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Michael Joyner, MD, FACSM: A Magnificent Anomaly

2023; Lippincott Williams & Wilkins; Volume: 27; Issue: 6 Linguagem: Inglês

10.1249/fit.0000000000000914

1536-593X

Dixie Stanforth, Joe Sherlock,

Biomedical and Engineering Education

In this Celebrate Success! column, we are featuring the content written by Joe Sherlock for ACSM's Spotlight, a web site feature that shines a light on ACSM's outstanding members and certified professionals. Reading it, I was transported back to my first year in graduate school at the University of Arizona (1980), listening to a bold, brash, and brilliant guy sprawling in the front row and challenging the professor. The freight train that was Michael Joyner was making connections and asking questions that were so far beyond my understanding that I couldn't even follow the conversation…and was probably not even on the same tracks! To celebrate the success of Joyner, we start with Sherlock's overview of his career followed by some pithy advice shared by Joyner with me at ACSM's Annual Meeting. Our conversation was free-ranging from training to mentoring to chasm jumping and jam sessions. Hold onto your hats as you meet Joyner, a distance athlete and also a self-described "15 on the 10-point extrovert scale;" a brilliant scientist and strategic thinker, still challenging conventional wisdom and making change happen today. A MARATHON CAREER: MEET 2023 ACSM HONOR AWARD RECIPIENT (BY JOE SHERLOCK)Michael Joyner, M.D., FACSMSpeaking with Michael Joyner, one feels as if one is sprinting to catch hold of a freight train. Formidable in both intellect and presence, Joyner sets the pace of the conversation, and you immediately fall into the role of an adoring but perhaps subpar student. You daren't fall behind — not because you are afraid but because you are in awe. At the very least, you want to see where the damn train is going; it will doubtless be both an interesting destination and a thought-provoking journey along the way. Then a few minutes pass, and you find yourself keeping up after all. There's a steady ebb and flow to the conversation, one guided by Joyner's instinctive ability to pace. Things are moving at speed, but a tightly controlled velocity designed to give you just as much as you can handle. No more, but certainly no less. Fortunate, too, that Joyner's own biography offers some hope for the supposedly subpar student. More on this anon. Joyner, recipient of the 2023 Honor Award of the American College of Sports Medicine, is the Frank R. and Shari Caywood Professor of Anesthesiology as well as departmental vice chair for research at the Mayo Clinic in Rochester, MN. He′s received numerous awards and accolades, from the American Physiological Society's Lamport Award for Contributions to Cardiovascular Physiology (1993) to an honorary doctorate from McMaster University (2019). He has well more than 500 publications to his name. His Google h-index is more than 100, with upward of 39,000 citations. He's contributed articles and op-eds to, among others, Outside Magazine and The New York Times. He's shared airtime with then-Vice President Mike Pence for his work treating COVID-19 patients. EARLY DAYS But we start the conversation at the beginning, so to speak. I enquire as to how he got into exercise science, and he recalls a case of serendipity. It was 1977. He was 19 years old and contemplating dropping out of the University of Arizona to join the fire department: "I was the least prepared person ever to go to college," Joyner says. "I did well on tests, but I was a terrible student." In fact, Arizona was the third institution in which he'd enrolled, having beforehand tried his luck at both Earlham College and the Northern Arizona University, respectively. Really, the bright spot in his life was distance running — despite deep reservations about his place in the academic world, he was a solid walk-on U of A track and field athlete.Photos in this column are courtesy of Michael Joyner, M.D., FACSM; Shelly K. Roberts, R.N.; and the ACSM archives.In this providential case, he was competing in a weekend road race when, toward the end of the run, he found himself keeping pace with a young graduate student named Eddie Coyle. Coyle was working in the laboratory of the legendary Jack Wilmore, a future ACSM president (1978–9) and Honor Award winner (2006). Coyle asked the younger runner if he would be interested in becoming a subject in a human performance study headed by Pete Farrell, another grad student in Wilmore's laboratory. Joyner agreed. The study just so happened to be the pivotal "Plasma Lactate Accumulation and Distance Running Performance," published in Medicine & Science in Sports & Exercise® in 1979. From there, Joyner's trajectory was set. "Jack started letting me come to Journal Club and started letting me participate," Joyner recalls, "because for some reason he realized that maybe I had some ability. And Eddie was super, super supportive." Later on in our discussion, Joyner shares, "I mean, I was barely 20 years old. The lightning bolt hit me and I said 'I want to do this,' right? And it was lucky because, you know, you didn't have the Internet. There was nobody telling you this was stupid, or that it wasn't possible, or that there would be some long and winding road." Eventually, with a diploma fresh in hand, Joyner followed Coyle to Wash U in the summer of 1981 to work with John Holloszy (the 1987 recipient of the ACSM Honor Award) on a study examining athletic detraining. Joyner, who had been in peak condition for his recent track season at Arizona, signed on as one of seven subjects and took a — presumably irritating — 12 weeks off so they could see what exactly would happen when high-level athletes potatoed from 60 to 0. The research eventually led to the 1984 publication "Time Course of Loss of Adaptations after Stopping Prolonged Intense Endurance Training," in the Journal of Applied Physiology: Respiratory, Environmental and Exercise Physiology. But by 1982, Joyner had been accepted by the U of A medical school, where he found himself compelled by