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From Bedside to Biotech
A researcher who is dedicated to clinical care, Gerard Burrow also knows how to raise
money. His new job as Dean of the School of Medicine is likely to test all of his talents.
November 1992
by Bruce Fellman
In 1986, Gerard Burrow ’58MD was visiting a tiny village with the tongue-twisting name of Pangnirtung on the Cumberland Sound of Canada’s Northwest Territories. A distinguished physician who was then the Sir John and Lady Eaton Professor at the University of Toronto, Burrow also served as Medical Examiner for the Anglican Diocese of the Arctic. He was in Pangnirtung for a conference, and following a picnic of caribou and seal, he checked in with some of the local officials and asked about the health of the villagers. The local nurse brought the medical examiner up short. “She told me very clearly that she was in charge and she didn’t need my help, thank you,” says Burrow, still amused at one of the few rebuffs he has suffered in 34 years of medical practice.
Yale showed no such resistance last July when it appointed Burrow as the 14th dean of the School of Medicine, succeeding Leon E. Rosenberg, who left the University last year to become president of the Squibb Pharmaceutical Research Institute in Princeton, New Jersey. “We greeted Gerry like a long-lost friend, which is exactly what he is,” says John Fenn ’61MD, chief of staff at Yale–New Haven Hospital.
Indeed, Burrow, a dapper, warm, and trim 59-year-old (his pastimes include surfing, sailing, and trail biking) from Boston, has deep roots at Yale, having progressed through the ranks from the Medical School to internship to residency to professor between 1954 and 1976, when he left for a 12-year stint in Canada. There, he worked at both the Toronto General Hospital and the University of Toronto in a variety of capacities until 1988, when he assumed the dean’s role at the University of California at San Diego (UCSD) medical school, along with the mantle of vice chancellor for health sciences, and presided over a period of unprecedented growth both in facilities and faculty.
This broad background makes Burrow a rare individual, a bonafide triple threat. He is a talented administrator (as well as fundraiser), an internationally respected researcher (his specialties are the thyroid gland and the medical complications of pregnancy), and a compassionate physician who has never stopped seeing patients. “Gerry’s an ideal role model,” comments Fenn. “He has a wonderful sense of humor, and he’s as good a listener as he is a talker. That’s very important for a dean—and a doctor.”
Burrow’s myriad talents will be put to immediate use, for the medical school he inherits—with its 2,600-member staff, 1,500-plus students and $300-million annual budget—is entering a period of change, one that in many ways reflects the ongoing revolution in medicine. “The major challenge to medical education now is the integration of a rapidly increasing fund of basic biomedical knowledge into a new pattern for the delivery of medical care,” wrote Dr. Michael Kashgarian, professor of pathology and biology, in a recent Yale Medicine editorial.
Burrow, who has extensive experience dealing with health-care research, practice, and delivery issues in three disparate cultures—Connecticut, Canada, and California—seems especially well suited to the job of guiding Yale’s medical school into the next century. “I’m interested in building bridges between the basic scientists and the clinicians—in going from the bench to the bedside, and back to the bench,” says Burrow.
The University’s great strength, he feels, has always been in research, and indeed many of the doctors who learned the trade here emerged as skilled scientists. In Burrow’s view, however, the clinical side of the Yale program has lagged behind the research. “Our clinical program needs to have the same luster as the basic research program,” he says. “Here we spend relatively more time teaching students how to generate and access information than how to deal directly with a patient.” But he argues that righting this imbalance should not be hard: “We have ties to excellent hospitals, with many superb community physicians.”
There are already shifts underway in the school’s basic curriculum, and the dean plans to encourage more hands-on training. “The form in which medicine is practiced is changing dramatically,” he says. But Burrow doesn’t see a return to the nostalgic, Norman Rockwell-esque, house-call era in which physicians often did more hand-holding than doctoring. “A lot of people are wondering why we can’t go back to that,” says Burrow. “Well, the doctor in Rockwell’s painting was sitting there because he didn’t know what else to do. One reason we don’t make house calls anymore is that we rely on the technology in the hospital to help us make diagnoses. But of course technology by itself is certainly not enough. A good physician is someone who takes responsibility for the patient. To do so requires a certain body of knowledge—along with compassion and caring.”
