Interview with Francis I. Kittredge, Jr., MD, JD, FAAN, and Roger N. Rosenberg, MD, FAAN
Roger N. Rosenberg, MD, FAAN
AAN President 1991−1993
and
Francis I. Kittredge, Jr., MD, JD, FAAN
AAN President 1999−2001
Sunday, April 23, 2017
Boston Entertainment and Convention Center
Boston, MA
Tim Streeter, AAN staff, Interviewer
(c) 2017 by the American Academy of Neurology. All rights reserved. No part of this work may be reproduced or transmitted by any means, electronic or mechanical, including photocopy and recording or by any information storage and retrieval system, without permission in writing from the American Academy of Neurology.
TS: I’m Tim Streeter, from the American Academy of Neurology, and I am here this afternoon with Dr. Francis Kittredge and Dr. Roger Rosenberg, and they have kindly consented to sharing some of their experiences as leaders of the AAN. Thank you so much for joining me this afternoon.
RR: Thank you.
TS: I am going to start out with the most obvious question, and I will start with you, Dr. Kittredge: When and why did you decide to become a neurologist?
FK: I first got interested in neurology in medical school because I had a neuroanatomy teacher whose name was Donald Kimmel, and he wrote a text book of neuroanatomy and he was probably one of the most exciting and excited teachers I ever met. He had a lisp and a stutter simultaneously, so you had to listen very carefully, but he was an extraordinary three-dimensional neuroanatomist and could project and draw on the board with both hands practically, the brain stem and things like that. It became extraordinarily exciting to take his course and by the time I had finished medical school, I had done a rotation in neurosurgery with a man by the name of Michael Scott, whose son became chairman at Children’s here in Boston, and fully intended to go into neurosurgery. Unfortunately, I was going to get drafted, so I went in the army and then came back and did family practice and then internal medicine for a total of 10 years and then decided I really wanted to do neurology, rather than neurosurgery and then I went back into neurology.
Interestingly, the people who got me involved in it were Bud Rowland, who I went to and talked to about taking neurology residency and he said that he thought I would do best in a clinically oriented and emphasis program and sent me down to see a guy by the name of Frank Elliott, who also wrote a text book of neurology. Frank greeted me enthusiastically and as part of it, I had told him I had been in law school for five years at night while I was practicing. His remark was only like Frank Elliott could give it to you and it was, “splendid.” He was a South African who came to the United States via Queens Square and the Moorfields Eye Hospital in London.
That is sort of how I got into neurology, but I had taken care of patients who had neurological problems in internal medicine. One I can remember as striking and I will use a pseudonym. Her name was Mary Bach. Mary was an absolutely striking young blonde woman with three beautiful blonde daughters, who developed acute MS and had serial attacks of MS that I tried to get her through with very minimal kinds of things to really use. Steroids and ACTH were the treatments at the time and that was what really introduced me or motivated me to go into neurology.
TS: Dr. Rosenberg?
RR: My story is a little different. I grew up in Milwaukee, Wisconsin, and our family doctor was Dr. Max Fox. This was at the time in the late 1940s, of polio epidemics and there was a polio epidemic in Milwaukee. We were quarantined to our yards. But he had an enormous influence because not only was he a wonderful internist, but he was also involved in the Milwaukee Isolation Hospital and seeing patients with acute polio, bulbar polio, patients with spinal cord polio, paralysis. He took me on rounds. He allowed me to see patients in iron lungs at the time and obviously I was very impressed and very overwhelmed by seeing a viral infection of the brain producing alteration in brain function, breathing, swallowing, paralysis.
I was in fifth grade and we had to do a science project and I wrote a science project on the medulla oblongata, which is involved in respiration, cardiovascular functions. That was an enormous influence, making rounds with Max Fox in his 1948 blue Plymouth and carrying his black bag and seeing patients with neurologic disease, had an enormous influence.
