American Society of Hematology

ASH Oral History: Ernest Beutler (1/9)

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ASH provides the following oral history for historical purposes. The opinions expressed by the interviewees are not necessarily those of ASH, nor does ASH endorse or make claim as to the accuracy of any of the information included here. This oral history also is not intended as medical advice; you should always seek advice from a qualified health provider for your individual medical needs.

The following oral history memoir is the result of two tape-recorded interviews with Dr. Ernest Beutler, conducted by Keith Wailoo on November 6 and 7, 1990, in La Jolla, California. Dr. Beutler has reviewed the transcript, and has made corrections and emendations (both in 1991 and again in 2007). The reader should bear in mind that the following oral history is a verbatim transcript of spoken, rather than written, prose.

November 6, 1990

Q: Today's date is November 6, 1990. My name is Keith Wailoo and I will be soon interviewing Dr. Ernest Beutler in Scripps. This is an initial test of the recording system.

Today's date is November 6, 1990. This is a test of the recording system. I'm doing an interview with Dr. Ernest Beutler of the Scripps Clinic and Research Foundation and my name is Keith Wailoo.

I wonder if you can tell us something about your early childhood and early educational experience and how that might have played a role in your selection of scientific fields?

Beutler: I was born in Germany and my parents fled the Nazis with us, my brother and sister and myself. This was in 1935 when I was 7 years old. My parents were both physicians. I was always interested in science and I can't remember that there was ever much question in my mind that I wanted to go into medicine and/or science. That is, after I got over the ambition to be a baseball player. I was an avid fan of the Milwaukee Brewers, and for a while I dreamed that I would be a professional ball player. That went by the boards, probably by the time I was 10 or 11 years old. When I was 15 my parents enrolled me in the University of Chicago 4-year college program, as it was it called. It was a program that was started by Robert Maynard Hutchins. Basically it truncated high school education to two years. The last two years of high school became part of the university education. In that sense the four year college program represented a two year program, but the last two years of high school were really at the university level. One of the many unique things about this program was that it allowed every student to proceed at their own pace. Even at the age of 15, my age when I started that program, I was not required to attend class. As a matter of fact I was not even required to register for a course. I could obtain credit for the course merely by taking the six hour comprehensive examination that was given at the end of that course. I entered the University in 1944 and the United States was still in World War II. Of course at that time no one knew that the war would end within a year or two, so there was some real advantage to accelerating one's education. Accordingly, I registered for several comprehensive examinations in advance and I took more than the usual load of courses. As a result I completed the four year college program and another year or so of credits in a period of two years. By the time I was 17 I was ready to enter medical school.

Q: And you did so?

Beutler: And I did so. Yes, I actually applied to two medical schools. One was Harvard University. The other was University of Chicago. In those days it was very difficult to be admitted to medical school. I might say that it was particularly difficult for Jewish students to get into medical school because most medical schools actually had a Jewish quota. They limited the number of Jewish students that could enter.

The year that I entered the University of Chicago there were 3600 applicants for 60 places. When to my joy I received an acceptance, and was asked to make a decision, I never waited to find out how Harvard would respond. So I entered medical school in 1946. At that time the University of Chicago was really a very outstanding university. It is still an outstanding university, but at the time there was a real uniqueness to the university. There was the four year college program that I've already mentioned. But also it was really a hotbed of scholarship. Enrico Fermi was there, for example, and lectured to the undergraduate students. Under the West stands, which had been used for football games until the University of Chicago found that they no longer could or wanted to compete with the professional type of college football that was being played at that time, the atomic bomb was developed by Fermi and other leading physicists.

Q: Under Stagg Field?

Beutler: In the stands next to Stagg Field. That's right. And so it was a very stimulating environment in which to be. The medical school, too, is quite unique. In the forties most medical schools taught medical students by enlisting the help of the voluntary or clinical faculty and having a few full time faculty members who performed some research and organized the teaching program. The University of Chicago had a full time faculty. It had no clinical faculty except in the departments of obstetrics and gynecology. To the best of my recollection, at the time I was a medical student the University of Chicago had 50 or 60 full time faculty members in the Department of Medicine alone. Some of them very distinguished. And likewise in the Department of Surgery. An extraordinary number of graduates from the University of Chicago continued their careers in full time academic medicine as I have. Statistics that I read some years ago indicated that about 30 percent of them were in academic medicine, which greatly exceeded the number two school, which was Harvard. So my undergraduate training at the University of Chicago, which was extremely strong, and being able to go to a school of medicine with a very academic tradition and academic direction were factors that were very important in my future career.

Q: Were there any particular faculty that you thought at the time to be exemplary of the academic tradition?