Whatever his commitment to patient care, Burrow has no intention of downplaying research, the hallmark that has traditionally set a Yale medical education apart from that offered at most other schools. His hope is to bring the often separate worlds closer together for the benefit of both. “The discipline and rigor of research are enormously helpful to being a good physician,” he says. “It makes you think much more critically, and that quality makes you a better clinician.”
That judgment is based on a solid personal grounding in both areas. After graduating from Brown University in 1954, he entered the School of Medicine, completing his internship in 1959. From New Haven Burrow moved on to two years as an assistant surgeon with the United States Public Health Service in Japan, where he concentrated on investigating the effects of prenatal exposure to the atomic bomb blast at Nagasaki. (While the exposed children he studied had a higher incidence of disease than their non-irradiated counterparts, they showed no unusual developmental problems.)
According to Burrow, the experience of being in the Orient profoundly altered his life. He and his wife, Ann (they have three grown children: a financier, a restaurateur, and a doctor), “really learned that less is more,” and they embraced the culture, she immersing herself in flower-arranging and doll-making, he pursuing a black belt in the martial art of judo. The Yale experience helped him in that pursuit in an unexpected way. “The first time I threw someone,” Burrow recalls, “I didn’t make any noise, and my teacher said, ‘you have to yell.’ So the next time, I yelled, BOOLA BOOLA! I thought it was a good word, very explosive, and my teacher agreed.” (Burrow got the belt.)
Burrow’s research interest in the thyroid—the body’s “master gland,” which is responsible for the regulation of both development and metabolism—grew directly out of the work he had done in Japan on pregnancies that went awry. (The authoritative textbook, Medical Complications During Pregnancy, which he co-edited, is now in its fourth printing.) In the years since, his research has concentrated on a still-perplexing question: What controls thyroid growth? At this point, Burrow and his collaborator, UCSD molecular biologist Judith Meinkoth, are attempting to chronicle the cascade of events that take place when thyroid stimulating hormone, which belongs to a class of chemical signals known as growth factors, arrives at the surface of thyroid cells. “If we can identify the messengers that stimulate or inhibit growth,” says Meinkoth, “then we’ll understand a lot about what happens with aberrant growth—in tumor cells, for example. It’s often an absence of some of these critical controlling molecules that allows a tumor cell to grow unabated. The messengers that stimulate proliferation may be targets for new therapies.”
The collaboration between Burrow and Meinkoth can be seen as an example of how willing and able the new dean is to break down traditional barriers. Meinkoth joined the project after Burrow’s longtime research partner, Margaret Eggo, had to return to her native England. “Margaret was a biochemist—I’m a molecular biologist,” says Meinkoth, pointing out that many researchers would hesitate to shift to entirely new methods in the course of a project. “It didn’t bother him at all,” says Burrow’s colleague. “He jumped right in because he was interested in what we could learn using a different approach.”
The scientific papers that have resulted from this collaboration join the more than one hundred that Burrow has produced over the years. In addition to publishing, he has pushed the state of the research art by serving on the editorial boards of scientific journals, including Metabolism, the Annals of Internal Medicine, and the Journal of Clinical Endocrinology. Burrow also plays an active role in numerous professional organizations, such as the Institute of Medicine of the National Academy of Sciences, the Society for Clinical Investigation, Sigma Xi (the national scientific honor society), the American Cancer Society’s Public Issues Committee, and the Association of American Medical Colleges’ Advisory Panel on Strategic Planning for Health-Care Reform.
