Reflections on a Lifetime of Disease Prevention

John Farquhar, MD

The year 1927 was certainly noteworthy! In that year, nine decades ago, Werner Heisenberg described his uncertainty principle. Philo Farnsworth transmitted the first image from a television camera tube. Charles Lindbergh made the first solo non-stop trans-Atlantic flight. The success of The Jazz Singer marked the end of the silent film era. António Egas Moniz developed cerebral angiography.

It was also the year that a pioneer in preventive medicine, John W. “Jack” Farquhar, MD, was born. Among myriad accomplishments, Farquhar (with Nathan Maccoby) co-founded the Stanford Heart Disease Prevention Program to activate communities to change their lifestyle, preventing disease and improving health. As the scope of the organization widened to include multiple aspects of disease prevention and health promotion, its name changed to the Stanford Center for Research in Disease Prevention and later to the Stanford Prevention Research Center (SPRC). 

At 90, Farquhar, the C.F. Rehnborg Professor in Disease Prevention, emeritus, and professor of medicine and health research and policy, emeritus, attributes his longevity in part to practicing what he’s been preaching—paying attention to lifestyles that are relevant to successful aging. In a recent interview, he discussed how the SPRC got started, some of its seminal achievements, and where he’d like to see the SPRC in the future.

What brought you to Stanford originally?

Well, let’s see… I was at the Rockefeller Institute (now Rockefeller University) with Hal Holman, who was invited to Stanford to become its youngest ever chair of the Department of Medicine. At the time, there was a desire to bring what they hoped was a youthful figure into a rather elderly faculty, and he was part of that revolution. In 1962 he asked me to come here with several other eager young faculty who were research oriented rather than clinically oriented.

What led you to start the SPRC?

As an intern I had a patient in his 40s who died, and I had to comfort his widow. That led me to think of the potential for prevention because we were in the middle of an epidemic of post–World War II expansion of smoking, and of poor diet, and the beginning of a decrease in physical activity due to automation. After World War II we were the richest nation in the world, and the returning veterans were all feeling this post-war irrational exuberance. But smoking rates went up, and there was a return to an expansion of dietary intake of saturated fat from meat and dairy products with a disregard for some of the foundations of atherosclerosis.

There was a combination of increased smoking rates and cholesterol levels from diet along with decreased physical activity. We entered into an epidemic of preventable coronary disease, and I was a pioneer in that from my exposure to it during my residency training. It led me to write the book The American Way of Life Need Not Be Hazardous to Your Health.

It was a new way of thinking, but it was gaining momentum internationally. Within the United States, our colleagues at the University of Minnesota in particular were similarly inclined. We formed policy groups and became a pressure group to influence the National Institutes of Health to pay attention to the prevention side of cardiovascular disease.

There was a lot of attention on techniques like heart transplants, but I was convinced that saving people one by one was not the most effective way to address the problem. I realized the need to make permanent lifestyle changes to prevent cardiovascular disease by reaching people in the community where it was needed the most. That led me, with Henry Breitrose and Nathan Maccoby in the Stanford Department of Communication, to create a multimedia campaign to motivate and educate communities to undertake major lifestyle changes. That was really the beginning of the “total community” approach.

Can you name some achievements that came out of the SPRC?

The advent of the total community approach to prevention was really our invention. It was the idea that you could mobilize a community through a campaign using newspapers, radio, television, and medical authorities to provide information and training that people needed in order to change their lifestyle toward a healthier one that would prevent cardiovascular disease.

The advent of the total COMMUNITY approach to prevention was really our invention.

Peter Wood, Bill Haskell, and I were involved in showing that exercise increased the HDL fraction of blood lipoproteins. That particular discovery then was taken up throughout the world, and hundreds of papers came out about the role of HDL as the protective fraction and LDL as the harmful fraction of blood lipids. 

Another area of achievement was some of the methods for smoking cessation. The use of nicotine replacement was a new thing, and we were one of the first groups working on that. Later, a few of our people, including Tom Robinson, who happens to be a pediatrician, developed the methods for educating high school students on risk factors associated with smoking, poor diet, and lack of exercise. That was quite an important chapter, which I would call adolescent or youth education.

We took up the battle over obesity, too. The theme that runs through all this is prevention of disease through lifestyle issues. The whole lifestyle category would include smoking, exercise, and diet. And you could toss in stress management.

Today’s SPRC includes the WELL for Life initiative that is aimed at changing the global well-being landscape. There’s also a new master’s degree program in community health and prevention research.

Where would you like to see the center in the future?

I’d like the center to continue to grow in importance to the department and the university as a source of knowledge for methods to promote healthy living. And to have the School of Medicine and the university play an important part in the restoration of what should have been present 30 or 40 years ago—attention to the prevention side of the equation. In the last five years there has been increased attention to prevention within the medical school and the university.

I hope that the center remains important in developing methods of influencing policy and/or of educating society and people in positions of authority. I’d like to see a change in our training system so that people with higher degrees are cognizant of the principles of ecology, economics, and political science such that they can be participants in health policy change.

I want education to remain accepted as part of the equation to have optimal public health. Who you are educating and how they will influence public policy is all part of the dream to produce people who are smart, knowledgeable, and trained to tackle these problems.