Our New President—C. Richard Boland, MD
2011; Elsevier BV; Volume: 140; Issue: 5 Linguagem: Inglês
10.1053/j.gastro.2011.03.038
ISSN1528-0012
Autores Tópico(s)Health and Medical Research Impacts
ResumoDuring Digestive Disease Week in Chicago, Illinois, in May 2011, C. Richard Boland, MD (Figure 1), will become the next president of the American Gastroenterological Association (AGA) Institute. Rick in many ways has the perfect balance of life experiences and career—a man shaped by his exposure to a disease within his family while growing up and ultimately finding the cause of it later in life—to lead our distinguished organization. Rick's stellar career to date has had him caretaking Native Americans and veterans of the US armed forces, as well as diverse gastroenterology and hereditary cancer patients. His research work is groundbreaking and world-renowned and has led to a better approach toward genetic testing of high-risk cancer patients. He has led two gastroenterology divisions, one research-based and one more clinical, and thus knows the challenges and impact of both. His commitment toward the field of gastroenterology shows in his extensive involvement with the AGA, which he is now poised to lead. He is also the consummate husband and father, athlete, music lover, friend, and mentor, someone everyone can talk to no matter the issue, and promises to be a visionary guide of our organization for the upcoming year. His interactions and keen understanding bridge the generations of gastroenterologists and hepatologists in practice today. In our view, the AGA will be very proud to have Rick lead the organization.UpbringingRick's father was a pediatrician, a graduate of Georgetown Medical School and the 12th of 13 children. Rick's paternal grandfather died when his father was 6 years old, leaving his father to be raised by his mother and older siblings. Rick's mother, the daughter of a Catskills inn owner, was a homemaker and married his father during his fourth year of medical school (she was in the women's naval corps during World War II stationed in Washington, DC). His father pursued a pediatric residency in Johnson City, New York, near his mother's birthplace, and ultimately settled in a pediatric practice and became a pillar of the community. Rick, the second eldest of 4 siblings, was born on October 19, 1947, in Johnson City and grew up in nearby Endwell, a town of approximately 12,000 people. Rick was named after his father (the C in his name stands for Clement, which his father was called, while Rick was called by this shortened version of his middle name). Before Rick's birth, his father entered into the military service, and was sent to Italy where he became ill from what was believed to be an ulcer. Upon his return to the United States in 1946, it was discovered at surgery that his father had stage III colon carcinoma originating from the cecum, at the age of 26 years. The surgery cured his father for another 23 years, and allowed him to live life and practice as a pediatrician.Although Rick's father worked until 8 or 9 pm, his family grew up very close. Family vacations were to the New Jersey shore or Cape Cod, and were wonderful opportunities to spend more time with his busy father. Rick's love for athleticism came from his father's elite achievements in sports. Rick participated in track, cross-country, and swimming teams throughout high school, but became more of a regular runner in his 30s. He still runs to this day. Rick graduated from Maine-Endwell High School, being one of the top students out of a class of 351 students and excelling in the sciences. He won the local science fair with his passion for wanting to understand what was inside a living organism. Because of this passion, the only Christmas gifts he remembers growing up were a microscope and dissecting kit at age 13 from his parents.Education and TrainingRick enrolled at the University of Notre Dame after a discussion with his proud Irish Catholic father. Notre Dame was initially all male, but later became coeducational after Rick's graduation. Rick enrolled in the pre-med major, but switched to liberal arts to improve his reading and writing education while maintaining his pre-med requirements. College was fun, a place to learn about a lot of things, and Rick would lose himself in the library stacks. Rick would visit back home in New York during Christmas and Easter breaks. During summers, Rick worked as a mason tender—building scaffolding, shoveling mortar, and carrying cinder blocks and bricks. Rick later graduated magna cum laude from the University of Notre Dame.Rick's father served as his initial physician role model for going to medical school, with his own internal drive taking over that challenge later. Rick applied to his father's alma mater, Georgetown Medical School, but his pre-med advisor suggested that he also apply to Yale Medical School based on his scholarship. With the blessing of his father, Rick accepted Yale's admission