The story of Erbitux: in medicine and outside medicine

While having lunch with Dr. Bruce Sheng-Dean Luo (羅盛典醫師, an ENT doctor who was leaving UPMC to go back to Taiwan then) yesterday [1/18/2014] he mentioned Erbitux, which is a very interesting biologic (or biological) that is worth talking about in many aspects, medicine or otherwise.

Soon [today is 3/27/17] another ENT doctor, Dr. Chun-Yi Chuang ( 莊俊義醫師), who was also about to go back to Taiwan, leaving UPMC.  The head and neck surgery is Dr. Chuang’s specialty.  Erbitux has been used for head and neck cancer, thus it is time to revise this writing, considering my current reading interest is monoclonal antibody.

Erbitux is a biological, not a conventional chemical drug

Unlike conventional drugs, such as chemotherapy agents for cancers, the biologicals are made by living cells. Erbitux (cetuximab) is a biological, a monoclonal antibody [more about this later] that binds to the epidermal growth factor receptor, thus inhibiting the binding of epidermal growth factor (EGF), resulting in inhibition of cell growth.  This is how Erbitux is used, in combination of conventional chemotherapy, to treat certain types of cancers: colorectal cancers and head and neck cancers, and the off-label use (not officially approved by FDA) in several types of cancers.

Martha Stewart

Erbitux was developed by ImClone, a biotech company. It was rejected by FDA in 2001, at which time the CEO and his friend, Martha Stewart, sold the shares the day before the news of FDA rejection was announced, for which they went to jail.  Martha Stewart was actually never prosecuted for insider trading, but for lying to the investigators; it is a crime to lie to the government officials.

Merck (“German Merck”, not to be confused with Merck, USA), a partner of ImClone, conducted another clinical trial and obtained FDA approval to treat colorectal cancer, metastatic, KRAS wild-type (without mutation) in 2004.  It was approved for the head and neck cancer in 2006, the first such medicine in 45 years.

There were 329 patients in the study, leading to 2004 FDA approval. Erbitux, when used in conjunction of standard chemotherapy, 23% of patients responded and tumor growth was delayed by 4.1 months.  When used alone, the response rate was only 10.8%, delaying tumor growth by 1.5 months only.

Biologicals, especially monoclonal antibodies, are where money is

This doesn’t sound very impressive, but enough to become a potential “blockbuster”, the stock price began to climb again, from below $20 a share, all the way up to $60s, and way passing the price Martha Stewart sold (in the $40s).  ImClone was bought by Eli Lilly at $70 a share in 2008. Bristol-Myers Squibb initially offered $60 a share; it was a bidding war then; all for the only product of the company—Erbitux.

Carl Icahn acquired a majority of stock and became the chairman of the board in 2006.  He paid $30 a share on average (he boasted saying he paid $20/share) and it was $70/share when the company was bought.  One cannot but respect this seasoned billionaire investor.

For a $200 million gift, Mount Sinai School of Medicine is now the Icahn School of Medicine at Mount Sinai.

Believe it or not, the era of personalized medicine (based on one’s genes) is upon us.  Erbitux is another example.  There was an important article at New England Journal of Medicine (4/2/2009), “Cetuximab (Erbitux) and chemotherapy as initial treatment for metastatic colorectal cancer”, in which it was reported that the benefit of Erbitux is only seen in the patients who have a “wild type” (i.e. normal with no mutation) KRAS gene.

This is a very important advance.  A genetic test will be done on the cancer tissue, the patients with a mutated KRAS gene (about 40% of the patients with colon cancers), Erbitux will not be given, thus are spared for the potential adverse effects.

This genetic test may give Erbitux an upper hand on the ongoing war between Erbitux and Avastin (bevacizumab—a vascular endothelial growth factor inhibitor, also a monoclonal antibody) for colorectal cancer.  Both products can command billion dollars sales a year.  Roche paid big bucks for Genentech, mainly because of Avastin and other biologicals blockbusters, the likes of Rituxan (rituximab) and Herceptin (trastuzumab), all of them monoclonal antibodies.

Omnipresent, omnipotent monoclonal antibodies

Monoclonal antibodies are tailor-made proteins that seek out and attach themselves to specific molecules, such as certain proteins on the cell surface.  Monoclonal antibody is produced through recombinant DNA technology.  One way to do it is first identify the gene that makes a specific antibody, then insert the genes into viruses, which infect bacteria.  The infected bacteria then produce antibodies faithfully. 

Dr. George Kohler and Dr Cesar Milstein produced the first monoclonal antibody, for which they’re awarded the Nobel Prizes in 1984.  “Theoretical work that would lead to the production of monoclonal antibody started in the early 1970s, but the New York Times would not mention the term until May 1, 1979.”  NY Times so reported in a regrettable tone in an 10 Oct. 2012 article.

