TEACHING SURGEONS’ HANDS TO HEAL

The Importance of the Academic Training and Research Centers The training of most surgeons today occurs in one of the nation’s leading university-affiliated academic medical centers such as the University of Minnesota Hospitals and Clinics, which is the venue for this story. All of our major American academic medical centers (AMC’s) are important: they are not only national treasures but also examples of “American exceptionalism” writ large, and a resource for all nations. Although many Americans may take these great institutions for granted since they have just “been there” all their lives, they should realize that similar centers do not exist to the same extent in any other country. America’s public and private sectors have made a costly investment to create and sustain these AMC’s over the last century, and they will be very expensive to maintain. So the question is, will the resources and public policy commitment be there to sustain them in the future? This book advocates that these American academic research and training centers need to be preserved if at all possible as they are the source for much of the progress in medicine. It is reasonable to predict that they will provide the innovative advances in medicine of tomorrow just as they have done in the past. They are in a word, American “national treasures” which Americans and the world cannot afford to see fall into decline. Men of great vision began establishing these AMC’s at the turn of the Twentieth Century, or what later also became the Century of American Medicine. The impetus for this effort was, like many other grand efforts, supported by one of America’s “Robber Barons,” Andrew Carnegie. Of course there are many other institutions such as the University of Chicago and the Rockefeller Institute that were founded by Rockefeller and the other titans of America’s great wealth. The effort in establishing our free market medical care system led to 72 Nobel Prizes in medicine while the Soviets received just one and that was in 1904 for Pavlov’s work on conditioned reflexes. The University of Minnesota Hospitals and Medical School have a sterling history of innovation and clinical achievements. It has produced outstanding trainees, leaders, and innovators, especially in the fields of cardiovascular surgery, transplantation, pediatrics, neurosurgery, otolaryngology and urologic surgery – among others. Thus it was, at one time, a superb training and research environment. But many of these Minnesota-initiated advances were achieved at a time when university physicians had great personal and economic freedom, and this allowed them to express their entrepreneurial and creative or “animal spirits.” Michel Paparella MD, the Chief of Otolaryngology at the University of Minnesota who was recruited two years before I was, said the physicians were described as “entrepreneurs” by the people who recruited him. During that time, the school encouraged and rewarded innovation. That is not only the Minnesota formula for success, but also the economic model for our country. Milton Friedman said, “No one has succeeded in organizing society in a better way than the free-market capitalism model in terms of producing a high standard of living and happiness.” ………….. Clinical Endourology – One of the first percutaneous stone removals was performed in Minnesota, and the development of closed treatments within the urinary tract based on the percutaneous nephrostomy portended the development of an entirely new field that survives and thrives today. The invention of endourology changed the paradigm in urology and it was the equivalent of the Big Bang in the urology universe. Just as the universe continues to expand outward, so does new techniques and instruments that are still evolving not only in urology but also in other fields of surgery that had their origin conceptually in Minnesota urologic surgery. Today the word endourology is found repeatedly in the program of almost every major urology meeting in the world. There were several important developments in urology during my time: the treatment of advanced testis cancer with chemotherapy, the development of cancer markers for prostate (the PSA test) and testicular cancers, nerve sparing to preserve sexual function after radical prostatectomy and the invention of endourology. Endourology was one of the first new areas for sub-specializations in urologic surgery. In terms of a lasting breadth of influence endourology would have to rank near the top in terms of significance in the progress that was made in our field between 1970 and 1990. It started a trend of surgeons in general tying to formulate treatments that did not involve open surgery - imagine that. Of course we were also involved in developing applications for the tumor markers, especially in testis cancer.