- Email: [email protected]
Our new president--Phillip P. Toskes, M.D
GASTROENTEROLOGY 1997;112:1437–1441
AMERICAN GASTROENTEROLOGICAL ASSOCIATION Our New President—Phillip P. Toskes, M.D.
Phillip P. Toskes, M.D.
P
hillip P. Toskes will become the 91st President of the American Gastroenterological Association (AGA) during Digestive Disease Week in May 1997. Phil is a multitalented individual who brings an extraordinary depth of experience and diversity to this position that makes him superbly qualified to lead the AGA in this time of remarkable change and constant challenge. Phil’s remarkable success as a clinician, investigator, teacher, and administrator will hold the membership in good stead. Phil is an action-oriented person who does not fear to take bold steps and has shown remarkable ability to effect significant changes in a number of areas that affect all of us in gastroenterology. Phil was born in Baltimore, Maryland, in an Italian neighborhood in east Baltimore. His parents, John and Mary Toskes, were always proud of the fact that Phil seemed to know at a very early age that he wanted to be a physician. Breaking tradition in his neighborhood, Phil’s parents decided not to send him to the local high school but rather to have him attend Baltimore City College, a high school with an advanced college prepara/ 5E1C$$0037
04-18-97 17:27:29
gasa
tory curriculum. Phil excelled in that competitive program, after which he completed his undergraduate training at Johns Hopkins University in 3 years in great part because of the fine preparation he had received at Baltimore City College. Phil’s father experienced an untimely death, and Phil’s remarkable mother, against great odds, took over the family business and demanded that both Phil and his younger brother Richard pursue and complete their life career goals. Phil has often remarked that the first real role model who greatly influenced him was his mother. Her incredible hard work and her commitment to seeing that her sons fulfilled their dreams was truly remarkable. Phil went on to receive academic scholarships for his undergraduate work at Johns Hopkins and his medical training at the University of Maryland Medical School, graduating with honors from both institutions. His brother went on to a very successful career in accounting, working for the Internal Revenue Service, and has risen to a position of leadership within the Internal Revenue Service. None of that would have been possible without the sustained commitment of Mary WBS-Gastro
1438 JAMES E. MCGUIGAN
GASTROENTEROLOGY Vol. 112, No. 5
Toskes to fulfil the dream of her husband and her dream in respect to her children’s careers. It will be obvious that throughout Phil’s career, certain individuals appeared as catalysts to stimulate him and to launch him into the next phase of his professional life. However, none of this would have been possible without the strong family support of both Phil’s family on both his mother and father’s side as well as the support of Dorothy and John Sponsel, the parents of Patricia Toskes, who has been Phil’s staunchist supporter, best friend, remarkably talented wife, and dedicated mother to his three children Tammy Toskes Price, Tracey Toskes, and Steven Toskes. Phil’s success has only been achieved because of the commitment from Pat and the rest of the family. What success has been achieved by Phil is in no small part due to the strong family support he has received. One of the first figures to loom very large in Phil’s career was Dr. Theodore Woodward, Professor and Chairman of the Department of Medicine at the University of Maryland Medical School. Early in his medical school career, Phil was taken under Dr. Woodward’s wing as one of the outstanding students that would be privileged to be in Dr. Woodward’s physical diagnosis group. Phil was incredibly impressed with this master teacher and clinician who seemed to know the answer to every possible problem a patient could have. It was Dr. Woodward who suggested that Phil work during his summers on pancreatic disorders in the laboratory of Dr. Howard Raskin. Dr. Raskin had had a successful career at the University of Chicago as an investigator of pancreatic function. That love affair with the pancreas started then and has remained with Phil to this day. As a medical student, Phil was awarded the Alpha Omega Alpha Research Award. Dr. Woodward continued to influence Phil greatly during Phil’s internship and residency in medicine at the University of Maryland Medical Center. During his residency at Maryland, Phil was a Meade Johnson Postgraduate Scholar of the American College of Physicians. Phil began to get the fire in his belly for academic medicine and following Dr. Woodward’s advice entered the University of Pennsylvania training program in gastroenterology. Although the traditional training program in gastroenterology at the University of Pennsylvania provided the first year for clinical activities and the second year for research, Phil decided on day one he wanted to get involved with research right away and began to work in his spare time, including weekends, in the laboratory of Dr. Frank P. Brooks. Dr. Brooks was a renowned gastrointestinal physiologist who introduced Phil to an in vitro model of pancreatic secretion studied in the rabbit. Although balancing his clinical duties with his introduction to research was at times a challenging bur/ 5E1C$$0037
04-18-97 17:27:29
gasa
