3/02/2011 Chris Karlesky ’01

Living the Public Health Major

A Liberal Arts Education Helps F&M Alumni Thrive in Health-Related Fields

First-year seminars are the core of a student’s initial semester at Franklin & Marshall, a point of departure from which to launch wide-ranging academic journeys. With an emphasis on critical thinking and clear writing, the courses encourage the intellectual development of liberal arts students.

But in the fall of 1999, a group of students in a first-year seminar helped to spark development in the College itself. Led by Dick Fluck, the Dr. E. Paul and Frances H. Reiff Professor of Biology and currently associate dean of the faculty, the class explored tuberculosis from several perspectives. Students learned about the pathology and epidemiology of the disease, its history and social impact. It was more than a course on tuberculosis; it was a foray into the world of public health.

  • Dick Fluck Dick Fluck

“I was humbled by my students, impressed by how much they taught themselves and each other,” says Fluck, who credits a $60,000 grant from the Oxford Foundation for facilitating his own research in public health and tuberculosis in the 1990s. “They were digging into a very narrow topic and were really fired up about it.”

The course attracted the attention of Lee Reichman, M.D., M.P.H., who visited Fluck’s class and eventually wrote about the seminar in Timebomb: The Global Epidemic of Multi-Drug Resistant Tuberculosis. Wrote Reichman, “I was certain [the students] knew more about tuberculosis than any other group of college students in the world, and far more than most doctors and policy makers.”

In the ensuing decade, a group of faculty members explored ways to incorporate public health into the F&M curriculum. Their efforts culminated in 2010 with the introduction of a new interdisciplinary major in public health, a 16-course program with tracks in biology and government. The major brings together students from various disciplines to explore a broad range of scientific and public policy questions.

Before the program was available, numerous students designed their course schedules with a public-health focus. Some created special-studies majors, while others took part in a traditional program—such as biology, government or sociology—and used their electives to delve into public-health-related topics. Recent graduates have attended some of the finest public-health graduate programs in the country, including Columbia University Mailman School of Public Health, the French National School of Public Health, Harvard University School of Public Health, The Johns Hopkins Bloomberg School of Public Health, and the University of Michigan.

“Now, students can express their interests through the major,” says Joseph Karlesky, The Honorable and Mrs. John C. Kunkel Professor of Government and co-chair of the public-health program. “The topic lends itself to treatment from a variety of different perspectives—sociological, political, philosophical and biological. And it’s an issue that won’t go away, because all societies must be interested in the health of their citizens.”

Kirk Miller, B.F. Fackenthal Jr. Professor of Biology and co-chair of the new program with Karlesky, is leading Introduction to Public Health for the first time this semester. Last summer, Miller led 14 students in a travel course to South Africa titled Global Public Health. “We’ve been thinking for 10 years that it could take off as a major,” Miller says. “We’ve always had a group of students interested in the delivery of health care, but not necessarily in medicine. This new major is driven by student interest, from the bottom up.”

The new major builds upon interest generated by Public Health Research: Pregnancy Outcomes in American Women, a multidisciplinary course offered in recent years. The course was team-taught by Miller; Sean Flaherty ‘73, professor of economics; Alison Kibler, associate professor of American studies and women’s and gender studies; and Berwood Yost, director of the Floyd Institute’s Center for Opinion Research.

“It’s an almost perfect multidisciplinary major,” Flaherty says of the new program. “It brings social science and science and even humanities perspectives to focus on what keeps the population healthy, and what makes it healthier. The Pregnancy Outcomes course was a nice example of doing that within a course itself.”

Even before F&M faculty members began to brainstorm a potential major in public health, many of the College’s alumni used their broad education to establish themselves in successful public-health careers. These are a few of the stories of those who are already living the public-health major.

Caswell Evans, D.D.S., M.P.H., ’65

  • Caswell Evans '65 Caswell Evans '65

Caswell Evans has held numerous titles during his four-decade career in oral health and public health, including dental director, professor and director of public-health programs and services. But when he recounts his days as an undergraduate at Franklin & Marshall, he talks about his more unlikely designation—English major.

Evans, associate dean for prevention and public-health sciences at the University of Illinois at Chicago College of Dentistry, had a strong interest in literature before arriving at F&M. At the same time, he had early thoughts of going into dentistry. Evans felt English was the most natural fit, and says his bachelor’s degree has served him well in his diverse career as a public-health professional.