offer over Georgetown, even though the tuition was higher (about $2500). Rick was 1 of 77 men and 8 women in his medical class. Yale Medical School had an unstructured curriculum with no tests, but students had a thesis requirement and had to pass parts 1 and 2 of the National Boards. Rick thrived in this environment, learning voraciously. Yale specialized in preparing medical students for academic careers, and many of his classmates became division chiefs, department chairpersons, or deans (eg, George Lister, Bob Bucholz, Lee Goldman, Jerry Rosenbaum, David Bailey, Rick Young, and so forth). At the time Rick entered medical school (1969), he realized that many diseases had unknown causes, and there were little effective therapies for them. His want for more longitudinal patient relationships helped him decide to pursue internal medicine over surgery for a career. His interests in helping his fellow men led him to perform an 8-week rotation in New Mexico caring for Native Americans during the summer between his first and second years. In addition to his father's illness, Rick's influence toward gastroenterology and hepatology came from some of his professors at Yale, such as Jim Boyer, Gerry Klatskin, and Howard Spiro.There are two events that happened in 1970 during medical school that changed Rick's life forever, and influenced his career and livelihood. During Rick's first year of medical school, his father became ill. At the age of 49, his father was discovered to have two synchronous cancers in his proximal colon, with metastasis to his liver. He died in July 1970. Rick's father's death not only influenced his career into examining his family's medical history, but also ended the financial support for Rick to complete medical school. Scholarships, loans, and ultimately a Public Health Service scholarship allowed Rick to complete his medical studies. Second, after his sophomore year at Notre Dame, Rick met his future wife Pat, marrying her in September 1970, a few months after his father's death. Rick was smitten by Pat, admiring her intelligence and discipline. Pat is not only Rick's wife, but lifelong friend, and has provided support for all aspects of Rick's personal and professional development and achievements since their marriage. Rick and Pat have 3 children, all girls. Tara, the eldest, is a high school teacher in San Francisco (and is the mother of Rick and Pat's first grandchild, Elliot); Maureen, the second eldest, has a Master's degree in public health and is the director of a free women's clinic in San Francisco; and Brigid, the youngest, is an MD graduate from the University of California San Francisco (UCSF) and currently a gastroenterology fellow at the University of California San Diego (UCSD) (Figure 2).Figure 2From Left to right in December 2010: Brigid, Elliot, Tara, Rick, Pat, Maureen, and Rich Maggiotto (Tara's husband).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Rick's MD thesis, entitled “A Familial Cancer Syndrome” and published by Yale University Press in 1973, focused on his family's medical pedigree. At the time, it became apparent to Rick that a potential hereditary form of cancer was likely in his family, but there was no knowledge at that time of any such syndrome. In addition to Rick's father, who had synchronous and metachronous proximal colon cancers before age 50, Rick's paternal grandfather had colon cancer at the ages of 27 and 45. Many of the 13 siblings in Rick's father's family had endometrial, ovarian, brain, colon, and stomach cancers, most at younger than age 50, and Rick's paternal grandfather's family showed evidence for colon cancer, including Rick's paternal great grandfather, at the age of 41. These facts ultimately drove Rick to try to understand what was happening in his family, an answer that came decades later through initial research from others as well as direct discovery of the cause within his own laboratory.Rick's acceptance of a Public Health Service scholarship during medical school committed him to spend 2 years with the Public Health Service after his internship. After doing his internship at St. Francis Hospital in Hartford, Connecticut, Rick decided that going back to New Mexico was the ideal way to complete his general medical officer commitment. He (and Pat) moved to Gallup, New Mexico, for the Indian Health Service, where he was a key provider for Native Americans with meager access to health care. General medicine was the norm, but so were obstetrics and Cesarean sections, assistance with appendectomies and cholecystectomies, among others. In many ways, at this stage in his life, Rick was very much like his father, caring for patients and being the pillar provider for a local community.Rick applied back at St. Francis to complete the remainder of his internal medicine residency, but was attracted to San Francisco and the excellent tradition for medical training at UCSF. His potential chairman at St. Francis, Steve Sulavik, suggested he consider