get the care they need,” explains William Ashmore,

chief executive officer of the State Employees Insurance

Board (SEIB). Contrary to early news accounts, he says,

Stockbyte/Getty Im

ages


SEIB is not imposing a “fat tax.” Employee representatives

have endorsed the program, he says.

Ashmore says “high-risk” standards that trigger

incentives are:

• BMI: 35 or higher

• Cholesterol: 240 total and higher

spending on Health care in 2007

tOtAl U.S. HEAltH CARE SPENdiNg: $2.3 tRilliON ($7,600 PER PERSON)1

scotts Miracle-Gro Gets Down to Details

Scotts uses both incentives and disincentives.

they include:

Carrots• $10 monthly fitness center membership fee,

reimbursable after 120 uses of the center

• Free health coaching

• Free medical services for employees and cov-ered dependents

• Free prescriptions for generic drugs

stICks• Scotts offers a voluntary health-risk ap-

praisal called Health Quotient. Employees who choose not to participate pay a $40-per-month insurance premium surcharge.

• if an employee takes the appraisal and is in the mid- to high-tier range of risk levels, he or she can opt to consult a health coach and take steps to lower risks. However, if that employ-ee chooses to do nothing, he or she will pay a $67 insurance premium surcharge per month.

• Blood pressure: 140/90 and higher

• Blood glucose: Greater than 180 mg/dl

“Alabama is probably barking up the right tree,” says

Rosenthal. “Some experts say setting very tight standards and

encouraging people to get to them may be missing the point.

Getting people below this very high level is much more impor-

tant in terms of mortality and morbidity than getting people to

look like [fitness experts] Jack LaLanne or Kathy Smith. Getting

people from a seriously high risk situation to a somewhat less but

still risky situation may be the most cost-effective approach.”

APPROACHES VARY WIDELY

Some companies are using carrots only. IBM, for instance,

offers cash payments for completing certain assessments. Says

IBM Well-Being Director Joyce Young, MPH ’81, “We have

programs aimed at every risk” (see “IBM: Carrots Only” on

page 6). The programs include some on-site fitness centers and,

due to the widely dispersed work force, Internet-based assess-

ments. IBM has spent $130 million on wellness since 2004.

That figure includes more than 100,000 payouts last year.

A “Smoke-Free Rebate” that IBM offered for three years

was recently discontinued, Young says, because the percent-

age of workers who smoked had plummeted to less than 10

percent. The company still offers a smoking cessation program

through an interactive Web site and telephone counseling.

IBM’s newest incentive, a “Children’s Health Rebate,” aims to

tackle childhood obesity.

One company’s wellness efforts were featured in a cover

story in Business Week in February 2007. Scotts Miracle-

1. National Coalition on Health Care, www.nchc.org/facts/cost.shtml

2. The Henry J. Kaiser Family Foundation, www.kff.org/insurance/7672/index.cfm

3. Centers for Medicare and Medicaid Services, www.cms.hhs.gov/NationalHealthExpendData/Downloads/proj2007.pdf

4. Business Roundtable, www.businessroundtable.org

Average annual employer health

insurance (family): $12,1002

(individual): $4,400

• Employer health insurance

premiums doubled since 2000.

• Workers paid $1,400 more

for premiums than in 2000.

U.S. government and private

health care spending is predicted

to increase by about 6.7 percent a

year through 2017 to $4.3 trillion,

or 19.5 percent of gross domestic

product.3

For four straight years, in the

Business Roundtable’s annual CEO

Economic Outlook Survey, execu-

tives cited health care expenditures

as the top fiscal pressure on their

companies. (in 2007, energy costs

were tied with health care costs as

the most weighty concern.)4

Winter 2009 9

Gro, headquartered in Marysville,

Ohio, built a $5 million “Wellness

Center” in 2005 near its headquar-

ters and maintains a medical clinic,

a pharmacy, and a fitness center. (See

“Scotts Miracle-Gro Gets Down to

Details,” page 8.) Scotts adopted a

controversial tobacco-free policy in

2006. It no longer hires tobacco us-

ers in certain states. Meanwhile, its

wellness program aims to encourage

smokers to quit.

But trouble emerged when,

in September of that year, a man

named Scott Rodrigues, who had been working at Scotts on

Cape Cod, Massachusetts, for about two weeks (of a 60-day

probation), took a required drug test that turned up nicotine.

Scotts, whose no-tobacco policy was slated to take effect the

next month, let him go. Rodrigues sued. As Business Week

noted, the outcome of the case—pending in federal court

as of November 1—is difficult to predict because there is so

little case law on this narrow topic.

Attorney Lewis Maltby, founder and president of the

National Workrights Institute in Princeton, New Jersey,

says employers should be cautious in implementing wellness

programs that may infringe on privacy and personal inter-

ests. But he says he knows of no other cases like the one in

Massachusetts. That includes Michigan, where Weyco Inc.,

now part of health-benefits manager Meritain Health, had not

only a no-smoking policy that included mandatory tobacco

testing of workers, but a no-smoking policy for spouses as well.

No Michigan statute prohibits that kind of action, Maltby says.

DO INCENTIVES REALLY WORK?

According to several studies, the cost-effectiveness of health

promotion programs varies widely. The Wellness Councils of

America maintains that the “return on investment,” or ROI,

of such programs is $3 or more for every $1 spent. However,

little has been published so far on the ROI of incentives alone.

Many experts agree that it takes two to three years for any

cost benefit to show up. Even in

the best-case scenarios, companies

would likely see slower growth in

health care costs rather than cost

reductions.

