Larry Meskin

Overview of the Man

Talk about your lucky breaks! In the early summer of 1970, I stumbled into the biggest, greatest, luckiest professional-career break of my life….despite being clueless as to the importance of what had just occurred. When I arrived at the University of Minnesota to pursue my MPH degree, the secretary handed me an envelope from a Dr. Meskin, which contained a note informing me that he was my mentor for the MPH program and apologizing for being away in England as I started my program. Oh yes, and the envelope also contained three articles that he had found in line with my public health interests that he wanted me to read prior to his return so we could discuss them. And thus my studies began…as they had for others before me, and would for many more in the years to come.

Larry Meskin presented as a mostly conventional man ‘on the surface’ when it came to dress and behavior, and hence clearly would be perceived by people meeting him—and even by acquaintances—as a ‘man of his time’ and fully in keeping with his time. To those who knew him longer, better, and at a deeper level, on thought issues, on health issues, on educational issues…his visions and dreams went well ‘beyond his time’, since he rarely confused ‘what was’ with ‘what could be’, and never with ‘what should be’. And it was truly a privilege to train within his realm, since one could not help being so much the better for aspiring to dreams and visions.

That very powerful combination of being ‘a man of his time’ with vision ‘beyond his time’ undoubtedly accounted for his string of notable career positions: first, as a prominent and creative Department Chair at the University of Minnesota School of Dentistry; second, as the conscience-driven clear voice nationally for dentistry as the Editor of the Journal of the American Dental Association (JADA); and third, as a leader of education in Colorado, where he initially was the Dean of the School of Dentistry, then Dean of the Graduate School, and then Vice-Chancellor for Academic Affairs at the University of Colorado Health Science Center, after which he served as the Vice-President for Academic Affairs and Research and Dean of the System-Wide Graduate School at the University of Colorado. To each position, Larry brought ‘that combination’ and with it, those changes and improvements that did not, in his hands, scare those whose world was being improved.

All that being true enough in the realms of education and dental practice, it was that very same powerful combination that motivated his actions—and marked his contributions—within his research spheres of public health, health services, and epidemiology. Larry was curious, highly intelligent, creative, and—importantly—he was honest about how he saw the world and its people (whether providers or patients), and he cared deeply about health issues and people’s health. That was what fueled and stirred his research passions.

Major Research Contributions

Larry began his research contributions within the field of oral pathology, as evidenced by his research publication history from the completion of his MSD degree in oral pathology in 1963 at the University of Minnesota through 1969. In this first phase of his research career, prior to 1970, the majority of his 33 published articles, in which he partnered with the oral pathology giants of that time, such as Bob Gorlin and Sam Pruzansky, addressed tumors, dentofacial clefting, syndromes, and other oral and dental tissue abnormalities. At first, his approach was exclusively from a classic clinical pathologist’s perspective, with only sprinkled hints of where he was to leave his indelible mark on oral health research, i.e., research that reflected his parallel, ongoing training in the mid-1960s via his pursuit of an MPH degree in 1964, and then a PhD in epidemiology in 1966. In those ‘sprinkled hints’, Larry began publishing a few articles on dentofacial clefting from an epidemiologic perspective. He also began venturing into the health service research arena (although that discipline had not yet been named as such) via articles on dental patients’ choice of dentists and other oral health manpower issues.

Larry conceived of, founded, and became the first Chair of the Department of Health Ecology at the University of Minnesota while a doctoral student at the University—as a sidebar activity to his own graduate studies. Early on, this responsible man of his time, with a creative vision beyond his time, saw both a need and an opportunity, and welded those ‘saws’ into a tool that would cut new paths in the field of dentistry and oral health. His vision was to create a strong interdisciplinary research department composed of behavioral scientists, public health dentists, and epidemiologists. He built, arguably, the premier department of its type in the country (other schools typically called their versions either Social Dentistry or Community Dentistry Departments, and one even used the near-title of Dental Ecology). Ironically (and again ahead of his time), the word ‘ecology’ was seemingly—at least titularly—‘associated with’ (if not causatively associated with) what became the two most robust departments with this focus in the US, as measured by research impact, department size, and longevity of existence.