den, Dr. Brooks’ approach to studying physiology had profound effects on Phil. In one of the first papers that Phil published he was one of the first to show the effect of adenosine 3*,5*-cyclic monophosphate on pancreatic secretion. Phil used the rabbit in vitro pancreas model to perform those studies. The University of Pennsylvania was a hub of gastroenterological expertise during that period. In addition to Dr. Brooks, there was a number of outstanding faculty such as Sidney Cohen, Donald Ostrow, Julius Deren, John Senior, and Ed Raffensberger. Much of Phil’s research has resulted from initial clinical observations that were taken to the bench and then back to the bedside. Phil combined his interests in the pancreas with an observation on a patient who had vitamin B12 malabsorption. This led to a very successful series of investigations that defined the role of the pancreas in the absorption of vitamin B12 . This work was published in outstanding journals and led to Phil’s receiving the Simon–Kamarov Prize for gastrointestinal research as a fellow while at the University of Pennsylvania. The success in studying the role of the pancreas in vitamin B12 absorption was in large part due to the expertise that Julius Deren brought when he joined the Penn faculty, having been trained in Tom Wilson’s laboratory at Harvard in the area of vitamin B12 transport. Phil benefited by the scientific expertise of Julius Deren and that of Frank Brooks, parlaying their mutual contributions to the development of a successful and productive research program. While at the University of Pennsylvania, Phil also met Jim Cerda who wrote a series of publications with Phil; their friendship has continued until the present time. After his fellowship training at the University of Pennsylvania where Phil’s work was supported by National Institutes of Health (NIH) fellowship, he entered the military, serving as a major in the army at the Walter Reed Army Institute of Research. It was there that another figure loomed large in Phil’s career: Dr. Marcel Conrad. Dr. Conrad was Chief of the Hematology Section at the Walter Reed Army Institute of Research and convinced the army that although Phil was a gastroenterologist, he would be best suited to conduct his research within the hematology section. That spawned a greatly successful period of creative research in Phil’s career. Dr. Conrad was an exciting person to be around, full of ideas, yet he allowed Phil abundant freedom to express himself and to follow his own research interests. That time at the Walter Reed Army Institute of Research was exceedingly productive and led to a host of investigations concerned with vitamin B12 , folic acid, and iron and initiated Phil’s interest in the small intestine bacterial overgrowth syndrome. In a series of investigations with Ralph Giannella, Phil WBS-Gastro
May 1997
OUR NEW PRESIDENT–PHILLIP P. TOSKES, M.D. 1439
unraveled the pathophysiological mechanisms of many of the aberrations observed in the blind loop syndrome. Theirs was a series of eloquently performed investigations, which defined the mechanisms for fat malabsorption, for vitamin B12 malabsorption, and for protein and carbohydrate malabsorption. It was at this point in time that Phil, along with his colleagues, showed convincingly the dual defect that existed in the bacterial overgrowth syndrome, the intraluminal disturbance coupled with direct damage to the enterocyte from bacterial production of toxins. Those were exciting times at the Walter Reed Army Institute of Research; in addition to Dr. Conrad in the Hematology Section, there were outstanding investigators such as Fred Rickles, Burt Glader, and Tom Bensinger. Phil continued with many interactions with members of the gastroenterology section at Walter Reed and cemented friendships that have endured with people like Ralph Giannella and Mark Donowitz. After his productive 3 years at the Walter Reed Army Institute for Research, I was successful in convincing Phil to join the faculty of the University of Florida College of Medicine as an Assistant Professor within the Division of Gastroenterology. Although Phil did not know where Gainesville was, he was familiar with the active and productive research program that we had developed to study the gastrointestinal hormones, particularly gastrin. I convinced Phil that it would be a good move for him to come to Gainesville and join the faculty of this relatively young medical center. Phil accepted my offer and that began a long-lasting relationship wherein I have been pleased to serve as Phil’s mentor. Phil’s career flourished because of his hard work and insight and, I hope, with some benefit of mentorship. Phil began a series of investigations on both small intestine bacterial overgrowth and pancreatic disorders that have become outstanding examples of clinical investigations. Indeed, Phil was elected to membership in the American Society for Clinical Investigation based on those investigations. In 1976 I became Chairman of the Department of Medicine at the University of Florida College of Medicine. In 1977 I asked Phil Toskes to be the Chief of the Division of Gastroenterology, Hepatology and Nutrition. At that time, Phil had received a Clinical Investigator Career Award from the Veterans Administration and declined my offer because he wanted to spend more time in the laboratory. Phil was achieving much success at that time in his investigations of bacterial overgrowth. It was at that time that he initiated the studies that led to the development of the 14C-xylose breath test, which has become an important test in the detection of this condition. I persisted, however, and in July 1978, Phil took over the directorship of the Division of Gastroenter/ 5E1C$$0037
04-18-97 17:27:29
gasa
