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Philip B Gorelick: changing neurological practice in the USA
In Context
Profile Philip B Gorelick: changing neurological practice in the USA Philip Gorelick’s strengths in science and leadership skills made medicine an obvious choice, but his career took many interesting turns before he settled into his current roles as Medical Director of Mercy Health Hauenstein Neurosciences and Professor of Translational Science and Molecular Medicine at Michigan State University College of Human Medicine (MI, USA). “In school, we all believed we could be anything we wanted. I saw a great opportunity to help society by becoming a physician,” he tells The Lancet Neurology. Gorelick completed his undergraduate degree in biology and medical degree at Loyola University, (IL, USA). He recalls being “immediately exposed to a neuroscience curriculum that was amazing—I had an affinity for neuroanatomy and have always found the nervous system so logical.” After gaining his MD, Gorelick worked briefly in internal medicine at the University of Illinois, but gradually focused on neurology, returning to Loyola to do a residency under Frank Rubino and then a stroke fellowship at the Michael Reese Hospital in Chicago under Louis R Caplan and Daniel B Hier. They helped Gorelick to develop the stroke expertise that would become the bedrock of his career. He later completed a master’s degree at the University of Illinois School of Public Health, where, working with Jacob Brody, Gorelick was funded by the US National Institutes of Health (NIH) to unravel the secrets of multi-infarct dementia, showing that cognitive impairment after stroke is related to cardiovascular risk factors. Gorelick led several other NIH funded studies, including those on dementia in elderly African-American patients, and a neuroimaging study of risk markers for dementia after stroke. “Incredibly, back in the 1980s, some thought that having cardiovascular disease or its risk factors excluded one from having Alzheimer’s disease,” says Gorelick, whose group was one of the first to show, in the mid-1990s, the occurrence of cardiovascular dysfunction in Alzheimer’s patients. “It has taken almost 20 years for the US Institute of Medicine to issue landmark guidelines on how managing these risk factors might protect brain health,” he adds. Gorelick’s work was also key in showing that stroke dynamically affects the white matter of the brain, with the thalamus appearing crucial in determining future cognitive impairment. During 1995-2005 he also served as principal investigator of a landmark, NIH-funded study: the AfricanAmerican Antiplatelet Stroke Prevention Study. “African Americans have some of the highest stroke rates and burden of stroke risk factors,” said Gorelick. “Our study across 60 US sites showed that a cheaper recurrent stroke prevention option, aspirin, was about as good as a more expensive option, ticlopidine—even though the latter drug had been promoted as being better based on a non-primary analysis.” www.thelancet.com/neurology Vol 15 April 2016
More recently (2011–14), Gorelick led a pilot study of global diagnostic and treatment methods for stroke, focusing on 12 mostly low-income and middle-income countries, and found that these countries have inadequate facilities for stroke management. He is also collaborating with the Korean Stroke Society on several studies of treatment of risk factors such as alcohol intake and blood pressure, and he has been invited to serve as an investigator for a grant application to the NIH to study outcomes after stroke in Nigeria and Kenya. At conferences worldwide, Gorelick is a passionate spokesperson for preserving cognitive vitality—encouraging prevention or treatment of cardiovascular risk factors to possibly prevent cognitive impairment. “It’s not just about avoiding stroke or heart attacks,” he explains. His other project follows the implementation of the US Affordable Care Act, which is transforming how the US healthcare system and its workers must operate. In a Policy View in The Lancet Neurology, Gorelick spells out how US neurology must move from a fee-for-service, profit-led system to one that delivers better care at a lower cost. “We have to embrace this new reality in every part of the system,” explains Gorelick, adding that 30% of health-system costs are considered waste, such as unnecessary tests and office visits. He has completed a telemedicine study showing that a quarter of referrals do not need to be face-to-face, and is helping primary-care physicians to reduce unnecessary referrals and tests. He is attempting to enter his centre into a 16-hospital consortium researching how to provide better stroke care at low cost. “I have been learning many secrets from Professor Gorelick, not only as an academic, but also as a humanist who always considers others who need help,” says his former trainee Hee-Joon Bae, now Professor of Neurology at Seoul National University College of Medicine (Seoul, South Korea). “I am now passing these skills on to my own trainees.” Another former trainee of Gorelick’s, Fernando Testai, Associate Professor of Neurology at the University of Illinois College of Medicine agrees. “Philip Gorelick’s investigations into antithrombotic treatments in African Americans and the contribution of vascular risk factors to the development of neurocognitive impairment gained him international recognition in the fields of cerebrovascular diseases and dementia.” With Bonnie, his wife of 40 years, Gorelick enjoys weekly get-togethers with his extended family. They enjoy movies and making the most of any travel opportunities occurring in Gorelick’s busy schedule. Early in this interview, Gorelick spoke of his teenage wish to live the American dream. Surrounded by his large loving family, and with a hugely satisfying career still going strong, someone might need to tell him: “you did it.”