Also, my wonderful mother had a neurological disorder, Raynaud’s disease, which produced a major vasoconstriction of her fingers and toes and was quite painful and I remember going with her to the Mayo Clinic for a sympathectomy. The neurosurgeon was Dr. Alfred Uihlein, and he helped her tremendously. I got to see personally at home a neurological disorder and therapy, which corrected it. She was on nitroglycerine ointment that helped improve her perfusion of blood flow and also had the opportunity to have a tutorial with Max Fox several summers.
That just continued right through high school, interest in neuroscience and the brain and took courses in college in neuroscience. Kenneth Roeder, in particular, in invertebrate neurophysiology, a major course I had as a junior student at Tufts University in Medford, Massachusetts, in the late 1950s. That is sort of how it began.
TS: You joined the AAN in 1966?
RR: I did. I was a resident at the time at the Neurological Institute, Columbia University in New York and H. Houston Merritt, was the chair. He encouraged me and the other residents. “You should go to the American Academy of Neurology. You need to see firsthand the scientific and clinical presentations, how they are presented, what is good science, to develop your interests and become more critical in evaluating what is good and what is not as appropriate. Go there and meet your fellow colleagues, as well as senior people. Get involved.” He encouraged me to attend and become a member and I did and I am very grateful to him for that.
TS: Houston Merritt didn’t think that the Academy was going to amount to very much when it was launched.
RR: There was a tradition of the American Neurological Association, which was the standard bearer for decades and it was felt at the time that we needed to diversify. We needed to make it more democratic. We needed to involve all those who were junior individuals wanting to get into neurology, had strong clinical interest and then let the scientific and academic aspects emerge from there. The ANA, you had to be elected and it was restricted in that regard for the very best, very appropriate, but the American Academy of Neurology was founded on the basis that all those who are interested in neurological disease, those who are neurologists who want to participate and become involved clinically, patient care, as well as research, are welcome and just come and participate. Obviously, that was a very important decision. Highly successful, from a few hundred members in 1948 from the four horsemen who began it, to 32,000 members now in 2017. I think the tide of history has proved to be correct that the Academy is the right way to go.
TS: Dr. Kittredge, you joined in 1971?
FK: Yes.
TS: What were your needs as a practicing neurologist?
FK: I was a resident at the time that I joined the Academy.
TS: Okay.
FK: I had been a resident for about a year, a year and a half, and in 1970, I went to my first Academy meeting and I wasn’t a member. I was a resident, so you got a special price to go and my chief sent us to go ahead and go to the Academy meeting. I can remember vividly it was in Bal Harbour, Florida, at the Americana Hotel, and the Americana Hotel at the time was big enough to take care of the entire meeting. I can recall vividly one of my interests was in neuroimaging. There were two neuro radiologists from the University of Minnesota that used to come and give the course. It would go from 8:00 in the morning until everybody fell asleep at 3:00 the next morning. They were two very exciting dynamic guys. I got quite interested in that and did neuroimaging in my residency and then got interested and did all those things that Roger and I are very grateful don’t happen today, like pneumoencephalograms and myelograms and air myelograms and things like that sort of thing, which were intensely uncomfortable for patients. They have now all been replaced by MRI and CT.
That was one of my interests and I suppose the best way to go ahead and compare Roger and I, is he really had an interest in basic science and how you take it from the laboratory to the bedside. I’m someone who has been interested in Neuroscience and taking it from the bedside to the clinical application and the introduction of new technologies as they became available. I was the first neurologist to go to Maine, in Northern Maine. I think there were two or three neurologists in the state. Today there are probably 30 some neurologists in the state.
It was very, very exciting and had an opportunity to do a lot of things that today residents in neurology really don’t do in neuroradiology and in neuroimaging. It is not a part of the formal program. They can take it as electives in certain areas, but that became very exciting for me and introducing new electrophysiology opportunities for our members in our group and that sort of thing.
