On the Frontier of Change: The University of Pittsburgh Graduate School of Public Health by Bookhouse Group

ON THE FRONTIER OF CHANGE THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

University of Pittsburgh Graduate School of Public Health 130 DeSoto Street, Pittsburgh, Pennsylvania 412.624.3001 www.publichealth.pitt.edu

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In the 1940s, Pennsylvania ranked near the bottom nationally in public health, with confusing state health laws, few qualified health department administrators, and no graduate school of public health. Pittsburgh was known as one of the nation’s dirtiest cities. Housing, transportation, and recreation facilities were inadequate. A lack of proper sanitation, sewage disposal, and garbage collection plagued the area, as did terrible water and air pollution. Ninety percent of absenteeism in plants was caused by health hazards not associated with work. The city’s health needs, civic pride, and philanthropy coalesced in 1948 to create the University of Pittsburgh Graduate School of Public Health, which today is also known as Pitt Public Health. Over the course of its sixty-five years, Pitt Public Health positively impacted the health of the region, nation, and world. Faculty at the school have identified strains of viruses, discovered genes that play large roles in chronic and contagious diseases, and contributed to the development and deployment of vaccines. Their efforts have resulted in the funding of one of the largest and longest HIV/AIDS research studies in history, so successful that the National Institutes of Health deemed it one of its wisest investments. Pitt Public Health faculty can be directly credited for the creation of the Children’s Health Insurance Program (CHIP), which remains today a major source of health care for low-income children, groundbreaking research that has affected the way the medical community prescribes medications and treats illnesses, and large biostatistical studies that have impacted the health of the industrial workforce. Today, Pitt Public Health continues to build upon its legacy by improving health across the life span, engaging partners around the globe, realizing health equity for everyone, and promoting computation and simulation for decision support in public health.

ON THE FRONTIER OF CHANGE THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

ON THE FRONTIER OF CHANGE Copyright © 2013 by University of Pittsburgh Graduate School of Public Health All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the University of Pittsburgh Graduate School of Public Health.

University of Pittsburgh Graduate School of Public Health 130 DeSoto Street, Pittsburgh, Pennsylvania 412.624.3001 www.publichealth.pitt.edu

AUTHOR STEVE LEVIN EDITOR ROB LEVIN DESIGN RICK KORAB INDEXING BOB LAND

Book Development

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THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Table of Contents F O REWOR D

CHA P T ER

Beginnings

CHA P T ER

Biostatistics

CHA PT ER 3

Epidemiology

CHA P T ER

Health Policy and Management and Behavioral and Community Health Sciences

CHA P T ER

Environmental and Occupational Health

CHA P T ER

Infectious Diseases and Microbiology

CHA P T ER

Human Genetics

APPEND I X

IND EX

â&#x20AC;&#x153;Our 6,000-plus alumni work daily to improve the vision of health for all, not only in Pittsburgh, but worldwide.â&#x20AC;?

Foreword

ublic health is the science and art of preventing disease, prolonging life, and promoting health through organized societal efforts. Clean air and water, effective vaccines, and improved nutrition are clear examples of how prevention—at the population level— has led to dramatic improvements in the human condition. Public health benefits everyone in the community, not just individual patients. In 1948 Pittsburgh could boast of its role as an unmatched global giant in the coal and steel industries. But that extraordinary productivity carried with it a heavy price in environmental pollution and industrial health hazards. That year, a commission was chartered by the A.W. Mellon Educational and Charitable Trust to identify the most urgent and long-range needs of Pittsburgh. Pointing to the glaring environmental and occupational health problems, the commission recommended that a school of public health be established in Pittsburgh. The new Graduate School of Public Health took up temporary quarters in a wing of the Pittsburgh Municipal Hospital, sharing the space with the laboratory of Dr. Jonas Salk, who was just beginning his work on polio vaccines. Thomas Parran, surgeon general of the United States for the preceding twelve years and a dominant national figure in the field of health, was recruited as the founding dean, and the A. W. Mellon Trust provided a $13.6 million endowment. The first class of thirty-four students matriculated in the fall of 1950. The first permanent building, now called Parran Hall, was constructed and ready for occupancy in 1955. This book tells the remarkable story—actually, the many remarkable stories—of the first sixtyfive years of our school. We are now a well-established and highly respected institution of 170 faculty, 650 masters- and doctoral-level graduate students, and more than 500 staff. We generate funds of more than $100 million each year, which supports excellence in public health education, research, and service. Our 6,000-plus alumni work daily to improve the vision of health for all, not only in Pittsburgh, but worldwide. As is told in the following chapters, our research has helped to transform public health. Paul Mellon, at the time of the dedication of the new school, eloquently said that “this building, the instruments and equipment, these are merely the work shop and the tools . . . What is real is the quest, the opportunity to know more of man—his body, his mind, his physical and social environment and the dynamic interrelationships which we call ‘human ecology’ or public health.” It is my honor to be dean of this extraordinary institution. —Donald S. Burke, MD Dean, Graduate School of Public Health UPMC Jonas Salk Chair in Global Health

Downtown Pittsburgh at the corner of Liberty and Fifth Avenues before smoke control.

CHAPTER THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Beginnings

n the 1940s, Pennsylvania ranked near the bottom nationally in public health, with confusing state health laws, few qualified health department administrators, and no graduate school of public health. Pittsburgh was known as one of the nation’s dirtiest cities. Housing, transportation, and recreation facilities were inadequate. A lack of proper sanitation, sewage disposal, and garbage collection plagued the area, as did terrible water and air pollution. Ninety percent of absenteeism in plants was caused by health hazards not associated with work. While the commonwealth of Pennsylvania could boast several schools of medicine, including one in Pittsburgh, by their very nature these schools focused on the individual patient in a one-on-one relationship. Public health is population-based and more concerned with disease prevention and health promotion than treating someone after that person has become sick. The city’s health needs, civic pride, and philanthropy coalesced in 1948 to create the University of Pittsburgh Graduate School of Public Health, which today is also known as Pitt Public Health. Three men—Edward T. Leech, editor of the Pittsburgh Press; I. Hope Alexander, MD, the city’s health director; and city councilman Abel L. Wolk—led the initial effort for a feasibility report on a proposed school of public health. Paul Mellon, scion of legendary businessman, banker, statesman, and philanthropist Andrew W. Mellon, used the prestige and power of the A. W. Mellon Educational and Charitable Trust to gift more than $13 million to make the school a reality on September 15, 1948. In June 1950 the Committee on Professional Education of the American Public Health Association accredited the school for the

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

The city’s health needs, civic pride, and philanthropy coalesced in 1948 to create the University of Pittsburgh Graduate School of Public Health, which today is also known as Pitt Public Health.

The snack bar in the renovated building will be named Stan’s Bar after the 1954 Stan’s Bar on Fifth Avenue. Today Parran and Crabtree Halls stand in this location.

degrees of master of public health and doctor of public health. The first thirty students were admitted that fall. From the beginning Pitt Public Health has played a critical role in increasing the life expectancy of local and state residents, and other Americans. In the 1940s, less than 1 percent of the state’s public health officials were certified. Pittsburgh and Allegheny County didn’t even have public health departments. The school’s founders hoped it would lead to “a sound [Allegheny County] Health Department with which a school of public health could cooperate . . . [in] a spirit of reactive achievement, a responsibility to be on the frontier of leadership, demonstrating the best in public health practice.” To achieve that, the University of Pittsburgh School of Law and Pitt Public Health were instrumental in the passage of the Local Health Administration Law in 1951, which allowed for creation of county health departments in Pennsylvania. Pitt Public Health played a major role in establishing the Butler County Health Department in 1953 and the Allegheny County Health Department in 1957. Allegheny County and Pitt Public Health have collaborated on venereal disease programs, county-wide health surveys, minority health, bioterrorism, tobacco cessation, influenza intervention, maternal and child health, and toxicology intervention services. Additional joint projects have included an adult behavioral risk survey for Allegheny County residents, student internships, evaluation of the Healthy Start program, and an analysis of hospital visits and air quality. Now nearing the completion of a massive refurbishing of its physical plant that will total more than $90 million, Pitt Public Health has set four primary goals to guide its future: Curriculum: Preparing the next generation of public health leaders through its comprehensive and innovative competency-based curriculum that improves training in ethics, systems thinking, integrated quantitative reasoning, large

Beginnings CHAPTER 1

The public health library, 1984.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Now nearing the completion of a massive $90 million refurbishing of its physical plant, Pitt Public Health has set goals in four primary areas to guide its future: curriculum, research, outreach, and support.

dataset analysis, and global health while providing local, national, and international opportunities for an increasingly diverse student body to gain research and practice experience. Research: Expanding public health knowledge through broader research collaboration that includes increasing its role in the scientific evaluation of Marcellus Shale drilling and conducting studies to reduce premature mortality both locally and regionally, diversifying its research funding portfolio, implementing greater faculty recognition, improving the quality of research training and support for doctoral students and postdoctoral fellows, and integrating unique research concepts across disciplines. Outreach: Increasing the health of populations regionally, nationally, and globally by training and mentoring faculty in technical assistance, policy advocacy, and the documentation of impact for their service activities; strengthening relationships with public sector organizations with responsibility for public health while collaborating with health-

IN THE NEWS $13,600,000 Set Up for Health School; University of Pittsburgh Gets Grant From Mellon Trust to Aid Urban Peoples The New York Times, September 23, 1948

The University of Pittsburgh announced acceptance today of a $13,600,000 gift from the A. W. Mellon Educational and Charitable Trust for a new Graduate School of Public Health as â&#x20AC;&#x153;an effective answer to a basic, vital need of the people of the Pittsburgh area.â&#x20AC;?

Beginnings CHAPTER 1

care providers, governments, and communities to implement targeted interventions; and improving policies and practice through the use of new methodologies. Support: Securing adequate resources to build and retain its diverse, world-class workforce while fostering support among alumni, donors, government, and industry; committing to continuous improvement in IT infrastructure while ensuring that computing resources are sufficient to address the growing computational needs of researchers; and integrating researchers across departments to address the strategic themes of improving health across life spans, engaging partners in global health, realizing health equality, and promoting public health dynamics.

Anil Ohja, PhD, explores how an enzyme triggers rapid breakdown of mycobacteria species, including causes of TB.

The first class of the Graduate School of Public Health with the faculty, 1950â&#x20AC;&#x201C;51.

View of man operating a mine car, circa 1940.

CHAPTER THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Biostatistics

or nearly a century, from the 1850s through the 1940s, the Pittsburgh Coal Seam was the country’s best for making coke, a critical ingredient for producing steel. Low in impurities and sulfur with a high proportion of carbon, it was also close to America’s iron and steel industry center—Pittsburgh. The coal contributed to the extreme concentration of heavy industries of iron, steel, and glass in the city, what would become known as the “Arsenal of Democracy” during World War II when Pittsburgh contributed 95 million tons of steel to the war effort, one-fifth of all made worldwide. But there were other results, too: mountains of slag from steel plants; raw sewage dumped into the city’s three rivers; and among the world’s worst air pollution, a black smog that turned day to night, irritated lungs, and ruined clothes. It didn’t come solely from the plants either; in 1940, more than 80 percent of Pittsburgh homes burned coal. With the formation of the state’s first school of public health at the University of Pittsburgh in 1948, and the hiring of Antonio Ciocco, ScD, as the chair of the Department of Biostatistics, the first steps were taken toward changing forever how employees would be protected in the workplace. Those steps led to the steel plants. With funding from the National Cancer Institute, a biostatistics study beginning in 1961 of almost fiftynine thousand steelworkers at seven Pittsburgh-area plants looked at the health of coke oven workers compared to other workers. It found that when compared to coworkers, those working the coke ovens had excess deaths from lung cancer. A second phase of the Mortality Experience of Steelworkers study began in 1965 and included an updated follow-up of workers in the

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Mountains of slag from steel plants; raw sewage dumped into the city’s three rivers; and among the world’s worst air pollution, a black smog that turned day to night, irritated lungs, and ruined clothes. It didn’t come solely from the plants either; in 1940, more than 80 percent of Pittsburgh homes burned coal.

Carrie Furnace scenic view.

Allegheny County steel plants, as well as cohorts of steelworkers from ten additional plants throughout the United States and Canada. The data confirmed that the lung cancer risk was related to the duration and intensity of exposure to coke oven effluents. The second phase of the study, which was funded first by the National Institute of Environmental Health Sciences and later by the National Institute for Occupational Safety and Health (NIOSH) and the Environmental Protection Agency, was directed by Carol K. Redmond, ScD, and formed the basis of one of the first standards set by the newly established OSHA in the early 1970s. The studies of steelworkers not only secured millions of dollars in federal research funding spanning five decades for the Department of Biostatistics, but also led directly to steel companies implementing maintenance and efficiency changes, including the use of respirators by steelworkers. The research extended Ciocco’s vision of changing the department’s initial focus from infectious to chronic diseases, conducting large-scale clinical trials, and expanding its mission to study health problems important in urban and industrial environments. Biostatistics was one of four original departments of the school of public health. This discipline concerns the application of statistical methods to problems in public health and medicine. Biostatisticians play an integral role in formulating research questions, designing studies, collecting and analyzing data, and interpreting results for appraising family and public health, assessing clinical treatments and interventions, and relating biological and societal factors to disease. Faculty in the department during the first two decades developed a vibrant, diverse research program to address numerous public health problems in genetics, demography, medical care statistics, and chronic disease epidemiology. Noteworthy research included extensive quantitative contributions to human genetics, which were unique in nature and scope. The Human Genetics Program owed its origins to the recruitment of Chung Chin (C. C.) Li, PhD. Li became internationally noted for his fundamental contributions to quantitative genetics and experimental design. The program in human genetics that evolved within the Department of Biostatistics encompassed research not only in population genetics but also laboratory research, especially in cytogenetics, as well as one of the first genetic counseling programs in the United States. Li became the second chair of the department when Ciocco retired in 1969. The Human Genetics Program was integral to

Biostatistics CHAPTER 2

For more than a century, Pittsburgh was marked as a smoky city. In 1941 an effective smoke control ordinance was passed in the city of Pittsburgh, but the onset of World War II delayed the enactment of the legislation until 1946.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

the department until 1969 when a separate department was formed within Pitt Public Health. Another early faculty member in the department whose research has had a major enduring influence on several fields was Mindel C. Sheps, MD, MPH. Sheps’s focus on demography was based on her strong feelings about issues relating to poverty, women’s rights, and social justice. Her seminal research papers in the early 1960s (along with Edward B. Perrin, PhD), described innovative stochastic mathematical models for human conception and the reproductive process. The importance of this work continues to be recognized through the prestigious Mindel C. Sheps Award for outstanding contributions to mathematical demography or demographic methodology given annually by the Population Association of America. In the late 1960s, Phillip E. Enterline, PhD, widely regarded as one of the founding fathers of the field of occupational epidemiology,

IN THE NEWS Study Confirms Efficacy of “Lumpectomies”; 8 Years after Surgery, Tumor Removal Plus Radiation Found as Valuable as Mastectomy The Washington Post, March 30, 1989

The largest U.S. study comparing treatments for breast cancer has confirmed earlier findings that a “lumpectomy” to remove only the tumor, followed by radiation treatments of the affected breast, is as effective as a mastectomy in which the entire breast is removed. The study lays to rest some of the caution with which experts greeted the earlier findings because those were made only five years after the surgery. “Because breast cancer can sometimes reappear as long as two decades after it is treated, researchers plan to continue to observe the patients in the lumpectomy study for the rest of their lives,” said Carol Redmond, chair of the University of Pittsburgh’s Department of Biostatistics and a coauthor of the study. “We’re very interested in knowing what the ultimate result is,” she said.

