By Harold I. Feldman, MD, MSCE
DBEI Chair, 2013-2019
We advance the full spectrum of population-health science, the DBEI’s vision statement says. We believe that inclusive spirit, combined with our leading expertise, can make a real difference. Just what is population-health science? In the DBEI, we have an instinctive answer: It is what we do. We focus on the health of human beings. If people are well, we want to keep them that way; this domain, prevention, is the focus of many conversations about public health. Yet if we think about human health as a whole, we see that managing people’s chronic or acute illnesses is also part of our collective responsibility—and it should be part of society’s collective conversation.
In the U.S., about half of all adults live with some kind of chronic illness; and most of us know at least one among the millions who have experienced an acute, life-threatening disease. We need new fundamental knowledge about these threats and about health risks to the general population. In the DBEI we make important discoveries along that whole spectrum: from injury prevention and drug safety; to chronic diseases such as cardiovascular or rheumatic conditions, diabetes, and dementia; to acute illnesses such as cancer, coronary heart disease, and infection. Among our many examples, here are three in 2017 spearheaded by members of our faculty:
- A team led by Mary Regina Boland, PhD, created a way to assess whether “category C” drugs—drugs for which the FDA offers no recommendation to pregnant women—are safe to take during pregnancy. These drugs account for about 38 percent of the drugs pregnant women take; the authors newly identified several drugs, such as the anti-psychotic haloperidol, that increased the risk of fetal loss.
- A team led by Danish Saleheen, MBBS, PhD, found that the genetic link between two common culprits, coronary heart disease and type-2 diabetes, appears to work in one direction: risk genes for type-2 diabetes are more likely to be associated with higher coronary heart disease risk than the other way around. That should make it possible to design drugs for type-2 diabetes that are safe for the heart and may even have additional benefits for preventing coronary heart disease.
-A team led by Haochang Shou, PhD, found evidence that bipolar patients’ dysregulated physical activity patterns during times when they are not suffering acute episodes may be a potential biomarker for this still-mysterious disorder that affects about six million adults in the U.S. each year. The team’s conclusions stem from the largest study yet to include the full range of mood disorder subgroups in a nonclinical sample.
I am proud to say that our faculty members are instrumental in identifying solutions to a vast array of challenges. Further, I believe communities such as the DBEI must be the ones to expand the population-health conversation. Just about every scientific activity in that arena calls for synergy across our three disciplines. Epidemiologists decide which populations we will study and how to engage their representative members, as well as which phenomena we will examine and how we will measure them. Informaticians make possible novel analyses of clinical data, such as those from electronic health records, and of data from population-based studies of common diseases such as asthma and cancer. Biostatisticians develop novel approaches to make inferences from complex data, often derived from many domains; they distinguish signals from noise. Inquiries that employ such expertise flow across the entire framework of our science—to prevention and to managing acute and chronic illness alike.
It is true that our disciplines, in various pairings, live in many schools of public health; but integrating the three under one departmental roof is quite unique. Further, our context in a leading school of medicine means that we are particularly well equipped to address illness as well as prevention. We can draw on deep insights from scientists and practitioners all across the Perelman School of Medicine—in areas such as biology, clinical care and advanced diagnostics—as well as on our own strengths in patient-centered approaches. That creates enormous opportunities—not only to expand the scope of our research but also to champion the notion that the science of population health must focus on individuals both healthy and ill, and on all of the people in the communities where they live and work.
We must practice and advocate publicly for population-health science in its fullest sense: It is science that addresses the health of every person.
Harold I. Feldman, MD, MSCE
DBEI Chair, 2013-2019