ology, Hepatology and Nutrition. He immediately made some tough decisions concerning training of fellows. The program became a 3-year training program when it was not common to have training last longer than 2 years. He also placed selected fellows into the laboratory on the first day of their fellowship; this has become a very successful endeavor and hallmark of the training program at Gainesville. Phil became the principal investigator of the NIH Training Grant in Gastroenterology, and he continues as the principal investigator for that very successful training grant to this date. Phil has been a leader in training endeavors within our Association. He chaired the NIH Clinical Science Review Committee Study Section, which was responsible for selecting individuals who were to be given a National Research Service Award, and he was the chairman of the study section for training grants, center grants, conference grants, and Clinical Investigator Awards in gastroenterology and nutrition. He also served as the overall chairman of the study sections devoted to training grants and clinical investigator awards for National Institute of Diabetes and Digestive and Kidney Diseases. He continued to speak out on training matters and made a number of innovative suggestions when he was Chairman of the National Digestive Disease Advisory Board from 1992 to 1994. The next important influence on Phil’s career came via the American Board of Internal Medicine (ABIM). Dr. John Benson, President of the ABIM, asked Phil to join the Gastroenterology Subspecialty Board in 1987. Phil became Chairman of the Subspecialty Board of Gastroenterology in 1991, a position he held until 1995. He was a member of the Board of Directors from 1991 to 1996 and a member of the Executive Committee from 1994 to 1996. All in all, Phil spent 9 years as a member of the ABIM, serving on a number of its important committees such as Chairman of the Committee on Subspecialty Medicine, a member of the Subcommittee on Credentialing on Physician Competence, a member of the Pretest Committee, a member of the Clinical Competence Committee, a member of the Question Selection Committee, and a member of the Subcommittee on Women’s Health. He was involved in matters pertaining to the ABIM at a very critical time in American medicine. In 1994, health care reform began to be talked about seriously by the government and Phil spoke out loudly and clearly for gastroenterology. He became a champion on the value of the gastroenterologist and articulated that point skillfully to generalists throughout the country as a member of a number of fora put on by the ABIM. Indeed in 1994, he cochaired two symposia on health care reform put on by the ABIM. Working with other leaders in the AGA, notably Don Powell, Phil WBS-Gastro
1440 JAMES E. MCGUIGAN
GASTROENTEROLOGY Vol. 112, No. 5
led the move toward right-sizing gastroenterology from his position at the ABIM. Phil was largely the driving force for lengthening of gastroenterology training program from 2 to 3 years. He presented the case for longer training and better training to the Residency Review Committee. This was not a popular move in all circles, but Phil did it because he knew it was right for gastroenterology and for medicine in general. At all times, Phil kept the AGA involved with ABIM matters and worked to develop within the ABIM understanding and respect for gastroenterology, in particular the AGA. No other subspecialty society stepped forward to make the bold moves that gastroenterology made, and gastroenterology has received numerous kudos for doing such. Phil was in the forefront of those decisions on behalf of gastroenterology. This ability of Phil to articulate the needs of gastroenterology and subspecialists in general to the primary care physicians was not unnoticed by members of the AGA. He has been asked to be the keynote speaker for the annual meeting of the AGA training directors twice in the past 4 years. He also was asked to be one of the keynote speakers to all the trainees at 1996 Digestive Disease Week and will do this again this year. A landmark article on training was put forth as a position paper of the ABIM and published in the Annals of Internal Medicine on April 1, 1996, entitled ‘‘Training of the Future Subspecialists in Internal Medicine.’’ Phil was the senior author and driving force for that position paper. That position paper, albeit provocative and controversial, has been praised in many circles of academic and private medicine. Again, it was not a popular move to make but it was a move that Phil believed was right for subspecialty medicine. Phil’s commitment to the AGA is obvious to those who know him well. He served on the Program Evaluation Committee, the Training and Education Committee, the Public Policy Committee, the ad hoc NIH Task Force, and the Committee to Select the AGA Industry Scholars. He also served on the Editorial Board of Gastrointestinal Diseases Today and directed the annual Postgraduate Course on the exocrine pancreas in New York in 1985, when Nortie Greenberger was President of the AGA. He was a presentor at the Meet-the-Professor sessions yearly from 1976 to 1995 and a participant in the AGA Post-graduate Course nine times, including 1996 and 1997. He has served in leadership capacities for the AGA, demonstrating his skills as a member of many AGA committees. He chaired the Training and Education Committee, was a member of the Governing Board on two separate occasions, was the Vice-Chair and Chair of / 5E1C$$0037
04-18-97 17:27:29
gasa
the Pancreatic Disorders Sections of the AGA Council, Vice-President of the AGA, President-Elect of the AGA, and now President of the AGA. When John Walsh and Don Powell began to formulate the concept of the Digestive Health Initiative under the umbrella of the AGA Foundation, they approached Phil to be the first Chair of the Digestive Health Initiative (DHI). In response to skillful coercion by Drs. Powell and Walsh, Phil agreed to undertake that responsibility, despite having a heavy schedule at the ABIM. The DHI under his leadership has been an awesome success. From every perspective, the DHI has fulfilled all of the expectations, and then some, of the founding fathers of the DHI. Some of the accomplishments include a highly successful campaign on Helicobacter pylori, followed by two evolving successful campaigns on colorectal cancer screening and viral hepatitis. Phil’s leadership has been shown again and again in his ability to get people to work together. No one that Phil asked to participate in DHI has refused him. It was clear that the DHI concept and program were evolving in