The clinical applications and treatments that were associated with them were really the most exciting things to watch evolve. Going from the 1960s, when the only treatment for Parkinson’s disease was Benadryl, or some similar sedative and where MS had ACTH and steroids, to a whole array of drugs that have come along and are now doing what Roger was describing earlier and that is, so much of the diagnostic nomenclature of neurology was descriptive rather than diagnostic. Diseases like MS, for example, were just one big lump that nobody really could understand and differentiate. Now we are doing what Roger is talking about and that is we are subdividing as neurologists are tending to do, into the genetic etiologies or at least the genetic associations with the presentation of these diseases and this is going to lead, I think, with identifiable targets for new therapies. That is the challenge, I think, and the excitement today.
TS: When you were a younger member of the Academy, how did you get involved in committees and leadership activities?
FK: I had no real interest in it until I got to Maine and started developing a group. I was the first and then about 15 months later, I got an associate and then we brought in two more and then we brought in two more and in about 1977, 1978, we introduced in our institution, which was a regional medical center, a visiting-professor day once a month. We would get an academic professor from Boston, New York; they came in from Wisconsin, St. Louis, Philadelphia, to spend the day. They would come in the night before and then they would teach and go on rounds with us and give a lecture and that sort of thing the next day.
One of the people who used to come up and came up several times was Dr. Ted Munsat, who was a former president of the Academy. He would come up and he was very interested because we bought the first CAT scanner in the state of Maine, and introduced it into our hospital. We also had developed really the first neurophysiology laboratory in the state and he came in and he could not believe all these things that we had available to us that they didn’t have available in his institution. His question to me was, “Well, how did you do this, get the hospital to spend all that money?” Our group just said, “We didn’t. We went out and did it ourselves for the hospital and we had a contract to go ahead and bring these things in and provide the service in the hospital with a contract with the hospital.” That worked very well for a long period of time.
Ted then said to me, he said, “I really would like you to get involved in the Academy.” He put me on the Technology Subcommittee of the Practice Committee, and on the Practice Committee, and that is the way I got involved with that.
TS: Was he like a mentor then to you within the Academy?
FK: He was a prince. He was a wonderful person to deal with and he was very encouraging. As a matter of fact, when Roger was nominated for president elect, Ted Munsat was the president of the Academy and Bud Rowland was to become the next president. I knew each of them in a different context. We sort of started doing things together.
TS: Dr. Rosenberg, how did you get started in leadership activities?
RR: I think I was heavily influenced by trying my best to increase and diversify and emphasize science within the Academy and I asked to be appointed to the Scientific Program Committee. I worked at that quite seriously. When I finished my clinical training at Columbia, I had the wonderful opportunity to go to the National Institute of Health.
[Break for technical adjustments.]
TS: Dr. Rosenberg, how did you get your start in leadership activities in the Academy?
RR: After my clinical residency at Columbia, I had the wonderful opportunity to go to the NIH into the Laboratory of Biochemical Genetics with Marshall Nirenberg, who won a Nobel Prize. He did for the genetic code. I was imbued each and every day with wonderful molecular genetics and genomics and the human genome project of the time, sequencing the human genome. Its origins in terms of understanding the universal genetic code in the Nirenberg lab. My background is I tried at that point—we are speaking about 1968, 1969, and 1970—to integrate molecular genetics with neurologic disease. My mind set was neuroscience. When I became a member of the Academy, I felt there was a need to try and bring that emphasis to the scientific program committee and I was a general member of the committee for a number of years and worked hard at it and we improved, I believe, across the board the scientific curriculum of the meeting, bringing more individuals of a diverse background to the meeting. I chaired the scientific program committee for six years.
My goal and objective was to try and double the scientific program, which would almost double the membership attending the meeting, which it did, but the content of the scientific program changed dramatically, so that we had basic science subjects in the program.
It was encouraged if we talked about a clinic disorder, it got into therapy and the molecular or biochemical or physiologic basis of the disease. Mechanism of disease. Pathogenesis of disease. Therapeutics to understand the basic cause of this neurologic disorder and understanding of therapy.
