Medical Schools Fight the War Against Disease

Epidemiologists go straight to the source, then sift their data one clue at a time.

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Matt Goldshore of Chappaqua, N.Y., found his way to Africa via the University of Texas, where he was studying chemistry with plans for medical school. One summer, he signed up to study at a crowded hospital in Moshi, Tanzania.

That experience changed Goldshore's life. He came back resolved to help the Catholic Sisters of Our Lady of Kilimanjaro fight HIV, malaria, and other diseases afflicting Moshi's people. Yet he doubted anyone could conquer such scourges as one physician treating one patient at a time. So, like a growing number of students, he set out to learn how whole populations become vulnerable to disease. He went to Washington, D.C., to study epidemiology at George Washington University.

Diseases such as AIDS, SARS, and bird flu were big news during the formative years of today's students. The story of modern epidemics is one of frighteningly fatal germs hopping the globe as readily as a YouTube video. Increasingly, the world calls on epidemiologists to respond not only to outbreaks of infectious diseases but also to natural disasters, food-borne illnesses, and life-threatening chronic diseases. Today's epidemiologists are designing the studies that lead to solutions.

An English doctor named John Snow opened the door in 1854 by plotting where a rash of cholera deaths had occurred in London. Snow's map revealed a cluster of cases around a suspect water pump. When the pump handle was removed, the cholera outbreak ended. "We didn't even know about infection until the late 19th century," said David Celentano, interim chair of epidemiology at Baltimore's Johns Hopkins University. The world's first school of public health was started at Hopkins in 1918, and it's still the leader. Its first targets included tuberculosis, flu, and colds.

Subsequently, epidemiologists discovered that mathematical methods work well at rooting out the underlying causes of heart disease, chronic ailments, and some injuries. Since HIV/AIDS surfaced in the United States during the 1980s, the frontiers of epidemiology have moved toward clinical trials of drugs and other interventions. "We don't wait for people to die to do our AIDS studies," Celentano said. "We know a cocktail of drugs that stops HIV in its tracks."

The AIDS epidemic touched off an avalanche of research grants that spurred the growth of public health schools across the nation and created jobs for people with skills in epidemiology. Holders of graduate degrees now work in every state government, many local governments, and the pharmaceutical industry, along with hospitals and other private businesses. Federal agencies, such as the Centers for Disease Control and Prevention and the Food and Drug Administration, are constantly hiring. At its headquarters in Atlanta, the CDC trains new public health graduates with strong academic records and teamwork skills. Trainees can earn more than $70,000 annually, plus bonuses, and their experience makes them very competitive for career CDC jobs with plump benefits.

Nose to the grindstone. Rare is the epidemiology career that leads to big money. But it's the opportunity to do mankind a big service that many students are seeking. In response, more and more universities are starting to offer their undergraduates a public health major that includes epidemiology. Johns Hopkins made that move seven years ago, and public health is now the second-most popular major for undergrads. For grad students, the School of Public Health's 530-member, full-time faculty offers graduate students a long menu of research topics. A Hopkins master's in public health costs $46,200, but the program takes just one backbreaking year of five quarters. Thanks to New York Mayor Michael Bloomberg, a wealthy electrical engineering alum of Johns Hopkins University, the school is determined not to let money stand in the way of a top-notch student who needs it; 60 percent of students get financial aid.

Large numbers of Hopkins students—27 percent of its doctoral candidates—come from foreign countries and arrive with deep experience in public health. Many students become teaching resources themselves. Epidemiology lab students working last fall on a case study involving the 2004 Indian Ocean tsunami were able to hear from a fellow student, Singaporean Army Lt. Col. Yih Yng Ng, about what first responders actually did to detect disease outbreaks in the hardest-hit area of Indonesia.