It was November, 1991, when the first victim fell ill. A toddler named Anne had been brought to Children’s Hospital in Fall River, Massachusetts, with bloody diarrhea. Dehydration and listless behavior soon followed, and then kidney failure. Within days three more girls at the same hospital, all from the same small town, showed almost identical symptoms. Doctors diagnosed the patients with hemolytic uremic syndrome (HUS), an uncommon disease.
Alarmed at so many cases of a rare malady appearing at once, a pediatrician at the hospital called the state department of health. By this time, tests of the girls’ stool had revealed the culprit: a specific strain of E. coli bacteria.
The state department of health reached out to the Centers for Disease Control in Atlanta for help, hoping to track down the source of the outbreak before anyone died.
The case went to Dr. Richard Besser. Today Besser is CEO of the College Road East-based Robert Wood Johnson Foundation, a post he has held since last April. In 1991 he was working a desk job at the CDC. The case that he began that day launched him from an obscure bureaucratic post into the public spotlight and into a career as a public health official and media personality. His new job at RWJF is his first foray into the nonprofit sector and also a return to his hometown.
Besser, now 58, grew up in Princeton, the third generation in a medical family. His grandfather was a family physician and his grandmother a nurse. The couple had an office in the basement of their Philadelphia walkup, where their neighbors would come for visits. They also did housecalls together, grabbing the iconic black doctors’ bag at a moment’s notice. “It was this ‘physician as a healer’ model,” Besser says.
Besser’s father, Dr. William Besser, was an OB-GYN who worked at Princeton Hospital. “I’m constantly running into people in town who are saying, ‘yeah, your dad delivered me,’ which is really kind of cool,” he says. In the summers, the Bessers would take the whole family to a Navajo reservation, where William Besser would replace one of the doctors there so he could take a vacation. Richard Besser says these trips were formative experiences that gave him an ingrained idea that being a doctor meant being of service.
Richard had two brothers and a sister. Mitchell also went into medicine and also took the idea of service seriously. He is an OB-GYN who runs Mothers2Mothers, an agency devoted to stopping mother-to-child transmission of HIV. Andrew Besser was a lawyer until he retired to run substance abuse recovery programs and charities full time. The sister, Karen, died in 2004 after going into a coma after minor surgery.
Besser earned his bachelor’s degree at Williams College and his medical degree from the University of Pennsylvania. He completed a residency in pediatrics at Johns Hopkins.
The family background might help explain why, in his first job after his residency, Besser had signed up for a post where he would be on the road, working to solve various disease outbreaks. Besser had joined a group called the Epidemic Intelligence Service, but in his four months on the job there had been nothing to investigate. Instead he had been fielding routine phone calls and going “a little stir crazy,” he later said. The story was told in detail in the book “The Deadly Dinner Party & Other Medical Mysteries” by Jonathan Edlow.
When the call came from Boston, Besser was on a plane within a day. Together with Dr. Susan Lett, director of the state Department of Public Health, he began the investigation right away, talking to the families of the stricken children. The families were all blaming fish sticks for the outbreak.
Instead of accepting this conclusion, the doctors sought out more potential victims in the area and looked for a common denominator in the case. The families all shopped at the same grocery store, and the fish stick theory could not be dismissed out of hand. But tests on fish sticks leftover in the families’ freezers came up negative for the bacteria.
After cataloguing everything the patients had eaten and drunk, they also interviewed neighbors who did not get sick, looking for differences in the diets. This process ruled out ground beef and chicken, both of which had been tied to previous outbreaks.
The doctors entered lists of foods eaten into a computer program that looked for patterns. The software found an unusual suspect that the doctors had overlooked: apple cider. It turned out the sick patients were more likely to have drunk cider than their healthy neighbors.
Besser and Lett went to interview the families of the victims, some of whom were on dialysis by then. They all had bought cider at the Old Swanzey Orchard, a garden equipment supply place that would make a few batches of unfiltered, unpasteurized cider every fall using an old wooden press.
