MD, 87PhD

What is your hometown?

Iowa City

How/when did you become interested in science and medicine?

I was exposed to science from an early age, because my father was on the faculty at the U of I College of Medicine. He was a skilled clinician devoted to his patients and was also a medical scientist that made many significant contributions to the field of immunology. He inspired me to try to understand the world around me, and to try to help people by using logical thought and quantitative reasoning to address their problems. This initially led me to major in Aerospace Engineering as an undergraduate at Iowa State University (but I remained a Hawkeye fan in enemy territory). During this time I received intense training in physics, mathematics and computer science, and became very interested in space science and aeronautics.

What interested you to pursue a career in medicine and medical education?

During two summers in college, I worked for NASA at Langley Air Force Base.  While there I met several astronauts that had both MD and PhD degrees, and I learned that obtaining specialized scientific training was a career pathway that might allow me to fly on the space shuttle. I was also advised that my training in the physical sciences would be valuable for solving problems in medical science.  This led me to apply to MD/PhD programs, although I ultimately decided against becoming an astronaut (at least not yet). Earlier in my life I had vowed to my father that I wouldn’t follow in his footsteps, so he probably thought this circuitous route to a career in medicine was pretty funny.

What interested you to specialize in neurology?

The brain is the most interesting organ in the body. I was attracted to the challenge of understanding how it works and curing diseases that affect it.  Patients with disorders of the nervous system often present with unusual symptoms and signs and can be challenging and fun to diagnose. There are already treatments for many of these patients. Recent progress in developing treatments for others has been astounding, and is continuing at a pace much faster than most fields in medicine. It is exciting to be part of that progress and to try to contribute to it. It is also gratifying to be able to treat patients with neurological diseases that other physicians either do not recognize or don’t understand well enough to know how to manage. I was initially attracted to neurology because of my research interests, but quickly found that the clinical practice of neurology is fun, challenging and rewarding.

Please highlight your major career achievements, awards, discoveries, etc.

My laboratory uses patch clamp electrophysiology, immunohistochemistry and molecular biology to understand how the brainstem regulates blood pH and CO2. We discovered that neurons that produce the chemical serotonin are sensors of pH and CO2. When breathing is impaired, the blood level of CO2 increases and pH decreases. This causes serotonin neurons to become more electrically active.  We now believe that these serotonin neurons play a critical role in many responses needed to maintain a normal CO2 level. For example, they cause an increase in breathing. They also cause arousal if a person is asleep and their face gets covered by a pillow, preventing airway obstruction by allowing the head to be turned. We have recently confirmed that this is the case in transgenic mice in which a development defect in generation of serotonin neurons leads to a severe defect in the response to CO2.

Although we began by studying a basic physiological process, our basic science work has become very clinically relevant. It has recently been found that infants that died of sudden infant death syndrome (SIDS) have a specific defect in serotonin neurons. SIDS claims 6 infant lives every day in the U.S. alone, and has long been thought to be a defect in the response to airway obstruction during sleep. We believe that death during sleep is precisely what would occur when there is a defect in CO2 sensation by serotonin neurons, and this may be more likely to occur in an infant since they are still developing. 

My laboratory is also interested in the role of GABA transporters in epilepsy. We have shown that these transporters can be induced to reverse by some anticonvulsant drugs, causing inhibition by nonvesicular GABA release. 

Another accomplishment I am proud of is that as Program Director of the Yale Neurology Residency and the head of a lab I have mentored many students and physicians. This has been a gratifying part of my career.

Is there a teacher, mentor or UI Carver College of Medicine faculty member who has helped shape your education?

Other than my father, my most important mentor was my PhD advisor Peter Getting, PhD. He was also trained as an engineer and then become interested in neuroscience, so we shared many interests. He was a great teacher and role model, and gave me the tools to be an independent scientist. He was Professor of Physiology, and founded the Neuroscience Program at Iowa. Sadly he passed away this year after a long illness due to a stroke at a young age.

I was also greatly influenced by Michael O’Donovan, PhD, who provided a lot of practical advice during my many struggles to get experiments to work, as well as Robert Fellows, MD, PhD, who founded and led the MD/PhD program at Iowa, and provided me with sage career guidance.

