INTERVIEW OF MICHEL A. IBRAHIM, MD DEAN SCHOOL OF PUBLIC HEALTH. ROBERT KORSTAD, PhD. Transcribed by. Jennie S. Maurer SPH

Transcription

1 INTERVIEW OF MICHEL A. IBRAHIM, MD DEAN SCHOOL OF PUBLIC HEALTH BY ROBERT KORSTAD, PhD Transcribed by Jennie S. Maurer SPH

2 L-T-3- Interview with Michel Ibrahim July 6, 1989 \j)#\z ON "Kft C <Uj"Ctf C by Robert Korstad Transcribed by Jennie Maurer The Southern Oral History Program University of North Carolina at Chapel Hill Original manuscript on deposit at The Southern Historical Collection Louis Round Wilson Library Copyright c 1992 The University of North Carolina

3 Page 2 Robert Korstad I guess if you could just tell me a little bit about your family and your background and growing up in Egypt and how you got interested in medicine. Michel A. Ibrahim It is interesting that you always go back and talk about family and origins and history and all that. My father was a principal of a high school, which was then the English Missionary School, so I have quite a bit of contacts with England in many ways, through that type of connection. And also I come from a Christian family. Way back, as far as I remember, so in essence, you see, the predominant culture in Egypt is the Moslem culture, which makes close to ninety percent of the population. We, as christians in Egypt have our culture and values more biblical and more, maybe western than Moslem, in a sense. An interesting statistics would be that when I went to medical school, although christians and Jews made less than ten percent of the population, they made over fifty percent of the students in the medical school. Which in essence, if you are a minority, religious minority, living in a culture which is different, one way to make it, is to get into the professions. Otherwise you just get no where. And at the time I was growing up, you know, Egypt was quite a bit British, the British were a colony like the United States was years ago. Actually, almost every country in the world, was a colony with a british at some point in time. When I was growing up, the country was much smaller than it is now, Cairo was less than three million people and a lot of cosmopolitan influence, British, French and that type of thing.

4 Page 3 But because the medical school was heavily british influence in its curriculum and education and professors and all that, so the relationship with England was very close in terms of education, politics, that type of thing, so that was kind of a lot of influence in my growing up with my religion in the country as well as my contact through my father. I was interesting in learning. After I got into medicine I really wanted to be an ear, nose and throat surgeon, and I tried that a little bit in Egypt and in England to specialize in ear, nose and throat surgery and then I somehow tried it for a year or so and decided I don't want to do that, and then I got interested in public health and prevention and I thought at the time, where would one go to study public health. England was closer and England had only one school of public health, and England was not necessarily known very much in public health, quite a bit of their public health community medicine education was in medical schools, big departments in medical schools. I wanted, really to get away from the medical model, I wanted to be more community type of thing, and the University of North Carolina had tremendous reputation in Egypt and many other countries, partly because there were many graduates of the School had been there. So did you know people in Egypt who had already to be North Carolina? Yeah, and they talked about where does one study - the University of North Carolina- and the Ministry of Health for example, had the University of North Carolina on their list as one of the good universities to do that. So initially, then and actually I

5 Page 4 came - left Egypt for good and came here in 1960, September 10th, 11th or 13th, 1960 and came to study biostatistics. And the first person I met, I spent one night at the Carolina Inn and -- actually I got up in the morning and asked the Clerk where is the University of North Carolina, I was use to living in big cities, and I thought he would tell me, you know, take a cab or take a bus, "where is the University of North Carolina?", he says, "across the street". And the first person I met was Ralph Patrick who was in Epidemiology met me at the Inn and he took me to meet my advisor in biostatistics. So I went to a wooden shack in front of Lenior Hall and went in and my advisor was Bernie Greenberg (laughter)-who was my predecessor-and he advised me on what courses would I take in biostatistics and that really was my introduction. Had you been to the United States before? No. So this was your first visit?...i had been outside Egypt, but not the US, this was the first trip to the US. So you came through New York? New York, directly to the Carolina Inn. (laughter) I guess you had been exposed to...