“It is difficult to tease out

which activity is responsible for

what behavior,” explains HSPH

alumna and IBM wellness program

head Joyce Young. Any change in

benefits prompts a cost change, and

“You have to control all the changes

to be able to see the effect of a

health-improvement change,” she

says. “It takes years before you see trends.”

As for IBM’s physical activity program, Young and

her collaborators at the University of Michigan Health

Management Research Center have determined that it does

deliver. From 2003 to 2005, participants—53.8 percent of eli-

gible employees—saw their health care costs rise by $291 a year,

compared to $360 for nonparticipants. At Scotts, spokesperson

Keri Butler says 80 percent of employees take advantage of the

company’s Wellness Center. The payoff? Costs are rising, but at

a rate “lower than the national average,” she reports.

For her part, HSPH’s Rosenthal says she recently ex-

plored whether people who take health risk assessments ac-

tually do make behavioral changes to improve their health.

“The results don’t suggest any dramatic effects,” she says.

“It’s not clear whether assessment alone will be very effec-

tive.” On the other hand, there is reason to believe penalties

will be. According to a body of research, Rosenthal says,

“People are much more averse to losing something than

they are excited about the possibility of a gain.”

Experts agree: More research is needed to learn just

how effective workplace incentives and disincentives really

are. When it comes to the daunting challenge of changing

people’s health-related behavior, “carrots” and “sticks” may

be the best tools available.

Larry Hand is associate editor of the Review.

“ Getting people from a seriously high-risk situation to a somewhat less but still risky situation may be the most cost-effective approach.”

—Meredith Rosenthal, HSPH associate professor of health economics and health policy

ROUNd OF dRiNkS like Maypole revelers, up to 40 students at a time can imbibe from this “beer bong.”

Winter 2009 11

Social and Environmental Threats

Gregg M

atthews/The N

ew York Tim

es/Redux

continued

Binge drinking 101

Fed up with their inability to deter underage students from

binge drinking on campus, 120 U.S. college presidents

proposed this past summer to open up a national debate about

the legal drinking age. “21 is not working,” the presidents

opined. Younger students were flouting the law.

But in raising the possibility of a lower legal age—perhaps

as low as 18—the presidents met with a din of protest.

Experts in law enforcement and highway safety

cried foul. Leaders in education, substance abuse, and

neurology—not to mention parents, including Mothers

Against Drunk Driving—blew their collective stacks.

Still more kids would start drinking in high school, they

charged. And, according to the National Highway Traffic

Safety Administration, about 900 more young people

would die in alcohol-related crashes each year.

Many protesters, including op-ed writers at the New York

Times and the Washington Post, have drawn support for their

argument from the father-of-all-drinking studies: the Harvard

School of Public Health’s College Alcohol Study (CAS).

According to CAS director Henry Wechsler, “Lowering the

drinking age would be like using gasoline to put the fire out.”

His 14-year study shows that the key difference between

alcohol-steeped, “wet,” so-called “party schools” and “drier”

schools boils down to a simple concept: environment. Students’

drinking habits depend to a great degree on the availability

of alcohol and their access to it. Both variables are heavily

influenced by college, community, and state policies.

“College presidents do need more help,” Wechsler says.

“But instead of giving up, they should join forces with the

community. They’ve got to strengthen existing policies and

restrict easy access to alcohol.”

PARTNERSHIPS KEY

The CAS surveyed more than 50,000 students at 120 four-

year schools in 40 states in 1993, 1997, 1999, and 2001.

The study defined “binge drinking” as consuming enough

College Alcohol Study calls for “environmental” changes at U.S. schools


alcohol to produce a host of problems

for the drinker and others in the same

orbit: five drinks for men and four

for women, at least once during the

previous two weeks. (See graph on

page 15, “Binge-drinking’s conse-

quences for students.”)

In the July 2008 issue of the Jour-

nal of Studies on Alcohol and Drugs,

Wechsler and CAS Co-director Toben

• Fewer alcohol outlets

• More laws controlling high-volume sales (drinks served in pitchers, fish bowls, boots, buckets; limits on so-called happy hours)

• Limits on irresponsible marketing practices (e.g., prohibit 25-cent beers, all-you-can-drink specials, and “ladies nights,” when women drink for free)

According to Toben Nelson, an

assistant professor of epidemiology and

community health at the University of

Minnesota, binge drinking rates among

schools range from 1 to 80 percent. But

for any given college or university, the

rate has remained remarkably stable over

time. “This suggests there is something

about ‘party schools’ that has earned

them their reputation,” Wechsler notes.

How U.s. students self-report drinking levels

abstainer

21% 18%

38% 22% Non-binge

drinker

occasional binge drinker (1-2 times in past 2 weeks)

Frequent binge drinker (at least 3 times in past 2 weeks)

Nelson summed up the CAS findings.

“There is no one size fits all” solution

to underage drinking on campus, they

emphasized. But schools and commu-

nities with fewer problems had:

• A comprehensive set of state minimum drinking-age laws (posses-sion, sale, age of workers at outlets)

• Stronger enforcement of these laws (e.g., through identification checks and keg registrations)

By changing the environment,

“You can change people’s behavior,”

says Wechsler, a semi-retired lecturer

in HSPH’s Department of Society,

Human Development, and Health.

“But you have to go far beyond educa-

tional, psychological, clinical, and

motivational programs for individuals,”

he says. “Changing the environment

is the best way to go, because crops of

students come and go.”

