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Joseph Barnett Kirsner, MD, PhD
In Memoriam Joseph Barnett Kirsner, MD, PhD
J
oseph B. Kirsner (Dr Joe to his patients) was a Zeus among the gods of gastroenterology and was almost immortal, living to the age of nearly 103. As our colleague Dr Eugene Chang stated, “he was here (at the University of Chicago) for two lifetimes.” To say that Dr Kirsner devoted his life to medicine is an understatement and is an insufficient description of the depth and breadth of his 75-year commitment to his patients, students, and colleagues throughout the world. Dr Kirsner had a remarkably productive and fulfilled career, and in fact he continued to serve and represent the GI Section and Department of Medicine until the last weeks of his life. He saw patients until the age of 95 years and what could be considered the culmination of his academic life occurred at the age of 100 years, when he stood to give a 1-hour Department of Medicine Grand Rounds on the history of gastroenterology, which earned a prolonged ovation by the standing room–only crowd of fellow faculty, housestaff, and students. The oldest of 5 children, Joseph Barnett Kirsner was born in Boston on September 21, 1909, to Ukrainian Jewish parents who had immigrated to the
Joseph B. Kirsner, MD, PhD. Photo courtesy of the University of Chicago Medicine.
United States. He grew up in Boston’s East End neighborhood, a foothold for recent immigrants. Throughout his adolescence, Kirsner held multiple jobs, delivering newspapers, stocking a grocery store, and working as a library clerk. He then worked his way through a six-year program at Tufts University that combined college and medical school. Reflecting on his parents’ difficult lives, he commented that he chose a career in medicine and derived his work ethic “to make them proud.” He entered medical school in 1929 and graduated in 1933. Planning a career as a general practitioner, he moved to Chicago for a 2-year internship at Woodlawn Hospital on the South Side, with free room and board plus a salary of $25 a month. There he met a patient, Minnie Schneider, who was hospitalized at Woodlawn with an ear infection. “She was a ballerina,” Kirsner recalled. “I fell totally in love with her.” They were married for 64 years when Minnie passed away in 1998. While at Woodlawn, Dr Kirsner began attending lectures at the University of Chicago. In August 1935, an entry-level faculty job opened up and he joined the hospital staff as an assistant in medicine with an annual salary of $1000. Dr Kirsner often noted that he was told that he could see patients, but if he did not perform important research, his position would be terminated. He initially worked with a faculty member in infectious diseases. After several months he inquired about research and his senior colleague quipped, “We don’t have any research to perform. We have learned all we need to know.” Disappointed by this response and seeking to preserve his position, he sought out Walter Palmer, MD, PhD, who had established the first academic gastroenterology unit in the United States in 1927. Thus began a partnership that would define Dr Kirsner’s subsequent career in gastroenterology. Dr Kirsner began working with Palmer, who was doing pioneering studies in stomach and intestinal disorders.
He also began a PhD program in biology, which he completed in 1942 (“A Study of Alkalosis with Special Reference to the Electrolyte Composition of the Blood Serum and the Role of the Kidney”). His early research led to an unusual collaboration. A penniless, homeless young man, known as Edwin R., enrolled in one of Dr Kirsner’s studies. Edwin badly needed treatment. He also needed a job and a place to live, so Dr Kirsner kept him hospitalized for an entire year as a patient and research subject and trained him to be a technician. “It would be difficult to gain approval for such an arrangement today,” Dr Kirsner acknowledged, “but it was acceptable to him, and he helped me start some of my research. Everybody was happy.” His interest in the inflammatory bowel diseases (IBDs) began in 1936, when he met a young woman who was suffering from the ravages of ulcerative colitis and died from the little-known disease. World War II forced Dr Kirsner to put his research on hold. In 1943, he joined the US Army as a physician. In August 1944, about 10 weeks after D-Day, his unit landed at Utah Beach, Normandy. They established bases at various hospitals in France and Belgium, one of which was hit by a German V-2 rocket that landed right in his office and killed a medical colleague. Dr Kirsner often reflected on that rocket, and he interpreted the events of that day as a sign that he was destined to continue in a lifetime of service to others. Over the next 6 months, he cared for US soldiers with severe battle wounds, captured German officers, and survivors of the Nazi concentration camps who had complex nutritional issues and suffered from refeeding syndrome. Soon after Victory in Europe Day, he was transferred to the Pacific Theater, where he advised on the rehabilitation of more prisoners of war, including a group of badly burned Dutch prisoners who were being held captive in Nagasaki in August 1945 when an atomic bomb obliterated much of the city. He was disGASTROENTEROLOGY 2012;143:1123–1124
