Father of preventive medicine, Dr Jeremiah Stamler, turns 100

  • Seniors
  • Monday, 06 Jan 2020

Dr Stamler (right), who was then director of heart research with the Chicago Board of Health, and lab technician Betty Humber conducting a glucose test on June 12, 1967, at the Civic Center in Chicago. — TNS

Dr Jeremiah Stamler has a little problem at work.

You know the kind: that checklist item that you can’t quite seem to check, the one part of the big project that you haven’t yet nailed down.

You can’t slam the door shut on the work until you get answers.

He knows the problem is out there, just waiting for him. And frankly, that’s just the kind of thing he thrives on.

Dr Stamler is a professor emeritus and active researcher at the Northwestern University Feinberg School of Medicine in the United States, who recently turned 100 years old.

His problem is cheese.

Dr Stamler’s speciality is preventive medicine – in fact, he helped invent the field.

He did pioneering research into the causes of heart disease and coined the term “risk factors” to describe circumstantial and genetic contributors that increase the risk of cardiovascular disease.

While working for Chicago’s Public Health Department in the 1960s, he developed the Heart Disease Control Program, aimed at educating the public and bringing focus to issues the city still grapples with, such as the availability of healthy food in poor neighbourhoods.

He’s an early adopter of what’s known today as the Mediterranean diet and his own best advertisement, a long-living testament to the lifestyle changes he advocates.

Currently, he’s one of only a tiny handful of scientists over age 90 to have an active US National Institutes of Health grant for research.

“We have immense amounts of things we should be grateful to Dr Stamler for,” says Dr Donald Lloyd-Jones, chair of Northwestern’s Department of Preventive Medicine, “because he’s improved our health as a nation and a world, but he’s also affected our society.”

He points out that Dr Stamler, who founded the Department of Preventive Medicine, “has retained 110% of his mental acuity. He’s forgotten more than I will ever know, and I don’t think he’s forgotten very much.”

But aside from being an obvious outlier in the healthy-habits-plus-great-genes department, the record of Dr Stamler’s life reveals another core characteristic that clearly fuels him.

He’s charming and smart, but he won’t back down.

Not for anything. Not for big food companies or basic human intransigence, or even the US Congress. Not for the toll age takes, not even for time.

He has made standing up for things his stock-in-trade.

“I think it’s a measure of his character,” says Dr Lloyd-Jones. “It’s remarkable. He’s my hero.”

A life in research

Dr Stamler was born in Brooklyn, New York, in 1919, and grew up in West Orange, New Jersey, the child of Russian immigrants.

From an early age, he was suspicious of mass-market food.

“The loaf of white bread is anathema,” he says. “My father got to this country, saw the white bread and was ready to get back on the boat and go home!”

Instead, he grew up with hearty rye breads and got an early start eating whole grains.

Other healthy habits came easy, he says: “I never liked butter. I don’t know why. It must’ve been something in the blood – intuitive.”

After medical school, he did what most of his contemporaries were doing and entered the US Army.

Near the end of World War II, he was sent overseas. “To Bermuda,” he says. “So I spent a lovely year in Bermuda, my wife came with me, and it was very nice.”

Shortly thereafter, the war ended, and like thousands of other GIs, he headed home to launch the next phase of his life.

He knew he wanted that life to be in research, and in 1947, found a place to pursue that work, taking a position at Michael Reese Hospital in Bronzeville, Chicago, under pioneering cardiology researcher Dr Louis Katz.

“Dr Katz told me, ‘Why the hell do you want to go into research?’” says Dr Stamler.

“’You never win. When you first discover something, people will say ‘I don’t believe it.’

“Then you do more research and verify it, and they’ll say, ‘Yes, but...’

“Then you do more research, verify it further and they’ll say, ‘I knew it all the time.’

“And he was right.”

Undeterred, Dr Stamler and his first wife Rose, who trained as a sociologist, but went on to become a major researcher in the fields of cardiovascular disease and hypertension in her own right, moved to Chicago in 1947.

“They offered me a US$200-a-month fellowship,” he says. “In those days, that was a fortune.”