See Policy View page 444
Tony Kirby 361
Profile Philip B Gorelick: changing neurological practice in the USA Philip Gorelick’s strengths in science and leadership skills made medicine an obvious choice, but his career took many interesting turns before he settled into his current roles as Medical Director of Mercy Health Hauenstein Neurosciences and Professor of Translational Science and Molecular Medicine at Michigan State University College of Human Medicine (MI, USA). “In school, we all believed we could be anything we wanted. I saw a great opportunity to help society by becoming a physician,” he tells The Lancet Neurology. Gorelick completed his undergraduate degree in biology and medical degree at Loyola University, (IL, USA). He recalls being “immediately exposed to a neuroscience curriculum that was amazing—I had an affinity for neuroanatomy and have always found the nervous system so logical.” After gaining his MD, Gorelick worked briefly in internal medicine at the University of Illinois, but gradually focused on neurology, returning to Loyola to do a residency under Frank Rubino and then a stroke fellowship at the Michael Reese Hospital in Chicago under Louis R Caplan and Daniel B Hier. They helped Gorelick to develop the stroke expertise that would become the bedrock of his career. He later completed a master’s degree at the University of Illinois School of Public Health, where, working with Jacob Brody, Gorelick was funded by the US National Institutes of Health (NIH) to unravel the secrets of multi-infarct dementia, showing that cognitive impairment after stroke is related to cardiovascular risk factors. Gorelick led several other NIH funded studies, including those on dementia in elderly African-American patients, and a neuroimaging study of risk markers for dementia after stroke. “Incredibly, back in the 1980s, some thought that having cardiovascular disease or its risk factors excluded one from having Alzheimer’s disease,” says Gorelick, whose group was one of the first to show, in the mid-1990s, the occurrence of cardiovascular dysfunction in Alzheimer’s patients. “It has taken almost 20 years for the US Institute of Medicine to issue landmark guidelines on how managing these risk factors might protect brain health,” he adds. Gorelick’s work was also key in showing that stroke dynamically affects the white matter of the brain, with the thalamus appearing crucial in determining future cognitive impairment. During 1995-2005 he also served as principal investigator of a landmark, NIH-funded study: the AfricanAmerican Antiplatelet Stroke Prevention Study. “African Americans have some of the highest stroke rates and burden of stroke risk factors,” said Gorelick. “Our study across 60 US sites showed that a cheaper recurrent stroke prevention option, aspirin, was about as good as a more expensive option, ticlopidine—even though the latter drug had been promoted as being better based on a non-primary analysis.” www.thelancet.com/neurology Vol 15 April 2016
More recently (2011–14), Gorelick led a pilot study of global diagnostic and treatment methods for stroke, focusing on 12 mostly low-income and middle-income countries, and found that these countries have inadequate facilities for stroke management. He is also collaborating with the Korean Stroke Society on several studies of treatment of risk factors such as alcohol intake and blood pressure, and he has been invited to serve as an investigator for a grant application to the NIH to study outcomes after stroke in Nigeria and Kenya. At conferences worldwide, Gorelick is a passionate spokesperson for preserving cognitive vitality—encouraging prevention or treatment of cardiovascular risk factors to possibly prevent cognitive impairment. “It’s not just about avoiding stroke or heart attacks,” he explains. His other project follows the implementation of the US Affordable Care Act, which is transforming how the US healthcare system and its workers must operate. In a Policy View in The Lancet Neurology, Gorelick spells out how US neurology must move from a fee-for-service, profit-led system to one that delivers better care at a lower cost. “We have to embrace this new reality in every part of the system,” explains Gorelick, adding that 30% of health-system costs are considered waste, such as unnecessary tests and office visits. He has completed a telemedicine study showing that a quarter of referrals do not need to be face-to-face, and is helping primary-care physicians to reduce unnecessary referrals and tests. He is attempting to enter his centre into a 16-hospital consortium researching how to provide better stroke care at low cost. “I have been learning many secrets from Professor Gorelick, not only as an academic, but also as a humanist who always considers others who need help,” says his former trainee Hee-Joon Bae, now Professor of Neurology at Seoul National University College of Medicine (Seoul, South Korea). “I am now passing these skills on to my own trainees.” Another former trainee of Gorelick’s, Fernando Testai, Associate Professor of Neurology at the University of Illinois College of Medicine agrees. “Philip Gorelick’s investigations into antithrombotic treatments in African Americans and the contribution of vascular risk factors to the development of neurocognitive impairment gained him international recognition in the fields of cerebrovascular diseases and dementia.” With Bonnie, his wife of 40 years, Gorelick enjoys weekly get-togethers with his extended family. They enjoy movies and making the most of any travel opportunities occurring in Gorelick’s busy schedule. Early in this interview, Gorelick spoke of his teenage wish to live the American dream. Surrounded by his large loving family, and with a hugely satisfying career still going strong, someone might need to tell him: “you did it.”
See Policy View page 444
Tony Kirby 361