I think that was my motivation, was the integration and upgrading the scientific content of the meeting and bringing all those; a whole array of backgrounds in physiology, pharmacology, virology, biochemistry, genetics, cell biology to the meeting.
TS: Speaking of the Annual Meeting, how have you seen it change, Dr. Kittredge, over the years?
FK: It is really hard to quantify how different it is. It has expanded to the point where I think if you really want to go ahead and go to the meeting, you buy the meeting proceedings, or however they characterize it. You look at it through the fall and winter coming up and spend an hour or something like that every few days to listen to another lecture, because there are so many programs going on simultaneously that you can never get to the ones you want to go to. You will go to one and then you will miss two or three others.
The range of the science, the technology, the clinical care and the therapeutics has become vast compared to what it was. I think the best way to put it is it was primitively elementary when we first started. The sophistication and the expansion of knowledge base was so enormous that trying to get it into one annual meeting is almost impossible. The challenge is selecting the most important things for everybody to see and hear at this meeting. I think today, let the persons who come to the meeting go ahead and elect to take the courses and take the scientific program in the form of an audiovisual at home on their computer through the rest of the year and that really has been, I think, a very exciting change. We tried to do that when I was president of the Academy in 1999 to 2001. I encouraged people. I said, “We have to put the entire program on the internet, so that we can go train and we can go ahead and inform neurologists.” Because of geography, they can’t come. Because of the distances involved and the time away from practice and coverage responsibilities and that sort of thing; so, it is available to them in another format that is accessible.
RR: I think that the fall conferences may have started around the period that you were president.
FK: One of the things we also encouraged during that period, I am sure Roger was involved in this, just as anybody else who was interested in education, was that we really needed to project the clinical program geographically, so that it was accessible to the practicing neurologists. So that you would have a program. My idea was that we should have one in New England in the fall and then late in the fall perhaps there is one in the South and then one in the Midwest or the West during the winter and spring, to go ahead and really supplement the annual meeting. It is not a substitute clearly, but it does create a geographic accessibility for members who could not otherwise come.
TS: Is there a certain point, and I’ll ask both of you this; right now, we have a Sports Concussion Conference, we have the Breakthroughs in Neurology Conference.
FK: Right.
TS: As well as the Fall Conference and we are bringing a winter conference back.
FK: Right.
TS: Is there a point where you start to cannibalize your attendance for the annual meeting?
RR: I don’t think so. I think if you look at the statistics and the census, the numbers keep going up. There is an insatiable interest in the brain. The most important question truly before all of medicine and science in the 21st century is how does the brain work. What are the basic mechanisms of how the brain stores and retrieves information, both visual and motor and cognitive and balance. That transcends into an understanding of neurologic disease.
As Dr. Kittredge said, the program has dramatically become encyclopedic. There is something for everybody at this meeting now. That was very important to me back in the 1990s, the late 1980s, when I chaired the Scientific Program Committee. The Scientific Program Committee needed to be designed so that it did appeal and that there was an attraction for everybody and that has not saturated. Now we have these regional courses.
The other changes that have occurred are the courses. The courses complement the scientific program, so that the very best individuals, whatever the subject matter, put on a comprehensive course in detail and get the very best faculty to teach everybody. You go into the courses and you see the most senior to the most junior people absorbing aspects of that particular subject. Can ask questions. The courses are complementary to the scientific program.
The other part is the plenary sessions. The plenary sessions are in the mornings now; Sunday, Monday, Tuesday, and Wednesday. They go on and they are terrific. The absolute spectacular talks that are presented are stimulus to us all. The very best speakers are present. The Brain Initiative that President Obama started, very important in terms of understanding how the brain functions. Christof Koch, who worked with Francis Crick, gave one of the plenary talks on how does the brain work and he is trying to get a structure from the brain called a synaptosome, a region of connection between nerve cells and trying to identify what are the messenger RNA species that are being produced. What are the neurophysiologic membrane effects that are occurring. He is trying to get at the code. The essential brain code, if there is one, and there probably is. Like the universal genetic code. That is the level of excellence that these plenary sessions now have, and they are complemented by the courses.
