There's something vigorously uncompromising about Dr. Mary Guinan.
Guinan is probably one of Nevada's most powerful women in public health. Her responsibilities -- ensuring a massive hepatitis C outbreak never happens again, expanding research capabilities, and persuading Nevadans to lead healthier lives -- leave little room for contradictions in her personal life.
The dean of UNLV's School of Public Health and acting state health officer purposefully parks a seven-minute walk away from the Rod Lee Bigelow Health Sciences Building and climbs 108 stairs every day to her fifth-floor office. She knows that a Starbucks scone has the same amount of transfat as a McDonald's small fries.
Having battled skin cancer, she advises everyone to be vigilant against Las Vegas' omnipresent sun. Her office could double as a haberdashery, with its colorful bouquet of widebrimmed hats. At an event at the AIDS Memorial Garden on campus, Guinan directed the 30 attendees to move into a sliver of shade before she'd start her remarks.
She quit smoking after medical school even though she "loved it." She gained weight and took up jogging -- "I was in bad shape. I couldn't walk a mile without stopping." -- and four years later completed the Boston Marathon.
"I feel like if I didn't practice what I preach, would anybody pay attention to me?" Guinan says.
Beyond her penchant for healthy living, there are a number of reasons why leading researchers at the U.S. Centers for Disease Control (CDC), Nevada's legislators, and the victims of unsafe health-care practices do pay attention.
Quite a Reputation
Guinan is passionate about public health, which she describes as population health (not health care for the poor, she'll pointedly explain). Her complex mission involves working in a network with local, state, and federal health authorities, conducting scientific research, eliminating health gaps between socioeconomic and ethnic groups, and providing quality education for students and the public.
Before Nevada, Guinan's 20 years at the CDC were marked by breakthroughs. She spent time in rural India, helping to rid the world of smallpox. She became a leading researcher on genital herpes, earning the nickname "Dr. Condom." In 1981, she was one of the first scientists to identify the epidemic that became known as AIDS. Three years later, she became the first woman to serve as chief scientific advisor at the federal organization.
She came to Nevada in 1998 to be the state health officer, a position that had been vacant for two years. By the time she took the interim deanship at UNLV's nascent School of Public Health, she had led an extensive study of the Fallon cancer clusters, ruling out a number of potential causes, and played a substantial role in getting the state's water fluoridated.
"I want my work to have meaning; that's why I love public health. It has given me an opportunity to work for the communities of the world," Guinan says.
Now, as permanent dean, she oversees a school with 240 students, more than $7 million in grants, three self-supporting research units, three master's degree programs, and the school's first joint doctoral program with the University of Nevada, Reno in the works. The collaboration with UNR is part of a long-term plan to merge the public health programs at the two universities, Guinan says. Nevada System of Higher Education Chancellor Jim Rogers believes the schools will obtain accreditation faster if they share resources, especially in a state with a tight budget and tremendous need for trained professionals.
Guinan also is acting state health officer, charged with coordinating Nevada's different health authorities. Officials asked her to fill the empty position following an outbreak of hepatitis C cases discovered at two Las Vegas medical centers this year. Health investigators have confirmed nine cases of hepatitis C that they believe were caused by health practitioners using unsafe injection practices at the clinics. More than 50,000 residents could have been exposed to blood-borne diseases.
Guinan is leading a team of infectious disease experts to examine the cases and make recommendations to prevent future outbreaks. "I want to make sure our system works, that the public feels safe when they go to any health facility," Guinan says.
The School of Public Health, meanwhile, is evaluating a program that Nevada could employ to educate patients about what to expect during procedures. Guinan also hopes to require infection control education for every licensed medical practitioner in the state.
"It's not just Nevada. This is a national problem," Guinan says. But officials now have the opportunity to overcome the state's dubious title as the site of the largest hepatitis scare in the country. "We will show some leadership in saying, 'This is how it's done. We recognized the problems, and we identified the solutions.'"
