- What is your job title and affiliation?
I am Professor of Pathology, Director of Clinical Chemistry and Associate Director of Molecular Diagnostics at the University of Virginia. You didn't ask this question, but I am also Editor of Clinical Chemistry.
- Briefly tell us about your educational and career background
My undergraduate degrees were in chemical engineering (BSChE) and liberal arts and sciences (AB) from Washington University in St. Louis. I worked at Sigma Chemical Co developing test kits for clinical laboratories before getting an MD from St. Louis University. My residency and fellowship training in laboratory medicine, experimental pathology and clinical chemistry were at Washington University.
- What are your Board certifications?
Sadly, I never took board exams. I may be the last such dinosaur who is gainfully employed (well, at least employed). Lack of board certification may provide one advantage in that it makes one more acutely aware of the need to live by one's wits. This might be good for a career in research, but it is probably bad for one's mental health. [Einstein said that research is a wonderful thing to do, but no one should do it for a living. He thought it best to have a job, like teaching, that paid the bills.]
- With which professional societies/organizations (e.g. AACC) are you involved?
I have been involved steadily with AACC since 1974. I have also served in the Academy for Clinical Laboratory Physicians and Scientists on its Executive Council and, more recently, as President. I was President of the Association of Clinical Scientists earlier. In more recent times, I have benefited from memberships in the Council of Science Editors and the World Association of Medical Editors.
- Just for fun, tell us a few interesting facts about yourself:
Most of those things are secret, but my wife will tell you that I like wines. I am not prejudiced about wines, I like both red and white, but I can't drink most cheap ones. In travel, I am partial to rugged coast lines such as those in the Big Sur, Costa Brava, and areas of the North and South islands of New Zealand.
- What area(s) do you specialize in?
I had an early interest in enzymes and thus naturally worked on various aspects of clinical enzymology. My more basic research was on calcium, both in cell signaling and in calcium transport. In the basic research, I worked with my wife, Liz Bruns, who, unlike me, had a license (PhD) to practice biochemistry.
- What initiated your interest in this (these) area(s) and how did you eventually choose this (these) area(s) for your career?
Students who trained at Washington University could hardly help but be interested in enzymes. Arthur Kornberg had been there as had Carl and Gerty Cori (all of whom won Nobel prizes) and many other pioneers before and after them. As Barry Commoner put it, the tenets of molecular biology were hollow without Kornberg's enzymes to do the work. I became interested in calcium because of my wife's work as a postdoctoral fellow in the laboratories of Lou Avioli, also at Washington University, a pioneer in metabolic bone disease.
- What are your clinical and research interests?
I have always been interested in the interface of the laboratory and the bedside. This remains an interest, and one that I pursue now as editor of Clinical Chemistry. I also enjoy attending the Internal Medicine Morning Report and the Case Conferences of the Endocrine Division at the University of Virginia. Such meetings highlight clinical needs and thus suggest areas in which we in the laboratory may be able to contribute.
- What, in your opinion, has been the most important contribution you have made to the field of laboratory medicine?
My most important contribution has been as editor of Clinical Chemistry. But it is critical to realize that the Journal is very much a team effort. I am less a person responsible for the Journal's successes than I am a servant of its legacy and of the immensely talented and self-sacrificing individuals who have served it in the past and those who do so now and will in the future. I am aware every day of that burden, and of my ethical responsibilities to authors and readers.
- Are there specific aspects of practicing laboratory medicine that you find unappealing?
I do not like to take time out for most things that seem to enthrall MBAs. This seems to work out well, as there are plenty of people who do like to deal with these things.
- What were some of the most rewarding and/or challenging moments of your career?
A challenging moment occurred when David Herold and I became convinced that a breakthrough treatment for burns was causing deaths of patients, and that the culprit was widely accepted as nontoxic. The deaths had been attributed, erroneously, to a range of causes, and autopsies had not identified the agent. The agent was polyethylene glycol (PEG), which was being used as a vehicle for antimicrobials in a burn cream. The Director of the University's Burn Unit was a leader in the field and, I think, justifiably proud of the new treatment. Fortunately, he also was rigorous and immediately supported research about our concerns in an animal model in his laboratory. Those studies of PEG recapitulated the findings in the patients. Dr. David Herold, now Director of Clinical Chemistry at UCSD, was a resident at the time and an expert in mass spectrometry; he realized that the only tool to study all the aldehyde and acid metabolites of PEGs that we predicted was the new technique of tandem mass spectrometry. Fortunately, Don Hunt at Virginia had been building such instruments, and a student of his was working on analytical techniques that proved to be relevant to our problem. The tandem MS demonstrated the presence of the predicted metabolites in both the patients and the animals. Finally, David and I (mostly David) demonstrated in vitro that purified dehydrogenases catalyzed the metabolism of PEG to the predicted metabolites. The Director of the burn unit was convinced and discontinued use of the new treatment. That was a relief, but when Dr. Herold presented the findings at a meeting of experts on burns, representatives of the company that manufactured the burn cream were heard telling physicians that the deaths of the animals were attributable to poor animal care, not to PEG. This was particularly insulting as the research director of that laboratory was a highly respected animal researcher with great concern for animals. Despite objections, the FDA, after reviewing the data, sent a "Dear Doctor" letter warning about use of the burn cream. The burn cream is still on the market, so if you see a combination of increased osmolal gap, increased anion gap, high total calcium with low ionized calcium, increasing creatinine and obtundation, be sure to tell the patient's caretakers to stop use of PEG.
- What excites you about practicing laboratory medicine everyday?
It is the interface of the laboratory and the bedside, and the opportunity to work with smart, informed and dedicated colleagues.
- What are your predictions for advances in laboratory medicine and/or your area over the next ten years?
Watch where NIH is spending money. Many advances in laboratory medicine will come in those areas in the next ten or more years
- What do you see as the challenges facing young scientists in laboratory medicine?
I will mention two. First, it is hard to stay stay up-to-date in laboratory medicine, and it is particularly challenging to do that and also be competitive for research funding. Thus, a challenge is to find ways to stay current and creative, and to have the discipline to make those things happen. Second, because a team is required to achieve excellence in service, a challenge is to maintain funding for adequate numbers of technologists and laboratory directors, both of which are in short supply.
- What specific goals would you recommend that young scientists in your discipline set for themselves? Any suggestions on how to achieve them?
Don't have too many goals. Important goals take a lot of work.
- Describe how you have been able to give back or contribute to the organizations and the profession in general through your involvement in AACC.
My emphasis has been on the journal. I believe that what is in the journal helps to define our discipline for ourselves and for others. It defines the scope of the field, and indicates the rigor and quality of our efforts. These things are important for our profession.
- How did you get started in these organizations and what advice do you have for young people wanting to get involved?
- Do you have any other specific comments or advice that you like to provide to the members of SYCL?
Find what interests you and, preferably, you are passionate about. The rest will take care of itself.