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Our new president-Daniel K. Podolsky, M.D.

2003; Elsevier BV; Volume: 124; Issue: 5 Linguagem: Inglês

10.1016/s0016-5085(03)00343-3

1528-0012

Lawrence S. Friedman,

History of Medical Practice

Figure It is a privilege and pleasure to introduce the AGA membership to our new president, Daniel K. Podolsky. He is a man of remarkable energy, talent, vision, and creativity and can be counted on to guide the Association capably and wisely. Daniel Kalman Podolsky was born in Detroit, Michigan, on May 17, 1953. He was the third of five children of Harold and Ruth Podolsky, first-generation Americans whose parents had emigrated from Russia in the early 1900s to Detroit via New York. By the time Dan started school, the family had moved to Southfield, Michigan, a suburb of Detroit. Despite the Great Depression, Dan’s father, who attended the Detroit public school system, went on to graduate from Wayne State University Medical School. To earn money for tuition he took a year off during medical school to work as a research assistant, studying the physiology of gastric secretion in dogs and starting the Podolsky legacy of publishing in the gastroenterology literature. He served in the Medical Corps in Europe and Africa during World War II, returned to do a medical residency at the Allen Park VA, and then went into solo practice in Lincoln Park, a working class section of Detroit, where he always kept evening hours to accommodate his patients’ work schedules. He was an old-fashioned GP who practiced general medicine, did surgery, and delivered babies. Once when Dan was learning to drive, Dan’s father pointed to a woman wheeling a baby carriage and proudly observed that he had delivered both mother and child. The first Dr. Podolsky set a shining example for Dan, who recalls his high standards, remarkable integrity, consummate professionalism, and extraordinary caring for his patients. He never overtly encouraged his children to become physicians, but his example sent a powerful message to Dan. He had numerous interests outside medicine—sculpting, art, jewelry design, woodworking, and pottery—and instilled in his children an appreciation of the arts. Dan’s mother Ruth had her hands full raising five children but made sure they had a rich and varied social network of family and friends. The family was close-knit, and remains so; to this day Dan stays in close contact with his siblings—Morris, an ophthalmologist in New York; Arnold, first an anesthesiologist and now a lawyer in Detroit; Maribeth, a glass manufacturer in Philadelphia; and Jonathan (the youngest and the spitting image of Dan), a real estate developer in Detroit—and the family often gets together for holidays and vacations. Dan’s mother recalls that “Danny” was headstrong from the start; at age 3 he told Santa Claus, “I don’t believe on (sic) Christmas!” And when Dan was in grade school, she was always being called to the school because he was disruptive in class (apparently because he finished his work faster than anyone else—an enduring trait); the problem was solved when Dan was given a job in the school library, which he could go to when his work was done. Greater Detroit was an exciting place in which to grow up in the 1960s. Not only was the automobile industry thriving, but the Motown music industry had also begun its meteoric rise. Young Dan and his friends frequently caught some of the great acts—Aretha Franklin, Smokey Robinson, the Temptations, and even Jimi Hendrix—and Dan has since had a love of music. He still boasts a huge collection of jazz and blues albums. Not surprisingly, Dan was a superb student. His best friend from boyhood, Alan Solway, recalls that by the eighth or ninth grade, it was clear that Dan had far surpassed everyone else in the class. “He never brought his books home the night before a test,” notes Alan, now an ophthalmologist outside Detroit. “He already knew the material. And he read voraciously; what they didn’t teach him in school, he filled in by reading, and he always remembered everything he read.” He was on his high school’s debate team and once went to the state championship; his debating skills have not diminished with time. On Sundays he arose at 3 am to deliver bagels and thus began another lifelong Podolsky habit—rising early in the morning. He once remarked to our colleague Bernie Aserkoff that he eventually took up running because there isn’t much else to do between 3 and 4 am. Because of his extraordinary scholastic record, Dan was accepted to Harvard College with advanced standing as a sophomore. He planned to major in science and decided to begin doing research the summer after starting college. Through his cousin Jay Shumaker, a fellow in gastroenterology, he was introduced to Milton M. Weiser and Kurt J. Isselbacher, the legendary Chief of the Gastrointestinal (GI) Unit at the Massachusetts General Hospital (MGH). Kurt was skeptical of having undergraduates in the Unit