Shapiro, Sam

Sam Shapiro (1914–1999) was both a founder and an exemplar of health services research as a recognized field of inquiry in public health and medical care. He was an innovative researcher, a dedicated teacher of a generation of health services researchers, a generous mentor to younger researchers, and a valued partner in research to colleagues.

Shapiro is widely recognized for research begun in the 1960s with Drs. Philip Strax and Louis Venet that demonstrated the effectiveness of screening mammography, combined with a clinical examination, in reducing breast cancer mortality. At the time, Shapiro was director of Research for the Health Insurance Plan of Greater New York. He, Strax, and Venet initiated a clinical trial that, between 1963 and 1968, enrolled 62,000 women aged 40 to 64 who were randomly assigned screening mammography and clinical examination versus regular care. Ten years later, cumulative mortality among women randomized to screening was about 30% lower than in the regular care group. In recognition of the importance of this work, Shapiro and Strax were awarded the Charles E. Kettering Prize for outstanding contributions to cancer diagnosis or treatment in 1988. Shapiro was the first public health researcher to receive this prize.

Shapiro was born and raised in Brooklyn, New York, and attended Brooklyn College, where he earned a bachelor's degree in mathematics in 1933. In the 1934–1935 academic year, he did graduate work in mathematics and statistics at Columbia University but left to work in Home Relief, a Depression-era program in New York City. In early 1943, he went to Washington, D.C., where he worked for the Selective Service System. In 1944–1946, he served in the U.S. Navy.

After being discharged from the Navy in 1946, he joined the National Office of Vital Statistics (now the National Center for Health Statistics), a component of the Public Health Service. It was there he began his work in public health, with responsibility for birth and infant death statistics. Among his earliest published papers are several concerned with the development and completeness of birth registration data and applications of these statistical data to answer public health questions.

He spent a year (1954–1955) as senior study director at the National Opinion Research Center (NORC) in Chicago, developing research designs and questionnaires for national and local studies on health services use. He joined the Health Insurance Plan (HIP) of Greater New York in 1955 as associate director of Research and Statistics and was promoted to vice president and director of Research and Statistics in 1959.

His research at HIP focused initially on the effects of prepaid group practice on health outcomes. With Paul Densen and others, he authored two research papers in 1958 and 1960 comparing prematurity and perinatal mortality among HIP members and the general population; he reported that women in the HMO began prenatal care earlier and had lower prematurity and perinatal mortality rates and that this occurred for both White and non-White groups. Differences were also observed between women seeing private physicians and those seeing “general-service” physicians.

Concurrently with the perinatal-care work, he and Densen examined patterns of ambulatory services utilization and hospitalizations. They designed and implemented one of the very early, if not the first, routine collections of encounter data in a prepaid group practice plan to support research on patterns of service utilization. His work in mental health began with analyses of prescriptions for psychotropic medications and patterns of medical care related to mental illness. Shapiro also conducted research showing that encounters for elderly patients took more time than for adults under age 65. This provided the basis for higher capitation payments by Medicare for elderly enrollees.

...