Everyone can participate now. There is something for everybody to come to the meeting. The answer is, it works. The meeting now is drawing this year over 14,000 members and the membership is over 32,000. It is a self-fulfilling prophecy in the sense that we thought this would happen and it is happening.
TS: Take you back to the 1990s and The Decade of the Brain. Did the Academy benefit from that?
RR: Yes, The Decade of the Brain in the 2000s had an effect. It had a major educational effect. It got people really interested in the brain. It increased the budget of the NIH. Those are very important. It was education not only of our colleagues in medicine and science, but the public. The public has an insatiable interest, as Dr. Kittredge said. We did not have good therapies for multiple sclerosis then; we do now. Parkinson’s then, we didn’t; we do now. Stroke then, we do now. The public is involved in this. They are our advocates with the Congress, the congressional appropriations, which has driven the ability to do more research. That is why we have to preserve the NIH budget now, which is under some concern. An increase in the budget for neurologic disease benefits everybody. No matter what your political persuasion may be. We have to deal with and develop new therapies for stroke and Alzheimer’s disease. These are democratic diseases. They affect everybody of any persuasion. We need to benefit the American people. I think The Decade of the Brain was the start and it had a real effect in terms of increasing the NIH budget of mobilizing the public at large from an education point of view and it just continues.
The budget now of the NIH is 32 billion dollars. NINDS and NIH, the mental health institutes are up, and we are getting answers to neurologic disease. Look at what has happened in terms of stroke; tPA and endarterectomy and stents. It has had a practical effect. The Decade of the Brain really focused the public’s education on the brain in a very concerted way for the first time. It had a real benefit. Now we see the dividends from that investment.
TS: Dr. Kittredge, you came into the presidency at the end of The Decade of the Brain. Did you see any effects? Did you have something to build off of during your presidency from that?
FK: I thought that The Decade of the Brain, as Roger said, was amazingly exciting. I mean, they expanded funding for NINDS by 100 percent. They doubled the budget over that 10-year period. The unfortunate thing is that after 2001, the budget has been sort of flatlined and as you know, the new budget that was just provided by the White House to the Congress proposes to go ahead and cut the NIH by 5.8 billion dollars. What portion of that is going to be a cut to NINDS, I don’t know. There is an integration that occurs that starts with the basic sciences and NIH is primarily interested in that. If we don’t have the basic science going on at NIH and we don’t have the translational science going on in the university system in the neurology departments, and that kind of thing, then industry does not then follow up with the clinical applications and development of new target drugs.
These are so closely linked and industry, as I understand it, has been pulling back from funding research on their part because of the fact that it is so difficult, expensive, and time-consuming to go ahead and introduce new drug products that are calculated, as Roger was saying, that have identified targets in the genome in the neuropathophysiology, if you will, that could be identified and targeted with new products because of the cost. There is a cost-benefit ratio to the investors and the people in the drug companies that really, I think, is at risk to some extent with that. You can’t really go ahead and cut our basic science research budget and expect that we are going to have new treatments and new cures for brain disease or any other group of diseases. You really need a guarantee or an assurance that you are going to maintain your budget at an inflation-adjusted level so that you don’t have to give up research programs because you don’t have the money.
TS: That leads us to advocacy and how the Academy has advocated for not only neuroscience research, but proper reimbursement for neurologists, for patient access. I have seen photos of you in Washington with Steve Sergay and Ken Viste.
FK: Right.
TS: You made some trips to Washington as well?
RR: I did, yes.
TS: How effective is that do you feel in making the Academy’s case, to go speak with these congressmen and representatives and senators?
