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The Clinical Effectiveness program


Setting up the Research Training and Clinical Effectiveness program
Howard Hiatt Physician
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I spoke of the program on medical injury as one that as a research activity that I wanted to get underway once I came to the Brigham. There had been a teaching program that was very much on my mind when I went to the School of Public Health. I'd, during my period at Beth Israel Hospital, focussed on the new biology, on what was then the new biology, of bringing molecular biology and its implications to bear on clinical problems, on disease states of many kinds. I spoke also of the fact that we had done very little in the realm of quantitative analytic science, and that was one of the reasons that I was interested in going to the School of Public Health. We did build there an extraordinary program in biostatistics. We, of course was Fred Mosteller, one of the great men in the field, and that program, as I said, was and remains perhaps the strongest anywhere. But, we did not succeed in bringing many physicians in, who are concerned with, with clinical research, into the program there, and so when I came to the Brigham I had been advised by one of my friends who had followed this with me, who said to me: you didn't succeed in pulling doctors who are concerned with medical research into the program at the school, now that you're at the Brigham, how about pushing them? I approached a colleague at the... at the Brigham, Dr Lee Goldman, a cardiologist and a clinical epidemiologist, and together we created what was called and what is called the program, the Research Training and Clinical Effectiveness. We... we lassoed three Fellows at the Brigham the first year, and literally pushed them into the program. I had gotten a small amount of money from a foundation to make it possible to pay for the costs of such a program, and they had such an experience that in year two, eight people applied to the program and we... we took them. By year three, there were 17.

Early in year two, I was approached by a young woman who was finishing her chief residency in one of the surgical specialities, and she said, I would like to take the program in Clinical Effectiveness, but I'm having difficulty persuading my chief to let me do it. Well, I knew him reasonably well and I went to see him. And, I told him about the program and that we wanted to bring his resident in, and he said to me, but she's... she's very smart. I said, yes, I know, this is a pretty rigorous program that's why we're prepared to take her. No, no, no, he said, she's capable of real research. So, I said, you mean the kind of research that goes on in your laboratory? He said, well, yes, that's what I mean. Well, you know, I spoke very early about the concern that the chairman of the committee that appointed me as Professor of Medicine with what I was doing, molecular biology, he said to me, isn't that more appropriate for a department of biochemistry? I had this as a kind of reprise. We were now moving into the area of quantitative clinical science and yet were going to have a little difficulty persuading some people that it was, is, in fact, science. It proved to be not too difficult because the young people voted with their feet. In the less than 20 years, perhaps 15 years, that the program's been in existence, I'm told there have been 1500 people who have come through the program. Tony Komaroff is one of the people who directed it for some time, and he was himself trained in quantitative analytic science when we were together at the Beth Israel Hospital, and appreciated how meaningful it could be. Subsequently, when I come to talk about what Paul Farmer and Jim Kim are doing, I'll talk about a further evolution in what is real research when I mention the anthropology that... that they do, the approaches that they take to evaluating the effectiveness of treatment of patients with tuberculosis and HIV/AIDS, and the need to broaden considerably the... the stage on which we carry out the... the treatment research and teaching programs that are required in institutions as they discharge their obligations.

Born in 1925, American Howard Hiatt set up one of the first medical oncology research and training units in the US and has headed up some of America's most prestigious medical institutions. Hiatt attended Harvard College and received his MD from the Harvard Medical School in 1948. He was a member of the team at the Pasteur Institute, Paris, that first identified and described mRNA, and he was among the first to demonstrate mRNA in mammalian cells. From 1991 to 1997, he was Secretary of the American Academy of Arts and Sciences, where he began and directs the Academy's Initiatives For Children program. He is also committed to helping disadvantaged people access decent health care.

Listeners: Milton C. Weinstein

Milton C. Weinstein, Ph.D., is the Henry J. Kaiser Professor of Health Policy and Management at the Harvard School of Public Health and Professor of Medicine at the Harvard Medical School. At the Harvard School of Public Health he is Academic Director of the Program in Health Decision Science, and Director of the Program on Economic Evaluation of Medical Technology . He is best known for his research on cost-effectiveness of medical practices and for developing methods of economic evaluation and decision analysis in health care. He is a co-developer of the CEPAC (Cost-Effectiveness of Preventing AIDS Complications) computer simulation model, and has conducted studies on prevention and treatment of HIV infections. He is the co-developer of the Coronary Heart Disease Policy Model, which has been used to evaluate the cost-effectiveness of cardiovascular prevention and treatment. He is an author of four books: Decision Making in Health and Medicine: Integrating Evidence and Values; Cost-Effectiveness in Health and Medicine,the report of the Panel of Cost Effectiveness in Health and Medicine; Clinical Decision Analysis; and Hypertension: A Policy Perspective.He has also published more than 200 papers in peer-reviewed medical, public health, and economics journals. He is an elected member of the Institute of Medicine of the National Academy of Sciences, and a recipient of the Award for Career Achievement from the Society for Medical Decision Making. Dr. Weinstein received his A.B. and A.M. in Applied Mathematics (1970), his M.P.P. (1972), and his Ph.D. in Public Policy (1973) from Harvard University.

Tags: School of Public Health, Brigham and Women's Hospital, Research Training and Clinical Effectiveness, Fred Mosteller

Duration: 6 minutes, 32 seconds

Date story recorded: September 2006

Date story went live: 24 January 2008