such a way that the AGA and gastroenterology, in general, would be proud of these efforts. The interactions with managed care organizations, the new National Institutes of Health request for application for research on H. pylori, the successful educational efforts put forth to primary care physicians, the remarkably effective consumer education programs, the five public service awards attained, the recognition and ties with respectable organizations like the National Cancer Institute, the satisfaction of hearing our members express their pleasure with the DHI efforts to help sustain the vitality of the gastroenterology subspecialty—all of these accomplishments of DHI have been sources of great pride for Phil. Phil is many different things to different people. To many people he is Mr. Pancreas having served as the President of the American Pancreatic Association and as a member of its Governing Board as well as on the Editorial Board of Pancreas. He currently is a member of the International Council of Pancreatology and is on the Editorial Board of the International Journal of Pancreatology. He has coauthored with Nortie Greenberger and Kurt Isselbacher the sections on the pancreas in Harrison’s Principles of Internal Medicine beginning with the 10th edition in 1983 until the present time. His association with Nortie Greenberger has been a long-lasting one and filled with mutual respect. They have contributed to a number of pancreatic programs together throughout the country and world. Phil’s pioneering work on feedback inhibition of pancreatic secretion and its relevance to the management of abdominal pain in chronic pancreatitis has gained worldwide respect. In addition to coauthoring the section WBS-Gastro
May 1997
OUR NEW PRESIDENT–PHILLIP P. TOSKES, M.D. 1441
on the pancreas in Harrison’s, Phil has been the sole author of the section on malabsorption for the past several editions in Cecil’s Textbook of Medicine and currently writes a section on pancreatitis in the Oxford Textbook of Medicine and on malabsorption secondary to bacterial overgrowth in Sleisenger and Fordtran’s Gastrointestinal Disease for many years, including the current edition. Phil’s impressive data base in internal medicine and gastroenterology, his ability to speak to his audience no matter who they are and convey his message clearly, and his remarkable productivity in his fields of interests have made him a sought-after speaker and visiting professor both within this country and throughout the world. This remarkable ability to make complex issues simple has been recognized by his being given the Distinguished Achievement Award of the Canadian Gastroenterological Association, the Distinguished Award of the Florida Gastroenterological Society, a recipient of the 17th annual Edwin Polish Memorial Lectureship, co-chairing the Second International Symposium on the Concepts and Classifications of Pancreatitis in Marseille, and being selected as the keynote speaker for the European Pancreatic Association, just to mention a few of these accomplishments in this area. Phil also has the unique ability to relate to practitioners with remarkable ease. They respect him as a clinician, teacher, researcher, and administrator. Evidence of this profound respect for him is the remarkable number of requests that Phil receives to be the keynote speaker at local meetings of GI groups. He has received every award the Florida Gastroenterological Association can give. He was President of the Florida Gastroenterologic Society, received the Borland Award for Gastrointestinal Research, and received the Distinguished Achievement Award of the Florida Gastroenterological Society in 1996 for remarkable contributions to gastroenterology in general and gastroenterology in Florida specifically. All these national activities notwithstanding, Phil has a remarkable presence here at the University of Florida. Not only is he a hands-on director of a very successful training program, whose graduates are populating GI faculties throughout the country and serving as directors
/ 5E1C$$0037
04-18-97 17:27:29
gasa
of GI units themselves, but he also serves as the Associate Chairman for Clinical Affairs of the Department of Medicine and has been an important person in my Department of Medicine. It would be impossible to list all the local committees that he serves on for the Department, the College, and the University. Needless to say, just about every important committee that exists, Dr. Toskes has served on and often chaired. This remarkable sustained contribution to this medical center was recently recognized by Phil being awarded one of the first Professorial Excellence Program Awards (PEP Award) in 1996. This was an award developed by the Florida Legislature to honor outstanding faculty members within the State of Florida. The competition was very keen, but Phil became one of the first awardees of this recognition award. So who is Phil Toskes, this new President of the AGA? Is he this outstanding clinical researcher who has in many ways made remarkable strides in our ability to diagnose and treat chronic pancreatitis? Is he this renowned teacher who can deliver a message so clearly to any level audience? Is he this master clinician who is respected so much by practitioners that they continue to give him accolades? Is he this nationally and internationally known gastroenterologist who contributes to textbooks throughout the world and who is listed in the Best Doctors in America in Marquis’ Who’s Who in America and Marquis’ Who’s Who in Medicine and Health Care? Or is he this administrator who can effectively change the behavior of people, whether it be through his interests in training matters or his dedication to his division, department, and university? I submit that he is all of these people and that is why he is such an appropriate person to lead the AGA in these times of tremendous change and remarkable opportunity. JAMES E. MCGUIGAN, M.D.
