Colin (Coke) McCord — Cutting to the Heart of Matters
A chest surgeon, Dr. Colin McCord, known as Coke to everyone, was incisive: He cut to the heart of matters. I was privileged to work with him for more than three decades and he had a profound influence on me — and on the lives of millions of people, most of whom will never know his name. Coke died at the age of 94 earlier this year. Obituaries in the New York Times and The Lancet summarize parts of his career; here, I share a personal perspective.
There was nothing in Coke’s training that could have predicted the course of his career. He graduated from Columbia University College of Physicians and Surgeons, completed surgical residency at Bellevue, and, practicing in New York City, became one of the most respected chest surgeons in the country. Then, in the late 1960’s, he saw first-hand what was happening in Vietnam and decided, “this isn’t what I was put on this earth to do.”
Studying at The Johns Hopkins School of Public Health, he learned the foundations of epidemiology. He and his family moved to India, where he helped document that oral rehydration and treatment of childhood pneumonia could reduce childhood deaths by half.
In 1980, Coke became an employee of the government of newly independent Mozambique, working as director of surgical services of a provincial hospital. As a rule, at least 5% of births require a surgical intervention such as a Caesarian section or women will die in childbirth or develop potentially devastating complications such as fistula. With his characteristic clarity of thinking, he made a spreadsheet with the minimum number of required Caesarian sections, the number of obstetrical surgeons, the number of surgeries one surgeon could do in a year, and the rate of training new surgeons per year.
His calculations proved that it would take decades for Mozambique to have enough surgeons to meet this need. McCord then convinced the government to establish a new type of health worker — “surgical technicians.” He created a program of one year of practical training followed by one year of mentored practice. More than two decades later, he documented that surgical technicians in Mozambique did more than 90% of operations in rural areas, with surgical outcomes just as good as those of university hospitals in the country. This innovative and life-saving program has since expanded to other countries in Africa.
Public health has generally lauded primary health care (with reason) and decried the over-emphasis on tertiary hospital care (also with reason). But Coke focused on the neglected area between the two: the public health aspects of surgery. He wrote highly influential chapters in the Disease Control Priorities book showing that secondary hospitals can be just as cost-effective as primary care. He emphasized the importance of scaling up access to life-saving interventions including emergency obstetrical care, trauma, and resuscitation.
In 1990, Coke and Dr. Harold Freeman documented that life expectancy for Black men in Harlem was shorter than that of men in Bangladesh. That article was published as I started my work as an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention. Coke suggested that we study chronic liver disease, which, surprisingly, was the third leading cause of excess deaths in Central Harlem. This led to a multiyear collaboration that determined that synergistic liver damage from alcohol and viral hepatitis strains B and C was the driver of that very high rate. People with both heavy alcohol use and viral hepatitis were 6 times more likely to have severe liver disease than people with either risk factor alone — and most patients with chronic liver disease had both.
When I became NYC Health Commissioner, I asked Coke to join the Department. He helped lead our tobacco control work, including publishing guidance to improve the way doctors supported patients who wanted to quit and helping get the smoke-free air act passed. He started an office in the South Bronx to help address health disparities, focusing on reducing teen and unintended pregnancies.
When he retired from surgery, he used his hands to become an accomplished carpenter, making much of the furniture of his home, after which, he told me with a twinkle in his eye, “the market was saturated.” A friend who knew Coke commented: “Coke was a terrific soul; he was kind to all, straight-forward, insightful, humble and had a good sense of humor.”
One day as I worked in my office as Health Commissioner, Coke ambled in with a book on nutrition. “You know,” he said (I hadn’t known), “trans fat is really bad stuff. We should do something about it.” That insight led to New York City banning the artificial chemical. At that point, only Denmark had done so. New York City’s move forced all chain restaurants that operated in NYC to change their products nationally. (The companies explained to us that using one product for NYC and another for the rest of the country was not logistically feasible; I thought it would also be a publicity nightmare for the companies — sparing New Yorkers but not the rest of the country from a toxin in their food.) New York City’s action led to the US banning trans fat.
And now my organization, Resolve to Save Lives, has worked with the World Health Organization to call for global elimination of this toxic food additive. Today, nearly half of the world’s population, accounting for nearly two thirds of prior consumption of trans fat, is protected by trans fat-free laws. Trans fat was previously estimated to kill up to 500,000 people per year around the world; already, millions of lives have been saved. When elimination is achieved, more than 17 million lives will be saved in the following 25 years. This quite well may not have happened without Coke’s insight.
Because of Coke’s incisive thinking and practical action, children around the world are more likely to survive, women in Africa more likely to have a safe childbirth, and people in most of the world are less likely to have a heart attack from trans fat. A remarkable legacy of a remarkable man.