Ten Lessons in Public Health: Inspiration for Tomorrow's Leaders

Epilogue

81 EPILOGUE Life is either a daring adventure, or nothing. helen keller Ispend a good deal of my time these days informally mentoring those who drop by my office for advice. They may be entering students or a young professor or even a chair or dean. Their main question is nearly always the same: “What should I do with my life?” My answer is always the same: “What would you like to do with your life?” After their first quizzical look, I respond with my four favorite aphorisms (a few of which you’ve already been exposed to in this treatise). The first and perhaps most important, is attributed to Yogi Berra: “If there’s a fork in the road, take it.” I have no idea what he meant by that, but I have given it my own interpretation . Life is filled with “forks in the road,” opportunities that call for a choice in direction. All too often, smart, goaloriented individuals find their ability to make these choices frozen by the number of their options and the importance they attribute to them. You can’t do randomized trials on forks in the road. You have to choose between them. My best 82 TEN LESSONS IN PUBLIC HEALTH advice is to choose the fork that excites you the most, the one that is most likely to keep you up at night thinking. That’s the path you will most likely find productive and fulfilling. And if that turns out not to be the case, don’t worry—life is filled with forks in the road, and another fork will soon come along. The second, and related, insight to live by was offered by Woody Allen: “Eighty percent of success is showing up.” If you don’t show up and aren’t engaged, you won’t encounter those forks in the road, nor will you be thinking deeply and innovatively (most often when sleeping or walking up a mountain path) in ways that lead to insights, insights that sometimes change you and change the world. Hence the third important aphorism: Louis Pasteur’s “Chance favors the prepared mind.” The most-cited example of this phenomenon, perhaps, is Fleming’s discovery of penicillin. Microbiologists (including Fleming, it must be mentioned) had been frustrated for years by the fact that bacteria would not grow on culture plates adjacent to fungal contaminants. They would hurl the plates away in frustration . Until the day that Fleming finally asked the (now obvious) question: Why don’t bacteria grow when adjacent to penicillium mold? Answer: Because the mold secreted a product that killed the bacteria—the first antibiotic was discovered . While I am not in Fleming’s league, my pursuing distant, ghostly forms to a cemetery at four in the morning, and recognizing my discovery’s practical implications, or my pondering why some Indonesian children were less likely than others to show up for their next examination, meant I was open to opportunities for discovery that unexpected events provided. If an experiment turns out exactly as expected , you haven’t truly learned anything. It’s the right angle , unexpected results that provide new insights and direc- EPILOGUE 83 tions, even if they put you at odds with established wisdom and those who hold to it. And that leads us to the last aphorism: “Persistence pays.” Had we not repeated, and helped others to repeat, our vitamin A supplementation trials, we’d never have established the basis for what is widely regarded today as a core child survival strategy. When younger colleagues grew angry at the negative responses to another one of our well-conducted trials, I would reassure them that we would one day prevail, by “burying the naysayers with data.” Get engaged, choose the most personally interesting of your options, think deeply and innovatively, and bury them with data. ...