From this point in 1970 forward, Larry’s own research and that of his department members set the tone, standards, and agenda for behavioral and health services research within the US, as well as contributed mightily to these same lines of research worldwide. This vision of Larry’s in the late 1960s provided the stimulus for research in the behavioral sciences, health services research, and epidemiology in dentistry that subsequently led, in the following decades, to the creation of an entire Group in the International Association for Dental Research, namely, the Behavioral Sciences, Epidemiology, and Health Services Research Group. Just as one might note that, prior to Alfred Kinsey, no one, on a major scale, had quantified the practice of sex (people just ‘did it’), one might equally note that, before Meskin and his Department, no one, on a major scale, had ever so systematically quantified the practice of dentistry (again, dentists just ‘did it’) by detailing the actions of both patients and providers within a system of health care delivery.

As a result of his studies, which deeply probed the practice of dentistry, Larry emerged as a champion not only of the disenfranchised in our country, but also of organized dentistry as well. Clearly, he must also have been a reasoned and very civil man of his time with a vision beyond his time to succeed in both types of research pursuits and to move smartly up the national leadership ladder. And it is with this combination of traits that the ‘research genius’ of Larry Meskin truly lies.

Finding ‘truths’ is the goal of all investigators, but getting those ‘truths discovered’ into play in the real world is well-recognized as being much harder for human-based investigators to achieve. Since I was on the scene in Larry’s Department from 1970 into the early 1980s (when he left to assume the Deanship, and then a series of other major posts, at the University of Colorado, and the Editorship of the JADA), I can attest to the following: Larry’s unusual skills as an impactful national-level health services researcher were forged in the fires of association with (accused of?) the full set of negative ‘isms’ of the 1970s (including socialism, and even communism—which, unbeknownst to today’s generation—was a very serious and confrontational charge in those post-Senator Joe McCarthy times) in the minds of state dentists. Out of these tense times and from these often-heated fires, Larry emerged as an ‘evidence-based’ leading spokesman for dentistry (including organized dentistry) in Minnesota, in Colorado, and for the country as a whole, decades before ‘evidence-based’ was a buzzword.

Dentistry’s interest today in ‘mid-level career professionals’ in the US is ‘déjà vu all over again’, harking back to a concept and practice area well-explored by Larry in the 1970s, when he imported expanded-duty dental auxiliaries from England into the curriculum at the University of Minnesota as a feasible and practical solution to bringing oral health services to the underserved. Unlike today, when this concept is finally being embraced as a political image solution for the dental profession, it was merely branded with the ‘isms’ of the day back in the 1970s, when he tried to spearhead changes in the dental practice acts that would allow this new workforce into the ‘real world’, i.e., outside university clinical settings.

Also during the mid-1970s, the ‘graying of America’ was a newly recognized phenomenon, not the well-worn observation it has since become. Under Larry’s leadership, his department developed the first graduate geriatric degree program in dental education.... in the world. Since this novel program was supported by a local health care foundation, funded trainee slots were an integral part of the program from the beginning, a feature which made it a practical career path for those with interests in geriatric dentistry, and it is one that continues today, some 30 years later, to produce a stream of oral geriatric researchers, teachers, and clinicians. Today’s IADR Geriatric Oral Research Group (GORG) clearly is one subsequent development that benefited from Larry’s vision...and practicality.

Finally, I would point out that Larry was, in his day, among a handful in dentistry to obtain his PhD in epidemiology. Here again, Larry saw an opportunity and a need, and once again he created. Only a few years after obtaining his own doctoral degree in epidemiology, he utilized existing PHS general training funds to attract and create a beginning national pool of oral epidemiologists, another of his creations that ‘took off’ in subsequent years. By the mid-1980s, NIDCR was funding specific NRSA T32 training programs in oral epidemiology at five leading US universities.

Major Research Lessons Learned ‘At The Knee’ of the Master Mentor

First research lesson learned: Keep learning, keep growing. By example, not by preaching, Larry demonstrated how to ‘grow one’s self’ throughout a career. Just two years after obtaining his PhD in epidemiology in the late 1960s, Larry was a WHO Traveling Fellow, learning about health care programs in the United Kingdom, Ireland, Sweden, and Denmark. He followed that in 1972 with a stint as Visiting Professor at the London School of Economics. And it never ceased as ‘a style’, leading eventually to his sabbatical devoted to ‘The Great Books Program’ at the College of St. John’s in 1990.