“One of the greatest advantages, not clear to me until years later, is that so much of public health depends on the clarity of the message, both spoken and written,” says Evans, who is past president of the American Public Health Association. “If you’re in an administrative or leadership position and can’t explain things clearly in writing or verbally, you’ve got problems.”

Evans earned his D.D.S. from Columbia University School of Dental and Oral Surgery in 1970. As he studied various treatments for dental and oral-health problems, he began to question whether there was a way to prevent the problems in the first place. He started to think about oral health as a part of general public health, opening a new world of possibilities. He enrolled at the University of Michigan School of Public Health and received his M.P.H. in 1972.

He is happy to see the introduction of the new public-health major to the F&M curriculum. “The study of public health at the undergraduate level is a fertile academic domain because it intersects and cross-walks with so many other subjects,” he says. “For example, and to name only a few, biology, including microbiology and genetics; mathematics, particularly statistics; the environment; occupational and animal health; law; public policy; and, of course, communication.”

He is particularly pleased because he feels public health is not as widely understood or as appreciated as it should be. “When public health works, when it’s successful, nothing happens. There are no disease outbreaks, and no food poisoning at wedding parties,” he says. “It’s tough for public health to get appreciation like a fire department might after putting out a fire. It’s a good thing for students to get an appreciation for public health early in their careers.”

Evans has gained an appreciation of public health on the front lines of his profession. After earning his M.P.H., he served as director of the county division of the Seattle-King County Department of Health in Washington. He later became director of public-health programs and services for the Los Angeles County Department of Health, a position that kept him on his toes for 13 years.

“In Los Angeles, there is a public-health catastrophe every day,” he says. “Whenever something didn’t happen, I wondered if I had all the right information. With environmental issues and personal issues in an area of 10 million people, it was very exciting and very challenging.” Evans was on site for the aftermath of the Rodney King riots in 1992, and for the Northridge earthquake in 1994. He says there were 400,000 people on the streets following the earthquake, presenting a range of public-health issues, including solid-waste problems, vaccine requirements, fires, floods and insects.

Evans returned to the East Coast in 2000 to become project director and executive editor of Oral Health in America: A Report of the U.S. Surgeon General.

He also directed a second report, National Call to Action to Promote Oral Health, in 2003. “These were evidence-based reports from which someone might derive policy,” Evans says. “Both reports served to bring a wider appreciation to oral health and were widely distributed to the academic community and to medical schools. Even if people know nothing about the subject matter, they’ll read the executive summary because it comes from the surgeon general.”

At the University of Illinois at Chicago, Evans helps to educate a new generation of oral- and public-health professionals. He is particularly excited about the community-based element of his program, which requires that students spend 60 days outside the dental school in various public-health settings. “They write an essay about their experiences,” Evans says. “And they’re being graded by an English major.”

Michael Iademarco, M.D., M.P.H., ’82

  • Iademarco and his wife, Elizabeth, in Vietnam  with their twins, Nico and Anna. Iademarco and his wife, Elizabeth, in Vietnam with their twins, Nico and Anna.

F&M’s progress toward a major in public health caught the eye of Michael Iademarco several years ago. A commissioned officer in the U.S. Public Health Service, Iademarco is chief of the mycobacteriology laboratory branch at the Division of Tuberculosis Elimination (DTBE) at the Centers for Disease Control and Prevention (CDC). He was a member of the faculty of Washington University School of Medicine, coordinated U.S. government health-related matters for Vietnam and worked on numerous projects for the World Health Organization.

“Back when I was interested in the sciences as an undergrad, there really was no mention of public health. And that wasn’t F&M’s fault,” says Iademarco, who majored in chemistry and mathematics. “Most people interested in medicine either went into private practice or an academic discipline.”

After graduating from F&M, Iademarco enrolled at the University of Virginia School of Medicine. During a “medical externship” to Kenya on a Reader’s Digest international fellowship, he took his first steps in the field of public health—even if he did not know it at the time. The three-month program allowed him to work in villages and clinics in Kenya. He met with the local witch doctor, spent time in animal husbandry and helped train community health workers. “I loved that experience, but continued on track to become a bench scientist, not realizing that what I was doing in Kenya was public health.”

By the 1990s, Iademarco established himself as a physician-scientist in the pulmonary and critical-care division of the Washington University School of Medicine. When his wife, Elizabeth, began working toward her master’s in public health, Iademarco says, “A light bulb went on.” He soon earned his master’s in public health from St. Louis University and made the transition from academics to public health.

