Doing Good Deeds Using Applied Epidemiologic Methods: Spotlight on Dr. Benedict I. Truman

by Michelle Haberstroh

“I aspired to a career as an international civil servant practicing global public health and preventive medicine as an employee of the World Health Organization (WHO).” 

This month, the Journal of Public Health Management and Practice spotlights editorial board member Dr. Benedict I. Truman. Dr. Truman is the Associate Director for Science (ADS) in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) at the Centers for Disease Control and Prevention (CDC). He directs the Office of the Associate Director for Science, oversees the assurance of science quality, integrity, and ethics in NCHHSTP; and he provides second level supervision of the Extramural Research Program Office in NCHHSTP that serves CDC’s three infectious disease centers. 

I had the opportunity to speak with Dr. Truman about his career path and his recent research published in the Journal of Public Health Management and Practice.

Michelle Haberstroh: In your most recent article published in JPHMP, “Celebrating 25 Years of Publishing Peer-Reviewed Articles on Infectious Diseases,” you suggest that building on past accomplishments must include addressing challenges to eliminate low-incidence infectious diseases, investigating and controlling outbreaks of new or reemergent infectious diseases, preventing infections among immunocompromised persons, reducing antimicrobial resistance, developing new and improved antimicrobials, improving diagnostic tests, and enhancing the protective effects of the human microbiome. Can you elaborate on a few of the points that you feel are most pressing?

Dr. Truman: Tuberculosis, a low incidence disease among US residents, can be eliminated, ie, the incidence of new TB disease can be reduced from 29 per million in 2017 to <1 case per million population in a future target year. After US TB elimination, most new cases are likely to be the result of reactivation of untreated latent TB infection (LTBI) acquired in high incidence countries by non-US–born persons who later immigrated to the United States, rather than the result of new infections acquired in the US. The speed of TB elimination in the United States can be accelerated substantially if we were able to (1) rapidly investigate and control the small outbreaks of TB that occur each year in the United States; (2) prevent new TB cases in immunocompromised persons with HIV infection; (3) reduce the transmission of Mycobacterium tuberculosis that is resistant to multiple first line drugs used to treat TB; (4) rapidly develop new and improved drugs to treat TB; (5) develop new tests to diagnose TB earlier after infection and to detect biological markers that indicate persons with LTBI who are no longer at risk for reactivation TB after completing LTBI treatment; and (6) increase the ability of harmless microbes that colonize the nose, mouth, and other anatomical places to prevent the bacilli from entering the body to cause TB infection.

“Choose courses and practical experiences that cover the full range of investigative methods.”

Michelle Haberstroh: Your background is in chemistry, medicine, and public health. Can you briefly walk us through your educational pathway and how it led to your current position? Did you see yourself working at the CDC throughout your studies, or did that become more apparent as new opportunities became available to you?

Dr. Truman: Each milestone in my education and training prepared me for increasing responsibility and opportunity at the next higher level of authority in public heath practice in a county, state, and national agency as follows: (1) BS 1975 (Chemistry) with honors – Phi Beta Kappa, Howard University; (2) MD 1979 with honors – Alpha Omega Alpha, Howard University College of Medicine; (3) internship in Internal Medicine 1979-1980, Howard University Hospital; (4) residency in Preventive Medicine & Public Health 1980-1983 (Chief Resident 1982-1983), Johns Hopkins Bloomberg School of Public Health; (5) MPH 1981 with honors – Delta Omega, Johns Hopkins Bloomberg School of Public Health; and (6) Epidemic Intelligence Service Officer 1983-1985, Centers for Disease Control and Prevention, US Public Health Service, Commissioned Corps – Field Epidemiologist assigned to the Monroe County Health Department, Rochester, NY. 

During my MPH and residency training at Johns Hopkins, I did not see myself working at the CDC throughout my career. Instead, influenced by the disciplines in which I concentrated my studies (International Health; Health Management & Policy), I aspired to a career as an international civil servant practicing global public health and preventive medicine as an employee of the World Health Organization (WHO). I changed my career aspiration after completing a 1-year residency practicum (1981-1982) and field assignment with the Pan American Health Organization (WHO Regional Public Health Agency for the Americas) in Washington, DC. PAHO sent me on a short-term consultancy (5 months) to the English-speaking Caribbean countries based in Barbados, where PAHO has its Sub-regional Headquarters for the Caribbean. My dissatisfaction with the itinerant lifestyle of an international civil servant caused me to reconsider that career choice. Job satisfaction, career growth, and excellent professional and personal relationships developed during my career enticed me to the CDC and have kept me there during 1983-1985 and 1989-2019.

Michelle Haberstroh: I am working on obtaining a graduate certification in epidemiology. What advice do you have for students interested in a career in epidemiology? 

Dr. Truman: The field of epidemiology is very broad in terms of populations of interest, health conditions of interest, and the range of investigative methods available. Thus, the student has much flexibility in choosing the kind of work that is satisfying, important, and well compensated. Choose courses and practical experiences that cover the full range of investigative methods, including (1) disease and risk factor surveillance; health condition surveys and vital events registration; health services and resource use assessment; (2) disease outbreak and environmental hazard investigation; (3) clinical and community intervention trials; (4) program evaluation and employee performance evaluation; and (5) research synthesis and professional practice guidelines development. With exemplary publications that illustrate a skillful command of the full range of “applied epidemiologic methods,” potential employers might welcome you to apply those skills in solving their priority problems in their populations of interest.