6 Page 5 Yeah, I was a cosmopolitan. Well of course I was impressed like everyone will tell you. They come from anywhere in the world, especially Western countries like France, England, Norway, Denmark, Switzerland, the first impression, how vast this country is. Now, you don't think about it, but it is a continent and people forget that. And I flew from New York to here and we would still look at the map, just a little tiny thing on the map. Was the south different? From the North? Well, I really didn't get to stay. I was surprised how things were maybe a bit slower than expected and maybe the accent because I was used to a lot of movies, to see movies and things, and several visitors from the US but none really from the south, it was kind of my first exposure to the South. I remember it was hot. also kind of unusual, although Egypt was hot but dry, it is a Mediterranean climate, here it was hot and humid. How did you find the classes and the students and the professors when you came? Well they were superb, my problem has been I came directly from medicine, from patient care, and I thought that public health really would be more -- have a lot more medicine in it, and that wasn't the case, because my first course was in statistics with Roy KeWer(sp) whom you may have interviewed? No, I haven't talked to him yet. He is an old-timer, terrific teacher, one of the best. As a matter of fact I sat and listened to him talking about statistical

7 Page 6 problems, about means and standard deviations and I said, what am I doing here, you know, I couldn't really do a Kai(sp) square test and a T test and I realized... I thought maybel'm misplaced, you know, I wanted medicine. So I went to Roy Kebter and said, Professor Kpbler am I in this class? He said,"what's your name?", he looked down, and'yeah, you are." So I tried to do a biostatistics program. I must say it wasn't really for me that much to specialize in biostatistics, becuse I really wanted to use my medical background, so Bernie and I-Bernie Greenbergtalked about what I really would be doing and he advised me in a way that really changed my career, he said after the first year in biostatistics, and I was going to get a Master which I did, a Master in Public Health in Biostatistics, he thought I really should do doctoral work in Epidemiology. Because that's really where I could use my medical background. He introduced me then to John Castle, the former Chairman of the Department of Epidemiology. He had been chairman for almost eighteen, nineteen years, and John Castle was sort of the second person who really formed my career and I got into epidemiology in 1961, Fall of 61', and I spent three years in that Department... I spent a year in the School of Medicine, with the Department of Community Medicine doing post-doctoral work, but altogether three years in Epidemiology and community medicine in the Medical School. And I found the epidemiology was what I really wanted, although I must tell you that every year that went by, I missed medicine so much I wanted to go back to patient care, so I would apply to various hospitals and I got responses from Duke University and responses from Wake Forest, Bowman Gray, to get a residency you know, and then go back into practice. I tried to do that. Duke was paying something like $25.00 per month plus room and board, which I needed money to live on. Wake Forest was much better. They wanted me to join them, initially

8 Page 7 work in the laboratory and then work myself up into a residency program, and I remember they were offering something like $ a month, which was a lot of money. And then I come back to Bemie Greenberg and John Castle and said, listen I have this offer from Wake Forest to go back and really I wanted to go back to clinical medicine tht's what I really love: they said, well wait, stay another year, you know, we will get you a fellowship, who knows. And I really did for the three years while I was learning epidemiology, I always took it from year to year, anticipating that I may actually quit and go back to medicine. What was John Castle like? Tremendous man. Very bright. He influenced the field of epidemiology from one angle that was in many ways unique. He did not invent it, but he really pushed it very hard, which deals with the social and psychological factors of the effect people's health. See, most of medicine was very much biologically oriented, you know, we think of germs and degenerative diseases and immunilogical problems, he came and, advanced, the theory of social factors. Psychological factors, and that was a major contribution on his part and he influenced me that way as well. He was a very good Chairman. I was a student then at the time. He also was my primary adviser on working on my dissertation and actually my dissertation was related to a method issue that deals with psychological factors and heart attacks. He had done some work on that, I think, too. Yes, cultural values, societal values and stress how they relate to illness.