because they did not stay long enough to complete meaningful work, but Dan persuaded Kurt and Milt to give him a chance. Perhaps the decisive factor was that Milt was another native of Detroit. Weiser, who recently retired as Chief of the Division of Gastroenterology at the State University of New York in Buffalo, recalls his early impressions of Dan. “He was brilliant, careful, studious, and competitive, and he had a photographic memory. But he had no airs, and he was a lot of fun. We were both movie buffs, and he seemed to know every line from every movie.” Dan’s project focused on a method to select differentiated from undifferentiated intestinal epithelial cells using lectins. Dan not only completed the work, but he also published the results in the Journal of Cell Biology and continued his research in the GI Unit through college and beyond. He has, in fact, been with the GI Unit at MGH continuously for 32 years, since age 18. Dan’s performance at Harvard was spectacular. After 3 years, he was graduated summa cum laude. His senior thesis, done under the mentorship of Weiser and Roger Jeanloz, Professor of Biological Chemistry at Harvard Medical School and an authority on carbohydrate chemistry, dealt with the role of glycosyltransferases in epithelial differentiation. At graduation, Dan received the L. J. Henderson Prize for the top thesis in biochemistry. To close the circle, Dan recently served as a mentor to one of the last students to study under Professor Jeanloz, who is now retired. By now, Dan was a valued member of the GI Unit and had his own technician. There was no question in Kurt Isselbacher’s mind that Dan needed to stay at Harvard for medical school. Even as a student, Dan often came to work in his laboratory in the wee hours of the morning, before classes or rounds. He continued to excel in medical school, was graduated magna cum laude, and at graduation received the Leon Reznick prize for outstanding research. His medical school roommate, Bruce Van Boeckel, now an internist in western Massachusetts, recalls that in medical school it was clear that Dan was brilliant and focused. Yet he found time to enjoy himself and even “party” on Saturday nights. “He was a regular guy, a complete person.” Most importantly, he met the love of his life and his future wife at Harvard Medical School. In many ways Carol Plesser was the opposite of Dan Podolsky. An only child whose parents had lost many family members in the Holocaust, Carol had attended Hunter High School, an exclusive Manhattan preparatory school, and Cornell University. At Harvard Medical School, she had not even met Dan during the first year; she sat at the front of the class, paid careful attention, and always used all the time given to complete a test. Dan would breeze into class, often late, sit in the back of the room, and always finish tests before anyone else; he would use the extra time to go to his lab. Fate intervened when, because of the alphabetical proximity of their last names, they were paired in their physical diagnosis course during the second year of medical school. Because the instructor spoke in a whisper, they often found themselves leaning forward—and toward each other—to hear him. The rest, as they say, is history. Carol and Dan were married just before graduation, and they celebrated their 25th wedding anniversary this year. After graduation, Dan did his medical residency at MGH, while Carol did a pediatrics residency at Boston Children’s Hospital, followed by a fellowship in adolescent medicine. Internal medicine residencies had just been lengthened to 3 years, and Dan became one of the first “short-trackers” when he began his gastroenterology fellowship at MGH after 2 years of medical residency; after 9 years in the GI Unit, Isselbacher was not about to let him go! Through his residency and clinical fellowship, he continued to run an active laboratory in the GI Unit, still coming in before sunrise and before rounds. Dan’s residency program director, George Thibault, now Vice President for Clinical Affairs at Partners HealthCare System, recalls that Dan was a superb resident despite running an active lab throughout his residency. “I don’t think he ever slept!” Barbara Nath, Dan’s co-fellow, recalls, “He worked all the time; he seemed to have 5 jobs, only one of which was being a GI fellow. I only saw him on rounds, but he always did his work, and he did everything brilliantly.” This was a golden age of the GI Unit under Isselbacher. In addition to Weiser, young faculty and fellows included Bob Glickman, Tom LaMont, Jack Wands, David Shafritz, Kay Tanaka (who had worked out the pathways of maple syrup urine disease and Jamaican vomiting sickness), Allan Walker (later Chief of Pediatric Gastroenterology at MGH, Children’s Hospital, and Harvard Medical School), Elliot Alpert, and shortly thereafter Jules Dienstag. Steve Goldfinger had just reported the benefit of colchicine in familial Mediterranean fever. Chester Jones, Isselbacher’s