Stanley Cohen: My American idol, my American hero
Another related story tells how great Stanley Cohen is.

Stanley Cohen

The discovery of restriction enzyme (so that DNA can be ‘cut’ open) by Stanley Cohen and Herbert Boyer paved the way for Paul Berg to develop recombinant DNA technology.  Genentech was founded on the knowledge of the discovery of restriction enzyme and recombinant DNA technology.  Herbert Boyer and Robert Swanson (the venture capitalist) were the cofounders.  Somehow Stanley Cohen didn’t participate, losing the chance to make a fortune when La Roche bought Genentech for 46.8 billion in 2009. 

Stanley Cohen went on to get his Nobel Prize for the discovery of the epidermal growth factor in 1986; he shared with Rita Levi-Montalcini, who died at age of 103 in 2012.  Cohen went to work with Rita Levi-Montalcini, who first discovered nerve growth factor.  Cohen subsequently discovered the epidermal growth factor; little did he, or anyone else, know that his discovery will one day make a huge impact on clinical medicine.  At age of 93 now, Stanley Cohen must be very gratifying in seeing his work bearing the fruits.

Why read Middlemarch? How did George Eliot treat the pretty woman in Middlemarch?

George Eliot

One would agree that Rosamond Vincy is the most beautiful girl among all characters in Middlemarch.  The homely, “not physically prepossessing” George Eliot is not known for her beauty, in fact, contrary to it we read so many unflattering, or even odious comments from many famous visitors, the likes of Henry James and Charles Eliot Norton.

I read this in Brenda Maddox’s “George Eliot in Love”, but there are many other sources.  (I also read Maddox’s other biography of “Rosalind Franklin: The Dark Lady of DNA”, which persuaded me to read her book about George Eliot).

(The following is how Henry James wrote to his father, upon visiting George Eliot, in 1869.

When the young Henry James [26-yer-old] arrives on the London scene to brashly proclaim Eliot [in her 50s] as “magnificently ugly--deliciously hideous. She has a low forehead, a dull gray eye, a vast pendulous nose, a high mouth, full of uneven teeth and a chin and jawbone qui n'en finissent pas.” Yet this first, crude impression s soon amended: “Now in this vast ugliness resides a most powerful beauty which in a few minutes steals forth and charms the mind, so that you end as I ended, in falling in love with her. . . Yes beholds me literally in love with this great horse-faced bluestocking.”

Charles Eliot Norton, an American professor of art at Harvard, who visited the Priory [residence of George Eliot and George Lewes] in 1869 and considered a portrait of George Eliot (by Sir Frederic Burton) “odious” and “vulgarizing”.

This may have led some writers to claim that George Eliot disliked the physical beauty of women, and was even “jealous” of the physical charm of her character, Rosamond, and “persecuted” her.  This is why we see Rosamond’s seemingly beautiful, made-in-heave (天作之和) marriage with Dr. Tertius Lydgate was not a happy one.

Whether this claim has any merit or not, one needs to ‘study’ Middlemarch to draw one’s own conclusion.

Let’s see how George Eliot described Rosamond’s charm and beauty.

Only a few children in Middlemarch looked blond by the side of Rosamond, and the slim figure displayed by her riding-habit had delicate undulations. In fact, most men in Middlemarch, except her brothers, held that Miss. Vincy was the best girl in the world, and some called her an angel.

The plain Mary Garth (who eventually married Rosamond’s brother, Fred) was not pretty, but Eliot described her as “Rembrandt would have painted her with pleasure, and would have made her broad features look out of the canvas with intelligent honesty. For honesty, truth-telling fairness, was Mary's reigning virtue”.  Standing together once Mary Garth said to Rosamond,

“What a brown patch I am by the side of you, Rosy! You are the most unbecoming companion.”

Eliot uses “transcendent” in a love scene for Rosamond (before her marriage to Dr. Lydgate): “She [Rosamond] blushed and looked at him as the garden flowers look at us when we walk forth happily among them in the transcendent evening light . . .”

When Rosamond and Lydgate first met at her uncle Featherstone’s house where Dr. Lydgate was making a house call. They readily got into conversation.  When Rosamond was about to leave,

Lydgate was quick in anticipating her. He reached the whip before she did, and turned to preset it to her.  She bowed and looked at him: he of course was looking at her, and their eyes met with that peculiar meeting which is never arrived at by effort, but seems like a sudden divine clearance of haze.  I think Lydgate turned a little paler than usual, but Rosamond blushed deeply and felt a certain astonishment.  After that, she was really anxious to go, and did not know what sort of stupidity her uncle was talking of when she went to shake hands with him.

