Howes Award | Department of Pathology and Laboratory Medicine

Jonathan Howes Lifetime Achievement Award Remarks – April 12, 2018

Joe W. Grisham

Mrs. Mary Howes, Bo Howes and Ben Bean, Professor Peacock, Professor Cordeiro- Stone, Members of the UNC Retired Faculty Association, and Guests:

I accept the 2018 Jonathan Howes Lifetime Achievement Award of the UNC Retired Faculty Association with a sense of the great honor that is conferred and an equal feeling of humility when I reflect on the eminence of the recipients who have preceded me. However, the accomplishments for which the award is given to me are not mine alone, but reflect the efforts of the entire faculty of the Department of Pathology—now the Department of Pathology and Laboratory Medicine—which I had the honor of leading for 26 years.

I am the first member of the medical faculty to receive the Howes Award. I am proud to represent them. It has long been a matter of great pride to the UNC Medical Faculty to be an intimate part of the entire University community in Chapel Hill. Since the UNC medical program was first added in 1879, it has been located in the midst of the campus, including in: Old West prior to 1895, New East from 1895 to 1905, Person Hall from 1905 to 1912, and Caldwell Hall from 1912 to 1939. Caldwell Hall, the first building constructed purposely to house the UNC Medical School, was replaced by MacNider Hall in the pine forest south of the main campus along Columbia Street. MacNider Hall is still a major component of the group of buildings that compose the health sciences complex—Schools of Medicine, Pharmacy, Public Health, and Dentistry, and UNC Hospitals, an architectural assemblage that I suspect some of you believe resembles downtown Cleveland.

Location of the medical school on the UNC campus was so important to the medical faculty that it became an issue in an early attempt to expand the school to 4 years and build a hospital to support clinical study and training in patient care. Other than the cost, the major issue centered on the fact that Chapel Hill was a small, rural village, and there was reasonable doubt that it could supply sufficient patients to maintain a hospital of 300 or 400 beds. At the time, a Charlotte newspaper described the location of a large hospital in Chapel Hill as “virtually an absurdity,” and advocated moving the medical school and hospital to a location with a larger population base. A committee to consider the expansion of the UNC Medical School and construction of a hospital was offered several million dollars in private funds provided the hospital was built in a larger city in North Carolina, and the medical school moved from Chapel Hill to the same city. UNC’s William MacNider, Professor of Pharmacology and later Dean of Medicine, argued persuasively that the enlarged medical school and hospital must be located on the UNC campus. He contended that medical students and faculty members needed to be intimately associated with faculty scholars in the humanities and fundamental sciences, and that this location was more important than the availability of a larger patient base. MacNider’s argument prevailed but the offer of private funding was withdrawn, and, as a consequence, eventual expansion of the medical school and hospital construction was delayed for several score years.

A former Professor and Chair of Pathology, James Bell Bullitt, who held these appointments from 1913 to 1945, made a significant contribution to a non-medical program of UNC. Professor Bullitt was much interested in the prehistory of mankind. During a sabbatical year he spent in Europe in 1928, he studied in museums and at active sites of archeological excavations, rather than at hospitals or medical research institutes which his professorship in pathology might have suggested. While in Europe, he collected archeological specimens that were added to UNC’s archeology museum. At UNC he also organized and led teams of UNC faculty members who excavated ancient sites in North Carolina, one of which is now the North Carolina State Historic Site known as Town Creek. Today cooperative ventures between the medical faculty and faculty in other parts of UNC continue to energize teaching and research across the campus.

What are pathology and laboratory medicine, the medical areas that I represent? Simply put, pathology is the study of disease, of the biological processes that go awry to produce disease; pathology essentially encompasses abnormal biology. Laboratory medicine is the burgeoning branch of medicine that applies and interprets the results of the myriad of analytic laboratory procedures, most now automated and computerized, that are used to diagnose a patient’s illness and guide therapy. Pathology is ancient. Laboratory medicine is brand new.

Next to Anatomy, Pathology is the oldest scientific element of modern medicine, over the past 500 years responsible for studies that led to elucidation of the manifestations of many diseases that affect us. Early pathologists dissected the human body to discover the observable manifestations of disease. One of the first, Giovanni Morgagni described anatomic evidence of disease in 700 deceased patients. He titled his seminal work “The Seats and Causes of Disease Investigated by Anatomy”. Morgagni’s studies were the first tentative step toward modern medicine. His work has been replicated, expanded, and continuously updated by newly available techniques of analysis of organs, tissues, and cells.

