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Presentation of the Julius M. Friedenwald Medal to Daniel K. Podolsky, MD

2009; Elsevier BV; Volume: 136; Issue: 7 Linguagem: Inglês

10.1053/j.gastro.2009.04.050

1528-0012

Lawrence S. Friedman,

Multiple and Secondary Primary Cancers

Established in 1941, the Julius M. Friedenwald Medal recognizes an individual who has made lifelong contributions to the field of gastroenterology and has provided significant service to the American Gastroenterological Association (AGA). Endowed by and named for a distinguished Baltimore gastroenterologist who was a cofounder and eighth president of the AGA, the Friedenwald Medal is the highest honor that the AGA bestows on a member. A 1912 essay describes Dr. Friedenwald as “a man of great sagacity, quick perceptions, sound judgment, noble impulses, and remarkable force.”1Hall C.C. Baltimore: its history and its people. Lewis Publishing Co, Baltimore, MD1912: 519Google Scholar This description applies aptly to this year's deserving recipient of the Friedenwald Medal, Dr Daniel K. Podolsky, also a past president of the AGA, a towering figure in American gastroenterology, and a gold standard academic who has made an extraordinary mark as an investigator, clinician, educator, leader, innovator, advocate, mentor, role model, and friend. He truly is a remarkable force. Daniel Kalman Podolsky was born in Detroit, Michigan, on May 17, 1953. The third of 5 children of Harold and Ruth Podolsky, whose parents emigrated from Russia to Detroit in the early 20th century, Dan was raised in Southfield, Michigan, a suburb of Detroit. Dan's father graduated from Wayne State University Medical School during the Great Depression. To earn money for tuition, he worked as a research assistant during medical school and, in a harbinger of Dan's interests, studied the physiology of gastric secretion in dogs. He served in the Medical Corps in Europe and Africa during World War II, after which he completed a medical residency at the Allen Park Veterans Affairs Hospital. He went into solo practice in Lincoln Park, a working-class suburb of Detroit, as an old-fashioned general practitioner who treated children and adults, performed surgery, and delivered babies. He had numerous interests besides medicine—sculpting, art, jewelry design, woodworking, and pottery—and instilled in his children an appreciation of the arts. His high standards, integrity, professionalism, and devotion to his patients influenced Dan to pursue medicine as a career. Dan's mother Ruth made sure that her 5 children had a rich and varied social network of family and friends. The family remains close-knit. Dan's brother Morris is an ophthalmologist in New York, brother Arnold was an anesthesiologist and is now a lawyer in Detroit, sister Maribeth is a glass manufacturer in Philadelphia, and brother Jonathan is a real estate developer in Detroit. Dan's mother recalls that when “Danny” was in grade school, the teachers often complained to her that Dan was disruptive in class; he finished his work so much more quickly than anyone else (an enduring trait) that he easily became bored. The problem was solved when Dan was given a job in the school library to go to when his work was done. During the 1960s, young Dan and his friends frequently caught the great Motown acts of the day: Aretha Franklin, Smokey Robinson, the Temptations, and even Jimi Hendrix. Since then, Dan has loved music, and he still boasts a huge collection of jazz and blues albums. Dan was a superb student. According to his boyhood friend, Alan Solway, now an ophthalmologist outside Detroit, “Dan far surpassed everyone else in the class. He never brought his books home the night before a test because he already knew the material. He read voraciously and remembered everything he read.” Dan was on his high school's debate team, which went to the state championship; he is still an imposing debater. On Sundays he awakened at 3 am to deliver bagels; he has remained an early riser and later took up running “because there isn't much else to do at 4 in the morning.” 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 do research during the summer after his first year. Through his cousin, the late Jay Schumaker, who was then a fellow in gastroenterology, he was introduced to Milton Weiser, a young investigator who later became chief of the Division of Gastroenterology at the State University of New York in Buffalo and is now retired, and Kurt J. Isselbacher, the legendary chief of the Gastrointestinal (GI) Unit at Massachusetts General Hospital (MGH) and later the first director of the MGH Cancer Center (and also a recipient of the Friedenwald Medal). Isselbacher was skeptical of having undergraduates in the unit because they did not stay long enough to complete meaningful work, but Dan persuaded Isselbacher and Weiser to give him a chance. Weiser recalls Dan as brilliant, careful, studious, and competitive, with a photographic memory. “He was a lot of fun. We were both movie buffs, and he seemed to know every line of every