John 'Jack' Farquhar, prevention-research visionary, dies at 91

John “Jack” Farquhar, MD, a giant in prevention research and professor emeritus of medicine and of health research and policy at the Stanford University School of Medicine, died Aug. 22 of natural causes. He was 91.

A boundary-busting cardiologist for his time, Farquhar was one of the first scientists to see cardiovascular disease prevention through the lens of public health. He focused on environmental and behavioral risk factors that spanned whole cities, envisioning interventions that could change the health behaviors of entire communities and ultimately prevent disease and improve public health.

“Jack was a visionary in disease-prevention research. His forward thinking helped usher in the precision health revolution,” said Lloyd Minor, MD, dean of the School of Medicine. “His passing is a tremendous loss for the Stanford community and beyond.”

Farquhar founded the Stanford Prevention Research Center and launched a handful of health programs at Stanford, including the Health Improvement Program for faculty and staff, and the Preventive Cardiology Clinic. Outside Stanford, he was a founding member of the International Heart Health Society and a member of the Committee to Prevent the Spread of Cardiovascular Disease into Developing Countries, an effort supported by the National Academy of Medicine. Farquhar was elected to the academy (formerly the Institute of Medicine) in 1978.

Native of Canada

Farquhar was born in Winnipeg, Canada, in 1927 and grew up there until he was 13, when he and his family moved to Pasadena, California. He was an athlete in high school, playing football and soccer. At 16, he won a Golden Gloves amateur boxing competition.

Farquhar attended the University of California-Berkeley, where he earned a bachelor’s degree in medicine, after which he enrolled in medical school at UC-San Francisco. He completed part of his residency at UCSF and part at the University of Minnesota, and then moved east for a fellowship as a research associate at Rockefeller University, where he dabbled in biochemistry, studying diet and blood lipids. In 1962, Farquhar packed his bags and headed west to accept a position as an assistant professor of medicine at Stanford.

Over the course of Farquhar’s first decade at Stanford, which included a sabbatical at the London School of Hygiene & Tropical Medicine, his views on cardiovascular disease began to shift. He was among the first to explore the idea that heart disease was largely attributable to one’s environment.

“Jack was a true pioneer,” said David Maron, MD, clinical professor of medicine at Stanford and director of preventive cardiology. “He understood the relationship between lifestyle and cardiovascular disease.” He was a new kind of investigator, Maron said, whose goal was to change lifestyle by changing communities.

A force for preventive medicine

The first manifestation of Farquhar’s vision debuted in 1972, when he and colleagues Nathan Maccoby, PhD, professor of communication, and Peter Wood, PhD, DSc, professor emeritus of medicine, led the launch of a large-scale field study that aimed to address disease risk by changing the behavior of entire communities. The landmark trial facilitated health-education campaigns and implemented health-improvement tactics, such as programs that offered healthy lunch options at schools, organized community footraces and taught about the dangers of smoking. Initially, the intervention started with three communities. When the National Institutes of Health saw success in those health campaigns, it granted massive funding to the trial that allowed for a new, bigger trial launch in five California cities. It became known as the Stanford Five Cities trial.

“Researchers traditionally randomized individual patients to a new therapy or drug, but here was Jack, randomizing entire cities to receive versus not receive community-based health campaigns,” said Christopher Gardner, PhD, professor of medicine, who trained under Farquhar and holds the Rehnborg Farquhar Professorship. “What Jack brought was really paradigm-shifting; he brought a multidisciplinary approach with a focus on behavior and environment.”

The Stanford Five Cities trial served as a way for Farquhar to promote the importance of community-based intervention and explain the importance of bringing multiple forces to bear in a community to reduce heart-attack risk, said William Haskell, PhD, professor emeritus of medicine at Stanford and friend and colleague of Farquhar’s.

Farquhar made sure that the Five Cities study reached all members of a community. He was particularly cognizant of the importance of diversity and inclusion at a time when the health of most ethnic groups was ignored, said Marilyn Winkleby, PhD, MPH, professor emerita of medicine at the Stanford Prevention Research Center. “Health campaign billboards stood along the highways in Salinas and Monterey in Spanish, and he would have his health column run in the local paper in Spanish,” Winkleby said. “He was thoughtful about subgroups that were often overlooked, especially those that have the highest risk and the fewest resources to enhance their health.”

To effectively carry out the Five Cities trial and what followed — the NIH grant included funds to monitor the cities for 10 years after the health interventions were completed — Farquhar began to recruit experts from a variety of fields, many of whom, such as Haskell, helped him found the Stanford Prevention Research Center.

“Jack may or may not have said so, but he was one of the key academic leaders in the country to put community health research on the map decades ago,” said Marcia Stefanick, PhD, professor of medicine at the center. “He pulled together amazing people who were capable of conducting both lifestyle and drug trials, like the Lipid Research Clinical Trial and Prevalence Study, thereby redirecting preventive medicine.” Even after Farquhar retired, he remained a pillar of the center, attending weekly meetings and providing guidance to the scientists who continued to carry out his original vision.

Fifty years later, the center thrives at Stanford and even has a global reach, helping to support research projects internationally, such as the Global Tobacco Research Initiative, which focuses on ways to prevent tobacco-related disease.

Fierce and compassionate mentor

Farquhar helped launch the careers of multiple researchers at Stanford who are still here today — Maron, Stefanick, Gardner and Abby King, PhD, professor of health research and policy and of medicine, to name a few — through a postdoctoral training program he established in 1975, called the SPRC Research Fellowship Program in Cardiovascular Disease Prevention. Today, Gardner is the program’s director.

“We’re now in our 43^rd year, and if you look across campus there are about 40 of these postdoc training awards, but none are older than Jack’s program,” Gardner said. “More than 100 investigators were trained as postdocs through this program — scores of research scientists who have become leaders in disease prevention and health promotion have emerged from it. You couldn’t calculate Jack’s impact, it’s so widespread.”

Maron, one of the scientists who trained in the center’s program, recounts the first time that he reached out to Farquhar.

“I was a medical student elsewhere in 1980, and I wrote to him to ask if I could do an elective with him and, sight unseen, he agreed to have me visit. It was so generous of him to allow me to have that experience — it gave me my first real foothold in what became my career. He was like a father to me, as I know he was to many others,” said Maron. “Jack was a humble man, he was kind, compassionate, imaginative, generous. Jack was a big dreamer; he had an ability to inspire others, and he made his big dreams come true.”

Among his many awards, Farquhar received the Gold-Headed Cane from UCSF in 1952; the American College of Physicians’ James D. Bruce Award for Distinguished Contributions in Preventive Medicine in 1983; the Dana Foundation Award in 1992; and the Fries Prize for Improving Health in 2005.

Farquhar is survived by his wife, Christine Farquhar, and his two children, Meg and John Farquhar.

A memorial service for Farquhar will be held Aug. 30 at 2 p.m. at Trinity Episcopal Church, 330 Ravenswood Ave., Menlo Park, California.

In lieu of flowers, the family suggests contributions to the John W. Farquhar, MD, SCRDP Postdoctoral Research Fund. The contributions should be sent to the attention of Diana Fox at the Stanford Prevention Research Center, 3300 Hillview Ave., Suite 100, Office 102, Palo Alto, California, 94304-1334.