an academic career, and hoped that he rejoin St. Francis. Although there was no open position at UCSF, the pre-eminent institution in San Francisco, Rick had the opportunity to join the Public Health Service Hospital in San Francisco, and took it. While there, his office was next to the chief of gastroenterology, Mark Rosenberg, with whom he became good friends. Rick began to craft out a career path toward academic gastroenterology, and set out “to know more about colon cancer than anyone on earth.” From his residency, Rick was able to take all of his electives at UCSF, which allowed the UCSF gastroenterology faculty to get to know him before he applied for fellowship. Rick joined UCSF as a gastroenterology fellow, doing 1 clinical year (training with John Cello and others) followed by 2 subsequent years in the laboratory of Young Kim, one of the country's pre-eminent colon cancer researchers. Young Kim's laboratory focused on cell membrane glycoproteins, and Rick's strong desire to understand colon cancer led him to have faith that his work in Young's laboratory eventually would lead him to an answer regarding hereditary colon cancer. Young's laboratory was teeming with basic researchers interested in gastrointestinal oncology, and Rick helped train the likes of Steve Itzkowitz and Bob Bresalier there, as well as associating with others in the laboratory such as Peter Lance.Career as a Physician and Scientist and LeaderRick quickly began his research investigative career, and obtained his first grants from the National Institutes of Health (NIH) and the Department of Veteran's Affairs (VA). His first article from Young's laboratory was published in the Proceedings of the National Academy of Sciences of the United States of America, and showed how malignant transformation in the colon could be monitored by changes in goblet cell mucin. After publishing several additional manuscripts, and having been on the UCSF faculty for 3 years after completing his fellowship, a dynamic young division chief serving under Bill Kelley, Tachi Yamada, recognized Rick's potential and recruited Rick to the University of Michigan. Although two of Rick and Pat's three girls were born in San Francisco (the elder having been born in the Indian Health Services Hospital in New Mexico), they were raised in Ann Arbor, Michigan. Tachi's personality was magnetic, and it was clear that good things would happen at Michigan. Rick was hired as the Gastroenterology Section Chief at the Ann Arbor VA, 3 years after completing his fellowship. Rick progressed up the academic ladder at Michigan, and clearly showed outstanding clinical and teaching prowess, in addition to his research in colon cancer.During the late 1980s, Rick began reading newly published articles regarding mutated oncogenes that were driving cancers, and was intrigued by remarkable data coming from Bert Vogelstein's laboratory at Johns Hopkins. Genetics, not glycoproteins, appeared to be key in the pathogenesis of cancer. In 1990, Rick took a 6-month sabbatical in the laboratory of Andy Feinberg, Vogelstein's first postdoctoral fellow, who was a faculty member and Howard Hughes investigator at Michigan. While on sabbatical in Andy's laboratory, Rick learned and honed microdissection techniques from paraffin-embedded tissues to use polymerase chain reaction to identify genetic changes, a concept that was completely novel at that time. He began to amplify repetitive DNA sequences called microsatellites, which later proved to be a key in understanding hereditary colon cancer, particularly Lynch syndrome. From this point onward, Rick completely changed the focus of his laboratory. While using microsatellites as markers, 3 key reports were published in 1993 that linked hereditary colon cancer to microsatellite alterations, and soon thereafter the first mutations of DNA mismatch repair genes were found linked to Lynch syndrome. While this revelation unfolded, Rick was at the forefront as his laboratory created the first in vitro models of Lynch syndrome. His pioneering microdissection technique to assess genetic changes was published shortly thereafter in Nature Medicine. The new focus of Rick's laboratory coincided with marked strides in understanding the genetics of colon cancer, and Rick's laboratory was near the center of it all. Ground-breaking discoveries regarding clinical, translational, and basic research on DNA mismatch repair and Lynch syndrome were published in Science, Gastroenterology, Journal of Clinical Investigation, Journal of the National Cancer Institute, Proceedings of the National Academy of Sciences of the United States of America, Cancer Research, Nature, and Journal of Biological Chemistry, among many others. Rick's contribution toward understanding hereditary colon cancer cannot be overstated. He helped standardize criteria for determination of microsatellite instability, the biomarker of defective DNA mismatch repair. This work, published in Cancer Research, has