Lydgate studied at Paris, Edinburgh and London [George Eliot was apparently aware that these three cities were the major medical centers in her days] whereas Rosamond is a “country girl” in Middlemarch.

“Tell me what you saw in London.”

“Very little.” (A more naïve girl would have said, “Oh, everything!” But Rosamond knew better.) “A few of the ordinary sights, such as raw country girls are always taken to.”

“Do you call yourself a raw country girl?” said Lydgate, looking at her with an involuntary emphasis of admiration, which made Rosamond blush with pleasure.  But she remained simply serious, turned her long neck a little, and put up her hand to touch her wondrous hair-plaits—an habitual gesture with her as pretty as any movements of a kitten’s paw.  Not that Rosamond was in the least like a kitten: she was a sylph caught young and educated at Mrs. Lemon’s.

“I assure you my mind is raw,” she said immediately; “I pass at Middlemarch.  I am not afraid of talking to our old neighbors.  But I am really afraid of you.”

Certainly, small feet and perfectly turned shoulders aid the impression of refined manners, and the right thing said seems quite astonishingly right when it is accompanied with exquisite curves of lip and eyelid. And Rosamond could say the right thing; for she was clever with that sort of cleverness which catches every tone except the humorous. Happily she never attempted to joke, and this perhaps was the most decisive mark of her cleverness.

Rosamond sang well and played piano eve better; this is the first time Lydgate listened to her playing piano,

Rosamond played admirably. . . It was almost startling, heard for the first time.  A hidden soul seemed to be flowing forth from Rosamond’s fingers; and so indeed it was, since souls live on in perpetual echoes, and to all fine expression there goes somewhere an originating activity, if it be only that of an interpreter.  Lydgate was taken possession of, and began to believe in her as something exceptional . . .

Unfortunately, George Eliot also wrote,

Poor Lydgate! Or shall I say, Poor Rosamond! Each lived in a world of which the other knew nothing.

There is an undercurrent that will eventually reveal the roots of an unhappy marriage.  That will be another post.  Stay tuned.

Why read Middlemarch? The religious Dorothea Brooke

I have been reading George Eliot’s Middlemarch for several years and still haven’t finished yet, but have read many chapters several times. I’ll write a series of “Why read Middlemarch?” talking about a character, an event or a little thing or everything.

This post is about the religious Dorothea Brooke, one of the protagonists.

The way George Eliot narrated the story of Dorothea Brooke—a provincial blue-stocking, a pious devotee, almost a saint—border on mockery.  I wonder this is anything to do with the fact that George Eliot herself was an “agnostic”, a term coined by her friend, Thomas Henry Huxley.

Dorothea liked horse riding and was good at it, but treated it like an earthly sensuous indulgence that only a pagan should enjoy it.  In Middlemarch, we read,

“Most men thought her bewitching when she was on horseback.  She [Dorothea] loved the fresh air and the various aspects of the country, and when her eyes and cheeks glowed with mingled pleasure she looked very little like a devotee.  Riding was an indulgence which she allowed herself in spite of conscientious qualms; she felt that she enjoyed it in a pagan sensuous way, and always looked forward to renouncing it... She was open, ardent, and not in the least self-admiring.”

We also read, “her sister Celia had more common sense. Nevertheless, Celia wore scarcely more trimmings; and it was only to close observers that her dress differed from her sister’s, and had a shade of coquetry in its arrangements.”

Virginia Woolf said Middlemarch is “one of the few English novels written for grown-up people.”

In a NY Times interview on 5/28/2015, when asked “What books are you embarrassed not to have read yet?” David Mccullough responded, “Mainly, ‘Middlemarch,’ by George Eliot, which I've had every good intention to undertake. Maybe this is the year!”

The sisters, Dorothea and Celia, went to live with their uncle (almost a comical character) as the young girls.  The uncle gave a box of jewelry that was handed down from their parents.  George Eliot tactically (in Chapter 1) used the difference of how we perceive jewelry and religion to tell the characters of the sisters.

It is a very long quote, but excerpt will not do its justice.  I have read it 3 or 4 times, hopefully you may endure it reading it once; it will be worth your while.  You’ll also catch a glimpse of George Eliot’s novel-writing technique.

Dorothea vs. Celia: religion and jewelry

“Dorothea, dear, if you don't mind—if you are not very busy—suppose we looked at mamma's jewels to-day, and divided them? It is exactly six months to-day since uncle gave them to you, and you have not looked at them yet."

Celia's face had the shadow of a pouting expression in it, the full presence of the pout”.  “being kept back by an habitual awe of Dorothea and principle; two associated facts which might show a mysterious electricity if you touched them incautiously. To her relief, Dorothea's eyes were full of laughter as she looked up.

