News From Senior Physiologists

Letters to Edgar Folk
William Carl Kaufman writes: “Thank you for your kind and thoughtful letter welcoming me to the ranks of the Senior Survivors, the Realm of the Ancients. A retired cardiologist colleague sent me a baseball cap with the logo, ‘How the hell did I get this old?’ A retired airline pilot friend admonished me, ‘Do not regret growing older. It is a privilege denied to many. I think of both statements regularly.
    “I am remiss in not answering promptly. I apologize. Retirement, which began a second time in September 1987, was going well until my beloved wife, critic and editor , Patricia, became seriously ill. After a long and courageous struggle with diabetes, a malicious disease, she died about a year ago. Such an event raises many questions and requirements for which one is not prepared. All are time consuming and many require a detailed response. Being a master procrastinator by nature I have found it easy to put other things off .
    “Notes about my career: My interest in physiology began during WW II in the military when I was a bomber pilot and became fascinated with the methods of protection against cold and hypoxia and devices for escape from disabled aircraft. My experiences left an enduring interest in aviation and its associated physiological problems.
    “At the end of the war I returned to the University of Minnesota and a study of biology and chemistry and continued to fly in the Air Force Reserve. At the end of the war most of the cadre of scientifically trained personnel in the Air Corps returned to their civilian pursuits. This left a need for capable trained officers as instructors and researchers in the ‘physiology of flight.’ In 1950 with a BA degree in Zoology and Chemistry I returned to active duty as a pilot and became a Physiological Training Officer to train flight crews in the use of oxygen equipment and survival techniques and equipment.
    “An MS was completed with John Marbarger at the University of Illinois and later a PhD with Loren Carlson at the University of Washington. (I had visited UCLA and, I think it was Allen Hemingway who said, ‘There’s a fellow up at Washington who, during the war, rode around in the back seat of a piggyback P-38. He would have a lab suitable for Air Force training.’) That fellow was Carlson.
    “The school assignments were interspersed with flying assignments and three tours at the Aerospace Medical Research Laboratory at Wright-Patterson AFB, OH, and an administrative assignment at the Aeromedical Laboratory at Holloman AFB, NM.
    “My research, mostly applied, was on the responses to the extreme environments that flight crews might encounter, extremes of altitude and speed, heat, cold, acceleration, and exposure to nuclear weapons. And one very interesting study of how African chameleons change their skin color.
I visited laboratories at Point Barrow and Johannesburg and, there, descended 6,000 feet below the surface in a gold mine. I flew to 43,000 feet in an F-86 and spent four hours in a prototype altitude suit at 55,000 ft in an altitude chamber. I survived a jet accident and a balloon accident and made a parachute jump. It was all satisfying and exciting. I saw most of the major cities in western Europe. I had the opportunity to work in some of the finest laboratories of their kind and fly the finest airplanes.
    “When I retired from the Air Force in 1968, I had the good fortune to obtain an NIH Senior Scientist Fellowship with the Medical Research Council in London, England, where I spent a year in Sir Peter Medawar’s organization with Drs. Edholm, Fox and Reg Whitney. I had money to travel and visit laboratories on the continent. It was an excellent preparation for becoming a faculty member at a new campus being opened by the University of Wisconsin where Fred Sargent was Dean. There I had grants from NASA and industry and taught
undergraduate Human and Comparative Physiology. And I am delighted to report that we had great success in placing students in medical, dental and graduate schools. That period of my life ended in retirement in 1987.
    “There has been some name dropping here but knowing people like James Hardy and Dr Ted Hammel—and meeting Dr. Folk on a field trip to Alaska—were one of the very enjoyable aspects of a career in Applied Physiology. The international travel and the visits to various laboratories were always accompanied by outstanding and genuine scientific and social camaraderie.
    “I feel very fortunate for having the career I did.
    “What am I doing: I take care of the household duties and yard work on an acre, part of which is natural with 70-foot firs, tend 40 Bonsai plants, exercise six mornings a week, watch the birds at my feeder, participate in the Cornell Laboratory Feeder Watch, cook a bit (not very well), read mysteries, Science News, Science Times—and The Physiologist—and contemplate rejuvenating the Lotus Elan we brought back from England. I participate in a fiction writing workshop. I sit in on liberal arts courses at the local branch campus. I am thinking about another short paper on windchill. And I am pleased to announce that I enjoy very good health.
    “Advice to young physiologists: I would recommend that they not ignore the opportunities that might be offered by the Military Services or the government agencies. Other than that, as Davenport said, ‘Physiology is fun.’ There were bad days, of course, but in general I looked forward to going to work every day, a laboratory is a wonderful toy and teaching is a gratifying experience.”