predecessor as chief, founder of the GI Unit in 1925, and like Isselbacher a past president of the AGA, was at the end of his career, and stalwarts Bob Schapiro and Bernie Aserkoff carried the bulk of the clinical load. LaMont, who was a first-year fellow when Dan began working in the laboratory, recalls “his boundless energy, quick wit, and apparently unlimited enthusiasm for science.” Dan’s phenomenal ascent continued, and within a year and a half of starting his GI fellowship, he was made an Assistant Professor of Medicine at Harvard Medical School. Dan’s early work explored intestinal epithelial differentiation and the control of proliferation. He also studied the role of glycoproteins, although he ultimately concluded that their complex structure resisted a ready analytical approach to fully understanding their function in the intestine. However, in studying glycoproteins he discovered characteristic alterations in patients with ulcerative colitis, thereby paving the way for current concepts about altered barrier function of the gut as a susceptibility factor for inflammatory bowel disease. In collaboration with James Madara, he also discovered similar glycoprotein abnormalities in the cotton-top tamarin, a naturally occurring animal model of colitis that recapitulates the natural history of human ulcerative colitis, including the development of colon cancer. This work ultimately led to the recognition that integrins and other adhesion molecules play a pivotal role in the inflammatory process and that administration of antibodies that block integrins has an ameliorating effect on colitis. This work paved the way for current trials of anti-integrin antibodies in inflammatory bowel disease. Dan’s work on the control of intestinal epithelial differentiation and proliferation led to the discovery and recognition of the importance of various growth factors and regulatory peptides in intestinal repair and healing in a variety of disorders. Among these peptides was intestinal trefoil factor, a previously unrecognized protein that Dan characterized, including cloning of its gene. Study of the trefoil factors, which are critical to sustaining mucosal integrity and promoting repair, continues to be a major focus of his laboratory group. Ramnik Xavier, a former fellow and colleague in the MGH GI Unit, notes, “the observations about trefoil proteins made by Dan’s lab have been a major contribution to gastrointestinal research and have served as a stimulus for the study of the trefoil factor family by many laboratories around the world.” The therapeutic implications of his work on trefoil peptides extend to nonsteroidal anti-inflammatory drug-induced gastropathy, chemotherapy-induced mucositis, alcohol-induced gastropathy, peptic ulcer, infectious diarrhea, and inflammatory bowel disease. Over the past few years, Dan’s laboratory has also become a leader in exploring the role of the epithelial cell in innate immune responses and in understanding important interactions between epithelial cells and the intestinal microflora, including the role of the NOD2/CARD15 gene product in the pathogenesis of Crohn’s disease. In addition, Dan directs a broad-based multidisciplinary program in inflammatory bowel disease, world renowned for its contributions and funded through the Digestive Disease Centers Program of the National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK). The center conducts a spectrum of research ranging from basic mechanisms of immune response and mucosal biology to translational and patient-related studies. No less pioneering an investigator than Kurt Isselbacher, one of Dan’s great mentors, marvels at Dan’s scientific accomplishments. “He has an uncanny ability to recognize the potential importance of unexpected observations. He is an incisive and insightful thinker, with a penetrating intellect; he immediately grasps the essence of an issue.” Anil Rustgi, a former fellow and colleague at the MGH and now Chief of the Division of Gastroenterology and Hepatology at the University of Pennsylvania School of Medicine, praises Dan as a “pioneer in basic science research of intestinal epithelial biology, regulation of cytokine gene expression, mucins and intestinal trefoil factors, and inflammatory bowel diseases.” In 1989, Dan succeeded Kurt Isselbacher as chief of the GI Unit at MGH when Kurt became director of the newly created MGH Cancer Center (Figure 2). Though seemingly destined for this position from the day he set foot in the GI Unit, Dan was only the third chief in the Unit’s history and, at age 35, quite young for a position of such eminence, especially by Harvard and MGH standards. Later he would also become the Mallinckrodt Professor of Medicine at Harvard Medical School. He wasted little time in enhancing the clinical and endoscopic faculty, expanding the facilities, strengthening the fellowship training program, and fostering both basic and clinical research. Through personal efforts, he successfully