In 1973, Wennberg left the University of Vermont (UVM) and joined the faculty at Harvard. "UVM had not been terribly happy with what I was doing,"Wennberg confided recently. "There was not a confrontation, but you could say there was a general lack of appreciation." But Harvard never was home. Wennberg's family stayed on the farm in Vermont, while he commuted to Cambridge.
At about the same time, Strickler was setting the stage for eventually bringing Wennberg to Dartmouth. Then the dean of Dartmouth Medical School, Strickler hired Michael Zubkoff in 1975 to chair DMS's Department of Community and Family Medicine. "That was a very controversial appointment," Strickler recalls. Zubkoff wasn't an M.D.—he had a Ph.D. in economics from Columbia. Initially, Strickler had been opposed to the idea of naming someone not a physician to chair a clinical department. But when Strickler met Zubkoff, he was surprised: "I thought he made a lot of sense. I thought he had good ideas. I liked his values."
Once he landed the job, Zubkoff knew he wanted to bring Jack Wennberg to Dartmouth. "When I was offered the job, that was the first call I made," he recalls. "I had met [Wennberg] and I knew his work in Vermont and Maine. And I also knew that he had been run out of town in Vermont." Zubkoff believed that Wennberg embodied "the best example of someone who bridged clinical medicine, economics, and an understanding of markets."
Peeling back the onion
Even so, it took Zubkoff a couple of years to put all the pieces together to bring him to Dartmouth. Meanwhile, he says, Wennberg "did some more papers, and they were well-received. And he was just very persistent. He was able to stick with the theme: 'There are these variations in how we care for very similar patients. Why?' Wennberg peeled the onion back and kept going deeper and deeper.
Today, Wennberg's name is universally respected. "It's become impossible to argue with Jack on the evidence," says blogger Matthew Holt, "even though his findings are tilting at a $2-trillion industry with good reason to ignore them."
"Professionally, my claim to fame is that I recruited Jack. And I'm no slouch," Zubkoff adds, laughing. "I was elected to the Institute of Medicine. But just as I define myself personally as the father of my children, professionally I'm the guy who brought Jack Wennberg to Dartmouth."
Strickler, too, looks back on the appointment with pride: "It was the best thing I did as dean of the Medical School aside from balancing the budget." It wasn't easy to come up with the funding for a permanent appointment for Wennberg. And there was even some resistance to his work within Dartmouth. "There were some hard-core scientists—biochemists, physiologists—who were skeptical and viewed what Wennberg was doing as a soft science, fuzzy sociology," Strickler recalls.
"But within four or five years of his arrival, the people who were opposed to his appointment had turned around 180 degrees," Strickler continues. And "Jack managed to co-opt our clinical faculty by working with them collaboratively."Wennberg proved to be not only a supportive colleague but also a charismatic mentor. Soon he was no longer a lone voice. He began to build a research empire, and that spawned an educational institute.
Wennberg's career reached a turning point in 1984. That year, he published "Dealing With Medical Practice Variations: A Proposal for Action" in Health Affairs. The journal presented his work without apology. Indeed, the prologue to the piece underlined the importance of his till-then largely unappreciated labors: "Without much attention from the profession and virtually no public fanfare, John Wennberg has been tracking the phenomenon of variations in the use of medical care for more than a decade. Wennberg, who ranks among the leaders of the nation's tiny cadre of medical-care epidemiologists, has been driven by the notion that practice variations were important to identify and understand because they suggest a misuse of care. . . . During his research pursuits, Wennberg has uncovered systematic and persistent differences in the standardized rates of use for common surgical procedures and other medical services in the United States." From the very first sentence of that paper, Wennberg's voice is as clear and bold as it had been seven years earlier when he described tonsillectomy as a "large, uncontrolled surgical experiment."
"Most people view the medical care they receive as a necessity provided by doctors who adhere to scientific norms based on previously tested and proven treatments," Wennberg wrote. "When the contents of the medical care 'black box' are examined more closely, however, the type of medical service provided is often