9 Page 8 Did Ed McGavran teach at all at that point? Did you have any contact with him? He was dean then, and I saw him from a distance, I was a student. It is good that you mention that because I m going to tell you some encounters with McGavran when I came back from Buffalo. See I left in 64', I received my education I knew Bemie Greenberg very well, because he was my first advisor in biostatistics, I knew John Castle very well, I knew lots of the faculty in the School, but at the time as a student, you see, you really dont' know the dean very much. You will see the dean once in a while and he will welcome you, but I don't think he would really have known me that much at the time. I left then in 64* and I accepted a position on the faculty of the Medical School in Buffalo. I did that for about four years and another four years of., or three and a half actually with the...i was a health officer in the Erie County Health Department, and the Erie County Health Department was the turning point in my becoming interested in administration, leadership and politics. Economics of health care. So it really got me away from being am-" academician, interested in acquiring knowledge and I became interested in applying what I had learned and doing it within a political system, you cannot do it in vaccum, do it within a political system, it was fascinating to learn the Republican Party was the party in power and my appointment and my colleagues were political appointments, so it was fascinating to me how to blend my science background with the politics. Why did you take the job in the first place? I mean what lead you to go off in that direction as opposed to do something else when you finished your PhD here?

10 Page 9 When I finished my PhD, I wanted to -1 was on the faculty of the Medical School and I loved it, and really I was spending my life as an academician and a physician epidemologist, doing research at the Medical School, but in 67', as you may recall, was the heart of the Viet Nam War and I remember there was... I was at a party with the Health Commissioner of Erie County and I was telling him I'm really packing and leaving, I may not see you again for a while, I was being processed within weeks to go to Viet Nam. Is that right? I was within weeks. So you were a U S citizen? Oh, yes, I was a citizen for some time. And then he said, well you know, we have a vacancy, we need physicians in the Health Department, as a Health Officer, if you were to Join us, I don't know, but the draft boards are local, and the draft boards may value your services to your county compared to sending you to Viet Nam. So I thought about it, and I said, I really would love to serve my country and I wouldn't mind dying for it at all, except Viet Nam wasn't the place to die for this country. Even at the time, I thought such a waste, and I really wouldn't mind dying for the US but not in Viet Nam. That bothered me. It was kind of a moral dilemma for me, this country has been terrific to me and my wife from here and my kids, and I would like to serve, but is that the best way to serve? So... Well anyway, I said fine. Initially you could get deferred by the local draft board if you are essential to what you are doing, so the Dean of the Medical School went to the draft board and said, please don't him to Viet

11 Page 10 Nam, cause I need him, he is esential. And everybody laughed and said, what do you mean esential, so many of them in the medical school you need them. Anyway when I decided to join the Health Department - the health department is political you ^4iow, get into your politics, I went to my last, the last hearing with the draft board to see they hear me one last time whether they defer me or not, and at that time I wasn't having an appeal that I'm really essential to the medical school, which I didn't think they would buy anyway. I remember I went that night to the draft board and the Buffalo News had a front page article in the? section which said,"professor joins Health Department", and they talk about me, that I am joining the Health Department and I'm going to stamp out venereal disease and gonorrhea, and syphilis and tuberculosis and, of course, people sitting out, said, yeah, keep him here. That's how I got into the health department. And with in retrospect it was a wonderful three and a half years of my life, just absolutely spectacular. I loved every minute of it. It was a big change, though, from being an academician? Oh, yeah. But you learn very quickly. Very quickly. But you get to apply I guess a lot of the... particularly as an epidemologist. Yes, apply the science I knew about the population, the disease burden of populations and how one would devise programs to deal with these issues. Realizing that science is not sufficient. You also have to deal with other factors in terms of government interest and people interests and industry and media and all of these impact on what you are wanting to do.