movie.” Dan's research focused on using lectins to select differentiated from undifferentiated intestinal epithelial cells. Dan not only completed the work, but also published the results in the Journal of Cell Biology. Dan's performance at Harvard was spectacular. After 3 years, he graduated summa cum laude. His senior thesis, written under the mentorship of Weiser and the late 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 best thesis in biochemistry. By the time he finished college and entered Harvard Medical School, Dan had his own laboratory and technician. Throughout medical school, Dan would come to work in his laboratory early in the morning, before classes or rounds. He excelled in medical school, graduated magna cum laude, and received the Leon Reznick Prize for outstanding research at graduation. His medical school roommate, the late Bruce Van Boeckel, who was an internist in western Massachusetts until his untimely death this year, has recalled, “In medical school it was clear that Dan was brilliant and focused, yet a regular guy who liked to party with his classmates on Saturday nights.” Perhaps most important, Dan met the love of his life at Harvard Medical School. In many ways, Carol Plesser was the opposite of Dan Podolsky. An only child of parents whose extended families had perished in the Holocaust, Carol had attended Hunter High School, an exclusive Manhattan preparatory school, and Cornell University. During her first year at Harvard Medical School, she never even met Dan; she sat at the front of the class, paid careful attention, and always used all the allotted time to complete her tests. Dan would breeze into class, often late, sit in the back of the room, leave early after catching the gist of the lecture, and finish his tests before anyone else so that he could run off to his laboratory. Fate intervened when, because of the alphabetical proximity of their last names, Carol and Dan were paired in the physical diagnosis course during the second year of medical school. Their instructor spoke in a whisper, and they often found themselves leaning forward—and toward each other—to hear him. They have been close ever since! They were married just before graduation and celebrated their 30th wedding anniversary last year. After graduation, Dan did his medical residency and fellowship in gastroenterology at MGH, while Carol did a pediatrics residency at Boston Children's Hospital, followed by a fellowship in adolescent medicine. Through his residency and clinical fellowship, Dan continued to run an active laboratory in the MGH GI Unit and still came in before sunrise. This was a golden age of the MGH GI Unit under Isselbacher. In addition to Weiser, young faculty and fellows included Bob Glickman, Tom LaMont, David Shafritz, Jack Wands, Elliot Alpert, 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, Boston Children's Hospital, and Harvard Medical School), and shortly thereafter Jules Dienstag (now dean for medical education at Harvard Medical School). Steve Goldfinger had just reported on the benefit of colchicine in familial Mediterranean fever. Chester Jones, Isselbacher's predecessor as chief, founder of the MGH GI Unit in 1925, and like Isselbacher a past president of 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 “Dan's boundless energy, quick wit, and apparently unlimited enthusiasm for science.” Within a year and a half of starting his GI fellowship, Dan was appointed assistant professor of medicine at Harvard Medical School. Dan's early research explored intestinal epithelial differentiation and the control of proliferation. He also studied the role of glycoproteins but ultimately concluded that their complex structure resisted a ready analytical approach to fully understanding their function in the intestine. 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, now chief executive officer of the University of Chicago Medical Center and dean of the University of Chicago Pritzker School of Medicine, he 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. Trials of anti-integrin antibodies in inflammatory bowel disease later followed. 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, which Dan rigorously characterized and the gene for which he cloned. Trefoil factors are critical to sustaining mucosal integrity and promoting repair. Ramnik Xavier, a former fellow and colleague in the MGH GI Unit, notes, “The observations about trefoil proteins made by Dan's laboratory have been a major contribution to GI research and have served as a stimulus to 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. Dan's laboratory became a leader in exploring the role of the epithelial cell in innate immune responses and in understanding 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, at MGH, Dan directed 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. The center has conducted a spectrum of research ranging from investigation of the basic mechanisms of the immune response and mucosal biology to translational and patient-related studies. Kurt Isselbacher, a