It seemed likely that this cider was the culprit, but this was surprising to the team because cider had generally been thought to be too acidic to harbor bacteria. However, Besser reviewed the medical literature and discovered a case in 1980 in Canada that traced an HUS outbreak to tainted apple juice.
Besser and his colleagues theorized that the bacteria came from cattle or deer in the orchard where the apples were grown. Because cider is generally made from apples that fall onto the ground, there was ample opportunity for the apples to become infected.
In the end the orchard stopped producing cider, and the outbreak was stopped after 23 known infections. All the patients recovered. The case prompted changes in the cider industry to improve safety. “It was an incredible experience to use science to find out the source of a problem,” he says.
The story of the outbreak and how it was stopped made the national news. Years later the ABC series Vital Signs did a special on the solving of the medical mystery, focusing on Besser’s investigation. Besser came away from the case with accolades, and moreover, met his wife, Jeanne, during the investigation. She is a food writer with seven cookbooks to her name. The couple now lives in Princeton, where Besser’s parents, both now retired, also reside.
Besser went on to hunt down more outbreaks, including cases of cholera that came from South America and diarrhea on a cruise ship. “It really showed me the power of science to answer questions of great importance, and of taking that information and changing policy so the likelihood of the event happening again is diminished,” he said.
Besser rose through the ranks at the CDC during his 13 years there, eventually serving as acting director in 2008 and 2009, a post he took up just as a swine flu pandemic was hitting the U.S. Besser took a hands-on approach to informing the public about the pandemic, giving press conferences every day. “We had a deliberate strategy of media outreach as a way of letting people know what we were doing and helping to understand what they could do to protect their health,” he says.
In this highly visible role, Besser strove to be a voice of reason. The Washington Post praised Besser’s “soothing bedside manner.” Staff writer David Montgomery wrote: “He is a scientist who has mastered the healer’s delicate art of simultaneously projecting deep concern and profound calm, telling national audiences to worry but not to worry.”
Besser’s ability to calmly reassure the public did not go unnoticed by media executives, and he was soon offered a job at ABC news as medical editor. In 2009 Besser was interviewed by Diane Sawyer and a few weeks later he was her co-worker.
As medical editor Besser offered a science-based perspective on health news.
“During an emergency people are looking for trusted sources of information,” Besser says. “During a crisis they may be frightened, and they want to know what’s being done to protect their health, and they want to know what they can do too. When I had the opportunity to go to ABC News, I thought that this could be a great chance to use communication to help people understand health better and make more informed decisions about their health.”
The media at large, however, do not always do a good job of calmly and clearly communicating health information during a crisis. Especially on cable TV news, sensationalist reporting can cross the line into fearmongering. “In television it’s minute-by-minute ratings, and there is a tendency to sensationalize,” he says. “What I tried to bring to my own work was a focus on evidence and a focus on fact.”
Besser’s skills at reporting potentially terrifying news were put to the test during the Ebola virus outbreak of 2014 through 2016. Besser traveled to West Africa to cover ground-zero of the deadly outbreak. “I tried to let people see where the crisis really was through my reporting from Liberia, and I tried to explain where the crisis wasn’t, which was right here in America,” he says. “It was challenging because I was seeing so many news sources hype up the fear.”
Finding reliable sources of news, especially on health topics, is more difficult for consumers now than ever before, with social media platforms helping spread fake stories about various health topics. For example, on January 25 one of top four most shared stories on the site was a fraudulent news article that claimed an unnamed “CDC doctor” warned that the flu vaccine itself was the cause of the deadly flu outbreak this winter.
“There are real issues in this country in terms of science literacy and in terms of health literacy,” Besser says.
However, he says, many journalists are doing a great job of science communication. Besser cited Kaiser Health News, Statnews, Politico, PBS, and public radio as being particularly good at health reporting.
But the audience for those platforms tends to be better educated than average, and Besser wants to get good health information out to the masses. As a health reporter he proved that social media could be used to distribute science-based information instead of just fake news: he held Q&A sessions on Twitter that reached millions of people.
“I saw it as a great way of providing factual information links to high-quality content so that people who had questions could get answers based on good information and make good decisions,” he says. He hopes to continue this kind of outreach in his new role as head of the Robert Wood Johnson Foundation.
