65 years out of Yale and still practicing

History taking and the physical exam remain at the heart of pediatrician Richard Dormont’s practice.

In Minot, N.D. (population 36,567), the local tourism board had to make up a slogan to help outsiders remember the place’s name. (Why not Minot? rhymes when pronounced correctly.) Yet the small north-central North Dakota town draws families from large cities in surrounding states and Canada who come seeking medical help for children with hard-to-diagnose diseases. They come to consult pediatrician Richard E. Dormont, M.D. ’40. Still in practice at the age of 89, Dormont enjoys a reputation as a brilliant diagnostician as well as a dedicated doctor available to patients at all hours. For several years, he has had a reduced patient load and shorter office hours, which allows more time for bird-watching and for visiting his four daughters. But retirement is not on his radar.

“I like keeping busy and using my skills,” Dormont said, 65 years after earning his medical degree.

A voracious reader of journals and a regular at medical conferences, Dormont is scrupulous about keeping up with new science. But he believes passionately that the tools he relied on in the early days of his practice—history taking and physical examination—remain the bedrock of medicine. Recently a couple raised in Minot brought their 19-month-old child home to consult Dormont after several physicians were puzzled by the child’s breathing problems. He made the potentially lifesaving diagnosis of congenital heart disease with equipment no more high-tech than a stethoscope and his own ears. The other doctors, Dormont said, had focused on breathing problems and examined the lungs rather than the heart. In addition, he said, physicians nowadays too often fail to perform a thorough physical exam.

Minot parents keep bringing him their newborns for routine care. “Every time someone has a new addition, they say, ‘Now you can’t retire until so-and-so’s 18!’,” said Leann Hayton, L.P.N.

Hayton met Dormont in 1968 when she came to work in pediatrics at Trinity Hospital in Minot. At first, Dormont’s “encyclopedic” knowledge was intimidating, but he quickly put her at ease. “Dr. Dormont is a wonderful and patient teacher,” she said. “I learned more listening to and working with him than I could have in any amount of schooling.”

Ruth Ann Rexine, R.N., also came to know Dormont through hospital pediatrics. She remembers his routine of making rounds before 7 a.m. (after breakfasting over medical journals), spending the day in his office, then doing rounds again at 5 p.m. If a child’s condition worsened, day or night, Dormont would be at the hospital in minutes. “Always in a suit and bow tie,” Rexine remembered.

She chose Dormont for her own children because of his legendary thoroughness, his custom of answering parents’ questions by phone every morning from 8:30 to 9 a.m. and for the way he could put children at ease.

Dormont had initially planned to pursue a career in internal medicine. But when he lost the residency he wanted, his pediatrics professor came to the rescue with a job in the pediatric outpatient department at Johns Hopkins Hospital. He saw diseases that have disappeared or are a rarity—polio, measles, mumps—and each of the 55 patients he saw every day got a physical examination. “It can be done,” Dormont said.

After Johns Hopkins, Dormont taught at Louisiana State University for two years, but decided academic medicine was not for him. “You have to be a politician,” he said. “I’m the world’s worst politician.”

Dormont served in the South Pacific during World War II and also practiced briefly in Texas. In 1953 he came to Minot, drawn by the chance to work in a group clinic. “That was almost considered communist on the East Coast,” he remembered.

But the practice suited him because it provided him with his own lab, was connected to a hospital and, most importantly, allowed him his own medical library.

Dormont has spent the later years of his career in solo practice. “That can be dangerous,” said James Moller, M.D., a University of Minnesota pediatric cardiologist who regularly comes to Minot for consultations. But, said Moller, Dormont is so intellectually rigorous that he challenges himself the way a good partner would. “He is always questioning, looking up things, studying,” Moller said.

Known universally as “Dr. Dormont,” he has cared for most of his community at one time or another.

“Whenever I’m birding, someone will stop and say hello. Usually it’s one of my patients,” Dormont said.

He estimates that he’s seen several hundred thousand patients during his career. As long as they keep seeking him out, he said, his practice will stay open.

—Colleen Shaddox

Familiar Faces

FDA’s top safety critic keeps a watchful eye on the public good

Whenever David J. Graham, M.D., M.P.H., HS ’81, wonders whether he made the right career move from Yale-New Haven Hospital resident to resident critic of the Food and Drug Administration (FDA), he recalls with remorse a patient who died under his care.