Postmortem dissections, usually called autopsies or necropsies, are now largely unnecessary in medical practice except in specific instances. Several technologies now enable diseased organs and tissues of sick individuals to be visualized, sampled, and studied before their death. As a consequence, the use of autopsies has declined dramatically in medical practice; today postmortem dissection is a more essential adjunct to law than to medicine, and most autopsies are now performed in the pursuit of criminal justice. Pathology has long had an experimental focus, which emphasizes the production and analysis of model diseases in laboratory animals, and these studies have replaced the human dissection as the source of new knowledge of disease mechanisms. The latest animal models are of genetic diseases, exemplified by the generation and analysis of selected genetic diseases in transgenic animal models by our own late Professor Oliver Smithies and his wife, Professor Nobuyo Maeda.

Diagnostic pathology, which analyzes structural changes in cells and tissues, continues to be important in the diagnosis of diseases in human patients, often examining tissue samples removed at surgery, or smaller samples of cells removed through needles or shed or scraped from tissue surfaces, the disciplines commonly called surgical pathology and cytopathology. Today anatomic pathology laboratories utilize automated machine methods and computer processing of data. In this way, these laboratories now bear a closer technological similarity to other hospital diagnostic laboratories that apply various laboratory-based analytic technologies to samples of blood or other body fluids. Both areas now use automated machines that generate massive amounts of data that must be manipulated by sophisticated computerized programs. Use of common analytic technologies and similar methods of computerized data management has allowed (actually it has necessitated) the unification of the operation of many separate and more-or-less independent hospital laboratories. Simultaneously, aided by these common technologies, it has become possible to integrate all types of laboratory data from a patient, whatever its laboratory source, into an individualized, patient-centered diagnosis and plan for disease management—personalized medicine if you will. At UNC, all of the laboratories are now unified and coordinated, thanks to the work of my colleague, William W. McLendon, Emeritus Professor of Pathology and Laboratory Medicine, for whom the UNC Hospitals’ diagnostic laboratories are named. Dr. McLendon and I were recruited at the same time as a team. It has been a great pleasure for me to work with him during our time together here.

Evelyn Malone, my late wife, and I were Southerners native to the rolling hills of middle Tennessee, the Highland Rim, on the eastern edge of the Nashville Basin. We loved the region of small farms populated by hard-working men and women, mostly descended from Scotch-Irish immigrants of a few generations earlier. Although racial discrimination was a fact there, it lacked overt racial conflict. We detested the racial turmoil that engulfed much of the South, and we lacked the courage to join the fight to attempt to resolve it. I was a newly minted physician, and we wound up in St. Louis where I had residency training at Washington University and Barnes Hospital. After I served a tour of duty in the Navy, we returned to St. Louis where I joined the faculty of Washington University and the clinical staff of Barnes Hospital. I developed a successful program that combined teaching, research, and diagnostic medicine. I was busy, professionally fulfilled, and content with my career.

However, Evelyn continued to feel that we should return to the South and, at last, take part in needed social change. An opportunity came in 1972 when I was invited to visit UNC and Chapel Hill to discuss my possible candidacy for the Chair of the Department of Pathology, soon to be vacated by the retirement of Professor Kenneth M. Brinkhous. Dean Christopher Fordham ultimately offered me the position, but acceptance of the job was not an easy decision for me to make. Although UNC had then operated a medical school for over 90 years, it lacked a hospital until 1952 and gave instruction in only the first 2 years— the so-called basic sciences—after which students had to transfer to a 4-year school to complete clinical training. Throughout its existence, the medical school was a ‘low budget’ operation; individual departments each had only 2 or 3 faculty members. Professor Brinkhous was appointed in 1945 as the first of a group of anticipated clinical faculty, expected to be necessary to staff a hoped-for hospital and an expanded medical program. He was supported to demonstrate that a viable clinical department could be developed at the small UNC Medical School. Brinkhous built an outstanding pathology department, centered on a research program that investigated the major form of hemophilia, a devastating bleeding disease that had no effective treatment. Although there was no hospital and thus no human patients to study, Brinkhous and his associates found dogs that had a nearly identical bleeding disease, a model of human hemophilia. They discovered its basis—a mutation of a gene located on the X-chromosome that blocked the formation of a protein that was necessary for the blood to clot normally. His research team also isolated this protein from donor blood and devised methods to purify and concentrate it so that it could be used as a readily available and effective therapeutic agent. This was an astounding research feat, which no one could hope to repeat, and for a neophyte like me, who might aspire to succeed Brinkhous, it was a sobering, even strongly negative, factor that tempered enthusiasm for taking on the task of replacing him.