Biostatistics CHAPTER 2

joined the department and began studies of occupational groups. In addition to Enterline and Redmond, other faculty involved with similar studies around this time included Howard E. Rockette, PhD; Joseph P. Costantino, DrPH; Gary M. Marsh, PhD; and Vincent C. Arena, PhD. Since then, hundreds of thousands of workers in industries including car manufacturing, petrochemicals, fiberglass, nickel, aluminum, copper and zinc smelting, tungsten carbide production, aviation, and pharmaceuticals—in addition to steel and coal mining—have been studied for disease risk. The statistical models developed from studies have been used to predict carcinogenicity of chemicals. For example, a cohort study Enterline began in the 1970s led two decades later to a larger, enhanced cohort study of U.S. man-made vitreous fiber (MMVF) workers. Enterline began the original study because of widespread concerns that MMVFs, such as insulation wool or fiberglass, might be the “next asbestos” in terms of lung cancer and mesothelioma risk. Studies, however, found little or no evidence of elevated risk for malignant lung disease or other diseases in general. The 1990s study, led by Marsh, and including Ada O. Youk, PhD, and Jeanine M. Buchanich, PhD, had a considerable impact on the domestic and foreign home insulation wool industry, and allayed homeowners’ fears worldwide about MMVF in their homes, offices, and cars. Based largely on the study, the International Agency for Research on Cancer in 2001 reclassified glass insulation wool as not classifiable as a human carcinogen. In 2008, Marsh formed the Center for Occupational Biostatistics and Epidemiology, or COBE. COBE utilizes the department-developed Occupation Cohort Mortality Analysis Program (OCMAP), a computer program that performs conventional analyses of data from occupational epidemiology studies, and the Mortality and Population Data System (MPDS), which is a large-scale data storage and retrieval system that includes all U.S. death records from 1950–2008. These two systems have become standard analytic tools for occupational epidemiologists, with more than three hundred U.S. and foreign users. The department has conducted numerous large-scale clinical trials involving hundreds of thousands of people that have improved the treatment and diagnosis of several diseases, including colorectal cancer, ear disease in children, and psychiatric disorders. One of the most far-reaching is the National Surgical Adjuvant Breast and Bowel

Antonio Ciocco, ScD

With the formation of the state’s first school of public health at the University of Pittsburgh in 1948, and the hiring of Antonio Ciocco, ScD, as the chair of the Department of Biostatistics, the first steps were taken toward changing forever how employees would be protected in the workplace.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Research professor Mindel Sheps, MD, MPH draws interested comments on a population formula from graduate students.

Project (NSABP), one of several multicenter cooperative clinical trial groups started by the National Cancer Institute in the early 1960s. From its inception the primary mission of the NSABP, which became internationally noted for its landmark clinical trials in breast cancer, has been to conduct multicenter randomized clinical trials of treatments for early-stage operable breast cancer aimed at improving survival and reducing morbidity from this disease. One of the original NSABP sites headed by Bernard Fisher, MD, in the Department of Surgery, was in Pittsburgh at what would later become known as the University of Pittsburgh Medical Center. When Fisher became NSABP group chairman in the early 1970s, he moved the group headquarters from Roswell Park Memorial Cancer Institute. He sought a biostatistician to collaborate in clinical trials testing his recently published, paradigm-changing theory: that breast cancer should be

Biostatistics CHAPTER 2

treated systemically rather than through extensive surgery. It countered sixty years of breast cancer treatment. He asked Carol Redmond to collaborate with him as the group statistician in 1972. Her biostatistical expertise and experience in large-scale follow-up studies from the steelworker mortality research ultimately converted Fisher’s theory into a testable hypothesis within a statistical framework. Their subsequent collaboration on clinical trials with the drug tamoxifen led to a prevention trial, a true public health effort in two critical ways:As a result of NSABP randomized clinical trials, women with early-stage breast cancer saw improved long-term survival, and radical mastectomies gave way to the less invasive lumpectomy as the preferred surgical technique. A third benefit was genetically targeted breast cancer therapies like herceptin. Fisher and Redmond collaborated on the trials for more than two decades. As her work with Fisher expanded, Redmond created in 1976 the Biostatistical Center for the NSABP and was its director until 1994. The NSABP Biostatistical Center remains a major research center within Pitt Public Health. It is currently directed by Joseph P. Costantino, DrPH, and several biostatistics faculty members are an integral part of the center. To date, more than 110,000 men and women have been enrolled in NSABP multicenter randomized clinical trials in breast and colorectal cancers. During the 1980s the department’s research continued diversifying, and additional major collaborative efforts with the School of Medicine evolved. Howard Rockette, who joined the faculty in the 1970s, established a collaboration with the Department of Otolaryngology that has provided the statistical analysis and study design for the twelve clinical trials and six laboratory/clinical studies in humans and animal models at the Otitis Media Research Center at Children’s Hospital of Pittsburgh. Important results from these trials included discovering the lack of efficacy of decongestant-antihistamine in treating otitis media, or inner ear infections, with effusion; quantifying the effectiveness of treating acute otitis media with antibiotics; and the benefit of tonsillectomy in treating chronic ear disease. As with all departmental collaborations, the medical and public health questions in this area have required and motivated the development of new biostatistical methodology, a key part of the department’s mission.

The Human Genetics Program owed its origins to the recruitment of Chung Chin (C. C.) Li, PhD. Li became internationally noted for his fundamental contributions to quantitative genetics and experimental design.

Chung Chin (C. C.) Li, PhD

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Gary M. Marsh, PhD, with a roll of fiberglass insulation.

Collaborations with University of Pittsburgh’s Medical Center (UPMC) continued developing. During the 1990s there were multiple research projects with Western Psychiatric Institute and Clinic (including the development by Sati Mazumdar, PhD, of statistical methodology in psychiatric and health services research), UPMC’s Department of Critical Care Medicine (investigations with adult and pediatric critical care physicians into genetic epidemiology of sepsis; geographic and sociodemographic differences in ICU delivery; the cost-effectiveness of critical care; and mathematical models of inflammation, injury, and organ dysfunction), and the Department of Radiology (to improve the diagnostic accuracy of chest images). The latter collaborative endeavor expanded in time to include research with the university’s Positron Emission Tomography (PET) Research Center and the Magnetic Resonance Research Center in the development of statistical methodology to better evaluate diagnostic imaging systems. In addition, collaborative efforts in health services research were conducted in both the Veterans Administration and UPMC health-care

Biostatistics CHAPTER 2

systems, and with local health insurance providers and pediatric trauma centers. With the advent of genomic data, statistical genetics is now integral to almost all collaborative efforts. The Biostatistics Facility at the University of Pittsburgh Cancer Institute (UPCI) has supported more than one hundred clinical cancer research protocols and grant proposals between 2005 and 2012, including twelve program projects and three successful National Cancer Institute–funded Special Projects of Research Excellence in lung, skin, and head and neck cancers. Daniel P. Normolle, PhD, directs the UPCI Biostatistics Facility and leads a group of several biostatistics faculty and staff in providing clinical and basic science investigators with statistical expertise in the design, execution, analysis, and reporting of cancerrelated research studies. The Department of Biostatistics has continued expanding its collaborations in recent years. The Juvenile Onset Diabetes Project at Children’s Hospital of Pittsburgh of UPMC is a thirty-year project focusing on type 1 diabetes, looking to provide better understanding of risk factors contributing to the increase in childhood diabetes. The department is also home to several members of the Public Health Dynamics Laboratory at Pitt Public Health. In addition, the current chair of the department, Sally C. Morton, PhD, directs the Comparative Effectiveness Research Core, which is part of the University’s Clinical and Translational Science Institute (CTSI)—acknowledging the central role of biostatistics in health-care reform.

Sally C. Morton, PhD

The current chair of the department, Sally C. Morton, PhD, directs the Comparative Effectiveness Research Core, which is part of the university’s Clinical and Translational Science Institute (CTSI)— acknowledging the central role of biostatistics in healthcare reform.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

(Top) Old card-punch data technology. (Bottom) Old biostatistics classroom.

Biostatistics CHAPTER 2

MILESTONES

Biostatistics 1949 Formed under Antonio Ciocco, ScD. 1951 C. C. Li, PhD, one of the founders of the field of population genetics, hired. The Human Genetics Program and the Biometry Program were in the department. 1961 Mortality Experience of Steelworkers study began and ultimately found those working the coke ovens had excess deaths from lung cancer. 1960s Mindel C. Sheps, MD, MPH, and Edward B. Perrin, PhD, published landmark publications on mathematical models of conception and fertility that have had a major impact on the field of demography.

Occupational epidemiological studies by Philip E. Enterline, PhD, Carol Redmond, ScD, and others.

1972 Redmond began collaboration with the National Surgical Adjuvant Breast and Bowel Project designing, implementing, and analyzing research that led to several groundbreaking findings on breast-conserving surgery, including the benefits of adjuvant chemotherapy and hormonal therapy for treatment. It also led to the first large-scale randomized prevention trial in breast cancer, demonstrating that a drug, tamoxifen, can reduce the incidence of breast cancer. 1980 Otitis Media Research Center established at Childrenâ&#x20AC;&#x2122;s Hospital of Pittsburgh of UPMC and the department assumed responsibility for statistical analysis and design of studies to determine the most effective management of infants and children with acute and chronic otitis media with effusion. 1990s Study by Gary M. Marsh, PhD; Ada O.Youk, PhD; and Jeanine M. Buchanich, PhD, MPH, determine man-made vitreous fibers have no elevated risk for malignant or nonmalignant respiratory disease. 2005 Biostatistics Facility of the University of Pittsburgh Cancer Institute formed to provide support for a broad array of projects and educational initiatives, ultimately supporting more than sixty clinical cancer research protocols. 2006 Findings from the Juvenile Onset Diabetes Project at Childrenâ&#x20AC;&#x2122;s Hospital of Pittsburgh of UPMC, a thirty-year project focusing on the etiology and prediction of type 1 diabetes, finds diabetes-related disorders such as heart and eye disease have not improved over the past thirty years.

Public Health Dynamics Laboratory formed.

2008 Center for Occupational Biostatistics and Epidemiology formed. 2011 Comparative Effectiveness Research Core formed.

Doctor checking the blood pressure of an at-risk patient for heart disease.

CHAPTER THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Epidemiology

he Department of Epidemiology’s deep roots and heritage have resulted in significant breakthroughs in the prevention and treatment of heart disease, diabetes, aging, and women’s health. Since 2001 it has generated more than $300 million in federal research funds and earned recognition as among the elite in public health. From 2001–2012 the department secured 51 percent of Pitt Public Health’s total external funds. The legacy of the Department of Epidemiology is rich with worldclass researchers and investigators, beginning with its first chairman, virologist William McD. Hammon, MD, PhD, who presided over what was then known as the Department of Microbiology and Epidemiology, one of the school’s original four departments. A native Pennsylvanian, a former missionary in the Belgian Congo, a Harvard Medical School graduate, and a consultant to the army surgeon general, Hammon was an internationally known epidemiologist and virologist before arriving at Pitt Public Health. A pioneer in the study of arboviruses, coining the term “arthropodborne viruses,” he later showed that Philippine and Thai hemorrhagic fevers were caused by dengue viruses. He also isolated the DEN-3 and DEN-4 virus strains. In 1950 he purified the gamma globulin component of the blood plasma of poliomyelitis survivors. It was his field clinical trials on immunization in the early 1950s of more than fifty thousand children that showed gamma globulin given by injection was effective in preventing polio. This laid the theoretical groundwork for the subsequent development of the Salk polio vaccine.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

The legacy of the Department of Epidemiology is rich with worldclass researchers and investigators, beginning with its first chairman, virologist William McD. Hammon, MD, PhD, who isolated the DEN3 and DEN-4 virus strains.

Hammon hired Dr. Monto Ho, MD, in 1959. Ho, who had authored a paper on interferon with Nobel Prize winner John F. Enders while at Harvard, knew the department needed a chronic disease epidemiologist, and that it should split into two departments to realize its potential. For Ho, whose interest was microbiology—he was a professor of medicine, microbiology, and pathology, with graduate students in public health and research fellows in infectious diseases, and, later, chair of the department—it was important to find someone with both the research background and academic chops to take over the new department. He found just the person in Lewis H. Kuller, MD, DrPH. Kuller arrived from Johns Hopkins University in 1972 and took over the reigns of the department. Within a year, it had split to form separate departments, with epidemiology under Kuller, and infectious diseases and microbiology under Ho. As chair of epidemiology, Kuller immediately shifted the department’s focus to researching chronic diseases such as type 2 diabetes, heart disease, aging, and cancer, and the relationship of lifestyle factors such as diet, exercise, and smoking to susceptibility. One of the first research efforts was the Multiple Risk Factor Intervention Trial (MRFIT) begun in 1972 to determine whether

IN THE NEWS Diet May Cut Stroke, Heart Risk The Washington Post, March 19, 1993

A growing body of statistical evidence has shown that the benefits of the so-called antioxidant vitamins—vitamin C, vitamin E, and beta-carotene, a relative of vitamin A—may lower the risk of stroke and heart disease. “People who eat a lot of carotene live a good, clean life, you might say. They have a lower rate of disease,” Lewis Kuller said.

Lewis H. Kuller, MD, DrPH

Epidemiology CHAPTER 3

changes in the risk factors known to cause heart disease—elevated blood pressure, levels of serum cholesterol, and cigarette smoking—could be modified in middle-aged men, and whether modifying the risk factors would reduce the risk of coronary heart disease.While the trial showed a modest reduction in short-term coronary heart disease, its larger impact was showing the practicality of conducting large trials—12,000 men were involved in the trial of the 367,000 screened. In the 1980s, most of what was known about women’s risk of disease was research on men. It wasn’t until 1990 that the National Institutes of Health established the Office of Research on Women’s Health, and in 1993 Kuller cochaired the first report on recruitment and retention of women in clinical studies sponsored by that office. The Department of Epidemiology already was deep into its own research by this time, beginning with the Healthy Women Study (HWS) in 1983. The HWS

It was Dr. Hammon’s clinical field trials on immunization in the early 1950s of more than fifty thousand children that showed gamma globulin given by injection was effective in preventing polio.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Kuller ultimately served thirty years as department chair, stepping down in 2002. Ness, a recognized expert in women’s health research, succeeded him.