Iademarco joined the CDC in 1998, working within DTBE to build public-health capacity in Asia, and then in 2001 became the division’s associate director for science. In 2006, he was named health attaché at the U.S. Embassy to Vietnam, where he spent four years coordinating American and Vietnamese health-related cooperation and serving as the in-country representative for the Secretary of Health and Human Services.

“We’ve had 15 years of good health diplomacy with Vietnam since the establishment of the [diplomatic relationship] in 1995,” Iademarco says. “Seventy-five percent of all U.S. resources sent to Vietnam go to health. You don’t read about Vietnam in the newspapers much anymore because the news is positive. Everyone is visiting, from Bill Gates to four-star generals.”

As health attaché, Iademarco worked with the Vietnamese government to ensure a collaborative approach between the two nations on public-health issues. He was part of many success stories, including a multilateral cooperative effort to prevent the spread of avian influenza. “Influenza H5N1 is endemic in Vietnamese poultry, presenting a risk for a global pandemic of a severe nature,” Iademarco says. “The United States cares about prevention. Vietnam is one part of a worldwide success story about how to prevent global pandemics.”

  • Vendors sell their wares at a food market in Hanoi, Vietnam. Vendors sell their wares at a food market in Hanoi, Vietnam.

Iademarco, who received two prestigious awards from Vietnam’s government during his tour of duty, says challenges remain in improving public health overseas. “In the U.S., we tend to encourage change based on scientific evidence. So in other countries, people often say, ‘Let’s get the evidence and change it.’ But we don’t go prepared to look at their laws and regulations. Legal and regulatory reform need to be at the forefront of our public-health practice.”

Iademarco returned to the CDC last summer, and to the central passion and interest of his career: tuberculosis. He now leads the national tuberculosis laboratory that conducts applied public-health research and serves as the nation’s reference laboratory. His F&M education helped to make possible his seamless transition between different positions over the years; in particular, he says an abstract math course he took with Arnie Feldman, the Carmie L. and Beatrice J. Creitz Professor of Mathematics, helped him develop as an analyst and thinker.

Yet Iademarco might best describe himself as a writer—another example of his liberal arts education at work.

“Ironically, the most important thing I do is write,” he says. “Everything from e-mails to international govern-ment agreements. I could go to F&M and talk to English majors about the importance of the written word in my work. Now I think about retiring and becoming a journalist.”

Rajita Bhavaraju, M.P.H., ’94

Rajita Bhavaraju graduated six years before F&M offered the first-year seminar on tuberculosis, but she would have been a perfect candidate for the class. Instead, her experience in another first-year seminar helped to launch her toward a career in health education— with a specialty in tuberculosis.

“When I came to F&M, I intended to go to medical school,” Bhavaraju says. “But I took a freshman seminar in sociology with Joel Eigen [Charles A. Dana Professor of Sociology] and fell in love with the subject. I began to think about what influences a person’s decisions by looking at the larger society.”

Bhavaraju is in her 14th year at the New Jersey Medical School (NJMS) Global Tuberculosis Institute, where she has held several positions, including program director of education and training. She has developed curricula for international distribution, supervised a staff of health educators and overseen work on multiple grant-based projects. Bhavaraju is also nearing completion of her Ph.D. in health education and behavioral sciences at the University of Medicine and Dentistry of New Jersey School of Public Health.

  • Bhavaraju trains other professionals how to track tuberculosis. Bhavaraju trains other professionals how to track tuberculosis.

A background in sociology has proven to be ideal preparation for Bhavaraju’s career in public health. In addition to Eigen, she credits Professor of Sociology Howard Kaye for having a positive influence on her career. “I took Sociology of Medicine and also did an independent [research project] with Dr. Kaye, looking at what influences people in the public-health-care system,” Bhavaraju says. “Sociology has a strong theoretical focus. Why do people behave the way they do? If they’re told to put on their seat belts, why don’t they? Sociology helps me understand the theoretical side of health issues. Medicine often looks at the individual in search of a cure. In public health, you look at things from a different perspective—communities and prevention.”

Bhavaraju began to focus on tubercu-losis while completing her M.P.H. at the New Jersey Graduate Program of Public Health in Piscataway, N.J. She decided to do a fieldwork project on tuberculosis after developing an interest in infectious diseases, and conducted her research at NJMS National Tuberculosis Center. “When the whole project was over, I asked if they had any job openings,” she says. “I began in the Education and Training Department, and I’m still there.

“It’s not health education in the traditional sense,” she says. “We work with nurses, physicians, state tuberculosis programs and public-health departments. We conduct TB-intensive training courses and train workers how to track the disease. It’s a very interesting process.”