At the time, 1979-1981, he was doing a residency in internal medicine at Yale after graduating from the Johns Hopkins School of Medicine and planning to become an expert on viral infections of the central nervous system. But the patient died of an unexpected adverse drug reaction, and even though Graham was not at fault, “I was the person who had prescribed the drug,” Graham says. The incident “contributed to my interest in studying drug safety.”

He also discovered during his time at Yale that he “didn’t enjoy the day-to-day grind of patient care,” so he settled on epidemiology. Since then, he has had a 20-year career as an epidemiologist at the FDA, forgoing more lucrative offers in the private sector. He is now associate director for science and medicine in the agency’s Office of Drug Safety. Despite (and because of) that title, he has also become the FDA’s most vocal and listened-to critic.

For years, Graham, 51, has been the FDA’s equivalent of an ingrown toenail, causing his employer pain as he went public with allegations that the agency was allowing prescription drugs it approved to stay on the market despite evidence from its own researchers that the medications were harming and killing people by the thousands.

In Graham’s view, the drug safety problems began in 1992 with the passage of a law aimed at getting lifesaving drugs onto the market faster. To speed up approvals, the law forced pharmaceutical companies to foot most of the bill for the review process. That left the FDA “captured by industry,” says Graham. “He who pays the piper calls the tune.” In the meantime, the same officials who approved the drugs were being asked to monitor their safety after they’d hit the market. If there’s evidence of harm, “now they’ve got to do an about-face,” he says. “At its heart, that is an inherent structural conflict of interest.”

Graham said a former boss told him that the drug industry was the FDA’s client, but Graham, an assistant scoutmaster and devout Catholic with six children, didn’t buy it. If he sees that a drug may be harmful, he’ll investigate. If the evidence warrants it, he’ll challenge the FDA’s regulatory position internally, even if it earns him the enmity of his superiors, which it often has. The FDA labeled one of his studies “junk science,” and forbade him to publish it in a major medical journal. (Six weeks later the FDA changed its mind and the article was published, last February, in The Lancet.)

Graham has called for the withdrawal of a dozen prescription drugs, and almost all of them have since been removed from the market—often after a fight with his superiors—in some cases by the drugmakers themselves. One case made Graham a star witness before the United States Senate’s finance committee in 2004, when Merck & Co. suddenly removed Vioxx, its popular painkiller, after the company’s studies showed a higher risk of heart attacks and strokes among users of the drug. Graham had been warning about Vioxx for years, but the FDA refused to pull the drug on his recommendations. He testified that the agency also urged him to change the conclusions of another damning study about Vioxx just before Merck’s surprising announcement. The voluntary withdrawal placed the agency in an unwelcome spotlight over its alleged failures to protect Americans against unsafe drugs. Meanwhile, Graham sought whistleblower status, and telephone calls disparaging him to the Government Accountability Project, a nonprofit that protects maverick insiders, were traced back to the FDA. (FDA officials say they allow employees to speak their minds, and couldn’t explain the incident.)

“The FDA has let the American people down and, sadly, betrayed a public trust,” Graham told the Senate committee.

“I think I’ve had a substantial impact, as much as FDA officialdom wants to bad-mouth me,” he says. “I point to the evidence and I say, ‘Look, I’m almost always right.’ I don’t recklessly recommend the withdrawal of drugs.”

He says he hopes to finish his career at the agency, even if more difficulty lies ahead. He has two suggestions for improving drug safety. First, the government should create a drug safety center parallel to the FDA’s drug approval center. The new center would oversee postmarketing regulation and would be able to call on the FDA commissioner to pull a drug it deems unsafe. Second, this center should be provided with enough money to do its job. (A bipartisan Senate bill co-sponsored by Democrat Christopher J. Dodd of Connecticut and Republican Charles E. Grassley of Iowa would do just that.)

“I feel fairly certain that I’ve probably saved more lives taking the career path I have taken than I would have with another career path,” Graham says. “That’s something that colleagues both within government and in academia remind me of periodically when I tell them of my tales of woe at the FDA—they remind me that I’m doing good.”

