Obituary of Epidemiology Legend: Ralph S. Paffenbarger Jr.

Ralph S. Paffenbarger Jr., M.D. Dr.P.H.

July, 2007

Dr. Ralph S. Paffenbarger Jr., an epidemiologist who led an early and long-running health study of Harvard graduates that has been influential in promoting vigorous exercise as a primary tool in preventing heart disease, died Monday at his home in Santa Fe, N.M. He was 84.

The cause was heart failure, his family said.

In the early 1960s, Dr. Paffenbarger and other researchers began to look at exercise and its effects on about 17,000 Harvard graduates, all men ranging in age from their 30’s to 70’s. The study, which was conducted at Harvard and Stanford, considered physical activities like sports, walking and climbing stairs and translated the exercise into calories expended by the men in the course of a week.

By the 1970s, the study’s preliminary findings suggested that men burning 2,000 or more calories a week faced a substantially lower risk of death from heart disease than their more sedentary peers. Indeed, in 1984, Dr. Paffenbarger concluded that, among 640 men in the study who had died of cardiovascular disease, the death rate for the most sedentary was nearly twice that for the most active. By the ’90s, the study refined that figure, finding that regular exercise reduced coronary death rates by 25 percent to 33 percent.

The results of the Harvard study became a major impetus for the aerobic exercise movement of the 1980s, as Dr. Paffenbarger and others argued that the benefits of exercise could accrue even if it was begun in middle age. He later calculated that vigorous activity, started early enough, could increase further life expectancy by one or even two years at age 80, adding that quality of life would probably also be enhanced, as there would be fewer chronic diseases like diabetes. In the 1990s, the study found that men ages 45 to 54 who began to exercise could expect to live 10 months longer on average than their sedentary peers.

By that time, Dr. Paffenbarger had taken the findings to heart. He was himself a sedentary man who became a long-distance runner at 45, eventually completing marathons in Boston and South Africa as well as the Western States Endurance Run, a grueling 100-mile race on a mountainous course.

Dr. Terence Kavanagh, an internist and professor of exercise sciences at the University of Toronto, said Dr. Paffenbarger was “a scientist who practiced what he preached,” showing “conclusively that sedentary individuals who became active got increasing protection from cardiovascular disease.”

The Harvard study was modeled in part on Dr. Paffenbarger’s earlier health study of 6,000 longshoremen working along San Francisco Bay. The Harvard study, which continues, also built upon the findings of Jeremy N. Morris, an English researcher who in the 1950s and ’60s conducted studies of exercise and cardiovascular disease among drivers and conductors of London’s bus system. Dr. Morris found that conductors, who climbed the stairs of double-decker buses, had lower coronary risks than the seated drivers.

Ralph Seal Paffenbarger Jr. was born in Columbus, Ohio. He graduated from Ohio State University and received a medical degree from Northwestern University. Dr. Paffenbarger then earned a doctorate in public health from Johns Hopkins University in 1954.

He was a professor of epidemiology at Stanford from 1977 to 1993, and continued his research until last year. He also taught at Harvard.

In 1987, he was named president of the American Epidemiological Society.

Dr. Paffenbarger is survived by his wife, the former Jo Ann Schroeder. The couple lived in Berkeley, Calif., before moving to Santa Fe about a year ago. Dr. Paffenbarger’s first wife, Mary Dale Higdon, died in 1988.

He is also survived by a daughter, Ann Dow of Portland, Ore.; three sons, Charles, of Berkeley; Timothy, of Oakland, Calif.; and Dr. Ralph S. Paffenbarger III, a dentist, of Ann Arbor, Mich., all from his first marriage; and four grandchildren.

Reflecting on his own late conversion to exercise, a habit that eventually included running 50 miles or more a week, Dr. Paffenbarger said, “By the second week, I was hooked.”

He continued: “I found it invigorating. I could consider my thoughts and conflicts, I could prepare letters, ponder problems, prepare talks.”

From the New York Times

Obituary of Epidemiology Legend: George W. Comstock

George W. Comstock, M.D. Dr.P.H.

July, 2007

Dr. George W. Comstock, an epidemiologist who made major contributions to the treatment and prevention of tuberculosis and was regarded by many peers as the world’s foremost expert on the disease, died Sunday at his home in Smithsburg, Md. He was 92 and had worked until last week.