more than 2000 citations. Rick has a long friendship with, and has received mentorship from Henry T. Lynch, the oncologist-epidemiologist who tracked and studied families with hereditary colon cancer before any of the genetics were known. Rick and Henry's outstanding review of Lynch syndrome (Rick coined the terms Lynch syndrome I and II), published in Gastroenterology before the discovery of the genes involved, has more than 800 citations. He has published more than 300 peer-reviewed manuscripts. Rick continues to maintain an active and creative research laboratory that is funded by competitive NIH grants.In addition to Rick's stellar investigative career to date, he is an outstanding clinician, and has a large referral practice that focuses on hereditary colon cancer. He is also an outstanding teacher and mentor to many former fellows and clinicians, as well as researchers. Examining Rick's list of trainees is staggering in what many are doing today, often years after being under his mentorship. There have been multiple division chiefs, a chair of medicine, the President of the Israeli Gastroenterological Association, residency and fellowship directors, and leaders of key programs at universities. There are surgeons, gastroenterologists, pediatricians, and visitors from several continents that have come to train with Rick. Rick has touched the lives of at least 57 scientists (excluding multiple students), many of whom are thought of as leaders today. What is most impressive is that not only did Rick mentor them as researchers, he mentored their careers. His laboratory has trained the likes of the two authors of this biography, John Carethers and Ajay Goel, but also Steve Itzkowitz and Bob Bresalier (as previously mentioned), Jim Scheiman, Mike Kochman, Mary Hawn, Sherry Huang, Chris Arnold, Juichi Sato, Dong Chang, Christoph Gasche, Yaron Niv, Giancarlo Marra, Luigi Laghi, and Erica Villa, among many others. His mentorship to students has also been transformative. One particular student, Matthew Yurgelun, joined Rick's laboratory, and cloned and helped develop an assay to detect the previously undetectable DNA mismatch repair gene mutation that was the cause of Rick's father's early cancers. Thus, science completed the clinical circle that defined Rick's family medical pedigree. His fortuitous embarkment on an academic medical career many years before that began with his MD thesis culminated with an answer to his father's young death.Rick's curiosity did not end with the beginning of an understanding of Lynch syndrome or DNA mismatch repair. A chance discussion with the late luminary Jim V. Neel at the University of Michigan sparked a line of investigation into a viral cause for sporadic colon cancer. Rick has defined this field in gastroenterology, which has led to multiple insightful publications showing that JC virus infects the gastroenterology track, and variations of the virus (JC virus) is associated with colon cancers.With all of Rick's accomplishments and astuteness for clinical work, teaching, and research, it was to be expected that he would be recruited to leadership positions, where he excelled. From the University of Michigan where he was Gastroenterology Section Chief at the Ann Arbor VA Hospital, Steve Wasserman, then Chair of Medicine at UCSD, recruited Rick as Division Chief of Gastroenterology, and Rick succeeded the late Jon Isenberg. There, Rick made several recruitments to the VA and UCSD in areas of hepatology, motility, cancer, mucosal immunology, as well as clinical gastroenterology. Rick also was involved in the UCSD Cancer Center, and became an Associate Director for Clinical Research, helping it achieve its National Cancer Institute–designated “comprehensive” status. After more than 8 years at UCSD, John Fordtran recruited Rick to head up a gastroenterology research laboratory and the clinical division at Baylor University Medical Center in Dallas, Texas. Rick's move there afforded him more time to devote to his research while simultaneously allowing him to grow a comprehensive clinical and translational hereditary colon cancer program. Rick's line of research remains one of the more prominent in the field of colon cancer research, and his contributions toward the genetics and clinical understanding of hereditary colon cancer remain profound.AnecdotesRick's long marriage to Pat and his relationship with his adult daughters remains phenomenal. His younger daughter Brigid is on track to become the next gastroenterologist in the family and is currently a fellow at UCSD. Rick continues to run daily early in the morning, often with Pat. When Rick was at the University of Michigan, he lived next door to Tachi Yamada, who was his running partner very early each morning, even during wintertime. Cumulatively, he has run the circumference of the earth twice. Rick was elected to the American Association of Physicians, honoring his academic and leadership career. In addition to Rick's work in the Indian