Cultural factors, too, can be

influential, the CAS found. Relatively

higher binge drinking rates prevail at

colleges that:

• Have many sororities and fraternities

• Have highly competitive athletic programs as members of National Collegiate Athletic Association (NCAA) Division I

• Normalize student drinking as historical tradition

Some schools have launched

campaigns aimed at making heavy

drinking socially unacceptable. That’s

all fine, Wechsler says, except that

students are bombarded daily with

inducements to drink. Their campuses

are ringed by bars and liquor stores

offering large drinks at low prices.

They see peer leaders in athletics and

fraternities drinking heavily.

“For interventions to be effec-

tive,” Wechsler says, “this super-wet

environment must change.”

LESSONS FROM TOBACCO

By way of example, Wechsler points

to the enormous success of tobacco-

control efforts. In Massachusetts

and elsewhere, five basic principles

continued

to discourage students from underage binge drinking, colleges must join forces with the community, strengthening alcohol-control policies and restricting easy access to alcohol.

Winter 2009 13

Five steps to changing BehaviorWant to alter student drinking pat-

terns—or many other health-related

behaviors, for that matter? Follow five

basic steps, HSPH experts say.

This five-step formula has been

critical to successful tobacco-control

campaigns, including the “Make

Smoking History” campaign launched

in Massachusetts in 1992. The state’s

efforts were led by its former public

health commissioner, Howard koh, and

his colleague, gregory Connolly. they

are now, respectively, HSPH’s Fineberg

Professor/director of the division of

Public Health Practice and a professor

in the division. By 2003, overall ciga-

rette consumption had fallen 48 per-

cent, from 117 to 60 packs per adult, as

people’s view of smoking turned from

“cool” to “socially unacceptable.”

Prior to that, HSPH helped

transform Americans’ view of what

is acceptable when it comes to

drinking and driving. in 1988, HSPH’s

Jay Winsten, an associate dean and

the Frank Stanton director for the

Center for Health Communication,

popularized the concept of the

“designated driver,” the adult who

abstains at a party so that he or she

can drive friends home safely.

As HSPH’s Henry Wechsler notes,

alcohol and tobacco differ, in that al-

cohol in moderate doses is generally

legal and safe for adults. (In modera-

tion, it can even be healthful for some,

other School researchers report).

Nonetheless, Wechsler says, these five

basic principles still apply.

step 1. Make It More expeNsIve

Smoking Drinking

Raise cigarette taxes. Use some of the new revenue for tobacco con-trol and public health programs.

step 2. Make It harDer to Do throuGh laws, reGulatIoNs, aND other CoNtrol polICIes

Enforce laws prohibiting sales to minors. Enact laws to create smoke-free workplaces, restau-rants, hospitals, schools and other public areas.

step 3. lauNCh publIC eDuCatIoN CaMpaIGNs about health-harMING eFFeCts baseD oN evIDeNCe FroM researCh, aND test theIr eFFeCtIveNess

Regulate discounts in pricing. Prohibit 25-cent beers and so-called happy hours and ladies nights. Raise taxes on these units of alcohol, which are often purchased by underage drinkers. Use some of the new revenue for alcohol-control efforts, particularly those related to binge and underage drinking.

Enact and enforce comprehensive drinking-age laws, including restrictions of purchasing, possessing, or consuming alcohol under age 21. Regulate access: limit new alcohol licenses in and near campuses; impose stiff penalties on students who provide alcohol to underage students. Control irresponsible marketing practices: limit container size (no pitchers, buckets, or all-you-can drink promotions). Require that kegs, half-kegs, and “beer balls” be registered in the buyer’s name to encourage responsible drinking.

Stress dangers not only to smokers, but also to nonsmokers through “sec-ond-hand” or “passive” consump-tion. Use public-service tV, print, and radio campaigns to reach people of all ages.

Emphasize harm incurred by bingers (academic failure; death, and injury by car crashes and alcohol poisoning) as well as to others (sexual assaults, other violence, noise, accidents, car crashes). Use public-service tV, print, and radio campaigns to reach students and the general public. If possible, persuade producers to insert story lines on the effects of binge drinking into tV shows and movies, as was done for HSPH’s designated driver campaign.

step 4. provIDe stroNG support For behavIoral ChaNGeOffer free or low-cost smoking-cessation programs, a quit line, and web-based counseling.

Provide education and information. Offer free, confidential counseling and health care. Establish alcohol-free dorms. Make alternative beverages available.

step 5. traNsForM publIC attItuDes towarD the behavIor

Apply 1-4 locally and at state and federal levels to make smoking “socially unacceptable”—harmful to all of society, not just the individual.

Apply 1-4 locally and at state and federal levels to make binge drinking “socially unacceptable”—harmful and disruptive to other students and society, not just the individual.


were used to slash smoking rates.

According to HSPH experts who led the

Massachusetts “Make Smoking History”

campaign, price controls, laws and

regulations governing access, support

programs, and mass communications

to educate the public all helped turn

people against smoking (see “Five steps

to changing behavior,” page 13).

A mass-media campaign was also

critical to lowering drunk-driving fatali-

ties through the HSPH-led “Designated

Driver” campaign. Begun in 1988,

this nationwide effort is credited with

helping cut alcohol-related fatalities by

25 percent within four years.

“There’s a lot colleges and their

communities can do” with regard

to problem drinkers, Wechsler says.

