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Presentation of the Julius M. Friedenwald Medal to Loren A. Laine

2018; Elsevier BV; Volume: 154; Issue: 8 Linguagem: Inglês

10.1053/j.gastro.2018.05.006

1528-0012

M. Brian Fennerty, Kenneth R. McQuaid, Fred S. Gorelick,

History and advancements in chemistry

The Julius Friedenwald Medal honors an individual who has made lifelong contributions to the field of gastroenterology and contributed significantly to the American Gastroenterological Association (AGA). This is the highest honor bestowed by the AGA, and we know of no one more deserving of this distinction than Loren Laine, the 2018 awardee. Over the last 3 decades, we have witnessed his outstanding service to the AGA and, more importantly, have benefited from his numerous contributions to the field of gastroenterology. Many of these have been seminal and have fundamentally changed the practice of our profession. Loren’s parents, both native East Coasters, met as students at the University of California–Los Angeles (UCLA). Loren was the first of their two children, and his younger sister, Susan, was born 2 years later. Loren grew up in the Los Angeles area as the stereotypical Southern Californian, living close to the beach and graduating from Palisades High School at age 16. He briefly moved away from coastal Los Angeles to attend Pomona College in Claremont, California, graduating magna cum laude and Phi Beta Kappa. After college, Loren moved the 50 miles back west to the coast for both medical school and internal medicine residency at UCLA. Loren’s decision to pursue gastroenterology was influenced by both his desire to become expert in one organ system and his curiosity about emerging endoscopic technologies. He accepted a National Institutes of Health (NIH)-sponsored research-track fellowship at the University of California–San Diego (UCSD) in 1982 (Photo 1). It was an exciting and stimulating time to be at UCSD; the Gastroenterology Division included renowned senior faculty such as Jon Isenberg, Alan Hoffman, and Marty Kagnoff, as well as emerging stars among the junior faculty such as Steve Pandol, Mario Chojkier, and Kiertisin Dharmsathaphorn. Undoubtedly, it was this rich training environment that fostered Loren’s first steps toward a dedicated academic career. Upon completing his first year of fellowship, Loren entered the laboratory of Mario Chojkier. Mario was his first scientific mentor, and Loren began work on a basic research project on liver fibrosis. Loren soon realized that he was much more attracted to asking and answering clinical questions than doing bench research. Fortunately, Mario also presented him with a second research opportunity: analysis of a gastrointestinal (GI) bleeding database that Mario had brought with him from Yale. This initial foray into clinical investigations of GI bleeding initiated an academic career that has provided some of the most important clinical contributions in gastroenterology over the last 30 years. Loren’s next career step was accepting an appointment on the faculty of the University of Southern California (USC) School of Medicine. At the time, the USC GI faculty consisted of only three members: Jorge Valenzuela, Hartley Cohen, and Ian Renner. Jorge, a supportive division chief, allowed Loren the freedom to develop his own clinical research interests. Hartley Cohen was an essential colleague, helping Loren refine his clinical skills and serving as a sounding board for difficult clinical or research questions. Loren thrived in the environment of the Los Angeles (LA) County + USC Medical Center. The GI Endoscopy Unit was his laboratory, and he began designing and performing clinical research studies soon after his arrival. His philosophy was that almost every patient seen in clinical practice could potentially also be a subject in a clinical research project. When he began his research, studies showed no benefit of performing endoscopy for upper GI bleeding, presumably because no endoscopic therapy was documented to be beneficial for patients with nonvariceal bleeding. His 1987 single-author paper in the New England Journal of Medicine, just 2 years into his academic career, documented endoscopic therapy as an effective and appropriate treatment for nonvariceal upper GI bleeding and was the first step in establishing his stature as an international expert in the management of GI bleeding. Loren’s career and clinical research path evolved to include multiple other areas related primarily to upper GI tract injury: for example, further optimization of endoscopic treatment of nonvariceal and variceal bleeding, pharmacologic management of ulcer