"What a wonderful little almanac you are, Celia! Is it six calendar or six lunar months?"

"It is the last day of September now, and it was the first of April when uncle gave them to you. You know, he said that he had forgotten them till then. I believe you have never thought of them since you locked them up in the cabinet here."

"Well, dear, we should never wear them, you know." Dorothea spoke in a full cordial tone, half caressing, half explanatory. She had her pencil in her hand, and was making tiny side-plans on a margin.”

“Celia colored, and looked very grave. "I think, dear, we are wanting in respect to mamma's memory, to put them by and take no notice of them. And," she added, after hesitating a little, with a rising sob of mortification, "necklaces are quite usual now; and Madame Poincon, who was stricter in some things even than you are, used to wear ornaments. And Christians generally—surely there are women in heaven now who wore jewels." Celia was conscious of some mental strength when she really applied herself to argument.

"You would like to wear them?" exclaimed Dorothea, an air of astonished discovery animating her whole person with a dramatic action which she had caught from that very Madame Poincon who wore the ornaments. "Of course, then, let us have them out. Why did you not tell me before? But the keys, the keys!" She pressed her hands against the sides of her head and seemed to despair of her memory."

"They are here," said Celia, with whom this explanation had been long meditated and prearranged.

"Pray open the large drawer of the cabinet and get out the jewel-box."

The casket was soon open before them, and the various jewels spread out, making a bright parterre on the table. It was no great collection, but a few of the ornaments were really of remarkable beauty, the finest that was obvious at first being a necklace of purple amethysts set in exquisite gold work, and a pearl cross with five brilliants in it. Dorothea immediately took up the necklace and fastened it round her sister's neck, where it fitted almost as closely as a bracelet; but the circle suited the Henrietta-Maria style of Celia's head and neck, and she could see that it did, in the pier-glass opposite.”

“There, Celia! you can wear that with your Indian muslin. But this cross you must wear with your dark dresses."

Celia was trying not to smile with pleasure. "O Dodo [Celia calls her Dorothea Dodo], you must keep the cross yourself."

"No, no, dear, no," said Dorothea, putting up her hand with careless deprecation.

"Yes, indeed you must; it would suit you—in your black dress, now," said Celia, insistingly. "You might wear that."

"Not for the world, not for the world. A cross is the last thing I would wear as a trinket." Dorothea shuddered slightly.

"Then you will think it wicked in me to wear it," said Celia, uneasily.

"No, dear, no," said Dorothea, stroking her sister's cheek. "Souls have complexions, too; what will suit one will not suit another."

"But you might like to keep it for mamma's sake."

"No, I have other things of mamma's—her sandal-wood box which I am so fond of—plenty of things. In fact, they are all yours, dear. We need discuss them no longer. There—take away your property."

Celia felt a little hurt. There was a strong assumption of superiority in this Puritanic toleration, hardly less trying to the blond flesh of an unenthusiastic sister than a Puritanic persecution.

"But how can I wear ornaments if you, who are the elder sister, will never wear them?"

"Nay, Celia, that is too much to ask, that I should wear trinkets to keep you in countenance. If I were to put on such a necklace as that, I should feel as if I had been pirouetting. The world would go round with me, and I should not know how to walk."

Celia had unclasped the necklace and drawn it off. "It would be a little tight for your neck; something to lie down and hang would suit you better," she said, with some satisfaction. The complete unfitness of the necklace from all points of view for Dorothea, made Celia happier in taking it. She was opening some ring-boxes, which disclosed a fine emerald with diamonds, and just then the sun passing beyond a cloud sent a bright gleam over the table.

"How very beautiful these gems are!" said Dorothea, under a new current of feeling, as sudden as the gleam. "It is strange how deeply colors seem to penetrate one, like scent. I suppose that is the reason why gems are used as spiritual emblems in the Revelation of St. John. They look like fragments of heaven. I think that emerald is more beautiful than any of them."

"And there is a bracelet to match it," said Celia. "We did not notice this at first."

"They are lovely," said Dorothea, slipping the ring and bracelet on her finely turned finger and wrist, and holding them towards the window on a level with her eyes. All the while her thought was trying to justify her delight in the colors by merging them in her mystic religious joy.

"You would like those, Dorothea," said Celia, rather falteringly, beginning to think with wonder that her sister showed some weakness, and also that emeralds would suit her own complexion even better than purple amethysts. "You must keep that ring and bracelet—if nothing else. But see, these agates are very pretty and quiet.”

"Yes! I will keep these—this ring and bracelet," said Dorothea. Then, letting her hand fall on the table, she said in another tone—"Yet what miserable men find such things, and work at them, and sell them!" She paused again, and Celia thought that her sister was going to renounce the ornaments, as in consistency she ought to do.

