By Sylvia Wassertheil-Smoller, Ph.D., F.A.C.E., F.A.H.A, in collaboration with Herbert
Medical School departments don’t exist just in their own professional world. They
exist in the context of the culture of their medical school, which in turn exists
in the broader cultural milieu of the society at a given point in time. And so it
is with our Department, which has been variously named in reflection of the priorities
of the times. I would like to give you a brief history of the department and its
metamorphoses – its evolution really, along with some personal reminiscences.
The precursor to the current modern Department of Epidemiology and Social Medicine,
was known as the Department of Preventive and Environmental Medicine
and its first
Chairman was the founding Dean of the College, Dr. Marcus Kogel. That name given
to the Department in 1955 surely reflected the emphasis that the faculty and its
Chairman Dean Kogel wished to convey -- teaching and research in prevention and
health promotion. Programs of instruction in those early years included the traditional
epidemiology and statistics, some material on the organization of health services
and most particularly "environmental values and hazards in man's natural habitats".
In 1960, Dr. Leonard Greenberg, an expert on environmental and occupational medicine,
assumed the Chairmanship. Over the following six years, Dr. Greenberg and Dr. Herbert
Schimmel engaged in a number of important air pollution studies under a grant from
the United States Public Health Service and in cooperation with the Department of
Health of the City of New York. This series of epidemiological studies clearly demonstrated
the relationship between air pollution, morbidity and mortality in the city and
most certainly contributed to the development on a national, state and local
level, of significant environmental control legislation and regulation. With the
retirement of Dr. Greenberg and the assumption of the Chairmanship in 1966 by Dr.
Martin Cherkasky, the goals, program and research of the department changed significantly.
Dr. Cherkasky, as Director of Montefiore Hospital, had a long-standing major interest
in social medicine -- reflected in the numerous innovative community programs
sponsored by the Hospital. Important both symbolically and as a response to the
new programmatic emphasis, the department at that time was renamed the "Department
of Community Health".
When I first came to Einstein in 1969, the summer of Woodstock, the summer when
man first landed on the moon, the Department was known as the Department of Community
Health. These were the days when students were activists whose goal was to improve
society. I was hired by Dr. Cherkasky and Mr. Herbert Lukashok, and they made me
feel the Department “was going places”. And it was. There was a major expansion
of the Department which began in the fall of 1969, and included recruitment of Dr.
Chuck Arnold an epidemiologist, Dr. Steven Jonas, and Dr. Raymond Lerner. And Jutta
Zankl, who is still the departmental administrative secretary, also remembers those
heady days. This was the time, in the late sixties and early seventies, when major
institutions, including medical schools and hospitals, were mobilized to address
the serious problems of poverty in urban ghettos and in the rural areas of the nation.
Major grants from the Rockefeller, Milbank and Commonwealth Funds provided resources
for the department to develop new educational programs for students directly relating
to health problems in the urban core. Curriculum changes reflected new program initiatives
designed to improve the health of the minority populations of the Bronx. Students
spent a significant amount of time in field placements in the Bronx - mostly
in Family Health Centers operated by the School and Hospital.
Teaching was an interesting and sometimes difficult experience in those days – when
students mounted strikes of classes they didn’t like, held sit-ins at Dean’s offices,
and called professors by their first name.Actually, that was flattering – when a
student called you by your first name, it meant you were in – you were not part
of the enemy force, and so I was honored when that happened the first time. But
the big word was “relevance” – and most students (and faculty) thought biostatistics
and epidemiology were not relevant to the problems of society, and so my own specialty
was held in rather low regard. Our Department as a whole, however, was at the forefront
of dealing with social issues. Dr. Jonas was the Medical Director at Morrissania;
Lincoln Hospital, with its turbulent politics and deep social problems, was in the
Einstein orbit; Dr. Lerner established the Bronx Information Project so that we
would know the demography and needs of the Bronx; Dr. Mildred Morehead, a pioneer
in the evaluation of quality of care of hospitals, established systems for improving
that quality, and Drs Arnold, and Lerner and I worked on an epidemiological project
that had political implications. Around that time New York State was poised to pass
a law allowing abortion. It was widely thought that it would be de facto useless
since most gynecologists would not perform abortions. We did a statewide survey
of all obstetrician/gynecologists which showed that around 90% would either themselves
perform or refer a patient to someone else who would perform an abortion. Our survey
was brought to the attention of legislators and perhaps had an impact. The law of
course passed, and I wonder how many young people today can imagine what it was
like when abortions were illegal.
