Back on Cedar Street, 600 celebrate
John Peters, the Yale System and reunions

By John Curtis

More than 400 medical alumni and friends and close to 200 public health alumni gathered in New Haven June 5 and 6 for a reunion weekend that featured a New England clambake, the roasting of retiring public health professor Lowell Levin, D.Ed., and a symposium on John P. Peters, M.D., a legendary Yale professor accused of disloyalty in the McCarthy era.

Alumni began trickling into the school Friday, June 5, for a series of lectures sponsored by the Yale Surgical Society in the Hope Building. Alumni also toured the historical library and Yale-New Haven Hospital. AYAM President Nicholas M. Passarelli, M.D. ’59, opened the weekend with welcoming remarks in the Hope Building. Robert H. Gifford, M.D., deputy dean for education, made a presentation on The Yale System, Its Evolution,
Its Strengths and Problems.

At a symposium Saturday morning, speakers described the life and achievements of Dr. Peters, known for his pioneering work in metabolism and his fight to clear his name during the McCarthy era, when his loyalty was questioned by a review board.

Before a buffet luncheon in Harkness Hall, alumni attended presentations on research at Yale by three professors who discussed new lines of inquiry in hypertension, women’s health and molecular psychiatry.

Symposium honors a hero of metabolism research who fell victim to McCarthy

At a symposium on John P. Peters, M.D., speakers paid tribute to one of the nation’s leading experts in metabolism who stood up to McCarthyism in the 1950s.

A nephrologist who taught at Yale from 1922 until his death in 1955, Dr. Peters came to national attention in the 1930s as secretary of the Committee of 430 Physicians, a group that advocated reforms that have become standard features of modern medicine. They believed that the health of the public should be a concern of government and that government should be involved in providing medical care. During the McCarthy era, Dr. Peters’ views and his signature on open letters espousing liberal causes surfaced as evidence of his alleged disloyalty to the United States. Although loyalty boards twice dismissed the case against him, a third board found his loyalty questionable and he was removed as a member of a study section of the Division of Research Grants and Fellowships of the National Institutes of Health.

Dr. Peters was distinguished by his persistent efforts to apply scientific advances to the treatment of patients. “At the same time this was incorporated in a context of moral dignity so that the application of science to the patient was associated with kindness, with a great deal of concern and followup,” said Donald W. Seldin, M.D. ’43, Professor Emeritus of Internal Medicine at the University of Texas Southwest Medical Center, in his talk, Reflections of a Student of Peters. “The plain fact of the matter is that he was a courageous man and a morally dignified man. He did for the profession what the profession needs, self-criticism, self-policing. Now, hopefully, Dr. Peters’ vision of medicine available to all the people and at high quality will be reinstituted.”

The discussion ranged from his medical contributions to his legal and moral battles. Catherine G. Roraback, LL.B. ’48, a Yale-educated attorney who represented dissenters in the 1950s, noted that Dr. Peters became a target of loyalty boards not because he broke a law, but because he exercised his right of free speech and association. George D. Lundberg, M.D., editor-in-chief of the Journal of the American Medical Association, traced the longstanding acrimony between the Committee of 430 Physicians and the AMA, which vehemently opposed the reforms the committee proposed. Many of those reforms, he said, are now integral pieces of medical practice in this country, such as federal support of medicine and programs such as Medicaid and Medicare.

Richard M. Peters, M.D. ’45, one of Dr. Peters’ sons, described how the loyalty hearings absorbed his father’s final years and, his family believes, shortened his life. Close to a dozen family members traveled to New Haven including Dr. Peters’ granddaughter, Barbara Ann Peters, M.D. ’79.

Franklin H. Epstein, M.D. ’47, professor of medicine at Harvard Medical School and Beth Israel Hospital, cited Dr. Peters’ contributions to the study of renal disease, noting that Dr. Peters was interested in the chemical derangements of disease. “It was the measurement of the chemical constituents of body fluids that provided the first of three solid foundation blocks, the cornerstones of Peters’ approach,” Dr. Epstein said. “He understood and appreciated the importance of accurate, impeccable measurement.”

Dr. Peters’ most enduring technical achievement was the introduction into the clinic of the flame photometer, which made possible within minutes accurate measurements of sodium and potassium in serum or urine samples. He used those measurements, an exacting analysis of diet, urine and feces, to treat his patients. Colleagues and students marveled at his ability to take the raw data and synthesize it into a logical framework. “His associates might experiment on animals, but he preferred to concentrate on examining disordered physiology at the bedside with accurate chemical techniques and the power of logical inference,” said Dr. Epstein.

According to Phillip Gorden, M.D., HS ’61-66, the director of the National Institute of Diabetes and Digestive and Kidney Diseases, Dr. Peters’ studies of body water, electrolytes, and acid-base balance were extremely important in the management of patients with diabetes mellitus.