Guinan didn't want to take a leave of absence from the university to step back into the role of state health officer, so university and state administrators opted to split her salary and time. Ron Smith, UNLV vice president of research and graduate studies, says sharing Guinan with Carson City at a time when the state is facing a budget deficit of historic proportions is another way to show how the university contributes to Nevada.
"Just the very fact that she's there and representing UNLV does a lot of good. She doesn't have to say a word about us or what we're missing or what we could use. Her reputation precedes her," Smith says.
Uttar Pradesh, India - 1975
Guinan got into public health by accident.
She went to medical school at Johns Hopkins to become a doctor specializing in blood disorders. "When I was graduating I realized there was this movement to eliminate smallpox from the world, and I thought, 'My goodness, that looks really interesting,'" says Guinan, who also holds a Ph.D. in physiology from the University of Texas.
She joined the CDC and spent five months in Uttar Pradesh in northern India, visiting remote villages, working to identify smallpox cases and then vaccinating villagers within a five-mile radius.
"I was a great source of interest to the women, especially the Muslim women because they weren't allowed outside. They wanted me to come into their houses, and they couldn't understand why I didn't speak their language. They didn't have a concept that there were other languages," Guinan says.
She slept in mud huts -- when she could find one. She had a Muslim paramedical assistant and a Hindu driver, who could not eat from the same cookware, so Guinan used leaves as plates to separate their food.
Each month there, she saw the smallpox cases drop. One state in India was declared free of the disease within the next year and public health workers saw cases decline in Africa. "You had this whole system of public health workers who went around looking for the disease and getting people to immunize the population," Guinan says. "It was so successful I decided this is what I want to do. I mean, (as a physician), I could take care of patients but I couldn't have had this level of impact on a population."
Becoming Dr. Condom
After India, Guinan trained as a medical internist in infectious disease, which led her back to the CDC. Its extensive research on genital herpes and AIDS would change the way the nation thought about these diseases. "I didn't grow up thinking I wanted to be a sexually transmitted disease expert," Guinan says. "That wasn't my career goal."
She started researching a potential cure for cold sores. In Atlanta, she presented a paper on oral herpes simplux at an American Society of Microbiology conference.
"That evening I'm watching the news and Dan Rather, and I see me -- Mary Guinan from Utah -- being quoted as an expert on genital herpes. The background footage showed me pointing to my lip," she says.
After conducting a study on genital herpes and women, Guinan became a sexually transmitted disease expert. "The media made me that." Reporters -- fascinated by this "typical nice American woman" who talked frankly about sex, syphilis, gonorrhea, oral sex, and herpes -- pursued her.
"I was Dr. Herpes. I would talk about condoms, so they called me Dr. Condom for a while. This is the milieu I was working in," she says.
While the media sought her out, others were put off by her work. "These were diseases people didn't want anything to do with. People would say, 'How did you end up doing that? Do you have a fixation with people's genitals?' I said, 'Do you ask OB/GYNs that?'"
Her supervisor at the time, Dr. James Curran, now dean of the Rollins School of Public Health at Emory University, recalled that familiar discomfort. "It was part of the kinds of discussions that go around working with STDs or in family planning or anything dealing with human sexuality. On one hand it's an uncommon topic for people and on the other it sometimes leads to jokes," Curran says. "It was stigmatized."
He credits Guinan's open and frank approach to her ability to handle the labels thrust upon her. She brought an enormous amount of awareness about genital herpes, at a time when the country was just beginning to learn about the disease and focus on prevention, Curran says.
In 1981, Guinan received a report from a colleague, Dr. Wayne Shandera, about five gay men in the Los Angeles area who had died with pneumocystis carinii pneumonia and serious immune deficiencies. Shandera thought the cause of death might be a new strain of cytomegalovirus, a member of the herpes family. He contacted Guinan to get his report into the CDC's Morbidity and Mortality Weekly Report (MMWR.)
"(The CDC) had never said homosexual in an MMWR before -- or gay or whatever -- so they didn't really want to put it in the title. I said, 'It's really important to put it in the title.' They didn't want to talk about gays but it was absolutely critical that we talk about gay men," Guinan says.
