Lisa M Schwartz

Abstract

Advocate for clear communication of medical risks. Born on June 30, 1963, in New York City, NY, USA, she died of cancer on Nov 29, 2018, in Lebanon, NH, USA, aged 55 years. For Lisa Schwartz, a champion of risk communication and health literacy, a key question for modern medicine was where to draw the line between well and sick. Schwartz, along with her physician husband, Steven Woloshin, believed that many of their colleagues—with the help of industry and the media—blurred that distinction. In a 2013 talk, Schwartz, a general internist, spoke of the dangers of “medicalizing life” by “turning ordinary experiences into disease”. She advocated instead for a less-is-more approach to medicine warning that the harms of some treatments can outweigh the benefits. As professors at the Dartmouth Institute for Health Policy and Clinical Practice, part of the Dartmouth College Geisel School of Medicine in New Hampshire, USA, Schwartz and Woloshin studied how the perception of risk shapes choices about health care. As Co-Directors of the Center for Medicine and Media at the Dartmouth Institute, they educated physicians, policy makers, and the public about evidence and trained reporters on how to accurately discuss risk and spot disease mongering. Barnett S “Barry” Kramer, former director of the Division of Cancer Prevention at the US National Cancer Institute, helped Schwartz and Woloshin train journalists for roughly a decade. “They were a delight”, Kramer told The Lancet. “Working with them from the get-go was one of the most gratifying points in my long career. They were—and Steve is—such clear thinkers and they worked so hard on making their messaging so clear, and they were also meticulous in their research.” Kramer called Schwartz's contributions—improved decision making by the public, more informed reporting of medical science by journalists, and better tools for physicians to discuss risk with their patients—“immense.” “They helped me understand medical evidence and develop, as they say, a ‘healthy scepticism’”, recalled Liz Szabo, a journalist with the Kaiser Health News. “And at a time when conflict of interest is everywhere, and everyone seems to be on the take, she was beholden to no one and could speak the truth, which was always refreshing.” Szabo described the collaboration between Schwartz and Woloshin as “a marriage of true minds. They published everything jointly. They signed their emails jointly, did interviews jointly.” “We were inseparable from the time we met” in 1990 as medical residents at Bellevue Hospital Center in New York City, Woloshin said. “We didn't really plan to work together, but we were always interested in the same areas, always discussing things, editing each other's writing. It turned into an amazing collaboration. People often assumed we always agreed about everything; we didn't, but we had so much love and respect for each other we were always able to push each other and make our work better and better.” Shortly before her death, Schwartz and Woloshin produced what would be their last work together, a 2019 paper for JAMA about the scope of medical marketing in the USA, which they reported had increased from US$17·7 billion to $29·9 billion between 1997 and 2016. Schwartz and Woloshin's work had a substantial impact on regulators. They created a “drug facts box”, endorsed by the US Food and Drug Administration, to help consumers better understand the risks and benefits of medications, as well as a website called Know Your Chances for the US National Cancer Institute to give laypeople a clearer sense of their risks for developing cancers. Schwartz's death is “a tremendous loss”, said Rita F Redberg, a cardiologist at UCSF Medical Center in San Francisco and a friend. “It's hard to say where we would be without their work”, said Redberg, the Editor of JAMA Internal Medicine. By raising physicians' awareness of drug safety issues, and trying to prevent the labelling of healthy people as sick, Schwartz helped push back what she saw as a steady march toward more use of potentially harmful, and often unnecessary, medications and treatments, Redberg said. Schwartz, who was Professor of Community and Family Medicine at the Geisel School of Medicine, was born in The Bronx borough of New York City. After graduating from the State University of New York at Binghamton in 1985, she attended New York University School of Medicine, where she received her medical degree in 1989. She received her master's of science from Dartmouth in 1996. Schwartz and Woloshin married in 1992 and have two children, Emma and Eli. “She was passionate about helping the public”, Woloshin said. “She wanted to help people learn how to cut through the hype so they could make good decisions about their health.”