Beutler: The one person, perhaps, who influenced me the most there was Leon Jacobson (deceased 1992). Leon Jacobson was the head of the hematology division. He later became chairman of the Department of Medicine and then Dean, and now he is retired, although I still see him from time to time. He was a fine role model. When we think about why somebody chooses a given field, or a given specialty within a field, more often than not, it's the people who are in that field at the place where they are being trained. I'm sure that was true for me at the University of Chicago. I liked hematology. I liked many of the other areas, too. But I was very impressed with the faculty of the hematology division. Not only Leon Jacobson, but also Matthew Block, William Bethard, and this is what motivated me to approach Jacobson and to ask him whether I could become a part of their division. The way that things were done--well, let me back up a little bit to quote from Richard III, "I run before my horse to market". I graduated from medical school in 1950. I was 21 and, as a matter of fact, I was first in my class. But interestingly enough, I was not accepted for the internships for which I applied. I applied at Beth Israel Hospital in Boston, and I was turned down. I applied at Johns Hopkins and I was turned down. I applied for an internship at the University of Michigan and I was turned down for that. But I was offered an internship at the University of Chicago and so I decided that that was the one that I would take.

Q: To what do you attribute that?

Beutler: Of course, I wondered about it at the time and I've wondered about it since. Actually I had personal interviews at each of these places and I think it's possible that the faculty that interviewed me felt that I wasn't sufficiently mature to be a physician. I was only 20 when I was being interviewed. In the case of Hopkins, for example, it was well known that there was a great deal of anti-Semitism and that would be very likely why they might not have considered me very seriously. Obviously, that wouldn't have been true at Beth Israel. But I thought afterwards, as things turned out, maybe they would have been glad to have me as an intern. But I wasn't unhappy with the University of Chicago as a choice. I might say in those days they had some kind of matching plan, so it was a matter of my not matching in the upper part of the offers that they were making. Maybe I was an alternate at one or another of those institutions, but I was not offered a slot and I was offered a definite slot at the University of Chicago. There were several different kinds of internships in those days and I took what was known as a mixed internship, which meant that I took six months of medicine, four months of surgery, and two months of obstetrics and gynecology. Nowadays, the trend is to have straight internships in which physicians who wish to become internists take just twelve months of medicine, surgeons take twelve months of surgery, and so forth. I think that's a mistake. After all, if the training program in internal medicine is to be four years, then I think having three and a half years of internal medicine and four months of surgery and two months of obstetrics and gynecology is really a pretty good mix. Much better than having no obstetrics and gynecology, no surgery. I believe that those experiences in surgery and obstetrics and gynecology are invaluable. The second year, that is the first year of residency, was a rotation through the in-patient services. Two months in each service. And I had two months of hematology, which I think was the first service I had, two months of gastroenterology, and so forth.

Q: Was that required for all residents?

Beutler: I'm not sure whether all residents rotated through all of the same services. I think that one could take six services, and there may have been eight so there may have been some who didn't get one or the other. But residents got most of the services. The following year, the second and third year of residency, were set up in such a way that one was attached to one or another division. And so it was at that point that it was appropriate for me to make a definitive choice about to what division was I going to be attached. Would I be attached to rheumatology, gastroenterology --? That's when my respect for the physicians in hematology motivated me to approach Leon Jacobson and ask him whether I could be in the hematology division. And he asked me only two questions. He said, "First of all, are you in trouble with anybody in the department?" I said, "No." And then he said, "Do you get along well with everybody in hematology?" I said, "Yes, I do." And the second question is the one that really stuck with me because, I think that Jacobson-really appreciated how important it was for people in unit to get along well with each other. I've always felt that I would much rather forego having a some very talented person in my unit if they were always at odds with others, than to have such a person and put up with squabbling.

Q: What was the structure of the hematology unit back then?

Beutler: There was the head of the unit: that was Leon Jacobson. Then there were two other faculty members. One was Matthew Block and the other was Bill Bethard.

Q: B-l-o-c-k?

Beutler: B-l-o-c-k. Matthew Block died about two or three years ago. He had moved on to the University to Colorado in the late fifties. He spent the remainder of his career there. And Bill Bethard (deceased 1997) actually moved to the Scripps clinic in about 1956. He remained at the Scripps Clinic for a few years and then worked with General Atomics in La Jolla and also was a consultant with the Salk Institute and in private practice. He retired about a year or two ago, and I still see him sometimes in La Jolla. Then there were residents who had, like myself, attached themselves to the department. One of them was Irwin Weinstein (deceased 2002) who later moved to UCLA and was probably the most prominent clinical hematologist in the Los Angeles area. My contemporary during the residence was Herman Klein who moved into practice in the Detroit area. The way that the division functioned is that, everyone had laboratory space and a research program, and the responsibility for the clinical service was rotated among the faculty. The residents would join rounds and listen to what was being said and participate in the discussions, but the primary responsibility would be with one of the faculty. They would make rounds with the students three mornings a week and the students would present new cases, and this would be a teaching exercise. The rounds were two or three hours in duration. An out-patient clinic operated every afternoon. I can't remember exactly how it was scheduled, but one would see patients there, again usually together with the students.

