Doctor whose work saved millions reflects on career

The publication of Alfred Sommer's new memoir, "10 Lessons in Public Health," comes precisely 30 years after the publication of the most important thing he's ever written: "Increased mortality in children with mild vitamin A deficiency," a report of a medical discovery that has saved an estimated 10 million children from blindness and death.

This is one of the classic stories from the realm of epidemiology, the stuff of medical detectives, and for it we slip back to the winter holidays of 1982 in Baltimore:

Sommer, an ophthalmologist and professor at the (pre-Bloomberg) Johns Hopkins School of Hygiene and Public Health, sits in his office overlooking Broadway. Calculator in hand, he pores over data from his studies of Indonesian children afflicted with night blindness caused by vitamin A deficiency. He's reviewed the data a couple of times already. This time, however, Sommer sees something new — the deficiency not only causes blindness in children; it causes many of them to die.

Several months later, in 1983, his findings are published in Lancet: "An average of 3,481 preschool-age rural Indonesian children were re-examined every 3 months for 18 months. The mortality rate among children with mild [night blindness] was on average 4 times the rate, and in some age groups 8 to 12 times the rate, among children without [night blindness]."

The study suggests vitamin A supplements "as much to reduce childhood mortality as to prevent blindness."

As excited as Sommer and colleagues are about his findings, the Lancet article receives virtually no reaction.

The Hopkins doctor then goes back into the field, conducting a trial in Sumatra involving 20,000 children. That's when Sommer shows that a few doses of vitamin A, costing just pennies each, could curb childhood mortality by 35 percent.

There were many nonbelievers, those who said it was too good to be true, or that Sommer's methodology was flawed. And there were people in the countries where Sommer did his groundbreaking work who believed he was poisoning children with doses of vitamin A; an insurgent in the Philippines said as much in a radio broadcast.

By now, of course, the rest is epidemiological history:

About 10 million children saved from blindness or death since the World Health Organization and UNICEF made the eradication of vitamin A deficiency a priority. And the work goes on; those organizations provide hundreds of millions of high-dose vitamin A supplements to children around the world each year.

So, important lessons from Sommer's new book: Use data to set policy; bury the nonbelievers in it. Good analysis of data means reanalysis.

And there are other take-aways from the vitamin A story: Have patience. If you think you're right, keep pushing. Develop a tough hide.

Sommer earned international acclaim for his life-saving research, and though he has had a rich career in other aspects of public health since then, he's still being honored for the work he did in the 1970s and 1980s.

In February, he was named a Dan David Laureate by Tel Aviv University. In June, he will share the $1 million prize with an economist recognized for her work on poverty and disease. Both recipients will donate 10 percent of the award to graduate students in their field.

Sommer's new memoir is also a gift to students — "Inspiration for Tomorrow's Leaders" is the subtitle — full of stories from a career spent in some of the poorest corners of the world, amid political upheaval and natural disasters.

Each chapter provides a lesson for the growing numbers of young adults studying at the Johns Hopkins Bloomberg School of Public Health — Sommer was its dean from 1990 until 2005 — and other institutions.

He notes long lines forming to get into his field, and even in this age of austerity, Sommer sees plenty of opportunities for public health professionals — even more so as populations grow and the Earth's climate changes.

"Somebody's got to be sure the water is clean," he says. "Somebody's got to make sure people are immunized if there's an influenza outbreak. Somebody's got to work on how to take this new virus that has appeared in southern China and create a new vaccine for it.

"Somebody's got to worry about the disadvantaged to make sure they get the health care they need. Somebody's got to figure out how we're going to pay for the health care we need. It's not health care people who do that. It's public health people using health economics and outcomes assessments. ... It's a huge world out there. You name it, it fits in public health."

I picked up one other lesson from Sommer's busy life and the vitamin A story, but it wasn't from his book. It was from his reply to my question about having played a role in saving 10 million lives. "All you can say," he said, "is this is really good. I feel good about this."

So, savor your accomplishment, enjoy the laurels from others, but keep moving forward. It's a huge world out there.

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