His research involved examining the effects of cholesterol and other factors suspected as drivers of cardiovascular disease.

“I was always interested in the heart artery problem. Why did human beings with diabetes get more heart artery disease?

“What’s the relation of habitual lifestyle, fat intake, saturated fat intake, cholesterol intake, salt intake, with cardiovascular disease? The interplay between multiple factors.

“And of course, we were all interested in tobacco even way back then.”

He studied his theories on animals.

“I was feeding cholesterol to chickens,” he says. “We could test everything that we suspected might have an impact, except smoking.”

And over time, he helped discover and confirm many of the things we now take for granted: High cholesterol and high blood pressure are linked to cardiovascular disease.

Into public health

Dr Stamler’s interest in these issues didn’t stop at the merely scientific, however.

He had long been interested in social causes – he and Rose had met at student meetings during World War II, while he was still in college, and her work leaned strongly into social justice.

He realised that his work had vast implications in the world outside the laboratory.

“From 1948 on, as our work accelerated,” he says, “we were more inclined to translate our findings into recommendations for the public.”

That approach began to earn him a few enemies.

“Here in Chicago, we had the North American Meat Institute, they were barking at me all the time.

“They had a very simple view: Why don’t you do research, write papers, publish them and shut up?

“We didn’t feel that was an appropriate posture for people doing research on a scientific problem of great public health importance – to do the research and then bury it. What the hell is the point?”

Big tobacco, big food companies and other interest groups weren’t too happy about Dr Stamler’s findings either.

He didn’t care. “I began to find the best ways to express all this to the public, and we decided that the best way is the risk factor concept,” he says.

“A set of well-defined traits, easily measured, frequently occurring, which when pre-sent, particularly in combination, are greatly associated with increased risk.”

Risk factors, which represented something the public could understand and act to change, changed the face of how Americans thought about cardiovascular health.

“The question was, what happens when you modify them, control them, lower them?” Dr Stamler says.

“Does the cigarette smoker at age 60, after more than 40 years of smoking, benefit from quitting smoking and lowering cholesterol?

“The answer is, it isn’t too late.”

Dr Stamler was driven by a desire to see that knowledge put into practice by the public.

“It’s a very important message,” he says. “From a practical point of view, it’s the only message.”

In 1958, he brought that activist approach to public health to city government, taking a position in Chicago’s Department of Public Health.

“I rolled up my sleeves and went formally to work,” he says. “A different kind of work. Quite different from feeding cholesterol to chickens.”

Reluctantly, he gave up animal research and turned his attention to the pressing concerns of the city’s health.

“We started with rheumatic fever prevention in kids,” he says.

“We developed a hypertension control programme, coronary prevention evaluation programme, all right there in (then Chicago Mayor Richard J) Daley’s Health Department.

“He actually used a picture of me with one of the participants in the programmes in one of his political campaigns, to show how up-to-date and modern his administration was.”

Dr Stamler also looked to tackle Chicago’s diet: “First and foremost, we worked to improve the mix of foods that were readily available in the supermarket.

“We encouraged broiling rather than frying, roasting on a rotisserie rather than frying, modest portion sizes.”

Chicago’s legendary steakhouses? They didn’t exactly fit Dr Stamler’s programme.

“It may be OK to victimise a tourist by selling him a 16-ounce (455g) steak,” he says, “but for the natives, let’s make it a 4- or 5-ounce (113g or 142g) steak.

“Let’s encourage fish and seafood, vegetables and fruits, whole grains.

“Not that we’re indifferent to the outside, but we feel a first responsibility to locals.”

The question of the role cheese, as seen in this filepic, plays in heart disease is what currently occupies centenarian researcher Dr Stamler’s thoughts.The question of the role cheese, as seen in this filepic, plays in heart disease is what currently occupies centenarian researcher Dr Stamler’s thoughts.

An un-American accusation

But it wasn’t steakhouses or even food lobbyists who posed Stamler’s next challenge.

In 1965, he was called before the US House Un-American Activities Committee (HUAC), a congressional committee aimed at ferreting out suspected communist sympathisers in America.