“Physicians and scientists who ignore social media do so at their own peril,” he says. Often, he says, many health experts refuse to engage in social media because the platforms are rife with fraudulent articles and idiotic comments from users. However, Besser says, this is exactly why physicians need to start pushing back.
“Why don’t you add a voice of reason to what’s on there?” Besser says. “When you look at where younger generations are getting their information, it’s not from network TV, and it’s not from printed newspapers, they get it electronically — through social media streams,” he says.
In addition to outreach, the $11 billion Robert Wood Johnson Foundation takes direct action on many health projects, distributing around $500 million a year in grants. In recent years it has focused on fighting childhood obesity, and on a broad “culture of health” initiative to promote healthy lifestyles, workplaces, and communities.
Although Besser says he inherited many values from his parents and grandparents, he has a much different view of medicine than they did. He views health as more than medical problems, but something that involves patients’ entire lives and arenas that are not traditionally within the purview of doctors — a perspective he shares with RWJF.
“We want to make it easy for people to lead healthy lives,” he says. “Things like having safe, affordable housing, access to healthy food, and schools that provide good education, like I had growing up here in Princeton, are really the building blocks of health,” he says.
To Besser, health begins by ensuring people can live in conditions that allow health to be possible. “To so many people in society, those things are not part of everyday existence. What we focus on here is working to ensure that everyone in America has a fair and just opportunity for health. I think it’s a pretty radical vision for health, but if we don’t address those things, I think as a physician, I’m not really doing my job.”
Recent scientific studies show just how much economic circumstances matter to health. A 2016 study by RWJF showed that people born in Princeton can expect to live to 87 while Trenton residents only live to an average age of 73 — a full 14-year difference only 12 miles apart.
“That’s not right,” Besser says. “We need to work hard to understand why that’s the case and work to change that. Sometimes you can say, if people would just make healthier choices they would lead healthier lives. Yes, choice has something to do with it, but it’s increasingly clear that the choices you make depend on the choices you have.”
For the past seven years, Besser worked in a New York community clinic, where most of the children were in foster care. Besser says these kids started life off with a big disadvantage. They often were exposed to violence, hunger, or extreme poverty at a young age, all of which affect development and the prospects for lifelong health and well-being.
He says scientists are currently working to understand how best to tackle these problems. “I’m optimistic that by taking this kind of vision and this kind of approach, we are going to see incredible improvements of people’s lives,” he says.
Besser hopes that the RWJF can make a difference with its own resources, especially in New Jersey, where the foundation has a special focus. But the scope of some of the problems that RWJF is trying to tackle can only be addressed by government policy.
Take school lunches, for example. Through its research RWFJ determined that more nutritious school lunches, with less junk food, would improve the health of children. “We could go school by school and convince them to serve healthier food,” he says. “Or we could work to encourage change in the federal program that supplies lunch to every school in America.” RWJF chose the latter, to great effect.
The foundation must take the seemingly contradictory approach of trying to influence policy while staying out of legislative battles. RWJF did not get involved in the Republican effort to repeal Obamacare. But it did launch an advertising campaign to encourage people to enroll in Affordable Care Act plans.
“Clearly we are not in favor of anything that would reduce the number of people that have health insurance,” Besser says. “When you think about some of the health problems facing this country, like the opioid crisis, and how complicated the problem is, it’s baffling to think that there would be changes that would reduce the number of people that have access to treatment,” he says.
In addition to undertaking this broader mission, Besser plans to continue his family tradition of direct service to the underprivileged. He plans to begin working at a free clinic in Trenton once his licensing paperwork is processed.
Besser says he is happy to be lead these projects while living in the town where he grew up.
“One of the things that makes this job so special is that I’m returning to my hometown,” he says. “I had a wonderful childhood here in Princeton. I went through the public schools. It’s been 40 years since I left, and now I’m moving back.”
The Robert Wood Johnson Foundation, College Road East, Box 2316, Princeton 08543. 609-452-8701. Richard Besser, president and CEO. www.rwjf.org.