Professor and Chairman Department of Medicine University of Florida College of Medicine Gainesville, Florida q 1997 by the American Gastroenterological Association 0016-5085/97/$3.00
WBS-Gastro
AMERICAN GASTROENTEROLOGICAL ASSOCIATION Our New President—Phillip P. Toskes, M.D.
Phillip P. Toskes, M.D.
P
hillip P. Toskes will become the 91st President of the American Gastroenterological Association (AGA) during Digestive Disease Week in May 1997. Phil is a multitalented individual who brings an extraordinary depth of experience and diversity to this position that makes him superbly qualified to lead the AGA in this time of remarkable change and constant challenge. Phil’s remarkable success as a clinician, investigator, teacher, and administrator will hold the membership in good stead. Phil is an action-oriented person who does not fear to take bold steps and has shown remarkable ability to effect significant changes in a number of areas that affect all of us in gastroenterology. Phil was born in Baltimore, Maryland, in an Italian neighborhood in east Baltimore. His parents, John and Mary Toskes, were always proud of the fact that Phil seemed to know at a very early age that he wanted to be a physician. Breaking tradition in his neighborhood, Phil’s parents decided not to send him to the local high school but rather to have him attend Baltimore City College, a high school with an advanced college prepara/ 5E1C$$0037
04-18-97 17:27:29
gasa
tory curriculum. Phil excelled in that competitive program, after which he completed his undergraduate training at Johns Hopkins University in 3 years in great part because of the fine preparation he had received at Baltimore City College. Phil’s father experienced an untimely death, and Phil’s remarkable mother, against great odds, took over the family business and demanded that both Phil and his younger brother Richard pursue and complete their life career goals. Phil has often remarked that the first real role model who greatly influenced him was his mother. Her incredible hard work and her commitment to seeing that her sons fulfilled their dreams was truly remarkable. Phil went on to receive academic scholarships for his undergraduate work at Johns Hopkins and his medical training at the University of Maryland Medical School, graduating with honors from both institutions. His brother went on to a very successful career in accounting, working for the Internal Revenue Service, and has risen to a position of leadership within the Internal Revenue Service. None of that would have been possible without the sustained commitment of Mary WBS-Gastro
1438 JAMES E. MCGUIGAN
GASTROENTEROLOGY Vol. 112, No. 5
Toskes to fulfil the dream of her husband and her dream in respect to her children’s careers. It will be obvious that throughout Phil’s career, certain individuals appeared as catalysts to stimulate him and to launch him into the next phase of his professional life. However, none of this would have been possible without the strong family support of both Phil’s family on both his mother and father’s side as well as the support of Dorothy and John Sponsel, the parents of Patricia Toskes, who has been Phil’s staunchist supporter, best friend, remarkably talented wife, and dedicated mother to his three children Tammy Toskes Price, Tracey Toskes, and Steven Toskes. Phil’s success has only been achieved because of the commitment from Pat and the rest of the family. What success has been achieved by Phil is in no small part due to the strong family support he has received. One of the first figures to loom very large in Phil’s career was Dr. Theodore Woodward, Professor and Chairman of the Department of Medicine at the University of Maryland Medical School. Early in his medical school career, Phil was taken under Dr. Woodward’s wing as one of the outstanding students that would be privileged to be in Dr. Woodward’s physical diagnosis group. Phil was incredibly impressed with this master teacher and clinician who seemed to know the answer to every possible problem a patient could have. It was Dr. Woodward who suggested that Phil work during his summers on pancreatic disorders in the laboratory of Dr. Howard Raskin. Dr. Raskin had had a successful career at the University of Chicago as an investigator of pancreatic function. That love affair with the pancreas started then and has remained with Phil to this day. As a medical student, Phil was awarded the Alpha Omega Alpha Research Award. Dr. Woodward continued to influence Phil greatly during Phil’s internship and residency in medicine at the University of Maryland Medical Center. During his residency at Maryland, Phil was a Meade Johnson Postgraduate Scholar of the American College of Physicians. Phil began to get the fire in his belly for academic medicine and following Dr. Woodward’s advice entered the University of Pennsylvania training program in gastroenterology. Although the traditional training program in gastroenterology at the University of Pennsylvania provided the first year for clinical activities and the second year for research, Phil decided on day one he wanted to get involved with research right away and began to work in his spare time, including weekends, in the laboratory of Dr. Frank P. Brooks. Dr. Brooks was a renowned gastrointestinal physiologist who introduced Phil to an in vitro model of pancreatic secretion studied in the rabbit. Although balancing his clinical duties with his introduction to research was at times a challenging bur/ 5E1C$$0037
04-18-97 17:27:29
gasa