“While lowering the legal drinking

age to 18 has very little support

from the scientific community, I

hope college presidents will take this

opportunity to meet and discuss all

that they can do to improve the situa-

tion on their campuses.

“Instead of spending their political

capital to weaken an effective policy, they

should show leadership in enacting poli-

cies firmly backed by research,” he adds.

Wechsler rattles off a few ideas:

Schedule exams on Fridays. Impose

community service for underage

drinkers. Ask local officials to regu-

late alcohol pricing and the size of

containers, and to shutter stores, bars,

and restaurants that repeatedly sell to

minors. And lobby states to lower the

legal blood-alcohol level for drivers

from 0.08 to 0.05 or lower, as is the

case in parts of Europe.

“Rather than punish students one

by one, I’d penalize the purveyors,”

Wechsler urges. “Do it to improve

the quality of life for everyone on

campus.”

SECOND-HAND TROUBLE

Alcohol has flowed like a river on college

campuses for centuries. Thomas Jefferson

complained about student drinking

when he was president of the University

of Virginia. And, as former Harvard pres-

ident Neil Rudenstine has noted, sheriffs

first began leading undergraduate proces-

sions at Harvard’s first commencement,

“to keep the drunkards in line.”

Students under the influence harm

not only themselves. A huge body of

research links alcohol consumption with

sexual assaults and other forms of violence.

And then there are the injuries and deaths,

most often traced to drunk driving.

At Harvard, about 140 students

a year (out of 6,700 undergraduates

and 12,300 graduate and professional

students) are treated at Harvard University

Health Services for alcohol poisoning or

transported to area hospitals, according to

physician director David S. Rosenthal. He

says these numbers are holding steady.

Director of Alcohol & Other

Drug Services Ryan Travia says

Harvard’s undergraduates are unusual,

compared to their counterparts across

the country. A large percentage of its

academically gifted freshmen say they

are “abstainers”—70 percent in the fall

of 2007. Although that figure fell to 57

percent later in the semester, when the

survey was repeated, it was still consid-

erably higher than CAS estimates of

the average percentage of non-drinking

U.S. freshmen at four-year schools: not

quite 25 percent.

Administrators also work hard

to nurture an environment and a

culture that supports students with

alcohol problems while discouraging

drinking. “We maintain close relation-

ships with alcohol licensing boards

continued on page 24

DrInKInG HaBIts oF traDItIonal* stUDentsBecause students gave multiple

answers, responses do not

total 100%

binge drinker 70%

Frequent binge drinker 38%

Drunk 10+ occasions 24%in last 30 days

Drunk 3+ times 34%in last 30 days

5+ alcohol-related problems 26%

* Undergraduates who drank any alcohol in past 30 days, are 18-23 years old, unmarried, and not living with parents

Winter 2009 15

Binge Drinking’s consequences for students

Missed class

Fell behind in school work

argued with friends

Unplanned sexual activity

Unprotected sex

Forgot where they wereor what they did

Did something they later regretted

Damaged property

Had trouble with police

Was injured

Drove after drinking

Drove after 5 or more drinks

rode with high or drunk driver

Had 5 or more different problems

9% 31% 62%

8% 23% 46%

9% 22% 44%

8% 22% 42%

4% 10% 22%

9% 27% 55%

16% 39% 62%

3% 9% 23%

2% 5% 13%

3% 11% 26%

2% 16% 39%

22% 50% 69%

10% 26% 53%

4% 16% 48%

Non-bingers

Bingers (5 drinks for men, 4 for women within 2 hours)

Frequent bingers(at least 3 times in the last 2 weeks)


Heart DiseaseIllustration, Rob Colvin/G

etty Images; photo, Kent Dayton/H

SPH

taKe HeartJust five lifestyle choices cut heart-disease risk for 80% of Americans.

What’s the added impact of genetics and stress?

lIFe work at hsph, eric rimm

explores links between diet and

alcohol consumption and risk of

stroke and heart disease in large

numbers of people. his research

also asks: how do diet and genetic

and biological factors affect an

individual’s risk?

e

very heart attack survivor has a story to tell. Harvard School of Public

Health Leadership Council member Rick Smith’s is a tale of good fortune.

There is no history of heart disease in Smith’s family. Slim, athletic, and health-

conscious at age 56, he exercises regularly and has always eaten healthfully. He

doesn’t smoke. Stress, however, has for many years been part of Smith’s job in New

York City’s investment industry.

Smith had a video X-ray of his heart called a CT angiogram taken in 2006,

but only because a former Harvard College roommate insisted he do so. To

Smith’s astonishment, his calcium score—a measure of atherosclerosis that he

presumed would be normal, meaning 100 or less—was 2,500. A few of his coro-

nary arteries were 60 to 80 percent blocked.

Bypass surgery helped save Smith’s life in February of 2008. In October, he

and his wife, Charlotte, asked HSPH Associate Professor Eric Rimm, director of

the Program in Cardiovascular Epidemiology, to talk with other HSPH friends

and supporters about factors useful for predicting heart disease risk—some well

known, others less so.

Cardiovascular disease is the number one cause of premature death in the United

States, killing about 870,000 people a year. Of these, female victims outnumber males

by roughly 50,000, partly because their symptoms too often go unrecognized.

What’s the average person to do? Highlights from Rimm’s talk offer answers.

Winter 2009 17

continued

Q: how can the average american

ward off heart disease?

A: Our research tells us that

Americans’ heart attack risk can be

cut by more than 80 percent by adopt-

ing five lifestyle factors: not smoking,

a healthy diet, maintaining a healthy

weight, regular physical activity, and

light to moderate alcohol consumption.