Health Service, Rick spent more than 22 years in the VA system, where he held VA grants the entire time. He also has been continually funded by the NIH since his fellowship. Rick loves to read about world history. He has a penchant for opera theater and symphony music. Rick also loves baseball, and with his New York roots is of course a Yankee fan.Our Next PresidentRick assumes the Presidency of the AGA Institute at a time of great change in American health care and research, and he is up to the task. Rick's background is well-rounded in all aspects of gastroenterology: research at the NIH and VA levels, clinical expertise from his training while running two subsequent gastroenterology divisions, and education and training from his division chief roles as well as mentorship roles. Rick has extensive experience working within the AGA as well. He has directed the AGA Postgraduate Course; chaired the AGA Research Committee, Gastroenterology Oncology Section, and the AGA Council; and was an Associate Editor for our flagship journal, Gastroenterology. His professional and personal experiences not only have shaped him, but have given him insight to the many issues we face in the field of gastroenterology. We believe that you will be proud of the leadership of C. Richard Boland as he takes the helm of the AGA Institute. During Digestive Disease Week in Chicago, Illinois, in May 2011, C. Richard Boland, MD (Figure 1), will become the next president of the American Gastroenterological Association (AGA) Institute. Rick in many ways has the perfect balance of life experiences and career—a man shaped by his exposure to a disease within his family while growing up and ultimately finding the cause of it later in life—to lead our distinguished organization. Rick's stellar career to date has had him caretaking Native Americans and veterans of the US armed forces, as well as diverse gastroenterology and hereditary cancer patients. His research work is groundbreaking and world-renowned and has led to a better approach toward genetic testing of high-risk cancer patients. He has led two gastroenterology divisions, one research-based and one more clinical, and thus knows the challenges and impact of both. His commitment toward the field of gastroenterology shows in his extensive involvement with the AGA, which he is now poised to lead. He is also the consummate husband and father, athlete, music lover, friend, and mentor, someone everyone can talk to no matter the issue, and promises to be a visionary guide of our organization for the upcoming year. His interactions and keen understanding bridge the generations of gastroenterologists and hepatologists in practice today. In our view, the AGA will be very proud to have Rick lead the organization. UpbringingRick's father was a pediatrician, a graduate of Georgetown Medical School and the 12th of 13 children. Rick's paternal grandfather died when his father was 6 years old, leaving his father to be raised by his mother and older siblings. Rick's mother, the daughter of a Catskills inn owner, was a homemaker and married his father during his fourth year of medical school (she was in the women's naval corps during World War II stationed in Washington, DC). His father pursued a pediatric residency in Johnson City, New York, near his mother's birthplace, and ultimately settled in a pediatric practice and became a pillar of the community. Rick, the second eldest of 4 siblings, was born on October 19, 1947, in Johnson City and grew up in nearby Endwell, a town of approximately 12,000 people. Rick was named after his father (the C in his name stands for Clement, which his father was called, while Rick was called by this shortened version of his middle name). Before Rick's birth, his father entered into the military service, and was sent to Italy where he became ill from what was believed to be an ulcer. Upon his return to the United States in 1946, it was discovered at surgery that his father had stage III colon carcinoma originating from the cecum, at the age of 26 years. The surgery cured his father for another 23 years, and allowed him to live life and practice as a pediatrician.Although Rick's father worked until 8 or 9 pm, his family grew up very close. Family vacations were to the New Jersey shore or Cape Cod, and were wonderful opportunities to spend more time with his busy father. Rick's love for athleticism came from his father's elite achievements in sports. Rick participated in track, cross-country, and swimming teams throughout high school, but became more of a regular runner in his 30s. He still runs to this day. Rick graduated from Maine-Endwell High School, being one of the top students out of a class of 351 students and excelling in the sciences. He won the local science fair with his passion for wanting to understand what was inside a living organism. Because of this passion, the only Christmas gifts he remembers growing up were a microscope and dissecting kit at age 13 from his