12 Page 11 Just before I forget, when you said McGavran, because when I came back in 71', when I left Buffalo and the health department, I said I really want to go back to academies and be a professor, no administration, I don't want to administer anything. You see you laugh because you knew what I did there. Otherwise I really would have gone into administration from Health Department, I could go to bigger and better health department, but I really made a conscious decision, so I came back in 71', and in 71' Dean Mayes, was dean then if I'm not mistaken, cause McGavran finished and Mayes came on and I was a professor then in Epidemiology. The first thing I think about is I was a student of the department and then I was professor, although I had a seven, eight year absence anyway, people find it difficult to move from a student to a professor in the same place, if you do it overnight. I had a period of absence, but it was a joy to become a professor in the department where you were a student. Which is really doubly joy tht not only that I became chairman of that department and then Dean of the School, so it is kinda of... although you really think about it, I don't remember being a student here now that I'm dean, you just go through these phases and you just play the role at the time. I suppose to others it is fascinating, here is a student trim and (unintelligible) to me it is just, you do it, and it becomes gradual. But anyway what is fascinating, when I came back in 71 is that I got to know Ed McGavran very well as a colleague and that is another thing, he was a famous man who really founded this school and made it what it is, that he and I then would be colleagues and chat about all sorts of things, but I had close encounters with him in continuing education, he was the Director of continuing eduction for some time, or at least a very active participant. So I went along to teach epidemiology with him in the ourses he was giving and what was interesting also that he was my former dean so to

13 Page 12 speak, he would defer to me when we talk about Epidemiology because he assumed I knew more than he did, I probably did, but he still was a big figure. So that was nice. When I came back Mayes was in his last year and was still professor and then Dean Greenberg became dean in 72'. And then John Castle got ill, I was made acting Chairman and then Dean Greenberg appointed me as Chairman of the Department of Epidemiology in although I was acting for two or three years before that. So another interesting history here, is again, Bernie Greenberg who used to be my advisor as a student now he is my dean and I'm Chairman, a different type of relationship. What was the atmosphere like here in late fifties and early sixties when you were in school? It was very small, much smaller than it is now, of course, and you get to know most of the students, most of the faculty. Many of the students were older physicians in their fifties and some were even sixty. Coming back to learn -- to get their Masters degree. Many of them were MD's, coming back to get Masters Degree so they can become Health Directors or what have you. For local counties and things? Yes. There were a lot of those people. Actually I felt, I'm out of place, I was so young, but I wasn't, maybe twenty-six, twentyseven. And I felt, you know, all these old people in their forties, fifties and sixties. Which things change now quite a bit. The

14 Page 13 average age was much higher than it is now. Much older than it is now. Those people all have a lot of experience, I guess? They come with experience and a lot of them - medical experience - and they get... there were a few people who really came for intellectual stimulation, you know. I knew a couple of people who were retired or close to retiring, who came because they were intrigued with the concepts of populations and epidemiology and public health and they want to have just a didactic experience for a year or so. So that kind of people. So the classroom environment must have been pretty stimulating with that mix of people in there? The only thing about the town, interestingly was of course segregation days were then, it was fascinating. And John Castle who was my advisor, who was out picketing for desegregation and I got so mad because I wanted him to help me with my dissertation, I said, you can do that later, I wanted him to help me to get my dissertation down, (laughter) This school, I think, even in those days had... It was also quite international. There was a lot of students from foreign countries, western countries, developing countries. See a large percentage at the time in the late forties - I'm sorry, late fifties, early sixties, which in the seventies, when Bernie Greenberg was dean, diminished a great deal, and then it is up again. It just reflected the characteristic of the time.

15 Page 14 Right. Did foreign students have... how did they fit in? You were kinda part of them, but not part of them in having grown up in Egypt, but having been in the US for some time. Yeah, many many foreign students sort of stuck to themselves and speaking their own language and the old(sp) was left separate. I'm very easy, now I could have been anywhere. I was determined when I leave a country I'm going to live like the country I live in, it could be anywhere, it happened to be the US. I was very outgoing. I wasn't interested at all in meeting with people from foreign countries or eat that food, I was wanting to get an American experience. Right away. Like when I went to England, I want an English experience. But that's me, and I sort of don't maintain ties very much, I just live the way people live and I like that, I adjust very quickly and I enjoy that. How did.. I guess the other thing I was interested in, the influence that some... the School was starting to really grow at that point and it then had a very difficult time early in the midfifties. Yes. And the seventies when I came back that-the Dean was Dean Mayes, as you well know, it was growing very rapidly. There was lots of NIH grants, lots of research money and that is really the period of growth of the school. And expanded a number of faculty and number of students. This place was no longer sufficient, which ws opened in 1963, and there was a large number of faculty and students were spread out in the town. That's why we started asking for a building. Where did you have your classes when you were a student here?