Some people may benefit from

medications—a statin to lower blood

cholesterol, say, or a blood-pressure

drug. But a healthier lifestyle is even

more critical for these people, because

they’re at highest risk.

Q: what about stress? Can it really

cause heart disease?

A: Yes, stress can lead to heart dis-

ease. For example, it can disrupt car-

diac function, either by altering the

electrical stability of the heart or by

hastening atherosclerosis and increas-

ing systemic inflammation. All of these

processes increase the likelihood of a

heart attack.

Though hard evidence is only

now emerging, anxiety, anger, and

other forms of distress appear to add

to our risk of heart disease. These

different types of distress can be

measured using rigorous methods and

then studied in relation to risk of de-

veloping heart disease (see bar chart

on page 18).

Obviously, it’s a huge challenge

to collect accurate measures of stress,

especially given the wide range of

people’s responses. My colleague

Laura Kubzansky, an associate profes-

sor of Society, Human Development,

and Health, is working on this now,

and also looking at how stress and

emotion impact health. The simplest

measures ask people about their feel-

ings and include statements covering

a range of intensity of feeling. For

example, a measure of anxiety might

include statements from “I worry

quite a bit over possible misfortunes”

to “I frequently find myself worrying

about something” to “I sometimes

feel that I am about to go to pieces.”

Answers put people somewhere on a

scale ranging from “not very” to “ex-

tremely” anxious.

Under stress, we react with a

set of biological responses designed

to prepare the body to cope with an

emergency. These responses are often

adaptive in the short-term, allowing

us to respond effectively to immediate

challenges. However, if these challeng-

es occur too frequently, or if we are

unable to turn off the stress response,

these biological responses can lead to

a kind of physiological wear and tear,

and health problems can arise.

Evidence so far suggests that

stress may be involved not only in

cases where people have underlying or

overt cardiovascular disease, but also

in the development of disease. As both

animal and human studies have shown,

stress is inversely linked to longevity.

We don’t yet know exactly how

much stress it takes to cause specific

health problems, or at what point over

the life course stress is most damag-

ing. Recent research suggests that dis-

tress in childhood predicts both adult

levels of distress 30 years later and a

variety of physical health outcomes

as well. If we live to age 50, discover

yoga, and are stress-free for the rest

of our lives, will we be able to rid our-

selves of accumulated damage from

stress? We don’t yet know, but this

is something investigators, including

Laura Kubzansky, are exploring.

Q: If stress and lifestyle might

not fully explain heart disease in

people like rick smith, what about

genetics?

A: The human genome—our full

complement of DNA, about 22,500

genes—is an important focus for the

future. At points all along our DNA

there are tiny, very subtle variations

that make people different. Most

“gene variants” have no apparent ef-

fect on health, but a few can heighten

susceptibility to a disease, such as car-

diovascular disease.

Using high-powered gene-reading

technology and a tube of blood from

each of our study participants, we can

compare DNA from people with heart

disease to DNA from a healthy group,

and ask: Which of these tiny points of

difference—technically, they’re called

“single nucleotide polymorphisms,” or

SNPs (“snips”)—correlate with heart

disease risk? Is risk affected whether

we’ve inherited a particular SNP from

one parent or both?

Two years ago, you could only

compare about 100,000 SNPs in a large

group of people. Now you can look at a

million. Next year it will be more.

Even a SNP that’s quite rare, yet

still significantly more common among

heart disease patients than healthy

people, might clue us in to biological

pathways leading to disease. We know

from genome scans that a single SNP

leads some people to have freckles, or

eye disease, or breast cancer. Now we

can look for SNPs for diabetes, celiac

disease—even a condition as complex

as cardiovascular disease, where many

genes may be involved.

Q: that sounds mind-bogglingly

complicated.

A: This work requires immense com-

puter power and statistical expertise.

Merck, the drug company, assists us with

data processing. From our ongoing stud-

ies of 300,000 men and women, we’ll

take 1,000 who have had a heart attack,

along with their million SNPs, and an-

other still-healthy 2,000, and their million

SNPs. And we’ll see which genes


are “talking together” to increase heart

disease risk.

What’s so novel about our work is

that we can combine all this information

on genetics with 30 years of data we’ve

collected on people’s diet and lifestyle in

middle and older ages. We hope to learn

about health factors that can modify

a genetic predisposition to coronary

disease.

Q: For someone who has a history

of heart disease, or major risk fac-

tors, what’s next?

A: A lot of people see their physician,

get a prescription, and stop there. Big

mistake! In one study that looked at

men who take medication, we still found

lifestyle to be critically important. A

“medications only” group had hundreds

more heart attacks compared to the

healthy-lifestyle group. Medication only

cuts heart attack risk by 30 percent. It’s

not enough.

Q: what about diet?

A: We think the Mediterranean diet will

be the healthiest option. You want a

healthful diet that you can stick to for a

lifetime, not just weeks or months. Rather

than worry about the total amount of fat

you eat, worry about the type. Aim for

‘good’ monounsaturated and polyun-

saturated fats, such as olive oil and other

vegetable oils. Avoid trans fats. Limit

saturated fats; choose lean proteins. Go

for whole grains and other minimally pro-

cessed carbohydrates.