parents. Rick's father was a pediatrician, a graduate of Georgetown Medical School and the 12th of 13 children. Rick's paternal grandfather died when his father was 6 years old, leaving his father to be raised by his mother and older siblings. Rick's mother, the daughter of a Catskills inn owner, was a homemaker and married his father during his fourth year of medical school (she was in the women's naval corps during World War II stationed in Washington, DC). His father pursued a pediatric residency in Johnson City, New York, near his mother's birthplace, and ultimately settled in a pediatric practice and became a pillar of the community. Rick, the second eldest of 4 siblings, was born on October 19, 1947, in Johnson City and grew up in nearby Endwell, a town of approximately 12,000 people. Rick was named after his father (the C in his name stands for Clement, which his father was called, while Rick was called by this shortened version of his middle name). Before Rick's birth, his father entered into the military service, and was sent to Italy where he became ill from what was believed to be an ulcer. Upon his return to the United States in 1946, it was discovered at surgery that his father had stage III colon carcinoma originating from the cecum, at the age of 26 years. The surgery cured his father for another 23 years, and allowed him to live life and practice as a pediatrician. Although Rick's father worked until 8 or 9 pm, his family grew up very close. Family vacations were to the New Jersey shore or Cape Cod, and were wonderful opportunities to spend more time with his busy father. Rick's love for athleticism came from his father's elite achievements in sports. Rick participated in track, cross-country, and swimming teams throughout high school, but became more of a regular runner in his 30s. He still runs to this day. Rick graduated from Maine-Endwell High School, being one of the top students out of a class of 351 students and excelling in the sciences. He won the local science fair with his passion for wanting to understand what was inside a living organism. Because of this passion, the only Christmas gifts he remembers growing up were a microscope and dissecting kit at age 13 from his parents. Education and TrainingRick enrolled at the University of Notre Dame after a discussion with his proud Irish Catholic father. Notre Dame was initially all male, but later became coeducational after Rick's graduation. Rick enrolled in the pre-med major, but switched to liberal arts to improve his reading and writing education while maintaining his pre-med requirements. College was fun, a place to learn about a lot of things, and Rick would lose himself in the library stacks. Rick would visit back home in New York during Christmas and Easter breaks. During summers, Rick worked as a mason tender—building scaffolding, shoveling mortar, and carrying cinder blocks and bricks. Rick later graduated magna cum laude from the University of Notre Dame.Rick's father served as his initial physician role model for going to medical school, with his own internal drive taking over that challenge later. Rick applied to his father's alma mater, Georgetown Medical School, but his pre-med advisor suggested that he also apply to Yale Medical School based on his scholarship. With the blessing of his father, Rick accepted Yale's admission offer over Georgetown, even though the tuition was higher (about $2500). Rick was 1 of 77 men and 8 women in his medical class. Yale Medical School had an unstructured curriculum with no tests, but students had a thesis requirement and had to pass parts 1 and 2 of the National Boards. Rick thrived in this environment, learning voraciously. Yale specialized in preparing medical students for academic careers, and many of his classmates became division chiefs, department chairpersons, or deans (eg, George Lister, Bob Bucholz, Lee Goldman, Jerry Rosenbaum, David Bailey, Rick Young, and so forth). At the time Rick entered medical school (1969), he realized that many diseases had unknown causes, and there were little effective therapies for them. His want for more longitudinal patient relationships helped him decide to pursue internal medicine over surgery for a career. His interests in helping his fellow men led him to perform an 8-week rotation in New Mexico caring for Native Americans during the summer between his first and second years. In addition to his father's illness, Rick's influence toward gastroenterology and hepatology came from some of his professors at Yale, such as Jim Boyer, Gerry Klatskin, and Howard Spiro.There are two events that happened in 1970 during medical school that changed Rick's life forever, and influenced his career and livelihood. During Rick's first year of medical school, his father became ill. At the age of 49, his father was discovered to have two synchronous cancers in his proximal colon, with metastasis to his liver. He died in Ju
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