Howard N. Jacobson writes: “Two events overlapped this summer. First, after 50+ years of unusual employment, I finally retired on May 31. Second, as you noted, I turned 80. Over this span I have been most fortunate with respect to both my working circumstances and the professionals colleagues, starting with my postdoctoral assignments in that small but potent Department of Physiology at Harvard Medical School. Headed by Eugene Landis, the faculty—who let us join in their brown-bag lunches—included John Pappenheimer, Cliff Barger, Ernst Knobil, Ralph Kellogg, and Paul Chatfield. The nature of my fellowship called for the Department of Obstetrics to take overall responsibility and for me to work in the Friday afternoon “Family Clinic” conducted by the Department of Maternal and Child Health (MCH), Harvard School of Public Health. Remarkably, it has been possible to combine the perspectives of all three disciplines in varying proportions in my university assignments over the years. Through it all my main field of work has concerned health professional education—with a core philosophy learned from Harold Stuart, Professor of MCH, HSPH, namely, ‘what do healthy people do?’
    “Having said all that, I have been able to stay fully employed and more or less healthy over the entire span. It has been interesting to watch the working calendar change over this span. When I began, June, July, and August were months when faculty could catch up on unfinished business, rest up, and prepare for the year ahead. These days, health professional education is nearly non-stop across the year.
    “As I noted, health professional education has been my central theme throughout and will also be my focus in my retirement, though unpredictably. Trained as I was in obstetrics/gynecology and MCH, my first major assignment was with the Federal Children’s Bureau in the preparation of the background information needed for a proposed White House Conference on Maternity Care to be held in 1964. The data raised all sorts of questions about what the workforce would be in a national maternal and infant care program. The potential role of the nurse in MCH services was one of the chief issues to be addressed. This effort furnished the stimulus to study selected European midwifery models of the MCH teams and their focus on healthy families. The model that stood out, to which I returned in the late 90s, was that of Sweden. Workforce issues were major concerns in the late 60s and early 70s with the arrival of Medicare and Medicaid, and a proposed universal health care program aimed at the early 70s. With midwives seen as essential, where would they be prepared, and what would be their connections with their physician counterparts? In this connection, I was appointed Director of the Macy Program at Harvard Medical School in 1969 with the task of finding the most favorable Nursing education program to collaborate with us. We were fortunate to come along at just the right time and Boston College School of Nursing joined. The goal was to prepare the basics of the health team in maternity care. A question that arose then and which has still (2003) not been resolved concerns for a health team to be successful the practitioners must learn from each other in as early a part of their training as possible. We elected to attempt to match up physicians at the residency level with nurses in a master degree program. This had the virtue of matching students in the terminal parts of the educational process. We realized that it was late in the professionalization process but it was the best we could do at the time. The abandonment of a national health plan in the early seventies led to the decline of interest in the MCH health team. The seventies and eighties were largely holding-times for major initiatives, although efforts to promote health care teams persisted. The recognition in 1969 of ‘Hunger’ in the USA led to major national efforts focused on the poor. Out of this came a variety of food programs and a renewed interest in nutrition education as part of clinical training. I became Director of the Institute of Nutrition of the University of North Carolina (UNC) in 1978 and had the happy assignment ‘to get the University of North Carolina involved in the nutritional concerns of its constituents (the taxpayers) in as visible a manner as possible.’ It was on my retirement in 1988 and subsequent appointment in the Department of Community and Family Health in the College of Public Health, University of South Florida, Tampa, that my efforts to help clarify the health care team resumed. It began with Florida’s Healthy Start Program for ‘all pregnant women’ and infants which was enacted in 1991. Immediately questions arose about who would provide the care ‘for all,’, and interest in midwifery re-emerged.
    “The Clinton Health Plan of 1993 opened the door to the plethora of approaches to health care we deal with today. The question for health professional education, in turn, becomes even more difficult—how to prepare students for an unknown and fast changing future. When should members of a future health care team begin to learn about each other and learn together? For the past seven years I have been a faculty member in a pilot program aimed at preparing interdisciplinary members of a health care team to provide culturally sensitive health care. We found that the fIrst challenge was to deal with the professional cultures themselves. The nurses and social worker were recruited from masters degree programs in their respective colleges, and turned out to be seasoned experienced practitioners. The only physician trainees available for the program turned out to be students between the first and second years in medical school.
    “At the same time we were exploring interdisciplinary health professional education, the health care arena itself was spinning off in all directions until today we have an array of approaches in primary health care that ranges from a more classical team of physicians, nurses, social workers, nutritionists on one end to a more biotech genome-based approach on the other. In between are a variety of HMOs and Managed Care approaches ranging from a web-based electronic approach to a ‘boutique’ model on the other. At the same time, health care organizational designs are equally on the move, with outsourcing, and Professional Employers Organizations (PEOs) One report cites the case that an X ray taken in California may be transmitted digitally and read by a radiologist in Bangalore, India. When one picks up a phone to ‘dial-a-nurse,’ who knows where that nurse may be located—also India? Indeed, the new President of the American Association for the Advancement of Science (AAAS) a physician and neuropharmacologist, in his Presidential Address reported that, ‘The US health system is failing in front of our eyes.. The current system can scarcely meet today’s needs...’ and ‘Scientists must now unite to insist that the system be prepared for the discoveries of the future, ..’ (Science, 13 June, 2003, p 1680). All of this raises questions about what should we prepare our health professional students to do, 15-20 years from now? That question, in turn, asks how does physiology as a discipline contribute? Who decides? Who will teach that new kind of physiology? Will it be outsourced? The rising generations do have their work cut out for themselves..
    “Well, there you are. I am currently settling down to share my experiences along these lines. The hope is that it might shed some light on the paths taken so far, and make it easier to plan for the next phases that are already upon us.”

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