Public Health Pioneers

At the end of August, Joseph Lau, MD, retired from the School of Public Health. During his career he has earned a reputation as an invaluable collaborator, mentor, pioneer, innovator, and beloved colleague.

Lau retired as professor of health services, policy, and  practice at the School of Public Health, where he was also the co-director of the Center for Evidence-based Medicine. A prolific researcher, he applied evidence-based methods to a variety of clinical, biomedical, and health care topics. His research focused on the development of tools and methods to conduct systematic reviews and meta-analyses to more reliably understand the impact of factors that may contribute to differences of results in scientific studies. His work has also evaluated methods of combining data and assessed the baseline risks in the interpretation of clinical trial results. Lau created the web-based Systematic Review Data Repository and has published over 230 articles on methodology for systematic review and meta-analysis. In a 2014 interview, the journal Research Synthesis Methods described Lau as “a world-leading expert in meta-analysis and systematic reviews.”

Born in Hong Kong and educated at a Catholic Boarding School, Lau immigrated with his family to New York City as a teen. He developed a habit of taking things apart and then trying to improve them as he put them back together. By the late 1970s while undergoing medical training, the young Lau was constructing his own personal computers and tinkering. In his senior year at college he helped set up a community free health clinic in New York City’s China-town, which has since evolved into a large and successful community health center. He received his MD from Tufts University School of Medicine and completed a fellowship in clinical decision making and medical computer science  at the New England Medical Center.

After they met at the Boston Veterans Administration Medical Center in 1988, Lau began to collaborate with the late Thomas C. Chalmers, a pioneer in the field of meta-analysis. Lau wrote one of the first computer programs to perform meta-analysis, and developed cumulative meta-analysis, a method to summarize scientific knowledge on a given topic and demonstrate how it changes over time. Together with Chalmers, Lau undertook a series of meta-analyses on treatments of acute myocardial infarction, and their results were published in The New England Journal of Medicine and JAMA in 1992.

Lau has served as professor of medicine and professor of clinical and translational science at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center. He directed the Tufts Evidence-based Practice Center from 1997 until 2012 and led the production of over 80 evidence reports, technology assessments, and comparative effectiveness reviews under contract with the Agency for Healthcare Research and Quality.

Much of Lau’s career has been dedicated to refining  methods for conducting and interpreting meta-analyses, understanding their limitations, and developing new  approaches to this work. He told The Lancet that his primary goals are “to modernize the processes of evidence integration and interpretation, raising the bar on systematic reviews and meta-analyses even higher,” and to facilitate evidence-based practice on a global scale.

Lau is widely recognized as a major force in transforming medicine through meta-analysis and its applications in diverse fields. David Moher, Director of the University of Ottawa Evidence-based Practice Center and Ottawa  Hospital Research Institute, remembers reading Lau’s  pioneering papers of the early 1990s. “It was probably one of the first times I’d seen meta-analysis; it seemed so efficient and sensible to me.”

But Moher adds that Lau’s personality was just as impressive as his research. “While Joseph’s external demeanour is often quiet, when he speaks it is with great thought and directly on point. He rarely gets irritated and exemplifies persistent and very focused leadership.” Norma Terrin, professor of medicine at Tufts, agrees that Lau’s personality and intelli-gence make for a compelling combination, describing him as an “original and unconventional thinker, a quiet and unassuming man who can blow your mind.”

Many of Lau’s colleagues cite his scholarly and personal support for his peers as integral to his work. “I have always admired Joseph’s ability to combine knowledge with  modesty and kindness,” says Dr. John Ioannidis, a professor at Stanford University. Dr. Deborah Zarin of the NIH says her most vivid memory does not involve Lau’s “phenomenal analytic skills,” but his “‘can do’ attitude.” Dr. Peter Bonis of Tufts University School of Medicine, concurs, noting that Lau “embodies productivity, excellence, patience, innovation, mentorship, kindness, intellectual curiosity, and dedication.”

Tom Trikalinos, Lau’s colleague in the department of health services, policy, and practice and the Center for Evidence-based Medicine, credits Lau with helping him grow as a researcher and scholar: “On matters of science, Joseph showed me glimpses of the big picture, and taught me to trust others and to function in a team.”

In 2014, Lau told Research Synthesis Methods that his ultimate  goal at Brown was “cultivating future generations of research  synthesis researchers and methodologists, not only in healthcare but also in other scientific disciplines that face problems similar to what we have encountered in medicine.” Judging from the influence of his research and the impression he has made on those he has worked with, Lau can rest assured that he has indeed laid a solid foundation for those future generations to flourish.