Yale System thriving, says new deputy dean

Although it is alternately misunderstood, revered, tolerated and adored, the Yale System is alive and well, Robert H. Gifford, M.D., deputy dean for education, told alumni gathered in the Hope Building during reunion weekend. Dr. Gifford noted that “the wheel has simply come ’round again” and cited F.P. Underhill, who chaired the school’s curriculum committee in 1922. “The student,” Dr. Underhill complained at the time, “has become the defenseless recipient of an overwhelming mass of facts.”

Reaffirming the goals of Milton C. Winternitz, M.D., who served as dean of the medical school from 1920 to 1935, Dr. Gifford said, “Memorization of a ‘mass of facts’ was far less important than a well-rounded education in fundamental principles, training in methods of investigation and acquisition of the scientific habit of mind.” Burdening the students with a heavy curriculum discourages independence and initiative and leaves little time for electives, independent thought or reading in the library, Dr. Gifford said.

Underlying the Yale System is the presumption that graduate students are mature individuals with a strong motivation to learn. As a result, attendance is not taken at lectures, small group teaching is emphasized and there are no grades or class rankings. Although examinations remain anonymous, a qualifying exam must be passed in every course and all students must write a thesis based on original research in order to graduate. According to Dr. Gifford, the school still adheres to these principles, but the number of lectures has gradually increased. And honor societies such as Alpha Omega Alpha, which recognizes only the top students in each class, have somewhat undermined the Yale System’s traditional opposition to class rankings, he said.

The freedom accorded to students brings with it a responsibility that is at times ignored, Dr. Gifford said. He took students to task for what he described as a “cavalier” attitude towards small group seminars which depend on student to student interaction. Attendance, he said, tends to drop, particularly around the time of the second year show in February and national board
examinations in the spring.

While most of the faculty support the system, he said, a minority “look at it with some derision as a way for students to slip by without academic rigor, to be self-indulgent, spoiled, entitled to do anything they want.”

Dr. Gifford also took on the issue of payment of faculty who assume major teaching burdens. Most faculty, those who give lectures or moderate seminars, receive no remuneration, and that is appropriate. “But asking someone to be a course coordinator, to organize a new course, to chair a curriculum committee, to organize and run a new course is a very different matter,” Dr. Gifford said, “and, in my judgment, should be accompanied by partial salary support.” He proposed enlarging an educational fund so that those who shoulder unusual time commitments to teaching can receive a portion of their salary for their efforts.

Noting the curriculum requires attendance at too many lectures, Dr. Gifford called for more case-based conferences as an alternative.

At EPH reunion, a global perspective

Public health has become a global affair, John Ashton, M.D., told alumni of Epidemiology and Public Health who gathered for their annual reunion on June 5. Today’s pressing issues—HIV and AIDS, drugs, food technology, genetic engineering—know no boundaries, said Dr. Ashton, the keynote speaker for the reunion. Although he is regional director of public health in Liverpool, England, Dr. Ashton said he felt like a “virtual alumnus” of Yale, because of his work over the past decade with Lowell Levin, M.P.H., ’60, D.Ed., who retired this year.

Dr. Ashton made his reference to Dr. Levin during his talk, Health Threats to Urban Life; Is It Too Late to Save Our Children? “We need a public health response which is a global public health response,” Dr. Ashton said, contrasting the present with the past. “The cities of 150 years ago could quite happily think of themselves as self-contained. We are now at the point where the majority of the world’s people will be living in large cities and towns. Most babies are being born into large towns and cities for the first time.” Increased speed of travel and the increased urbanization of the planet often divorce health issues from their local origins and deny public health workers local solutions, he said.

He noted a danger in the concentration in cities of large numbers of young men with no stake in their communities. “The events in Jakarta over the last two weeks are the tip of an iceberg which we have yet to see,” he said, referring to riots in Indonesia in May. “Is it too late to save the cities? In many ways that is the wrong question. The fate of our cities is indivisible from the fate of the planet.”

Many of those at the reunion had come to bid farewell to Dr. Levin, who started teaching public health at Yale in 1963 and plans to continue teaching part-time in his retirement.

“It’s unfortunate that it takes Lowell threatening to leave that brings us all together,” Dean Michael H. Merson, M.D., joked before turning reflective. “We would never want Lowell to leave us. He will be a major part of our school for many years, even though he claims to be retiring.”

Friends and colleagues took turns telling tales about Dr. Levin at a Friday evening roast under a tent on the lawn in front of the EPH building. Dr. Merson described Dr. Levin’s unorthodox approach to founding the school’s international division. “There is no record of this division ever being created,” the dean joked, noting that he can find no memos, no paperwork, nothing to trace the division’s history. Mr. Levin simply created it, he said. “Lowell just took advantage of people being out of town and on sabbatical.”