The issue of reforming the health-care system in the United States is occupying much of Burrow’s thoughts these days, and he intends to position Yale in the front lines of the health-care reform debate. “The health-care system is in chaos,” he says. “To be spending more money than anyone else in the world, and yet to have 35 million people with no health insurance and half the children in inner cities not getting basic immunizations—it’s just wrong.”
At UCSD, Burrow had ample experience with the gap between the nation’s wealthy and those in need of medical care, something he refers to as the paradox of deficiency and excess. “Ten percent of the women who delivered at the UC Medical Center had no prenatal care, which results in a fourfold increase in low birth weight babies,” he says. “Many of these mothers are simply the working poor—they make too much to qualify for Medicaid, but not enough to afford a doctor. At the other end, we had hospitals that did close to 40 percent Cesarean sections, which is twice the national average.”
In his professional life, Burrow has observed two very different responses to the health-care dilemma. California stressed a managed-care approach, which contained costs but created an almost ghoulish competition among hospitals and doctors for patients. Canada, on the other hand, provides universal care, but its critics worry that any national system implemented in this country will quickly turn into a bloated, inefficient bureaucracy.
While the Medical School’s new dean is convinced that some form of national system is essential, he shares the concern about how it might be carried out. “What has made medicine in this country great is its entrepreneurial spirit, and we don’t want to kill that,” says Burrow. “But we’re getting close to anarchy. We have to replace what we have now with something.”
Among the areas Burrow feels Yale might profitably explore in dealing with the present situation are changes in the legal system, cutting administrative costs, and centralized planning. And New Haven, Burrow argues, offers an ideal laboratory for such explorations. “We’ve entered into a real partnership with the city,” says Burrow, citing as examples the Medical School’s involvement in a needle-exchange program (YAM, April 1992) to help check the spread of aids, and its efforts in the community to prevent tuberculosis.
These collaborations require their own special brand of cooperation, both between town and gown and, perhaps even more tricky, within the University itself, where individual disciplines have sometimes resembled impregnable fiefdoms. But the walls can come down, says Burrow. As an example, he points to a joint effort by the Medical School, the department of epidemiology and public health, the School of Forestry and Environmental Studies, and scholars in international studies to look at the effects of the deforestation of the Brazilian rain forest on the health of the people who live there.
Such partnerships happened often at UCSD, and Burrow wants to try similar ones at Yale. “The divisions among the disciplines are blurring,” he says. “We need to construct an environment that encourages the blurring, and yet at the same time gives people a sense of belonging.”
The new Boyer Center for Molecular Medicine (YAM, May 1991) seems to be just what this doctor ordered. “One interesting thing happening in the 90s is that as medicine moves towards biology, biology is moving towards medicine. We’re getting into commonalties,” says Burrow. One of the connecting links is biotechnology, a field in which, Burrow believes, Yale should become a major player. In fact, the University may have no choice, for research money is on the decline, and the National Institutes of Health—one of the prime funding agencies for biomedical research—are pushing science in a more immediately practical direction. Conventional fundraising can pick up only part of the slack, says Burrow, so some form of commercial cooperation appears all but essential to prime the discovery pump. “In one sense, we have a responsibility to do this, because it’s the way we get our discoveries out to the public,” says Burrow. “But it also makes sense financially.”
Once again, Burrow cites as an example his experience in California, where UCSD and the city of San Diego created a mutually beneficial biotechnology partnership. Burrow feels Yale and New Haven could do the same. “One thing I learned in California is that it’s possible to collaborate with industry and maintain academic integrity, and there’s a definite benefit to making it work: jobs. I see no reason why we couldn’t replace the industries we’ve lost in New Haven with biotechnology companies.”
From bench to bedside to biotechnology, and back again—that’s the vision Burrow hopes to bring to Yale. “We’re positioning ourselves for the 21st century,” he says. “The breadth and depth of this university allow us to be one of the truly premier medical schools in the world. It’s just a matter of putting the pieces together.”  |
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