John Downey MD, MPH ’08

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(Originally published in Interdisciplinary MPH Program Alumni and Student News, Spring 2012)

John DowneyJohn Downey MD, MPH ’08, writes: “I fondly remember my year in the interdisciplinary MPH program at Cal—though the Spring of 2008 seems like a long time ago. The whirlwind of finishing my master’s thesis, graduation, and a quick return to clinical training unfortunately meant I’ve had little time for reflection on public health and how it would influence my career.

“Unlike most of my colleagues from medical school, I came to Cal after my first year of clinics. Having witnessed first-hand the successes and failures of our state’s and nation’s health network, the experience of full-time clinical medicine informed my study of public health. Needless to say, the MPH was transformative, and I wondered how I would fit back into the rigid framework of specialty residency training and, later, sub-specialization.

“I applied for residency in radiology, the specialty also known as diagnostic imaging or medical imaging. Truth be told, there is, unfortunately, little public health in radiology. When a patient has reached the point of needing a radiologic study, she is usually well beyond primary or even secondary prevention, perhaps with the exception of mammography, if early detection counts.. Nonetheless, I was drawn to radiology not because of its public health potential, but because I knew I would enjoy my training and practice.

“I completed my internship at Memorial Sloan-Kettering Cancer Center in New York City and returned to California to continue my residency in radiology at Stanford University Medical Center, where I am now finishing my second year. I have two more years of residency and this summer will be applying for an additional year of subspecialty fellowship training in breast imaging. Breast imaging involves screening and diagnostic mammography (X-rays), ultrasound, and magnetic resonance imaging (MRI).

“Within a medical specialty that has little to do with public health, breast imaging is one sub-specialty that focuses on secondary prevention. It does so by screening for breast cancer. By detecting cancers early before they have had a chance to spread, mammography has been shown to reduce mortality from breast cancer by 30%. As we all know, primary prevention —addressing and resolving causative factors prior to the development of disease—is a major goal in public health. For breast cancer, there are a number of immutable risk factors such as gender, family history, and genetics. But several risk factors are ripe for public health intervention—including radiation exposure, excess weight, and alcohol consumption.

“Despite all of the risk factors associated with developing breast cancer, 70% of women with breast cancer have no significant attributable risk factors. So we must rely on secondary prevention by early detection and intervention to reduce morbidity and mortality.

“Beyond risk factors for breast cancer, I’m interested in addressing the socioeconomic and racial disparities that manifest themselves in differential rates of mortality from breast cancer. For example, although more white women develop breast cancer, the cancer that affects black women tends to develop at a younger age and has a more aggressive biology. This means that new prevention and detection strategies will need to be established to address these racial disparities. I hope that in the next few years I can begin to integrate more public health principles into both my research and practice.

“Although not related to breast imaging, I’m happy to say my Interdisciplinary Program project paper, “Is Patient Safety Improving? National Trends in Patient Safety Indicators: 1998– 2007,” was published the February 2012 issue of the journal Health Services Research. The paper explores the rates of various preventable medical errors across the United States.

“Finally, on a personal note, my partner of three years, Brad, and I will be getting married in Hawai’i in 2013.”

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