At the 2010 ACR/ARHP Annual Scientific Meeting in Atlanta, the ACR and ARHP honored a group of distinguished individuals who have made significant contributions to rheumatology research, education, and patient care. The Rheumatologist spoke with the winners about their individual contributions to advancing rheumatology. This month, we’ll meet the ACR award winners, and in a future issue, we’ll meet the ARHP winners.
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Explore This IssueDecember 2010
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Presidential Gold Medal
William P. Arend, MD
Distinguished Professor Emeritus, Division of Rheumatology, Department of Medicine, University of Colorado Denver School of Medicine
Background: A graduate of Williams College in Williamstown, Mass., and Columbia University College of Physicians and Surgeons in New York, Dr. Arend completed his residency and a fellowship at the University of Washington School of Medicine in Seattle. He has been a professor of medicine and immunology at Colorado for 27 years, receiving the distinguished professor title in 2009. Dr. Arend is known for his groundbreaking discovery of the interleukin (IL)-1 receptor antagonist protein (IL-1Ra). The recombinant form of IL-1Ra (anakinra/Kineret) is nearly identical to the natural human protein was approved for the treatment of rheumatoid arthritis. It has also produced impressive benefits in the treatment of autoinflammatory syndromes and has been used in gout. A former ACR board member, Dr. Arend was editor of Arthritis & Rheumatism from 1995 to 2000. He has volunteered for numerous ACR committees and training programs, and was elected a Master of the ACR in 2002. He currently is engaged in collaborative research on the complement system. After 40 years of patient care, he stopped seeing patients six months ago.
Q: What part of research really drives you?
A: What has driven me through my career is a sense of curiosity; curiosity about human biology; curiosity to unravel normal biology; and, in the process, to understand how normal mechanisms are altered to lead to states of disease. … I feel very fortunate that I am one of but a few medical investigators who’s seen his research move all the way from the test tube … to the development of a new form of therapy and the marketing of that therapy over the past 10 years. I’ve seen the full spectrum, from basic cell abnormalities all the way through a new therapeutic agent.
Q: What does this award mean to you?
A: This award really has been a very satisfying thing to receive. I have worked for the ACR in a variety of roles and positions. I’ve also been very involved in education. In addition to research and patient care, education has been a major source of my career. To be recognized by my peers in rheumatology is very meaningful. I’ve tried to forward the interest not only of basic research, but of education. I appreciate the ACR’s efforts to bring together research, education, and new clinical knowledge. To be recognized for my activities in all of these areas is deeply rewarding.
Q: What advice would you give a rheumatologist interested in research?
A: Be true to yourself. You can’t force yourself to do research if you don’t have the innate drive. Seek out an environment where people have been successful and will help to develop your innate abilities.
Suzanne L. Bowyer, MD
Director, Section of Pediatric Rheumatology, and Pediatric Rheumatology Fellowship, Indiana University School of Medicine, Indianapolis
Background: Dr. Bowyer takes an adult passion to the practice of children’s medicine. A 15-year volunteer with ACR, she sees the professional society as a conduit through which she can help promote the undersized field of pediatric rheumatology. She understands that the field draws fewer young physicians than other subspecialties, but she emphasizes—to anyone interested in the sales pitch—that pediatric rheumatologists love their jobs.
Dr. Bowyer sees her volunteer work as part and parcel of her responsibilities to her field. She proudly notes that the ACR has established a visiting professor program for medical schools that lack a pediatric rheumatologist to give trainees exposure to pediatric rheumatologists who otherwise wouldn’t be exposed to the discipline. Those and other efforts to encourage more budding pediatricians to focus on rheumatology have boosted the number of first-year fellows nationwide from less than 10 to nearly 30. That’s a far cry from the numbers when she completed her pediatric fellowships at the National Jewish Center for Immunology and Respiratory Medicine and the University of Colorado School of Medicine, both in Denver.
Q: Why add volunteer work to your already crowded plate?
A: Pediatric rheumatology is a small field. We need to do so much to take care of the kids and develop the science in our own field to move the ball forward and improve care. There are very few pediatric rheumatologists—less than 200 of them around the country—so much of what we’ve done in the ACR is to teach adult rheumatologists about caring for children with arthritis.
Q: Why is it so important to you to promote pediatric rheumatology?