recruited the cadre of fine “private” practitioners—Bob Schapiro, Bernie Aserkoff, Peter Kelsey, Barbara Nath, and Cheryl Bunker—to join the full-time faculty. This single accomplishment most impressed his predecessor Kurt Isselbacher. “It set the stage for greater participation by the GI Unit in controlled and multicenter trials.” He then recruited Bill Brugge, who introduced endoscopic ultrasonography to the Unit and later succeeded Schapiro as Director of Endoscopy, and Larry Friedman, to help with fellowship training and medical education. Dan himself began the practice of holding “Chief’s rounds” with the fellows once a week at which he methodically reviews all aspects of academic career development: planning research, obtaining grants, writing and publishing articles, presenting at national meetings, joining societies, understanding the economics of practice, and myriad other topics. As the clinical practice in the GI Unit grew, Dan pressured the hospital for more space and resources, culminating in 1997 in a new 20,000 square foot office/endoscopy complex that is a model of its kind. Clinical and endoscopic volume exploded; in the past 5 years alone, endoscopic volume increased from 7000 to 22,000 procedures a year! In addition to supporting Brugge, Kelsey, and Schapiro in expanding the range of advanced interventional endoscopy services, he encouraged Norm Nishioka to pursue research in photodynamic therapy and optical coherence tomography. Subsequently, an advanced fellowship was started by Bill Brugge and Dan in collaboration with David Carr-Locke at the Brigham and Women’s Hospital. With Bruce Sands, Dan expanded clinical activities in inflammatory bowel disease through the Center for the Study of Inflammatory Bowel Disease, with participation by additional faculty, including Scott Snapper, Ramnik Xavier, and Richard Hodin, a colorectal surgeon. He also established a High-Risk GI Cancer Center, led initially by Anil Rustgi and then by Dan Chung. He encouraged Lee Kaplan to develop and lead the very successful multidisciplinary MGH Weight Center. With Jules Dienstag, he established a Liver-Biliary-Pancreas Center and expanded the liver transplant program, now under the direction of Ray Chung, with a growing faculty that included Dienstag (who now serves as Dean of Admissions at Harvard Medical School), Andrea Reid, Michael Thiim, and colleagues from the Brigham and Women’s Hospital. He began a clinical motility center, now under the direction of Brad Kuo. And he increased the faculty with the addition of Diane Abraczinskas, Brenna Bounds, Chin Hur, Myles Keroack, Vijay Yajnik, and Ben Stanger. All this was done while his own research program flourished; 60 or more postdoctoral fellows (in addition to the more than 50 clinical fellows) came from all over the world to work in the Podolsky laboratory. In addition, he has authored or co-authored more than 150 original articles in high-quality peer-reviewed journals as well as many reviews and chapters in leading textbooks of gastroenterology and internal medicine. Despite the remarkable expansion of the GI Unit, Dan was always careful to recruit people who would get along well with each other and who would pursue excellence in their respective areas of interest. He provided opportunities and support but never forced people to do anything they were not inclined to do. Scott Snapper describes Dan’s approach to building the GI Unit as “searching for outstanding people with a serious academic interest.” This overriding philosophy has served the Unit well and has created what Ray Chung describes as a “culture of excellence.” Bernie Aserkoff recalls his surprise at his first meeting with Dan as chief of the GI Unit when Dan opened by asking, “What can I do for you?” “This is a reflection, Bernie says, “of how much Dan cares about the people who work for him.” On the other hand, “he’s a tough negotiator. Don’t try selling him endoscopes,” remarks Bernie; “he’ll hold out for the absolutely lowest bid.” Patricia Stevens, the Administrative Director of the GI Unit, concurs. “He has a good sense of how to make a practice profitable. He knows when a program or project should be supported and when it should be self-sufficient.” She marvels at his business acumen. “He can process numbers and business concepts quickly; he’s an administrator’s dream!” Observes elder statesman Bob Schapiro, “he sees the big picture, grand concepts. He listens to all opinions, but he makes the final decision himself. Most importantly, he keeps his promises.” Adds Barbara Nath, “he is profoundly honest,” a characteristic praised as well by Scott Snapper, who lauds Dan’s “tenacious honesty and personal integrity.” Norm Nishioka concludes, “Dan is a wonderful leader. He never takes his eye off the big picture for the GI Unit. I am in awe of him.” This sentiment is echoed by many. Dan’s faculty and fellows admire his teaching skills, mentoring, and personal interest in them. Brad Kuo notes, “Dan has