How important is your small town doc?

Impact of small town physicians.

By JP Saleeby, MD

Don’t underestimate the value or impact of your local small town medical doctor. Medical Meccas such as Duke University, Emory or even Harvard are not the only venues of heady research and medical advancements. There is an old Arabic proverb my father often shared with me that goes: “There are those folks that can never seem to find a miracle at their local church.” Referring to those of a particular mindset who will often ignore local resources to seek out an answer some distance from home. Medicine lost a pioneer in epidemiological research when on January 6th, 2005 Dr. Curtis G. Hames, Sr. passed away in Savannah, GA. Dr. Hames, a 1944 graduate of the Medical College of Georgia, in Augusta, literally revolutionized the way the world viewed the rural primary care physician. By becoming a luminary in the field of epidemiology, he gave us great insight into medicine and took research out of the hands of ivory towered institutions and into the hands of community based physicians. No longer could university programs claim exclusive rights in expanding the frontiers of medical knowledge. This humble individual spent much of his life in the study of how his small town patients interacted with their environment.

Dr. Hames started out as a primary clinical practitioner in Claxton, Georgia. Claxton is a rural small town known for its poultry industry. Another noteworthy badge of honor the town has is that it is the fruitcake capital of the world. More fruitcake is produced in this town than anywhere else in America. One would not think of this place as hosting a physician researcher that would have made a global impact on medicine and health. By the mid-1950’s Dr. Hames began an epidemiological study of Evans County residents that attracted international attention. The National Institutes of Health (NIH) funded the Evans County Heart Study from 1958-95. This spotlighted Dr. Hames' research into examining patients within their environment, their local microcosm. He made some very noteworthy discoveries that doctors today utilize on a daily basis.

Over 560 scientific papers in major medical peer-reviewed journals worldwide are credited to Dr. Hames, on subjects including heart disease, genetics, cancer, hypertension, stroke, pesticide pollution, neuro-hormones, immunology, viral disease and the effects of social interaction on disease.

The value of High Density Lipoprotein (HDL) Cholesterol was elucidated in one of his first studies. Dr. Hames looked into the subject of cholesterol’s impact on cardiovascular health. It showed the protective value of HDL-Cholesterol. In another study he researched the possible impact of the absence of a certain trace mineral called selenium in the diet of these Georgia residents.

Dr. Hames’ study brought selenium much recognition. Selenium is necessary for the production of glutathione peroxidase an important antioxidant in liver detoxification. It has known protective effects against cancer as well as heart disease. The cardiac condition known as Keshan’s Disease is one that responds favorable to adequate levels of selenium. This mineral also works in conjunction with Vitamin E to enhance the antioxidant effects of this important fat-soluble vitamin. Levels found in nature depend on soil content, and apparently subjects in Dr. Hames studies that fell victim to heart disease were ingesting far less selenium (due to depletion in the soil) than what was necessary to be protective. Today’s top dietary supplements contain therapeutic doses of selenium thanks in part to Dr. Hames research. Because of the impact of his findings the Evans County Heart Study became the model for many other family practice community-based research projects.

To make these astonishing discoveries attention to detail prevailed in his data collection. In his introductory article in the Archives of Internal Medicine (1971) Dr. Hames wrote, "… from the clinical observations that coronary heart disease appeared to occur less frequently among blacks than whites, even though hypertension was obviously more common in blacks and they consumed higher animal fat diet." African-American men with high blood pressure and high fat diets were thought to be at much higher risk for heart disease, but his data showed otherwise and thus the hunt was on for that factor which yielded his counties difference. He would tirelessly note specifics on households, age, and marital status of subjects entered into the study as well as characterize the terrain composition, diet and industry in the area. He referred to this as "the total approach" to understanding the basis of disease and health. Where others failed it was his great patient rapport as a physician that was credited with an astonishing 92% success rate in studies designed to include every adult resident in the county. So not only was he a scientist, but he was also a humanitarian who genuinely cared about his patients.

It has been noted that Dr. Hames' basement yielded freezers that contained soil and water samples. There were environmental substances labeled by time and location as well as clinical specimens stuffed away in his home. Not even the locally harvested butter bean escaped his scrutinizing eye.

Dr. Hames held posts as a clinical professor at the Medical College of Georgia (MCG) and professor in the department of epidemiology at the University of North Carolina. He was also adjunct professor of Health Studies at Georgia Southern University and at Mercer Medical School. He was truly a dedicated epidemiologist in a rural setting and produced finding that affect medicine to this day. For this we can be thankful. Hopefully other young local physicians will follow and take up the torch in his footsteps. In 2007 the medical library at MCG dedicated a room in honor of Dr. Hames and to house his collection of manuscripts.

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JP Saleeby, MD is medical director of the Emergency Department at Marlboro Park Hospital, Bennettsville, SC. For more information please visit www.saleeby.net

© 2008