A: Over one-third of medical schools don’t have pediatric rheumatologists. Kids in the U.S. have to travel an average of 50 miles to see a pediatric rheumatologist. We all have patients who travel two to three hours to come see us. We need to get pediatric rheumatologists in all areas, not just the large cities and states.
Q: You have received numerous awards from other organizations, as well as the 2009 Deborah Kredich Award from the ACR. How does this latest one compare?
A: This is positively far and away the most prestigious award I’ve ever received. It’s a very humbling experience. I’m completely blown away.
Henry Kunkel Young Investigator
Mariana J. Kaplan, MD
Associate Professor of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor
Background: A 15-year ACR member, Dr. Kaplan’s research focuses on the identification of mechanisms that lead to organ damage in systemic autoimmune diseases. She has proposed a new paradigm for the pathogenesis, as well as a potential treatment, of premature atherosclerosis that complicates autoimmune diseases, particularly lupus. Dr. Kaplan proposes that there is a profound imbalance between vascular damage and vascular repair in lupus, with a critical role for Type 1 interferons. The enhanced vascular damage and impaired repair induced by these interferons may also be implicated in the progression of kidney disease in lupus through a vaculopathic effect. She also is identifying the role of anomalies in antigen-presenting cells in lupus pathogenesis, particularly neutrophils and dendritic cells.
Dr. Kaplan is a member of the ACR/REF Scientific Advisory Council and the Lupus Foundation of America. She is section editor of the Journal of Immunology, as well as advisory editor for Arthritis & Rheumatism. She has been elected to the American Society of Clinical Investigation.
Q: What should rheumatologists in clinical practice know about your research?
A: We are trying to identify potential targets that are implicated in the development of chronic complications in patients with lupus and other autoimmune diseases. As patients live longer, they accrue significantly more damage and the blood vessels are an important target.
Identifying Type 1 interferons as crucial culprits in the development of premature vascular damage could lead to significant changes in prevention strategies. Now that clinical trials that block Type 1 interferon effects in lupus and other diseases are ongoing, identifying these molecules as potentially very important in damage of the blood vessels may lead to changes in the paradigm of how we treat these diseases and prevent their complications.
Q: What specifically attracted you to lupus research?
A: It’s a disease that affects mostly young women and significantly impacts their quality of life; the multisystemic nature of the disease; the lack of understanding of what leads to the loss of self-tolerance. And then that there is so little known and so much to learn about these diseases. There is a high potential for significant improvement of their quality of life, if we better understand how autoimmunity starts, evolves, and perpetuates.
Q: What inspires to you to continue your clinical work parallel to your research?
A: I see this as an opportunity to have a high impact on the health and quality of life of these patients, by contributing in the short and medium term to their well-being by providing care, but also, in the medium and long term, by increasing the knowledge of what leads to the development of these diseases and their complications.
Mark L. Robbins, MD, MPH
Physician, Department of Rheumatology, Harvard Vanguard Medical Associates, Boston
Background: Dr. Robbins appreciates his award, but is quick to share the pride with others, saying in an e-mail that “there were a lot of other people involved in the work that is being recognized, so in a way it is an acknowledgment of the efforts of all the people I worked with.” Dr. Robbins believes that the ACR serves to support the practicing rheumatologist, particularly in “tumultuous times in medicine” that are punctuated by the growth of electronic medical records, quality reporting, and the financial impact of healthcare reform.
Dr. Robbins, who earned his Master’s in Public Health from the Harvard School of Public Health in Boston, encourages rheumatologists from all types of practice to volunteer, in part because he believes “everyone, whether they are from private, multispecialty, or academic medical practice has something valuable to contribute toward improving education, research, and clinical practice.”
Q: What is the state of physician volunteerism today and why is it important?
A: The productivity emphasis in your work life and the relative time bankruptcy that everybody is facing … makes it harder to find people who are willing to volunteer. They may be more protective of their time. I think we’re all feeling a little bit more squeezed and the question is, What do you give up? But I think [service] is vital. The staff are the foundations of what the ACR has done …. the volunteers are the enriching characteristics that provide the content and some of the innovation.
Q: What do you get out of the service you put in?
A: It is about intellectual stimulation. It is about being with, being around, and working on projects with essentially some of the most innovative and knowledgeable thinkers in the field of rheumatology.
Q: You give so much credit to colleagues whose work is recognized by proxy with an award like this. What do awards like this mean in the greater context?
