Behind the Lectern: Vincent Mor

That entrepreneurial spirit eventually led to looking beyond the University for research funding.

Yes, the Brown tradition has always been focused on undergraduates. Undergraduates were involved in faculty members’ research, but that research was not necessarily funded from external sources. It might have been work in the library, for example, or with another university. But our work required significant amounts of new data, significant amounts of new information. So we needed extra money to do that research, and that extra money required getting grants from outside. That entrepreneurial initiative was fairly new in the Brown environment. There were some small initiatives, but the Department of Community Health and the faculty that were emerging in that group made that sort of their vision and their purpose. 

So between gerontology, alcohol and addictions, statistics, international health—these broad initiatives worked together, learning the ropes, how to deal with this stuff administratively, and we forged new processes for the University in order to become leaders in the field in these emerging areas in medicine and public health.

At the time, these initiatives were still a part of the Division of Biology and Medicine. Public health wasn’t really how you thought about your work yet?

In the early ‘80s and ‘90s we didn't think in terms of public health so much. We thought in terms of clinical medicine because of our connection there. As time went on, both the research and the people we were recruiting were more and more drawn to this population perspective that is public health. That fusion between medicine and public health was in some sense what catalyzed our vision and the work that we did.

Your work directing the national hospice study wasn’t just important for the early formation of public health at Brown, of course; it had a major impact for all Americans with the creation of a new Medicare benefit. 

A new benefit to the Medicare program was added, which was the hospice benefit. Our team was involved with the Medicare actuaries and bureaucrats who were designing the program after the bill passed because they used the data from our study to actually create the benefit as it currently still exists, for better or for worse. 

We continued to study end of life care, cancer, aging, long-term care, all formulating around this issue of how people cope with disability and chronic illness that leads to death. 

Tell us about what motivates you to study end-of-life care?

My mother died in 1978 of cancer. She was at a world class cancer center, but when she was dying, she was down at the end of the hall on a scheduled dosage for morphine pain management rather than as needed, and rather than being close to the nurses, she was far away because the nurses kept the patients they were trying to save close to them.

My wife is a Ph.D. social worker who does clinical work with people getting radiation oncology who have serious illnesses, so both of us are fully steeped in the world of understanding end of life and its complexities. We have open conversations about advanced directives. 

When my younger brother died of melanoma years ago I made sure that he got into the right hospice arrangement, that his clinical care followed him, and that it worked extremely well. And it was a very positive experience for something that would be otherwise horrible. And he also grew in the process. So I guess it shapes who I am.

And today, hospice is a regular part of end of life care.

It's really wonderful. I chair the board of our local hospice so I can give back to our community and have an opportunity to see how it works in an optimal circumstance. It's a not-for-profit and the staff are devoted. They have an inpatient unit where family members can stay and great services for people in the community.

I see that as a manifestation of what is possible when a health care provider and a health care system is embedded in the community and offers services to a population that really are otherwise not available. 

There are all kinds of other policy issues that one could deal with, but this is a service that patients and families write to us about how grateful they are. It’s just a remarkable experience.

Junior faculty and our students have an opportunity to engage as well. The hospice here is a teaching point for residents and medical students and it's because of the relationships we’ve built over time with this organization, which was one of the participants in the original national hospice study that I did forever and ever ago.

Now that you have seen these few research projects and initiatives grow into a fully accredited School of Public Health, what do you think distinguishes Brown among her peers?

Unlike my colleagues at Harvard or at Hopkins or at the University of Michigan, we are embedded into a single university. There’s a School of Public Health, a School of Medicine, and now a School of Engineering as well, but they are all fundamentally linked to the undergraduates and the entire teaching program of Brown. That makes our public health program quite different. 

We have an undergraduate concentration and so undergraduates go down the hill, and don’t always like walking back up the hill, but they go down the hill and take advanced courses. The basic courses are offered up the hill, so the faculty walk up the hill and do their lectures. It's a very popular undergraduate concentration.

Administrative connections are more fluid here than they are in other places as well, and the linkage to sociology and economics and environmental studies is really strong. School of Public Health faculty are also very much involved with mathematics and computer science.

In many respects, the School of Public Health emerged with what is now called a Data Science Orientation. The best of what was in the social sciences merged with the best of epidemiology, epidemiological sciences, the clinical departments and a clinical knowledge base to forge a data enterprise that makes it possible to answer really, really important policy questions, with local effects as well as national effects. 

Those policy questions are not just about money, but also about how you intervene, how you communicate public health messages. That makes it quite vibrant and quite interrelated. Our Department of Epidemiology, our Department of Behavioral and Social Sciences, the Departments of Biostatistics and Health Services, Policy and Practice, they're all addressing similar kinds of integrated questions, and that is important.

There's much less focusing down one alley than we see in other more established schools of public health. We're ready to embrace the changes that are coming about where we need to be able to integrate clinical medicine sciences with public health and epidemiological and health services research. 

Did your research change course when COVID-19 emerged?

Within two weeks after the first person died in a Washington state nursing home of COVID, we were working with one of our colleagues, a nursing home company, and they transferred their entire electronic medical record to us every night.

And then once a week, my research team met with their clinical people to try to work with them about what their problems were and what they needed to know to best solve their problems in the field as it was. So, that is really some of the greatest sort of applied health services research that's been done, to my knowledge, and it's one of the things that I was most proud of being involved with in the 40 years I've been here at Brown.

Help us understand why the study of dementia care is so important.

It is a huge public health issue because of the aging of the population. As the baby boomers age, that incidence rate will mean more and more for society. Dementia is a really profound personal issue for families and it will have a very substantial impact on the politics of America and other aging societies. It will also make critical demands of healthcare, which may or may not be appropriate given other kinds of needs.

That's why dementia is such an important issue. It's what dementia means for the people around the person who has cognitive impairment and is no longer able to manage for themselves. With this kind of disease it often takes more than one care person. If you think about the multiples, it’s a big, big effect. The real issue is the delivery of care to these people and their care partners and their families. 

The prevalence of dementia is going to change, and must change, the way in which doctors, nurses and other clinicians actually interact with their older population. And it’s going to be a really important factor that’s going to affect medical schools, medical education and residency. How we use research to inform that educational process is going to be the challenge.

Dementia is the future of aging research. It's going to be how we tie together neurosciences and social sciences. And Brown is uniquely placed to make an impact in the field.

Looking back on your career as an educator, what experiences have been the most rewarding?

When I first came to Brown, I didn't know about education. I only knew about my research. Over time, we developed a doctoral program, initially in epidemiology, and then epidemiology and health services research, and now we have four doctoral programs, and I am still in contact with many of my students.

Many of them are doing similar kinds of work, and it is unbelievably gratifying to me to see them at a conference or to see them present their work and to know that these were students who had a particular area of interest, often in aging, sometimes long-term care, which is often given short shrift elsewhere, and so they come to us and it's amazing.

It’s their passion and we shape them so that they have the tools to ask their questions in as rigorous a manner as possible. You'll see a student the first year and, you know, I'm not sure. Can they ask a question? Can they manage these data? Do they have the discipline to do that? Can they keep their eyes focused while also keeping them wide? And then you see them four years later give their dissertation with such aplomb, with such grace and rigor. And it's just remarkable. It's just the best.