In Memoriam, continued charged in 1946 at the rank of major with 3 battle stars. Back at the University of Chicago, Dr Kirsner continued his research in IBD and rose steadily through the academic ranks. He became an associate professor in 1947, professor in 1951, chief of gastroenterology in 1960, and the Louis Block Distinguished Service Professor of Medicine in 1968. In 1971, he was named the chief of staff and deputy dean for medical affairs, a position he negotiated to avoid the standard university retirement at the age of 65 years. His 77-year institutional commitment exemplifies a degree of loyalty, passion, and perseverance that is rare-to-nonexistent in today’s day and age. He published more than 750 scientific papers and 18 books, including 6 editions of his authoritative textbook, “Inflammatory Bowel Disease.” The 2004 edition of this text is 842 pages. He trained more than 200 of the field’s leading specialists. Although he officially stopped seeing patients at the age of 95 years, former patients continued to call him for advice in all areas of health and medicine. Dr Kirsner’s 2 greatest regrets were that he did not identify “gastrin” and that he was unable to identify the cause of IBD, the latter of which plagued him until his passing. The reasons for his intense interest in the IBDs were obvious. They were problems that no other clinician could handle due to the incurable and embarrassing symptoms with social and psychological stigmas once believed to be due to neuroses. He researched the potential causes, including intestinal microbes and the immune system, and was a pioneer in the concept of genetics. Late in his life, he often reflected on the genetic and familial elements of IBD and told stories of many families he met with multiple affected members, and he was keenly interested in the scientific advances in the field, suspecting an infectious component in
combination with the complex genetic underpinnings. Dr Kirsner was instrumental in the creation of the General Medicine Study Section of the National Institutes of Health, was a chair and long-term supporter of the Crohn’s and Colitis Foundation of America (CCFA), and helped found several professional societies, including the American Society for Gastrointestinal Endoscopy and the American Association for the Study of Liver Diseases. He received every major award in our field, including the CCFA Lifetime Achievement Award on 2 occasions (1991 and 2002) and CCFA’s Janowitz Lifetime Achievement Award in 2008. He also received the American Gastroenterological Association’s Distinguished Educator Award. The AGA Foundation Fiterman Award for Clinical Research is named in honor of Joseph B. Kirsner. In 1961, several of Dr Kirsner’s patients and friends provided financial support for his research and founded the Gastro-Intestinal Research Foundation (GIRF). Subsequently, GIRF has raised tens of millions of dollars to support the research and unique educational activities within the GI Section in honor of Dr Kirsner’s quest for “excellence” in patient care, as well as the building of transformative laboratories and clinical units of our current and future hospitals at the University of Chicago. Some of these funds provided the support for the University of Chicago IBD genetics laboratories and were directly contributory to the discovery of the first gene associated with Crohn’s disease in 2001. Dr Kirsner was incredibly proud of the GI Section that he built and continued to support by raising funds long after his investigative career was over. Dr Kirsner’s dedication to patient care was legendary. He said, “My principal mission became excellence in the care of the patient. The patient was the goal for everything that we did. If we did re-
search, it would eventually evolve into a new therapeutic procedure, a better way of taking care of a particular problem and the patient would benefit.” He never gave up on or refused to treat a patient, no matter how complex or how sick. He treated all patients, from royalty to those with little means, with the same level of dedication and accessibility. He was incredibly demanding of his staff and trainees related to all particulars of patient care. From schedulers to physicians, patients came first. All his patients knew how to reach him at his office phone at 6–7 am, and his clinics started at 6:30 am. Dr Kirsner had little tolerance for physicians who did not share this devotion. “After nearly 70 years in the practice of medicine,” Kirsner wrote in a 2002 essay for the Journal of the American Medical Association, “I cannot condone the diminished sensitivity of physicians to patients.” Dr Kirsner’s legacy will not be forgotten. He established standards of excellence for research, education, and in particular patient care that exemplify the highest goals achievable for any physician. He was our mentor and the epitome of the term “doctor.” In 2009, Dr Kirsner’s biography was published by a former trainee, Dr James Franklin: “GI Joe: the Life and Career of Dr Joseph B. Kirsner.” Dr Kirsner is survived by his son, Robert Kirsner, PhD, professor of linguistics at UCLA, and Robert’s wife, Elaine. He is also survived by his grandson, Daniel, as well as his granddaughter, Rachel Kirsner Schneider, JD, and her husband, Steve, and their children, Yaron, Gilad, Amira, and Eden. STEPHEN B. HANAUER DAVID T. RUBIN University of Chicago Medicine Chicago, Illinois http://dx.doi.org/10.1053/j.gastro.2012.08.001
EDITOR’ S NOTE: As a testament to Dr Kirsner’s contributions to our field at large, this commentary is being jointly published in the November 2012 issue of the following journals (as unanimously agreed upon by the respective editors): American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, Digestive Diseases and Sciences, Gastroenterology, Gut, and Inflammatory Bowel Diseases.