"Yes, dear, I will keep these," said Dorothea, decidedly. "But take all the rest away, and the casket."

She took up her pencil without removing the jewels, and still looking at them. She thought of often having them by her, to feed her eye at these little fountains of pure color.

"Shall you wear them in company?" said Celia, who was watching her with real curiosity as to what she would do.”

“Dorothea glanced quickly at her sister. Across all her imaginative adornment of those whom she loved, there darted now and then a keen discernment, which was not without a scorching quality. If Miss Brooke ever attained perfect meekness, it would not be for lack of inward fire.

"Perhaps," she said, rather haughtily. "I cannot tell to what level I may sink."

Celia blushed, and was unhappy: she saw that she had offended her sister, and dared not say even anything pretty about the gift of the ornaments which she put back into the box and carried away. Dorothea too was unhappy, as she went on with her plan-drawing, questioning the purity of her own feeling and speech in the scene which had ended with that little explosion.

Celia's consciousness told her that she had not been at all in the wrong: it was quite natural and justifiable that she should have asked that question, and she repeated to herself that Dorothea was inconsistent: either she should have taken her full share of the jewels, or, after what she had said, she should have renounced them altogether.

"I am sure—at least, I trust," thought Celia, "that the wearing of a necklace will not interfere with my prayers. And I do not see that I should be bound by Dorothea's opinions now we are going into society, though of course she herself ought to be bound by them. But Dorothea is not always consistent."

Thus Celia, mutely bending over her tapestry, until she heard her sister calling her.

"Here, Kitty [Dorothea calls her younger sister Kitty], come and look at my plan; I shall think I am a great architect, if I have not got incompatible stairs and fireplaces."

As Celia bent over the paper, Dorothea put her cheek against her sister's arm caressingly. Celia understood the action. Dorothea saw that she had been in the wrong, and Celia pardoned her. Since they could remember, there had been a mixture of criticism and awe in the attitude of Celia's mind towards her elder sister. The younger had always worn a yoke; but is there any yoked creature without its private opinions?”

A farewell to a medical giant and a great humanitarian: Thomas Starzl, M.D. PhD.

We went to Dr. Thomas Starzl’s memorial service at Heinz Memorial Chapel on March 11, 2017.  It was to celebrate a life of a medical giant and a great humanitarian.  We arrived at the chapel one hour before the service beginning at 1pm to guarantee a seat. After more than 400 or probably 500 people crowded into the chapel, many could only stand in the back.  Katy, representing the World Journal (世界日報), was sent to the press section and couldn’t get a good spot as the reporters from various agencies have been there for hours.

We went on behalf of Dr. Dr. Chao-Long Chen, (陳肇隆醫師), a Dr. Starzl’s protégé

We went to this “Homegoing Celebration” not only to pay the respect to the father of liver transplant but also to represent Dr. Chao-Long Chen, (陳肇隆醫師, a Dr. Starzl’s protégé) who couldn’t make the trip from Taiwan.

The service was followed by a reception at the Cathedral of Learning Tower across the lawn from the Heinz Chapel.  Thus we had a chance to talk with Joy Starzl, the wife and soul mate to Dr. Starzl, “whose love propelled him throughout their 36 years together.” (quoted from the statement in the memorial service program).

I have written about a special event of celebrating Joy’s birthday (when Dr. Chen was trained under Dr.Starzl at the University of Pittsburgh in 1983) that earned Dr. Chen a title of “Master Cook” from Dr. Starzl.

grand celebration of a 90th birthday party: Dr. Chao-Long Chen, Dr. Thomas Starzl and Joy Starzl

“Giants in medicine: Dr. Thomas Starzl (father of liver transplant) and Dr. Chao-Long Chen 陳肇隆醫師 (father of liver transplant in Asia)” 

http://doctorjytsai.blogspot.com/2016/03/giants-in-medicine-dr-thomas-starzl.html

Joy Starzl: an amazing lady

Joy was indeed an amazing lady as Dr. Chen told us; she treated us as if we were Dr. Chen, reminiscing the fond memory of event that happened long ago. She vividly remembers the great work that Dr. Chen, the master chef, turned out on her birthday party for more than 100 people.  She kept reminding us not to forget to ask Dr. Chen about the recipe for his delicious soup.

Dr. Chen was glad that he came to attend Dr. Starzl’s 90^th birthday party last year. We showed Joy many of the photos taken at the grand party of birthday celebration that Dr. Chen sent us.  Katy also showed the report of Dr. Starzl in the World Journal (世界日報).  Thus we shared a brief moment of fun and joy at the time of sorrow.