When William Glazier assumed the Acting Chairmanship of the Department in 1971,
the programmatic emphasis of the previous years continued. He defined the role of
the Department of Community Health to be “a concern with those social, economic
and environmental factors which impinge upon and affect the health status of the
individual and the community in which they live". Programmatically, the department
provided support and technical assistance to school-wide efforts to develop primary
care and health manpower initiatives. Mr. Irving Lewis joined the department at
around that time, coming from a government post in Washington. He brought a public
policy and economic perspective to the work of the department and his wise counsel
was held in high regard over the time of his tenure at Einstein.
As I noted at the beginning, a medical school and its departments are placed within
the context of the larger society, and society at that time was not yet revolutionized
with regard to women. At the Einstein Campus, I was only the second woman to join
the full-time faculty in our department; Mildred Morehead was in our department
from its inception. But these were still times when I would be asked to get coffee,
not in any way because of any sexist bias – it most certainly was not anything at
all conscious – but rather it was an absent-minded sort of thing; it was just taken
for granted that a young woman gets the coffee, or runs the errand. I did not mind
that at the time, was even unaware of it, until on one occasion which I remember
so clearly, Dr. Chuck Arnold, who was my age, put his hand on my arm as I started
to get up from the conference table, and said quite deliberately, “No, sit down,
I will do it”. A truly liberated man for his time! It should be noted however, that
in the intervening years, our department had five full professors who were women,
a superb record in the medical school.
Meanwhile, on the West Campus, in the mid-sixties, with the establishment of the
formal affiliation between the College of Medicine and Montefiore Hospital, the
Department of Social Medicine at Montefiore became an academic department of
the College parallel to the Department of Community Health at Einstein, with Dr.
Victor W. Sidel as its Chair. Though the departments remained separate until 1984,
one policy governed appointments and promotions. There was a unified medical student
teaching program and close collaboration on overall program planning and activities.
Under Dr. Sidel’s leadership, the department became a strong advocate for underserved
and underprivileged populations. The Department embarked on international health
programs, with Dr. Roberto Belmar, and union health programs, prison health service
and other community health programs, such as the Methadone Treatment Program directed
by Dr. Ernest Drucker. Dr. Drucker became well known in research and in programs
for substance abuse; Dr. Nancy Dubler initiated a law and ethics program and pioneered
clinical applications of ethical principles with “bedside consultations” at Montefiore.
Dr. Sidel, became internationally known as President of the American Public Health
Association, President of the Physicians for Social Responsibility, and a leader
in other organizations devoted to promoting public health and social justice.
Back on the East Campus at Einstein, Herbert Lukashok became Acting Chairman in
1975. For the next nine years he led the department with unparalleled grace. A true
scholar and a gentleman, in his unassuming and principled manner, he brought people
together, resolved differences and showed respect and compassion to students, faculty,
staff. Under his leadership, a Health Psychology program was initiated jointly
with the Ferkauf School under the direction of Dr. Gil Levin, and after he retired,
Dr. Charles Swencionis. Students from Ferkauf work on the research projects of our
faculty and many do their dissertations under the supervision of Department faculty.
One of the star graduates of that program, Dr. Carol Morgan, joined the Department
upon her graduation and developed a program in cancer education. After her untimely
death, Dr. Alyson Moadel has assumed direction of that program in our Department
and has expanded it. Dr. Lukashok also laid the groundwork for a major activity
in Bioethics at the College with the recruitment of Dr. Ruth Macklin, who is internationally
known in the field and who has brought great stature to the department and the medical
school which has nurtured her activities.