1124
J
oseph B. Kirsner (Dr Joe to his patients) was a Zeus among the gods of gastroenterology and was almost immortal, living to the age of nearly 103. As our colleague Dr Eugene Chang stated, “he was here (at the University of Chicago) for two lifetimes.” To say that Dr Kirsner devoted his life to medicine is an understatement and is an insufficient description of the depth and breadth of his 75-year commitment to his patients, students, and colleagues throughout the world. Dr Kirsner had a remarkably productive and fulfilled career, and in fact he continued to serve and represent the GI Section and Department of Medicine until the last weeks of his life. He saw patients until the age of 95 years and what could be considered the culmination of his academic life occurred at the age of 100 years, when he stood to give a 1-hour Department of Medicine Grand Rounds on the history of gastroenterology, which earned a prolonged ovation by the standing room–only crowd of fellow faculty, housestaff, and students. The oldest of 5 children, Joseph Barnett Kirsner was born in Boston on September 21, 1909, to Ukrainian Jewish parents who had immigrated to the
Joseph B. Kirsner, MD, PhD. Photo courtesy of the University of Chicago Medicine.
United States. He grew up in Boston’s East End neighborhood, a foothold for recent immigrants. Throughout his adolescence, Kirsner held multiple jobs, delivering newspapers, stocking a grocery store, and working as a library clerk. He then worked his way through a six-year program at Tufts University that combined college and medical school. Reflecting on his parents’ difficult lives, he commented that he chose a career in medicine and derived his work ethic “to make them proud.” He entered medical school in 1929 and graduated in 1933. Planning a career as a general practitioner, he moved to Chicago for a 2-year internship at Woodlawn Hospital on the South Side, with free room and board plus a salary of $25 a month. There he met a patient, Minnie Schneider, who was hospitalized at Woodlawn with an ear infection. “She was a ballerina,” Kirsner recalled. “I fell totally in love with her.” They were married for 64 years when Minnie passed away in 1998. While at Woodlawn, Dr Kirsner began attending lectures at the University of Chicago. In August 1935, an entry-level faculty job opened up and he joined the hospital staff as an assistant in medicine with an annual salary of $1000. Dr Kirsner often noted that he was told that he could see patients, but if he did not perform important research, his position would be terminated. He initially worked with a faculty member in infectious diseases. After several months he inquired about research and his senior colleague quipped, “We don’t have any research to perform. We have learned all we need to know.” Disappointed by this response and seeking to preserve his position, he sought out Walter Palmer, MD, PhD, who had established the first academic gastroenterology unit in the United States in 1927. Thus began a partnership that would define Dr Kirsner’s subsequent career in gastroenterology. Dr Kirsner began working with Palmer, who was doing pioneering studies in stomach and intestinal disorders.
He also began a PhD program in biology, which he completed in 1942 (“A Study of Alkalosis with Special Reference to the Electrolyte Composition of the Blood Serum and the Role of the Kidney”). His early research led to an unusual collaboration. A penniless, homeless young man, known as Edwin R., enrolled in one of Dr Kirsner’s studies. Edwin badly needed treatment. He also needed a job and a place to live, so Dr Kirsner kept him hospitalized for an entire year as a patient and research subject and trained him to be a technician. “It would be difficult to gain approval for such an arrangement today,” Dr Kirsner acknowledged, “but it was acceptable to him, and he helped me start some of my research. Everybody was happy.” His interest in the inflammatory bowel diseases (IBDs) began in 1936, when he met a young woman who was suffering from the ravages of ulcerative colitis and died from the little-known disease. World War II forced Dr Kirsner to put his research on hold. In 1943, he joined the US Army as a physician. In August 1944, about 10 weeks after D-Day, his unit landed at Utah Beach, Normandy. They established bases at various hospitals in France and Belgium, one of which was hit by a German V-2 rocket that landed right in his office and killed a medical colleague. Dr Kirsner often reflected on that rocket, and he interpreted the events of that day as a sign that he was destined to continue in a lifetime of service to others. Over the next 6 months, he cared for US soldiers with severe battle wounds, captured German officers, and survivors of the Nazi concentration camps who had complex nutritional issues and suffered from refeeding syndrome. Soon after Victory in Europe Day, he was transferred to the Pacific Theater, where he advised on the rehabilitation of more prisoners of war, including a group of badly burned Dutch prisoners who were being held captive in Nagasaki in August 1945 when an atomic bomb obliterated much of the city. He was disGASTROENTEROLOGY 2012;143:1123–1124