Roberta B. Ness, MD, MPH

in 1983 was a follow-up to the MRFIT that included only men. The collaborators included outstanding women research scientists at Pitt such as Karen Matthews, PhD; Rena Wing, PhD; Arlene Caggiula, PhD; and Elaine Meilahn, DrPH, and was the first study to focus on cardiovascular risk among women during pre- to postmenopause, including effects of both blood hormone levels and hormone replacement therapy (HRT). The study continued to 2012 and established the importance of cardiovascular risk factors, especially lipoproteins measured premenopausal as determinants of vascular disease among women to age seventy-five. The study also was one of the few to include detailed evaluations of social and psychological factors by Matthews, and new imaging modalities. In addition, the Women’s Healthy Lifestyle Project (1992–99) successfully showed that modification of diet and exercise could slow changes in cardiovascular risk throughout early postmenopause and the development of vascular disease. The controversy about the value of HRT, generated in part from the HWS, led to the creation of the Women’s Health Initiative (WHI) in 1994. It has become the largest research study in the world to focus exclusively on women’s health, and Pitt Public Health was an original site. At that time, HRT was the leading drug used among women, and up to 60 percent of women were on it to purportedly prevent heart disease and forestall aging. Kuller’s research group at Pitt was suspect of the reported benefits of HRT and concerned about the breast cancer risk. In fact, over the years, the WHI’s research showed that women who used HRT were at increased risk for stroke, cardiovascular disease, blood clots, breast cancer, and dementia. The findings led to a dramatic drop in the use of HRT and an accompanying dip in breast

Epidemiology CHAPTER 3

cancer. “Anytime you have a widely used drug, you’d better be damned sure that it works,” Kuller said. “That was a major, major impact.” HRT drugs now carry warning labels about their health risks, and menopausal women today are advised to use the lowest effective dose for the shortest period of time. And it was Kuller’s research team in 2010 in the WHI that reported high blood pressure—already a risk factor for cardiovascular disease—might put women at greater risk for dementia later in life. During the mid-1990s the term “gender-based biology” was popularized, but it was Kuller and Roberta B. Ness, MD, MPH, who established the concept. Ness arrived at Pitt Public Health in 1993; at the time, women were understudied in biological sciences. What the pair contributed to the discussion was a scientific rationale for why that was shortsighted. In 1999 they published Health and Disease among Women: Biological and Environmental Influences, which shed light on such differences as rates of illness, causes of death, metabolization of medications, lifestyle-related health issues, and uses of service. Kuller ultimately served thirty years as department chair, stepping down in 2002. Ness, a recognized expert in women’s health research, succeeded him. The department, the school’s largest, has produced other dramatic findings. Beginning in the late 1980s, osteoporosis research led by Jane A. Cauley, DrPH, found that a single bone density measurement could accurately predict the likelihood of spinal fractures in women over a fifteen-year period. Osteoporosis, which affects 30 million American women, can be devastating for older women, with its association with loss of independence and quality of life. Her research as part of the Study of Osteoporotic Fractures, the largest and longest prospective study of osteoporosis ever, examined the physical and psychological changes occurring in postmenopausal women and has shown not only ethnic differences for the rate of bone loss but also a connection between bone mineral density and the risk of breast cancer. The Center for Aging and Population Health, directed by Anne B. Newman, MD, MPH, secured funding from the U.S. Centers for Disease Control and Prevention to develop and market “10 Keys to Healthy Aging,” a resource guide to maintaining good health for people sixty-five and older. The center is unique among the CDC’s three dozen locations across the country as it focuses solely on health promotion and disease

Jane A. Cauley, DrPH

Beginning in the late 1980s, osteoporosis research led by Jane A. Cauley, DrPH, found that a single bone density measurement could accurately predict the likelihood of spinal fractures in women over a fifteenyear period.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Anne B. Newman, MD, MPH, current chair of the Department of Epidemiology, secured funding from the U.S. Centers for Disease Control and Prevention to develop and market “10 Keys to Healthy Aging.”

Epidemiology CHAPTER 3

Thomas Parran Jr. Thomas Parran Jr., MD, the first dean of the University of Pittsburgh’s Graduate School of Public Health, was a visionary when public health was still in its infancy. His background during the 1920s was in rural health services administration, sanitation, and control of communicable diseases while at the U.S. Public Health Service, but it was his zeal in transforming public sentiment about syphilis from an “unspeakable” disease to a medical condition and threat to public health that led to his appointment in 1936 as surgeon general by President Franklin D. Roosevelt. His publication the following year of Shadow on the Land: Syphilis was about the global disease that afflicted more than 1 million Americans annually, and was a leading cause in its final stages of mental illness, blindness, and types of paralysis. An architect of the structure of American and international public health, he built up medical research at the National Institutes of Health, led the creation of the World Health Organization, advocated for national health insurance, and supported the Hill-Burton Act in 1946 to improve the nation’s hospital system. Hired as the first dean of the nation’s tenth school of public health in 1948, during his decadelong tenure he organized the original departments, made the senior appointments, procured accreditation, oversaw construction of the school’s primary facility, and helped secure nearly $7 million in grants. In 1969, a year after his death at age seventy-five, the public health school building was renamed in his honor.

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The EDC began with five employees. By 2012, under the codirection of Sheryl F. Kelsey, PhD; Steven H. Belle, PhD; and Stephen R.Wisniewski, PhD, it had more than 120 faculty and staff who coordinate the design, data management, and statistical analysis for more than two dozen projects sponsored by the National Institutes of Health and other agencies.

Sheryl F. Kelsey, PhD Electron microscope.

Epidemiology CHAPTER 3

prevention for people age fifty and older. The department has a long history of conducting research in promoting active life expectancy, beginning with the Systolic Hypertension in the Elderly Program (SHEP) in the mid- to late 1980s. Led by Kuller with the late Kim Sutton-Tyrrell, DrPH, it proved that older adults have fewer strokes when systolic blood pressure is lowered with inexpensive diuretics. Currently, the center is conducting several major clinical trials to prevent disability, including the landmark clinical trial of physical activity to prevent disability, the Lifestyle and Independence for the Elderly (LIFE) Study. The department’s historic and unique Epidemiology Data Center was established in 1980 by the late Katherine M. Detre, MD, DrPH, to assess interventional procedures for various diseases that afflict millions of people worldwide, with a particular focus on multicenter clinical trials and patient registries. In 2000 she began the Bypass Angioplasty Revascularization Investigation (BARI 2D), a forty-site study of individuals with cardiovascular disease and diabetes. Funded by the National Heart, Lung, and Blood Institute (NHLBI), the landmark study found no difference in five-year survival between the revascularization group and the medical therapy group or between the insulin-sensitization group and the insulin-provision group. The study was initiated by an NHLBI research award of more than $52 million, one of the largest in University of Pittsburgh history. In addition to being the principal investigator of BARI 2D, Detre led investigations into the effects of cholesterol-lowering drugs on coronary artery disease, cardiovascular risk factors in women, long-term outcome of liver transplantation, resuscitation following brain injury, and bariatric surgery. The EDC began with five employees. By 2012, under the codirection of Sheryl F. Kelsey, PhD; Steven H. Belle, PhD; and Stephen R. Wisniewski, PhD, it had more than 120 faculty and staff who coordinate the design, data management, and statistical analysis for more than two dozen projects sponsored by the National Institutes of Health and other agencies. Since its inception, the EDC has collaborated in more than one hundred research studies. Another legacy program in epidemiology addresses type 1 diabetes. Starting as a registry with Children’s Hospital in the 1970s, a population-

The department’s historic and unique Epidemiology Data Center was established in 1980 by the late Katherine M. Detre, MD, DrPH, to assess interventional procedures for various diseases that afflict millions of people worldwide, with a particular focus on multicenter clinical trials and patient registries.

Katherine M. Detre, MD, DrPH

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Trevor J. Orchard, MD

The Orchard study proved that tight control of blood glucose levels could reduce the complications of diabetes. Continued long-term followup has shown dramatic reductions in mortality fifteen years later.

based registry was developed in 1981. This led to a major national study called the Diabetes Complications Clinical Trial (DCCT), led by Trevor J. Orchard, MD, in Pittsburgh.This study proved that tight control of blood glucose levels could reduce the complications of diabetes. Continued long-term follow-up has shown dramatic reductions in mortality fifteen years later. Beginning in the early 1990s, Ronald LaPorte, PhD, began assembling an online repository of lectures. Known now as the Supercourse (www.pitt.edu/~super1), it has become one of the worldâ&#x20AC;&#x2122;s best-known global health projects. Through LaPorte, along with core developers Faina Linkov, PhD; Mita Lovalekar, MD, PhD; and Eugene Shubnikov, MD, Supercourse has developed a network of more than fifty-six thousand scientists in 174 countries sharing a free library of more than five thousand PowerPoint lectures in thirty-one languages. The lectures allow academics around the world to share their work as a resource to teachers, professors, and other educators.

Studies conducted on strength and range of motion for research on aging.

Epidemiology CHAPTER 3

MILESTONES

Epidemiology 1949

Founded as Department of Microbiology and Epidemiology under William McD. Hammon, MD, DrPH, its first chairman.

1954–55

Research conducted on rheumatic disorder by Sidney Cobb, MD.

1973

Splits into Department of Infectious Diseases and Microbiology and Department of Epidemiology, with Lewis H. Kuller, MD, DrPH, first chairman of epidemiology.

1980

Epidemiology Data Center founded by Katherine M. Detre, MD, DrPH.

1981

The Pittsburgh Insulin-Dependent Diabetes Mellitus Registry leads to national and international trials to prevent complications of diabetes.

1991

Healthy Women Study begins.

Pittsburgh cohort contributes to the national clinical trial Systolic Hypertension in the Elderly Program (SHEP), the first to show the effectiveness of treating systolic hypertension in older adults.

Women’s Health Initiative (WHI) begins.

1992

Women’s Healthy Lifestyle Project begins.

1999

Publication of Health and Disease among Women: Biological and Environmental Influences by Kuller and Roberta B. Ness, MD, MPH.

2002

The WHI’s principal results are published, showing that overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up.

2005

Researchers report that older African American women have a lower risk of bone fracture than their white counterparts.

2006

Diabetes Prevention Support Center begun, which translates the work of the Diabetes Prevention Program, preventing and delaying type 2 diabetes, into primary care practices, work sites, and in the military.

2008

Study by Kristen J. Mertz, MD, MPH, and others finds Pennsylvania’s repeal of universal helmet law increased head injury deaths and raised hospitalization costs.

2010

According to a study by Kuller, older women with hypertension have an increased risk of developing brain lesions that cause dementia later in life.

2011

Landmark study by Trevor J. Orchard, MD, finds that between 1965 and 1980, life expectancy for people with type 1 diabetes had improved by fifteen years.

2012

Naoko Tajima, MD, PhD, chair of the International Diabetes Epidemiology Group, becomes second epidemiologist and second woman to receive prestigious Hagedorn Award from the Japanese Diabetes Society. 29

Proud father greeting his newborn daughter. The work done at Pitt will help influence positive outcomes for maternal and child health.

CHAPTER THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Health Policy and Management and Behavioral and Community Health Sciences ames A. Crabtree, MD, knew when he organized the Department of Public Health Practice as one of Pitt Public Health’s original four departments that it would need to be equal parts research and education. The goals he established at the outset—recognition of the social and technological factors underlying health and disease and their interrelationships, and an understanding of principles of health administration and organization—were fundamental underpinnings to the work that carries on today.The Department of Public Health Practice evolved into the Department of Health Services Administration, and then split in 2002 to form the departments of health policy and management, and behavioral and community health sciences. The aged, mental health, public health administration, and environmental sanitation were critical components for Crabtree’s department. One of Crabtree’s most important appointments was Walter J. McNerney, MHA, who served not only as an assistant to the coordinator of hospitals and clinics at the University of Pittsburgh but also as an important faculty member at Pitt Public Health, where he started a program in hospital administration. McNerney left the department in 1955 and went on to become one of the nation’s leaders in health administration. In 1961 he was appointed

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

One of Crabtree’s most important appointments was Walter J. McNerney, MHA, who served not only as an assistant to the coordinator of hospitals and clinics at the University of Pittsburgh but also as an important faculty member at Pitt Public Health, where he started a program in hospital administration.

president of the national Blue Cross and Blue Shield Association, a position he held for two decades. During that time he was an advisor to President Lyndon B. Johnson, helped create the Medicare and Medicaid programs during the 1960s, and oversaw the merger of Blue Cross and Blue Shield in the late 1970s. The department’s development of the core Master of Hospital Administration Program (MHA) beginning in the 1960s produced some of the most outstanding health organization administrators in the country, including past and current leaders of major health systems in California, Arizona, Georgia, and Pennsylvania. A study of the program’s 233 graduates from 1952–1972 found that of the 218 employed, 73 percent of them were in hospitals, and 56 percent of those were either chief administrative officers or associate directors. Over the course of the 1950s and 1960s, numerous programs were established within the department, each with its own director. One of those became known as the Health Law Center. At the time, most hospitals handled legal needs through board members who were lawyers. There were few laws affecting hospitals, and little applicable case law existed since most were free from liability by their association with universities, or by being charitable institutions or nonprofits.

Walter J. McNerney, MHA

Nathan Hershey facing the Pitt Faculty Senate in 1980.

Health Policy and Management and Behavioral and Community Health Sciences CHAPTER 4

IN THE NEWS Scans 77 Volumes in Hour

Pittsburgh Post-Gazette, August 16, 1962 Not long ago, an IBM computer at Pitt read through every law Pennsylvania has (77 volumes—six million words) and found the one it wanted in less than an hour. Then it printed the law faster than 40 secretaries can type. “I became perturbed,” said John F. Horty, “when people talk about electronic data retrieval as if it’s something in science fiction that will happen someday. It’s happening now.” Horty is the director of the Health Law Center at the University of Pittsburgh, which since 1959 has been in the business of applying electronic computers to the law. It was the first such center anywhere, and as of two weeks ago, it became the first to have its own computer (an IBM 1410) exclusively devoted to the law. Pitt’s new computer is being used now both for research in data retrieval and in actual case work. Horty estimated it would cost $50 to $100 to answer a lawyer’s given question. There is not ever likely to be a computer in every law office, however. They cost $1.5 million, but don’t buy them; they are rented for about $19,000 a month.