Dean Fordham insisted that renewal and even expansion of departmental research was feasible, and he pointed out other elements of institutional leadership that needed attention. These included improvements in the diagnostic laboratories of the hospital and the augmentation of professional and support staff positions to allow open access to minority groups. A major feature of the medical school at that time was that it was an institution in which white males vastly predominated, including faculty, clinical trainees, and medical students. Only in the relatively small graduate programs and the cadres of secretaries were there many females. For example, among the pathology departmental faculty of over 25 individuals with clinical responsibilities in 1972, only 2 were women and, as I later found, their salaries were a fraction of those paid to men in equivalent positions. Professor Nadia Malouf-Anderson, my long-term colleague, was one of these two women faculty members; she persevered to have a long and distinguished career at UNC. Racial minorities, particularly African Americans, were largely absent, except in the most menial job categories. The multi-campus University of North Carolina system, led by its new president, William Friday, was under federal suit to increase access to positions in the UNC system to minority candidates, especially African Americans, both students and faculty, but also including gender-based minorities as represented by females. Dean Fordham aggressively supported efforts to address issues of minority access in the Medical School, as did his successor, Dean Stuart Bondurant.

I remained unconvinced that I was the right person to take on the changes needed in the UNC Pathology Department. It was my wife who convinced me that we should move to Chapel Hill and join the UNC faculty. She reminded me of our long-deferred goal to return to the South. Convinced by a teacher at George Peabody College, which she had attended, she concluded that Chapel Hill was a location in which we might contribute. Her teacher at Peabody, with the resounding name of Trezevant Payer Yeatman, II, obtained three degrees from UNC, including a PhD in sociology. Yeatman, a direct descendant of James K. Polk, another UNC graduate and former President of the United States, extolled the virtues of UNC, Chapel Hill, and North Carolina to his students at Peabody. Most of his opinions were recapitulated in an article in the New York Times in 1972, which designated Chapel Hill as “the capital of the Southern mind” and praised the role of UNC in renewing the South. The Times article pointed out that Chapel Hill had recently elected an African American mayor and that North Carolina then had a liberal state government, contrasting with most Southern states. (A copy of the Times article was, of course, sent to all of the final candidates for the UNC Pathology Chair.) Evelyn concluded that Chapel Hill was the right Southern location for us and we moved to UNC.

So what did I do at UNC from 1973 to 1999 that merits the award you have given me? Actually, very little except to encourage and support faculty members who were eager to pursue the objective to make all positions in the Department of Pathology open to all qualified persons, irrespective of their race, gender, or national origin, with appointments based only on the candidates’ perceived ability to meet institutional needs and objectives. A corollary was that all comparable positions were to receive equivalent salaries blinded to the gender of the occupant. Faculty positions also carried the opportunity to direct graduate students, to conduct research of one’s choice, and to compete for research funding, with assurance of laboratory space and institutional administrative support. The years of my tenure at UNC were halcyon in terms of research funding for individual scientists. The national funding philosophy at the time emphasized imagination and innovation in research proposals, and favored the view that the individual scientist was most likely to express these qualities. Most of our faculty members obtained independent research support. The federal philosophy of research funding has now shifted to favor multi-investigator groups or centers that usually transcend departmental limits, and often embrace a quasi-political element that impedes innovation. It would be difficult to achieve our goals to diversify the faculty in today’s research funding environment.

I will not bore you with statistical details of the results. Suffice it to relate that the process of recruiting new faculty changed. Open positions were advertised widely and typically received a cosmopolitan response. We appointed many female faculty members, and our graduate and clinical training programs served many African Americans, some of whom stayed on the faculty. Funding of research in the pathology department increased by over five-fold as each faculty member was enabled to seek, and if successful utilize, funds to support their independent programs.

I will close on a lighter note by describing my experiences with Senator Jesse Helms, who often took jibes at UNC and Chapel Hill. Perhaps his most famous mot came when the General Assembly was considering a bill to establish a state-funded zoo. Mr. Helms’ questioned the need to build an expensive facility to house exotic animals when, according to him, a similar objective could be accomplished more cheaply by simply constructing a fence around Chapel Hill. As the Pathology Department became well known in conducting recruitments for open faculty positions, unsuccessful candidates occasionally challenged us on the choices we made. A few unsuccessful candidates threatened to appeal to Senator Helms. In these instances, I would call the Senator to discuss the matter. Mr. Helms always supported our efforts to appoint the most qualified applicant and never interfered. From that experience I concluded that no matter how censorious, our political critics still take pride in the University and its accomplishments.

For me the Howes Lifetime Achievement Award of the Retired Faculty Association is the capstone to my career in academics.

Thank you.