A: I don’t think there’s a higher honor or a greater respect that you can get other than having your peers recognize your work and the contributions you (and others) have done over a relatively long period of time. That’s what something like this means—it’s an acknowledgment of the efforts. I don’t think you do the work that you do for awards. I don’t think anybody thinks about these things when they’re doing the work. You do the work because you like it.
Henry Kunkel Young Investigator
William H. Robinson, MD, PhD
Associate Professor of Medicine, Stanford University, Palo Alto, Calif., staff physician, VA Palo Alto Health Care System
Background: Dr. Robinson earned medical and graduate degrees from Stanford and completed his internal medicine residency at the University of California at San Francisco. He returned to Stanford for his rheumatology fellowship and now operates a 12-person research lab. His team is developing new diagnostic tests to guide physicians in the selection of therapies that will be most effective in an individual RA patient. He also is investigating the role of low-grade inflammation in osteoarthritis. Dr. Robinson, who spends about 15% of his time in the clinic, co-founded the Humane Immune Monitoring Center at Stanford and is director of the Proteomic Core Facility at the VA Palo Alto. He is an associate editor of Arthritis Research & Therapy, and serves on the Medical and Scientific Committee of the Arthritis Foundation’s Northern California Chapter.
A recording of the award ceremony is available online via ACR SessionSelect at www.rheumatology.org.
Q: What motivates you today?
A: Trying to make a contribution to one of the rheumatic diseases, so that we can help our patients. Even though there has been tremendous progress and multiple new drugs approved over the last 20 years for the treatment of RA and several of our other diseases, there is still tremendous unmet need.
Q: You say diagnostics are objective one in your lab, and that osteoarthritis is objective two. Tell me a little more about your interest in OA?
A: Five years ago, not a single person in my lab worked on OA; now a third of my lab works on OA. We’re very interested in elucidating the pathways driving the progression of OA, and we think low-grade inflammation plays a critical role, much like it does in Alzheimer’s disease and macular degeneration.
Q: What has been the most satisfying part of your research?
A: Mentoring young researchers, including fellows and students, in the laboratory and seeing them succeed. Their success is my success. They are the ones really in the lab innovating. It’s that and seeing people with rheumatic diseases benefit from the therapies.
Q: What advice do you have for the next generation of researchers?
A: You have to decide what you want to do with your career, identify your goals, and then persist. Academic research is like running a double marathon. It is all too easy to become dissuaded or to let yourself get derailed. Focus and persistence are critical to successfully run an academic career.
ACR REF Excellence in Investigative Mentoring
Michael H. Weisman, MD
Director, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles; Professor of Medicine in Residence at the David Geffen School of Medicine at the University of California at Los Angeles (UCLA); Professor Emeritus, University of California at San Diego (UCSD).
Background: Dr. Weisman, who has published more than 200 peer-reviewed articles and five books, has considered mentoring an important piece of practicing medicine since his medical school days at the University of Chicago. As he learned from those who came before him, he says, he discovered the value of collaboration and the passing of knowledge from one generation of physician to the next. He notes that he still talks to his first mentors, whether it’s his first chief of medicine or colleagues from his residency in internal medicine and rheumatology training at UCSD or from his military service as a lieutenant commander in the U.S. Naval Reserve at Camp Pendleton outside San Diego.
His current research focus is environmental and genetic risk for susceptibility and severity of chronic rheumatic diseases and, while that interest and his status as an investigator for the National Institutes of Health keeps him busy, he still finds time to work with younger physicians and the ACR, because he believes that continuum of giving back serves both himself and the field of rheumatology. Speaking of continuums, Dr. Weisman is one of the few nationally recognized physicians who can say he was born at the hospital where he now works, having been delivered at the then-Cedars of Lebanon Hospital in the City of Angels.
Q: What does being a mentor represent to you?
A: You can tell whether somebody’s paying attention and that’s important. Their success becomes important to you. Their growth, their development, their success, their independence—all of those things become important to you.
Q: What would you tell a rheumatologist who wants to be a mentor, but fears they don’t have the time to devote?
A: I’d tell them it’s the best thing they could do for themselves and other people. It’s all about people. Everything we do is about people and that’s the important issue. It’s not the grant, it’s not the contract, it’s not the position. It’s all about people and relationships … I’ve seen it from both ends, both in success and failure. I’ve learned it from failures in my life and as well as my successes.