About 200 people came to the roast and reunion. “Maybe this time you’ve come to see if he’s really going to do what he keeps threatening to do—say bye-bye to Yale,” Joel Kavet, M.P.H. ’67, master of ceremonies, told the crowd. “We risk the prospect of turning Lowell Levin loose on an unsuspecting world.”

Friday morning, alumni attended a series of seminars on a variety of public health issues, including HIV/AIDS, urban health, alcohol and asthma. In the afternoon, alumni panels described their experiences and discussed the relevance of programs to public health practice.

For many alumni, the reunion was more than a coming together of former classmates—many had crossed paths in their professional lives. “It’s striking,” said David A. Kessler, M.D., dean of the medical school, at a Friday afternoon luncheon for EPH alumni. “There are so many of you that I know and have grown up with.”

Dr. Kessler singled out one alumnus who served as his mentor in Washington in the 1980s: Samuel P. Korper, MPH ’69, Ph.D. ’76, was honored as this year’s distinguished alumnus. “I decided, on a volunteer basis,” Dr. Kessler recalled, “to spend some time on the Hill. I walked in in 1981 and I knew nothing. I had no idea of how that town worked.” Working as an unpaid aide to the Senate’s labor and human resources committee, Dr. Kessler was assigned to reauthorize three programs. “I had no idea what to do. It was at that time I was fortunate enough to meet Sam.” Dr. Kessler, of course, went on to become commissioner of the Food and Drug Administration. “I could not have been in a position to contribute and function in that town had I not been trained by Sam Korper. He has shown throughout his career such tremendous dedication to improving the health of our country.”

Dr. Korper started his career as a Peace Corps volunteer in Nyasaland in central Africa. By the time he and Dr. Kessler met, Dr. Korper had been in Washington for about three years. Dr. Korper worked at the Department of Health and Human Services and the National Institutes of Health, where he was director of the division of legislative analysis. He now serves as senior advisor to the Substance Abuse and Mental Health Services Administration.

In his talk to alumni, Dr. Korper offered a mixed view of the state of public health in this country. Too few graduates are seeking long-term careers in the public health, he lamented. On the other hand, he added, “the opportunities in public health, in both the public and private sectors, from the molecular to the global, are truly breathtaking.”

The ethos of public health, he noted, includes public service, usefulness and altruism. It is, he said, “a profession that has an incredible array of critically important responsibilities.”

Yale scientists offer glimpse of cutting edge research

“We are in the midst of one of the great revolutions in the history of medicine,” Richard P. Lifton, M.D., Ph.D., told medical school alumni during the reunion weekend, referring to progress in charting the human genome.

Dr. Lifton, professor of medicine, genetics and molecular biophysics and biochemistry, was one of three faculty researchers who highlighted their work to alumni. Joining him were Carolyn Mazure, Ph.D., professor of psychiatry and director of the Donaghue Women’s Health Investigator Program at Yale; and Eric J. Nestler, M.D., Ph.D., director of the molecular psychiatry program. Dr. Nestler studies genetic and
biomedical links to addiction.

Dr. Lifton searches for genetic causes of diseases such as hypertension. Underlying the medical revolution he described are tools that include genetic maps of human chromosomes and the development of complete physical maps of the genome.

“With these tools we can begin to unravel the source of those diseases,” Dr. Lifton said. “Ultimately it gives us some insight to develop new strategies to treat those disorders.” He cited a family in which high blood pressure was identified in 23 members and was subsequently linked to a single gene, one of 10 genes he and members of his team have isolated that regulate blood pressure. After more than five years of exciting progress in this work, his lab is poised to apply the knowledge to more common forms of the disease affecting at least 50 million people in this country alone. “We can offer them specific treatment tailored to the genetic abnormality,” Dr. Lifton said. “This has really accelerated the pace of biomedical research. We can apply those tools coming out of the Human Genome Project to the investigation of disorders such as hypertension.”

Women, noted Dr. Mazure, live about six years longer than men on average but spend more time in the hospital. “We do need to know more about how to keep women healthy,” she said. “We need more data for understanding and treating the disorders which women present.”

Although federal regulations require the inclusion of women in federally-funded research projects, that was not always the case. “The assumption frequently was made that treatment and procedures which were developed for men also worked for women,” said Dr. Mazure. “We now have a growing body of significant data to cause us to revisit those assumptions.”

Dr. Nestler’s laboratory, in a study of gene expression using transgenic mice, has found that turning on certain genes recreates biochemical and behavioral changes characteristic of addiction. Dr. Nestler is trying to understand lasting effects of addiction on the brain. Scientists believe these changes are regulated by gene expression in neurons in areas of the brain known as the mesolimbic dopamine system.

“We can examine an animal,” said Dr. Nestler, “study molecular changes in specific brain regions, demonstrate that those changes are important for the behavior of addiction in our animal models, and then use that information to come up with ways to perturb that system in people.” This information is critical to the understanding of relapse and recurring addictive behavior, and may very likely provide the basis for new treatments for addiction in the next five to 10 years.