Interview with Prof R. LaPorte

Prof R. LaPorte Director, Disease Monitoring and Telecommunications WHO Collaborating Centre Professor of Epidemiology Pittsburgh, PA, USA

Prof Zoccali: You are one of the most creative modern epidemiologists. What led you to be interested in epidemiology?

Prof LaPorte: I am eclectic, having being trained in cognitive psychology. I like “stuff” outside of epidemiology that can be brought into our field.

Prof Zoccali: What would you do to increase the interest of Clinicians in epidemiology and what would you say to them to assert the importance of your subject?

Prof LaPorte: There needs to be more interesting training in medical schools to bring them in. We need to focus not only on clinicians but also on non clinicians. I would argue, however, that the most important group are the non clinicians, with a view to forming networks of networks. For example the hurricane in the US needs to tie epidemiologists, architects, clinicians, physicists, meteorologists, etc together, and the internet can do this.  Clinicians are important but we need top experts in many areas so that on the internet we can “pick their brains” for prevention and mitigation. Most clinical research stinks because clinicians have little training in research design, epidemiology and statistics. One way to get clinicians interested in our field is for tenure to be looming with the knowledge they have to publish... We need opportunities to excite young people about what we love so dearly: epidemiology and health. Short training courses involving clinicians and non clinicians with expert faculty are very powerful. The network you created is fantastic. Why not build short clinical trail methodology on top of this?

Prof Zoccali: It is my impression that convoluted language is often the reason why busy clinicians rarely read epidemiologic studies.

Prof LaPorte: Possibly, but epidemiology is, in many ways, merely the common sense of science.

Prof Zoccali:  You  have been one of the very first to seize the great opportunity of the Internet for the diffusion of medical knowledge. The Internet is now a sort of nervous system of mankind. How has your thinking evolved on this theme in recent years?

Prof LaPorte: IT and public health is starting to mature. It is very exciting. The power of the Internet is that it is high tech and high touch. We can create powerful friendship networks worldwide to work together. It has two important characteristics for public health, we can share large quantities of information virtually for free. The power of the Internet is not the computers, but the ability to form groups of interest and intellectual strength worldwide that can be brought to bear on any problem.

Prof Zoccali: Prevention has long been a much neglected area in nephrology. The unsuspected high frequency and the high risk for cardiovascular complications of minor degrees of renal insufficiency has now made preventive nephrology a fashionable area. Based on your wide ranging experience, what advice would you give to kidney specialists who have an initial interest in this field?

Prof LaPorte: Nephrologists are impressive, especially related to networks of clinical trials, and are primed to prevention. There needs to be short courses of training linking those in epidemiology and statistics with nephrologists.

Prof Zoccali: You invented the field of 'telepreventive medicine'. Could you tell us what telepreventive medicine is and what developments you foresee for this form of prevention?

Prof LaPorte: It is best to contrast. Telemedicine is the application of expensive, high bandwidth information sytems to a small number of sick people to cure disease. Telepreventive medicine is the application of cheap, low bandwidth information system to large number of healthy people to prevent disease. Prevention has always been more important for health.

Prof Zoccali: Could you make an example of this?

Prof LaPorte: The past few days have been horrific because of the hurricane disaster in New Orleans. We wanted to tell you about how you or someone you know can potentially help. On of the major gifts we can give in a disaster is our knowledge. As Nelson Mandela has said “Education is the most powerful weapon you can use to change the world”. We decided to provide the people world wide top quality scholarly material that you can present to your students or you can provide to other educators to help them teach students whether they are in first grade, or in college. We gathered 40 meteorologists, disaster experts, and public health officials and we produced a scholarly lecture on Hurricanes which can be used by any of us. We give this to you, but it is not for free. We expect that each of you will use the lecture to teach about hurricanes and that also that this is a gift that is meant to be given, therefore please distribute this to at least 5 of your friends. http://www.pitt.edu/~super1/lecture/lec20371/index.htm . In addition, we invite all of you to see the Cutler Lecture on Sept. 29 from 4:00-5:00 at the GSPH by Dr. Eric Noji on Global Disasters.  Eric is one of the major global leaders in disasters. He was the head of disasters at CDC, as well as WHO. We provide for you the slides of his lecture in English, Russian, Arabic, and Spanish. Eric is a dynamite speaker and is currently at ground zero of the hurricane damage. Please visit to web page below to find more information: http://www.publichealth.pitt.edu/specialevents/cutler2005/webcast.html

Prof Zoccali: Presently you have a particular interest in type1 diabetes and recently performed a study on seasonal trends and geographic variations of this disease in China. Do you feel that China with its very large population and its accelerating economic growth is a  particularly important area for testing preventive strategies?

Prof LaPorte: China is extremely important, especially for evaluation on a large scale, perhaps the most important concept of epidemiology, Omran's epidemiologic transition. The Chinese investigators are cutting edge. We will learn much about global health in China.

Prof Zoccali: Unparalleled access to information is an objective success of the present medical publishing system. The right and control of intellectual property and the freedom of scientific communication are perhaps the major challenges that the system has to face now. This is truly a hot topic. We sorely need solutions, not just brilliant discussions. What is the best way to solve the problem?

Prof LaPorte: This would need a lot of writing. I would suggest doing a search on me in the BMJ  http://bmj.bmjjournals.com/cgi/content/full/313/7072/1609?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=La+Porte&andorexactfulltext=and&searchid=1125487423629_3960&stored_search=&FIRSTINDEX=10&sortspec=relevance&resourcetype=1, most of the important issues are discussed in a series of questions.

Prof Zoccali: A standard question. What paper influenced you most?

Prof LaPorte: Oran's epidemiologic transition papers from the early 70s. If you read these papers, you will never look at the world the same way again.

Prof Zoccali: Epidemiology apart, what are your hobbies?

Prof LaPorte: My life revolves around email. I am fortunate to be able to travel with my wife, Jan Dorman, who is a molecular epidemiologist. Also, my global friends are the best in the world.

Please come to the global lecture on disasters. This is especially important for those in renal  disease because of the crush syndrome.  It will be offered in 5 different formats including web casting as part of the University of Pittsburgh Culter lecture. Eric Noji, M.D. the guru of global disasters from CDC and WHO will be presenting.