My HSPH colleague Meir Stampfer

and his collaborators recently published

the longest study to date in which people

testing three contrasting diets actually

adhered to them closely: a low-fat diet

of less than 30 percent fat (10 percent

saturated), 20 percent protein, 50 percent

carbohydrate; a Mediterranean diet of up

to 35 percent fat (including olive oil and

nuts), 50 percent carbohydrate, the rest

200

160

120

80

40

0

1.2

1

0.8

0.6

0.4

0.2

0 0 1 2 3 4 5 Healthy lifestyle score

re

lati

ve r

isk o

f c

oro

na

ry H

ea

rt D

ise

ase

anxiety anger General Distress smoking

IMpact oF HealtHy lIFestyle on coronary Heart DIsease rIsKp

erc

en

tag

e o

f e

xce

ss r

isk

IMpact oF stress on Heart DIsease rIsK

This chart shows the relative risk of heart disease in U.S. men depending on how many of the five most influential healthy lifestyle behaviors (i.e., not smoking, healthy diet, maintaining a healthy weight, regular physical activity, and light to moderate alcohol consumption) they report employing. The healthy lifestyle score on the horizontal axis ranks men from low to high on a scale of 0 to 5, where 5 = individuals who report employing all five of the healthy behaviors. A man who performs all of these healthy behaviors is 80 percent less likely to de-velop heart disease than a man who performs none of them. Those who change their lifestyle by adopting even one healthy behavior can cut their risk of heart disease by more than 50 percent.

Source: Health Professionals Follow-up Study, 1986–2004, Circulation

Risk of heart disease increases as levels of anxiety, anger, or more general symptoms of distress increase. These effects have been observed for both men and women. The increase in risk due to distress (roughly 170 percent) is not much less than that of smoking (about 180 percent), which is already a powerful and well-documented risk factor.

Sources: L. Kubzansky, Cleveland Clinic Journal of Medicine, 2007; S. Yusuf et al., Lancet, 2004

Winter 2009 19

protein; and the Atkins diet of about 40

percent fat, 20 percent protein, and the

rest carbohydrate.

This study was conducted in Israel

at a company where participants were

fed lunch, the main meal in that country.

Compliance rates were 85 to 90 percent

over two years, almost twice as high as

rates typically achieved in U.S. studies.

In the beginning, all three diets led

to weight loss. But people couldn’t stick

with the low-fat diet—they were too

hungry. In the long run, they lost the least

Mediterranean diet did much better.

That goes to show that dietary fat

is actually good for you, so long as it’s

mostly polyunsaturated fat (including

omega-3 fats) and monounsaturated fats.

Q: what sets hsph apart from other

research institutions?

A: Here, scientists working with animals

are interacting with epidemiologists

working with human populations. That

speeds up advances.

For instance, my HSPH colleague

risk of heart disease, even after account-

ing for red flags for risk like cholesterol

and inflammatory molecules.

It’s rewarding to apply lab discover-

ies to humans. This initial Ap2 work was

done one SNP at a time for one gene.

But in the body, proteins made from

multiple genes are all “talking” and sig-

naling one other at once.

Heart disease, obesity, and cancer

likely involve many SNPs and genes. To

study links between a million SNPs and

health gets challenging. But computer

amount of weight. Given its links to low-

er heart disease and colon cancer risk,

we recommend the Mediterranean diet.

Q: what’s the story with fish? Good

or bad?

A: Far too much media attention is paid

to contaminants in fish, which in no way

outweigh its health benefits. Recently

a colleague and I pulled together the

world’s literature on fish and heart dis-

ease, and on fish and death rates from

any cause. If you ate two servings of fish

a week, depending on the type, you’d

take in 250 to 1,000 mg of fish oil con-

taining heart-healthy omega-3 fatty acids

on average, per day. Among those eating

no fish, there is a substantially higher risk

for sudden death by coronary heart dis-

ease than among people eating as little

as 250 mg of fish oil a day. The biggest

benefits come from just one or two serv-

ings of salmon a week.

Q: how should someone eat who’s

already had a heart attack?

A: There is really only one large-scale,

long-term trial, in men, where they

randomized heart-attack survivors to

a low-fat diet or to a Mediterranean

diet. In terms of survival, men on the

Gökhan Hotamisligil, chair of the

Department of Genetics and Complex

Diseases, uncovered the function of a

gene that essentially prevents diabetes

in mice. He found that, when you breed

mice without this gene, called Ap2, you

can feed the mice lots of fatty foods

and they still won’t get the high blood

sugar and other clinical warning signs for

diabetes that you’d expect in a typical

mouse. We can’t delete people’s genes

the way we do by breeding mice, but a

drug could have the same effect.

Q: how is hsph’s mouse discovery

relevant to humans?

A: We sequenced the comparable

gene for Ap2 in humans and found that

about 3.5 percent of the population

has one copy of a rare SNP that may

somehow change the gene’s function.

In about 8,000 people, women with

this SNP had about 50 percent lower

risk of a heart attack. Men had about

27 percent. Overall, the SNP was linked

to a one-third lower risk in humans.

Now, pharmaceutical companies and

university scientists are looking to block

or limit Ap2’s protein production.

We can now measure the Ap2 pro-

tein in blood. Our study participants with

high Ap2 levels had a 50-percent higher

algorithms based on our biological

knowledge should help us understand

the complex origins of chronic diseases.

It’s incredibly exciting.

Q: what resources do you need?

A: In the last five years, government

funding rates have dropped—especially

for new research. Faculty salaries largely

come out of those grants. We’ll need

financial resources to bring in students

and postdocs. We want to engage

thousands of new study participants

with broader genetic backgrounds

and ages. And we’ll need computing

infrastructure to support this work.