Distinguished Clinician Scholar
Sterling G. West, MD
Professor of Medicine and Program Director, rheumatology fellowship, University of Colorado Denver School of Medicine.
Background: Working with others has been a fundamental tenet of Dr. West’s career since his undergraduate education at West Point in New York. After completing medical school, he began a two-year rheumatology fellowship at Walter Reed Army Medical Center Washington, D.C. about 30 years ago. He quickly rose to head of rheumatology at Fitzsimmons Army Medical Center in Aurora, Colo. While in the military and since joining the faculty at the University of Colorado in 1995 as the fellowship program head, he estimates he’s trained more than 50 fellows, a point he proudly points out because “they’re the future of rheumatology.”
Dr. West’s mindset works particularly well in the University of Colorado’s Division of Rheumatology, which has received four of the top nine annual awards from the ACR since 2008. (See p. 35 for the ACR Presidential Gold Medal winner Dr. Arend).
Q: Why is it important to balance your clinical, educational, and service roles?
A: In order to be an effective teacher of fellows and the like, you have to be involved with the rest of the discipline. Through those various activities, you have an appreciation for what’s going on, plus you’re up to date on the various problems and the current knowledge base.
Q: You spent almost 25 years of your career in military service. How did that experience shape your philosophy and your practice?
A: I’ve been very fortunate by having been able to both train in the military and practice a specialty in the military because the military has a great patient population with a lot of support, and so consequently you’re able to do things you might not be able to do as easily on the civilian side. Being able to start a fellowship and become the program director relatively early in my career was an opportunity I could not have had if I had not gone though the military.
Q: How do you impress upon the next generation of rheumatologists the value of volunteerism to professional and advocacy groups?
A: It has to start on day one of the fellowship and encouraging them to not only learn the book-smart type things that need to be done and the research activities that are expected of them, but to stay involved in the community itself, the Arthritis Foundation, the J.I.A. (Juvenile Idiopathic Arthritis) camps. … It’s not just staying within the clinic and seeing patients. There’s a responsibility to give back, if you will, to the field and the arthritis community.
Patience H. White, MD, MA
Vice President for Public Health, Arthritis Foundation; Professor of Medicine and Pediatrics, George Washington University School of Medicine and Health Sciences
Background: Dr. White has been in an academic medical center practice seeing adult and pediatric rheumatology patients for more than 30 years. She graduated from Harvard Medical School and completed her residency at Beth Israel Deaconess Medical Center in Boston. She has completed rheumatology fellowships at Brigham and Women’s Hospital (adult) and Northwick Park Hospital in London (pediatric).
Dr. White was instrumental in developing the “Fight Arthritis Pain” osteoarthritis awareness (OA) campaign, a collaborative effort of the Ad Council, Arthritis Foundation, and ACR. She is working with the American Academy of Pediatrics, the American College of Physicians, and the American Academy of Family Practice to develop an algorithm to help youth with special healthcare needs transition successfully to adult healthcare.
Q: You have a lot of irons in the fire. Is your work more focused on patients, physicians, or policymakers?
A: I’d probably say all three. I want to change health policy, so it’s a lot about gathering national partners to influence policymakers about doing the right thing for people with arthritis. It’s about assisting physicians to help the person with arthritis can get the right diagnosis and be treated quickly. It is about trying to educate people with arthritis, so they are armed with the right information at the right time and they can get to the right physician and get the right treatment.
Q: What changes have you seen in the past 30 years?
A: It’s the best time ever to be a rheumatologist. There is so much we can offer our patients, so much we can do to help people get better. It’s so exciting. When I started practice, I saw kids who had juvenile arthritis, many of whom were going to grow up with a severe disability. We don’t see that today. It’s just fantastic.
Q: Healthcare reforms are beginning to take shape; how do rheumatologists factor into the changes that are on the horizon?
A: In terms of system change, it’s trying to get the healthcare system to respond to what people with arthritis really want and need. They are very eloquent about what they want. They have pain and want to get better. If that means they need to get to a rheumatologist sooner and have better access to appropriate healthcare professionals, therapies, and health insurance, so be it.
Q: What do you say to the next generation of physician researchers?
A: Become a physician; it’s the most rewarding field I can think of. I get up every day and think, ‘My gosh, somebody pays me to do this?’ You get the honor of touching so many people’s lives, whether they are people with arthritis in my practice or the hardworking professionals I have the pleasure of working with.