After a sharp increase in tuberculosis cases during the 1990s, rates of the disease are at an all-time low, Bhavaraju says. The news is positive, but it also makes it more difficult for Bhavaraju and her colleagues to keep the disease on the minds of health professionals. “TB is not on the radar screens of nurses and physicians as much as it used to be,” she says. “Funding has shifted from TB to other issues, like bioterrorism. Our clinic staff has dwindled. It’s like being a victim of your own success.”

Bhavaraju has been part of an increasingly global effort to eliminate tuberculosis. The name of her employer might be the best evidence of the shift toward an international focus; several years ago, the National Tuberculosis Center became the Global Tuberculosis Institute. Although incidence rates have fallen in the U.S., the disease remains a significant public-health problem worldwide. This is what makes Bhavaraju’s job of educating health professionals so vital.

“In our field, public health is about getting people to do what you want them to,” she says. “And it’s about why people do the things they do.”

The perfect task for a sociology major.

Brian McCormick, Esq., M.H.S., ’97

  • Brian McCormick,  Esq., M.H.S., ’97 Brian McCormick, Esq., M.H.S., ’97

He is neither a pharmacologist nor a physician. He wears a business suit, not a lab coat, and works with clients, not patients. But listen to Brian McCormick describe his job, and you might wonder if he moonlights as a scientist.

“I’m not a scientist, but I do try to speak their language,” he says.

McCormick is a senior associate with the international law firm Hogan Lovells, where he focuses on the U.S. Food and Drug Administration’s regulation of pharmaceuticals and biological products. He is an expert on the complex and highly regulated process of drug development, approval and marketing, and on the numerous pieces of legislation that set the guide-lines for a drug’s long journey from the lab to the patient. His voice is an important one as pharmaceutical companies plan development programs, conduct research and try to begin to market their products.

McCormick took his first steps in the world of health policy as a student at F&M, when he used his Marshall Scholarship to intern in the Office of HIV/AIDS Policy at the U.S. Department of Health and Human Services. A gov-ernment major, he delved into FDA policy and larger issues, such as the politicization of science and regulation during a senior independent honors thesis with Karlesky, the present-day co-chair of the public-health program. He became so interested in health policy that he began working toward his master’s in health sciences at the Johns Hopkins Bloomberg School of Public Health the following year.

In his second year at Hopkins, McCormick returned to the Office of HIV/AIDS Policy for a yearlong internship. “That’s when I became interested in the legal side of things,” he says. “I was able to see inside the highest levels of the government and saw that many of the most significant health-policy decisions are made by lawyers. During that year, I decided to go to law school.”

Upon graduating from Georgetown University Law Center in 2002, McCormick knew exactly where he wanted to work: a firm that practiced in the life sciences and health care, including FDA regulation. He found that place in Hogan Lovells, then known as Hogan & Hartson. In eight years with the firm, McCormick has kept current with a fluid and complicated regulatory environment. He has worked on a number of cases that have culminated in high-profile litigation and other proceedings with the government.

“The FDA is charged with ensuring that our drugs are safe and effective. But how those standards get applied is always changing and can shift depending on who is in the White House, on Capitol Hill—even depending on what’s in that morning’s newspaper,” McCormick says. “We’re helping clients navigate this ever-changing regulatory environment. What kinds of studies will they need? What kind of results should meet FDA’s criteria? We help them through what can often be a bewildering process.”

McCormick has experience with a variety of legislation, but he spends much of his time on issues arising from the Hatch Waxman Act, a landmark 1984 law relating to the approval of generic products. He also works hard to master new legislation as soon as it becomes official, as he did in 2010 with the passage of the Biologics Price Competition and Innovation Act. Biologics include highly innovative products derived by biological—as opposed to chemical—processes. They are more complicated than other drugs, and more tightly regulated. But McCormick enjoys the challenge.

“The best part of my job is working with clients to see the science develop,” says McCormick, who spent four months as in-house counsel for a California biotech company several years ago. “They all have a passion for what they do. We work every day on helping clients develop new drugs for cancer, multiple sclerosis and other diseases.”

Though he may not work in a laboratory, McCormick operates seamlessly in a world of rapidly developing technology and cutting-edge treatments.

“That’s the point of the public-health major,” he says. “People may go into biology or chemistry, but the way the world works, there’s a policy angle to everything. If you want to help people, having an interdisciplinary background is really, really important.”

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