Asking for support for big freezers that

store 3 million blood samples isn’t very

sexy. But it takes enormous resources

to run a “freezer farm,” with its huge

liquid nitrogen coolers. Each of these

giant containers holds 18 to 27 racks

holding 10 boxes of 100 tubes each.

A top priority is funding projects

that pull together all our expertise at

HSPH. We’re training today’s students

to work across scientific disciplines.

Mastering one is no longer enough.

Karin Kiewra is the associate director of Development Communications at HSPH and editor of the Review.

hard evidence is now emerging that anxiety, anger, and other forms of distress appear to add to the risk of heart disease.


Training Leaders

In July, incoming MPH student Mohan Sundararaj was

settling into an orientation session at the Harvard School of

Public Health when a familiar face popped out of the crowd.

“It hit me like a flash,” he says. “Do I know this person?

Then I thought, ‘My goodness, that’s Sanjeev from 7th grade.’”

Sanjeev Sriram was a boyhood friend of 18 years ago—the

new kid at St. Michael’s Academy in Chennai, in Tamil Nadu,

India, to whom he’d once been close. Sundararaj reintroduced

himself, and the pair discovered that although their paths had

diverged, they shared a passion for public health.

Don’t I Know you

From chennai?

reunited childhood friends share passion for helping kids

COMMON gROUNd Sanjeev Sriram (left) and Mohan Sundararaj, who met in india as 7th graders, are now both at HSPH.

Winter 2009 21

Kent Dayton/HSPH

ADVOCATING FOR AT-RISK KIDS

Sriram, now 29, has spent most of his life in the United

States, but the two years he spent with his parents in

India had a lasting impact. The contrast between the

urban streets of Chennai and his childhood home in rural

Greenville, South Carolina, was dramatic.

“I think around age 12 you’re at a point in your devel-

opment where you’re going to be either a very ‘me-centered’

person or a more ‘we-centered’ person,” Sriram says. “Living in

India exposed me to the idea of collective responsibility. How

can I live for myself when there are this many people in need?”

As a medical resident in the University of California at

Los Angeles Pediatrics Program, Sriram developed a plan

to educate residents about the experiences of foster children

and other high-risk youth in the court system. “A lot of

foster kids with medical issues fall through the cracks,” he

says. “Social workers, judges, and attorneys may miss the

health care issues involved in making good family place-

ments. A kid may have special nutritional needs or appoint-

ments that need to be kept. And pediatricians need to learn

to communicate with lawyers, judges, and social workers.”

HEALING BODIES AND MINDS

Meanwhile, Sundararaj, also 29, was exploring a different

medical direction. An accomplished pianist born into

a family of doctors, he followed their path into Sri

Ramachandra Medical College, a Harvard Medical

International Affiliated Institution in southern India. There,

he earned his medical degree but dreamt of becoming a

concert pianist. The chance discovery of the field of music

therapy, which has been shown to help patients cope and

recover, offered a way to combine his two callings, so he

moved to Boston to study at the Berklee College of Music.

Before graduating in 2004, Sundararaj interned at a

hospice in Palm Beach County in Florida. He worked with

terminally ill patients, helping them come to terms with

death. In music therapy sessions, he performed songs they

loved and helped them write lyrics, which he then turned

into songs. “There’s an intimacy with a music therapist that

patients couldn’t get by listening to a CD,” Sundararaj says.

“It’s not a casual process, it’s part of a treatment plan. And

as a therapist, I’m trained to deal with the psychological

issues that comes up during a session.”

While he could anecdotally document that patients’

anxiety eased, he found the population difficult to study,

given the daily changes that arose in their advanced stages

of disease. “It’s a constant struggle that scientists in the in-

tegrative medical arena have to go through,” he says. “It is

hard to come up with empirical evidence that it helps, but

for individual patients it is so obvious.”

Sundararaj moved back to Chennai to pursue a resi-

dency in internal medicine, and concurrently set up a

private music therapy practice. Later, he moved to Calcutta

to work as a physician and became involved with Project

Haven, a home for orphaned girls between the ages of 5

and 13 who have suffered abuse and neglect. Sundararaj

volunteered with them as both a physician and a music

therapist, endeavoring to heal their bodies as well as their

damaged psyches.

SCHOLARSHIPS FOR TWO

Now Sundararaj is studying health policy and management

at HSPH through a prestigious Catherine B. Reynolds

Foundation Fellowship in Social Entrepreneurship. He

hopes to establish a nonprofit organization to promote

evidence-based music therapy for disadvantaged children in

India. This will involve offering training fellowships, earn-

ing accreditation, and working to gain governmental recog-

nition of music therapy as an allied health care profession.

Sriram’s focus is in health care and management. His

advocacy for children helped garner him a fellowship in

minority health policy from the Commonwealth Fund/

Harvard University. He plans to continue his clinical work

with underprivileged kids. But he also hopes to work on

policy issues beyond the confines of the pediatrician’s office,

such as universal early childhood education and counter-

ing the influence of advertising in the childhood obesity

epidemic.

After what Sriram calls a “pretty grinding schedule” of

MPH foundation courses during the summer, both he and

Sundararaj are looking forward to taking courses in leader-

ship, management, and minority health policy. Then they’ll

both get back to the business of changing the world, one

child at a time.

Amy Roeder is the Development Communications Coordinator in the Office for Resource Development at HSPH.

two scholarship winners aim to better the lives of disadvantaged children.


