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EP46 Leadership and Impact in the Social and Behavioral Sciences with Dr. Ralph DiClemente
Alexandra Arriaga: Hello everyone and welcome back to I AM GPH. My name is Alexandra Arriaga, and today we're going to talk to Dr. Ralph DiClemente, who is the chair of the Department of Social and Behavioral Sciences at NYU. Dr. DiClemente was trained as a health psychologist at the University of California, San Francisco, where he received his PhD in 1984. After completing a Master of Science at the Harvard School of Public Health, he has focused on developing intervention packages to blend community and technology based approaches that are designed to optimize program effectiveness and enhance programmatic sustainability. Dr DiClemente is the author of 10 CDC defined evidence based interventions for adolescents and young African American women and men. He is the author of more than 550 peer reviewed publications, 150 book chapters in 21 books. He serves as a member of the Office of AIDS Research Advisory Council and today he will tell us more about what inspired him to pursue public health, his research, and his advice to MPH students. Please stay tuned. Today we're joined by Dr. Ralph DiClemente. He is the Chair of the Department of Social and Behavioral Sciences here at NYU. How are you doing today?
Ralph DiClemente: I'm doing well, Alex. Thanks for having me on.
Alexandra Arriaga: Of course. Our pleasure. So could you please tell us a little bit about your background and what brought you to NYU?
Ralph DiClemente: Well my background in terms of why public health?
Alexandra Arriaga: Sure.
Ralph DiClemente: Okay. Well initially I was a biology major, and I was thinking about medical school down the road and then it dawned on me that treating one person at a time was never going to fully affect change in the world. And so I started to think about an old parable I heard. The old parable goes something like this. There's a man walking along a river, and he sees bodies floating down the river, he runs in and he pulls him out, and another body comes down and he runs in, and he pulls him out and then another body comes down, and he runs in and pulls him out. So an observer, i.e me, go up to the man and I think, excuse me, what are you doing? He goes,"You see me busy here buddy, I'm pulling bodies out of the river." I said, "I know you’re pulling bodies out, why don't you go upstream and see who's throwing them in the river?" He goes, "I don't have time for that." And that was the whole parable of public health versus clinical medicine. Clinical medicine is dealing with those bodies coming down the river one at a time. Public health, we want to work upstream to prevent people getting ill so they're not those bodies floating down the river. And that whole focus on prevention is what attracted me to public health. Really, you've heard the expression an ounce of prevention is worth a pound of cure?
Alexandra Arriaga: Yes.
Ralph DiClemente: That's not true. The reality is an ounce of prevention is worth much more than a pound of cure because a number of diseases can't be cured once you've acquired them, HIV, diabetes, to name a few. So prevention is critical and much and so valuable that once you've acquired a condition you may not be able to cure it or effectively treat it.
Alexandra Arriaga: Yeah. And so what specifically brought you to NYU and what are your goals as a faculty member?
Ralph DiClemente: Well, NYU was easy. NYU is ahead of the curve in many respects. Many universities are older, and they're much more traditional. NYU has always been the university that's on the front edge at a curve leading innovation and the opportunity to come to the School of Public Health here and to build a world class Department of Social and Behavioral Sciences. Now the goals, I have three. One is innovation, and we want to create programs that are public health consequence. Our mission is not to study health, but our mission is to promote health. And so those are the type of programs we want to develop across the life's trajectory. The second mission is to make our department integrally community engaged. The community is part of the solution to our health problems, by not engaging them we miss a vital component of our health promotion strategy. And third, and perhaps the most important part, is we want to be student centric. Students are our primary mission and after all is said and done, we can do great programs, we can write lots of books and articles, but our number one legacy will be the caliber, and the character of the graduates who will leave from NYU. The work that they continue to do down the road many, many years after they leave here is our best legacy.
Alexandra Arriaga: I love that. So bringing it back, before you were a faculty member, when you were doing your postdoc at UCSF, you were working on cancer control, right?