In Memoriam, continued charged in 1946 at the rank of major with 3 battle stars. Back at the University of Chicago, Dr Kirsner continued his research in IBD and rose steadily through the academic ranks. He became an associate professor in 1947, professor in 1951, chief of gastroenterology in 1960, and the Louis Block Distinguished Service Professor of Medicine in 1968. In 1971, he was named the chief of staff and deputy dean for medical affairs, a position he negotiated to avoid the standard university retirement at the age of 65 years. His 77-year institutional commitment exemplifies a degree of loyalty, passion, and perseverance that is rare-to-nonexistent in today’s day and age. He published more than 750 scientific papers and 18 books, including 6 editions of his authoritative textbook, “Inflammatory Bowel Disease.” The 2004 edition of this text is 842 pages. He trained more than 200 of the field’s leading specialists. Although he officially stopped seeing patients at the age of 95 years, former patients continued to call him for advice in all areas of health and medicine. Dr Kirsner’s 2 greatest regrets were that he did not identify “gastrin” and that he was unable to identify the cause of IBD, the latter of which plagued him until his passing. The reasons for his intense interest in the IBDs were obvious. They were problems that no other clinician could handle due to the incurable and embarrassing symptoms with social and psychological stigmas once believed to be due to neuroses. He researched the potential causes, including intestinal microbes and the immune system, and was a pioneer in the concept of genetics. Late in his life, he often reflected on the genetic and familial elements of IBD and told stories of many families he met with multiple affected members, and he was keenly interested in the scientific advances in the field, suspecting an infectious component in
combination with the complex genetic underpinnings. Dr Kirsner was instrumental in the creation of the General Medicine Study Section of the National Institutes of Health, was a chair and long-term supporter of the Crohn’s and Colitis Foundation of America (CCFA), and helped found several professional societies, including the American Society for Gastrointestinal Endoscopy and the American Association for the Study of Liver Diseases. He received every major award in our field, including the CCFA Lifetime Achievement Award on 2 occasions (1991 and 2002) and CCFA’s Janowitz Lifetime Achievement Award in 2008. He also received the American Gastroenterological Association’s Distinguished Educator Award. The AGA Foundation Fiterman Award for Clinical Research is named in honor of Joseph B. Kirsner. In 1961, several of Dr Kirsner’s patients and friends provided financial support for his research and founded the Gastro-Intestinal Research Foundation (GIRF). Subsequently, GIRF has raised tens of millions of dollars to support the research and unique educational activities within the GI Section in honor of Dr Kirsner’s quest for “excellence” in patient care, as well as the building of transformative laboratories and clinical units of our current and future hospitals at the University of Chicago. Some of these funds provided the support for the University of Chicago IBD genetics laboratories and were directly contributory to the discovery of the first gene associated with Crohn’s disease in 2001. Dr Kirsner was incredibly proud of the GI Section that he built and continued to support by raising funds long after his investigative career was over. Dr Kirsner’s dedication to patient care was legendary. He said, “My principal mission became excellence in the care of the patient. The patient was the goal for everything that we did. If we did re-
search, it would eventually evolve into a new therapeutic procedure, a better way of taking care of a particular problem and the patient would benefit.” He never gave up on or refused to treat a patient, no matter how complex or how sick. He treated all patients, from royalty to those with little means, with the same level of dedication and accessibility. He was incredibly demanding of his staff and trainees related to all particulars of patient care. From schedulers to physicians, patients came first. All his patients knew how to reach him at his office phone at 6–7 am, and his clinics started at 6:30 am. Dr Kirsner had little tolerance for physicians who did not share this devotion. “After nearly 70 years in the practice of medicine,” Kirsner wrote in a 2002 essay for the Journal of the American Medical Association, “I cannot condone the diminished sensitivity of physicians to patients.” Dr Kirsner’s legacy will not be forgotten. He established standards of excellence for research, education, and in particular patient care that exemplify the highest goals achievable for any physician. He was our mentor and the epitome of the term “doctor.” In 2009, Dr Kirsner’s biography was published by a former trainee, Dr James Franklin: “GI Joe: the Life and Career of Dr Joseph B. Kirsner.” Dr Kirsner is survived by his son, Robert Kirsner, PhD, professor of linguistics at UCLA, and Robert’s wife, Elaine. He is also survived by his grandson, Daniel, as well as his granddaughter, Rachel Kirsner Schneider, JD, and her husband, Steve, and their children, Yaron, Gilad, Amira, and Eden. STEPHEN B. HANAUER DAVID T. RUBIN University of Chicago Medicine Chicago, Illinois http://dx.doi.org/10.1053/j.gastro.2012.08.001
EDITOR’ S NOTE: As a testament to Dr Kirsner’s contributions to our field at large, this commentary is being jointly published in the November 2012 issue of the following journals (as unanimously agreed upon by the respective editors): American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, Digestive Diseases and Sciences, Gastroenterology, Gut, and Inflammatory Bowel Diseases.
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