anesthesiology, particularly how well its basic components fit into his previous exercise physiology experience. He would go on to pursue anesthesiology for his clinical residency. "The things you do in anesthesia — you think about breathing. You think about carbon dioxide. You think about oxygen. You think about blood pressure. You think about heart rate," he says. "Those are the same things you think about during exercise." A CAREER PROGRESSES We go on to discuss the anesthesiologist's role as the patient's temporary autonomic nervous system, maintaining homeostasis while the patient is undergoing the physiological challenge of surgery. As it relates to physiology: "We're studying how this system works, how it's affected by hypoxia, how it's affected by exercise, blood loss, a number of other things I'm interested in. And in clinical anesthesia, we're thinking about what happens when we turn the regulatory system off." However, Joyner is quick to delineate the realms in which he operates. He completed a clinical residency with extra research training at Mayo, expecting to stay a few years and then return to Arizona. Instead, he remained in the Land of 10,000 Lakes. Joyner's current role at Mayo has him working as an anesthesiologist approximately 20% of the time. The rest is devoted to physiological research and teaching. "Most of what I do is study humans in a clinical research center who are exercising, who we're giving a different source of physiological challenges to," he says, adding, "I'm an anesthesiologist thinking about physiology, but mostly what I am is a physiologist who also happens to be an anesthesiologist." And his research has delved into a fair number of seemingly disparate questions, from the causes of fatigue in subjects with cerebral palsy to the physiology behind world records. Joyner is himself a 2:25 marathoner, and many may recognize him as the name behind the 1991 physiological model that proposed the possibility of a sub–2-hour marathon. Naturally unsatisfied by narrow lanes of inquiry, Joyner is also instinctively suspicious of reductionism. His 2015 Times op-ed "Moonshot' Medicine Will Let Us Down," presented doubts about the utility of precision medicine for the average person. The article caught the attention of Nigel Paneth, a pediatric epidemiologist at the University of Michigan, who reached out to Joyner via email. Together, they set up a network of researchers with varying fields of expertise but similar concerns about siloing in the scientific enterprise. "People who wanted to take a more broad-based, multifactorial view," Joyner says. COVID-19 AND CONVALESCENT PLASMA Through another series of happenstances, one of the experts in their group was Arturo Casadevall, an immunologist and microbiologist at Johns Hopkins University. In the early stages of the COVID-19 pandemic, Casadevall penned an article for the Wall Street Journal in which he proposed, based on a doctor's inspired intervention during a 1934 measles outbreak, using the blood plasma of convalesced COVID-19 patients to treat those with an active infection. David Epstein, author of The Sports Gene, subsequently tweeted about the article. Joyner — who was at the 2020 Olympic Marathon trials to give a talk about his 2-hour marathon research — saw the tweet, sensed momentum, and immediately emailed Casadevall. Because of his anesthesia background, as well as some work he'd done with the U.S. Army, Joyner was familiar with the ins and outs of the nation's blood-banking system. He thought they had a good chance of actually making this thing happen. He and Casadevall, along with other colleagues, set up sister research protocols at Hopkins and Mayo. By March 2020, Peter Marks, director of the FDA's Center for Biologics Evaluation and Research, emailed Joyner about heading up an expanded access program for convalescent plasma. The effort treated more than 90,000 people early in the pandemic. As alluded to earlier, then-Vice President Mike Pence visited Mayo to hear Joyner's update on the project. The meeting was broadcast on multiple national networks. Of particular note, however, has been the effect of the plasma treatment on COVID-19 patients who also have leukemia or lymphoma. "We've had patients who've had COVID for 300 days," Joyner says. "Immunocompromised patients. This isn't long COVID. These people have been actively infected, and they don't get horrible COVID because their immune system is suppressed." We discuss the role of the inflammatory response, including cytokines. Then he floors me by saying, "So what happens is we've given these people a couple units of plasma and they get better right away." We move along, but later in the conversation he offers a generalist's insight into the plasma program's success: "I think having a physiological perspective was helpful there," he says, "as opposed to an infectious disease or microbiological or immunological perspective, just to be able to bring some outside thinking." CURRENT AND FUTURE EFFORTS The convalescent plasma work is ongoing, but I ask about other irons he has in the fire. He rattles off a few ideas he and his teams are exploring, among them the effect of high altitude on exercise performance and working with people who are outliers on the continuum of physical health — particularly high-level athletes versus those with heart failure versus people who have left-shifted hemoglobin (i.e., those who possess a particular subset of hemoglobin that has a higher-than-average oxygen affinity). In this latter case, he's interested to know whether humans with said unique hemoglobin perform better at altitude than the average person. Certain animals that inhabit or travel through dizzying elevations, including some geese that overfly Mount Everest, have similarly configured hemoglobin. It seemed worth looking into. Preliminary results suggest they're onto something. He's also interested in what information might be gleaned from large datasets in an increasingly wearable-focused medical and fitness world. This work, however, remains in a "precognitive" state. It's the second time he's used the word during