How or why did you choose the UI for your education and medical training?

I was attracted to the University of Iowa because of the strength of the scientific community, including the people mentioned above. It is very important to get advice from those who are successful, and who understand what needs to be done to obtain success yourself. The presence of an NIH funded MD/PhD program was also a strong indication that there would be support for the kind of career I was interested in pursuing.

What kind of professional opportunities or advantages has your UI medical training provided?

Although I was drawn to Iowa by its science, the medical training made me as well prepared to be a physician as graduates of any other medical school, and better than most. The long hours and hard work I went through in those days gave me clinical skills that formed a solid foundation for my later residency training. The strengths of clinical training and science are widely recognized throughout the country by professors at other medical schools.

Please describe your professional interests.

In addition to running a basic laboratory research, I attend on the neurology wards for 1-2 months per year and in a general neurology clinic for ½ day per week. I also run the Yale Neurology Residency Program, teach physiology to first year medical students, and give lectures to other students and physicians.

What are some of your outside interests?

I have a great family. My wife Mary has always been very tolerant of my obsession with my work, but keeps me sane by pulling me away from it when she can. My daughter Diana is 18 and is a freshman in college majoring in molecular biology. My son Matt is 17, and is planning to go into engineering. Interesting career choices. They try to go with me on business trips as much as they can, so they have seen a lot of the world. As a result they seem to understand global issues better than most people their age.

I have always enjoyed athletics. I try to run as much as I can, and ski, golf, and play racquetball as much as I can get away with. I also love to travel, which is convenient because my job requires that I travel a lot. I am much more likely to accept a speaking engagement when it is in an exotic locale (or if it includes the opportunity to golf or ski on the side).

I have recently become addicted to rocks. It started with small projects, but then grew to a large cobblestone pathway, and culminated in a dry construction stone wall made out of 60 tons of Connecticut field stone that emulates many of the walls found in New England that still stand after 200 years. I was in withdrawal this year so am in the middle of a flagstone pathway. I figure it is a better addiction than most.

Do you have an insight or philosophy that guides you in your professional work?

I try to keep a very a positive attitude. There are many times that a career in medicine or science can be very difficult. If you can make it through these times without collapsing, then the hard work is usually rewarded. Finally, it is really important to surround yourself with smart, outwardly-looking, motivated people.  They bring out the best in you. 

What is the biggest change you've experienced in medicine since you were a student?

There has become a lot more oversight by regulatory agencies than there used to be. This is understandable to a point, but sometimes it gets excessive. On the positive side, new technologies have greatly improved the diagnosis and treatment of many diseases. These changes are a direct benefit of past medical research.

What one piece of advice would you give to today's medical students?

If you have a career that you enjoy, you are much more likely to be valuable and successful. If you choose a field because it is lucrative, or because others tell you that it is the hot field, you may find that you don’t enjoy going to work. 

What do you see as "the future" of medicine?

There are still many diseases that can only be treated with symptomatic therapies, rather than being cured. Molecular and cellular biology and biochemistry, although often viewed as esoteric and boring by medical students and practicing physicians, are the key to cures for devastating diseases like cancer, heart disease, Alzheimer’s disease, ALS, and many, many others.  Those who recognize that these fields are where the advances will come from are going to be the ones that make them happen.

What do you see as “the future” of your research in neurology?

My group is now working with a team of scientists divided among 5 institutions to find a cure for SIDS. Our team includes a neuropathologist who studies brains of SIDS infants, pediatricians that perform physiological tests on living newborn infants, a molecular geneticist that designs transgenic mice, and neuroscientists including myself that study these mice. Our dream is to find a simple, cheap and noninvasive test (like the PKU test) that could be given to every infant in the first weeks of like. This test would identify those infants at highest risk of SIDS, and they could then be treated to prevent death.

I believe that my work on the basic biology of serotonin neurons will also become more obviously relevant to several other neuropsychiatric diseases in which serotonin is central, like migraines, panic disorder, sleep apnea and epilepsy.  We are currently working to establish these links.