What Carl Sandburg felt about Lincoln is what I did Starzl

Being a history buff and medicine man, I am naturally interested in the history of medicine (limited to modern medicine as my first love is still science). History of organ transplant is one of the topics I have been reading for years. I have read every article about Dr. Starzl in Pittsburgh Post-Gazette, NY Times, or even in Scientific American that I could lay my hand.  His more scholarly articles, especially about advanced immunology, are beyond me.  I have read many chapters in Dr. Starzl’s autobiography more than two or three times, “The Puzzle People: Memoirs of a Transplant Surgeon”.

When interviewed at the time Carl Sandburg just finished his monumental Lincoln (2,400 pages 1,200,000 words), he said “That son-of-a-gun Lincoln grows on me,” he was shaken, he felt as if he “was parting with him [Lincoln], after all those years, like people who had live with him.  When Lincoln died, for a time light went out for me, the tears came.”

I never met with Dr. Starzl and yesterday was the first time we met and talked with Joy Starzl, but what Carl Sandburg felt about Lincoln is what I did Starzl.  After many years of reading him and about him, “that son-of-a-gun Starzl grows on me.”  Like Dr. Chen uttered, “震驚、不捨、衰悼” upon hearing the passing of Dr. Starzl.

 From the many speakers of “Words of Remembrance” we learned the many aspects of a great life other than his achievements in medical field.  For those interested in Dr. Starzl’s professional achievements, one can read the post I mentioned above and below.

“Cyclosporine brought the liver transplants out of dark age: The stories related to Professor Jean Borel, Dr. Thomas Starzl and Dr. Chao-Long Chen (陳肇隆醫師)”

http://doctorjytsai.blogspot.com/2017/01/cyclosporine-brought-liver-transplants.html

The legacy of a transplant pioneer and a true humanitarian

It is difficult to measure Dr. Starzl’s immense contribution, as the former Pitt Chancellor, Mark Nordenberg, said, “We cannot know how many lives Tom already has saved, directly and indirectly. But we do know that lives will continue to be saved for as long as we can imagine because of his work. . . Dr. Starzl was a true gift to humanity.”  This is also reflected by what Dr. Chen said of his mentor, “今後仍有無數病人與家庭受惠， 是醫學史上偉大的開創者與恩師”.

He is better known as the father of liver transplant; it is less well known he also single-handedly saved the kidney transplant fate in 1963.

After returning to Taiwan, Dr. Chen has since become the father of liver transplant in Asia and has trained hundreds, if not more, of transplant surgeons from various countries across the world.  It is very gratifying for Dr. Starzl to know what Dr. Chen’s team has achieved.  Whatever Dr. Starzl sowed, It reaped through the work of Dr. Chao-Long (陳肇隆醫師), 李伯皇醫師 and 鄭隆賓醫師. 
The torch was passed. The light didn't, doesn't and will not go out.

Dr. Chen personally knows many fellows from all over the world trained under Dr. Starzl and have since established their own liver transplant centers in their respective countries.  I am personally aware that two other liver transplant surgeons (台灣大學醫學院外科教授李伯皇醫師 and 台中中國醫藥大學附設醫院器官移植中心院長鄭隆賓醫師) in Taiwan were also trained by Dr. Starzl.

A great intellectual, a loving husband, father and grandfather and a humanitarian

His grandson, Ravi, talked about the time he spent together with grandfather, many of the topics were apparently esoteric and abstract that were difficult to understand, he said “I loved my grandpa.  In our time together, we spoke about things in dimensions and ways that were often difficult for others to understand.”  Dr. Starzl was not afraid to challenge his grandson, as Ravi continued, “Yet no matter how deep, abstract or esoteric the intellectual constructs we would build became, neither my grandpa nor I ever feared the other could not follow. Our minds crossed the thresholds of alien worlds effortlessly. We were dolphins playing in a sea of information.”

The service program statement said he had “an expansive knowledge of an appreciation for all music from classical to modern jazz,” we saw a photo of him playing trumpet.  “He enjoyed watching and analyzing movies, often researching their production and topic matter for hours, both before and after repeated viewings.”

 I am glad that I share this characteristic with him.  I do not watch movies often, but I “studied” some old classic movies, the likes of Casablanca, The Big Country and Duel in the Sun.  To study Casablanca I had to read Ingrid Bergman’s biography.  I have watched and studied one of the last scenes (“I will be there” by Tom Joad, played by Henry Fonda) of The Grapes of Wrath numerous times.  I have read and studied George Eliot’s Middlemarch for many years and still haven’t finished yet, but have read many chapters many times.  I have read several books about George Eliot and Middlemarch and studied many characters in depth.  It is fun to search all archaic articles about Eliot in NY Times.