Ralph DiClemente: That was a long time ago Alex, how'd you find that? You must have went the dusty archives to get that.
Alexandra Arriaga: Yes. But you simultaneously also started working on some pretty interesting projects dealing with HIV and adolescents. So how did that happen? How did that start?
Ralph DiClemente: Well, I'm glad you asked. It's a long time ago, so I'll prod my memory a bit. HIV came on the scene with three publications in the New England Journal of Medicine. They were published simultaneously in 1981. In 1979 I was a graduate student at the University of California in San Francisco, studying psychology, health psychology to be exact because I was interested in mind body influences on health. And of course HIV came on the scene, and it was quite a focus on this new and scary disease in all honesty. No one had identified the cause of the disease. So transmission route was unknown. Long term effects unknown, short term effects we knew. It was immune compromise and a host of opportunistic infections. And unfortunately the mortality rate at the time was very, very high. So while the focus was squarely on men who have sex with men and injection drug users, the cause of the disease was identified. It had many names, and it went through a number of iterations in names, but it settled on the HIV virus and this virus was sexually transmitted and also transmitted through sharing of injection drug needles. So a friend and I were sitting around one night after work, and we were thinking like if this virus can be spread sexually, what group gets a lot of sexually transmitted infections, and which group has the highest rates of unintended pregnancy? And we said adolescents, which is actually still true today.
Alexandra Arriaga: Yeah.
Ralph DiClemente: So we said, if adolescents acquire a lot of sexually transmitted diseases, and a lot of adolescent young women have unintended pregnancy due to sexual transmission obviously, and as viruses transmitted sexually, why aren't we focusing on these young people? So I have a good friend of mine and we sat together and after work during the day we would work together at night in my advisor's office. She gave us the key to her office at the university, and her photocopy key, which was great in those days. That was like having goals, and we would actually work in her office, sleep in her office. So we didn't have to go home because we'd have to be back early for our real job as postdoctoral fellow in cancer control and we developed a scale and measures, and we did the first study of adolescents and AIDS ever published in the world. It actually started the field of adolescence and AIDS.
Alexandra Arriaga: That's amazing.
Ralph DiClemente: Yeah, that was a... And subsequently, as you know now when we look back... and we don't have to look back very far, I was really fortunate to be on a White House task force on adolescents and AIDS. 25% of all new HIV infections are among young people, 18 and younger, one quarter. And 50% of all new HIV infections are among people, young people, 24 and younger. So here's a condition that's certainly severely impacting young people, but at the time no one was engaged in adolescence and AIDS.
Alexandra Arriaga: So you started that novel approach.
Ralph DiClemente: We did. We fought, in a sense had a little vision and recognizes a virus is sexually transmitted, who requires a lot of sexually transmitted infections? Young people.
Alexandra Arriaga: Make sense.
Ralph DiClemente: Exactly.
Alexandra Arriaga: Yeah.
Ralph DiClemente: But no one was focused on that at the time. They were focused on the other populations and appropriately so because they were actually be getting infected. But from my standpoint, our mission was prevention.
Alexandra Arriaga: Yeah.
Ralph DiClemente: How do we give young people the tools, and the education they need so they can avoid getting infected with HIV, because there was no cure.
Alexandra Arriaga: Working upstream.
Ralph DiClemente: Working upstream. Thank you, Alex. Thank you. Absolutely.
Alexandra Arriaga: And so even nowadays you're still working with many health promotion related projects. Correct?
Ralph DiClemente: We have a number of projects? Yes.
Alexandra Arriaga: So can you tell me more about those?
Ralph DiClemente: Well, I'll give you a few. We've actually migrated a bit and we should. The one thing about science, it continually evolves. Otherwise you're doing yesterday’s science to confront today's problems and that we don't want to do. In fact quite the opposite, our mission is to give young people both the knowledge base, the tool set and the experience to confront today's public health problems. But also to give them a lens, a framework, so that they could effectively confront tomorrow's emerging public health problems.
Alexandra Arriaga: Yeah.
