Martha Hill is obsessed with the gap. Not the one between the generations (or even the clothing store) but between what works in biomedical studies and how those findings can be put into practice.
Speaking last weekend in Orlando, Fla., before the annual scientific meeting of the American Heart Association, Hill called for bridging the divide between good science and good health care.
"We know that behavioral and biologic interventions can reduce illness, disability and death from heart disease and stroke," said Hill, now in the midst of her one-year term as the American Heart Association's president. "However, there is a gap between the intervention efficacy in studies and intervention efficiency in practice, a gap between potential and reality, intention and action, between information and behavior."
Sitting now in her office in a tiny row house on Washington Street, where her day job is running the Center for Nursing Research in the School of Nursing, Hill says, "We know which drugs and treatment models work and have good risk/benefit ratios. Getting it into practice is the issue. What are we going to do to close this gap?"
Hill's answer reveals the new point of view she brings to the American Heart Association presidency. She is the first non-physician to head the organization, which supports the development of new knowledge to decrease disability and death due to cardiovascular disease and stroke. Her goal is to bring her background as a behavioral scientist and a nurse to focus on these medical issues.
"We need to integrate the social and biomedical sciences," she says. "Not enough time is spent in seeing how social and behavioral issues affect the findings in clinical trials and how those findings are brought to the people who need them."
Hill's own research in Baltimore raised her perceptions of the gap and at the same time prompted ways of bridging it. Working with Hopkins colleagues Lee Bone and David Levine at the interface of clinical care and community health, she studies and treats high blood pressure in African American men.
"They have higher hypertension but lower control rates, especially in young men," she says. "They also have disproportionate complications--renal failure, stroke and cardiac enlargement."
Despite warnings, the members of her team had little trouble recruiting and following her subjects. They began by hiring an outreach staff of African Americans, mostly from the East Baltimore community. And they learned the logistics of finding and following their patients using a team approach; the pairing of a nurse and a community health worker was more effective than the traditional one of doctor and patient.
"We worked hard to establish respect and trust," says Hill. "We did home visits to establish a relationship with the families as well as the patients. Young black men are often nomadic, so family support was important. Both families and patients felt honored by our effort."
This effort paid off when patients were asked to come into the hospital for blood and other biological tests. "Treating people with respect, like by not keeping them waiting, helped us reach a 91 percent follow-up rate," she says.
The team learned, too, how the social environment complicates delivery of the bright promises of the research lab. Alcohol and illicit drug use eroded the value of much of their work, and they spent as much time on preparing patients to hold jobs as on actual care.
The benefits of this approach haven't flowed only in the direction of the patients, either. "It's wonderful to see people learn," Hill says, recounting the enlightenment of a medical student on the team, who made his first home visits and learned to connect the worlds of the hospital and the street.
"I'm a boundary spanner, and I work on making boundaries really permeable," she says. "You can do all you want in the lab, but if you can't make it meaningful to help people's lives, you haven't succeeded."
Hill worries that awareness, treatment and control of high blood pressure are dropping, despite 30 years of knowledge that medication can lower blood pressure and dramatically reduce the likelihood for stroke, heart failure, kidney disease and probably coronary artery disease and heart attacks. This is frustrating, she says, because heart disease is still underdiagnosed and undertreated, especially in women.
To some extent, she says, the traditional organization of research by disease or organ system is out of date. Angiogenesis, genetics and molecular biology cross old conceptual boundaries and may lead to changes in funding patterns. Concerned about the current politicization of biomedical research funding, she is putting together a group within the American Heart Association, working with others to double overall funding from the National Institutes of Health. At the same time, she admits, current reality will push the AHA to monitor specific funding for heart disease and stroke.
"Some of this is regrettable, but these days the squeaky wheel gets the oil."
Hill is the fifth person from Johns Hopkins to serve as president of the association. Physicians E. Cowles Andrus, Helen Taussig, Richard Ross and Myron Weisfeldt have previously held the office.
"As I've traveled around the world, I'm impressed by the regard in which the American Heart Association is held. Doctors, nurses, the public all look to it as a source of valid information."
Now Martha Hill will set out to bring that information from its source to the people for whom it can do the most good.
"Nurses know the power of data," she says, unfazed by any gaps or boundaries in her path. "You need the data, and you need the passion to get things done."