Critique 228: A Tribute to Elizabeth Barrett-Connor, MD (1935-2019)

It is with great sadness that we have learned of the death on 9 June 2019 of Elizabeth Barrett-Connor, a major contributor to the field of epidemiology for many decades and, especially, to a scientifically balanced and sound appraisal of the relation of alcohol consumption to health.  Elizabeth was a member of our International Scientific Forum on Alcohol Research until April 2019, when she retired from the Forum because of ill health.

With degrees from Mount Holyoke College in Massachusetts, Cornell University Medical College, and London School of Hygiene and Tropical Medicine, Elizabeth also had medical training at the University of Texas Southwestern Medical School and the University of Miami in Florida.  Joining the faculty at the University of California, San Diego, in 1970, she became a Distinguished Professor of Family Medicine and Public Health.

As described in the UCSD Faculty Profile from her university, “Dr. Barrett-Connor’s research concerned healthy aging with a focus on gender differences and women’s health.  Dr. Barrett-Connor was founder and director of the Rancho Bernardo Heart and Chronic Disease Study, begun in 1972, with continuous support (4 MERIT awards) from the NIH.  She served as a principal investigator of many multicenter clinical trials, including the Postmenopausal Estrogen/Progestin Interventions trial, the Heart and Estrogen-Progestin Replacement Study, the Raloxifene Use in the Heart study, and the Diabetes Prevention Program Observational Study.  She was Past President of the Epidemiology Section of the American Public Health Association (APHA), the Epidemiology Council of the American Heart Association (AHA), the Society for Epidemiologic Research (SER), and the American Epidemiological Society (AES).  She was a member of the Institute of Medicine (IOM), and a Master of the American College of Physicians (ACP).”

The author of more than 1,000 scientific publications (starting with articles on shigellosis and sickle cell anemia in the 1960s), during her career Dr. Barrett-Connor made important contributions to many fields, including epidemiology, gerontology, endocrinology, cardiology, gender effects, and lifestyle factors such as physical activity, diet, and alcohol consumption.  She was the key individual responsible for maintaining and extracting data from the very long-term follow up of participants in the Rancho Bernardo Study of Healthy Aging.  She was honored by the American Heart Association by the establishment of the annual Elizabeth Barrett-Connor Competition for young trainees in epidemiology.

Dr. Barrett-Connor was a highly respected mentor of young trainees and faculty.  It is noteworthy that she was an author on at least 22 scientific publications during 2018-2019 that included, just in 2019, titles such as “Hearing impairment and cognitive decline in older, community-dwelling adults,” “Effects of APOE on cognitive aging in community-dwelling older adults,”  “Genetic Ancestry Markers and Difference in A1c Between African American and White in the Diabetes Prevention Program,” “Cardiovascular Risk Factors Associated With Venous Thromboembolism,” and “Lifetime physical activity and late-life cognitive function: the Rancho Bernardo study.”

The obituary in the New York Times on 20 June 2019 by Karen Weintraub included a revealing anecdote about Elizabeth’s early days: “According to family lore, she was heading to the train station to take a nursing school entrance exam when she bumped into a friend.  ‘You’d make a terrible nurse,’ the friend was said to have told her.  ‘You can’t take orders from anybody.’   Acknowledging the truth of her friend’s comment, Dr. Barrett-Connor instead applied to medical school.”

Dr. Barrett-Connor was presented with a large number of awards.  For example, all in one year she received awards from The University of Western Australia, the Society for the Advancement of Women’s Health Research, the Society for Epidemiologic Research, the Cleveland Clinic Foundation Department of Cardiology, and Scripps Clinic and Research Foundation.

In 2018, Dr. Barrett-Connor was awarded the Fred Conrad Koch Lifetime Achievement Award by the Endocrine Society with the following comments: “Elizabeth Barrett-Connor, MD, has made paradigm-shifting contributions in endocrine physiology and the role of hormones in disease pathogenesis (focus on gender differences) in cardiovascular disease, diabetes, osteoporosis, and breast cancer.  It is hard to imagine the existence of any other individual whose work reflects such staggering impact.  The hallmarks of Dr. Barrett-Connor’s enduring success — a driving quest for the truth, rigorous scientific discipline, and a joyful passion — have infused every aspect of her career, whether as investigator, lecturer, teacher, or mentor.  She has helped make women more visible in the endocrinology field, not by example of her own shining star, but by her constant recognition of light coming from others.”

In a tribute to Dr. Barrett-Connor in Diabetes Care in April, 2019, former trainee and now Professor at the University of Cambridge in the UK, Kay-Tee Khaw noted: “When asked what her motto or philosophy of life was in an interview for her local newspaper, La Jolla Light, Elizabeth Barrett-Connor’s response was that she did not have any one particular philosophy so much as an attitude: ‘My defining principle is that I am a pathological optimist.’  Boundlessly curious, fearless, challenging, inspiring, and great fun to be with are some of the words her colleagues and mentees might use to describe her.”

In addition to her unbelievable contributions to the scientific literature and as a mentor to countless trainees and faculty, Elizabeth was a close friend to many of us in the Forum, who always enjoyed meeting with her at numerous conferences.  She especially appreciated the contributions of good food, wine, and vibrant conversation on such occasions.

Among the number of comments received from Forum members were the following: “Dr. Barrett-Connor enjoyed critical debate, not only of scientific topics but also of politics and cultural issues.  At a European conference, Elizabeth was one of the outstanding speakers with a talk on nutritional experiences in the US.  When a female colleague from Finland was so moved by a certain theme and started crying Elizabeth commented very politely ‘I don`t like weeping women.’  Elizabeth was a strong woman with a lot of empathy and a lot of humour.  She has truly been a wonderful and worldwide ambassador for public health and humanity.”

Stated another member: “Elizabeth argued against some of the best, was a clear, linear thinker, and never wavered in self-confidence.  She strongly believed in the scientific method, as stated by Popper: ‘The only reason to have a hypothesis is to try to disprove it.  If you couldn’t disprove it, you might be right—not guaranteed to be right, but you might be right.’  It teaches us about humility in science; something we need more of.”

We will sorely miss her