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All the people you’re going to meet

There’s a scene in the TV series “Smallville” where Chloe Sullivan tells Clark Kent (the guy who’d become Superman) about all the people she’s met in her travels:

If you know your comics — and superhero movies — then you know that she’s talking about Batman and Wonder Woman. (In the Batman movie from 1989, the Joker asks where Batman gets all those wonderful toys. Also, in some comics set decades into Superman’s future, he and Wonder Woman hook up as Lois Lane has died from old age.) It was neat to see how Smallville addressed the fact that Superman would need help in the future, just like Chloe and others were helping him all the time now.

That scene got me thinking about all the people in my future who I’m yet to meet, and all the people I’ve met so far.

I was sitting in class the other day, listening to fellow students give 5-minute presentations on their thesis proposals. The process for a thesis at our school is that you and your advisor decide on a topic (or set of topics), then you work on several aims for your project, present a proposal to a group of people, and then you get it approved and go into working on your project. There are also two oral exams between the proposal and the approval. Then you defend, and, voila, you’re a doctor.

I’ve even got my spiel ready for that day, kind of.

Anyway, as I sat in class, I got to hear what the other doctoral students (we’re not candidates until after the oral exams) were planning for their research. It made me think of that scene in Smallville. “You’ll meet a guy who wants to dig deep into genes to find autism,” a voice in my head said. “And there’s this woman who will turn the world of infectious disease on its head,” the voice continued. “And her… She’ll give patients a better idea of what they’re getting into so they can make the best decision possible on what treatment to go with.”

“All of them will join you in the sun… You will help them accomplish wonders.” This last one in Joe-El’s voice, like this:

When you think of the number of people graduating from this school with degrees in public health at all levels — bachelor’s, master’s, doctoral — you can’t help but wonder where the heck they are given that the problems around the world are so many. You’d think that all of those problems could be easily addressed with the wealth of knowledge coming from this country alone in terms of public health and medicine. But things are not that simple.

Very few people want to go to where the problems are, so we’re left with places with less than one physician per 100,000 people. As much as I don’t like to admit it, we need physicians to take care of patients on an individual level when us epidemiologists figure things out at a population level. When we found out that smoking causes lung cancer, it was up to the individual providers to translate that knowledge to their individual patients. That’s pretty much the paradigm we’re stuck in today.

It’s not a bad paradigm, though. Public health is more broad than one individual. We’re figuring things out on a large scale. So we need people who know their patients to address the individual variations present in those patients. In the example of smoking, the healthcare provider may add on behavioral therapy or medication to help the patient quit smoking. Or they may begin the process of getting the patient screened for cancer based on the smoking history presented by that patients. These are things that we can’t (and should not) do as public health professionals.

That reminds me… I went to the undergraduate campus a few months ago and met some of the kids getting the bachelor’s in public health. (Yes, they’re kids. They’re that young.) About 3/4 of them told me that they were getting their bachelor’s in public health as a way to get into medical school. They honestly saw public health as something that would help them in medical school. Maybe, but I’d be very surprised if anywhere near half of them end up practicing in public health once they get their medical degree. In fact, I’ve met plenty of medical students doing a joint degree (MD/PhD) who decide not to go back to medical school and get on with public health.

Either way, I’m very excited to see what all of these “kids” will come up with to make the world a better place. Most of them are very bright, and all of them are very dedicated. (Some of us are just dedicated, making up for the lack of intelligence with hard work, or vice versa.) I’m not a fatalist who sees no point in “saving millions at a time.” In fact, I look forward to the eradication of a few more diseases in my lifetime, and the extension of the quality and quantity of life in generations to come.

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René F. Najera, DrPH

I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
About History of Vaccines: I am the editor of the History of Vaccines site, a project of the College of Physicians of Philadelphia. Please read the About page on the site for more information.
About Epidemiological: I am the sole contributor to Epidemiological, my personal blog to discuss all sorts of issues. It also has an About page you should check out.

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