Anybody who knew me as a teenager, including me,” Bill Rakowski insists, “would have never expected me to have the career that I had. I’m not saying it was stellar – but to wind up at an Ivy League?” Rakowski, professor of behavioral  and social sciences and associate dean for academic affairs at the School of Public Health, retired after a decades-long career at Brown, and speaks like someone who still can’t believe the good fortune he’s had along the way.

Though he came from a large extended family – his father had eight sisters and two brothers and his mother had four sisters and four brothers – he says “I truly was a first-generation college student, and essentially was feeling my way the whole time.” Yet from this beginning he went on to carry out groundbreaking research in the behavioral sciences; to dedicate himself to the promotion of public health; and to teach, mentor, and advise countless people along the way— winning him the admiration of students and colleagues alike.

Rakowski’s path to public health started when he went to Notre Dame for his undergraduate studies, where he was a “dyed-in-the wool psych major.” He describes psychology in the early seventies as an open discipline where “there was room to be creative,” giving him the opportunity to explore the more non-traditional psychology classes that interested him. “I was an over-achiever,” he admits, and he was fascinated with aging as a health topic.

After Notre Dame he earned his PhD in Human Development from Penn State, where he specialized in adult development and aging and wrote a dissertation on perceptions of luck and perspectives of time in middle age adults. He spent time as a postdoctoral researcher at the University of  Michigan before coming to Brown in 1986 as a hospital- based faculty member at Memorial Hospital in Pawtucket. Initially trained as a gerontologist, he transitioned to broader  types of disease prevention, such as cardiovascular disease and cancer.

Vince Mor, a professor of health services, policy and practice who helped talk Rakowski into coming to Brown in the first place, praises Rakowski’s “highly successful research career in the domain of cancer prevention and control” and adeptness at “how to do fundable research.”

His big research break came while studying the effectiveness of mammograms. He surveyed women about their mam-mography practices, hoping to find that as women took action, they ultimately felt the benefits of mammograms outweighed the drawbacks. He and his colleagues collected the data, ran the numbers, “held our breath when we hit the submit key on the computer,” and, to their delight, the data fit the pattern they were looking for. They wrote a seminal paper detailing their results for Health Psychology in 1992. “That was an important finding,” he says, and the success of this work opened up opportunities for further research.

In 1991, in the midst of his cancer screening research, Rakowski became a tenure-track faculty member. Since that time, much has changed in public health at Brown, not least of which was the transformation of the department of community health into the full-fledged School of Public Health. Rakowski, however, has not just witnessed these changes, but helped make them happen. “I’ve had a bit of a hand in it,” he acknowledges. Becoming associate dean, he says, was an opportunity “to contribute to the development of the School,” as he wanted to take part in maintaining the growing School of Public Health.

Recognizing these contributions, Terrie Fox Wetle, dean of the School of Public Health, says she is “so appreciative of Bill’s ‘can do’ spirit of service to the University and to the School of Public Health,” adding that “his eye for detail and fluency in administrative matters have been invaluable” during the development of the School.

Dean Wetle said that Rakowski is also “noteworthy for his commitment to students, especially our undergraduate  concentrators.” Rakowski himself cites working with students as a highlight of his career. “There’s something about the undergraduate program, the undergraduate world here at Brown, that’s kind of special.” He worked extensively with students, serving two stints as undergraduate concentration director. He has even had the opportunity to watch some of them rise from undergraduates to doctors, an experience  he humbly describes as “gratifying. Not for anything that I did. But just to see them develop and diversify and flourish.  It’s great.”

Annie Gjelsvik, assistant professor of epidemiology, recalls developing and co-teaching a course with Rakowski when she was a new faculty member. “It was an amazing opportunity to learn from a master teacher. Each week he brought  stories and humor to the course and brought even the  driest topics alive.”

Reflecting on his long career at Brown, Rakowski remarks,  “it’s been a really intriguing ride over the years.” He’s a raconteur, filled with an insider’s insights into how Brown works. His experiences with many extra-curricular  organizations were “instructive in terms of peeling back the curtain and seeing the wizards of Oz operating.” He explains this participation in university life as an effort to raise the visibility of public health, to show that they are constructive players in the university. Besides, “there are a lot of nice people to work with” at Brown, he says. “I just  got along with a lot of people.”