Ralph DiClemente: So there's always this evolution as people mature, societies mature, new emerging infections. HIV didn't exist till before 1981 at least in people, Ebola, Zika, where were these infections 25 years ago, 20 years ago.
Alexandra Arriaga: Yeah.
Ralph DiClemente: And who knows what lurks around the corner next month, next year, two years from now. But we have to be ready for it, because we know there are a number of other health threats that are out there. We don't know what they are, but we know they're out there and so we confront those threats. We don't want to confront them and reinvent the wheel. We want to confront them through a lens of experience and the knowledge and the theory base.
Alexandra Arriaga: Yeah. Taking it back to evolution and public health. I know that a lot of your projects blend the community aspect with technology based interventions. Correct?
Ralph DiClemente: Exactly.
Alexandra Arriaga: And so could you tell us more about your perspective on the role of technology in public health and what are some benefits and maybe some challenges?
Ralph DiClemente: Technology is clearly a buzzword, but it's also emblematic of the evolving society. We recognize that technology is pervasive and is low tech and high tech. There's personalized tech and broad based media, but they're all technologies to some degree. Now we have an array of technology that goes from the cell phone, which is an incredibly powerful device that we've used the cell phone in terms of brief mobile phone-based counseling to prevent alcohol use and transmission of sexually transmitted diseases very effectively. By 10 minute phone calls from a health coach every other month, we reduced the incidence of chlamydia by 50% and the incidence of gonorrhea by 60% in young women. That's impressive from a 10 minute phone call.
Alexandra Arriaga: It is.
Ralph DiClemente: Right.
Alexandra Arriaga: Very impressive.
Ralph DiClemente: So that's one type of media. Another type of media is interactive media on a computer, which we're using now as well in our projects in Russia with young HIV, HCV infected women to reduce their alcohol use. Unfortunately, they don't have the type of drugs we currently have to treat HCV, it's very expensive treatment. And any alcohol use is not good if you had a HCV. So we've tried to reduce their alcohol use to zero if we can, but certainly to minimize it. And we're using interactive media, where they go onto a computer, the young women and the computer has a story, and they put in the names. They can fill in friends, they can put in family and they go back and forth with the computer program. That's another level. And then a third level is using biosensors. So now if we're doing and we do diabetes prevention or screening programs, you can actually monitor your diabetes by using a little chip on the back of your arm. You don't have to use injections to test your blood sugar anymore, and that's available actually in your local pharmacy. But we were doing these things years ago before they had officially come to market. We're also able to measure alcohol intake now from just a urine specimen, but in the old days, alcohol metabolizes very quickly. But now we can detect alcohol for up to 21 days after drinking. So that tells us how effective our programs are at reducing alcohol use. So, technology needs to be blended with our programs. But here's a word of caution and you mentioned caution. The caution is technology is not a panacea. Technology is a modality. You still need solid social and behavioral science theory. You still need good research designs and you need one other thing, to start at mix. You need some innovation.
Alexandra Arriaga: Innovation.
Ralph DiClemente: Innovation. And that is key. And here's where I will share another little parable. Thomas Edison was asked about genius, and he described genius in a certain way. I'm going to modify his quote. So innovation is 99% perspiration and 1% inspiration. And that's advice I would give to any aspiring student. Perseverance. Some people will not like your ideas, persevere. Sometimes you'll experience failure, embrace it. Sometimes you'll have little successes, celebrate them. Every day is an opportunity an opportunity to learn, an opportunity to create yourself, to create your profession, to hone your skills. And that doesn't mean every day is going to be a success. Every day we're going to take a risk and we want to take risks. If we don't take risks, we don't push the envelope. We want to be on the front edge of that curve. Creating innovation. And sometimes when you're on the front edge of a curve, your risk doesn't pan out. Right?
Alexandra Arriaga: Yeah.
Ralph DiClemente: But that's okay. We want to learn from that and brace that failure, learn from that failure, feed back into ourselves, recreate ourselves, and now we're primed for success, but we got to celebrate that success. We've learned more from our failures than we will ever learn from our successes.