pioneering investigator himself, marvels at Dan's scientific accomplishments. “He has an uncanny ability to recognize the potential importance of unexpected observations. He is blessed with a remarkable intellect; he immediately grasps the essence of an issue.” Anil Rustgi, a former colleague at the MGH and now chief of the Division of Gastroenterology at the University of Pennsylvania and editor of Gastroenterology, praises Dan as a “pioneer in basic science research of intestinal epithelial biology, regulation of cytokine gene expression, mucins, intestinal trefoil factors, and inflammatory bowel diseases.” In 1989, Dan succeeded Kurt Isselbacher as chief of the MGH GI Unit when Isselbacher became director of the newly created MGH Cancer Center. At the young age of 35 years, Dan was only the third chief in the history of the unit. Later he also became the Mallinckrodt Professor of Medicine at Harvard Medical School. He acted quickly to enhance the clinical and endoscopic faculty, expand the facilities, strengthen the fellowship training program, and foster both basic and clinical research. He recruited a cadre of fine “private” practitioners—Bernie Aserkoff, Cheryl Bunker, Peter Kelsey, Barbara Nath, and Bob Schapiro—to join the full-time faculty. According to Kurt Isselbacher, “This set the stage for greater participation by the MGH GI Unit in controlled and multicenter trials.” He then recruited Bill Brugge, who became a national leader in endoscopic ultrasonography and later succeeded Schapiro as director of endoscopy, and Larry Friedman, who focused on fellowship training and medical education. As the clinical practice in the MGH GI Unit grew, Dan pressed the hospital for more space and resources, culminating in 1997 in a state-of-the-art 20,000-square-foot office/endoscopy complex. By 2004, a second 10,000-square-foot facility was added as clinical and endoscopic volume soared; in a decade, endoscopy volume increased from 7000 to well over 35,000 procedures a year. Dan supported Brugge, Kelsey, and Schapiro in expanding the range of advanced interventional endoscopy services and encouraged Norm Nishioka to pursue research in optical coherence tomography, photodynamic therapy, and other techniques for the management of Barrett's esophagus. An advanced endoscopy fellowship was started by Bill Brugge and Dan in collaboration with David Carr-Locke at Brigham and Women's Hospital and subsequently spawned many outstanding endoscopists and endoscopic investigators. Later, advanced fellowships in hepatology and inflammatory bowel disease expanded the training opportunities in the unit. With Bruce Sands, Dan expanded clinical activities in inflammatory bowel disease through the Center for Study of Inflammatory Bowel Disease, with participation by additional faculty, including Joshua Korzenik, Scott Snapper, Ramnik Xavier, Vijay Yajnik, 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 a 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 Andrea Reid (who later succeeded Dan as the GI fellowship program director), Daniel Pratt, Michael Thiim, and colleagues from Brigham and Women's Hospital. He began a clinical motility center, now under the direction of Brad Kuo, and increased the clinical and research faculty with the addition of more than a dozen new faculty members. All this was done while Dan's own research program flourished, with more than 60 postdoctoral fellows coming from all over the world to work in the Podolsky laboratory. In addition, he authored or coauthored more than 150 original articles in high-quality, peer-reviewed journals, as well as more than 100 reviews and chapters in leading textbooks of gastroenterology and internal medicine. If you ask members of the MGH GI Unit what they appreciate most about Dan, the unhesitating answer will be his role as a mentor (Figure 1). Bruce Sands, now acting chief of the MGH GI Unit, describes what happened when he found himself unsatisfied as a scientist in Dan's laboratory (despite success in cloning genes, mapping promoter regions, and publishing papers). Dan said simply, “You cannot succeed on borrowed enthusiasm.” He encouraged Bruce to pursue his passion and talent for scientific inquiry closer to patients and nurtured him as a clinical investigator, directing him to courses at the Harvard School of Public Health and promoting his participation as a key investigator in what would turn out to be a landmark clinical trial of infliximab. Perhaps more than any other responsibility as chief of the MGH GI Unit, Dan valued his role as fellowship program director. He held weekly “Chief's Rounds” with the fellows, at which he methodically reviewed all aspects of academic career development. He took a personal interest in their career development and personal growth and guided them through the intricacies of establishing themselves as independent investigators, academicians, or clinician-educators. More than 70 former Podolsky GI fellows have gone on to eminent positions in GI research, practice, and education, and several are chiefs of academic divisions of