Times were changing and epidemiological research was becoming more relevant to the
students, and the research endeavors in our department were becoming more collaborative
with other departments. My own major research activities in the latter part of the
1970’s and early 1980’s were originally in collaboration with Dr. Donald Blaufox,
the current Chairman of Nuclear Medicine, and included the landmark Hypertension
Detection Follow-up Program (HDFP) and its multiple successors, such as TAIM (the
Trial of Antihypertensive Interventions and Management), and SHEP (The Systolic
Hypertension in the Elderly Program) -- randomized clinical trials concerned with
the treatment, control, and public health aspects of hypertension. Clinical trials
research in multi-center, collaborative studies became the primary focus of my own
research, and cardiovascular disease epidemiology constituted the major part of
the department’s research efforts. This included diabetes research and health promotion.
Dr. Roger Mazze joined our department and worked with the beloved Sam Rosen in the
area of diabetes.
When Dr. Judith Wylie-Rosett joined our department in the 1980’s, she launched a
major effort in nutrition, both in teaching and research. Initially, the areas she
worked in were nutrition and cancer, in collaboration with Dr. Seymour Romney and
the Department of Obstetrics and Gynecology, and subsequently, up to the present,
in diabetes, obesity, and cardiovascular disease. She has been a leader in nutrition
and health promotion in the major diabetes prevention trials, in demonstration and
evaluation projects in obesity treatment, in dietary interventions in the Womens’
Health Initiative and in nutrition curriculum development. Dr. Jonathan Tobin joined
our faculty in the 1980’s and expanded our departmental collaborations to neurology
in his work on the Bronx Aging Project and the Teaching Nursing Home project, along
with work in health services research on gender bias in referral patterns for cardiovascular
disease diagnostic procedures. This work is being carried forward by Dr. Janice
Barnhart who is looking at non-clinical factors in diagnostic and treatment decision
making in cardiovascular disease. Thus, the work of the Department was integrated
with the mission of other departments and the inter-departmental collaborative model
was firmly established.
In September of 1984, Dr. Michael H. Alderman became Chairman of a newly unified
department -- combining the Department of Community Health at the College with the
Department of Social Medicine at Montefiore. The name of the new, unified department
became the Department of Epidemiology and Social Medicine, reflecting the blend
of purposes and philosophical goals.
Dr. Alderman led the department for fourteen years, and during his tenure, the department
expanded both on the East Campus at Einstein and on the West Campus at Montefiore.
The choice of a clinical epidemiologist to head the department was consistent with
the prevailing view of the College that research and training in epidemiology must
be the primary focus of the newly unified department. Dr. Alderman has described
epidemiology and its quantitative science biostatistics as "the basic sciences of
clinical medicine" -- reflecting his belief that clinical epidemiology provides
the scientific basis for the practice of personal encounter medicine. Therefore,
the primary initial goal of the new department was to establish a strong, academically
credible research and teaching activity in clinical epidemiology in the department
and throughout the College of Medicine. Dr. Alderman was able to unify the
diverse department and earn it a high degree of respect throughout the medical community.
This new direction certainly did not imply a diminishing interest in community health.
Rather, it demonstrated the strong belief on the part of the Chairman and faculty
that a solid base of epidemiological and health services research was the most effective
way for an academic department in a medical school to address the health problems
of its community. I should say that this view was not unanimously accepted, and
there was initially a perceived tension between the objectives of focusing on immediate
social problems and engaging in epidemiological scientific research, a tension,
that I believe Dr. Alderman dispelled by his leadership and genuine interest and
commitment to public policy issues as well as to scientific rigorousness (but a
tension that was re-visited when Dr. Alderman stepped down in 1998 and I assumed
the Interim Chairmanship).
During Dr. Alderman’s tenure as Chair, our teaching program grew and under the direction
of Dr. Paul Marantz, became highly respected throughout the College and well-liked
by the students. Dr. Marantz further expanded our teaching mission by starting the
2 year Master’s in Clinical Research Program for Physicians. This master’s program
is state-certified and highly successful. Dr. Marantz has received a federal grant
to expand and continue this program. Our department now does a great deal of teaching
to medical students in a first year course, as part of case-conferences in subsequent
years, and in the Master’s program.