FK: I think it is a very interesting question because all politics is local. The interesting thing is that for about 25 years I went to Washington every year at least once or twice and I knew Bill Cohen, who was a senator from the state of Maine. I knew [Senator] Olympia Snowe. I knew the congresspersons and that sort of thing from the state of Maine. We only had two congressmen and two senators. I knew all of them all the time going through and they were accessible. You supported them and that sort of thing. You had an opportunity really to educate them, which is the essential part of any advocacy program, is to go ahead and inform the decision makers or the people that are going to be the decision makers in Washington.
Again, you have the other side of the coin where you have the agencies and the departments like CMS—which is Medicare, Medicaid and that sort of thing—and access to them in terms of trying to assure as best you can that there is adequate funding for patient care and this, maybe crassly put, is the doctors’ income. The reality is that we can only go ahead and field so many clinical neurologists if the money is there to support the salaries and the overhead. What has happened over the last 20 years really is that that funding has been consistently lagging inflation, so that as the time goes on, you’re hazarding the entire clinical enterprise. So that today, there are not a great many neurologists that are going into neurology coming out of residencies and fellowships. With lots of debt from medical school, who can afford to go out in independent practice or start a practice? They all become employees of institutions of some sort or another, whether university or whether it is a community hospital. It has a number of different ramifications, but it is the entire continuum of funding from the basic research at NIH to the patient care at the bedside that is affected.
RR: I have little to add. Dr. Kittredge has said it so well. Every medical specialty is advocating, and we better speak up for our interests and the needs of our patients. The economic pie is only so large, and we need to speak. It has been said, “not to speak is to speak, not to act, is to act.” Our patients depend upon us. We are their advocates. They are dependent on us to speak up for them and their needs and to develop research and to develop adequate reimbursement for neurologists to be motivated to continue to fight the fight. I think that battle continues to go on. It’s not going to stop, and we need to be as innovative and as aggressive as we can to speak up for our patients.
TS: Were there discussions during either of your terms about starting a political action committee?
RR: Not to my knowledge. Dr. Kittredge and I, on the other hand, were very active in starting a program which we called the Academy of Education and Research Foundation, very much so. Dr. Kittredge and I had the view that, as he indicated, in order to get people to want to go in to do research after a residency, they weren’t prepared. They need fellowship support. They needed research grants. To go from a residency into a research program and to write grants and become independent without any formal training was extremely difficult. I do remember in 1991, 1990, going to Jan Kolehmainen, who at the time was the executive director, and indicated we need to do something to develop the needs for post-residency fellowship training to get people to go into research. We talked about a development office and I really said, “No, we need to move forward with a foundation of some sort. Something independent and dynamic.” I shared my thoughts with Dr. Kittredge and with Bud Rowland, who was the president at the time. We went forward and we established the AAN Education and Research Foundation. I was delighted to be the president as it began, but Dr. Kittredge was the first chair of the foundation.
FK: I was the first president.
RR: First president of the foundation and he moved it forward and established it and was responsible for its success.
FK: It is interesting because the conversation started during Bud Rowland’s term and Bud established a committee of the board that was the financial development committee of the board of trustees or the executive board of the Academy and Roger was on the committee and I chaired it and Steve Ringel was on the committee and we came back with two recommendations. The first was that we start a foundation, as Roger says, and the second was to go ahead and start a publishing company to take over the journal and develop other publications for the Academy that would go ahead and provide additional revenue. The foundation was started, I remember it vividly, sitting at a board meeting with Bud Rowland, who was sitting there, and Bud had an interesting comment and we were talking about money and at the time Audrey Penn was the deputy director at NINDS and was in charge of translational research. She was pushing that. But, as we said, “Well, what are we going to do with the money when we raise it?” Bud says, “I think we ought to go ahead and start clinical fellowships,” and that was the genesis of our clinical fellowship program, which is usually a two-year program after residency in a specialty or in a subject that is of interest.
RR: It has been a great success. The synergism among all of us a great success. Now it is the American Brain Foundation.
TS: Right.
RR: It is funding millions of dollars and dozens of wonderful fellowships.
TS: More than 20 million dollars it has given away?
RR: The total is—
TS: More than 20 million.