Distinguished Clinical Investigator
Gary S. Hoffman, MD, MS
Harold C. Schott Professor of Medicine, Department of Rheumatic and Immunologic Diseases, Cleveland Clinic; Professor of Medicine, Lerner College of Medicine, Cleveland Clinic
Background: Dr. Hoffman earned his medical degree from the Medical College of Virginia in Richmond and completed advanced training at Dartmouth Medical School–Mary Hitchcock Clinic in New Hampshire. He was a general rheumatologist for 12 years before joining the National Institutes of Health in 1986, where he directed the Vasculitis and Related Diseases Section.
Dr. Hoffman is founder of the Cleveland Clinic Center for Vasculitis Care and Research, and is founder and past chair of the International Network for the Study of the Systemic Vasculitides (INSSYS). He has led investigations of new therapies for vasculitis and coordinated multicenter studies of diagnostic laboratory and imaging tools to assess vasculitis disease activity. Named a Master of the ACR in 2009, his current research focuses on factors that may determine organ vulnerability and selective targeting.
Q: It seems your decision to join the NIH helped you find your research niche. What was most important about that opportunity?
A: The NIH gave me an opportunity to focus in one particular area where there was profound, unmet need. I had a spectacular mentor in Anthony Fauci, who was really the most informed person in the world at the time in this area. … In my first day on site, I saw more patients with vasculitis than I had in my entire 12-year career.
Q: What inspired you to develop the vasculitis research network?
A: Realizing that one person couldn’t possibly take on the challenge of performing large studies in rare diseases alone, I developed a consortium of collaborators. It was really necessary to bring multiple talents together and to generate adequate numbers of patients so you could study these patients more than just one at a time. … That consortium ultimately grew to have the intellectual firepower, numbers of patients and resources, so that we could plan studies that had never been conceived as being possible before.
Q: What guidance can you provide young researchers?
A: If research is part of your passion, it’s not practical to try to be successful by looking at four or five problems that are unrelated to each other. I think that limited my productivity in my early career, although I do not regret it. The opportunity to focus in one area was a gift from the NIH, and I am forever grateful for that.
Distinguished BASIC Investigator
John A. Hamilton, PhD
Professorial Fellow and Director of the Arthritis and Inflammation Research Centre and Deputy Head, Department of Medicine, University of Melbourne in Parkville, Victoria, Australia
Background: Research has always had an allure for Dr. Hamilton. He earned his PhD at the University of Melbourne, and did postdoctoral training at the Australian National University and the Walter and Eliza Hall Institute. His career has included stints at the Basel Institute for Immunology in Basel, Switzerland, the Ontario Cancer Institute in Toronto, and Rockefeller University and Sloan-Kettering Cancer Center, both in New York. In 2001, he was the founding chief executive officer of a global consortium, the Cooperative Research Centre for Chronic Inflammatory Diseases. He is currently a senior principal research fellow of the National Health and Medical Research Council of Australia and has supervised 27 doctoral students and mentored 40 postdoctoral scientists.
Dr. Hamilton, who helped convene the 2005 Word Congress on Inflammation, traces his initial interest in rheumatology in part to a relative who suffered from juvenile arthritis. Through her, he says, he saw the daily travails of “this terrible disease.” His research has focused on the biology of inflammation, which impacts on other diseases, including cancer, diabetes, Alzheimer’s, and heart disease. His major contributions have been in cytokine-mediated effects on macrophages and synoviocytes.
Q: Your career has always been focused on academia. What was the pull of research versus clinical care?
A: I’ve always had a desire to do research that was relevant to patients, but I wanted to approach it from a fundamental perspective. My original degree was in chemistry, then I went into more biological areas, namely biochemistry, microbiology, and then immunology as a gradual transition. Rather than doing a medical degree, I thought I could make a contribution to medicine through my basic research.
Q: What does it mean to be honored for contributions to rheumatology?
A: As an academic, one is very appreciative of peer recognition. For us, it’s the most important type of recognition … you’re really trying to put your ideas out there and get them accepted. That’s your job.
Q: As the ACR’s second non-U.S. researcher to receive the award, does that make the honor more meaningful?
A: Australians always liked to be recognized internationally, and the ACR is a huge and significant organization. A great deal of the best research in rheumatology is presented at its annual meeting. Obviously I feel pretty good about the award.
Richard Quinn is a freelance writer based in New Jersey.