bleeding, nonsteroidal anti-inflammatory drug injury, Helicobacter pylori infection, AIDS-related GI disease, and others. Along the way, he taught himself study design and statistical analysis and became an exceptional clinical trialist. He also gained expertise in meta-analyses, working first with Deborah Cook of McMaster University on landmark meta-analyses that helped establish the utility of endoscopic therapy for nonvariceal bleeding and the superiority of ligation over sclerotherapy for variceal bleeding. While at USC, Loren also served in a variety of important administrative roles. He was Director of Endoscopy at USC and Chief of the Section of Gastroenterology at the LA County + USC Medical Center for many years. He also served as president of the USC Medical School Faculty Assembly, President of the LA County + USC Medical Center Medical Staff, and Chief of Staff for the LA County + USC Medical Center. In 2011, Loren ventured from the beaches of California to the beaches of Long Island Sound and joined the faculty at Yale. His role was to foster clinical research at Yale, including its affiliated West Haven Veterans Administration (VA) Medical Center. Throughout his career Loren has mentored dozens of people at various levels of training, from medical students to mid-career faculty. He has continued to do so at Yale, inspiring a new wave of interest in clinical GI investigation. Each year at Yale, Loren has worked with fellows and residents in designing and performing numerous research projects, leading to important publications in journals such as Gastroenterology and JAMA. Although continuing to work in GI bleeding, given his breadth of knowledge and clinical methodological skills, he has mentored fellows and junior faculty in a variety of areas, such as inflammatory bowel disease, screening colonoscopy, and pancreatico-biliary disease. Loren has provided formal education in study design and assessment of the medical literature and assisted in sponsorship of several fellows pursuing PhD degrees in Yale’s Investigative Medicine program. Loren’s remarkable clinical acumen and encyclopedic mastery of the literature shine at the weekly clinical case conference and journal club that he directs for the Yale fellows and faculty. Loren has also established new research initiatives since his arrival at Yale. Over the years he has collaborated widely with investigators around the country and the world, and that has continued at Yale. He currently is working on numerous GI bleeding projects with international experts, including a fruitful partnership with Adrian Stanley from Scotland and Stig Laursen from Denmark (Photo 2) and updating of international consensus guidelines led by Alan Barkun from McGill University. He is a principal investigator (along with Gary Wu from University of Pennsylvania and Colleen Kelly from Brown University) on an NIH-sponsored AGA national fecal microbiota transplant registry with biorepository, and he is a principal investigator (along with Yu-Xiao Yang from University of Pennsylvania and Sameer Saini from University of Michigan) on a national trial of proton pump inhibitor de-prescription. At Yale, Loren is also collaborating with Fred Gorelick on a VA Merit Award examining the effects of a new survival factor in acute pancreatitis. Yale has benefited greatly since Loren’s arrival, and he has continued to serve as an inspiring and dedicated mentor and a leader in clinical research. In a new chapter at Yale, Loren agreed to take on the responsibilities as interim chair of the Digestive Diseases Section beginning in January of this year. We are sure that his energy and his broad experience with clinical care, research, and administration will serve him well in this new position and lead to great success in management of this large and diverse division. Loren has served in many important elected and appointed positions in the AGA for more than 20 years. He served on the AGA Council (the body that develops AGA scientific and education programs, most importantly for Digestive Disease Week) for over a decade—first elected to be Vice-Chair and Chair of the Esophageal-Gastric-Duodenal Disorders section in 1995, followed by election as Vice-Chair and Chair of the Clinical Practice Section of the AGA in 1999, and finally elected as Chair of the AGA Council in 2003. Loren was the Director of the AGA Spring Postgraduate Course, the premier educational offering of the AGA, in 1995. Loren’s most important service to the AGA began with his election in 2010 as Vice-President and culminated in his serving as AGA Institute President (2012–2013) and AGA Chair (2013–2014). Loren made many important