RR: Dr. Kittredge, Dr. Rowland, and I feel pleased about that; that, that mission has been accomplished and wonderful people are now in academic medicine and doing science and research to help life for us all.
FK: We created, I think in a sense, the seed corn for academic neurology.
RR: I think so.
FK: Because the interesting thing was these folks came out of their foundation fellowship and were successful at a very high level of getting an RO1 grant from NIH and that was something, at least some years ago, where 95 to 98 percent of them were in academic neurology. As a matter of fact, the chairman at Harvard, here, was one of our first fellows.
RR: It’s terrific. It really—it goes on and on and on in terms of what it is—
FK: It’s just the ripple effect has been phenomenal.
RR: I look back in terms of my contributions and that would be probably number one, the scientific program development, number two, and bringing Francis Crick to the meeting as the presidential lecturer in 1991. Crick and Watson, the double-helical structure of DNA. He got interested in consciousness. He said that was an expression, if you will, made his contribution in terms of the double-helix, and the next big question was how does the brain work and what do you begin with when you begin with consciousness. What consciousness? Visual consciousness, because the brain is involved with at least two-thirds of its connections with vision in some way. He published a great deal and with Christof Koch, as well, in journal Nature, on the beginnings of neural correlates of consciousness (NCC), as he called it. In his first book, “The Astonishing Hypothesis” Crick in which he said, “It is an astonishing hypothesis in the beginning of the 20th century that the mind and the brain are linked. They are not separate. Cartesian dualism is over.” The mind is the brain, its architectonics, and its circuitry. The mind emerges from the complexity of the brain and so, that was my third, I think, important contribution, was to bring Francis Crick to the meeting and when he walked in to give the presidential lecture, you could have heard a pin drop and his talk was just absolutely brilliant and he set the tone in terms of a molecular biologist pointing out to our colleagues the importance of it, to understand the brain at the most fundamental level. If we can do that, then understanding translationally, as Dr. Kittredge mentioned, translational will follow, but we need to have the very basic to begin with. That was the mechanism of the NIH.
When I was there in the Nirenberg lab, we didn’t talk about translational medicine. We didn’t talk about application. We talked about the universal genetic code. We talked about the brain code and differentiation and my project was to grow neuroblastoma cells and to dissect brain areas and cell culture and look for neuronal differentiation, the formation of neurites with dibutyryl cyclic AMP and to show the induction of choline acetylase glutamic acid decarboxylase and acetylcholinesterase under very specific conditions. That was basic and now it is translational, and the NIH is doing that and there is even a movement we should go back and emphasize basic research again at the NIH, because look at what has developed.
The translational effect has been remarkable. I think, as Dr. Kittredge said, this American Brain Foundation that our group founded and developed has had an enormous impact in terms of the incremental effect on this generation and generations in the future to maintain that basic science foundation and translational applications.
TS: Another organization that you were involved starting was UCNS.
FK: I was involved in 1995. Ken Viste, who was at that time president, involved the board of the Academy and some of the people on the committees in a long-range planning initiative and there were five committees that were established and I served on one on neurological sub-specialization. During the process of going through that, one of the things that had happened was that the American Medical Association and ABMS, which is the American Board of Medical Specialties, had decreed that we are not going to recognize any more sub-specialties. There were too many of them and they were proliferating like rabbits or however you might like to characterize. The reality, of course, was that the science and the technology and the applications and the specialization was evolving at a very rapid rate. People were sub-specializing and the difficulty was that getting academic recognition and getting financing depended on your recognition as your specialty. Whether you were talking about neurophysiology or whether you were talking about neuroimaging or you were talking about movement disorders or neuropathology. If you didn’t get that recognition, you didn’t get the academic appointment and you didn’t get the kind of financial support you needed to go ahead and do your work. We said what we really need to do since the ABMS is not going to go ahead and recognize any more, is to create our own board and out of the committee came this recommendation that we start an organization which became the UCNS. That was to establish neurological sub-specialties and create an ABMS quality board certification process for each of these new sub-specialties; they are in pain, they are in movement disorders, they are in all kinds of sub-specialties in neurology now, stroke.
