Biostatistics IS Public Health!

This week, I had the pleasure of hearing Dr. Tom Farley speak to our school’s incoming students about his book Saving Gotham, A Billionaire Mayor, Activist Doctors, and the Fight for 8 Million Lives. As part of our orientation activities, we assigned the students to read Dr. Farley’s book about the monumental strides New York City took to improve the public’s health. If you’re not from these here parts, you may not know that Dr. Farley served as the NYC Health Commissioner from 2009-2014 under Mayor Michael Bloomberg. He is now the Philadelphia Health Commissioner and is also an amazing resource for our School of Public Health.

The book, an exciting work of non-fiction, chronicles the NYC Health Department’s efforts to reduce the rates of smoking, limit the intake of salt and sugar, and eliminate trans fats (among other programs) in NYC. The stories Dr. Farley tells, and the characters in them, unfold as if reading fiction, except that these stories really happened, and these characters actually made them happen. As I read the book, I couldn’t wait to find out what was going to happen, even though I already knew what happened. I could recall the late-night comedians ridiculing the Mayor’s efforts to reduce sugar-sweetened beverage intake, and remember when calorie labeling on menus went into effect. The work done by the NYC Health Department during that time was incredible – important life-saving and precedent setting efforts. It was public health at its finest (editors note: some could argue the health department was overreaching their authority – this is a topic for another time!). Many themes emerged from the book. You can pick your favorite for discussion: leadership, politics, teamwork. However, what was most striking to me was the display of how truly interdisciplinary real public health is. Not a single one of these policy changes (or proposed changes) could have happened without a diverse team of public health professionals: folks who analyze the scientific data, someone to translate the research into lives saved; an expert in policy development; someone who could work with the communities to implement changes; someone to hold focus groups and someone else to analyze the outcomes from those focus groups… the list could go on and on. In order to effect change, each public health discipline is equally important.

So what? We all know that the world is becoming more interdisciplinary, right? Maybe… while I was reading this book, there was also a very important discussion circulating among the Chairs of Biostatistics Departments about the role of statistics in public health. Recently, the Council on Education for Public Health (CEPH), the accrediting body for Schools of Public Health, presented the proposed revised criteria for accreditation. While setting out to  develop criteria that get away from the five core disciplines of public health, and moving towards criteria that allow flexibility and creativity in curriculum (both of which are good things), CEPH has essentially erased Biostatistics from their accreditation criteria (NOT a good thing). This is of great concern to many of us, because if the accrediting body ceases to recognize Biostatistics as a core component of a public health education, where does that leave us? I’ll come back to that question.

For many years, I have jokingly referred to Biostatistics as the “bastard child” of public health. Biostatisticians are not like their colleagues in other public health disciplines in a lot of ways. Students receiving MS or PhD degrees in biostatistics don’t typically have to take courses in the breadth of public health disciplines, like Master’s of Public Health students do. Among faculty, it is unusual for a biostatistician to get a large grant for which they’re the primary investigator – often their PIships come from methods grants that are typically smaller in dollar amounts or they are funded through collaborative research. It is also typical for a biostatistician to have many fewer first authored manuscripts in methodological areas, and perhaps many more second authored manuscripts in which they act as the collaborating statistician. Some biostatisticians find their collaborators mainly in medical schools or cancer centers, and some biostatistics departments are located in these clinical departments or divisions. However, there are many, many Biostatisticians who are true public health professionals – developing methods or collaborating on studies that are concerned with addressing public health challenges. I believe that most of my colleagues would consider themselves public health professionals, I certainly do (even though a good portion of my collaborations are clinical). Because what we do is integral to the process of improving the health of the public. And this has only become more and more evident through these discussions among the chairs, the activities we’ve been conducting among our students, and my day-to-day life interacting with the faculty in my school.

Despite biostatistics’ differences from other public health disciplines, biostatistics is an integral part of the field. Biostatisticians are trained to help translate data into answers (see a great interview here about what biostatisticians do and how biostatistics fits into public health), through the appropriate application of statistical methods. But biostatisticians can (and do) do much more than that. Biostatisticians can help determine appropriate data collection instruments, ensure appropriate data collection methods, and assess whether outcomes are suitable for answering the questions of interest. To be clear, there are many public health professionals who are not trained in biostatistics who have many of these skills as well. However, beyond that, as the field of public health grows and the questions we are trying to answer become more complicated, the methods we are currently using may no longer fit the questions we ask. Biostatisticians have a large role in developing new methods to address the increasingly complicated public health questions. Without biostatistics, public health will stagnate.

So back to the question – where does this omission of biostatistics from the CEPH guidelines leave us? Our first step is to try to modify the proposed guidelines to be more inclusive – many of the biostatistics Chairs submitted comments to the CEPH council and we produced letters signed by the many of the Chairs, and the Presidents of the American Statistical Association (ASA) and the East North American Region of the International Biometrics Society (ENAR). Talking points for conversations with Deans were developed, and plans to continue discussions among the Chairs were made. These strides are important and hopefully will have impact on the guidelines, but if they don’t, the results could be disastrous for public health. As public health becomes more interdisciplinary, it is important to ensure that each discipline continues to grow, or there is a real danger that biostatistics could lose its identity. And that would be a shame, because biostatistics is public health.

Happy Anniversary to ME!