In Memoriam

As the polio virus swept across

the United States in 1948,

32-year-old Thomas Weller was logging

long hours in a Harvard Medical School

laboratory, working to develop a new

way to culture viruses in test tubes so

that scientists could then test drugs

against the pathogens. Having already

succeeded in growing the mumps virus,

Weller now turned to his pet project:

the chicken pox virus, varicella.

One day in March 1948, after

adding varicella to several test tubes filled

with human embryonic tissue and a

special nutrient broth, Weller saw that

four unused test tubes remained. It struck

Weller and his collaborators, Drs. John

Enders and Frederick Robbins, that the

time was right for a new experiment.

From the freezer, Weller retrieved

a sample of mouse brain infected with

poliovirus and added it to the remaining

test tubes, on the off chance that the

virus might grow in the special broth.

The varicella cultures never took, but,

remarkably, the polio cultures did—an

essential step in scientists’ quest to

prevent the disease.

Until that point, researchers had

only been able to grow poliovirus in its

customary target, nervous tissue—with

the result that experimental vaccines,

made with weakened viruses, caused the

immune systems of test animals to attack

neurons in the brain, igniting dangerous

levels of inflammation. By finding a way

to grow the virus in non-nervous tissue,

Weller helped make it possible for Alfred

Sabin and Jonas Salk to create safe polio

vaccines.

SCIENCE FOR THE POOR

Weller later recalled no “eureka”

moment. Persistence and serendipity

had prevailed, and the breakthrough

led to a Nobel Prize in physiology

or medicine for Weller and his two

colleagues in 1954. Their virus-

HSPH lAUREAtE thomas Weller was a pioneer in culturing the poliovirus and other dangerous pathogens.

a Man of cultures remembering the late

hsph Nobel laureate thomas weller

Winter 2009 23

Poliovirus, CDC/ D

r. Fred Murphy, Sylvia W

hitfield; Dr. W

eller photographs, Harvard Medical Library in the Francis A

. Countway Library of M

edicine

culturing technique was soon widely

adopted, making it possible to produce

the vaccine on an industrial scale and

immunize millions of people.

The Nobel came just months

after Weller had joined the Harvard

School of Public Health as the Richard

Pearson Strong Professor of Public

Health and head of the Department

of Tropical Health (now Immunology

and Infectious Diseases), a position

from which he retired in 1981. He

died on Aug. 23, 2008 at age 93.

In 1957, Weller isolated and

cultured varicella as well as cytomega-

lovirus, a form of the herpes virus that

can cause birth defects. In 1960, he

accomplished the same feat for rubella,

the cause of German measles, using

virus obtained from his 10-year-old

son, Robert. Later, focusing on para-

sitic diseases, Weller was involved in

efforts to eradicate schistosomiasis

in developing countries through the

World Health Organization and other

nongovernmental agencies.

Weller’s pioneering science

ultimately helped save hundreds of

millions of lives. Observes outgoing

HSPH Dean Barry R. Bloom, an

immunologist and vaccine expert:

“Professor Weller became a champion

for public health and the effort to

focus the best of science on the diseases

and problems of the poorest people on

the globe.”

FROM BIRDS TO HUMANS

Weller initially appeared headed in a

very different direction. He studied

medical zoology and parasitology at

In his autobiography, published

in 2004, Growing Pathogens in Tissue

Cultures: Fifty Years in Academic

Tropical Medicine, Pediatrics, and

Virology, Weller modestly chronicled

his “life in science.”

“My primary goal was to pursue

what I found interesting and medically

important,” he wrote. “I was curious

and tenacious, and I had my share of

luck.”

MENTOR TO GREAT MINDS

Calling Weller “one of the greatest

scientists of the 20th century,” Dyann

Wirth, chair of the HSPH Department

of Immunology and Infectious Diseases

and the incumbent Richard Pearson

Strong Professor of Infectious Diseases,

told the Boston Globe that Weller had “a

dedication to training the next genera-

tion, and a real vision of how to solve

some of the biggest public health prob-

lems.”

Weller took great pride in

mentoring young scientists. Among his

many outstanding students at HSPH

was William Foege. In the 1970s, this

epidemiologist played a leading role in

the successful campaign to eradicate

smallpox worldwide.

A 2006 talk reprinted in Harvard

Medical School’s alumni magazine

captured Weller’s confidence in fresh,

hungry talent. “I’d rather be recognized

as an effective teacher than a Nobel

laureate,” he said.

Amy Roeder is the Development Com-munications Coordinator in the Office for Resource Development at HSPH.

the University of Michigan, where he

published his first paper on tracking

blue jays and did a master’s thesis on

a fish parasite he had discovered. But

at Harvard Medical School, Weller

became interested in human parasitic

and infectious diseases.

Weller’s clinical training in pedi-

atrics got under way at Children’s

Hospital in Boston but was inter-

rupted by World War II. Enlisting

in the Army Medical Corps, he was

stationed in Puerto Rico, where he

helped develop a malaria reporting

system that led to reductions in the

high infection rate at Fort Buchanan.

By 1947, he was back at Children’s,

where, with his former professor, John

Enders, he co-founded the research

division of infectious diseases.

tRiUMPHANt tRiO thomas Weller (left) with F. C. Robbins and John Enders at the 1954 Nobel Prize ceremony.

admirers call thomas weller “one of the greatest scientists of the 20th century” and a “champion for public health.” weller wrote: “I was curious and tenacious, and I had my share of luck.”

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