She was part of an integral CDC task force that did extensive interviews with the gay community to identify this new disease and how to prevent its transmission through the use of condoms. Within 18 months, the team had discovered it also was transmitted by blood injection and birth processes. They learned the disease transmission was similar to that of the hepatitis B virus and that it affected immune cells, inciting the search for a new virus.
"Dr. Guinan investigated the first case of a woman with AIDS in the United States and was actively engaged in the epidemic studies of the first cases in AIDS. She was a true leader," Curran says. "None of us were surprised when she went on to a broader, more diverse leadership role in Nevada."
Guinan Goes to Nevada
After two decades at the CDC, Guinan wanted an experience in local public health. She's a big believer in a state's primacy in deciding matters of public health. She fell in love with Nevada as the state's public health officer from 1998 to 2002, in part because of the closeness of the small but growing population.
"If you make your case, you can call a senator's office and talk to your congresspeople," she says. "You can make networks." And that's when public health workers start affecting change.
Guinan is a network conduit. When she set out to help the state fluoridate its water in the face of daunting opposition, she found supporters within a number of key constituencies. One of them was Louise Helton, a member of the Junior League of Las Vegas. Helton organized the league women, who spent time calling every legislator in Clark County about the issue.
The Legislature passed a law enacting fluoridation in large counties, but required voter approval in 2000 via a ballot initiative. While Guinan and her fellow advocates geared up for the election, the Southern Nevada Water Authority began fluoridating Clark County's water supply in the interim. Knowing that voters typically vote no on initiatives, particularly when inundated by a number of them, advocates carefully phrased the question to ask voters if they wanted the county to stop fluoridating the water. "It was during the Gore/ Bush election. We didn't know who was president, but we knew we got fluoridation in Clark County," Guinan says. "I could not have done that in Georgia; there would not be this sort of statewide group working together, knowing each other, getting the Junior League out. I love how you can do that here."
When she stepped down from the state office, Guinan became executive director of the Nevada Public Health Foundation, where she began her efforts to rid Nevada of smoking indoors.
UNLV then tapped her to lead the new School of Public Health. "She is that perfect combination of a person trained to be a clinician on the one hand and on the other hand trained to do research," says Carol Harter, president of UNLV at the time of Guinan's hire. Harter had been impressed by the millions in grant money Guinan attracted for research in the community. "There was surely nothing like the hepatitis C crisis (at the time), which more than anything else points to why we need a School of Public Health. (The school's faculty) just does things that are so incredibly timely for Nevada and Las Vegas."
Guinan focused her staff and students on the Clean Indoor Air Act or Question 5, a voter referendum Nevadans approved in 2006 to ban smoking from businesses except for casinos. Many Las Vegans recall a war between that initiative and a similar one, Question 4, which banned smoking on school grounds, daycare centers, and video arcades, but left designated smoking areas of bars and restaurants.
Denise Tanata Ashby, executive director of the Nevada Institute for Children's Research and Policy within the School of Public Health, analyzed the act and the opposition initiative for the public. She also wrote a policy brief describing the need for Question 5, particularly as it related to children and second-hand smoke.
Now Guinan has set research of the effectiveness of this landmark law as a priority for her school. She expects the ban to come under continual fire. "People always ask, 'Is there intelligent life in Nevada?' and I say 'Yes, they voted for the Clean Air Act; they are a smart population,'" Guinan says. But she's not one to rest on laurels. "Just think of these things that have happened that are going to improve the lives of people for the rest of time -- unless they overturn it."
Over the next decade Guinan sees the Public Health School evolving in an educational system rich with research and community outreach programs. She wants to expand research, so lawmakers can make betterinformed decisions about Nevada health care.
"We know what our goals are and we know what we have to do and we're making good friends with our community partners," Guinan says. "They can understand the research that we do. It's not a million molecules -- not that I'm putting that down -- but the research in public health is the kind of research that people can understand. And it's the kind of research that can change lives in Nevada."