Second research lesson learned: Have the courage of your convictions. A bit scary for someone who has ‘visions beyond his time’, but it was clear from his actions that ‘conviction without courage’ equals no new developments or directions. Larry never seemed deterred by the fact that his proposed hypotheses would shake up the status quo, either by making obvious the weaknesses of the current system of care, or the benefits of an alternative, fresh approach. Rather, he considered it an expected and/or necessary outcome, and he welcomed (no, more truthfully, he actually ‘relished’) the challenge of taking his public health, health services, and epidemiologic research findings into the real world to strive for improvements.

Third research lesson learned: Know your own research expertise limits and partner wisely. Raised in the pre-‘translational research’ era (and even before the litany of buzzword-named sequential eras of trans-disciplinary research, which in turn was preceded by cross-disciplinary research, and multi-disciplinary research before that), Larry did it (just never worried about the ‘labeling’ of it enough to name it).

Fourth research lesson learned: If you want your research ‘to count, to matter, to get-into-play’, then take the time to envision how your findings will be perceived by those whose world it will change and help them to grasp the goodness within your public health findings. As a public health and health systems investigator, Larry was never interested in ‘test tube’ findings that had no application in the real world, so working to get the ‘real working world’ to accept evidence-based scientific findings from his discipline was an integral, expected, and necessary last step in his approach to research.

Summing Up the Man as Research Mentor

Aghast at my naivety, the post-doctoral Fellow with whom I had just played racquetball was warning me to change my ways if I ever wanted to land a job after my training was completed. He had just learned that I’d been playing racquetball 2-3 times a week with my mentor, Dr. Meskin, for the past few years. He told me in no uncertain terms that not letting my mentor win at racquetball was a career-ending mistake, since ‘all hires’ depend on that letter from your mentor. I have no doubt that there was a ring of truth in all he said, but talk about your lucky breaks! I had indeed stumbled into the “biggest, greatest, luckiest professional-career break” of my life: Dr. Larry Meskin was my research mentor, a man whose ego was intact, and a man who valued all good challenges.

As my career moved along during the next 30 years, Larry and I often spent time catching up with one another at research meetings, and he would always work this line into his introduction of me to any of his myriad peers in the dental research world, “Yep, he was my postdoc, and if I said ‘white’, he’d say ‘black’....or the other way round!” Larry not only sought multi-faceted discussion on issues, he also sought and welcomed lively debate in those discussions.

Those two anecdotes sum up a lot about Larry Meskin as a research mentor, as he was to so many over his career: a mentor emphasizing public health research founded in a deep honesty, a true confrontation with reality, and a driving passion to improve oral health for all. A bit romantic? You bet. And all the time we were training with him (and, of course, spending time with his wife Estelle, who served those outrageous, overstuffed, and delicious Reuben sandwiches for all at midnight, and accompanying them and their children Scott and Sarah on windy Halloween rounds), we felt like family! From all of us who had the privilege of training under you: “Thank you, Larry!”

Summing Up the Man’s Impact on Dental Practice

Impact? After a lifetime characterized by innovative public health and health services research leadership, academic leadership within dental schools and at the university level, and as the ‘conscience and monthly voice’ of dentistry via his editorship of JADA, Larry’s career had impact. After nearly 50 years in the profession, Larry’s funeral in 2007 was described by one nationally prominent attendee as ‘...the largest funeral I’ve ever seen’. Larry’s research and writings spanned nearly five decades, during which time he published over 130 articles in scientific journals and 130 ‘health services research-oriented’ editorials in JADA, and consulted frequently to government, major universities around the world, PAHO/WHO, and leading non-profit foundations as well as commercial companies. The fields of ‘oral epidemiology’, ‘oral behavioral sciences’, and ‘oral health services research’ largely emanated from just a handful of visionary research leaders of the 1970s as dental education, dental research, and research training burgeoned in that era, and Larry was an acknowledged leader among those visionaries.

Is it any wonder that he was recognized by the American Student Dental Association in 1999 as one of the ‘Top 25 Dental Visionaries”? Is it any wonder that he was a founding member of the Santa Fe Group, the nation’s leading think tank in dentistry for exploring challenges facing the profession, seeking solutions, and serving as a catalyst for change? Is it any wonder that he received the University of Colorado’s highest honor, its Thomas Jefferson Award, bestowed upon a faculty member who demonstrates “broad interests in literature, arts and sciences, and public affairs”?

No. That he was so honored is not a wonder, it was merely appropriate, for he was a wonder to know, and he not only continues to inspire, he is also a wonderful man to remember.