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An Interview With
Jonathan M. Samet, M.D., M.S.
March 19, 2014

samet

Director, USC Institute for Global Health
One of the world's leading experts on the health risks of inhaled pollutants

Jonathan M. Samet, M.D., M.S., is a man driven to make a difference in the health of individuals and whole communities. In his 30 years of scientific research, he has pursued new discoveries to improve environmental health and preventive medicine. At the same time, he has worked tirelessly to provide service that improves public health. On the scientific front, he has studied indoor and outdoor air pollution, the links between radon and lung cancer, and an array of health issues surrounding active and passive smoking. In turn, he has translated those findings via expert witness testimony in litigation against tobacco interests, written reports such as several U.S. Surgeon General’s Reports, and counsel to legislative leaders at the federal, state and local levels of government.

An international authority on the effects of smoking and air pollution on health, Samet has become founding director of the new USC Institute for Global Health and the Flora L. Thornton Chair of the Department of Preventive Medicine of the Keck School of Medicine.

Faculty Profile
Keck School of Medicine

Global Alliance for Clean Cookstoves

   
   
   

Spencer:

You’ve used the phrase, “Big epidemiology for big problems.”  I was wondering what is your perspective on this new era?

Dr. Samet:

I think that epidemiology has been tremendously successful in identifying causes of disease that we can do something about.  Smoking is a great example, because it’s such a powerful cause of diseases. There are multiple factors that really drive health and now we’ve added on genes and the epigenome, and we’re understanding that biology is incredibly complex. So, we need what I call the “big epidemiology” to sort these questions out.  There’s clearly a shift in the field from the time when individual investigators had questions and they tried to answer them by doing a case-control study or a survey or some sort of cohort study. Now we’re looking to different kinds of resources for doing studies – perhaps national cohorts, patient-based cohorts – and the model’s changed.

Spencer:

Is there room, do you think, for the individual researcher?

Dr. Samet:

Sure, there’s always going to be room for the individual researchers, but some are going to be leaders of teams and some are going to be members of teams. There will be a lot more team-based research.

Spencer:

You and other epidemiologists often tell the story of Dr. John Snow and his role during the cholera outbreak in 1854. How is that story is relevant today?

Dr. Samet:

I think that what John Snow did is he had a hypothesis. He thought that cholera was water-borne in its transmission.  He collected data to test his hypothesis and very importantly having done this he said, “Well, something needs to be done.” The wrong story is that he took the handle off the Broad Street pump.  The right story is that he talked to the council about removing the handle from the Broad Street pump.  And again, this  speaks to the role of scientist versus the decision-maker and where lines might sit.  A little bit like what I discussed in my presentation today on the Surgeon General’s report.

Spencer:

What are some of the disadvantages of scientists engaging in policy?

Dr. Samet:

Well, I think the answer to that question depends on what you mean by engagement.  Of course, scientists do engage in policy; they should. They should be involved in translating, making sure that those policy makers understand what the science shows and where the knowledge lies and where uncertainty beings. So, I see that as an important role of scientists. Some scientists may choose to become policy makers.  Some scientists may choose to become advocates.  But for those who want to be scientists, most critically they need to translate, and they need to start to publish – that’s an important starting point. And then, after that, they need to foster understanding and that may mean writing letters, that may mean going to hearings, that may mean talking to those who aren’t talking, talking to the media who get the word out.

The disadvantages come from stepping into arenas where powerful forces are often in play. It’s not the scientist’s role to step into the world of decision-making. I mean sometimes there are complexities that we don’t understand, or traps, things that someone might get involved in unwittingly. They don’t want to be there.  So, you have to watch very carefully where you’re going.

Spencer:

I am from a large research university. Do you think there’s an overemphasis on publication? Is the culture wrong?

Dr. Samet:

Publication is essential and long has been essential.  At the level of individual acknowledgement, promotion, advancement within academic systems there’s an extraordinary emphasis, of course, on publication. The old ‘publish or parish’ phrase unfortunately is true.

The phrase says ‘publish or parish’ doesn’t say ‘publish meaningful things,’ and I think that’s where the distinction lies.  Clearly with the proliferation of journals there’s a high expectation on publication.  I think what every scientist after a while in his or her career will begin to ask is, “Have I published meaningful papers?” and if they had an impact.  And that, to me, is the most critical sort of looking back.

Spencer:

You have spent much of your career studying indoor pollutants such as second-hand smoke, asbestos, radon, formaldehyde, nitrogen dioxide, lead, and mold.  In 2014, where lies the greatest challenge?

Dr. Samet:

The landscape of indoor pollution problems has changed.  The second-hand smoke problem, at least in many places, has come under control.  We know a lot about radon. I think it depends on where you are in the world.  If it’s in high-tech countries like the United States, to me the questions about indoor air quality relate to how do we assure healthy indoor air quality while having sustainable environments and reducing energy consumption.

We have to understand our building materials, our products, and our furnishings. We got into trouble 20, 30 years ago with sick building syndrome. I think in part because people did not understand that the HVAC systems and changes in use could really lead to problems of the air quality.

Then, if you look globally, biomass smoke combustion remains a huge issue. In some environments we have tremendous problems with high levels of outdoor air pollution as well as with our indoor environments, so the problems live on.  And they’ll always be important because we spend so much of our time indoors.