Through an NIH grant, army veteran and law school graduate Nathan Hershey and two others undertook a two-year project resulting in the publication of the Hospital Law Manual, which was sold by subscription to universities, hospitals, and associations. It was the first codification of health policy law. The manual ultimately formed a critical part in the early 1970s of the fledgling LexisNexis database that today is the world’s largest electronic database for legal and public-records-related information. The Environmental Sanitation Program, which was established in 1951, initially dealt with administrative practices and the role of engineering agencies, before evolving into areas of water and air pollution, which today play a critical role in community health. The program proved to be an important nexus of collaboration with the Bureau of Air Pollution Control at the Allegheny County Health Department and Pitt’s School of Engineering.

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Elsie Broussard with a young subject.

Health Policy and Management and Behavioral and Community Health Sciences CHAPTER 4

Elsie R. Broussard, MD, DrPH, whose career in the department would ultimately span five decades, began as head of the community health program in 1967. Trained as both a pediatrician and a psychiatrist, she focused on maternal-child interactions, which she video recorded for coding and research to score parental interaction and involvement and child receptivity. Among her programs was the Pittsburgh First-Born Project, a longitudinal study begun in 1963, focusing on how a mother’s perceptions of her newborn impact the child as he or she matures. As late as 2010, Broussard, then a professor emerita, continued publishing her findings on the now middle-aged cohort. In 1967 Edward A. Suchman, PhD, published his seminal Evaluative Research: Principles and Practice in Public Service and Social Action Programs, the first book to propose using science to assess the value, impact, and outcomes of public health programs. The book was an immediate bestseller and helped establish the approaches taken in evaluating the Great Society efforts of the mid-1960s such as Head Start, Model Cities, and various health-planning programs. This book placed Pitt Public Health among the founders of the field of evaluation research. Edmund M. Ricci, PhD, began teaching the first evaluation courses in the early 1970s. As the research continued to gain national funding, it expanded into other areas. In 1990, for example, shortly after the massive Armenian earthquake that killed forty-five thousand people, the International Federation of the Red Cross and Red Crescent Societies selected Ricci to lead an international team to Armenia to evaluate the rebuilding effort. A year later, Ricci, by then chair of the department, cowrote the first evaluative analysis of a large-scale natural disaster. His suggested model for pre-event education, rescue operations, fire and police logistics, and rehabilitation would be used later that year following a devastating earthquake in Costa Rica, and in 1992 in Turkey. A few years later he joined Judith R. Lave, PhD, and others in evaluating the health care provided uninsured children in southwestern Pennsylvania by Highmark Insurance’s Caring Foundation. Ricci designed the study, and Lave, a professor of health economics, was the lead investigator.The study, published in a 1998 issue of the Journal of the American Medical Association, changed the health fortunes of millions of American children across the country. It compared children newly enrolled in the health insurance program with those who were continuously enrolled, and found that extending

Ricci joined Judith R. Lave, PhD, and others in evaluating the health care provided uninsured children in southwestern Pennsylvania by Highmark Insurance’s Caring Foundation. Ricci designed the study, and Lave, a professor of health economics, was the lead investigator.

Judith R. Lave, PhD

Everette James, JD, MBA

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Edmund M. Ricci, PhD, suggested models for pre-event education, rescue operations, fire and police logistics, and rehabilitation, which were used in 1991 following a devastating earthquake in Costa Rica, and again in 1992 in Turkey.

Health Policy and Management and Behavioral and Community Health Sciences CHAPTER 4

Health Policy Institute When Beaufort Longest Jr., PhD, was hired as the founding director of the Health Policy Institute (HPI) in 1980, his marching orders were to conduct studies of issues, problems, and opportunities critical to the region’s health care. His first study that fall concluding that the excess of hospital beds in the region led to overutilization “just about got me run out of town,” Longest said. But it was precisely the type of analysis that the consortium of regional foundations, the University of Pittsburgh, and the Allegheny Conference on Community Development had in mind when they founded HPI. The institute has collaborated with Pitt’s Center for Bioethics and Health Law, the Center for Minority Health, and the Institute of Politics. It has developed publications and presentations on health policy and management issues, lectures, and briefings while conducting studies on the supply of physicians, chronic care, community health, governance, health economics, and a score of other issues. By 2011 it had evolved into a healthsciences-wide initiative under the leadership of Everette James, JD, MBA, the former Pennsylvania secretary of health. HPI works with researchers and students from the six health sciences schools—medicine, nursing, pharmacy, rehabilitation science, dentistry, and public health—to conduct applied health policy research. Donald Burke, dean of Pitt Public Health, created a new associate dean position for public policy, which was filled by George A. Huber, JD, MSIE, MSSM, former first general counsel and senior vice president for UPMC. Huber has developed more efficient ways for the Pennsylvania Department of Health and Pitt Public Health to work together through use of a master agreement. Beaufort Longest Jr., PhD

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Yuting Zhang, PhD

Some of HPM’s most important research includes that of Yuting Zhang, PhD, an expert in using public and private insurance claims data to evaluate the effects of pharmaceutical policies and interventions on health outcomes.

Nicholas G. Castle, MHA, PhD

it to previously uninsured children led to more appropriate utilization of physicians, reduced family stress, and eased family burdens.The study swayed Congress, and within a few years the Children’s Health Insurance Program (CHIP) had expanded from three states, including Pennsylvania, to all fifty, and remains today a major source of health care for low-income children. Although not a separate program, the appointment of Lave in 1982 increased the department’s strength in the area of health policy. Lave was an expert in the design of prospective payment systems that were implemented by the Medicare program. In 1967, to reflect its changing responsibilities, the department name was changed to the Department of Health Administration. Thirtyfive years later, with the growing research efforts in health policy, it split into two departments: Health Policy and Management, and Behavioral and Community Health Sciences (BCHS). The MHA program and joint programs with the university’s law and business schools remained with Health Policy and Management, while BCHS offered a doctoral program concentrating on behavioral and evaluative research. By 2007, HPM was offering a doctoral program in health services research and policy. Some of HPM’s most important research includes that of Yuting Zhang, PhD, an expert in using public and private insurance claims data to evaluate the effects of pharmaceutical policies and interventions on health outcomes. She has focused on Medicare’s prescription drug program, especially its effects on underserved minorities and patients with severe mental health and chronic physical conditions such as cardiovascular diseases. The research of Julie Donohue, PhD, on the impact of pharmacy insurance benefits on prescription drug use and expenditures has focused on evaluating the impact of the Medicare Part D drug benefit on medication access among elderly and disabled beneficiaries. She also studies doctor-patient communication on prescription drugs, the cost-effectiveness of mental health interventions, and efforts to provide information on the comparative effectiveness and prices of prescription drugs to consumers. The quality and costs of long-term care has been a department research staple. The research of Nicholas G. Castle, MHA, PhD, has been critical in developing quality-of-care measures for long-term care institutions and nursing homes, and understanding the impact of those facilities’ organizational structures and leadership on the quality of care provided.

Health Policy and Management and Behavioral and Community Health Sciences CHAPTER 4

As Pitt Public Health developed efforts in computational health with the creation of the Public Health Dynamics Laboratory in 2010, HPM began strengthening its research in modeling, simulation, and quantitative policy analysis. Under the direction of current chairman Mark S. Roberts, MD, MPP, a physician and decision scientist, the department expanded its policy research portfolio and faculty recruitment in those quantitative areas. While research continued to flourish in the early 1990s, Pitt Public Health faced a problem prevalent in public health schools across the country—the spirit of cooperation that the school’s founders hoped for was broken. “There was concern about a lack of good relationships with practitioners,” said Margaret Potter, JD, MS.

Mark S. Roberts, MD, MPP

Under the direction of current chairman Mark S. Roberts, MD, MPP, a physician and decision scientist, the department expanded its policy research portfolio and faculty recruitment in those quantitative areas.

Margaret Potter, JD, MS

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Minority health issues have been a hallmark of BCHS research.The research of Patricia I. Documét, MD, DrPH, has been on Latino health and the saliency of social relationships.

Potter says Dr. Crabtree was attuned to those needs and began the Center for Public Health Practice (CPHP) in 1995. She has led the center since its inception. Resolved to restore community collaborations, the CPHP established a threefold purpose: • To bolster outreach to people already in the field • To serve as a point of contact within the schools and community • To assure students had access to good internships “It took some time, but the effort paid off,” Potter said. The return on investment was evident in significant events that impacted public health and in its practice. With the outbreak of the H1N1 virus in 2009, the CPHP was able to provide immediate consultations as when to close schools and also offered technical assistance. As one of the first schools to receive federal funds from the Health Resources and Services Administration (HRSA), the center provided training to the Allegheny County Health Department, teaching them to improve how to do annual plans that immediately became more relevant and measurable. Today, the CPHP remains engaged and committed to its vision of maintaining a sustainable and resilient public health system. Potter uses her dual training in law and public health to chair a statewide

Patricia I. Documét, MD, DrPH

IN THE NEWS Pollution Linked to Ills of Young: Study Finds Exposure Tied to Asthma and Eczema The New York Times, June 15, 1970

A team of researchers, including Edward R. Schlesinger, professor of maternal and child health of the University of Pittsburgh, has found a close association between continuing exposure to air pollution and asthma and eczema in children under 15— particularly in boys under five years of age. The report, which appears in the current issue of the American Journal of Public Health, is part of a long-term study of childhood diseases in Erie County. Results of their study, they said, have “important and widespread implications in terms of medical costs, physician and hospital utilization, and personal suffering.” What the researchers found is that in the areas with the lowest air pollution, the average annual incidence rate of childhood asthma was 32.4 hospitalized cases per 100,000 population at risk whereas the rate was 50.7 in the areas with the highest air pollution.

Health Policy and Management and Behavioral and Community Health Sciences CHAPTER 4

advisory committee working to overhaul state public health laws. Varying dimensions of aging continue to be a focus of Behavioral and Community Health Sciences. From its start, this research has stressed interventional approaches. An early effort led by Myrna A. Silverman, PhD, a professor emerita, assessed the design of the first purpose-built Alzheimer’s special care unit in western Pennsylvania. More recent efforts include behavioral interventions to prevent morbidity (such as falls or depression), enhancing patient choice (as in end-of-life care), and promoting prevention (for example, by increasing vaccination uptake, medication adherence, and physical activity). These increasingly involve state agencies and hospital systems as partners, along with new modes of delivery, such as Internet network interventions and use of electronic medical records. Minority health issues have been a hallmark of BCHS research. The research of Patricia I. Documét, MD, DrPH, has been on Latino health and the saliency of social relationships. One study is the use of group visits for cancer screenings by Latinas. Another study, known by the acronym LEGS, works on community-based participatory initiatives such as using lay health advisors to assist Latino men in building community connections and obtaining health services. Faculty research on violence in intimate relationships—both heterosexual and homosexual—and among youth has led to a focus on behavioral risk factors such as smoking, drug use, access to guns, and high-risk sex. Efforts in these areas increasingly focus on computational and experimental approaches and seek to link behavior to its neural substrate. Another BCHS initiative is the Center for Lesbian, Gay, Bisexual and Transgendered (LGBT) Health Research, the first program to offer MPH and doctoral public health training geared to LGBT health. Directed by Ron Stall, PhD, MPH, the LGBT health center has produced a trove of findings since its establishment in 2005, partly in response to the stigmatizing and marginalizing of that portion of the American population to poor health. Among the center’s findings is that behavior does matter:The risk for HIV/AIDS is fueled by multiple epidemics that include depression, drug use, violence, childhood sexual abuse, and stigma. Other areas of research include gay aging, how nurses’ homophobic feelings inhibit care, and bullying. Studies have shown that young people who self-identify as gay,

The research of Julie Donohue, PhD, on the impact of pharmacy insurance benefits on prescription drug use and expenditures has focused on evaluating the impact of the Medicare Part D drug benefit on medication access among elderly and disabled beneficiaries.

Julie Donohue, PhD

Ron Stall, PhD, MPH

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lesbian, or bisexual, or engage in same-sex sexual behaviors, are more likely to experience sexual abuse, parental physical abuse, and bullying from peers than other youth. Dr. Steven Albert, the chair of BCHS, has also worked with several of his faculty in providing public health expertise to UPMC during its required community health needs assessment under the Affordable Care Act.

Partnerships with community barbershops is one strategy the Department of BCHS uses to reach underserved populations. Pictured here is Steve Albert, chair of the Department of Behavioral and Community Health Sciences, as part of Take a Health Professional to the People Day. Volunteers in the health professions provide health screening and education at area African American barbershops and hair salons.

Health Policy and Management and Behavioral and Community Health Sciences CHAPTER 4

MILESTONES

Department of Health Policy and Management Department of Behavioral and Community Health Sciences 1949 Founded and organized as the Department of Public Health Practice by James A. Crabtree, MD, with special areas of study, including public health administration, medical and hospital administration, environmental sanitation, public health law, mental health, and public health nursing. 1958 Waldo L. Treuting, MD, named department chair. Health Law Center established. 1959 Cecil G. Sheps, MD, MPH, named director of program in hospital administration. 1967 External committee recommends department name be changed to Department of Health Administration. Edward A. Suchman, PhD, publishes Evaluative Research: Principles and Practice

in Public Service and Social Action Programs.

1973 Environmental sanitation program’s Maurice A. Shapiro, MEng, leads the Westernport Bay Environmental Study in Melbourne, Australia, a multidisciplinary program to obtain broad scientific knowledge of the bay and its surroundings preceding major urban and industrial development. 1974 Gordon K. MacLeod, MD, named chairman; oversaw emergence of Department of Health Services Administration. Later appointed Pennsylvania secretary of health. 1980 Formation of Health Policy Institute under Beaufort B. Longest Jr., PhD, director. 1987 Interschool MHA program was first of its kind to afford students opportunity to earn MBA along with MHA. 1998 Judith R. Lave, PhD, Edmund M. Ricci, PhD, et al, publish in Journal of American Medical Association findings of child health insurance study. 2002 Department of Health Services Administration divided into new departments of Health Policy and Management and Behavioral and Community Health Sciences. 2005 Center for Lesbian, Gay, Bisexual and Transgendered Health Research established; first such certificate program in the world. 2008 Doctoral degree in health services research and policy approved by the University of Pittsburgh. 2009 Yuting Zhang, PhD; Julie Donohue, PhD; and Judith R. Lave, PhD, find that the Medicare Part D drug plan’s gap in coverage—the so-called donut hole—is linked to seniors’ cutbacks in the use of antidepressants, heart failure drugs, and diabetes medicine. 2011 Study led by Cindy L. Bryce, PhD, finds that women, African Americans, and Medicare-covered patients hospitalized with liver-related conditions are less likely to be evaluated and referred for a liver transplant. 2012 Howard B. Degenholtz, PhD, with the help of a local social media company, develops video game Doctor Transplant to encourage people to donate their organs upon death.