This post is not about myself; but to show you why and how I appreciate and respect Dr. Starzl, for his being a great doctor, an intellectual, and a relentless knowledge seeker.  Many of the anecdotes and personal experiences of the speakers can attest to it.

Seeing the sad Chooloo next do Joy Starzl, my heart was heavy (photo credit: PGH Tribune)

Dr. Starzl’s love to his family and friends extended to his many canine companions, including Bevo, Thor, Maggie, Tiki, Shelby, Basta, Chooloo, and Ophelia (is it from Hamlet?).  Chooloo sat in the front row with the family.  Seeing the sad Chooloo my heart was heavy.

Taps and flag presentation from U.S. Navy Honor Guard

After serving in the Navy (1944-45), he earned a B.A. degree in 1947 from Westminster College (at Fulton Missouri) where he served as Churchill’s go-fer [running errand] for Winston Churchill when he went to delivered his famous Iron Curtain speech on March 5, 1946.  He then obtained his M.D. and Ph.D. from Northwestern University before he went to Johns Hopkins for post-graduate training.

This is why we saw a solemn Taps and Flag presentation to the family, Joy Starzl, by U.S. Navy Honor Guard.

Dr. Starzl put Pittsburgh in medical map of the world

Dr. Starzl came to University of Pittsburgh on January 1, 1981 and has since created a legend and legacy, putting Pittsburgh in the medical map of the world.

John Fung M.D. Ph.D.

Sen. Bob Casey also attended the memorial service. His father, former PA Governor Robert P. Casey, received a heart and liver transplant in 1993 by Dr. John Fung, who also spoke at the memorial service.  Dr. Starzl retired from the surgery in 1990, but continued to be active doing research in the Transplantation Institute that now bears his name.  He did come back to do a baboon-to-human liver transplant in 1992.

Sen. Bob Casey shaking hands with the former and current Pitt Chancellors (photo credit to Pittsburgh Tribune)

Dr. Starzl arrived at Pittsburgh at the end of 1980 and Joy joined him shortly thereafter, in his Puzzle People, we read “When she [Joy] walked down the center of aisle in an orange and yellow gown, there was silence then a thunderous ovation.  We were in the right city.”

It is of interest and significant to mention that Burl Osborn, the published of Dallas Morning News sent a professional photographer for their wedding.  Burl Osborn received a kidney transplant by Dr. Starzl in 1966 about 15 years before the wedding and lived on to become the publisher.

Starzl was chosen Pittsburgh Man of the Year in Science and Medicine in 11/1981.  I also saw a photo of him throwing the baseball to open a Pittsburgh Pirates game.  The Pittsburgh Chancellor also mentioned how Dr. Starzl received a tumultuous standing ovation when he showed up in the university game.

A compassionate humanitarian: a touching testimony from a kidney transplant survivor

During his talk, a successful kidney survivor (Hollis Hurd) recalled one day in the hospital when Dr. Starzl grabbed him from behind telling many nurses around that he was his favorite patient.  Hurd ended the talk by saying “Doc, when I see you again, and I know I will, I will be hugging you and telling everyone you are my favorite physician. And it will be true. It may sound crazy, but I can't wait.”

In a 7/7/1992 article at NY Times, Lawrence Altman wrote, “In advancing the frontiers of surgery, he sometimes fell short of the perfection he sought. Many patients died. Other surgical colleagues could protect themselves by excusing their errors or by quickly erasing bad memories, he wrote in an autobiography to be published this year. By contrast, he wrote, he still painfully remembers patients who died many years ago.”

We read in the NY Times obituary of 3/5/2017 that it was the death of Stormke Jones at age of 13 in 1990 that took its toll emotionally, the exhaustive Starzl decided to call it quit from surgery in 1990, stating it was “an uncompromisingly difficult life.”  Few people could grab the truth of what kind of a life a medical pioneer and a sensitive and compassionate humanitarian went through.

A great compassionate doctor treats each and every patient as a person with a precious life, not as a “case”.

Happy birthday to you, Dr. Starzl

Yesterday (March 11) would have been Dr. Starzl’s 91^st birthday, at the end of Joy’s talk, she kindly asked everyone inside the chapel to sing “Happy Birthday” to Dr. Starzl. All rose to sing a “Happy Birthday” chorus; it was quite an emotional moment.

John Fung,M.D. Ph.D. (credit to Pittsburgh Tribune)

photographers at work

photographers at work

Lincoln spoke at Gettysburg on Nov. 19, 1863, still reverberates today

Reading Lincoln and Churchill led me to discover the beauty of the English language.  Churchill was a Nobel literature laureate, Lincoln would have been one were the Nobel Prize available in his time.

Lincoln is a great man, but what made him great?  His moral courage and gift for words would be among the many characteristics.