Q: It was a relatively small group?

Beutler: It was a small group. It was very small group. At that time there were perhaps two or three large hematology groups in the nation. The largest were probably William Dameshek's in Boston, Max Wintrobe's in Salt Lake, and Carl Moore's in St. Louis. Those departments turned out a great many hematologists, most of whom ended up in clinical practice, and a few of whom are prominent in hematology today. But Jacobson's program was a very small one. There were just a handful.

Q: Do you think there was a special value in the size of the department?

Beutler: Yes. Very much so. And as a matter of fact -- I find that in many ways that I've emulated what Jacobson has done and many of my attitudes about research and about organization, I can attribute to his philosophy. In fact, Jacobson was a very successful investigator. Very low key. Difficult to understand when he spoke. Not very articulate. But he made several important discoveries. His discoveries led to the whole area of bone marrow transplantation and he is the one who discovered that erythropoietin is made by the kidney. He was elected to the National Academy of Sciences, became chairman of his department and the dean. He was a very successful man. It was evident to me from the beginning that his philosophy was that you try to get good people, that you give them independence, and that if you charge them with some responsibility you don't second guess them, but just give them backing. And that you don't take a ride on other people's work. Those are all very important principles, and ones that I hope I've followed in my career. He also was not one of these people who built big collaborative teams, or joint projects -- something that has become very popular in science -- which I find to be very unproductive and unstimulating and the wrong way to do science.

Q: Why specifically?

Beutler: I would say that the bottom line is that it really doesn't work very well. The philosophy is that science is so complicated that you really can't do everything yourself, and so what you have to do is find a collaborator. If you want to do molecular biology, you find a molecular biologist and you send the material to him or her. If you want to do protein chemistry you send the samples to a protein chemist. I've seen some people who really don't do anything themselves, but just send samples to other people. Superficially this may seem like a good way to do science, but the problem is that if the molecular biologist is a good molecular biologist, he or she really wants to work on his or her own problem and your problem gets a very low priority. Moreover, there are nuances of the problem that he or she may not understand. Or there may be things that the molecular biologist observes that would be very important if somebody who understood the whole problem observed it. So I think that the best research is not done by networks of collaborators, but by an individual investigator with a small, dedicated, loyal team. Jake had -- that's what Jacobson's nickname was -- Jake had two technicians who had been with him forever, and this was, mind you, 40 years ago. Actually, when he came to The Academy meetings about two or three years ago he had one of those technicians with him as his guest. They had probably worked with him for a span of over 30 years. I have with me two technicians who have been with me for 22 years each and three technicians who have been with me over 10 years. That's the core of my research team. I have fellows. They contribute, of course, but they are there to learn more than to add productivity to the research program. When I decided 10 or 12 years ago that it was really for us to master the techniques of molecular biology to answer some of the questions that we hadn't been able to answer earlier, my approach was to bring molecular biology into our laboratory so that we would have the skills ourselves. As a result we now have a very strong molecular biology laboratory. The way that I accomplished this was first of all, to send one of my long term technicians to work with a colleague for a week to acquire some of the technology we wanted to learn then. Two years later I brought into my laboratory a very good young MD molecular biologist, Joseph Sorge, who worked with me for two or three years, and who taught all the people in my laboratory how to perform the techniques of molecular biology.

I myself performed hands on research until about 15 years ago or so. But I do relatively little now. Occasionally I will tilt a test tube or spot something on a piece of paper. Nonetheless, I'm very close to the laboratory. It's right out here as you saw, and I oversee everything that's being done. In my view that is the correct and productive way to do research. I believe, too, that there are some enormous benefits from having relied heavily on technical assistants as I do. One is that I can afford to take a chance on a project which may not pay off at all. One can't in good conscience do that with a postdoctoral fellow. The fellow's career is on the line. I have a responsibility for that career. If I give that fellow a "pie in the sky by-and-by" kind of project, and nothing comes of it, then he or she isn't going to be able to get a good post afterwards, because they won't have any publications. But if I want one of my technicians to perform a chancy project and that technician doesn't publish anything for 2 or 3 years, that doesn't really matter, you see. And there is the matter of continuity. I sent Wanda Kuhl, who's been with me for 22 years, to work with Y.W. Kan in his lab for week about 10 years ago. Subsequently she learned how to perform some of the other techniques from Joe Sorge. She's still here. If this knowledge was being passed on from fellow to fellow there would be a great deal lost. At the same time one has to realize that if one wants to have a long term impact on science, that one also has to train people, and for that reason I do have fellows in the laboratory. But I believe that it's important to realize that the fellows are young scientists who are in the laboratory to be trained, not people to be exploited so that I can write more papers. Of the publications that emanate from this laboratory about 80 percent really come from the work of myself and my technicians, and not from the fellows. The fellows contribute some work, too, but the core of the work at this laboratory is performed by technicians. That's very unusual in the United States these days, and even more unusual in Europe.

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