BCHS team develops methodology for health needs assessment for UPMC hospital system.

Jane Cauleyâ&#x20AC;&#x2122;s research group installing a pollution monitor.

CHAPTER THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Environmental and Occupational Health

riginally known as the Department of Occupational Health when it began as one of the schoolâ&#x20AC;&#x2122;s original four departments under its first chairman, Adolph G. Kammer, MD, its focus was on problems of then current importance to the health of workers at the end of the 1940s, particularly environmental heat, toxicology of new military and industrial chemicals, radiation, industrial hygiene, and environmental carcinogens. A specialty board-approved residency in occupational medicine and graduate teaching programs for occupational physicians, industrial hygienists, toxicologists, environmental physiologists, and health physicists facilitated the transfer of departmental research into clinical applications. Those basic tenets have contemporized into studies and research that today add a critical link between occupational and environmental health and epidemiology. The broader view is exemplified by the experience of toxicologist Meryl H. Karol, PhD, who took sabbaticals in the early 1990s to Italy and Japan as part of her chemical toxicity research in the Department of Environmental and Occupational Health (EOH). But it was her nine years from 1995â&#x20AC;&#x201C;2004 as a director and secretary-general of the International Union of Toxicology (IUTOX) that broadened her vision and ultimately led to the integration of global health as a fundamental part of the Graduate School of Public Health. Until late 2001, American public health schools focused primarily on domestic issues. After attending IUTOX meetings in Egypt, Turkey, China, Europe, and Australia, Karol realized there was a different way

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

The broader view is exemplified by the experience of toxicologist Meryl H. Karol, PhD, who took sabbaticals in the early 1990s to Italy and Japan as part of her chemical toxicity research in the Department of Environmental and Occupational Health.

Meryl H. Karol, PhD

to look at public health and its effect on people. Overseas, she found, concerns were more elemental: basic water quality, parasitic and fungal diseases, how to grow crops, and surviving the harsh conditions of everyday living. In 2003 she initiated the development of a two-credit course called â&#x20AC;&#x153;Critical Issues in Global Healthâ&#x20AC;? with the goal of increasing understanding of international public health issues and pushing Pitt Public Health into a prominent role in international health. This course grew into a fifteen-credit certificate program in global health involving students from every department with courses in chronic diseases, nutrition, hunger, government structures, and mental health, among others. As a toxicologist Karol, a professor emerita, gained an international reputation for research in environmental epidemiology and immunotoxicology, particularly the mechanisms of chemical toxicity. Of particular interest to her were isocyanates, reactive chemicals used in the production of polyurethane foams, paints, lacquers, and electrical insulation. Methyl isocyanate was the causative agent in the 1984 Bhopal, India, gas tragedy that killed between three thousand and eleven thousand people. Karol was sent by the State Department to Bhopal to investigate, and later consulted with multinational companies that manufacture and use isocyanates on ways to safely handle the chemical to protect employees. She developed a method to detect isocyanates, and a test procedure to detect development of an adverse immune hypersensitivity response to isocyanates. Today, Pitt Public Health is recognized as an institutional leader in global health. It provides critical computer model evaluations of potential risks to populations from exposure to physical, chemical, or biological agents. Another example is the research of Aaron Barchowsky, PhD, to determine the impact of low levels of arsenic in drinking water and how it causes blood vessels to change their appearance so that global standards can be established. Jane E. Clougherty, MSc, ScD, as an assistant professor and the director of exposure science, focuses on differential susceptibility to air pollution by chronic stress and has developed several of the early epidemiological and toxicological models for exploring these synergistic effects. Similarly, the research of Kyra Naumoff-Shields, PhD, includes the development and use of novel exposure assessment methods, the

Environmental and Occupational Health CHAPTER 5

Testing aluminum clothing.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

public health implications of climate change, and linking science to policy. Another research area is genetically engineered (GE) foods. The first generation of GE crops—they’ve been produced in the United States since 1996—primarily benefited farmers through herbicide-tolerant soybeans and corn, and pest-protected (Bt) corn and cotton. Bt corn has a direct benefit to consumers as well since it contains significantly lower levels of mycotoxins, or fungal toxins, than conventional corn. The most important dietary mycotoxin from a global health standpoint is aflatoxin, which contaminates corn and peanuts and is the most potent natural human liver carcinogen known. Research by Felicia Wu, PhD, to determine the global burden of liver cancer attributable to aflatoxin exposure found that it is as high as 28 percent of cases worldwide with most cases occurring in Sub-Saharan Africa, Southeast Asia, and China. She also has conducted research on how climate change will affect mycotoxin concentrations in the global food supply. Most recently, her work has focused on social network

IN THE NEWS Science Panel to Scrutinize Shale Gas Drilling Pittsburgh Post-Gazette, May 23, 2013

A National Academy of Sciences committee will review a host of risks and public concerns associated with shale gas drilling operations nationwide. Bernard Goldstein, emeritus professor and [emeritus] dean at the University of Pittsburgh’s Graduate School of Public Health, said there’s a lot that’s unknown about the impact of shale gas development activities on public health, and Pennsylvania’s failure to allocate any funding to study health impacts from the $180 million a year in impact fees it collected from gas drillers doesn’t help. “Seventeen state agencies, departments and commissions got impact fee funds but not a penny went to the state Department of Health,” said Dr. Goldstein, who is scheduled to moderate an NAS committee. “I may not have proof that shale gas development is causing health problems, but there’s a lot of people out there who have gotten unhealthy and are absolutely sure drilling is the cause. We need to find out what is really happening,” he said.

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models applied to understanding how food safety regulations affect food trade worldwide. The work of Herbert S. Rosenkranz, PhD, is credited with pioneering the use of computer programs to predict the toxicity of chemical pollutants. Before arriving at Pitt Public Health in 1990 he helped develop one of the first computer programs to predict the carcinogenicity of chemicals based on their chemical structure, thus launching the field of computational toxicology. The professor emeritus was founder and director of the Center for Environmental and Occupational Health and Toxicology in 1993 that involved EOH and the University of Pittsburgh Medical Center, and served as both chair of EOH and as interim dean from 1998–2001. Bernard D. Goldstein, MD, former dean of Pitt Public Health and a professor emeritus in EOH, has focused his recent research on the public health implications of the Marcellus Shale, which he calls a “classic environmental issue having a public health aspect to it.” In 2012 he had seven different projects related to the natural gas resource. “It’s not something that’s happening at one big coal mine,” Goldstein said. “It’s an issue that has a time dimension to it that is at least decades long, so it’s not like the Deepwater Horizon oil spill. This Marcellus Shale issue will be going on for many years.” Goldstein says experience has shown that unless accurate scientific measures are used to define the key policy issues of Marcellus Shale related to human health, those issues will ultimately be decided by court rulings on lawsuits brought by the public. If that happens, he said, the cost to industry will be “into the billions of dollars.” The Marcellus Shale highlights one of the key issues for public health: the ethics of telling the truth to power. In medicine, a physician tells the truth to a single patient. But in public health, Goldstein said, the truth is being told to “this power that’s the state health department, the university leadership, whomever it is. You’re dealing in public health with a lot of issues that bring up ethical constraints and a lot of issues about who’s really in power.” Occupational and environmental exposure, and the potential harm of biological, chemical, and physical agents to human health, always have been integral to the department’s research. This was evident from the department’s beginning when its studies focused on industrial hygiene and achieving a better understanding of the complex factors

Aaron Barchowsky, PhD

Another example is the research of Aaron Barchowsky, PhD, to determine the impact of low levels of arsenic in drinking water and how it causes blood vessels to change their appearance so that global standards can be established.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Environmental heat and its health impact gained public notoriety in the early 1950s after four hundred heat-related casualties and one death occurred during summer training among recruits at the U.S. Marine Corps Recruit Depot at Parris Island, South Carolina.

Jane E. Clougherty, MSc, ScD

affecting the health of workers, and then utilizing that knowledge to develop procedures for protecting and improving their health. Environmental heat and its health impact gained public notoriety in the early 1950s after four hundred heat-related casualties and one death occurred during summer training among recruits at the U.S. Marine Corps Recruit Depot at Parris Island, South Carolina. EOH’s Harwood S. Belding, PhD, and Theodore F. Hatch, MS, developed the Belding-Hatch Heat Stress Index, which was widely used in field settings for heat-stress studies. Belding; Hatch; Bruce A. Hertig, ScD, MPH; Kenneth K. Kraning, ScD; and David Minard, MD, PhD, with funding from the National Institutes of Health, then developed the Wet-Bulb Globe Temperature index (WBGT), originally based on temperatures read with a shaded dry thermometer, a shaded wet bulb thermometer, and a “globe” consisting of a thermometer enclosed within a blackened six-inch copper sphere. By 1956, heat-related injuries were greatly reduced among the Marine Corps, and the WBGT index played a critical role in developing national standards for occupational exposures to environmental heat. Today, the WBGT is a composite temperature used to estimate the effect of temperature, humidity, wind chill, and solar radiation on humans, and is still used by industrial hygienists, athletes, and the military to determine appropriate exposure levels to high temperatures. The research of Yves C. Alarie, PhD, was on airborne chemicals and sensory and pulmonary irritation. In 1966 he developed RD50, defined as a ten-minute exposure concentration producing a 50 percent respiratory rate decrease in rats or mice in order to estimate severe respiratory irritation. Called the Alarie Test, in 1984 it became the American Society for Testing and Materials Method E981—the so-called Standard Test Method for Estimating Sensory Irritancy of Airborne Chemicals—and has been used worldwide. It can be applied to any gas, vapor, or aerosol. Alarie developed the University of Pittsburgh Protocol for Measurement of Acute Lethality of Thermal Decomposition Products of Materials, or UPITT. The methodology was adopted by numerous testing agencies, including Underwriters Laboratories and the state of NewYork for its Uniform Fire Prevention and Building Code. An emeritus professor, Alarie is regarded as a pioneer in the use of computerized techniques in respiratory toxicology. More recently, the research of Luis A. Ortiz, MD, has looked at the use of mesenchymal stem cells in the treatment of silica-induced lung fibrosis from exposure to large amounts of coal dust, quartz crystals, and other

Environmental and Occupational Health CHAPTER 5

mining materials. His work, performed as part of the multidisciplinary team at the Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at the University of Pittsburgh, has delivered compelling evidence that adult human mesenchymal stem cells can stimulate host cell repair and regeneration. It is an exotic example of cell-based therapy for potential environmental or occupational use. The Radiation Health Program, the first such program not initiated by the federal government, began in the department in 1950 with the support of the Rockefeller Foundation. It was introduced by Herman Cember, PhD, the initial departmental health physicist, with the help of Joseph Watson, PhD, an environmental physiologist who collaborated in Cember’s research on the health effects of inhaled radioactive particles, as well as Albert A. Spritzer, MD, an occupational physician and adjunct faculty member, who also served as medical director for Westinghouse Nuclear Division. Niel Wald, MD, a specialist in radiation medicine, was recruited in 1958 by Dean Thomas Parran, who became acquainted with Wald’s work as director of hematology at the National Academy of Sciences–National

The Radiation Health Program, the first such program not initiated by the federal government, began in the department in 1950 with the support of the Rockefeller Foundation.

November 11, 2011, Shale Gas conference.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Department chair Bruce Pitt and researcher Karla Wasserloos use a hypoxic chamber to explore optimal levels of oxygen for growing and repairing lung tissue.

Environmental and Occupational Health CHAPTER 5

Research Council Atomic Bomb Casualty Commission’s Hematology Program in Hiroshima, where Wald had spent the early 1950s conducting hematologic studies on Japanese survivors of Hiroshima and Nagasaki. He also had done research on exposure effects at the Nevada Nuclear Test Site for Oak Ridge and Los Alamos National Laboratories. Wald, a professor emeritus, headed the new Radiation Health Division in the department, including the Radiation Emergency Response Program, which provided clinical tools to deal with radiation overexposure in the growing regional and national nuclear workforce. These included a whole-body radiation measurement room, a radiochemistry laboratory for excreta and tissue samples, a cytogenetics laboratory for blood chromosome damage analysis, and use of in- and outpatient facilities when needed in the University of Pittsburgh Medical Center’s hospitals. In 1969 the division became a department in the school to facilitate the increasing joint activities with the medical center and its radiology and nuclear medicine functions. In 1979 the Radiation Health Department was called on to advise the commonwealth’s health department in carrying out its responsibilities during the Three Mile Island nuclear power plant accident and the subsequent followup health monitoring of the exposed population. A census of some ninety thousand persons in a five-mile radius of the plant developed the database for this purpose. Today, few medical therapies exist to counter the variety of longterm and acute injuries that would result from a nuclear or radiological attack. As part of the University’s Center for Medical Countermeasures Against Radiation, Valerian E. Kagan, PhD, DSc, is researching the development of small molecule radiation protectors and mitigators that can be accessed easily and administered quickly in the event of such an attack or nuclear emergency. Kagan’s work in oxidative lipidomics—the identification, characterization, and quantitative analysis of oxidatively modified lipids by mass spectrometry—has led to an increasing ability to perform analyses of individual molecular species of oxygenated lipids and deeper research into the role of mitochondrial signaling in acute brain injury, neurodegenerative diseases, cancer, lung disease, and sepsis. In addition, James Peterson, PhD, and George D. Leikauf, PhD, have contributed important research in several NIH-sponsored programs for countermeasures against chemicals such as cyanide, phosgene, chlorine,

Today, few medical therapies exist to counter the variety of long-term and acute injuries that would result from a nuclear or radiological attack.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

As part of the University’s Center for Medical Countermeasures Against Radiation, Valerian E. Kagan, PhD, DSc, is researching the development of small molecule radiation protectors and mitigators that can be accessed easily and administered quickly in the event of an attack or nuclear emergency.

Valerian E. Kagan, PhD, DSc

and ammonia. The department’s research into the relationship of environmental factors to human health and disease extends inside the home; Americans spend more than 90 percent of their time indoors, two-thirds of that in their homes. Research by Julian B. Andelman, PhD, measuring indoor human exposure to volatile chemicals from both potable water supplies and in the bathroom, stunned the American public in the 1980s. “I tell all my friends to take quick, cold showers,” he said at the time, as his research showed that the longer and hotter the shower, the greater the evaporation from the water of significant amounts of carcinogenic chloroform and trichloroethylene and their subsequent absorbance into the body. Deficiencies in the air at home are also in question. Asthma, for example, is associated primarily with indoor, rather than outdoor, exposure to contaminants. Triggered by numerous factors—tobacco smoke, dust mites, mold, pet dander, cockroaches—asthma is one of the most common disorders in childhood, affecting more than 7 million children. Working with Meryl Karol, Felicia Wu’s research has included how educational intervention could help parents avoid environmental triggers in the home, resulting in lower home pollutant levels and fewer children’s asthma symptoms.