Without Lincoln speaking to consecrate Gettysburg battlefield ground on November 19, 1863, Gettysburg Battle wouldn’t be so well known to the whole world.  One can be ignorant to the Civil War, but one always knows Gettysburg Address.

How wrong Lincoln was when he said, “The world will little note, nor long remember what we say here, but it can never forget what they did here.”  What he said here had since belonged to the ages, like Edwin Stanton (Lincoln’s War Secretary) said of Lincoln when he drew his last breath, “Now he belongs to the ages.”

Great writers are skilled in using plain simple words; Churchill and Lincoln are no exceptions. A November 17, 2013 NY Times Editorial pointed out Lincoln used “here” eight times in the “270 words or so” (there are several versions of the speech); seven of them in the last paragraph and one in the second paragraph.  Of some 270 words about two-thirds are single syllable, only a half-dozen four-syllable.

But, in a larger sense, we can not dedicate -- we can not consecrate -- we can not hallow -- this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us -- that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion -- that we here highly resolve that these dead shall not have died in vain -- that this nation, under God, shall have a new birth of freedom -- and that government of the people, by the people, for the people, shall not perish from the earth.

We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live.

Yet these 270 some words are “woven into 10 complicated sentences” that only a man of letter can master.  One also noticed the repetitive triplets: “we cannot dedicate, we cannot consecrate, we cannot hallow this ground.”

Everett [the key note speaker of the consecrated dedication, a great orator of his days] wrote Lincoln a day after, “I shall be glad, if I could flatter myself, that I came close to the central idea of the occasion, in two hours, as you did in two minutes.” To which Lincoln replied, “In our respective parts yesterday, you could not have been excused to make a short address, nor I a long one. I am pleased to know that, in your judgment, the little did I say was not entirely a failure. . . . Our sick boy [Tad], for whom you kindly inquire, we hope is past the worst.”

The day before Lincoln left for Gettysburg (by train), Tad (their son) was sick and doctors had no idea what ailed him.  Mary was still mourned for Willie [another son, Willie, who died at White House not too long ago].  Many historians were not nice to Mary; some even made up the story saying Mary threw herself on the floor in an outburst of tantrum, trying to prevent Lincoln from leaving.

Nothing is further from the truth.  Mary sent her husband a telegram the same afternoon when Lincoln left saying “The doctor has just left.  We hope dear Taddie is slightly better.  Will send you a telegram in the morning.”  Mary was apparently trying to comfort and alleviate Lincoln’s anxiety so he could do a good job; a good job indeed.  The second telegram arrived at ten o’clock Nov. 19, just before Lincoln left Wills house [where Lincoln stayed the night before.  Prof. Pan also drove us to see the house], as Stanton [Lincoln’s War Secretary] told Lincoln that “Grant was staring a big battle at Chattanooga.  Mrs. Lincoln reports your son’s health as a great deal better and he will be out today.”

Lincoln apparently also told Everett that their son, Tad, was sick when he left White House and that’s why Everett “kindly inquire” in his letter to Lincoln.

I took every chance to defend for Mary Lincoln, even on the occasion of Gettysburg Address.  Mary often time traveled with her husband.  She missed the chance of hearing the greatest speech of all time simply because she was a loving mother.

Unfortunately we didn’t have the photo of his delivering of the speech at Gettysburg.  The great orator, Edward Everett, was to blame.  After hearing Everett spoke for two hours, the photographer took it easy slowly preparing his equipment (dry plates, black box on a tripod, etc.) when Lincoln began to speak. Bending and hiding his head under the hood, he heard Lincoln said, “Government of the people, by the people, for the people shall not perish from Earth”

William Safire once wrote of a “speech made on May 29, 1850—thirteen years before the Gettysburg Address—by Theodore Parker at an antislavery convention in Boston, calling for ‘a democracy, that is, a government of all the people, by all the people, for all the people. . .’ ”

Everett’s 13000-word oration is classical as Lincoln’s 270 some-word sermon is biblical. Some point out that “Four score and seven years ago” is coming from Genesis 16:16, “Abram was four score and six years old when his son Ishmael was born.”

(Those who believe in predestination also point out that Lincoln is the 16^th President, who lived in 1600 Pennsylvania Avenue. And his first name is Abraham—Genesis 16:16 “Abram was . . .”)

We do not see words like “Union”, “slavery” or “Constitution”, but “nation” was mentioned four times.  We also see many religious words, such as “conceived in liberty”, “hallow”, “consecrated”, and “that this nation, under God, shall have a new birth of freedom”.

I still have much to say, but this post is already too long for Lincoln’s compact, poetic prose; a timeless work that made America of what she is today.  It may not be just a coincidence that Gettysburg Battle ended on July 4 as America was born again with “a new birth of freedom”.