Brazil and my life in Health Technology Assessment

Abstract

My father wanted me to be a physician (as a farmers' son, he was too poor to go to medical school, but that was his ambition for me). In medical school in North Carolina, USA, I had no introduction to public health or evaluation of medical interventions. My favorite professor was a cardiologist, so I intended to become an academic cardiologist 1,2. He said the only thing I remember up until then on either public health or evaluation, concerning a clinical trial of anticoagulants to prevent coronary artery disease. As a medical intern and resident, I also learned little of either public health or evaluation. However, I do remember that we were encouraged to experiment on patients. I particularly remember trying out a popular technology, "gastric freezing in bleeding peptic ulcer", which I remembered with regret later, when trials came out showing that the practice was useless and harmful 3. A fellow trainee introduced me to the idea of disease prevention, which made great sense to me. The next year I went to the Centers for Disease Control and Prevention (CDC), in Atlanta, USA, for two years. In the second year, CDC was asked by the Peace Corps to organize a training program on schistosomiasis control for projects in Brazil. I visited Brazil for a month to understand the problem and possible solutions. In addition to Rio de Janeiro, I visited Salvador (Bahia State), Belo Horizonte (Minas Gerais State), and Petrópolis (Rio de Janeiro State). Then, I went to public health school at Harvard University for two years to study for a master's degree in public health, in the Department of Tropical Public Health. But my courses convinced me that public health administration was a better subject for me. In the second year at Harvard, working for another master's degree, I studied sociology and sociology research methods, as well as health service administration 4. At the end of that time, in 1969, I was invited to join the Mount Sinai Department of community medicine in New York (called social medicine or preventive medicine in some schools). My main colleague in that department was an Argentine physician, Dr. Sammy Bosch. Sammy had been a clinician, but had visited Kaiser health centers in California and Oregon and then developed a prepaid group practice in Buenos Aires. With President Nixon's health maintenance organization policy, we attempted to develop a new prepaid practice in New York (we weren't successful). We also taught subjects related to prepaid practice to medical students and others 5. Sammy Bosch was a Milbank Faculty Fellow. He nominated me an Associate Fellow. We developed a proposal that involved international visits and studies concerning health care organizations.

In Memoriam: H. David Banta

“…David received his Medical Doctor Degree from Duke University, and obtained Masters Degrees of Public Health and of Sociology from Harvard University in the US (3). He taught community medicine and public health at the Mount Sinai School of Medicine in New York, and became an associate fellow of the Milbank Faculty.…”