Environmental and Occupational Health CHAPTER 5

MILESTONES

Environmental and Occupational Health 1949

Founded as Department of Occupational Health under Adolph G. Kammer, MD.

1956

Several department members, including Harwood S. Belding, PhD, and Theodore F. Hatch, MS, develop the Wet-Bulb Globe Temperature index.

1966

Yves C.Alarie, PhD, develops RD50, which later becomes the standard test method for estimating the irritancy of airborne chemicals.

1969

Department of Radiation Health formed as outgrowth of a similar program in the department for nineteen years.

1979

Niel Wald, MD, leads follow-up studies on residents within five-mile zone of Three Mile Island nuclear plant after March accident.

1984

Meryl H. Karol, PhD, investigates Bhopal, India, gas disaster.

1980s

Julian Andelman, PhD, shows significant amounts of cancer-causing chemicals evaporate out of water during showers and are absorbed into the body.

1998

Joseph J. Schwerha, MD, MPH, joins faculty to direct the EOH occupational medicine residency program and certificate in public health preparedness and disaster programs, while serving as principal investigator of a long-standing training grant from NIOSH to help meet the increasing demand for occupational physicians and nurses, industrial hygienists, and safety professionals.

2001

Bruce R. Pitt, PhD, wins NIH MERIT award for research on lung disease.

2002

Pittsburgh Bioterrorism Lecture Series begins.

2003

Meryl Karol, PhD, helps develop and teach Pittâ&#x20AC;&#x2122;s first global health course.

2006â&#x20AC;&#x201C;07 Patricia Opresko, PhD, and Cheryl L. Fattman, PhD, win prestigious NIEHS ONES new investigator awards. 2007

Department adds a DrPH track to go along with existing PhD and MPH degrees.

Experts in infectious diseases and microbiology work to define, treat, and prevent the spread of disease in people throughout the world.

CHAPTER THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Infectious Diseases and Microbiology

t was a Wednesday afternoon in the fall of 1980 at Pittsburgh’s Presbyterian Hospital. Charles R. Rinaldo Jr., PhD, was on “sit-down rounds,” semiformal presentations given by Department of Infectious Diseases and Microbiology (IDM) fellows and medical residents, doctors, faculty members, and staff. On this particular date, an IDM fellow suggested a more detailed look at a patient with a stubborn case of pneumocystis, a form of pneumonia. Maybe, he said, cytomegalovirus (CMV) should be investigated. Rinaldo’s interest was piqued. At Massachusetts General Hospital, prior to arriving in 1978 at the University of Pittsburgh’s Graduate School of Public Health, he had worked on immunosuppression in human CMV mononucleosis. At Pitt he paired his virology research with his clinical microbiology laboratory at Presbyterian. And while he didn’t believe that CMV was causing the patient’s illness, it provided a portal to begin research. That afternoon marked the beginning of Rinaldo’s lifework and the transformation of the department as a whole. While the war against AIDS continues three decades later, IDM has been defined by its research and successes against the disease. Faculty members’ investigations have led to important discoveries and enabled scientists around the world to advance research not only in AIDS but virology, immunology, cancer, and infectious diseases. The most enduring facet of IDM’s work against AIDS evolved from a 1982 pilot study beginning in Pittsburgh’s gay community.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Pitt Men’s Study investigators and staff, 1986.

Phalguni Gupta, PhD, in his lab.

That formed the basis of the University being awarded in 1983 one of the National Institutes of Health (NIH) first five major contracts for AIDS research: more than $4 million for the four-year project, the equivalent of more than $9 million in 2012. (The other sites were Baltimore, Chicago, Los Angeles, and San Francisco. San Francisco later dropped out.) The national project was called the Multicenter AIDS Cohort Study, or MACS, the largest and most extensive epidemiological study of HIV/AIDS in the world. It continues to be funded by NIH through 2014. The Pittsburgh portion is known as the Pitt Men’s Study. A landmark study in 1996 led by John W. Mellors, MD, of the University of Pittsburgh Medical Center together with several MACS researchers in IDM showed a single measurement of the amount of HIV in a patient’s blood could predict the subsequent risk of AIDS or death before the patient showed signs of the disease. By 2012, there had been a host of significant accomplishments by IDM faculty in addition to Rinaldo, including Phalguni Gupta, PhD; Lawrence A. Kingsley, DrPH; and Anthony Silvestre, PhD, about how the virus was spread, how to measure its progression, and interventions that helped HIV-positive people live longer. Their research also provided the basis for numerous studies in virology, neuropsychology, and therapeutics by not only other University of Pittsburgh researchers but scores of investigators at other institutions. More than $70 million in extramural funding has been secured for IDM’s research into AIDS. Since its inception as one of Pitt Public Health’s original four departments in 1948, when it was known as the Department of Microbiology and Epidemiology, IDM has been involved in the research and treatment of some of the world’s most devastating diseases. In the

Infectious Diseases and Microbiology CHAPTER 6

Jeremy Martinson, PhD, in his lab, where research is conducted on human genomic variation and resistance to infectious diseases.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

1940s the man who would become the department’s first chairman, William McD. Hammon, MD, PhD, was the first to establish the mosquito as the major epidemic vector of the Western equine encephalitis virus. Hammon also discovered two of the four types of dengue virus in 1960, which is still one of the major causes of severe tropical illness. In the 1960s, along with R. W. Atchison, PhD, Hammon discovered adenoassociated virus, now used to deliver genes in therapy of several human diseases. Bruce C. Castro, who was then a doctoral student, and now a prominent alumnus, was also part of that discovery. Through the 1970s, Monto Ho, MD, who succeeded Hammon as department chair, and colleagues made important discoveries on the epidemiology of CMV infection, showing that it was transmitted to transplant recipients by the transplanted organ. They were pioneers in the investigation of interferon, a cytokine induced in viral infections that has antiviral properties, and they patented interferon enhancement that was useful for clinical production before the recombinant interferon was available. Later, Ho obtained an NIH grant to study the serology of transplant recipients and donors, collaborating with Thomas E. Starzl, IN THE NEWS Bang for the Buck: Three Modest Nih Investments Yield Big Dividends Science, July 25, 2008 The U.S. National Institutes of Health (NIH) spends nearly $3 billion annually on HIV/ AIDS research to support research studies that may not yield results for decades. One project, the Pitt Men’s Study, is a confidential research study of the natural history of HIV/AIDS, ongoing since 1984. The study has followed a cohort of approximately 3,000 men to gather information on the epidemiology, virology, immunology, and pathology of the HIV, and is part of a national study, the Multicenter AIDS Cohort Study (MACS). Anthony Fauci, head of NIH’s National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, which funds these projects, notes MACS among one of the NIH’s modest yet successful investments that continues to advance the field in ways large and small, year after year. Charles Rinaldo, PhD, current chair of the Department of Infectious Diseases and Microbiology.

Infectious Diseases and Microbiology CHAPTER 6

Jonas Salk and Biophilosophy The enduring legacy of Jonas E. Salk, MD, is his discovery and development of the first safe and effective polio vaccine while at the University of Pittsburgh. Less well known is his interdisciplinary approach of combining laboratory research with human values and concerns, called “biophilosophy.” The Salk Institute for Biological Studies opened in 1963 in La Jolla, California. He defined “biophilosophy” as the application of a “biological, evolutionary point of view to philosophical, cultural, social, and psychological problems.” Salk believed human evolution was mental as well as physical, and that science and the humanities should work together “to make the decisions and choices that Nature has made until now . . . or the greatest value to human life and society as a whole.” He pioneered the concept in his 1973 book, The Survival of the Wisest. Describing himself as “someone who draws upon the scriptures of nature,” he was concerned about global health issues of environment, sustainability, and international cooperation and urged unusual and uncommon approaches to problems. He was, he said, a biomedical scientist trying to understand humanity’s paradoxes. He saw science and medicine as focused strictly on the prevention of death and disease. The future, he said, belonged to pro-life and pro-health girded with cooperation, collaboration, and consciousness. “We are the product of the process of evolution,” he said, “and, in a sense, we have become the process ourselves.”

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Through the 1970s, Monto Ho, MD, who succeeded Hammon as department chair, and colleagues made important discoveries on the epidemiology of CMV infection, showing that it was transmitted to transplant recipients by the transplanted organ.

Left to right: Monto Ho, MD and Don Burke, dean

MD, PhD, to study transplant infections and proving that the mechanism of virus transmission is from donor to recipient. During the 1980s, among other seminal findings, IDM faculty discovered a new species of the Legionella bacterium—later termed Legionella micdadei—that caused pneumonia in normal and immunocompromised hosts, and showed that development of lymphoma in organ transplant recipients was caused by Epstein-Barr virus, a herpes virus transmitted through the donated organ. But the longest-running study in IDM, and one of the longest in University of Pittsburgh history, is the Pitt Men’s Study, which the department developed in 1983 in order to conduct extensive investigations into AIDS. Along with Pitt medical student David Lyter and local clinician Stephen N. Fisher, MD, Rinaldo sought gay volunteers in order to study the disease. With the help of Pittsburgh’s gay bar and bathhouse owners, they signed up more than seventy men from Pennsylvania, Ohio, and West Virginia. Rinaldo’s outdated lab at Presbyterian—“straight out of Louis Pasteur,” he said—was the site for urine, blood, semen, and expectorant specimens. At the time, there was no known cause for the disease. Silvestre was brought on as co-investigator for the project. Rinaldo remains the principal investigator. The Pitt Men’s Study, along with the companion studies at Johns Hopkins, Northwestern, and UCLA that formed the MACS, has been a powerful force in the development of data about AIDS that has transformed one of the previous century’s most devastating epidemics into a chronic illness. As a focal point for information, treatment, and hope, it’s the perfect example of community-based participatory research that has translated into improving public health.

Infectious Diseases and Microbiology CHAPTER 6

Anthony Silvestre, PhD

At the time, there was no known cause for [AIDS]. Silvestre was brought on as co-investigator for the project. Rinaldo remains the principal investigator.

Tony Silvestre was featured in Pittsburgh’s Out as a call for participants in the Pitt Men’s Study. (Inset) The Pitt Men’s Study used a napkin to advertise for participants in gay bars throughout the region.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

The University of Pittsburgh is a local branch of the Multicenter AIDS Cohort Study, which began in 1983 and studies the natural history of HIV/AIDS.

Youth Empowerment Project, the Pittsburgh task force fundraising walk, 1996.

MILESTONES

Department of Infectious Diseases and Microbiology 1949

Founded as Department of Microbiology and Epidemiology under William McD. Hammon, MD, DrPH, its first chairman.

1951

Staff shows that gamma globulin protected monkeys against polio paralysis.

1954–55 Research conducted on psychosomatic conditions (James P. Dunn, MD), occupational diseases (H. M. Utidjian, MD), and chronic diseases in miners (Ian T. T. Higgins, MD, and Millicent Higgins, MD, DrPH). 1962

Monto Ho, MD, first to demonstrate interferon production in cell culture, one of the first recognized cytokines now known to have numerous antiviral and cell regulatory functions.

1973

Splits into the Department of Epidemiology and the Department of Infectious Diseases and Microbiology.

1986

Victor L.Yu, MD, and his graduate students, Janet E. Stout and Jeff Zuravleff, show that Legionella pneumophila was ubiquitous in the water supply of a hospital with endemic Legionnaires’ disease; further studies show that heating or chlorinating of water sources could decrease the bacteria’s spread.They used a new artificial medium to grow this bacteria that was developed by doctoral student Robert Wadowsky and Robert Yee, PhD.

1987

Lawrence A. Kingsley, DrPH, is first to establish clearly that anal-receptive intercourse is the major risk factor for transmission of HIV among homosexual men.

1988

Pennsylvania/MidAtlantic AIDS Education and Training Center, a national leader in supporting the training and education of health professionals who care for those with HIV/AIDS, establishes headquarters at Pitt Public Health under the leadership of Linda Frank, PhD, and Monto Ho.

1995

Charles R. Rinaldo Jr.; PhD, Xiao-Li Huang, MD; Zheng Fan, MD; and graduate student John Ferbas show that dendritic cells, the body’s most potent antigen presenting cells, are the main producers of interferon alpha and can stimulate anti-HIV T cell responses, providing a new approach to restoring the immune system in AIDS patients.

1997

David T. Rowe, PhD, develops quantitative assay to measure the level of Epstein-Barr virus in blood; later used nationwide to monitor transplant recipients for EBV infection and lymphoma development.

2000

Phalguni Gupta, PhD, with graduate student Kelly Collins, develops one of the first organ culture models to study transmission of HIV-1 in the female genital tract.

2005

Janet E. Stout, PhD, asked by the Veterans Administration medical inspector general to assist in devising a new VA Legionella prevention directive, which was issued nationwide in 2008.

2010

Annie Nagy, MPH, awarded Albert Schweitzer Lambaréné Fellowship, the first ever to be awarded to anyone from the school.

2010

Simon Barratt-Boyes, PhD, shows that inflamed lymph nodes in monkeys serve as a reservoir for dendritic cells through recruitment, activation, and death that contributes to AIDS pathogenesis.

2011

Phalguni Gupta, PhD and his postdoctoral fellow Chengli Shen, MD, discover origin and dynamics of HIV-1 subtype C infection in India.

C. C. Li, PhD

CHAPTER THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Human Genetics

he Department of Human Genetics was established in 1989, but its origins extend to the earliest days of the Graduate School of Public Health with the 1951 hiring of C. C. Li, PhD, by former surgeon general of the United States Thomas Parran Jr., MD, dean of Pitt Public Health. Today, with the plethora of genetic discoveries and advances, genetics has captured the attention of the public by focusing on diseases such as cancer, cardiovascular disease, and the neurological conditions of Alzheimer’s disease and Parkinson’s disease. The foresight in hiring Li says much about the prescience of Parran, as well as the recommendation of Li by Nobel Laureate Hermann J. Muller, PhD. Li, author of the seminal book Population Genetics and several other textbooks on population genetics considered classics in the field, began working on the genetic associations of chronic diseases at a time when few were aware of such connections. In the process he helped promote understanding of the medical importance of genetics, a first step toward genetic testing and counseling, and gene therapy. He and colleague J. Howard Turner, ScD, were the first to propose that 6 percent of newborns might develop a hereditary disease during their lives. Li developed several statistical methods, including a statistic to compare the similarities between Variable Number Tandem Repeats (VNTRs), the so-called DNA fingerprints used in forensics. His pioneering research in “the singles methods” of segregation, calculation of posterior probability of paternity, and analysis of variance in linear models helped Pitt Public Health gain national and international recognition in statistical and population genetics. He later served as chairman of the Department of Biostatistics, laying the foundation for human genetics to become its own department. A

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Since 2002 the Genetic Counseling Program has been codirected by Elizabeth Anne Gettig, MS, and Robin E. Grubs, PhD, who have served, respectively, as presidents of the National Society of Counseling and the American Board of Genetic Counseling.

