The Burlington, Iowa native is an international authority on recurrent miscarriage, pregnancy in transplant patients and other immunology problems in obstetrics and gynecology. He is the editor of Obstetrics & Gynecology, the premier journal of the specialty, and a professor and chair emeritus at the University of Utah.
How/when did you become interested in science and medicine?
I did not come from a medical family, had no particular experience or contact with medicine, and had no pre-conceived major when I started at the University of Iowa. I developed an interest as an undergraduate student, but it was not science that attracted me. I think it was the chance to work with people in what I considered, and still consider to be, the most noble profession of them all.
What interested you to pursue a career in medicine and medical education?
Once I started medical school, I was fascinated with the challenge and what medicine was all about. It was such a privilege and so much fun to take care of patients as a medical student, an intern, on the Indian Reservation (U.S. Public Health Service Commissioned Corps), and as a general practitioner in rural Iowa. However, I got so busy and had so little time that it was pure luxury when I returned to the University for specialty training. I appreciated just having time to read and learn, and I enjoyed teaching and managing patients with complicated obstetric and gynecologic surgical problems. It was also the right place at the right time for me to do exciting research in a unique area in the forefront of medicine – transplantation and immunology. I knew then that academic medicine was for me.
Please highlight your major career achievements, awards, discoveries, etc.
In 1992-93 I had the honor of being the William C. Keettel, M.D., Endowed Visiting Professor at the University of Iowa. I was noted in 1994 in The Best Doctors in America, in 1996-97 The Best Doctors in America; Pacific Region, and again in The Best Doctors of America in 1998-99. In 1996-97 I served as the president of the American Gynecologic and Obstetric Society and in 2006 was recognized in America’s Top Obstetricians and Gynecologists by the Research Council of America. In 2007 I was honored with the Distinguished Service Award from the American College of Obstetricians and Gynecologists, District VIII. And since 2001, I have had the honor of serving as Editor-In-Chief of Obstetrics & Gynecology.
Is there a teacher, mentor or University of Iowa Carver College of Medicine faculty member who has helped shape your education?
I greatly admired many of the faculty when I was a medical student and resident for their hard work, tremendous medical knowledge, skills, and for their dedication to patient care and teaching. William Keettel, M.D., Chair of the Department of Obstetrics and Gynecology, particularly influenced me and was a true role model. He was a gentleman, had vast experience in the specialty, developed an excellent academic department, and was highly respected both locally and nationally. When I became Chair of my own department, I often thought about what he would do when various situations arose and decisions had to be made.
How or why did you choose the University of Iowa for your education and medical training?
I really never thought about going anywhere else. I knew about the University of Iowa and cost was a factor in those days, so it was best for my situation. I knew the medical school had a great reputation, and I did not apply anywhere else. Getting accepted into medical school after three years saved me a whole year’s expenses. It turned out to be exactly the right place for me.
What kind of professional opportunities or advantages has your University of Iowa medical training provided?
I owe my whole professional career to the University of Iowa. In retrospect, I suspect I represent what Universities should do – take a pretty green young kid and provide him/her with an opportunity. The whole university scene was educational and a wonderful time for me. I greatly benefitted from an experience that many never have, and it is also where I met my wife. I will forever be grateful to the University of Iowa, the College of Medicine, and I will always be a loyal Hawkeye fan.
As a graduate of the University of Iowa Carver College of Medicine and a former faculty member, what does being the recipient of the Distinguished Alumni Award mean to you?
It is honestly one of my proudest moments. I never envisioned anything like this when I arrived in Iowa City many years ago. I only wish my mother and father could have enjoyed this honor along with my family and me.
Please describe your professional interests.
My present research interest is on the relationship of fetal maternal chimerism to immunologic tolerance and the effects of fetal exposure to immunosuppressive drugs on the long-term health and pregnancies of the offspring from transplant patients.
Otherwise my current professional interests revolve around my role as the Editor of Obstetrics & Gynecology. With the present health care system in disarray, I am interested in how we can improve things for physicians and patients. I am also working on how to adapt the journal to the electronic era, better ways for physicians to keep up with medicine, and how to more efficiently transfer the medical literature and evidence based medicine into the actual patient care setting.
How did you become interested in Obstetrics and Gynecology and what led you to study recurrent miscarriage?
While I was in general practice, I realized that I liked delivering babies and doing surgery, so Obstetrics and Gynecology was a natural. After my residency, I studied with Rupert Billingham who along with Sir Peter Medawar and Leslie Brent, won the Nobel prize for producing immunologic tolerance. This discovery led to a renewed interest in clinical organ transplantation, but immunosuppressive drugs were required to prevent rejection. Billingham believed the key to developing immunologic tolerance in organ transplant recipients was to understand why the fetus was not rejected by the mother. This led to a series of experiments in maternal fetal immunology and immunologic problems in pregnancy that I have continued throughout my career. Recurrent miscarriage was a condition believed to be in some cases due to immunologic mechanisms which led to my research in that area.
As editor of Obstetrics & Gynecology you are continuously providing new information and practices to educate the members of your specialty. What would you say is the biggest change in Obstetrics and Gynecology since you were a student?
Like all areas of medicine, it has become more complicated and more specialized. There has been a gradual shift from a profession devoted to service to a for profit business model. Scientific advances have been spectacular, but escalating costs, a litigation mentality, and a more hurried and impersonal approach to patient care, have been detrimental. We need to move away from commercialization and back to a focus on what is right for patients. Physicians are also now confronted with “information overload” from a variety of sources. I envision my role as Editor of Obstetrics & Gynecology to make sure the journal is the primary source of information for our specialty that is reliable and that physicians can trust.
Throughout your prestigious career, you still seem to remain focused on education. What maintains your interest in medical and graduate resident education?
I have always enjoyed interacting with students, residents, fellows, and faculty. Until I stepped down as Chair, I made teaching rounds every week, and I still never miss our Morbidity and Mortality Conference. I just like the camaraderie and teaching atmosphere and the intellectual curiosity engendered. It is personally rewarding to see the residents we trained who are now great physicians and junior faculty members in my department who have gone on to important positions in academic medicine.
You have made significant contributions to the field of Obstetrics and Gynecology, from publishing papers and editing journals that serve to further the advancement of the specialty, to uncovering some of the basic mechanisms of recurrent miscarriage due to lupus anticoagulant syndrome. What would you say has been your greatest achievement in medicine?
That’s difficult to say. I am probably best known in my field for our studies on immunologic aspects of recurrent miscarriage and the relationship of antiphospholipid antibodies to pregnancy complications. However, I personally consider myself to be primarily a clinician. I hope my legacy is just that I was a good doctor and teacher. My present position as Editor-In-Chief of Obstetrics & Gynecology is a privilege that few ever have.
What are some of your outside interests?
I enjoy golf and skiing and am a big sports fan. Our family is very important to my wife and me; we have 4 kids and 11 grandkids.
Do you have an insight or philosophy that guides you in your professional work?
What one piece of advice would you give to today's medical students?
Find an inspiring mentor, decide to make a difference, and have a passion for whatever you do.
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