If you’ve followed my blog, you know that I experienced a very severe bout of depression a little over 10 years ago (if you haven’t read it, you should… ). This illness occurred, likely coincidentally, during a transitional time in my life, as I was making the transition from a graduate student to a tenure-track assistant professor. After 1 year in that position, I wanted to kill myself. Literally. There is no clear cause of depression; certainly there are chemical imbalances that play a role, but it is unknown what triggers instigate bouts of depression. I really don’t know what my trigger was at that time, but I had always feared that the major transition in my life played a role. This fear haunted me as I went through the process of interviewing for my current position, moving and getting settled in. In fact, all the academic aspects of being a Department Chair didn’t frighten me as much as the fear that my depression would return.

And now, here I am 1 year into my new job – Happy Anniversary to Me! And it couldn’t have gone better! Rather than hiding under my desk crying, I am welcoming 3 new faculty to my Department! Rather than barely making it through the day, I’m excited to get out of bed in the morning to learn what awaits me at work. That’s not to say that there haven’t been challenges and that it is all flowers and rainbows. But overall, it has been an exciting year, during which I have learned an incredible amount.

Some of the lessons I’ve learned are very specific to my institution, like the process for approving grant proposals, how to approve time-off requests, how to approve expense reports (Department Chairs do a lot of approving!). But others are more about academic life in general – things I wish someone had told me about being a Department Chair, and things I wish someone had told me about being a good faculty member. Not to say that I wasn’t a good faculty member before, but there are things I could have done to be better.

Once upon a time, I loved email – when I first met my now husband back in the early 90s, email was new to us and was a fun way to communicate. I loved going to the computer lab to see if I had any new email and was always disappointed if I didn’t. I’ve always thought I was good about returning emails, and I realize now how important it is to reply to emails. However, I’ve grown to HATE email! I hate, hate, hate it! (I know, as my husband likes to reminds me, it isn’t nice to hate.) But email has become the primary means for communicating these days (for us old people, at least) which means that I receive a lot more email every day that I need to deal with, but also that I send a lot more email every day that I expect others to deal with. In both instances, the process of actual work can stop if one party does not respond. Luckily, I had been adequately prepared for the increased volume of emails that I would be receiving, so I wasn’t so surprised by that. However, I always thought that everyone else was as good about returning emails as I am, and wasn’t prepared for how I needed to compensate for those who aren’t.

Something else I was not prepared for was how lonely I would feel in this position. I was at my former institution for 11 years and had built a huge community there. Last fall, I went back for a research meeting, and could not walk down the street without running into someone I know. A benefit of that was that if I needed a statistical consult, or if I felt overwhelmed and needed to get some reassurance that everything would be okay, or even if I just wanted someone to go to lunch with, I knew who I could ask – different people for each of these, possibly, but all those roles were filled. Even as my role in the Department changed, my relationships with my colleagues were solid and I was able to easily balance my leadership responsibilities with my professional support system.

However, I’ve come into my new position new to my institution. I really like the faculty in my Department, but I haven’t had the benefit of “growing up” with them academically. While I realize it takes time to build the types of relationships I had previously, I also am cognizant of the fact that my relationship with the faculty in my Department is a little different. If I want to complain about something that happens in a Department meeting, I can’t always do so with them. If I need to get advice about a personnel issue, I have to be careful what I say and to whom I say it. One solution I’ve found for this is to build a different type of network – I have a monthly breakfast with the other department chairs in my school (there are 4 of us total), and have just started having lunch with a few other department heads outside of my school. And I need to practice patience – my relationships with the faculty in my Department are starting to grow, and I know that in time my loneliness will dissipate. Plus, my department has a great staff who I share my office suite with, and they are always wiling to help cure my loneliness (even if they don’t know that they’re doing it!).

This last year hasn’t been easy – there has been a tremendous amount of new things I’ve had to learn, both because I’m at a new institution and also because I’m in a new role. I’ve actually enjoyed this very much – I often say that I’m in academics because I love to learn new things, and this was the only way I could stay a student forever. While some of the things I’ve had to learn have been monotonous, others have been hard lessons about dealing with very personal issues. I’ve had the great fortune to hire 3 new faculty, but this also meant I had the extremely difficult job of telling very well-qualified candidates, who I really got to know and came to like very much, that I wasn’t going to be able to hire them. I had a long-standing adjunct stop teaching for our department, in part because I was unwilling to provide a substantive salary increase (I think), and had to scramble to find someone to teach a class this fall. I’ve made choices that I know haven’t always pleased everyone, but I feel confident that I’ve made those choices with the best intentions and the belief that they are the best for our Department. And I know that I’ve made mistakes – all leaders do, we ALL do– and I hope that I’ve learned from those mistakes and moved on.

As I face my second year as Chair, I know there will be many more challenges, and also much more learning. I’m looking forward to new things, such as teaching my first undergraduate class in my professional career; in collaboration with my department, developing a PhD program in Biostatistics; and advising my first doctoral student since I arrived. I also get to begin my fall with the annual reviews with the faculty and staff, a process that isn’t always easy, but I enjoy because it provides an opportunity to connect with each person individually and discuss their accomplishments and goals. It is also a time for me to reflect on what I’ve accomplished, and to set some goals for myself and my department. I look forward to reflecting back on those goals in a year, hopefully with the same enthusiasm for moving forward that I have now.