John W. Adamson, MD, and Janis L. Abkowitz, MD
Clement A. Finch, MD, eighth president of the American Society of Hematology, died on June 28, 2010, just six days shy of his 95th birthday. Clem, as he was known, was the first head of the Division of Hematology and one of the founding professors of medicine at the University of Washington, joining Bob Williams, Belding Scribner, and others in building a preeminent research university.
Clem remained at the University of Washington for his entire career and over that time established what was then the strongest laboratory for the study of iron biology in the world. His interest in iron was originally sparked by Joseph Ross, a nuclear medicine physician with whom Clem worked for a year after completing his clinical training. Clem recognized the value of being able to work with radioactively labeled iron to quantify iron absorption and excretion and to define the mechanisms of iron trafficking and storage. His work led to the ability to measure iron turnover (ferrokinetics) and to use quantitative measurements to classify anemias. In fact, the Seattle classification of anemia, including concepts such as effective versus ineffective red cell production, continues to this day.
Clem was an astute clinical and physiological observer who established principles that only later were explained at the molecular level. He recognized that, with inflammation, iron was retained by macrophages, leading to what he called “iron-restricted” erythropoiesis. We now know that the molecule responsible for the phenomenon is hepcidin. He also defined the functional defect in hereditary hemochromatosis — the inability to down-regulate iron absorption and iron release from macrophages — leading to the gradual accumulation of iron in the body. He realized that simple phlebotomy was an effective form of treatment for the disease. His experimental studies quantitating iron absorption demonstrated that iron-deficient individuals increased iron uptake from the diet, while patients who had iron overload from repeated blood transfusions decreased their iron absorption. This principle became known as the “stores regulator” of iron absorption. Paradoxically, patients who had chronically ineffective red cell production also had increased iron absorption, despite normal or increased body iron. This mechanism became known as the “erythropoietic regulator” of iron absorption, the one concept that is not yet fully explained at the molecular level.
While his contributions to iron biology are his most recognizable work, Clem also made major contributions to blood banking. In fact, as chief resident, he was head of the Peter Bent Brigham Hospital’s blood bank and transfusion service. This interest carried over to his early days in Seattle, where he worked with Ernie Simon and Beverly Gabrio to improve storage solutions to preserve the function of red cells in storage.
While a consummate scientist, Clem was, first and foremost, a teacher and mentor. His work led to three teaching manuals, all based on similar principles of classifying disorders on the basis of insights learned from studying red blood cell production. Red Cell Manual, which Clem co-authored with Robert Hillman, was the prototype and was used as a tool for teaching hematology to medical students and house staff. This inspired The White Cell Manual and Manual of Hemostasis and Thrombosis, which were written by those working closely with Clem in Seattle.
Altogether, more than 150 physicians or basic scientists trained with Clem in Seattle, many coming from other countries to spend time working on iron metabolism. Trainees remember Clem’s humanity, humility, and perceptiveness. Many of those individuals have gone on to make major contributions of their own. But, there was no one quite like Clem. He was, literally and figuratively, a giant in his field — towering above almost everyone else in height as well as in intellect. Those of us who had the privilege of knowing and working with Clem were forever changed. And, we are forever grateful to have had the opportunity.
The family suggests memorial gifts be sent to the Clement A. Finch Professorship of Medicine at the University of Washington. Alternatively, donations can be sent to ASH to recognize Clem’s service to the Society and contribution to the discipline of hematology.
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