The emergence of AIDS, other sexually transmitted disease and more recently TB,
as major threats to health in the inner city provoked the rapid development of research
and demonstration projects led by Department members at Montefiore. Dr. Ellie Schoenbaum
began and continues to direct major programs in the epidemiology, prevention and
treatment of AIDS and has recruited faculty in this area, including Dr. Mayris Webber,
who has addressed psychosocial and health care issues. At the same time, social
scientists in the Department have contributed substantially to the evolution of
National Health Policy in this arena. Dr. Peter Arno is heading major and important
efforts focusing on economics and health policy, particularly in relation to the
race and social class disparities in health and access to care.
As science advanced, epidemiology was becoming more collaborative with the basic
sciences, and Dr. Gloria Ho, who came to Einstein from Johns Hopkins, initiated
a new direction in our department: molecular epidemiology. Together with Dr. Robert
Burk, she made seminal findings regarding the transmission of the human pappillomavirus
and the identification of viral subtypes which posed greatest risk of cervical cancer.
She continues her research in molecular epidemiology with new studies of prostate
cancer. Molecular epidemiological research continues to expand in our department
and is being carried forward by new faculty, Dr. Howard Strickler and Dr. Robert
Kaplan, who are studying genetic and/or molecular bases of cancer and cardiovascular
Dr. Alderman’s own main research interest has been in the epidemiology of hypertension
and the determination of risk factors in the prevention of cardiovascular disease.
Prior to arriving at Einstein, Dr. Alderman founded and directed the pioneering
Worksite Hypertension Control Program which continued to be an integrated effort
for hypertension and hypercholesterolemia intervention maintained by a union-sponsored,
occupationally-based program in New York City. Dr. Alderman, during and after his
role as Chair, has been a leader in major collaborative multi-center clinical trials
of hypertension treatment (e.g., ALLHAT) and in other national clinical trials in
cardiovascular and diabetes risk reduction modalities. He has also served as President
of the American Society of Hypertension and is considered an “opinion leader” in
During this time also, our department served other departments and centers within
the College in providing statistical and epidemiological expertise, and we were
helpful in the successful grant applications for the NCI-designated Cancer Center
and the General Clinical Research Center, as well as for ongoing consultations and
collaboration with those centers. My own research also continued to flourish during
Dr. Alderman’s stewardship. Together with a multi-disciplinary team both from within
and outside of our department, notably Obstetrics/Gynecology and Medicine, we became
a clinical center for the Women’s Health Initiative, a 40-center, 11-year, national
study of 160,000 women, consisting of a set of interrelated clinical trials and
an observational study of postmenopausal women to address the prevention of heart
disease, cancer and osteoporosis, as well as Alzheimer’s disease and other health
problems of aging. This study has reported important results from one of its components,
which affects millions of women and has changed medical practice. The randomized,
double-blind, clinical trial of estrogen plus progestin versus placebo was halted
three years before the scheduled completion in 2005, on the recommendation of the
Data and Safety Monitoring Board, because women in the active treatment had more
breast cancer, heart attacks, strokes and blood clots than women in the placebo
and the overall risks exceeded the benefits. Women receiving these hormones also
had twice the rate of dementia as women taking placebo. Other parts of the Women’s
Health Initiative are continuing as planned.
In 1998 I became Interim Chair of the Department and Dr. Ellie Schoenbaum at Montefiore
became the Interim Vice-Chair. The stated research mission of the Department was
to design and implement translational research in three phases: translation of basic
science discoveries to clinical studies; translation of clinical studies to population-based
studies; translation of population-based findings to health services delivery applications
and public policy issues. Our educational mission is to train future physicians
who can critically evaluate the medical literature and future investigators who
will create that literature.
