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Nigel Paneth, M.D., '70: Snow job

than 20 years. It has revealed many risk factors for brain damage in preemies, including how the baby is delivered, and it has helped to identify the best predictors of long-term outcomes for such infants.

Many of Paneth's colleagues have expressed doubts about the wisdom of his devoting so much time to the National Children's Study, given its unusually long timeline. "I won't see a paper out of this for 10 years," he says. "If you're at my age, that's possibly beyond retirement." But, he continues, "how can you not be involved in something so ambitious and so potentially powerful? Even if you have some hesitations about the details, you have to go for it."

"We see opportunity where others do not," says Leviton of himself and his Michigan collaborator. For example, when Paneth arrived at Michigan State in 1989, he saw an opportunity to start a program in epidemiology from the ground up. In 1997, that program became a department. By 2005, Paneth had established the only NIH-funded training program in the country that's devoted exclusively to perinatal epidemiology. The program accepts one predoctoral and two postdoctoral fellows each year. Leviton, who serves on the advisory board for the program, recently asked one of the trainees if the fellows actually get time with Paneth, given his numerous commitments. "He's too busy for everybody else, but for us he's available," Leviton recalls the graduate student saying.

"There are so many arrogant people in our field," says Leviton. He clearly does not put Paneth in that category, adding, "Nigel's refreshing that way." Perhaps Paneth's humility and skepticism stem from his wide-ranging intellectual curiosity. For example, to better understand the historical roots of his field, Paneth has long studied the life of Dr. John Snow, a pioneer in epidemiology and

Grew up: England, Switzerland, Israel, New York City
Education: Columbia College '68 (A.B.), Dartmouth Medical School '70 (B.M.S.), Harvard Medical School '72 (M.D.), Columbia University School of Public Health '78 (M.P.H.)
Training: Pediatric intern and chief resident, Bronx Municipal Hospital Center; clinical fellow in pediatrics, Albert Einstein College of Medicine
Family heritage: His mother was British and his father was a Hungarian—a Jewish anti-Nazi journalist—who fled to England in 1939
Cherished possession: An 1855 book by German hygienist Max von Pettenkofer, with notes in the margin by London medical officer John Simon; both were dead wrong about how cholera was transmitted

Paneth has long studied the life of Dr. John Snow, a pioneer in epidemiology and anesthesiology. What he admires most about Snow is his originality.

anesthesiology. Snow is famous for having pinpointed the source of an 1854 cholera epidemic in London. When local authorities insisted that cholera was caused by "miasma," or disease-causing vapors, Snow figured out that the disease was actually being spread by contaminated water from a public pump. In 2003, Paneth and four otherMSU professors coauthored a biography of Snow titled Cholera, Chloroform, and the Science ofMedicine: A Life of John Snow; it was published by Oxford University Press.

"Snow didn't allow an education to get in the way of his genius," Paneth noted during an interview on National Public Radio shortly after the book came out. "He left school at 14. He was virtually

entirely self-taught." Some of Snow's ideas, particularly about cholera, were not accepted during his lifetime, even after they had been proven accurate.

Snow's original writings are "exquisitely rare," says Paneth, who collects old medical books. Paneth once purchased an uncatalogued box of 19th-century books about cholera froma dealer in Great Britain, hoping a volume by Snow might be among them. What he ended up with instead was "pretty much the entire repertoire of government reports on the [London] cholera epidemics in 1848 and 1854," says Paneth. "It was fascinating to contrast what John Snow was doing on his own, without any resources, and what the officials, who were paid [to investigate the epidemics], were finding."

What Paneth admires most about Snow is his originality. "What he understood that other people did not understand . . . [was that] of all the things you need to know about a disease, the single most important . . . is its mode of transmission." Remembering that principle helps Paneth keep an eye on the big picture in his own research. Lack of thyroid hormone may indeed be the agent, or direct cause, of some forms of brain damage in preemies. But, he admits, thyroxine deficiency may be just one piece of a larger problem he calls "placental withdrawal syndrome."

Although he would likely balk at such a comparison, Paneth seems to embody several of the characteristics he so admires in Snow: unconventional thinking, cross-disciplinary training, an ability to see the forest for the trees, and a preference for research that can be readily applied. "I'm not interested really in research that just finds out enjoyable things to learn," says Paneth.

Only in research that improves people's lives.

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Jennifer Durgin is Dartmouth Medicine magazine's senior writer.

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