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Mr. Public Health

TIMES STAFF WRITER

Don’t smoke, but do eat breakfast and get a good night’s sleep. Lay off the sauces, the booze, the in-between-meal Chee-tos and, for God’s sake, get off that couch!

These ABCs of healthy living are so ingrained in our minds--at least as ideals--it’s hard to believe they aren’t a given.

But not long ago, they were not so widely embraced. And if there is one man who has done more than anyone else to prove their worth, it’s Dr. Lester Breslow.

Colleagues at UCLA and across the country call the energetic 82-year-old “Mr. Public Health,” mostly because he helped set the course for modern thinking about health and fitness. Breslow was uncannily on target, not just about smoking, but about many of the more subtle influences on the quality, and quantity, of human life.

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And over his lifetime, he’s accumulated a devoted--and distinguished--following.

“What a role model,” said Dr. Philip Lee, former UC San Francisco chancellor and assistant secretary of health during the Johnson and Clinton administrations. “I’m 73, and I look at Les and think, ‘Boy, if I can do just half of what Les has done. . . .’ ”

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Back in the early 1960s, while at the state health department, Breslow launched what now are considered landmark studies in Alameda County showing that adopting just seven healthy habits could add years, as well as vitality, to the average life.

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Among the striking findings of the study of about 7,000 adults: A 45-year-old male who practiced six of the seven habits could expect to live 11 years longer than one who followed fewer than than four of them.

Breslow had faith in his hunches about health, which, for the most part, were rooted in scientific research (except the breakfast tip, which he admits was little more than an educated guess). But when the findings first came out, showing that even one or two habits made a measurable difference in a person’s general well-being, even the good doctor did a double take.

“I’d never seen such a systematic, positive, strong finding,” he said, smiling at the thought 30 years later in his UCLA office. “I thought it was some prank.”

Once his colleagues on the project convinced him that the results were no gag, he became more wedded than ever to the notion that health is more than just the absence of disease, and that medicine is more than the search for a diagnosis.

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"[I] think of health as the capacity for full living. Some people think of health as a state, they speak of health status . . . but I think of health as what underlies, what comes before health status, namely the competencies that people have . . . in a variety of physical, social and psychological rubrics.”

So medicine, he reasoned, should not confine itself to draining abscesses, prescribing potions and setting broken bones. Health practitioners ought to step in earlier, to help set the conditions for healthy living.

That, in essence, is what Lester Breslow’s career has been all about. Through his stint at the Minnesota health department, his tour of duty at the California health department (culminating in a three-year term as director), his years at the UCLA School of Public Health (including eight as dean), he has doggedly pursued this single ideal.

He is pursuing it still.

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At an age when most people have either died or long since retired, Breslow is jetting across the country to give expert testimony in states’ anti-tobacco lawsuits, fielding pointed queries from lawyers half his age.

He was lead author of a July report--known informally as “The Breslow Report"--that brazenly urged a revamping of the Los Angeles County health department from the top down.

In his spare time, he’s been collaborating on research exploring the relationship between medicine and public health. And, for posterity’s sake, he’s been squiring around a young medical resident from Canada to acquaint him with the ways of the public health world in this country.

“He’s in his early 80s, and he doesn’t show any signs of slowing down,” marveled Richard Brown, a UCLA colleague, who, like Breslow before him, has served as president of the American Public Health Assn.

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A strange state of affairs for a man who considers himself a lifelong devotee of moderation.

“Even then [in the 1960s], I had the notion, and I still do, that moderation and regularity of life is perhaps the most important influence on health,” he said.

In his case, friends and colleagues say, he would have to add a passion for his work, his family--including his second wife, his three sons by his first marriage and their families--and, of course, his beloved vegetable and fruit garden.

But he has not always been admired. In fact, he had some trouble talking the California health department into hiring him. After delivering half of a planned 15-minute speech to the department chief in 1946 about the increasing importance of chronic diseases such as cancer and heart disease, he was told, rather bluntly, to go back to Minnesota and try his ideas there. He was hired only after a friend got him an interview with someone else.

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By Breslow’s own reckoning, his early work was received with a shrug by some of his physician colleagues.

“I don’t think they were very interested. They were taught, and I was taught, that we approach things through what we call biomedical science. We receive your complaints--you have a pain or an ache here, and then I [give] an exam. I respond to your complaint, and then I arrive at a diagnosis--say, ‘You’ve got cancer of the right kidney,’ and I treat you for it, or, ‘You’ve got a mild upper-respiratory infection. Take two aspirin! . . .’

“We have what I call a complaint-response system of medicine [focusing] on the individual to the extent that they do not have a perspective on what has happened in the whole of a population.”

This is only beginning to change. One colleague remarked that for all the awards and acknowledgments that Breslow has received in the field of public health, many physicians still are not well versed in his work.