Even though I was Chair for just two years, it was during a critical time in the
history of the Department. As the search for a permanent Chair proceeded, there
was talk of splitting the Department again and absorbing the Montefiore component
of our department into Family Medicine and keeping the Einstein part as a pure Epidemiology
Department. Our faculty did not favor that, but there was a concern on the part
of Montefiore administration that it would be difficult to find a Chair to lead
such a diverse department. Some candidates who had come for consideration were either
not acceptable to one side or to the other. I was very opposed to such a split because
I believed our Department was unique in its broad scope and its activities ranged
across the whole spectrum of issues relating to the improvement of health among
all people. We had a communality of purpose and a collegial affinity and I believed
that cutting off a whole arm would be going backwards. Happily, we were able to
keep this from happening. Ultimately, we were fortunate in recruiting the current
Chair of the Department, Dr. Thomas Rohan, and so the Department remained unified
under the name of Department of Epidemiology and Social Medicine. Dr. Ellie Schoenbaum
is the Vice-Chair on the Montefiore Campus.
Dr. Thomas Rohan became Chairman in the spring of 2000. He came to Einstein from
the University of Toronto Faculty of Medicine. He has a distinguished research career
with special focus in cancer epidemiology. He is also Associate Director for Population
Sciences in the Albert Einstein Cancer Center, is Principal Investigator of a number
of collaborative studies in cancer, and editor of an important book on Precursors
of Cancer. Dr. Rohan has initiated a large expansion of the Department, with recruitment
of new faculty in the areas of biostatistics, diabetes and cancer epidemiology and
prevention. A new Division of Biostatistics has been created with Dr. Mimi Kim as
the Head the Division. Dr. Thomas Wills has also joined our department and his work
in the city schools on substance abuse broadens our preventive research efforts.
New faculty have also joined our department on the West Campus. In keeping with
our wider focus, our name has been changed to the Department of Epidemiology
and Population Health.
Currently, the Department has about 50 full-time faculty with primary appointments
in the Department and additional faculty with secondary appointments and in affiliate
institutions such as Beth Israel Medical Center and Long Island Jewish Medical Center.
The faculty are grouped into Divisions, which are: AIDS Research; Bioethics; Education;
Epidemiology; Biostatistics; Health and Behavior; Nutrition and Health Promotion;
Philosophy and History of Medicine; and Public Health and Policy Research. Additional
notable programs and Departmental affiliations include the Center for Quality Research
in the North Shore-Long Island Jewish Health System, the Department of Outcomes
Analysis and Decision Support at Montefiore Medical Center, headed by Dr. Eran Bellin,
and the faculty affiliations at Continuum Health Partners, Beth Israel Medical Center.
Throughout several Chairmanships, the Department has been administratively supported
by Merrily Calabrese, and the Unified Department, first by Paul Meisner, subsequently
by Leonard Vicente, then by James Jordan and now by John Cecconi.
The evolution of our Department has been mirrored in the epochal name changes it
has seen: from a focus on epidemiology and preventive medicine as the Department
of Preventive and Environmental Medicine, through a period of social change and
a focus on community action as the Department of Community Health, to a marriage
of social purpose and the advancement of scientific knowledge, as the Department
of Epidemiology and Social Medicine, and now as a department whose mission encompasses
a wide spectrum of activities along the continuum from molecular discoveries to
population-based studies and programs to advance and preserve health, as the
Department of Epidemiology and Population Health. The Department continues to flourish, and
is invigorated with new junior faculty. It is an exciting place in which to work,
exceptional in its collegiality, diversity and intellectual stimulation.
Under Dr. Rohan’s leadership, we have grown to be an exceptionally productive department
in research and teaching while nurturing our historic commitment to improve the
health of underserved populations. Such unity of purpose among our faculty, in the
milieu of our diversity in research interests and methods, is a tribute to Dr. Rohan’s
vision. On a personal note, I want to use this opportunity to express my thanks
to the Department, its Chairmen and the Medical College, for providing me with such
a rich professional home and with so much personal warmth during some difficult
times in my life. It is that special feeling of connection that makes working in
this Department and this school, such a great pleasure.