den, Dr. Brooks’ approach to studying physiology had profound effects on Phil. In one of the first papers that Phil published he was one of the first to show the effect of adenosine 3*,5*-cyclic monophosphate on pancreatic secretion. Phil used the rabbit in vitro pancreas model to perform those studies. The University of Pennsylvania was a hub of gastroenterological expertise during that period. In addition to Dr. Brooks, there was a number of outstanding faculty such as Sidney Cohen, Donald Ostrow, Julius Deren, John Senior, and Ed Raffensberger. Much of Phil’s research has resulted from initial clinical observations that were taken to the bench and then back to the bedside. Phil combined his interests in the pancreas with an observation on a patient who had vitamin B12 malabsorption. This led to a very successful series of investigations that defined the role of the pancreas in the absorption of vitamin B12 . This work was published in outstanding journals and led to Phil’s receiving the Simon–Kamarov Prize for gastrointestinal research as a fellow while at the University of Pennsylvania. The success in studying the role of the pancreas in vitamin B12 absorption was in large part due to the expertise that Julius Deren brought when he joined the Penn faculty, having been trained in Tom Wilson’s laboratory at Harvard in the area of vitamin B12 transport. Phil benefited by the scientific expertise of Julius Deren and that of Frank Brooks, parlaying their mutual contributions to the development of a successful and productive research program. While at the University of Pennsylvania, Phil also met Jim Cerda who wrote a series of publications with Phil; their friendship has continued until the present time. After his fellowship training at the University of Pennsylvania where Phil’s work was supported by National Institutes of Health (NIH) fellowship, he entered the military, serving as a major in the army at the Walter Reed Army Institute of Research. It was there that another figure loomed large in Phil’s career: Dr. Marcel Conrad. Dr. Conrad was Chief of the Hematology Section at the Walter Reed Army Institute of Research and convinced the army that although Phil was a gastroenterologist, he would be best suited to conduct his research within the hematology section. That spawned a greatly successful period of creative research in Phil’s career. Dr. Conrad was an exciting person to be around, full of ideas, yet he allowed Phil abundant freedom to express himself and to follow his own research interests. That time at the Walter Reed Army Institute of Research was exceedingly productive and led to a host of investigations concerned with vitamin B12 , folic acid, and iron and initiated Phil’s interest in the small intestine bacterial overgrowth syndrome. In a series of investigations with Ralph Giannella, Phil WBS-Gastro
May 1997
OUR NEW PRESIDENT–PHILLIP P. TOSKES, M.D. 1439
unraveled the pathophysiological mechanisms of many of the aberrations observed in the blind loop syndrome. Theirs was a series of eloquently performed investigations, which defined the mechanisms for fat malabsorption, for vitamin B12 malabsorption, and for protein and carbohydrate malabsorption. It was at this point in time that Phil, along with his colleagues, showed convincingly the dual defect that existed in the bacterial overgrowth syndrome, the intraluminal disturbance coupled with direct damage to the enterocyte from bacterial production of toxins. Those were exciting times at the Walter Reed Army Institute of Research; in addition to Dr. Conrad in the Hematology Section, there were outstanding investigators such as Fred Rickles, Burt Glader, and Tom Bensinger. Phil continued with many interactions with members of the gastroenterology section at Walter Reed and cemented friendships that have endured with people like Ralph Giannella and Mark Donowitz. After his productive 3 years at the Walter Reed Army Institute for Research, I was successful in convincing Phil to join the faculty of the University of Florida College of Medicine as an Assistant Professor within the Division of Gastroenterology. Although Phil did not know where Gainesville was, he was familiar with the active and productive research program that we had developed to study the gastrointestinal hormones, particularly gastrin. I convinced Phil that it would be a good move for him to come to Gainesville and join the faculty of this relatively young medical center. Phil accepted my offer and that began a long-lasting relationship wherein I have been pleased to serve as Phil’s mentor. Phil’s career flourished because of his hard work and insight and, I hope, with some benefit of mentorship. Phil began a series of investigations on both small intestine bacterial overgrowth and pancreatic disorders that have become outstanding examples of clinical investigations. Indeed, Phil was elected to membership in the American Society for Clinical Investigation based on those investigations. In 1976 I became Chairman of the Department of Medicine at the University of Florida College of Medicine. In 1977 I asked Phil Toskes to be the Chief of the Division of Gastroenterology, Hepatology and Nutrition. At that time, Phil had received a Clinical Investigator Career Award from the Veterans Administration and declined my offer because he wanted to spend more time in the laboratory. Phil was achieving much success at that time in his investigations of bacterial overgrowth. It was at that time that he initiated the studies that led to the development of the 14C-xylose breath test, which has become an important test in the detection of this condition. I persisted, however, and in July 1978, Phil took over the directorship of the Division of Gastroenter/ 5E1C$$0037
04-18-97 17:27:29
gasa