Alexandra Arriaga: So our viewers may not know, but taking risks has actually worked out quite well for you. You have 550 peer reviewed publications in addition to 21 books and 150 book chapters.
Ralph DiClemente: You're making me blush.
Alexandra Arriaga: That's impressive.
Ralph DiClemente: If I turned red here, it's going to be very embarrassing.
Alexandra Arriaga: No, you're good. But that's very impressive. And as a student, I guess I'm just wondering, how do we get to that level? How do we become scholars and how do we succeed?
Ralph DiClemente: Okay, these are great questions. And you know, the route or the path to success is different for everyone. So my path is mine. Would I want someone to emulate what I do? I'm not sure that's going to be the best approach. And again, people need to find or better yet people need to create what works best for them. And not everyone has to aspire to numbers. I mean, to be honest, people are often successful, but they don't give themselves enough credit for being successful. It's because we've been grown up in a society where success is encouraged but taken for granted. While failure is certainly chastised and punished essentially.
Alexandra Arriaga: That's very true. Right?
Ralph DiClemente: Just think about it being in school, right? If you did well on tests, okay, you did well. If you did poorly, wow, you will left back a year and you had to take the class over again. Openly. They would say, Oh, who got the F who got a D? They would read the grades out in class. Public chastisement. That's not a good way to educate people. And it's not a good way to reward people. And reward is much more effective than punishment. And so we want to do that. So here's my advice to any early career investigator, perseverance. Read everything you can get your hands on because don't just read in your area of interest. You may pick up an idea from a cognitive area or, or a totally disparate field that could help inform you in your work.
Alexandra Arriaga: Yeah.
Ralph DiClemente: That's the key. Read everything and synthesize everything. Information is not just fragmentary pieces floating in the universe where you can pick up one and pick up another. The brain is a fabulous organ. Take those pieces of information that look like they're fragments, bring them together and synthesize them so now they create an entirely different element and keep doing that.
Alexandra Arriaga: Yeah.
Ralph DiClemente: So keep reading, keep looking, keep thinking and keep creating yourself every day. Get up and create yourself.
Alexandra Arriaga: And I like that you're emphasizing create rather than find, I think we were talking about earlier where create puts in control of what's happening.
Ralph DiClemente: Yes, indeed. Thanks Alex. That's very well taken. Creating puts you in control. You're the person making you. Finding is much like a scavenger hunt. I'm going to go out and find myself. Well, no, you're going to create yourself. That's going to be a much more active, proactive approach. And as you said, you're the one in control, not someone else.
Alexandra Arriaga: That's great advice. And switching gears a little bit, here at the College of Global Public Health, we say that we are reinventing the public health paradigm, and I was wondering what does that mean to you?
Ralph DiClemente: One of the reasons, again, I came to NYU was because of this phrase, reinventing the public health paragon, and it could mean a lot of things. One of the things it means, changing the way we perceive public health threats, changing the way we perceive public health. The first and foremost issue in public health is not disease prevention alone. You're not here just to prevent disease. Public health is here to promote health so that people can achieve the most in their life. Our mission is to improve quality of life and promote their health, not just prevent disease. We have a broader mission, much deeper, richer mission. Secondly, reinventing the public health paradigm means transdisciplinary science. It's not a single scientific lens. Today's problems are so complex and so interconnected that we need a team approach, a team science approach essentially. And that's what we do very well here. We're very collaborative. We partner, we create research teams that confront today's more complex, interrelated problems. Those are, I think, the two keys for me in this whole idea of paradigm.
Alexandra Arriaga: And so also, besides the whole part of perspiration and working for your goals, do you have any other advice for MPH students who want to produce impactful work?
Ralph DiClemente: Yes, and again, I will borrow from Thomas Edison and I'll borrow from two people actually, Thomas Edison will be one. He was asked later in his life how we have produced so many patents working in his workshop. He was asked, you must've spent many hours working in your laboratory to produce all these patents, to which Edison thought for a second- pregnant pause. And he said, "You know, I've spent a lot of hours in my laboratory, but I never worked a day in my life."
