Alvan Feinstein

Alvan R. Feinstein (December 4, 1925 – October 25, 2001) was a clinician, a researcher and an epidemiologist who made significant impact on clinical investigation, especially on the field of clinical epidemiology that he helped define.^[1] He died at the age of 75 in Toronto on 25 October 2001 and is survived by his wife and two children.^[2]

Born in Philadelphia, Feinstein received his bachelor's degree (BSc 1947) and master's degree (MSc, 1948) at the University of Chicago. Feinstein received his medical degree (MD, 1952) at the University of Chicago School of Medicine. He completed his residency training in Internal Medicine at Rockefeller Institute. He was Board Certified in Internal Medicine in 1955 and became the medical director of Irvington House Institute (which later became part of New York University Langone Medical Center).^[3] While there, he studied patients with rheumatic fever and challenged the belief that proper treatment after an early diagnosis kept those patients from developing severe heart disease later in life. He demonstrated that the disease had different forms including one which causes joint pain and seldom progresses to heart disease. The other, which does result in heart disease, has no symptoms to evoke early detection. Thus, diagnosis of the disease at an early stage leads to a favorable outcome not because of early treatment but because those patients tend to have a less-virulent form.^[2]

In 1962, Feinstein joined the Yale University School of Medicine faculty and became the founding director of its Robert Wood Johnson Clinical Scholars Program in 1974. Under his direction, the program became recognized as one of the leading centers for training in clinical research methods.^[4]

He published his first paper as a medical student in 1951 and more than 400 throughout his career. He wrote six major textbooks, two of which, Clinical Judgment (1967) and Clinical Epidemiology (1985) are among the most widely referenced books in clinical epidemiology. He completed the last one, Principles of medical statistics (2002), just before his death. At the time of his death he was the Sterling Professor of Medicine and Epidemiology, the Yale School of Medicine's most prestigious academic position.^[5][6] His editorial work included that of the Journal of Chronic Diseases (1982–1988) and he founded and was editor of the Journal of Clinical Epidemiology (1988–2001).^[7]

Awards

During his career, Feinstein garnered numerous recognitions and awards; including the Francis Gilman Blake Award as outstanding teacher to Yale medical students (1969), Richard and Hinda Rosenthal Foundation Award from the American College of Physicians (1982), Robert J. Glaser Annual Award from the Society for General Internal Medicine (1987), J. Allyn Taylor International Prize in Medicine (1987), Gairdner Foundation (Canada) International Award (1993), and an honorary Doctor of Science degree from McGill University (1997). In 1991, Feinstein was named the Sterling Professor of Medicine and Epidemiology, Yale University's most prestigious academic honor.^[4]

Relationship with the tobacco industry

In his later years, controversy marred his career with claims that he may have helped the tobacco industry by publishing articles minimizing the deleterious effects of smoking.^[8]

A review of Feinstein's publications in 2002 concluded that "perhaps in hindsight Feinstein could be criticized for not having clearly indicated the sponsorship of the tobacco industry behind these publications, of which he was fully aware. However, this does not suffice to infer that he was the tobacco industry's man. Feinstein's attitude in matters of publication appears balanced".^[9] However, this review, an invited article written soon after Feinstein's death and published in the Journal of Clinical Epidemiology, may not be unbiased. For the fourteen years preceding his death, Feinstein was Editor in Chief of this journal, which was the publication outlet for numerous articles and opinion pieces by Feinstein and his colleagues that aimed to debunk the research on tobacco, for which role the journal was subsequently criticized.^[8]

References