Preventive Medicine

Preventive Medicine is the medical specialty devoted to population health and the prevention of disease. As such, the training of Preventive Medicine physicians not only includes clinical training in the treatment and prevention of traditional domestic communicable diseases, as well as tropical and travel medicine—but also academic training in such areas as biostatistics, epidemiology, and health policy analysis. After completing internship, as part of my residency, I learned these skills by earning a masters degree in public health (MPH) at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland. The next year, while still in training, I put this education to good use by developing a program to reduce redundant immunizations of Army recruits. At the time, in a somewhat misguided attempt at efficiency, the Army had been giving every recruit heading off to war the same four or five vaccines, regardless of whether they had previously received these. The program I proposed, which would implement a system for testing the blood of new recruits for immunity so as to permit customizing the vaccines they received, was clearly the right thing to do medically—but I knew if it slowed down the processing of new recruits, the Army would never permit it. Thanks to my training, I was able to demonstrate that the program could work within the tight schedules of the recruit centers. Additionally, it would save money, as the costs of expensive vaccines were used to fund the much less expensive blood testing and the staff needed to organize the effort. Within a few months of presenting my proposal to senior Preventive Medicine physicians, the Army Surgeon General gave formal approval to implement the program, and I received a letter of commendation from my commanding General.

At Johns Hopkins where I trained in public health [1], the Bloomberg School’s motto had been “Protecting Health, Saving Lives, Millions at a Time.” It pleased me to know that within a few short years, as the number of Army recruits increased by tens of thousands year over year, my program would protect the health and improve the lives—at least in some small way—of at least one million new soldiers [2]. Impressed early in my career by the power to make a difference within the seemingly impenetrable Army medical bureaucracy, I looked forward to my first assignment at the Army Medical Surveillance Activity (AMSA), in Washington, DC, where I hoped to continue to make a difference working in military public health.

It was there at AMSA, in the months before my deployment, that I supervised a team of civilian analysts who poured over military health data, conducting analyses, identifying patterns of disease, and informing recommendations to military leaders on how to better protect the health of the force [3]. The Army Medical Department’s motto was, “To Conserve Fighting Strength.” We considered it a critical component of living up to this motto to provide our leaders information on what diseases the fighting strength was being affected by, and how these could be better prevented.

Throughout the history of the US Army, the primary threats to the health of fighting forces had been from infectious diseases and injuries [4], and the work of AMSA had been primarily in these areas. The majority of my work consisted of overseeing injury reports, and conducting analyses on acute respiratory disease and infectious diseases such as malaria, influenza, HIV, hepatitis [5], and sexually transmitted infections [6].

As with my earlier work on vaccine policy, prevention strategies in these areas almost immediately improved the health of the force, and ensured that even more healthy soldiers were available for the war effort. This work was almost perfectly aligned with the goals of military leadership, so our efforts were strongly supported and well funded. With the benefit of supplemental wartime funding, AMSA soon moved into new office space just outside the Washington, DC beltway, to merge formally with an organization known as the Global Emerging Infections Surveillance and Response System (GEIS) to become the Armed Forces Health Surveillance Center, with a focus particularly on infectious diseases [7].

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