our conversation, and the repetition is telling. Despite his rapid-fire conversational style, Joyner is a man who lets things work out organically, and in their own time. Or, rather, he doesn't needlessly rush things. One recalls once more that he is a long-distance runner. There are moments you should push and times to let the road simply roll on beneath your feet. Press on, reflect, regroup, stay in a holding pattern. Everything in its season. We'll get there. "I'm sure we'll make a lot of mistakes," he says. "I'm sure there'll be some false starts. But I think that if you see the mountain peak 50 miles away, it looks pretty good." This segment by Joe Sherlock was originally published on ACSM.org in May 2023: https://shorturl.at/flnXY. BE LIKE MIKE Capturing a conversation with Joyner is, as Sherlock discovered, an adventure. In attempting to describe his journey, Joyner says: "There's no fixed Monopoly board for your career…your career only makes sense when you look back. The catalytic person was Eddie Coyle who got me to be a subject in Pete Farrell's dissertation project and later recruited me to be a 'detrainer' at Washington University with Dr. Holloszy. Equally catalytic were the 'enriched environments' anchored by Jack Wilmore and my interactions with John Holloszy. Then along the way, people like Doug Seals, Roger Enoka, Jerry Dempsey, and Jim Hagberg influenced me. Plus, many good profs at the University of Arizona College of Medicine and then John Shepherd at Mayo. It has been a case of 'when the student is ready the teacher appears,' plus a collection of enriched environments." Here are a few thoughts from Joyner which prompt personal reflection, whether you are on Boardwalk or Baltic: 1. Resist being pigeonholed: Joyner consistently uses training as a metaphor for life and personal growth. He is insistent that whatever "it" is, treat "it" like distance running: "Every day take a bite out of it and you're going to get better." He sees no limits…only possibilities that are most fun and rewarding when explored with others who are willing to move out of their lanes and collaborate. 2. You can't leap a wide chasm in two jumps: Since his earliest days, he remembers deciding that if there was something he was interested in, he might as well "go for it." His innate curiosity in everything was stoked by extensive reading, museum visits, and hanging out on the University of Arizona campus with his dad. He has a uniquely deep, wide-ranging historical perspective that enlarges his ability to see and frame the big issues in many disciplines. Whether you are talking exercise science, training methods, or epidemics and beyond, Joyner is fearless in suggesting new ideas, often grounded in some relatively obscure concept long forgotten or discarded (i.e., 1934 measles story mentioned previously). 3. Life is a continual intellectual jam session: And, he says, "look for themes and be willing to constantly improvise." He sees this in the work he does in the laboratory where postdocs and young physicians are encouraged to work creatively within an existing theme or to develop a new line of research and make it their own. He describes the environment he has created by providing infrastructure and resources as a "Montessori school for adults" where asking great questions and "improv" rule, rather than traditional learning, which often prizes "getting the right answer." 4. History doesn't repeat itself, but it does rhyme: Looking back to move forward has clearly added value to Joyner's career trajectory. He points to the historical richness of working with Wilmore at the University of Arizona, noting that Wilmore was trained by Steve Horvath, who worked with D.B. Dill at the Harvard Fatigue Lab. He stresses the need to "limit your ROI [return on investment] thinking" and to do things you are truly interested in. Are you curious about something? Love a particular topic? Use your energy there and it won't be wasted and you won't be bored or simply putting in your time. 5. Your career is not a zero sum game: Although he acknowledges that is how many people operate, he prefers a different equation. His goal is "not to cultivate like-minded people, but a network of people who also pursue excellence." Known as an outstanding mentor, Joyner is quick to list and credit those who believed in him from his early days in the running boom of the late 70s (especially track coach Dave Murray) to many who supported him throughout his professional journey as mentioned throughout this column. He also highlights the value of "prementors" or those just a step or two ahead in the process. From his first journal club with Dr. Wilmore as an undergraduate student to his wide-ranging work at Mayo Clinic today, Joyner has lived what he describes as "a life of luck and timing where my curiosity was indulged." As we finished our time together, Joyner spoke toward the future and the exciting new challenges and adventures he sees. He remembered a quote attributed to JFK, noting it might be apocryphal, but agreed it makes a good story ending for these days: "The Chinese use two brush strokes to write the word 'crisis.' One brush stroke stands for danger; the other for opportunity." Although it is no surprise that Joyner would mention this rather esoteric quote, it reminded me of the description of the birth of the Harvard Fatigue Lab. In the 1989 D.B. Dill Lecture, Carleton Chapman (1) recognized the work of the five-man "Pacesetter" team who developed "…the concept of a laboratory devoted to human physiological research that was holistic rather than systems- or organ-oriented, that was strongly interdisciplinary, and that focused on measurements both at rest and under stressful conditions…" Chapman called the laboratory a "magnificent anomaly," which is the perfect description of Joyner, both personally and professionally. We are grateful Joyner has embraced the opportunities available during his slice of history with characteristic curiosity and fearlessness…cheers to ACSM's 2023 Honor Award recipient! To read more about Dr. Joyner's accomplishments click here: https://shorturl.at/bdsMZ.