great insight into how to develop an academic career; he spends time with fellows and junior faculty instructing them on how academics and research work.” Comments Dave Forcione, a senior fellow, “When you think of all that he’s accomplished in a short time, you may be intimidated. But he has the ability to recognize someone’s talent, and he goes to great lengths to nurture those talents.” Jerry Evans, a first-year fellow, was particularly impressed that Dan even helped his wife (and many other spouses of fellows and faculty) find a job. Perhaps more than any other responsibility, Dan has valued his role as program director in training GI fellows and guiding them in pursuing their career goals. More than 50 former Podolsky GI fellows have gone on to eminent positions in gastrointestinal research, practice, and education, and several are chiefs of academic divisions of gastroenterology. Among these is Jake Liang, a former fellow and colleague in the MGH GI Unit and now Chief of the Liver Diseases Section at NIDDK, who recalls receiving astute advice from Dan over the years and notes that “he expects nothing less than the best from those around him.” Dan’s administrative responsibilities at MGH extend well beyond the GI Unit. Among his numerous jobs, he is also vice chair of the Department of Medicine, chair of the MGH Executive Committee on Research, a member of the Partners HealthCare System Research Committee and Partners Research Council Strategic Plan Task Force, and a member of the Harvard Medical School Appointments and Promotions Committee. Perhaps no one appreciates Dan’s contributions to MGH more than Dennis Ausiello, Jackson Professor of Clinical Medicine and Physician-in-Chief at MGH, who praises Dan’s “ability to synthesize complex information about systems and creatively come up with a plan to move forward better than anyone else I know.” He notes that Dan has been the architect of a council system for the governance of the Department of Medicine, interdepartmental research centers, practice management reforms, and various educational programs at MGH. Tim Wang, a former fellow and member of the MGH GI Unit and now Chief of the Gastroenterology Division at the University of Massachusetts Medical Center, observes, “There are few individuals who do as many things as well as Dan. He is the standard by which the rest of us are now judged.” Steve Goldfinger sums up Dan’s impact on his colleagues at MGH this way: “We consider ourselves especially lucky because he fulfills every role one could desire of a leader: deep interest in advancing the careers of his colleagues, a master planner for the future whose strategies always evolve from broad consultation and consensus, and a constant source of wisdom and encouragement. And with all this, Dan also possesses a modesty and humanity that make it hard for him to acknowledge anything resembling an accolade.” Fellow Bostonian Tip O’Neill used to say that all politics is local. The same is true for reputations in medicine, and at MGH Dan is known as a superb clinician. He sees patients in the office regularly, attends on both the gastroenterology consult and inpatient medical services, and only recently gave up his primary care practice to focus on inflammatory bowel disease and challenging GI cases. He does screening colonoscopies and takes call with the rest of us. Senior endoscopy nurses Sandy Hession and Jane Harker note how Dan leads by example. “He works in the trenches. He’s inclusive, open to suggestions from the entire staff, and receptive to new ideas. He brings everyone together.” Dan’s clinical savvy and judgment are highly refined; he can handle the most complex medical cases and deal with challenging psychological issues posed by a patient with the type of “end-stage” functional disease that reaches the chief of GI at the MGH. He has tremendous clinical acumen and is the clinician we often turn to for advice about difficult cases. His commitment to his patients is especially inspiring. Says Peter Kelsey, “He is the most demanding clinician in his thoroughness and respect for his patients. He is unwavering in the responsibility he feels toward his patients.” Bernie Aserkoff adds, “He goes out of his way to make care better for people.” Dan has been active in the AGA since the early 1980s, with a gamut of activities that span research, training, practice, and leadership. He views his foremost contributions as centering on promoting research and supporting the career development of young people in gastroenterology. He takes a long-range view of research support as a means of advancing clinical practice. He has been chair of the AGA’s Research Policy Committee and Vice President for Research of the Foundation for Digestive Health and Nutrition. These roles have been enhanced by his prior experience as a member of the Advisory Council of the NIDDK. He is also currently a member-at-large of the National Scientific Advisory Committee of the Crohn’s and Colitis Foundation