The cause was cancer of the prostate, said the Johns Hopkins Bloomberg School of Public Health in Baltimore, where Dr. Comstock taught for more than 40 years.

Two sets of studies by Dr. Comstock in the 1940s and ’50s had a critical impact on the federal government’s response to tuberculosis. One set led public health officials to reject the tuberculosis vaccine known as BCG, which had been under consideration for routine use among American children.

The second series of studies led the health profession to adopt the use of the drug isoniazid (INH) as a mainstay in treating tuberculosis, which mainly affects the lungs and remains a leading killer in the world today.

Many BCG vaccines are used throughout the world. By the late 1940s, one such vaccine had been found effective in two trials in the United States. But the government wanted further research and dispatched a team led by Dr. Comstock to conduct studies among schoolchildren in Georgia and Alabama from 1947 to 1950. The studies found that the vaccine was largely ineffective. Public health officials then decided against routinely vaccinating children in the United States with BCG.

On receiving an award from the National Foundation for Infectious Diseases for his work, Dr. Comstock said he suspected he was the first person to be so honored for persuading people not to use a vaccine.

Dr. Comstock attributed the discrepancies among the trials to variations in different strains of the BCG vaccine and a lack of standard manufacturing techniques. Later, genetics studies documented that there was no uniformity among BCG vaccines, said Dr. Richard E. Chaisson, a tuberculosis researcher at Johns Hopkins.

In 1957, the United States Public Health Service sought a doctor to study tuberculosis patterns in Alaska, where one of every 30 natives was in a tuberculosis hospital. Dr. Comstock volunteered, saying he saw an opportunity to study preventive treatment.

He conducted a controlled trial in 29 villages near Bethel, Alaska, where tuberculosis was rampant. Members of each household were given the drug INH or a placebo for a year, Dr. Chaisson said.

The study showed the effectiveness of INH in preventing tuberculosis: after a year, INH produced a 70 percent decline in cases of the disease; a follow-up study five years later showed the drug’s benefit had been sustained.

In the trial, Dr. Comstock and his family took INH themselves to convince the participants of his belief in the therapy’s safety, Dr. Chaisson said. After the trial, Dr. Comstock returned and gave INH to those who had received the placebo.

The federal Centers for Disease Control and Prevention’s latest guidelines on INH therapy use Dr. Comstock’s data to this day.

George Wills Comstock was born in Niagara Falls, N.Y., on Jan. 7, 1915, the son of George Frederick Comstock, a metallurgical engineer, and Ella Gardner Wills Comstock. He entered Antioch College planning to become a metallurgist.

While working eventually on the vitamin deficiency disease pellagra, for the pharmaceutical company Eli Lilly, he developed an interest in nutritional diseases. He went on to earn a medical degree from Harvard Medical School in 1941 and a master’s degree and a doctorate in public health from the University of Michigan and Johns Hopkins, respectively.

In medical school, Dr. Comstock, a thin, considerate man who stood about 6 feet 6 inches, rejected his parents’ wish that he study piano and instead bought a recorder, using money he had made by selling his blood for transfusions, a customary means of income for medical students in those days. Later, he took up the bassoon and played in symphony orchestras.

He interned with the Public Health Service and later became chief of its tuberculosis epidemiologic studies. After he retired from the agency in 1962, he moved to Johns Hopkins. He was editor of the American Journal of Epidemiology from 1979 to 1988.

Dr. Comstock founded the Johns Hopkins Training Center for Public Health Research and Prevention in Hagerstown, Md., where for 30 years he oversaw community-based research studies on cancer, heart disease and an eye disease known as histoplasmosis. The center was renamed for Dr. Comstock in 2005.

He was a lifelong advocate of public health efforts and expressed disappointment in later years that more doctors were not devoting their services to it. In an interview in 2003, Dr. Comstock said that members of medical school faculties had little contact with public health departments.

Dr. Comstock was preceded in death by his first wife, of 60 years, Margaret Karr Comstock, and his sister, Ruth Comstock Dunlap. He is survived by his wife, the former Emma Lou Davis; two sons, Dr. Gordon Frederick Comstock of Arcade, N.Y., and Dr. Lloyd Karr Comstock of Chapel Hill, N.C.; a daughter, Martha Wills Comstock Williams of Marietta, Ga.; five grandchildren; one great-granddaughter; two stepchildren, Jonathan Davis and Anna Davis; and two step-grandchildren.

From the New York Times