16 Page 15 In many of these, Miller Hall, for example, was one; that's where the Epidemiology department was housed for a time, this wooden shacks so to speak were... Over here by the Medical School? Yeah, and trailers and some medical school. It was spread out all over? Yeah. And I remember when this was opened in 63' there was a student room actually on the second floor and had a desk that was a treat to have a desk. Every student have their own desk? Graduate students. Those that were working towards a doctoral degree. There was a student room for epidemiology and I had a desk and several of the others would have desks as well. It must have been a big change when this building was built? Oh, it was enormous, yes. To bring everybody together at least for one year or so. Yes, they did, and then they begin to out grow the place. So how did you feel about coming about here then as a Professor?

17 Page 16 It was in I felt very good. Initially there is that lingering doubt that applies to anyone when you go back, there are you know, people say you cannot go home again in a sense. When I decided to move, I made it known to my colleagues that I'm really ready to leave Buffalo, I loved Buffalo, I loved the work, but I was ready to make a change, I had been there about seven years and in order for me to grow I needed additional excitements. And also I wasn't sure if I wanted to spend the rest of my life in the health department, as much as I enjoyed it. So I got several offers, maybe a dozen offers throughout the country in epidemiology department, chairman of epidemiology department, professors, and here was one of many offers. And my wife being just a hundred miles away from here, wasn't eager initially to come back and I wasn't eager to come back in a place where I was a student. You know, how would I be treated and so on and so forth. But then we decided that it would be a good place to come back to. It is a good school, good town. Now we think it really was a very good decision. We loved it since we came. And our kids, you know, grow up in this... Actually, one was born here, my oldest, Danny, was born in Chapel Hill in 1963, and the other three were born in Buffalo. Tell me a little bit about the research that you did after you came back here. As you made this move back into academics as a professor and teacher? I tried to do health service research, rather than strictly epidemiologic causal type of research. I tried to do health service in terms of application. So we tried to do studies on nurse practitioner, you know nurse practitioner was a new thing happening, we tried to develop programs to evaluate this kind of program. Health care type of studies. Had a training program to

18 Page 17 \S / train epidemiologists in health service research. I had a project on a community-wide treatment and control of high blood pressure, we used Edgecomb County as one of our community laboratories. So this was the thrust of my work, is health service research and application, trying to use my background and policy and politics and health care economics that I learned from the department. And up to this day, really my interest is."how does one use science?" and in public health really the science in public health is epidemiology and biostatistics, the core of public health. How does one use the findings of these scientific programs in the formulation in terms of policy?- health policy. I wrote a book on this as you know, Epidemiology and Health Policy. So that has been my interest. It is interesting how by the time you became dean, you really had experience both as a medical doctor, as a practitioner in biostatistics and epidemiology and really in public administration. And the medical school, faculty in the medical school. Yeah, I feel fortunate that I have been exposed to a variety of public health practices and disciplines and experiences that I feel sort of.. you know I have a well rounded background in public health. What were some of the problems at the School when you came back or took over the department of epidemiology? There were a lot of concerns in the seventies about curriculum development, about where the Mill Bank report came out in the early midseventies, it was very critical of the schools of public health. There was a lot of tension, I think in the school here, between people who were interested in having this be a more research

19 Page 18 oriented institution, as opposed to other people who were interested in more of the service oriented institution. I would have to respond to this question, Bob, depending on what phase of my life are you talking about? We thought maybe as dean.. we will talk about that in another session, but when I was professor in Epidemiology, and Chairman of Epidemiology, I really didn't care that much about school problems. And that's what the chair's... not that I didn't care maybe is not a good word, I cared about the school problems, but that wasn't really my concern. I was interested in the Department of Epidemiology and because we are very much a department oriented type of school, I felt that my loyalty was for the department. So the challenges in epidemiology at the time... one challenge that was unique to this place and important historically... John Castle was a terrific guy. Enormously popular, enormously liked by the faculty, staff and students, extremely successful, well known, nationally and internationally, but he ran the department as a one-man show. So the Epidemiology Department in the School of Public Health was really John Castle and Associates. So one of my challenges is how to institutionalize the various programs and administration of the department and in essence get them through a transition phase to learn to be independent. And I felt this was one important task for me to do, which I think I did pretty well. You know, in terms of we need to have admission committees, not just... you met by, you know, I like this student and I admit him. Also the department got bigger so it needed a curriculum committee. It begin to have a better financial base for the department and make sense of the fiscal policy of the department, have a promotion committee within the department, so and so forth. So I had a phase of really - which