Robin E. Grubs, PhD

Elizabeth Anne Gettig, MS

favorite topic of his work was the intersection between science and society, and he was an early supporter of genetic counseling. In 1960 he served as president of the American Society of Human Genetics, which later presented him with its Award for Excellence in Human Genetics Education for contributions recognized as being of “exceptional quality and great importance.” In 1971 Turner founded Pitt’s Genetic Counseling Program, one of the nation’s oldest. The two-year program has produced hundreds of genetic counselors who serve families and patients afflicted with genetic diseases all across North America. As Li said in 1977, “Genetic counseling and eugenic law . . . are as different as day and night . . . [Genetic counselors] respect, not deny, your civil liberties and your basic human rights.” The Genetic Counseling Program has focused on the communication of fundamental, unbiased information and nondirective assistance in the decision-making process regarding genetic testing, diagnosis, and adjustment of a family or individual to hereditary information. Kenneth L. Garver, MD, PhD, was its second director. Since 2002 it has been codirected by Elizabeth Anne Gettig, MS, and Robin E. Grubs, PhD, who have served, respectively, as presidents of the National Society of Counseling and the American Board of Genetic Counseling. It is the nation’s second-largest and second-longest-running training program in genetics. Robert E. Ferrell, PhD, was recruited in 1984 to lead the Human Genetics Program and expand its traditional strength in statistical genetics to molecular genetics and experimental genetics. He established a human molecular genetics laboratory and recruited additional molecular geneticists, including M. Ilyas Kamboh, PhD, who later served as the department chair from 2005 to 2013. As the genetics program grew through the research of Li, Ferrell, Aravinda Chakravarti, PhD, and others, it was upgraded to a full Department of Human Genetics in 1989 under chairman John J. Mulvihill, MD, a cancer epidemiologist. It was the first such department within an American school of public health. That same year Chakravarti and colleagues played a key role in the identification and characterization of the cystic fibrosis gene. The Department of Human Genetics has contributed significantly to understanding the genetic basis for many diseases impacting human

Human Genetics CHAPTER 7

Robert E. Ferrell, PhD

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

In 1994 Kamboh established a study to understand the genetic basis of Alzheimer’s disease, a leading cause of dementia among the elderly, and amassed the largest collection of Alzheimer’s cases in western Pennsylvania.

health. It fosters a spectrum of multidisciplinary research and provides a broad range of training, branching out to numerous areas of medicine and biology, and their intersection with society. By virtue of the department’s focus on common diseases and its home in Pitt’s Graduate School of Public Health, faculty have developed and used genetic methods to investigate the causes and treatment of hereditary and acquired human illnesses; explore the impact of genetics on public health, education, and disease prevention; and analyze the elements of decision-making when families or individuals are considering the use of genetic tests or technology. For example, in 1994–95, Ferrell and David N. Finegold, MD, established the Lymphedema Family Study in order to identify new genes that predispose to primary, or inherited, lymphedema, which is the swelling of extremities due to the accumulation of lymph. By 2012 they had identified four of the seven genes that cause

Kamboh’s study contributed to the identification of six new genes for Alzheimer’s disease.

Human Genetics CHAPTER 7

primary lymphedema.They hypothesized that mutations in those genes may also increase susceptibility to secondary lymphedema, a condition occurring commonly as a result of the treatment of breast and other cancers. In 2011 they identified Connexin 47 as a susceptibility gene for secondary lymphedema. In 1994 Kamboh established a study to understand the genetic basis of Alzheimer’s disease, a leading cause of dementia among the elderly, and amassed the largest collection of Alzheimer’s cases and normal controls from a single geographical location in western Pennsylvania. It eventually contributed, in 2011, to the identification of six new genes for this devastating neurodegenerative disease. Kamboh initiated a study in 1997 on the genetics of lupus, a prevalent autoimmune disease in which the body’s immune system attacks its own tissues instead of foreign substances such as bacteria and viruses. By 2008, his research group, which includes F.Yesim Demirci, MD, had played a major role in the discovery of three new genes for systemic lupus erythematosus. Susanne M. Gollin, PhD, in 2011 discovered a new biomarker, or biological marker, for a pair of genetic defects seen in tumor cell cultures that are resistant to radiation and chemotherapy. In cell cultures, the resistance to therapy can be reversed using a drug that targets and kills cells with this genetic defect combination. The importance of the finding is that the biomarker can be used to identify patients with tumors resistant to standard therapy.Those patients can be given targeted therapy to first effectively kill the tumor cells, followed by standard therapy. The efficacy of this protocol is that it avoids tumor cells becoming genetically altered as a result of treatment, thereby preventing them from becoming resistant to therapies. These studies have led to breakthroughs not only for oral cancer but other cancers including lung, breast, and ovarian, and are predicted to apply to prostate cancer and brain tumors. In 2013 the department recruited Dietrich A. Stephan, PhD, as its chairman. Stephan is well known for his identification of the genetic basis of a multitude of both rare and common human diseases. In addition, Stephan has blazed a trail in translating his research findings into the causes of human

M. Ilyas Kamboh, PhD, and F. Yesim Demirci, MD. Kamboh, who served as department chair from 2005 to 2013, has contributed to the identification of new genes for Alzheimer’s diseas and systemic lupus erythematosus.

Dietrich A. Stephan, PhD, chairman.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

diseases into a plethora of diagnostic tests that can identify diseases early— often even before they strike—and are used routinely in the marketplace across the globe to help physicians and patients make correct decisions. Stephan is most well-known for his pioneering work in inventing and building the infrastructure to allow testing of individuals for genetic risk factors for chronic diseases so that they may understand their hard-wired risks for such common diseases such as heart disease, age-related blindness, diabetes, and cancers—and thus be able to manage their risks to stay healthy. This has enabled genetics to penetrate to a public health level—whereas historically it was relegated to rare human diseases—and promises to transform health care by extending the healthy life span. In addition to diagnostics developments, Stephan’s therapeutic development programs have resulted in first-in-man trials for a number of new and effective therapies, including drugs for diseases of the brain such as autism spectrum disorder and amyotrophic lateral sclerosis (Lou Gehrig’s disease), pediatric and adult cancers such as brain cancer, and several still in development for currently intractable and devastating diseases.

IN THE NEWS Pitt Researchers Locate Gene for Hirschsprung Disease PR Newswire, July 30, 1993

Researchers from the University of Pittsburgh Graduate School of Public Health have mapped a gene responsible for Hirschsprung disease (congenital megacolon) to human chromosome 10, according to a paper published in the August issue of Nature Genetics. Hirschsprung disease (HSCR) is a birth defect that affects one in every 5,000 live births.

Human Genetics CHAPTER 7

Public Health Dynamics Laboratory When Donald S. Burke, MD, was named dean of the University of Pittsburgh Graduate School of Public Health in 2006, it came with a condition: He wanted to start a computational simulation laboratory. He already had a National Institutes of Health (NIH) grant for initial funding, and within two years he secured two larger ones—from the NIH and from the Bill & Melinda Gates Foundation—and the Public Health Dynamics Laboratory (PHDL) was set. Today, it is unique among the half dozen similar laboratories in the country in that it focuses on public health, not just infectious diseases. Burke is considered a world leader in computational modeling, the study of the behavior of a complex system through computer simulation. It’s the idea of “emergent property”: that something occurs because of the interaction of multiple individual components that is very complex and difficult to predict statistically. It allows researchers to take a starting point—an influenza epidemic beginning in PNC Park on a Thursday, for example—and use simulations to determine where it would spread and how, the impact if schools were closed or vaccinations were issued in nursing homes, or any number of other actions, and develop mitigating strategies. The PHDL, under Director John J. Grefenstette, PhD, has developed computational methods to improve the theory and practice of public health in such areas as vaccine distribution in developing countries, infectious disease dynamics, global access to public health databases, and social networks and their effects on obesity, smoking, and other health behaviors. The interdisciplinary lab brings together computer scientists, biostatisticians, epidemiologists, applied mathematicians, and public health policy experts to develop tools for exploring critical public health problems.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Associate Dean Eleanor Feingold, PhD, is noted for revising the curriculum so that it reflects the need in the public health field.

Susanne Gollin, PhD, with microscopic image of biomarkers identifying tumor resistance to standard chemotherapy.

Human Genetics CHAPTER 7

MILESTONES

Department of Human Genetics 1951

C. C. Li, PhD, hired for genetics program within Department of Biostatistics focusing on statistical genetics.

1971

Genetic Counseling Program founded by J. Howard Turner, ScD.

1984

Robert E. Ferrell, PhD, established human genetics laboratory.

1989

Human genetics program upgraded to a full department under John J. Mulvihill, MD.

Aravinda Chakravarti, PhD, and colleagues played a key role in the identification and characterization of the cystic fibrosis gene.

1994–95

Lymphedema Family Study established, which a decade later led to the identification of four genes for primary lymphedema and a susceptibility gene for secondary lymphedema.

1994

Genetics of Alzheimer’s disease study established, culminating in the identification of six new genes for late-onset Alzheimer’s disease in 2011.

1997

Genetics of lupus study established, which contributed to the discovery of three new genes for lupus in 2008.

1998

A paper describing the PedCheck program for identifying Mendelian inconsistencies in family data developed by Jeffrey R. O’Connell, PhD, and Daniel E. Weeks, PhD, ultimately becomes cited more than fifteen hundred times. It’s one of several new statistical methods developed by faculty members for analyzing genetic data that have also been implemented into widely used software.

2000

Bora E. Baysal, MD, PhD, and Ferrell identified gene for hereditary paragangliomas, showing for the first time that mitochondria can play an important role in the pathogenesis of certain tumors.

2001

Weeks and Ferrell discover one of the major genes for age-related macular degeneration.

2011

Susanne M. Gollin, PhD, identified a new genetic biomarker that could be used to identify patients resistant to radiation and chemotherapy.

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Deans of the Graduate School of Public Health Thomas J. Parran Jr., MD, 1948–58 James A. Crabtree, MD, DrPH, 1958–66 Antonio Ciocco, ScD, 1966–68 (acting) John C. Cutler, MD, 1968–69 (acting) Herschel E. Griffin, MD, 1969–80 M. Allen Pond, MPH, 1980–81 (acting) Raymond Seltser, MD, MPH, 1981–87 Edgar N. Duncan, PhD, 1987 (acting) Thomas P. Detre, MD, 1987–90 (interim) Donald R. Mattison, MD, 1990–98 Herbert S. Rosenkranz, PhD, 1998–2001 (interim) Bernard D. Goldstein, MD, 2001–5 Roberta B. Ness, MD, MPH, 2006 (interim) Donald S. Burke, MD, 2006–present

First faculty and administrative appointments at University of Pittsburgh Graduate School of Public Health, 1948–50 Thomas Parran Jr., MD, dean James A. Crabtree, MD, professor and chair, Department of Public Health Practice Antonio Ciocco, ScD, professor and chair, Department of Biostatistics Adolph G. Kammer, MD, professor and chair, Department of Occupational Heath William McD. Hammon, MD, DrPH, professor and chair, Department of Epidemiology and Microbiology Paul M. Densen, DSc, associate professor, Department of Biostatistics Theodore F. Hatch, MS, professor, Department of Occupational Health Francis S. Cheever, MD, professor, Department of Epidemiology and Microbiology

Index

Numbers in italics indicate images ——— Affordable Care Act, 42 aflatoxin, 48 AIDS research, 57–54, 62, 65 Alarie,Yves C., 50, 55 Alarie Test, 50 Albert, Steve, 42 Alexander, I. Hope, 1 Allegheny Conference on Community Development, 37 Allegheny County (PA) collaborating with Pitt Public Health, 2 Health Department, 2, 37, 40 steel plants, 8 aluminum clothing, testing of, 47 Alzheimer’s disease research, 67, 70, 71, 75 American Society of Human Genetics, 68 American Society for Testing and Materials Method E981, 50 Andelman, Julian B., 54, 55 Arena, Vincent C., 11 Arsenal of Democracy, 7 asthma research, 40, 54 Atchison, R.W., 60 Award for Excellence in Human Genetics Education (American Society of Human Genetics), 68 barbershops, health partnerships with, 42 Barchowsky, Aaron, 46, 49 BARI 2D. See Bypass Angioplasty Revascularization Investigation Barratt-Boyes, Simon, 65 Baysal, Bora E., 75 BCHS. See Department of Behavioral and Community Health Sciences Belding, Harwood S., 50, 55 Belding-Hatch Heat Stress Index, 50 Belle, Steven H., 26–27 Bhopal (India) gas tragedy, 46, 55 biomarkers, 74 Biometry Program, 17 biophilosophy, 61 biostatistics, 7, 13, 15 biostatistics classroom, 16 Biostatistics Facility (UPCI), 15, 17 Blue Cross and Blue Shield Association, 32 breast cancer research, 12–13, 17 treatment for, 10 Broussard, Elsie R., 34, 35

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Bryce, Cindy L., 43 Bt corn, 48 Buchanich, Jeanine M., 11, 17 Bureau of Air Pollution Control, 33 Burke, Donald S., 37, 62, 73, 76 Butler County (PA) Health Department, 2 Bypass Angioplasty Revascularization Investigation, 27 Caggiula, Arlene, 22 Caring Foundation, 35 Carrie Furnace, 8 Castle, Nicholas G., 38, 38 Castro, Bruce C., 60 Cauley, Jane A., 23, 23 Cember, Herman, 51 Center for Aging and Population Health, 23 Center for Environmental and Occupational Health and Toxicology, 49 Center for Lesbian, Gay, Bisexual and Transgendered (LGBT) Health Research, 41, 43 Center for Occupational Biostatistics and Epidemiology, 11, 17 Center for Public Health Practice, 40 Chakravarti, Aravinda, 68, 75 Cheever, Francis S., 76 Children’s Health Insurance Program (CHIP), 38 Children’s Hospital of Pittsburgh, 13, 15, 17, 27 Ciocco, Antonio, 7–8, 11, 17, 76 clinical trials, 8, 11–13, 19, 31 Clougherty, Jane E., 46, 46 Cobb, Sidney, 29 COBE. See Center for Occupational Biostatistics and Epidemiology Collins, Kelly, 65 Comparative Effectiveness Research Core, 15, 17 computational modeling, 73 Costantino, Joseph P., 11, 13 CPHP. See Center for Public Health Practice Crabtree, James A., 31–32, 40, 43, 76 Crabtree Hall, 2 “Critical Issues in Global Health,” 46 CTSI. See University of Pittsburgh Clinical and Translational Science Institute Cutler, John C., 76 cytomegalovirus, 57 DCCT. See Diabetes Complications Clinical Trial Degenholtz, Howard B., 43 Demirci, F.Yesim, 71, 71 Densen, Paul M., 76 Department of Behavioral and Community Health Sciences, 38, 42, 43

