In Memoriam: Yale Expert in Clinical Research Methods, Alvan R. Feinstein

Alvan R. Feinstein, M.D., the Sterling Professor of Medicine and Epidemiology and director emeritus of the Robert Wood Johnson Clinical Scholars Program at Yale, whose work dramatically altered the conduct of clinical research and the training of physicians, died on October 25.

In a letter to the faculty of Yale School of Medicine, Dean David Kessler, M.D., and Ralph Horwitz, M.D., professor and chair of medicine, stated, "Alvan Feinstein blended a commitment to clinical care with an unrelenting confidence in the value of rigorous clinical research, and in doing so modeled a life of scholarship and friendship. He was a master at developing young scholars by holding them to the only standard he knew, the highest attainable."

Feinstein, 75, was the author of six books and more than 400 original articles, and was renowned for his scholarly work that refocused clinical research from the laboratory to studying patient health and medical care as a whole. "Alvan had a profound effect globally on medicine," said John Concato, M.D., associate professor of medicine and associate director of the Robert Wood Johnson Clinical Scholars Program. "His work has influenced two generations of physicians conducting research at the bedside and not just in the laboratory."

Born in Philadelphia, Feinstein went to schools in that city before attending the University of Chicago, from which he received a bachelor's degree, a master's degree in mathematics and his doctor of medicine degree. After clinical training in internal medicine at Yale and research training at Rockefeller Institute, he became medical director at Irvington House, near New York City, where he studied patients with rheumatic fever.

In 1962, Feinstein joined the Yale faculty and in 1974 became the founding director of the Robert Wood Johnson Clinical Scholars Program at Yale. Under his direction, the program became recognized as one of the leading sites for training in clinical research methods. For many years he was director of the Clinical Examination Course (for second year Yale medical students) and also created a course, Quantitative Clinical Epidemiology, that was replicated widely at other medical institutions.

His research and scholarship covered diverse areas including patterns of, and treatments for, rheumatic fever; cancer prognosis and therapy; the appropriate use of diagnostic tests; and methods of study design and statistical analysis in clinical investigation. His new clinical approaches and methods were reported in three books: "Clinical Judgment" described the goals and methods of clinical reasoning; "Clinical Epidemiology" presented the structure and contents of clinical research with groups; and "Clinimetrics" described the strategies used to form clinical indexes and rating scales for important clinical phenomena such as pain, distress and disability. His distinctively clinical approach to quantitative data was presented in three other books, "Clinical Biostatistics," "Multivariable Analysis" and, most recently, "Principles of Medical Statistics."

He was elected to membership in the American Society for Clinical Investigation, the Association of American Physicians, the American Epidemiological Society, the Interurban Clinical Club and the Institute of Medicine.

During his career, he collected many honors and awards. Among those he most cherished were the Francis Gilman Blake Award as outstanding teacher to Yale medical students (1969), Richard and Hinda Rosenthal Foundation Award from the American College of Physicians (1982), Robert J. Glaser Annual Award from the Society for General Internal Medicine (1987), J. Allyn Taylor International Prize in Medicine (1987), Gairdner Foundation (Canada) International Award (1993), and an honorary Doctor of Science degree from McGill University (1997). In 1991, Feinstein was named the Sterling Professor of Medicine and Epidemiology, Yale University's most prestigious academic honor.

Feinstein is survived by his wife Lilli Stentz, his daughter Miriam F. Gottleib and son Daniel. A memorial service is being planned for mid-November at Yale School of Medicine. Donations may be made to the Alvan R. Feinstein Historical Library Fund at Yale School of Medicine, c/o Bonnie Sargent, P.O. Box 7611, New Haven, CT 06519.