—John Dillon

With an interest in the past, admissions dean doubles as a chronicler of local lore

Two years after receiving his medical degree, Thomas L. Lentz, M.D. ’64, made the decision, along with his wife, Judith, to leave New Haven and move to the country. They found a pre-Revolutionary War house in Killing-worth, Conn., about 40 minutes from Lentz’s job as an instructor in anatomy at the School of Medicine. (When the medical school offered him a position he decided not to pursue a residency.)

Soon everything started growing: the Lentz family, the size of their new home, the Ohio native’s involvement in his adopted community and his role at the School of Medicine, where he is now associate dean for admissions and financial aid and professor of cell biology.

On moving day the Killingworth house was “livable,” but needy. “There was a lot of work to do,” said Lentz. “It never ends.” He painstakingly restored an antique barn that was reduced to its stone foundation. He and his wife bought surrounding parcels as they became available. Today their place in the country is an 80-acre spread that requires a great deal of landscaping work, though the five sheep they raise for wool keep the grass trimmed.

Restoring a 1759 house piqued Lentz’s interest in Killingworth history. He was a founding member of the historical society and serves as historian of the Congregational Church in Killingworth. (He also is a member of the town’s land trust and an elected member of the planning and zoning commission.) In 1976 when the historical society was raising funds to restore a 19th-century schoolhouse, Lentz assembled a pamphlet of old photographs from the town that sold for $5. This year a copy sold on eBay for $180. Clearly, there is a market for vintage Killingworth images. So in another attempt to enrich the historical society, Lentz wrote A Photographic History of Killingworth, a much more ambitious project. The softcover book features more than 200 photographs along with his narrative.

Lentz said that he wrote the book “in his spare time,” a curious choice of words for a man with teaching responsibilities, his own research interests and a passionate commitment to selecting applicants who will be not only exceptional physicians, but also leaders in their profession. “It never gets old and stale, because there’s always something new,” Lentz said of his interactions with students and applicants. “These kids are doing such amazing things that it’s really exciting to talk with them. I wish I could take them all.”

The typical applicant has changed since Lentz began serving on the admissions committee in 1968. Today many arrive at the medical school with postcollege experience working in health care as well as authorship of one or more scientific articles. Lentz wondered whether the medical school would accept him today.

“We went to college, we majored in biology, maybe we belonged to the premed club. We worked summers as an orderly in a hospital. We might have worked a semester in the lab,” Lentz said.

Lentz is particularly suited to admissions as “one of the staunchest sup-porters of the Yale System,” said James D. Jamieson, M.D., Ph.D., professor and past chair of cell biology. “It’s been a joy to work with him, because I’ve learned so much from him.”

Jamieson is impressed with Lentz’s low-key style in the lab and classroom. With some students coming from humanities backgrounds, Lentz’s thorough, methodical teaching of histology leaves each student excellently prepared, said Jamieson. Lentz fine-tunes lectures he has given literally hundreds of times, added Jamieson, to incorporate new information and increase his effectiveness.

While Lentz’s students still spend time bent over traditional microscopes, his lab also uses a “virtual microscope”—high-resolution scans of slides that students can view and manipulate on computer screens. The new technology makes it easier for students to work together and with faculty, as everyone is viewing the same image simultaneously.

The soft-spoken professor is slow to speak about his own accomplishments but quick to talk about his department, which began as a section in 1973 under the leadership of Rockefeller University scientist George E. Palade, M.D., who would win a Nobel Prize two years later. In addition to pursuing his own research on primitive nervous systems, structure-function relationships of the nicotinic acetylcholine receptor and, more recently, the entry and transport of rabies virus in neurons, Lentz serves as the department’s historian—he stores departmental photographs and papers and wrote a history of cell biology at Yale for the department website.

The history of his department and of the School of Medicine itself is palpable in Lentz’s office. He rescued from the garbage the chair he offers to visitors. It belonged to Thomas R. Forbes, Ph.D., who came to Yale in 1945. Forbes eventually became the Ebenezer K. Hunt Professor of Anatomy and chaired the admissions committee throughout the 1950s and 1960s. Lentz had sat in that chair for his own admissions interview. It gives him a good deal of pleasure to offer the chair to accomplished hopefuls today. “They inspire me,” he said.

—Colleen Shaddox


			Originally published in Yale Medicine, Summer 2005. Copyright © 2005 Yale University School of Medicine. All rights reserved.