Saturday, September 1, 2007

Dr. Joseph Murray, Plastic Surgeon & Scientist

Over at Respectful Insolence today's posting is "You want to know how to make a surgeon angry?" The short answer is

"Surgeons and other medical staff are the equivalent of technicians, engineers, plumbers or carpenters. They are not scientists. They are not studying the details of the relevant science. They don't have to understand it - just carry out procedures by rote. Though the ones who do have a clue will be a lot better at adapting to new circumstances because they'll make more correct guesses based on their understanding than the clueless ones will."

Maybe some of us fall into that category (though we still don't like it pointed out), but others are like Dr. Joseph Murray. In 1990 he was awarded the Nobel Prize in Physiology or Medicine. You can read his acceptance speech here. He received the award for his work that greatly advanced the progress in transplantation surgery. On December 23, 1954, he performed the first successful human renal transplantation between identical twins.

"Dr. Murray credited the watershed accomplishment to a collaborative effort, praising the renal transplantation team assembled at the Brigham by Physician-in-Chief George Thorn and Surgeon-in-Chief Francis Moore. Dr. Murray ultimately transplanted kidneys in about two dozen sets of identical twins. Once he and his team had shown that transplantation could succeed between genetically identical persons, they were eager to discover how to break the immune barrier and expand the usefulness of kidney transplantation beyond this limited population. To this end, Dr. Murray explored the use of total-body irradiation and bone marrow replacement for suppressing the immune system. In 1959, he used this technique successfully to transplant a kidney and bone marrow between two genetically nonidentical twin brothers (N Engl J Med. 1960;262:1251-1256). The 24-year-old recipient, John Riteris, lived 29 years with his transplanted kidney. Ultimately, however, this approach did not prove to be a dependable and successful protocol. It was not until immunosuppressive drugs appeared on the scene that a more reliable method of overcoming immune rejection was developed. In April 1962, Murray and the Brigham kidney transplant team performed the first successful kidney transplant using an immune-suppressing agent—azathioprine—on 23-year-old Mel Doucette (N Engl J Med. 1963;268:1315-1323).

Although transplant research and surgery was his focus for many years, Murray considered his "true calling" to be the work he was also doing in plastic surgery—particularly facial reconstruction in children disfigured by cancer or birth defects. "At heart, I’m a reconstructive surgeon," he said. When demands on his time forced him to choose between transplantation surgery and reconstructive plastic surgery in 1971, Murray followed his heart, resigning as chief of transplant surgery at the Brigham to focus on his plastic surgery practice. While the two types of surgery might seem disparate, Murray explained that it was plastic surgery that introduced him to questions surrounding transplantation when he was fresh out of Harvard Medical School. As a US Army officer stationed in Pennsylvania during World War II, he worked with burn patients sent back from the war, gaining extensive experience in plastic surgery; his work with skin grafts raised the issues of immune rejection he would later find ways to address.

Murray did not travel overseas during World War II, but his reconstructive surgery skills eventually led him around the world. In 1962, at the invitation of Paul Brand, MD, a surgeon who helped rehabilitate leprosy patients in India, Murray spent 2 months in Vellore training local plastic surgeons and their staff in various modern techniques. A decade later Murray traveled to Tehran, Iran, where he operated on a wide range of patients, including children with severe burns that occurred when they fell into open ovens in their homes.

Murray continued his practice into his 60s. In 1986, 3 months away from retiring from active surgery, he had a stroke. Although he recovered quickly and was cleared by his doctors to return to the operating room, he chose to retire. "I had 48 years of surgery under my belt, and I decided to just enjoy other aspects of my life," he said.

An avid tennis player and hiker, Murray had been active all his life and he eventually resumed these activities. Retirement, though, allowed him more time to spend with his family—his wife, Bobby; their six grown children; and his grandchildren—with whom he is close. He also recently penned his autobiography, Surgery of the Soul: Reflections on a Curious Career (Science History Publications, Cambridge, England; 2001), and is working on other book ideas.

Looking to the future of transplantation, Murray commented on the lack of donor organs: "We’re victims of our success. It’s literally an insoluble problem until you can create organs in some other way." From JAMA article--Joseph Murray, MD Transplant Pioneer; Vol. 292 No. 24, December 22/29, 2004


Murray wrote, "It is absolutely essential for medical progress that dedicated clinical surgeons and scientists understand and work with scientists of other basic disciplines. It is a simple fact that basic scientists cannot be surgeons, so it is essential that surgeons be scientists."


References

Joseph E. Murray (1919– ), Nobel Laureate, 1990 by Michael Cash BS, Christopher Dente MD, and David Feliciano MD; Arch Surg. 2005;140:270-272.

Interview with Dr Joseph Murray by Francis L. Delmonico; American Journal of Transplantation 2002; 2: 803–806

Joseph Murray, Md Transplant Pioneer: JAMA; Vol 292, No 24, December 22/29, 2004

2 comments:

Harry said...

Surgeons NOT scientists? That's just stupid. Like you said, some may not be so into research, but reading the relevant literature when practicing and the scientific knowledge-base attained at medical school and pre-med does not mean surgeons are simply technicians!

and don't surgeons have to take part in research in order to get accepted onto the surgical programmes in the first place?

rlbates said...

Harry, we are encourage to write papers when we are in training, but some of them are more clinical oriented than lab. And I think we are better surgeons if we are observant.