The committee was known for subpoenaing a range of people, from the entertainment industry, academia and other spheres of public life.

“They had informants who told them who to call,” says Tom Sullivan, an attorney who worked on Dr Stamler’s HUAC case, “and the people took the Fifth Amendment (to the US Constitution, invoking a right against self-incrimination) and that was the end of it.

“It ruined many lives and employment and wreaked havoc.”

The consequences for refusing to answer the committee’s questions was blacklisting, and in Dr Stamler’s case, Sullivan says, “Mayor Daley would have fired him immediately.”

Dr Stamler chose not to exercise a right against self-incrimination, instead choosing not to answer the committee’s questions to him by challenging its constitutional right to do so.

Sullivan and his team filed suit against the committee on behalf of Dr Stamler and his colleague Yolanda Hall, who worked as a nutritionist in his department and was also an outspoken activist on issues such as fair housing and civil rights.

The committee found the pair in contempt of the US Congress.

“The clients were facing years in jail for contempt of Congress,” says Sullivan, “and Jerry Stamler decided he was willing to take that chance, to make this a test case.”

Litigation followed for eight-and-half years, during which Dr Stamler continued to champion public health, but rarely spoke publicly about the court battle.

In late 1973, the case settled, with the committee, which had begun to lose steam, backing down and Dr Stamler’s side agreeing to withdraw its complaint.

In 1975, HUAC was disbanded. “The case,” says Sullivan, “was the decisive factor in ending it.”

Those who know Dr Stamler best say the story isn’t out of character.

“He has a mantra,” says Dr Lloyd-Jones, “just apply firm, steady pressure.”

When his scientific discoveries or medical recommendations meet resistance, Dr Lloyd-Jones says, his response is always the same: Keep smiling. But don’t back down.

“He knows that if you apply firm, steady pressure over time, the data will win the day.

“If we make sure our assertions are grounded in the very best science, the truth will out.”

Confronting cheese

In 1972, Dr Stamler was appointed as the founding director of the Department of Community Health and Preventive Medicine at Northwestern, where his research continued and he took on the role of mentor to a stream of new cardiologists and researchers.

The work has never let up, though Dr Stamler has decided where to draw the line in one arena.

“He sort of stopped advancing in his tech use at fax machines,” says Dr Lloyd-Jones, “so when we send him papers to read, we email them to his assistant, they print them out, he takes the hard copy, he marks them up extensively in pen, and he faxes them back.”

Currently, Dr Stamler’s working with a team on metabolomics, the study of products created by the body’s metabolic processes.

Those faxed notes, Dr Lloyd-Jones says, are sharp as ever.

“He’s really at his core a scientist. He’s always about taking the data and what it is giving you, and not over-interpreting it.”

Dr Stamler sticks to his guns at home as well.

“We eat a lot of egg whites in this house,” he says. “And I’m not saying that to make nice with the Egg Board.

“I like hard-boiled egg white with tomato in a good sandwich with whole wheat bread.”

Diet is key to good health, he says, and happiness is important too.

He shares homes in New York, Italy and Chicago with his second wife, Gloria, a childhood friend with whom he reconnected after Rose died in 1998.

Though age has robbed him of mobility and he now uses a wheelchair, Dr Stamler says he has one answer for people who wonder whether he’ll retire: “No.”

“If you think about it,” he says, “I should have retired about 30 years ago.

“But I’ve kept going, on the basis that there’s still some fascinating stuff out there that we haven’t touched very well.”

Like, for instance, cheese – a supposed villain when it comes to heart health.

“There may be more there than meets the eye,” says Dr Stamler.”It’s too early to say.

“People say ‘Why are you still working?’ It’s intriguing questions like that.

“What’s the bottom line with cheese? It just keeps you intrigued and going on.”

For the scientist, at least, cheese has a benefit. Maybe even, at this point, a touch of symbiosis.

“I’m annoyed with my ignorance about cheese,” Dr Stamler says, contemplating his next move.

“I haven’t taken the time to get that clear. It sounds simple, but doing it well is a big job.” – Chicago Tribune/Tribune News Service

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