Alexandra Arriaga: When you love what you do, it's not really work.
Ralph DiClemente: And when you love what you do, it's not really work. I feel very fortunate to love what I do. Love what you do, be passionate about what you do. If you're not passionate about it, no matter what it is, whether you're an actor, a singer, a dancer, you work in a store, whatever you do, be passionate about it. If you're not, it may be time to consider a different field. Something that you are passionate about because that will bring out the best in you. When you sink in your passion into that mission. And our mission here is clearly students, mission is research, and the mission is promoting the health of our communities, the community locally, community in New York City, community globally.
Alexandra Arriaga: So we actually received a question from one of our viewers and Diana says, how do young professionals and early researchers break into the field if they're lacking those numbers behind them and on their CVs? And I feel like by numbers it means many publications and...
Ralph DiClemente: Well Diana, that's, A, an excellent question. I don't think you need those numbers to be honest. Everyone starts at the beginning. If you remember the movie The Wizard of Oz, when Dorothy was saying, well, how do I go? How do I get to the witch? How do I get to this wizard? And someone says, start at the beginning. And that's my advice to you. You don't need lots of numbers that's going to come down the road. And those numbers are really a byproduct of your research and your passion. If you love what you do, you're passionate about it, you'll be good at it. And if you're good at it, those byproducts, those numbers, grants, whatever, build naturally accrue to you. But start at the beginning. Learn, learn well, learn slowly. Perhaps the best advice I can give you: think about academic careers or academia as an Olympic event. If academia was an Olympic event, it would be a marathon, not a sprint. This is good. This is a lifelong endeavor. It's not, I'm going to spend a year, I'm going to spend two years, I'm going to spend three. This is a life long engagement, a lifelong issue of love. You love the work you do, you love the effects it has. And you love the fact that you can make some people's lives a little better.
Alexandra Arriaga: Great. And one final question for you. Where does your motivation come from? Your motivation to the research every day and work really long hours?
Ralph DiClemente: Well, much like Edison, I don't feel like I work every day. I feel like it's a gift. I get up. I do what I do because I love what I do. And then motivations spring from perhaps two sources, one extrinsic motivation. The fact that our programs are adopted/ and they benefit people so people live better lives. They live, lives with less morbidity, they live lives with a higher quality of life. I hear back from many of the people who've been in our program many years afterwards and they still stay in touch. And it's so great to hear from people that they're doing well, thanks to your program. I was able to, you know, not get pregnant in high school I avoided that. Now I'm in college and through college and I have a career and a family. That's wonderful. That's extrinsic motivation. There is intrinsic motivation for myself. When I was younger, I was ill. So for about a year I couldn't walk. And during that year I spent the whole year pretty much in front of the TV. Just watching TV because we had a lot of kids and a lot of relatives in our household, and there was no one who was going to be able to take care of me. We were taken care of my elderly grandparents, my uncle who was blind at the time. And so I was a young person and it was a little hard to share the attention.
Alexandra Arriaga: Yeah.
Ralph DiClemente: So I spent a lot of time alone in front of the TV looking at the world, but from that point, I learned how important it is to be healthy. Without your health, you have nothing else to build on. Some people would say, wow, would it be great if I was wealthy? No. If someone asked me, what's the one thing I could wish for and above all others, it would be good health. If you give me good health, I can work toward those other goals. I'll work toward the aspirational goals, career success, relationships, love, but give me that nice solid platform of being healthy.
Alexandra Arriaga: Yeah.
Ralph DiClemente: And so being unable to walk for a year really reinforced in me the importance of being healthy. And since that time I've worked very hard to stay healthy and to promote health. And one way of doing that is through my work.
Alexandra Arriaga: Yeah. Thank you so much for sharing. Thank you, Dr. DiClemente.
Ralph DiClemente: Thank you, Alex. Pleasure to be here.