contributions as a Presidential officer. He developed a process to fill all AGA appointed positions (eg, committee chairs and members) in a more equitable and organized fashion, ensuring appropriate skills and diverse representation. Loren’s recognition of the importance of the gut microbiome led to establishing the AGA’s Center for Gut Microbiome Research and Education. To this end, he organized the first congressional briefing on the gut microbiome. In support of our clinical activities, Loren was instrumental in developing the AGA’s guideline process and undertook direct involvement in the crucial Relative-Value-Scale Update Committee review and re-valuation process for endoscopic procedures. Few AGA members have spent more time serving in the leadership of the AGA as a member of the Governing Board: Loren served 3 separate terms on the AGA Governing Board from 2000 to 2014 and has continued to provide service to the AGA after his presidency—as a member of the Center for Gut Microbiome, the Center for Diagnostics and Therapeutics, and the Research Advocacy Subcommittee. His service and contributions to gastroenterology beyond the AGA are also impressive: member of the American Board of Internal Medicine (Gastroenterology Subspecialty Board); Food and Drug Administration GI Drugs Advisory Committee member and Anti-infective Division Advisor; American College of Graduate Medical Education GI Training Program reviewer; President of the Western Gut Club (the western section of the American Federation of Clinical Research); member of multiple committees for the American Society for Gastrointestinal Endoscopy and American College of Gastroenterology; ad hoc reviewer for the NIH, VA, Gates Foundation, and Hong Kong Research Council; and associate editor of Gastroenterology and Gastrointestinal Endoscopy. Loren is also an exemplary educator, as evidenced by over 160 visiting professorships and invited lectures at over 150 national and international scientific meetings. It is very hard to find a gastroenterologist who has not heard Loren speak, thus experiencing his great energy and love of teaching. The international recognition for Loren’s work led to invitations to speak and travel around the world. He traveled widely and often, enjoying the opportunities to sample great food, explore new and exotic places, and meet new people. During one of his trips, in Switzerland, this seemingly life-long bachelor was introduced to Nancy Carberry, a remarkable woman who lived in Philadelphia. Their relationship, although bi-coastal, blossomed, and in 2002 they were married (Photo 3). Nancy moved to LA to work as a Vice-President at Warner Brothers Studios. In LA, Nancy and Loren developed an interest in rescuing German shepherds. After their first dog, Hannah, they brought many more dogs into their home over the years. They helped place most in new caring homes, although some ended up living permanently in their household. Since leaving USC to join the faculty at Yale, Nancy and Loren have continued to provide a warm and welcoming environment, for dogs and people, in their new home in Connecticut (Photo 4).Photo 4Loren and Nancy’s dogs at their home in Connecticut.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Loren’s lengthy list of publications and exceptional H-index (86, March 2018) attest to the impact he has had in the field of gastroenterology. His long and continued productivity is well illustrated by his publication history in the New England Journal of Medicine: his first article in the journal, on upper GI bleeding, was published in 1987, and his most recent article, also on upper GI bleeding, was published nearly 30 years later in 2016. Through his clinical research, publications, mentorship, and lectures, along with his extensive and outstanding service to the AGA and gastroenterology, Loren has enriched generations of gastroenterologists and greatly affected the practice of gastroenterology. Among many accomplishments, he has taught us about diagnosis, prognosis, and management of GI bleeding, defining optimal medical and endoscopic treatments; helped define appropriate diagnostic and treatment strategies for H pylori; and taught us about the development, management, and prevention of GI tract injury and bleeding due to nonsteroidal anti-inflammatory drugs and anti-thrombotic therapy. In doing so, he has changed all of our clinical practices for the better and improved the lives of patients. We are proud to present Loren Laine, outstanding colleague, superb mentor, loyal friend, great husband, and exemplary clinical investigator, who changed the landscape of gastroenterology, as your 2018 Friedenwald Medal awardee.