It does enable people to go ahead and gain the kind of academic and professional recognition they need to attract the kind of financial support they need for treatment programs, such as the stroke programs, I am sure you have read about or heard about on TV and time is brain. It is just like years ago they talked about time is heart muscle; if you don’t get to the hospital in time to get treated appropriately. That I think has been a really important advance and when I became president, I appointed Steve Sergay to go ahead and complete the initiative and get the boards up and going and one of the others is neuro intensivists, which now have a program for certification. It has been a wonderful experience doing that.
As a matter of fact, after we did that, I was called by the people of the American Board of Medical, not medical specialties, but the people with the Board of Internal Medicine and asked us how we did that. I said, “We just got the best academic talent we could to put together, to go ahead and create our own board for neurological sub-specialties, so that it had academic rigor and recognition and it worked very well.
TS: I know that you both have other things that you wish to do here at the meeting. Just a couple more quick questions. Jan Kolehmainen, what kind of an executive director was he?
RR: Oh, Jan was a wonderful person. He was so compassionate. He was able to be approached. He participated actively in the decision-making process. He welcomed new ideas. He was kind and generous, very intelligent and I enjoyed greatly working with him. He was a very effective and dynamic leader of the Academy and established many of the foundations with us. Made it possible for us to accomplish what we wanted to accomplish and he, if you will, synergistic and very complementary to everything that we tried to do and provided wonderful ideas himself. We all miss him greatly.
TS: He left around the time that you were president?
FK: The Academy, between the time I joined in 1971 and the time Jan left, I guess it was about 1998 or 1999, and I got involved in the Academy in the early 1980s, in the Practice Committee and that sort of thing. I didn’t have a lot of contact with Jan. I sort of peripheral to his sphere of influence, but the Academy was evolving at that time very rapidly and with the support of NIH, NIH residents was a program that was sponsored by NIH back in the 1960s and 1970s to expand the number of neurologists available in the country. That was extraordinarily successful. Jan left just before I became president and at the end of Steve Ringel’s term in 1999, Cathy Rydell came on as the new [executive director] and I was on the committee that interviewed the nominees, or at least the people who were the candidates and we selected Cathy. I think it has been and extraordinarily good choice.
TS: What did you see in her?
FK: She was personable. She was clearly energetic and she was clearly knowledgeable about how—she had been a politician. She was, I think, in the legislature in North Dakota, if I am correct.
TS: Right.
FK: That’s my recollection. She was then involved with a couple other organizations before she came to us, but she was a very exciting, dynamic, knowledgeable, and collegial individual to go ahead and identify and when we did the interviews, she was clearly, I thought, the best candidate we had. She was selected and we fortunately, turned out to be right.TS: I would have to agree with that, having worked with her for 15 years almost. It has been an enjoyable experience working at the Academy and even though you two preceded my being here, I want to thank you for everything that you’ve done for the Academy.
FK: I think you can also thank the staff. I think they’ve done a phenomenal job. This meeting is evidence of the achievements that they have realized over the years. We recognize you folks as much as we do anyone of our clinical or research scientists who come here to talk, because without you we couldn’t do it.
RR: Absolutely true. The staff is remarkable and I’ve enjoyed working with each and every one of you. You, yourself have made major contributions to the success and the growth of the Academy and it will continue.
TS: Thank you very much.
FK: Yes. Thank you so much.
RR: Thank you very much. Appreciate it.
FK: Good. Thank you.
TS: Thank you very much for coming down.
FK: Good. You are welcome.
RR: Thank you, Dr. Kittredge.
FK: Thank you, Roger, it’s always wonderful.
RR: A pleasure.
2017 Annual Meeting in Boston: Tim Streeter; Roger N. Rosenberg, MD, FAAN; and Francis I. Kittredge, Jr., MD, JD, FAAN.