“I am most passionate about scientific work because it is the first step in rational decision making regarding the other activities…

The constant motivation has been the opportunity to do good deeds using ‘applied epidemiologic methods.'”

Michelle Haberstroh: You started working at the CDC as an Epidemic Intelligence Service (EIS) Officer and you are now the Associate Director for Science, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). How did you get involved with EIS, and what were some of your other career moves between EIS and your current position at the CDC?

Dr. Truman: In my final year of preventive medicine residency, three EIS alumni encouraged me to apply to the EIS program, as follows: another preventive medicine resident; the director of my residency program; and the dean of the school of public health.

Between EIS and my current job, I held the following positions: (1) Physician Epidemiologist II, Bureau of Communicable Diseases Control, New York State Department of Health (NYSDOH), Albany, NY [1985-1986]; (2) Physician Epidemiologist III – Director, HIV/AIDS Surveillance and Epidemiology Program, Division of Epidemiology, Center for Community Health, NYSDOH, Albany, NY [1986-1988]; (3) GM-14 Medical Officer – Assistant Director for Science, Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control & Prevention (CDC) [1989-1991]; (4) GM-14 Medical Officer – Chief, Chronic Disease Surveillance, Office of surveillance & Analysis, NCCDPHP, CDC [1991-1995]; (5) GP-15 Medical Officer – Senior Scientist, Prevention Effectiveness Activity, Office of the Director, Epidemiology Program Office, CDC [1995-2000]; (6) GP-15 Medical Officer – Associate Director for Science, Office of Minority Health & Health Disparities, Office of the Director, CDC [2000-2010]; (7) GP-15 Medical Officer – Associate Director for Science, Epidemiology and Analysis Program Office, Office of Surveillance, Epidemiology & Laboratory Services [2010-2011]; (8) GP-15 Medical Officer – Associate Director for Science, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC [2011-present].

Michelle Haberstroh: You have held numerous positions within the CDC, such as Associate Director for Science in CDC’s Office of Minority Health and Health Disparities and currently as Associate Director for Science of NCHHSTP. Your published research seems to mirror each new position you’ve taken. How does your role at the CDC affect the type of topics you write about?

Dr. Truman: My role at the CDC influenced my judgment of the importance of the topic and the salience of the study question and its answer in improving the priority health outcomes within the portfolio of my primary work unit. Thus during my tenure with the CDC’s Office of Minority Health and Health Disparities, I wrote about the population burden of health disparities and the effectiveness of interventions to reduce them.

Michelle Haberstroh: What aspects of your work are you most passionate about? Why? What motivated you to pursue a career in infectious disease?

Dr. Truman: Preventive Medicine and Public Health work involves (1) scientific work in search of universal truths that are useful in improving population health, (2) applying useful scientific findings in prevention programs that improve population health, (3) advocating for effective intervention policies and optimal allocation of resources to reduce health disparities that disproportionately affect socially disadvantaged populations, and (4) educating and mentoring the next generation preventive medicine and public health practitioners.

I am most passionate about scientific work because it is the first step in rational decision making regarding the other activities. 

At different points in my career, my primary focus has been infectious diseases, chronic (non-infectious diseases, adolescent and school health, minority health and health disparities, and research synthesis and practice guidelines development. The constant motivation has been the opportunity to do good deeds using “applied epidemiologic methods.”

Michelle Haberstroh: A new article has recently been published-ahead-of-print on JPHMP, “County-Level Socioeconomic Disparities in Use of Medical Services for Management of Infections by Medicare Beneficiaries With Diabetes—United States, 2012.” What was the aim of your study? Was there anything surprising about your findings?

Dr. Truman: The aim of the study was to assess (1) the extent of the burden of HIV/AIDS, viral hepatitis (A, B, or C); sexually transmitted infections with Chlamydia trachomatis (chlamydia), Treponema pallidum (syphilis), Neisseria gonorrhoeae (gonorrhea), human papillomavirus, and genital herpes; and tuberculosis; (2) the distribution of those infections by anatomic site; and (3) absolute and relative disparities in those infections by sex, race/ethnicity, education, employment and other county-level social determinants among Medicare beneficiaries. 

We expected the socioeconomic gradient with higher prevalence of infections in the most disadvantaged, compared with the least disadvantaged. But we were surprised that disadvantaged Medicare beneficiaries received high volume of services for these conditions contrary to our expectation of lower access to care for disadvantaged persons.

Michelle Haberstroh: Is there anything you’d like to add?

Dr. Truman: I sincerely appreciate the opportunity to reflect on and share the story of my career with readers of the profile with the hope that my experiences make the path forward clearer for students now making career choices.

Read more of Dr. Truman’s work in the Journal of Public Health Management and Practice*:

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Michelle Haberstroh is a graduate student at the University of Illinois Springfield, pursuing an MPH with a certification in Epidemiology, and an MA in Human Services with a concentration in Child and Family Services. 

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