Our last year in Edinburgh, 1969, was a time for coming to terms with reality. I had quite a high profile by the beginning of that year. I had been principal investigator for almost all the research I'd done for the Royal Commission on Medical Education, had published many original articles that had been widely praised and discussed and I had taken several initiatives that led to other publications. I'd presented results of my work at important national meetings in the UK and at international meetings and seminars in Australia and the USA. I was getting attractive invitations from universities and research groups in USA, Canada and elsewhere in UK, but not from Australia. I'd been passed over when I applied for the foundation chair of community medicine at Monash University in Melbourne, which had gone to a well connected professor of medicine who had no experience and no track record of community-based research in epidemiology. I'd been informed in quite unmistakable language that I would not be promoted from top-of-the-scale senior lecturer to reader (= associate professor) at the University of Edinburgh. Early that summer I'd been invited to present a paper at a think-tank at Airlie House, near Dulles Airport, just outside Washington DC. This proved to be at least in part a pretext to enable several senior people at Harvard Medical School and Harvard School of Public Health to consider me for a challenging cross-appointment that would link the medical school to the school of public health. After the Airlie House meeting I flew to Boston, met the deans of Harvard Medical School and the School of Public Health, was offered and provisionally accepted the cross appointment. But I had many misgivings. Accepting this position meant migrating back to the USA, where we would have to find a place to live perhaps 2 hours commute away, and this time, unlike my previous post at the University of Vermont, we would have to concede and assume that the USA would be our permanent home, would have to become American citizens with all that this entailed.
I had received another invitation, to become a professor of epidemiology and community medicine at the University of Ottawa. Almost as an afterthought I flew from Boston to Ottawa, where I'd been booked into the rather down-at-heel but picturesque old colonial Bytown Inn. I arrived in late afternoon of a hot summer evening. I'd already eaten, so I strolled up to Parliament Hill, then over to the Rideau Canal and south beside the Canal to somewhere near where I live now, on the corner of Queen Elizabeth Drive and First Avenue, where as dusk began to fall, mums and dads sat quietly chatting on their front verandas while their kids played street hockey. I had an epiphany. This would be a better place to raise our children than some far distant outer suburb of Boston. These didn't look like the kind of people who would keep a loaded handgun in their homes! Canada hadn't gotten involved in the ruinous Vietnam War. Canada had a parliamentary democracy, not the corrupt pseudo democracy of the USA where political decisions usually depended on which special interest group bought the most favours from elected office-holders.
Harvard is one of the most prestigious universities in the world and it was a rare distinction to be invited to join the staff. But there were drawbacks. The position was funded by 'soft money' - I would have to raise money to pay my own salary as well as the salaries of the team of researchers I would be expected to recruit. I was fairly confident that I could do this. I was full of ideas, unanswered questions about determinants of the quality of medical care both in hospital-based and community-oriented practice. (Even now, almost half a century later, some of these questions haven't been answered by studies using validated evidence). More troubling was the harsh reality of academic politics that had defeated previous efforts to build a secure bridge between the medical school and the school of public health.
Ottawa University medical school was young, established in 1945 and undistinguished, to put it mildly. To call it mediocre was to flatter it. Turning this inside out, it had nowhere else to go but up. It had tremendous possibilities, a small medical school in a large city with two large hospitals meant rich resources for teaching, for staff-student interaction, in both languages too. I had the track record the medical school was seeking, clinical experience and impressive training and experience in epidemiology. I was ideally qualified to lead the department of epidemiology and community medicine with its combination of research focus and family practice. But we loved life in Edinburgh, so didn't want to think about leaving this lovely old city.
Wendy and I agonized over the decision for as long as we dared. Both Harvard and Ottawa wanted my decision within a relatively brief time, 2 or 3 weeks as near as I can recall after many years. It was the most difficult decision we've yet faced and while we were deliberating over it we thought of little else, talked about little else.
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