Five Questions With: Michael P. Carey

"THE RISE in prescription drug abuse and unintentional deaths due to prescription medication overdose is certainly troubling and speaks to the larger issue of addiction in this country," said Michael Carey, director of the Centers for Behavioral and Preventive Medicine at The Miriam Hospital. / COURTESY THE MIRIAM HOSPITAL

Michael P. Carey is the new director of The Miriam Hospital’s Centers for Behavioral and Preventive Medicine, where he will lead a wide range of programs, research and services focused on prevention, such as stopping smoking.

A clinical psychologist, Carey founded Syracuse University’s Center for Health and Behavior in 1989. He is a well-established researcher in the field of HIV prevention and risk reduction, with more than 250 peer-reviewed articles.

Providence Business News asked Carey to talk about the ways that risk can be mitigated, and how businesses can become partners in prevention.

PBN: in your new position as director of the Centers for Behavioral and Preventive Medicine at Miriam Hospital, how much emphasis will be placed on research as compared to programs and services?

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CAREY: My new position is very exciting, with responsibilities that cut across a number of domains including research, faculty development, program evaluation, education and training. I view these activities as interdependent and mutually enhancing. That said, during my first year at the Centers, my top two priorities will be: strengthening the research portfolio of the Centers; and mentoring my junior colleagues so that they can reach their potential. I eagerly look forward to meeting with practitioners, educators, researchers, and other colleagues from our community to promote health using cutting-edge, scientifically grounded approaches. This is an exciting time for collaboration.

PBN: The targets of your efforts — quitting smoking, obesity and weight management, HIV/AIDS prevention — involve changing individual behaviors. Does there also need to be a focus, as your colleague Dr. Barbara Roberts has suggested with heart disease, on larger societal interventions?

CAREY: Absolutely. To promote health, prevent disease, and improve the quality of life, we need to employ a wide variety of complementary approaches, including those at the individual level and the society level. Individual level interventions can be very effective, and their effectiveness can be enhanced when considered in the context of social, economic, and environmental factors. So, it is important to also address family, social, cultural, and environmental factors to optimize health and reach the entire population.

I am happy to say that a number of the Centers faculty are engaged in innovative research that involves the full spectrum, ranging from understanding basic bio-behavioral mechanisms to developing cutting-edge, individual-level interventions to changing the health behaviors of whole communities.

For example, several projects involve family members and communities in intervention efforts. Others are using small group programming, radio and TV campaigns, and new media and technology to promote health more efficiently and to reach an increasingly mobile populace. The impacts of both approaches are enhanced when implemented in a coordinated way.

PBN: One of the initiatives proposed as a preventive measure for HIV/AIDS is universal screening as part of normal yearly physicals, to help remove the stigma. Do you agree?
Broadening the reach of disease detection and risk reduction counseling is a very important goal. Further, as you point out, there is the added benefit of minimizing the stigma and embarrassment some people may feel – two potential barriers to testing. So, from the perspectives of “reach” and access, universal screening has much appeal. That said, there are times when such testing may not be indicated or cost-effective.

So, I think there is room for innovation around universal screening to minimize the barriers, increase access and convenience, optimize early detection and risk reduction, and control costs.

With rapid advances in technology, exciting new ways to promote uptake of screening (for many health threats) are becoming less costly and more widely available. Generally speaking, most people like to know more about how they can promote their own health – risk screening is a valuable tool that can provide helpful information. This is an exciting area of research and practice.

PBN: How important is the workplace as a partner in prevention? Is there more that businesses can do?
There have been some terrific worksite health promotion efforts including those developed in the Centers. So, yes, the workplace holds great promise for prevention programming. Some employers are already engaged in some truly innovative programming including, for example, providing walking path or other facilities for physical activity, providing healthier food choices, offering stress management guidance and guidance regarding alcohol, tobacco, and other substances.

Some provide financial incentives for employees who are proactive about their health. Such strategies are well received by employees, facilitating the recruitment and retention of excellent employees. Promoting the health of employees is just plain smart – a healthy workforce will be more productive with lower turnover, and fewer absences due to ill health and distress. The enhanced productivity coupled with the lower health care costs is good business practice. Many of the most successful companies recognize that prevention is not only a great employee benefit but it also provides a robust return on investment.

PBN: The current epidemic in drug abuse involves prescription painkillers — more people die every year in Rhode Island from accidental overdoses involving prescription opioids than from car accidents? Is this an area that you and Miriam Hospital will be involved in addressing?
The rise in prescription drug abuse and unintentional deaths due to prescription medication overdose is certainly troubling and speaks to the larger issue of addiction in this country, whether it be prescription medications, illegal drugs or nicotine and tobacco. Although our research in the Centers for Behavioral and Preventive Medicine focuses more on reducing the prevalence of smoking – which is responsible for 1 in 5 deaths in the U.S. alone – it’s possible that our findings, be it innovative new addiction treatments or a better understanding of the mechanics of smoking behavior, could offer additional insight into other forms of addiction, including prescription medication abuse.