Index

Department of Biostatistics, 7–8, 15, 67, 75 Department of Environmental and Occupational Health, 45–46 Department of Epidemiology, 19, 29, 65 Department of Health Administration, 38, 43 Department of Health Policy and Management, 43 Department of Health Services Administration, 31, 43 Department of Human Genetics, 67–68, 75 Department of Infectious Diseases and Microbiology, 29, 57, 65 Department of Microbiology and Epidemiology, 19, 29, 58, 65 Department of Occupational Health, 45, 55 Department of Public Health Practice, 31, 43 Department of Radiation Heath, 55 Detre, Katherine M., 27, 27, 29 Detre, Thomas P., 76 Diabetes Complications Clinical Trial, 27 Diabetes Prevention Program, 29 Diabetes Prevention Support Center, 29 Doctor Transplant, 43 Documét, Patricia I., 40, 41 Donohue, Julie, 38, 41, 43 Duncan, Edgar N., 76 Dunn, James P., 65 EDC. See Epidemiology Data Center electron microscope, 26 emergent property, 73 Enders, John F., 20 Enterline, Phillip E., 10–11, 17 environmental heat, health impact of, 50 Environmental Protection Agency, 8 Environmental Sanitation Program, 33 EOH. See Department of Environmental and Occupational Health Epidemiology Data Center, 27, 29 Erie County (PA), 40 Evaluative Research: Principles and Practice in Public Service and Social Action Programs (Suchman), 35, 43 Fan, Zheng, 65 Fattman, Cheryl F., 55 Fauci, Anthony, 60 Feingold, Eleanor, 74 Ferbas, John, 65 Ferrell, Robert E., 68, 69, 70, 75 Finegold, David N., 70 Fisher, Bernard, 12–13 Fisher, Stephen N., 62 Frank, Linda, 65

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Garver, Kenneth L., 68 Gates (Bill & Melinda) Foundation, 73 gender-based biology, 23 genetically engineered foods, 48 Genetic Counseling Program, 68, 75 Gettig, Elizabeth Anne, 68, 68 Goldstein, Bernard D., 48, 48, 49, 76 Gollin, Susanne M., 71, 74, 75 Great Society programs, 35 Grefenstette, John J., 73 Griffin, Herschel E., 76 Grubs, Robin E., 68, 68 Gupta, Phalguni, 58, 58, 65 Hagedorn Award (Japanese Diabetes Society), 29 Hammon, William McD., 19–20, 21, 29, 60, 65, 76 Hatch, Theodore F., 50, 55, 76 Head Start, 35 Health and Disease amongWomen: Biological and Environmental Influences (Kuller and Ness), 27, 29 Health Law Center, 32–33, 43 Health Policy Institute, 37, 43 Health Resources and Services Administration, 40 Healthy Women Study, 21, 29 Hershey, Nathan, 32, 33 Hertig, Bruce A., 50 Higgins, Ian T.T., 65 Higgins, Millicent, 65 Highmark Insurance, 35 Hill-Burton Act (1942), 25 Hiroshima, survivors of, 53 Hirschsprung disease, 72 HIV research, 60, 65. See also AIDS research Ho, Monto, 20, 60, 62, 62, 65 home, health risks at, 54 hormone replacement therapy (HRT), 22–23 Horty, John F., 33 Hospital Law Manual, 33 HPI. See Health Policy Institute HRSA. See Health Resources and Services Administration HRT. See hormone replacement therapy HSCR. See Hirschsprung disease Huang, Xiao-Li, 65 Huber, George A., 37 Human Genetics Program, 8, 13, 75, 68 HWS. See Healthy Women Study

Index

IDM. See Department of Infectious Diseases and Microbiology, 57–58, 62 insulation wool, 11 interferon research, 60, 65 International Agency for Research on Cancer, 11 International Federation of the Red Cross and Red Crescent Societies, 35 International Union of Toxicology, 45 isocyanates, 46 IUTOX. See International Union of Toxicology James, Everette, 35, 37 Japanese Diabetes Society, 29 Johnson, Lyndon B., 32 Juvenile Onset Diabetes Project, 15, 17 Kagan, Valerian E., 53, 54 Kamboh, M. Ilyas, 68, 70, 71, 71 Kammer, Adolph G., 45, 55, 76 Karol, Meryl H., 45–46, 46, 54, 55 Kelsey, Sheryl F., 26, 27 Kingsley, Lawrence A., 58, 65 Kraning, Kenneth K., 50 Kuller, Lewis H., 20, 20–23, 27, 29 LaPorte, Ronald, 28 Lave, Judith R., 35, 35, 38, 43 Leech, Edward T., 1 Legionella research, 62, 65 LEGS, 41 Leikauf, George D., 53 LexisNexis, 33 LGBT, health issues of, 41 Li, Chung Chin (C.C.), 8, 13, 17, 68, 67–68, 75 Lifestyle and Independence for the Elderly (LIFE) Study, 27 Linkov, Faina, 28 Local Health Administration Law (1951), 2 Longest, Beaufort B., Jr., 37, 37, 43 Los Alamos National Laboratory, 53 Lovalekar, Mita, 28 lupus research, 71, 75 Lymphedema Family Study, 70–71, 75 Lyter, David, 62 MacLeod, Gordon K., 43 MACS. See Multicenter AIDS Cohort Study Magnetic Resonance Research Center, 14 man-made vitreous fiber (MMVF) workers, study of, 11 Marcellus Shale drilling, 8, 49

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Marsh, Gary M., 11, 14, 17 Martinson, Jeremy, 59 Massachusetts General Hospital, 57 Master of Hospital Administration program, 32, 48 also see MHA program Matthews, Karen, 22 Mattison, Donald R., 76 Mazumdar, Sati, 14 McNerney, Walter J., 31, 32 Medicaid, 32 Medicare, 32, 38, 41, 43 Meilahn, Elaine, 22 Mellon, Paul, ix, 1 Mellon (A.W.) Educational and Charitable Trust, ix, 1, 4 Mellors, John W., 58 Mertz, Kristen J., 29 mesenchymal stem cells research, 50–51 methyl isocyanate, 46 MHA program, interschool, 32, 38, 47 Minard, David, 50 mining, 6, 11 minorities, health issues of, 38 Model Cities, 35 Mortality Experience of Steelworkers study, 7, 17 Mortality and Population Data System, 11 Morton, Sally C., 15 MPDS. See Mortality and Population Data System MRFIT. See Multiple Risk Factor Intervention Trial Muller, Hermann J., 67 Multicenter AIDS Cohort Study, 60, 58, 64 Multiple Risk Factor Intervention Trial, 20, 22 Mulvihill, John J., 68, 75 mycotoxins, 48 Nagasaki, survivors of, 53 Nagy, Annie, 65 National Academy of Sciences, 48 National Academy of Sciences–National Research Council Atomic Bomb Casualty Commission, 53 National Cancer Institute, 7, 12, 15 National Heart, Lung, and Blood Institute, 27 National Institute of Environmental Health Sciences, 8 National Institute for Occupational Safety and Health, 8, 55 National Institutes of Health, 21, 27, 25, 26, 33, 50, 55, 58, 60, 73 National Surgical Adjuvant Breast and Bowel Project, 11–13, 17, 21 Naumoff-Shields, Kyra, 46 Ness, Roberta B., 22, 23, 29, 76 Nevada Nuclear Test Site, 53

Index

Newman, Anne B., 23, 24 New York Uniform Fire Prevention and Building Code, 50 NHLBI. See National Heart, Lung, and Blood Institute NIH See National Institutes of Health NIOSH. See National Institute for Occupational Safety and Health Normolle, Daniel P., 15 NSABP. See National Surgical Adjuvant Breast and Bowel Project NSABP Biostatistical Center, 13 nuclear attack, 54 Oak Ridge National Laboratory, 53 O’Connell, Jeffrey R., 75 Occupation Cohort Mortality Analysis Program (OCMAP), 11 Office of Research on Women’s Health, 21 Ohja, Anil, 5 Opresko, Patricia, 55 Orchard, Trevor J., 28, 28, 29 Ortiz, Luis A., 50 OSHA (Occupational Safety and Health Administration), 8 osteoporosis research, 23 Otitis Media Research Center, 12, 17 Out, 63 oxidative lipidomics, 53 Parran, Thomas J., Jr., ix, 25, 51, 67, 76 Parran Hall, ix, 2 Pennsylvania, public health in, 1–2 Pennsylvania Department of Health, 37, 48 Pennsylvania/MidAtlantic AIDS Education and Training Center, 65 Perrin, Edward B., 10, 17 Peterson, James, 53 PHDL. See Public Health Dynamics Laboratory Pitt, Bruce R., 52, 55 Pitt Men’s Study, 58, 58, 63, 60, Pitt Public Health. See University of Pittsburgh Graduate School of Public Health Pittsburgh (PA), 4 industries in, 7 pollution in, 7, 8 public health problems in, ix, 1, 8 Pittsburgh Bioterrorism Lecture Series, 55 Pittsburgh Cancer Institute, 15, 17 Pittsburgh Coal Seam, 7 Pittsburgh First-Born Project, 35 Pittsburgh Insulin-Dependent Diabetes Mellitus Registry, 29 Pittsburgh Municipal Hospital, ix polio vaccine, 19, 61 pollution monitor, 44

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

Pond, M. Allen, 76 Population Association of America, 10 Population Genetics (Li), 67 Positron Emission Tomography (PET) Research Center, 14 Potter, Margaret, 39, 39–40 public health defined, ix, 1 telling truth to power, 49 public health library, 3 Public Health Dynamics Laboratory, 15, 17, 39, 73 punch card date technology, 16 Radiation Emergency Response Program, 53 Radiation Health Department, 53 Radiation Health Division, 53 Radiation Health Program, 51 radiological attack, 53 Redmond, Carol K., 8, 10, 11, 13, 17 Ricci, Edmund M., 35–36, 36, 43 Rinaldo, Charles R., Jr., 57–58, 60, 62–63, 65 Roberts, Mark S., 39, 39 Rockefeller Foundation, 51 Rockette, Howard E., 11, 13 Roosevelt, Franklin D., 25 Rosenkranz, Herbert S., 49, 76 Roswell Park Memorial Cancer Institute, 12 Rowe, David T., 65 Salk, Jonas E., ix, 61 Salk Institute for Biological Studies, 61 Schlesinger, Edward R., 40 Schweitzer (Albert) Lambaréné Fellowship, 65 Schwerha, Joseph J., 55 Seltser, Raymond, 76 Shadow on the Land: Syphilis (Parran), 25 Shale Gas conference, 55 shale gas drilling, 48. See also Marcellus Shale drilling Shapiro, Maurice A., 43 Shen, Chengli, 65 SHEP. See Systolic Hypertension in the Elderly Program Sheps, Cecil G., 43 Sheps, Mindel C., 10, 12, 17 Sheps (Mindel C.) Award, 10 Shubnikov, Eugene, 28 Silverman, Myrna A., 45 Silvestre, Anthony, 58, 62, 63 Simmons (Dorothy P. and Richard P.) Center for Interstitial Lung Disease, 51

Index

Special Projects of Research Excellence, 15 Spritzer, Albert A., 51 Stall, Ron, 41, 41 Standard Test Method for Estimating Sensory Irritancy of Airborne Chemicals, 50 Stan’s Bar, 2 Starzl, Thomas E., 60 steelworkers, biostatistical study of, 7–8 Stephan, Dietrich A. 71, 71–72 Stout, Janet E., 65 Study of Osteoporotic Fractures, 23 Suchman, Edward A., 35, 43 Supercourse, 28 Survival of theWisest,The (Salk), 61 Sutton-Tyrrell, Kim, 27 Systolic Hypertension in the Elderly Program, 27, 29 Tajima, Naoko, 29 Take a Health Professional to the People Day, 42 “10 Keys to Healthy Aging,” 23, 24 Three Mile Island accident, 53, 55 Treuting, Waldo L., 43 Turner, J. Howard, 67, 68, 75 Underwriters Laboratories, 50 University of Pittsburgh, 7, 11, 31–33, 40, 43, 51, 62 See also University of Pittsburgh Graduate School of Public Health; University of Pittsburgh Medical Center Cancer Institute, 15, 17 Center for Bioethics and Health Law, 37 Center for Medical Countermeasures Against Radiation, 57, 54 Center for Minority Health, 37 Clinical and Translational Science Institute, 19 Institute of Politics, 37 Protocol for Measurement of Acute Lethality of Thermal Decomposition Products of Materials (UPITT), 50 School of Engineering, 37 School of Law, 2 School of Medicine, 17 University of Pittsburgh Graduate School of Public Health. 57, 72 See also listings for individual departments and programs accreditation of, 1–2 collaborating with Allegheny County, 2 cooperative spirit in, concern about, 43–40 creation of, ix, 1 curriculum, goals for, 2–4 first class of, 5 outreach, goals for, 4–6

THE UNIVERSITY OF PITTSBURGH GRADUATE SCHOOL OF PUBLIC HEALTH

research, goals for, 4 support of, goals for, 5 University of Pittsburgh Medical Center, 12, 14–18, 49, 53, 58 UPCI. See University of Pittsburgh Cancer Institute UPMC. See University of Pittsburgh Medical Center U.S. Centers for Disease Control and Prevention, 23, 24 U.S. Marine Corps Recruit Depot (Parris Island, SC), 50 Utidjian, H.M., 65 Variable Number Tandem Repeats, 67 Veterans Administration, 14, 65 VNTRs. See Variable Number Tandem Repeats Wadowsky, Robert, 65 Wald, Niel, 51, 53, 55 Wasserloos, Karla, 52 Watson, Joseph, 51 Weeks, Daniel E., 75 Westernport Bay Environmental Study (Melbourne), 43 Western Psychiatric Institute and Clinic, 14 Wet-Bulb Globe Temperature (WGBT) index, 50, 55 WHI. See Women’s Health Initiative Wing, Rena, 22 Wisniewski, Stephen R., 26, 27 Wolk, Abel L., 1 women’s health, 19, 22–23 Women’s Health Initiative, 22–23, 29 Women’s Healthy Lifestyle Project, 22, 29 World Health Organization, 25 Wu, Felicia, 48, 54 Yee, Robert, 65 Youk, Ada O., 11, 17 Youth Empowerment Project, 64 Yu, Victor L., 65 Zhang,Yuting, 38, 38, 43 Zuravleff, Jeff, 65

Index

University of Pittsburgh Graduate School of Public Health 130 DeSoto Street, Pittsburgh, Pennsylvania 412.624.3001 www.publichealth.pitt.edu