Spencer:

You spoke a little bit this morning about e-cigarettes and I was wondering what your views are on the popularity of them. Should we be promoting them? 

Dr. Samet:

Sure.  So really, the e-cigarettes – in the present form – have not been around too long.  I mean certainly in the US it’s only been the last two years that it’s been an explosive growth and the current wave began about 2004, from China. The role remains to be established around points I made earlier: harm reduction for individual people who might use an e-cig instead of a combusted, conventional cigarette versus the possibility of population harm because children will use them. Young people will use them and become nicotine addicted and transition perhaps to either dual use with e-cigarettes and cigarettes, or cigarettes alone.

With hundreds of flavored products out there, it’s hard to believe that those are for people who are already addicted to nicotine. Flavors like bubble gum and cookies and cream or whatever are not for established smokers, and they have the potential to lure younger non-users into being nicotine addictive.

Spencer:

Last year there was a report describing four cases of women under 40 who developed breast cancer, just beneath the area where they carried their cell phones.  In light of the Million Women Study, do  you believe that cell phones pose any cancer risk?

Dr. Samet:

There are questions that can be answered and there are questions that are not to be answered.  I think if you said, “Do cell phones cause any cancer risk? Can we say 100 percent that they don’t cause any cancer?” Absolutely not.

This is obviously very challenging to study. There’s a lot of work going on, there’s an important bioassay going on, there’s some epidemiological work in progress. I think this is a story where we need to be monitoring very carefully for changes in brain cancer incidents. After all, with the majority of people on the planet using these devices fairly extensively, it is important to understand the risks.

Spencer:

It is generally accepted that tobacco is the single most-important cause of preventable death in the world and is projected to be the leading cause of death by 2020.  Seventy percent of tobacco deaths will be in developing countries. I’m wondering in your opinion, what more we can do today to reverse that trend?

Dr. Samet:

We are doing a lot and I think there’s hope attached to successful implementation of the WHO Framework Convention on Tobacco Control. And Bloomberg and Gates have both put up a fairly substantial amount of money to foster implementation and policy change in the high-burden countries. So, I think there’s a lot of hope there that the epidemic can be staved, which as you said, is unfolding in low and middle income countries.

And I’m hopeful.  There are so many global tobacco control movements and some countries have moved quite actively, some countries quite surprisingly – like Turkey, for example.  Even Russia has a new strong tobacco control law. If these laws are put into place and truly implemented and enforced, hopefully some of the projections of what could happen will not ring true.

Spencer:

You recently completed a meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy.  What do you hope will be the impact of this study and will it persuade those who have been doubtful?

Dr. Samet:

I will have to give credit for that work to Beth Pineles, my MD/PhD student, who worked very hard on that for about three years, and I think did the most exhaustive review of the literature to date. Some of the studies she reviewed went back decades. There’s so many reasons that women who are pregnant should not smoke and women who want to be pregnant or are pregnant should not smoke. Hopefully we’re adding to that literature.  This is sort of a matter of translation, and it has to be an issue that’s taken very seriously by the OB/GYN community and with primary-care providers that take care of pregnant women.

There’s still about 500,000 women a year in the United States who smoke while pregnant and the right number is zero, for sure.

Spencer:

Every successful career is marked with some frustration and disappointment.  Can you think of a moment that you found especially difficult and how you overcame that challenge?

Dr. Samet:

It’s a challenging question. I think probably the biggest challenge – and for anybody in the kind of career I’ve had – a research career – is keeping your science relevant, staying funded. You can only stay funded if you have ideas that are on the cutting edge and are relevant. I have to say that is the big challenge.  Like everybody else I’ve had grants that weren’t funded that I scratched my head about, but that’s part of the game.  Some grants are perhaps more frustrating than others, but I’m not sure I’ll put my finger on one frustration versus another.

Spencer:

I’ve heard you have a dominant outdoor lifestyle that helps you avoid indoor pollution. I was wondering how you accomplish this when so much of what you do probably takes place inside?

Dr. Samet:

There’s always time to exercise.  So, roughly for the last 40-plus years I’ve probably worked out most days. It’s physical health and mental health, just folded into the day. When I was younger and as a dad I would be up at 5:00 running and later doing things with my son.  And now, its just part of the day. There’s always time if you want to make it. It’s important for your physical health and general well being.

Spencer:

Over your career, what would you say has been your greatest accomplishment?

Dr. Samet:

I’d probably point to two things.  I mean one is all of the people I’ve trained who I’ve seen go on to do incredible things. I think that’s something everybody who gets to the more senior end of their career will look back on and think about. Probably the other is seeing the impact of some of the things I’ve done that have actually made a difference, such as second-hand smoke and tobacco, actually leading policy change on air pollution, and seeing that work make a difference.  I think being around long enough to watch some of the things actually have impact and change things, has been gratifying, so those are the things that I would point to.

Spencer:

And just to close, I was wondering if you had a favorite quote?

Dr. Samet:

“The real purpose of the scientific method is to make sure nature hasn’t misled you into thinking you know something you don’t actually know.” –Robert M. Pirsig

“The times they are a changin”  -Bob Dylan