gastroenterology. Dan's effectiveness as a mentor is praised by Andrew Chan, a former fellow and now a faculty member in the MGH GI Unit, who describes Dan as a “fierce advocate for my career development who helped me understand the rigors and challenges of academic medicine and the importance of protected time.” Dan's administrative responsibilities extended well beyond the MGH GI Unit. At MGH, Dan was appointed by Dennis A. Ausiello, Jackson Professor of Clinical Medicine and physician-in-chief, to serve as vice chair of the Department of Medicine; he also served as chair of the MGH Executive Committee on Research. In 2005, James Mongan, President and Chief Executive Officer of Partner, HealthCare System, Inc, invited Dan to become chief academic officer of Partners, a position that gave him oversight responsibility for Partners' $1 billion research enterprise, graduate medical education, and senior faculty appointments and promotions and brought with it an appointment as the faculty dean for academic programs at Partners at Harvard Medical School and membership on the Harvard Medical School Council of Academic Deans. During his tenure as chief academic officer of Partners (while still serving as chief of the MGH GI Unit), he completed a major review and reorganization of Partners' research management, led a significant strategic planning effort to position graduate medical education at Partners' hospitals for the future, guided the planning for a system-wide approach to tissue banking, and initiated a comprehensive review of Partners' interactions with industry. Robin Jacoby, chief of staff of Partners, notes, “Working with Dan, often by email at all hours of the day and night, from cities and airports around the world (since he never let his active GI-related travel schedule interfere with his Boston-based responsibilities) was a lot of fun.” She marveled at Dan's intellect, prodigious capacity for work, academic and personal values, and wit. Steve Goldfinger has eloquently summed up Dan's impact on his colleagues at MGH, Harvard, and Partners: “Dan 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.” Dan is a superb clinician. 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 gastroenterology at MGH. He was often the clinician his colleagues turned to for advice about difficult cases. At MGH, he saw patients in the office regularly, attended on both the gastroenterology consult and inpatient medical services, and even cared for primary care patients, although his clinical practice was focused on inflammatory bowel disease. He performed screening colonoscopies and took call with the rest of us. Dan was committed to his patients no matter what his other obligations were. Former fellow Deanna Nguyen, who took over the care of some of Dan's patients when he left MGH, describes how his former patients continue to praise his medical skill as well as his accessibility. “If he did not get back to them by email, he would call them directly, even from Japan!” His notes were concise, says Deanna, “but they always contained all the pertinent information.” Perhaps the highest tribute comes from one of Dan's patients, Gary Larrabee, who asked that his name be used in this article: “I feel blessed beyond words to have been under the care of Dr Podolsky for nearly a quarter century. I rest in his remarkably talented hands virtually all the credit for my ability to lead a normal life.” Dan has been active in the AGA since the early 1980s, with a gamut of contributions that encompass research, training, and practice and that culminated in his election as president of the AGA. His many roles in the AGA have been enhanced by his experience as a member of the Advisory Council of the National Institutes of Diabetes and Digestive and Kidney Diseases. Among numerous awards during his illustrious career are two of the most prestigious AGA distinctions: delivering the Morton J. Grossman Distinguished Lecture at Digestive Disease Week in 2006 and receiving the AGA's Distinguished Achievement Award in 2007. Dan served as editor of the AGA's flagship journal Gastroenterology from 1996 to 2001. During his tenure, he introduced several new features, including “Comments from the Editors,” a new cover design that displayed a distinctive photograph from one of the articles, and the bundling of clinical articles and research articles separately. The journal's impact factor rose substantially. 