ology, Hepatology and Nutrition. He immediately made some tough decisions concerning training of fellows. The program became a 3-year training program when it was not common to have training last longer than 2 years. He also placed selected fellows into the laboratory on the first day of their fellowship; this has become a very successful endeavor and hallmark of the training program at Gainesville. Phil became the principal investigator of the NIH Training Grant in Gastroenterology, and he continues as the principal investigator for that very successful training grant to this date. Phil has been a leader in training endeavors within our Association. He chaired the NIH Clinical Science Review Committee Study Section, which was responsible for selecting individuals who were to be given a National Research Service Award, and he was the chairman of the study section for training grants, center grants, conference grants, and Clinical Investigator Awards in gastroenterology and nutrition. He also served as the overall chairman of the study sections devoted to training grants and clinical investigator awards for National Institute of Diabetes and Digestive and Kidney Diseases. He continued to speak out on training matters and made a number of innovative suggestions when he was Chairman of the National Digestive Disease Advisory Board from 1992 to 1994. The next important influence on Phil’s career came via the American Board of Internal Medicine (ABIM). Dr. John Benson, President of the ABIM, asked Phil to join the Gastroenterology Subspecialty Board in 1987. Phil became Chairman of the Subspecialty Board of Gastroenterology in 1991, a position he held until 1995. He was a member of the Board of Directors from 1991 to 1996 and a member of the Executive Committee from 1994 to 1996. All in all, Phil spent 9 years as a member of the ABIM, serving on a number of its important committees such as Chairman of the Committee on Subspecialty Medicine, a member of the Subcommittee on Credentialing on Physician Competence, a member of the Pretest Committee, a member of the Clinical Competence Committee, a member of the Question Selection Committee, and a member of the Subcommittee on Women’s Health. He was involved in matters pertaining to the ABIM at a very critical time in American medicine. In 1994, health care reform began to be talked about seriously by the government and Phil spoke out loudly and clearly for gastroenterology. He became a champion on the value of the gastroenterologist and articulated that point skillfully to generalists throughout the country as a member of a number of fora put on by the ABIM. Indeed in 1994, he cochaired two symposia on health care reform put on by the ABIM. Working with other leaders in the AGA, notably Don Powell, Phil WBS-Gastro
1440 JAMES E. MCGUIGAN
GASTROENTEROLOGY Vol. 112, No. 5
led the move toward right-sizing gastroenterology from his position at the ABIM. Phil was largely the driving force for lengthening of gastroenterology training program from 2 to 3 years. He presented the case for longer training and better training to the Residency Review Committee. This was not a popular move in all circles, but Phil did it because he knew it was right for gastroenterology and for medicine in general. At all times, Phil kept the AGA involved with ABIM matters and worked to develop within the ABIM understanding and respect for gastroenterology, in particular the AGA. No other subspecialty society stepped forward to make the bold moves that gastroenterology made, and gastroenterology has received numerous kudos for doing such. Phil was in the forefront of those decisions on behalf of gastroenterology. This ability of Phil to articulate the needs of gastroenterology and subspecialists in general to the primary care physicians was not unnoticed by members of the AGA. He has been asked to be the keynote speaker for the annual meeting of the AGA training directors twice in the past 4 years. He also was asked to be one of the keynote speakers to all the trainees at 1996 Digestive Disease Week and will do this again this year. A landmark article on training was put forth as a position paper of the ABIM and published in the Annals of Internal Medicine on April 1, 1996, entitled ‘‘Training of the Future Subspecialists in Internal Medicine.’’ Phil was the senior author and driving force for that position paper. That position paper, albeit provocative and controversial, has been praised in many circles of academic and private medicine. Again, it was not a popular move to make but it was a move that Phil believed was right for subspecialty medicine. Phil’s commitment to the AGA is obvious to those who know him well. He served on the Program Evaluation Committee, the Training and Education Committee, the Public Policy Committee, the ad hoc NIH Task Force, and the Committee to Select the AGA Industry Scholars. He also served on the Editorial Board of Gastrointestinal Diseases Today and directed the annual Postgraduate Course on the exocrine pancreas in New York in 1985, when Nortie Greenberger was President of the AGA. He was a presentor at the Meet-the-Professor sessions yearly from 1976 to 1995 and a participant in the AGA Post-graduate Course nine times, including 1996 and 1997. He has served in leadership capacities for the AGA, demonstrating his skills as a member of many AGA committees. He chaired the Training and Education Committee, was a member of the Governing Board on two separate occasions, was the Vice-Chair and Chair of / 5E1C$$0037
04-18-97 17:27:29
gasa
the Pancreatic Disorders Sections of the AGA Council, Vice-President of the AGA, President-Elect of the AGA, and now President of the AGA. When John Walsh and Don Powell began to formulate the concept of the Digestive Health Initiative under the umbrella of the AGA Foundation, they approached Phil to be the first Chair of the Digestive Health Initiative (DHI). In response to skillful coercion by Drs. Powell and Walsh, Phil agreed to undertake that responsibility, despite having a heavy schedule at the ABIM. The DHI under his leadership has been an awesome success. From every perspective, the DHI has fulfilled all of the expectations, and then some, of the founding fathers of the DHI. Some of the accomplishments include a highly successful campaign on Helicobacter pylori, followed by two evolving successful campaigns on colorectal cancer screening and viral hepatitis. Phil’s leadership has been shown again and again in his ability to get people to work together. No one that Phil asked to participate in DHI has refused him. It was clear that the DHI concept and program were evolving in such a way that the AGA and gastroenterology, in general, would be proud of these efforts. The interactions with managed