20 Page 19 was unique to that particular department's history-to institutionalize many of the functions and make it, in a sense, a department of epidemiology which made up of the faculty and the chair, rather than the chairman and the faculty. I think that was true for all departments who came after the founder of the department. Exactly, John Larsh was the same, Dan Okun and... I get that exactly Bob, you are right. You are probably the last... the Department of Epidemiology was probably the last department to have a full time chair so that he was here later. You are absolutely correct. It wasn't unique in epidemiology, but it was across the board. You had more administrative experience when you came to that than most people who made that transition. I had enough experience and sense to use my experiences in applying it to a very delicate situation. For example, I had the... Castle then, was not only the former chairman, but he was sick with cancer, he was a dying man. How would I then-1 was his student- sit up and preside over the faculty when he is sitting there as a member of the faculty and not only the reversal of roles, but the man is sick and dying. How do I handle that situation? It must have been hard.

21 Page 20 I brought everything I learned to bear on the situation, and it was okay. You had a fairly large faculty about the mid-seventies? Close to maybe sixteen, eighteen. Compared to the past. And then in terms of substantive issues, we began to think that we needed to expand into other areas. We have cancer epidemiology, we are doing a little bit of that, we tried to expand that, we tried to expand the environment and occupational epidemiology. We began to expand the health service epidemiology. In addition to cardiovascular disease which has been the hallmark of the department. My challenges were, number one, to get the department moved into an organizational entity that would be the democratized in a sense institutionalization of many of the functions within the department and programmatically move in a big way into areas of cancer, health service research, which was started, I did not invent them, but they were pretty small and I did put in a lot of effort into the cancer health service research and diversify the department efforts beside cardiovascular diseases and also begin to recruit students. One thing I did in epidemiology, at the time the affirmative action was coming into the university and said well you must have so many faculty and so on and so forth and so many students, and I realized then it is good to have black faculty in the school and the university, but I believe then as Chairman of the department, the best thing we could do for minorities is to begin with the students. So I really spent some time with the faculty to increase the number of minorities in the student body with the belief that if we have more of them and we

22 Page 21 graduate them, and they go out and saturate the pool, whether they work for us or somebody else, that really doesn't matter. I remember one year we admitted four black students out of sixteen or so, which was very good. Unfortunately, that has not been the custom that much. I mean every unit in the university is trying to admit black students but I feel that some of the efforts is spent on recruiting faculty maybe sort of running in the same place, you hire a black faculty member and somebody else hire him/or her because they pay more and what have you and then you end up losing that, I felt the best contribution we could make is to begin at the base. RK One thing I've noticed... right now I'm reading the Dean's Cabinet minutes from the 70's, it is interesting how the whole issue of smoking changes. I guess I just read a memo the other day in which it must have been Dean Greenberg finally said well we can't smoke in the Dean's cabinet meetings anymore even though they are two hour or an hour and a half long, so we will have a break. Smoking break. Yeah, smoking break so everybody can go out and smoke. And then about a year later in the minutes of it, it is referred to as a coffee break and not a smoking break. It is interesting how that changes. And for an epidemiologist I know that that was a... that smoking was a very important issue and also in a State like North Carolina, how did you deal with the issue, or how did it change? Well the issue is a fascinating one because of the reasons that you mentioned. It is a public health menace, we know that it is