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“I’m still astounded by the extent to which he and his contribution is not known in the medical sector,” said Dr. Roz Lasker of the New York Academy of Medicine, a fellow researcher of Breslow’s. “In public health, everyone knows him--he’s one of the most eminent people . . . in the country. It would behoove the medical sector to become more aware [of him].”

To some clinicians, struggling to treat increasing numbers of sick patients efficiently, Breslow’s notions of healthy living may seem overly broad, even unrealistic. Violence, child abuse, teen pregnancy? How does Breslow’s approach address these social scourges?

Breslow does not back down: Social conditions, he says, help define a society’s health.

“How are we going to maintain people’s ability to perform, to do the ordinary things of life, and hopefully even to enjoy those things? . . . That is increasingly becoming what I see as the [emerging] health problem.”

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Breslow may wax diplomatic, but he calls it the way he sees it. And that, from time to time, has not pleased the powers-that-be. For example, he and two other smoking opponents earlier this year were ousted from a state tobacco oversight committee by then-Assembly Speaker Curt Pringle (R-Garden Grove), and replaced by more moderate types.

Breslow, especially, had gained a reputation for asking pointed questions of the state health department. Some, his critics evidently believed, were too pointed.

In spite of Breslow’s self-assessment as a man of moderation, his wife says that he has long been fired up about social causes.

“My husband was a radical when he was in college,” confides Devra Breslow, married to Breslow for 30 years. As far back as the 1930s, she said, he was leading an antiwar demonstration to “get the Marines out of Nicaragua.”

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For one so outspoken, Breslow had humble beginnings. In fact, as a youth growing up in Bismarck, N.D., the son of a pharmacist, he had trouble speaking at all. He had a severe stammer that all but condemned him to silence. His mother took care of that. She hooked him up with a nurse who put him on a strict program that involved reading aloud, writing, and relaxation exercises.

He’s too much of a scientific skeptic to credit the nurse, but, for whatever reason, he did stop stammering. And he did a lot of reading to boot. He dared to join a debating team and, before long, he was selected keynote speaker at his high school graduation.

After that, he turned toward medicine. His reading and his personal experience with a disability made him decide that he wanted to be a psychiatrist. But after braving the years of chemistry and anatomy--not his strong suits, he says--he couldn’t get beyond a summer stint at a state mental hospital. His job there was to stick gastric tubes down patients’ throats to bring them out of convulsive shock.

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“Well,” he recalls, “I came out of that summer feeling that, really, there wasn’t much that psychiatry had to offer.”

A friend suggested that with his interest in communities and politics, he would be better suited to the growing field of public health. Shortly after that, he enrolled in a public health program at the University of Minnesota.

He has no regrets--well, no major regrets. There was that time, in the 1940s, when, as California’s chronic disease chief, he crossed out a sentence in a school brochure stating that smoking was bad for the health.

“I didn’t think there was evidence for it,” he says ruefully. Only a few years later, one of the studies he commissioned suggested he was dead wrong.

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He quickly made amends. In 1964, three of the studies in which he was involved were cited in the famous U.S. surgeon general’s report linking smoking to lung cancer. And he has had a hand in tobacco policy, in one way or another, ever since.

With so many obligations--late nights in the office, early morning meetings, teaching, travel and lectures--one might expect him to cheat a bit on the seven healthy habits.

So does he?

“I say, ‘Moderation in all things,’ ” he replies with a laugh, “even moderation. . . . There’s nothing sacred about these things. You don’t have to run the marathon, but you do have to get off the couch.”

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Breslow even confesses to trying the big no-no: smoking. As a boy, he would sneak out to the edge of town, buy a corncob pipe, stuff it with corn silk and puff away for hours in the empty bleachers of the local ball park. “It doesn’t really smoke too well,” he said, “and there’s not much taste.”

He also tried Old Gold cigarettes, which went by the motto, “Not a cough in the carload.”

“It hurt my throat,” he said. “I was looking for a cigarette I could smoke and not hurt my throat, but I never found one.”

With some lapses here and there, he says--and his wife confirms this--he practices what he preaches about healthful living. Lest there be any doubt about his own vitality, he bounds up the steep stairs to his terraced garden, leaving a breathless visitor behind.

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Besides work, this is his greatest joy. He cleared the rocks from the Bel-Air hillside himself. He keeps count of each fruit and vegetable he harvests. He insists that visitors take home bags of lemons and figs.

Asked if it is this pruning and digging, after hours at the office, that has kept him going for so long, he feigns indignation.

“Not long enough!” he quips.

For Dr. Breslow, it is clear, there is still much more to do.

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(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

The 7 Healthy Habits:

1. Don’t Smoke.

2. Drink in moderation.

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3. Get seven to eight hours.

4. Exercise, at least moderately.

5. Eat regular meals.

6. Maintain a moderate weight for your height.

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7. Eat breakfast.


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