of America. For 10 years Dan was a member of AGA’s Undergraduate Teaching Project and enjoyed collaborating with eminent colleagues in producing superb slide sets and teaching materials. Bob Greenberg, Executive Vice President of the AGA, has worked closely with Dan on AGA activities for many years and observes, “Dan is very smart, quick to identify issues and their long-term implications, but also decisive. He is willing to make decisions and stand by them when they are right and change them without agonizing over them when change is warranted. He has internalized the values of the AGA and has the ability to apply these values to new challenges and opportunities in a way that will enable the AGA to continue to face the future with confidence.” Dan recently completed a highly successful term as editor of AGA’s flagship journal, Gastroenterology. During his tenure, he introduced several new features, including “Comment From the Editors,” which gave him and the associate editors the opportunity to “sound off” on issues of importance to the readership, from research funding, to screening colonoscopy, to underdiagnosis of celiac disease, to declining reimbursement. The look of the journal changed with a new cover design featuring a distinctive photograph from one of the articles and bundling of clinical articles and research articles separately. The quality of the science remained excellent, and the impact factor of the journal continued to rise. All who worked with Dan on the journal admired his critical thinking, commitment to scientific excellence, fairness, and superb editorial abilities. Tom LaMont, now chief of the Division of Gastroenterology and Hepatology at the Beth Israel-Deaconess Medical Center in Boston, served as Senior Associate Editor of Gastroenterology during Dan’s tenure as editor and describes him as a “true polymath, with a very broad and deep grasp of many areas. His vast command of the scientific literature coupled with his unique talent for organization and leadership made him a terrific editor.” LaMont further notes, “Dan excels as a basic researcher, journal editor, bedside physician, teacher, mentor, and chief of one of the premier GI divisions in the world. The AGA is fortunate to have a leader of Dan Podolsky’s stature as its President. He knows what’s important to our specialty and our science and how to guide us through these turbulent and challenging times.” As AGA president, Dan’s goals will be to (1) ensure that the AGA remains committed to supporting the clinical practice of gastroenterology and strengthen programs to support the practicing gastroenterologist; (2) advance research and invigorate the research agenda; (3) recognize the importance of the AGA to gastroenterology throughout the world and foster international relations; and (4) advocate for academic medicine at a time when it is under siege because of financial pressures, unfunded mandates for training, and centrifugal forces that threaten to dissociate the opportunities provided by mapping of the human genome from translation of these advances into practice. At the heart of this agenda is Dan’s conviction, epitomized by the GI Unit at MGH, that research and training nurture clinical practice and that the ultimate goal for all members of the AGA is excellence in clinical gastroenterology. There are many superlatives that can be applied to Dan but none that would give him greater satisfaction than “family man.” Although we in the MGH GI Unit view ourselves as part of his extended family (all 250+ of us, counting physicians, researchers, nurses, secretaries, technicians, and our families, get together each year for the beginning-of-the-year picnic at the Podolsky’s home in Wellesley and the holiday party at the Wellesley College Club), Dan takes greatest pride in his own family (Figure 3). Carol is now the pediatrician to the Newton school system. Their children are Matt, age 20, who is finishing his sophomore year at Harvard, where he is majoring in history and government; Mike, age 17, who is a senior at Roxbury Latin, a computer whiz, and budding jazz guitarist; and Anna, age 14, who is a freshman at the Winsor School, where she’s turned from accomplished gymnast to serious fencer. An invitation to the Podolsky house is a treat, and among Dan’s special talents are gourmet cooking—from homemade sushi to matzo balls that are as good as Grandma’s—an impressive wine collection, and the ability to converse knowledgeably about almost anything. And then there is the famed Podolsky wit—the stories, anecdotes, quotes, and quips that come from half a lifetime of experiences, worldwide travel, an insatiable appetite for books, a photographic memory, and a passion for the New Yorker. He once quipped, “You’re supposed to see problems as opportunities. However, some problems are just problems.” With Dan Podolsky as president of AGA, we can predict with confidence that he will turn problems into opportunities and opportunities into solutions.