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 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.” As AGA president in 2003–2004, Dan set out to (1) ensure that the AGA remained committed to supporting the clinical practice of gastroenterology and practicing gastroenterologists, (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 the heart of this agenda was 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 improving care for the patient. He convened a strategic planning task force to develop a vision and goals for the AGA going forward. “He wisely recognized that the AGA was in a remarkable period of growth and was composed of a diverse membership, with the expectation that all constituencies of the organization—whether in clinical practice, research, education, or training—needed to be represented and supported,” according to Emmet Keeffe, who cochaired the task force with Dan and succeeded him as president of the AGA. “During this time,” says Keeffe, “I worked side-by-side with Dan and was impressed with his remarkable breadth of knowledge, intelligence, and decisive leadership in developing a successful strategic plan that was ultimately adopted by the AGA governing board and that gave focus and budgetary discipline to the organization.” Keeffe believes that the strategic plan revitalized the AGA and created many important agendas that continue to live on. Chung Owyang, chief of the Division of Gastroenterology at the University of Michigan, notes that “nothing embodies Dan's vision and impact more concretely than the formation of the Future Trends Committee, which was an outcome of the strategic planning process that he initiated and led.” Chin Hur believes that Dan's insistence as AGA president that new technologies undergo rigorous clinical trials fostered the study of computed tomographic colonography (virtual colonoscopy). “In this way a clearer understanding of its benefits and limitations emerged prior to its widespread introduction into clinical practice.” Bob Greenberg, executive vice president of the AGA, who worked closely with Dan on AGA activities for many years, has observed, “Dan has internalized the values of the AGA and as president applied these values in a way that has enabled the AGA to continue to face the future with confidence.” In 2008, Dan was lured away from the only professional home he had ever known to become the third president of the University of Texas (UT) Southwestern Medical Center in Dallas, where he also holds the Philip O'Bryan Montgomery, Jr, MD, Distinguished Presidential Chair in Academic Administration and the Doris and Bryan Wildenthal Distinguished Chair in Medical Science and is a professor of internal medicine. His departure from the GI Unit, MGH, Harvard Medical School, and Partners was bittersweet, providing an opportunity for his colleagues and friends to pay tribute, in an outpouring of e-mails, letters, and remarks at farewell events, to Dan's extraordinary contributions to research, innovation, clinical and educational excellence, and mentorship and to recognize that taking on the presidency of an outstanding institution was an opportunity for Dan to extend his values and ideals more broadly. At UT Southwestern, Dan's appointment was received with great enthusiasm, and in making the transition to Dallas, he exhibited his characteristic energy, creativity, and commitment. According to Willis C. Maddrey, executive vice president for clinical affairs at UT Southwestern, “Dan's ability to grasp the essence of complex issues and to formulate and clearly communicate effective action plans is evident to all. He was fully prepared for the challenges of leading UT Southwestern.” Dan's greatest pride is reserved for his family (Figure 2). Until the move to Dallas, Carol was the pediatrician for the Newton, Massachusetts, school system. Their children are Matt, age 26, who is a graduate of Harvard College (where he majored in history and government) and recently of Columbia Law School; Mike, age 24, who also graduated from Harvard College and is now completing his second year at Harvard Medical School, with plans to train in internal medicine and infectious diseases; and Anna, age 20, who is a junior at Harvard College, where she is majoring in psychology, is an accomplished member of the varsity fencing team, and plans to attend medical school. An invitation to the Podolsky home has always been a treat, and among Dan's special talents are gourmet cooking (from homemade sushi to matzo balls 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 has a quote for nearly any academic situation, including this one from Groucho Marx: “Those are my principles, and if you don't like them, I have others.” Of Julius Friedenwald it was said, “Of unblemished reputation, he commands the respect and confidence of the entire community. He has devoted his life to a noble calling and is now crowned with its choicest rewards.”1Hall C.C. Baltimore: its history and its people. Lewis Publishing Co, Baltimore, MD1912: 519Google Scholar For his groundbreaking scientific achievements, his masterly leadership of committees, divisions, departments, institutions, and the AGA itself, and his vital role as mentor, teacher, practitioner, and friend, Daniel K. Podolsky too commands the respect and confidence—and gratitude—of our profession, and he is most deserving of our specialty's choicest reward, the Friedenwald Medal. The author thanks Robin M. Jacoby, PhD, and Barbara J. Nath, MD, for their critical review of this manuscript. CorrectionGastroenterologyVol. 137Issue 2PreviewFriedman LS. Presentation of the Julius M. Friedenwald Medal to Daniel K. Podolsky, MD. Gastroenterology 2009;136:2389–2394. Full-Text PDF