23 Page 22 clear now... the data indicate that it is bad for you in terms of cancer, heart disease.emphyezima, on and on and on. And also you have the public health issue which is clear, it is detrimental to your health, and another equally important issue was the human right issue. My right and your right. I should be able to smoke if I want to. And you don't have to smoke if you don't want to. So that's an issue, but a third issue is how about if you infringe on my right, what happens if I don't like the smoke. And it is irritating my eyes. And then a fourth issue is, we are in North Carolina where tobacco is a big thing. I remember in 1976 or 7, I was invited by the Edgecomb County Goldleaf Festival to speak at their Festival on health and tobacco, and I said you must be kidding. Why are you calling me? I have nothing good to say about tobacco. I would be scared to come to Edgecomb County and talk about tobacco and health. They said, oh, no do come we want to hear you and so on and so forth and we are eager to hear from a health person. I remember at the time I hung up the phone and called Bernie Greenberg right away and said, listen they want me to do this and I knew that if I say tobacco is terrible I'm sure the headlines the next day would say. Chairman of Epidemiology in a State supported school hacks tobacco and if I say tobacco is good for you then, then my colleagues would never forgive me for what I said, I couldn't win. (laughter). So the way I dealt with this after I accepted the fact that I would do it and warned the dean then I would do this, so be prepared. As a matter of fact I sent him my speech to review, if he had any trouble with it. Because my wife is from North Carolina and the country there, I met with several of my friends on the farm and they say why are you troubled by tobacco and smoking and why do you think that public health people are not welcome, talking about tobacco smoke. They say

24 Page 23 well you (talking about public health people) single us out in smoking and health. That really gave me my punch line in a sense,... well let me not single out tobacco, so why don't I talk about health promotion, disease prevention, talk about nutrition, exercise, on and on and then talk about tobacco smoke as one of those. So that was a nice way not to attack it, but I'm a public health person, I talk about health promotion activities and smoking is one of them. That was helpful. And then the other thing, when I went I was terrified, I drove to Tarboro waiting to speak and that is one of the few times I was scared to go to a meeting, I didn't know how it would go. And then on the other side when I arrived, actually had dinner, I thought I was going to be the only speaker, I realized that the tobacco company, public relation man was the other speaker on the same platform. So I used him in essence as a barometer...when I say something and they get very mad, I say, maybe I went too far and I didn't want to offend the farmers END OF TAPE A - SIDE I TAPE A - SIDE II (continued) and he feels very good about what I said, and he begins to compliment me. I may have went to far on the the other side. So I tried to balance it, and I still have the Edgcomb County newspaper with my picture on one side, his picture on another and a fabulous report health and tobacco. It was a very educational piece. I did not attack the state, I did not attack the evidence, I tried to be... so that was really my first test about smoking and health. You know, of course, our policy here and how we wanted to make it a smoke free building, which was courage in a way, I didn't know what the implications of that might be, but luckily it worked out okay. But historically, it

25 Page 24 started by saying Bernie Greenberg tried not to smoke at the Dean's Cabinet was a big decision. It offended a lot of people, and they had created a break to take care of that, then we had rooms designated and that type of thing. We've come a long way. Well it is interesting. One thing I'm trying to do is to take little things like that and look at them over the period of fifty years, I mean you have somebody like Ed McGavran who is a chain smoker, and you know, going from that kind of point even Rosenau smoked a pipe all the time. And smoking, as you well know at that time was the thing to do. Right, nobody thought anything about it. Yeah, we all did it. And you know it is kind of something that was, pleasant to do, social, you now. You remember, you probably don't remember the days when people offered cigarettes at the table? Cigars, it was somethng like instead of offering coffee, they offered a cigarette, it is passe* now. This has been good, this has been very helpful. And... Well it is interesting. You are a very good historian, because you trigger a lot of these stories, there must be another dozen like these that are buried somewhere in one's memory that would only come out when you start scratching a bit. I think we will come back and talk again later in the summer, maybe July or August and give me a chance to really read through the materials so that I'm pretty up to date on what has

26 Page 25 gone on, so I can ask fairly informed questions. That will really form the last part of the book. I will be very happy to talk with you at that time, because it is fresh in my memory... END OF TAPE A - SIDE B