care organizations, the new National Institutes of Health request for application for research on H. pylori, the successful educational efforts put forth to primary care physicians, the remarkably effective consumer education programs, the five public service awards attained, the recognition and ties with respectable organizations like the National Cancer Institute, the satisfaction of hearing our members express their pleasure with the DHI efforts to help sustain the vitality of the gastroenterology subspecialty—all of these accomplishments of DHI have been sources of great pride for Phil. Phil is many different things to different people. To many people he is Mr. Pancreas having served as the President of the American Pancreatic Association and as a member of its Governing Board as well as on the Editorial Board of Pancreas. He currently is a member of the International Council of Pancreatology and is on the Editorial Board of the International Journal of Pancreatology. He has coauthored with Nortie Greenberger and Kurt Isselbacher the sections on the pancreas in Harrison’s Principles of Internal Medicine beginning with the 10th edition in 1983 until the present time. His association with Nortie Greenberger has been a long-lasting one and filled with mutual respect. They have contributed to a number of pancreatic programs together throughout the country and world. Phil’s pioneering work on feedback inhibition of pancreatic secretion and its relevance to the management of abdominal pain in chronic pancreatitis has gained worldwide respect. In addition to coauthoring the section WBS-Gastro
May 1997
OUR NEW PRESIDENT–PHILLIP P. TOSKES, M.D. 1441
on the pancreas in Harrison’s, Phil has been the sole author of the section on malabsorption for the past several editions in Cecil’s Textbook of Medicine and currently writes a section on pancreatitis in the Oxford Textbook of Medicine and on malabsorption secondary to bacterial overgrowth in Sleisenger and Fordtran’s Gastrointestinal Disease for many years, including the current edition. Phil’s impressive data base in internal medicine and gastroenterology, his ability to speak to his audience no matter who they are and convey his message clearly, and his remarkable productivity in his fields of interests have made him a sought-after speaker and visiting professor both within this country and throughout the world. This remarkable ability to make complex issues simple has been recognized by his being given the Distinguished Achievement Award of the Canadian Gastroenterological Association, the Distinguished Award of the Florida Gastroenterological Society, a recipient of the 17th annual Edwin Polish Memorial Lectureship, co-chairing the Second International Symposium on the Concepts and Classifications of Pancreatitis in Marseille, and being selected as the keynote speaker for the European Pancreatic Association, just to mention a few of these accomplishments in this area. Phil also has the unique ability to relate to practitioners with remarkable ease. They respect him as a clinician, teacher, researcher, and administrator. Evidence of this profound respect for him is the remarkable number of requests that Phil receives to be the keynote speaker at local meetings of GI groups. He has received every award the Florida Gastroenterological Association can give. He was President of the Florida Gastroenterologic Society, received the Borland Award for Gastrointestinal Research, and received the Distinguished Achievement Award of the Florida Gastroenterological Society in 1996 for remarkable contributions to gastroenterology in general and gastroenterology in Florida specifically. All these national activities notwithstanding, Phil has a remarkable presence here at the University of Florida. Not only is he a hands-on director of a very successful training program, whose graduates are populating GI faculties throughout the country and serving as directors
/ 5E1C$$0037
04-18-97 17:27:29
gasa
of GI units themselves, but he also serves as the Associate Chairman for Clinical Affairs of the Department of Medicine and has been an important person in my Department of Medicine. It would be impossible to list all the local committees that he serves on for the Department, the College, and the University. Needless to say, just about every important committee that exists, Dr. Toskes has served on and often chaired. This remarkable sustained contribution to this medical center was recently recognized by Phil being awarded one of the first Professorial Excellence Program Awards (PEP Award) in 1996. This was an award developed by the Florida Legislature to honor outstanding faculty members within the State of Florida. The competition was very keen, but Phil became one of the first awardees of this recognition award. So who is Phil Toskes, this new President of the AGA? Is he this outstanding clinical researcher who has in many ways made remarkable strides in our ability to diagnose and treat chronic pancreatitis? Is he this renowned teacher who can deliver a message so clearly to any level audience? Is he this master clinician who is respected so much by practitioners that they continue to give him accolades? Is he this nationally and internationally known gastroenterologist who contributes to textbooks throughout the world and who is listed in the Best Doctors in America in Marquis’ Who’s Who in America and Marquis’ Who’s Who in Medicine and Health Care? Or is he this administrator who can effectively change the behavior of people, whether it be through his interests in training matters or his dedication to his division, department, and university? I submit that he is all of these people and that is why he is such an appropriate person to lead the AGA in these times of tremendous change and remarkable opportunity. JAMES E. MCGUIGAN, M.D.
Professor and Chairman Department of Medicine University of Florida College of Medicine Gainesville, Florida q 1997 by the American Gastroenterological Association 0016-5085/97/$3.00
WBS-Gastro